How to Avoid Problems in Redo Coronary Artery Bypass
How to Avoid Problems in Redo Coronary Artery Bypass
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如何避免重做冠状动脉搭桥术时出现问题
DOI：
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发表时间：
2001
影响因子：
1.6
通讯作者：
V. Machiraju
中科院分区：
文献类型：
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作者：
V. Machiraju
摘要背景：与直接冠状动脉血运重建术相比，重做心脏手术仍然具有较高的死亡率和发病率。 可以采取各种措施来降低不良结局的发生率。根据我们的经验，我们已经积累了在手术过程中采取的安全步骤，以达到积极的结果。方法：我们回顾了过去4年中在两个机构进行的再次冠状动脉旁路手术（CABG）的经验。虽然两个机构的外科医生是相同的，但由于患者转诊、手术设备、麻醉管理和术前护理的机构差异，我们将数据分开。五名外科医生采用几乎相似的心肌保护技术进行CABG;然而，根据资历和临床经验，手术技巧略有不同。我们在一个机构进行了433次再次冠状动脉血运重建，在第二个机构进行了201次。其中15%的患者还接受了其他手术，如瓣膜修复术、瓣膜置换术或动脉瘤切除术。在该患者组中，160例患者接受了紧急或急诊CABG。紧急手术定义为在与心导管插入术相同的入院期间进行患者血运重建，紧急手术定义为患者在导管插入术的同一天接受手术，特别是当存在血流动力学不稳定时。总死亡率为7%，而择期再次CABG死亡率为3%。住院时间为8.5 - 12.6天。并发症包括18例患者围手术期卒中和19例患者非致命性围手术期心肌梗死（MI）。导致死亡的主要因素是卒中、围手术期出血和探查、肾衰竭、呼吸衰竭和营养不良。结论：我们概述了再次冠状动脉旁路移植术期间为取得成功而采取的预防措施和安全手术方法。
Abstract Background: Redo cardiac surgery still carries higher mortality and increased morbidity as compared with primary coronary revascularizations. Various steps can be taken to decrease the incidences of adverse outcomes. From our experience, we have accumulated safe steps to be taken during the surgical procedure to reach a positive outcome. Methods: We reviewed our own experience of redo coronary artery bypass surgery (CABG) at two institutions during the last 4 years. Though the surgeons were the same at both institutions, because of institutional variability of patient referrals, operative equipment, anesthesia management, and preoperative care, we kept the data separate. Five surgeons performed CABG with almost similar myocardial preservation techniques; however, the surgical skill varied slightly depending on the seniority and clinical experience. We performed 433 redo coronary artery revascularizations at one institution and 201 in the second institution. Fifteen percent of these patients also had additional procedures, such as valve repair, valve replacement, or aneurysm resection. In this patient group, 160 patients underwent either urgent or emergent CABG. Urgent surgery was defined as patient revascularization during the same admission as cardiac catheterization, and emergency surgery was defined as a patient undergoing surgery on the same day as the catheterization, especially when hemodynamic instability was present. The total mortality was 7%, while the elective redo CABG mortality was 3%. The length of stay ranged from 8.5 to 12.6 days. The morbidity included perioperative stroke in 18 patients and nonfatal perioperative myocardial infarction (MI) in 19 patients. Major factors contributing to the mortality were stroke, perioperative bleeding and exploration, renal failure, respiratory failure, and malnutrition. Conclusion: We outlined the precautions and safe surgical approaches to be undertaken during redo CABG for a successful outcome.