Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass
Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass
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DOI：
10.1016/s0022-5223(98)70209-0
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发表时间：
1998-06-01
影响因子：
6
通讯作者：
Bailey, LL
中科院分区：
文献类型：
--
作者：
Gundry, SR;Romano, MA;Bailey, LL
背景：在不停跳心脏上进行冠状动脉血运重建术的兴趣已经复苏。因此，目前还没有将该技术与传统的心脏停搏液冠状动脉搭桥术进行长期比较，目的：本研究的目的是比较接受冠状动脉搭桥术的患者组在使用或不使用心肺转流术的情况下的长期生存率和无干预结局。方法：从1989年6月至1990年7月，所有由三位外科医生进行冠状动脉血运重建的患者均考虑在心脏跳动下进行冠状动脉血运重建：107例患者在心脏跳动下进行冠状动脉搭桥术，112例患者在心脏停搏液搭桥术的帮助下进行血运重建。平均年龄（65 ± 10岁）和风险因素相同。心脏跳动下手术的患者有2.4 +/- 0.9个移植物，而使用心脏停搏液的体外循环患者有3.2 +/- 1.1个移植物。结果：在7年随访时，心脏跳动下手术的107例患者中有86例（80%）存活，而使用心脏停搏液的体外循环患者中有88例（79%）存活。前一组107例患者中有13例（12%）发生心源性死亡，后一组112例患者中有10例（9%）发生心源性死亡。然而，107例心脏不停跳手术患者中有32例（30%）因症状需要导管插入，而心脏停跳组112例患者中有18例（16（p = 0.01），这导致心脏跳动组的107名患者中有21名（20%）需要血管成形术或第二次冠状动脉搭桥术，而112名患者中只有8名（7%）需要血管成形术或第二次冠状动脉搭桥术停搏液转流组30例，停搏液转流组无一例需再次手术。心脏不停跳组的大多数再介入是经皮腔内冠状动脉成形术（21例患者中的15例[71%]）。结论：尽管每例患者少了一个移植物，但两组的生存率和心源性死亡率相似。然而，心脏不停跳组中需要再导管插入术的患者是前者的两倍（30%对16%），20%需要第二次干预。只有7%的心脏停搏液组需要再介入，有限的心脏跳动血运重建提供了与体外循环完全血运重建相当的长期结果，但代价是再介入增加了三倍。
Background: There has been resurgent interest in coronary revascularization performed on the beating heart. Heretofore, there has been no long-term comparison of this technique to traditional coronary artery bypass with cardioplegia, Objective: The purpose of this study was to provide a comparison of long-term survival and intervention-free outcome between patient groups subjected to coronary bypass accomplished with or without the use of cardiopulmonary bypass. Method: From June 1989 to July 1990, all patients treated for coronary revascularization by three surgeons were considered for coronary revascularization with the heart beating: 107 patients underwent coronary bypass on the beating heart, and 112 patients underwent revascularization with the aid of bypass with cardioplegia. Mean ages (65 +/- 10 years) and risk factors were identical. Patients operated on with the heart beating had 2.4 +/- 0.9 grafts versus 3.2 +/- 1.1 grafts for patients having cardiopulmonary bypass with cardioplegia, Results: At 7-year follow-up, 86 of 107 (80%) patients operated on with the heart beating were alive versus 88 of 112 (79%) patients in whom cardiopulmonary bypass with cardioplegia was used. Cardiac deaths occurred in 13 of 107 (12%) patients in the former group versus 10 of 112 (9%) patients in the latter group. However, 32 of 107 patients operated on with the heart beating (30%) needed catheterization for their symptoms versus 18 of 112 (16%) patients in the bypass with cardioplegia group (p = 0.01), This results in 21 of 107 (20%) patients in the beating heart group needing angioplasty or a second coronary bypass versus only 8 of 112 (7%) patients in the bypass with cardioplegia group, No patient in the bypass with cardioplegia group required reoperation. Most of the reinterventions for the beating heart group were percutaneous transluminal coronary angioplasty (15 of 21 [71%] patients). Conclusion: Despite one less graft per patient, survival and cardiac death rates were similar for the two groups. However, twice as many patients in the beating heart group required recatheterization (30% versus 16%), and 20% needed a second intervention. Only 7% of the bypass with cardioplegia group required reintervention, Limited revascularization of the beating heart provides long-term results comparable to full revascularization with cardiopulmonary bypass, but at the cost of a threefold increase in reinterventions.