Our experiences for off-pump coronary artery bypass grafting to the circumflex system.
Our experiences for off-pump coronary artery bypass grafting to the circumflex system.
复制标题
我们在回旋系统非体外循环冠状动脉旁路移植术方面的经验。
DOI：
10.1016/s0003-4975(03)01326-2
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发表时间：
2003
影响因子：
4.6
通讯作者：
Takazumi Nakamura
中科院分区：
文献类型：
--
作者：
Tomoaki Suzuki;M. Okabe;F. Yasuda;Y. Miyake;M. Handa;Takazumi Nakamura
非体外循环冠状动脉旁路移植术（OPCAB）的完全血运重建一直是困难的。血流动力学恶化通常会妨碍进入回旋区。本研究介绍了仪器进入回旋区，我们的临床experience.METHODS从1999年8月至2002年12月，140例患者接受OPCAB通过胸骨切开术在我们的机构。本研究的对象是114例需要重建旋动脉的患者。无排除标准。一系列的技术和工具被开发出来，以提供进入回旋区，同时保持血流动力学的稳定性，包括左心包牵引技术，右心包压缩，右胸骨牵开器，和一种类型的分流管。95%的病例实现了完全血运重建。并发症包括呼吸功能不全（0.8%）、肾功能不全（7%）和胸骨伤口感染（0.8%）。10例患者（8%）需要输血。无患者发生围手术期心肌梗死或卒中。无手术转为体外循环。无手术死亡。出院前血管造影显示99%的通畅率。CONCLUSIONSWith我们的技术和仪器，非体外循环冠状动脉血管重建术的回旋区可以安全地进行，以实现完全血运重建。早期临床效果良好，但需要长期纵向随访来评估OPCAB手术的未来有效性。
BACKGROUNDComplete revascularization has been difficult in off-pump coronary artery bypass grafting (OPCAB). Hemodynamic deterioration often prevents access to the circumflex territory. This study presents instrumentation for accessing the circumflex territory, and our clinical experience.METHODSFrom August 1999 through December 2002, 140 patients underwent OPCAB via sternotomy in our institution. The 114 requiring reconstruction of the circumflex artery are the subjects of this study. There were no exclusion criteria. A series of techniques and instruments were developed to provide access to the circumflex area while hemodynamic stability was preserved, including the left pericardial traction technique, compression of the right pericardium, a right sternal retractor, and a type of shunt tube.RESULTSPatients received an average of 3.2 grafts (range, 2 to 6). Complete revascularization was achieved in 95% of the cases. Complications included respiratory insufficiency (0.8%), renal dysfunction (7%), and sternal wound infection (0.8%). Blood transfusions were required in 10 patients (8%). No patient suffered perioperative myocardial infarction or stroke. No operation was converted to cardiopulmonary bypass. There was no operative death. Predischarge angiography demonstrated a 99% patency rate.CONCLUSIONSWith our techniques and instruments, off-pump coronary revascularizaion of the circumflex area may be performed safely to achieve complete revascularization. Early clinical results are excellent, but long-term longitudinal follow-up is required to assess the future effectiveness of OPCAB procedure with our techniques.