Coronary artery bypass without cardiopulmonary bypass: analysis of short-term and mid-term outcome in 220 patients.
Coronary artery bypass without cardiopulmonary bypass: analysis of short-term and mid-term outcome in 220 patients.
复制标题
无体外循环的冠状动脉搭桥：220 名患者的短期和中期结果分析。
DOI：
10.1016/s0022-5223(05)80165-5
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发表时间：
1995
影响因子：
6
通讯作者：
R. Mohr
中科院分区：
文献类型：
--
作者：
Y. Moshkovitz;A. Lusky;R. Mohr
220 名患者，特别是那些患有高危疾病的患者，在没有体外循环的情况下接受了冠状动脉旁路移植术。早期不良结局事件包括手术死亡（7名患者，3.2%）、非致命性围手术期心肌梗死（6名患者，2.7%）、脑血管意外（1名患者，0.4%）和胸骨感染（3名患者，1.4%）。 15例主动脉钙化患者中有2例死亡（13%），33例接受急诊手术的患者中有4例（12%）死亡。多变量分析显示这两个危险因素是早期死亡的唯一预测因素（比值比分别为 8.0 和 9.8）。术前危险因素如左心功能不全（射血分数≤35%）（40例，18%）、充血性心力衰竭（46例，21%）、急性心肌梗塞（59例，27%）、心源性休克（7例，3%）、年龄70岁以上（59例，27%）、肾功能衰竭（19例，9%）、脑血管意外和颈动脉未发现疾病（11 名患者，5%）是早期死亡或不良结果的主要预测因素。在 12 个月的随访期间（范围 1 至 21 个月），有 4 例心源性死亡和 3 例非心源性死亡（1 年精算生存率为 93%），17 例（7.7%）心绞痛提前复发。主动脉钙化、乳内动脉不使用、再次手术和糖尿病是不良事件的独立预测因素。我们的结论是，无需体外循环的冠状动脉旁路移植术可以以相对较低的手术死亡率进行，尽管心绞痛早期复发的风险似乎有所增加。因此，对于具有适当冠状动脉解剖结构的患者，应考虑该手术，因为心肺转流术对这些患者具有高风险。对于钙化的主动脉或紧急手术，该手术仍然是危险的。
Two hundred twenty patients, preferentially those with high-risk conditions, underwent coronary artery bypass grafting without cardiopulmonary bypass. Early unfavorable outcome events included operative mortality (7 patients, 3.2%), nonfatal perioperative myocardial infarction (6 patients, 2.7%), cerebrovascular accident (1 patient, 0.4%), and sternal infection (3 patients, 1.4%). There were two deaths (13%) among 15 patients with calcified aorta and four (12%) in 33 patients who underwent emergency operation. Multivariate analysis revealed these two risk factors to be the only predictors of early mortality (odds ratios, 8.0 and 9.8, respectively). Preoperative risk factors such as left ventricular dysfunction (ejection fraction ≤35%) (40 patients, 18%), congestive heart failure (46 patients, 21%), acute myocardial infarction (59 patients, 27%), cardiogenic shock (7 patients, 3%), age 70 years or older (59 patients, 27%), renal failure (19 patients, 9%), and cerebrovascular accident and carotid disease (11 patients, 5%) were not found to be major predictors of early mortality or unfavorable outcome. During 12 months of follow-up (range 1 to 21 months), there were four cardiac and three noncardiac deaths (1-year actuarial survival 93%) and 17 cases (7.7%) of early return of angina. Calcified aorta, nonuse of the internal mammary artery, reoperation, and diabetes mellitus were independent predictors of unfavorable events. We conclude that coronary artery bypass grafting without cardiopulmonary bypass can be done with relatively low operative mortality, although there seems to be an increased risk for early return of angina. This procedure should therefore be considered for patients with appropriate coronary anatomy, in whom cardiopulmonary bypass poses a high risk. This procedure is still hazardous with calcified aorta or emergency operation.