全动脉化非体外循环冠状动脉搭桥术的临床应用

目的探讨全动脉化非体外循环冠状动脉旁路移植术(冠脉搭桥术)的手术技术、安全性和近中期手术效果。方法 2004年3月～2012年4月接受全动脉化非体外循环冠脉搭桥术(包括微创冠脉搭桥)患者35例,人均搭桥2.7支(1～4支)。其中常规开胸非体外循环冠脉搭桥30例,胸腔镜辅助下微创冠脉搭桥5例。同期行体外循环下全动脉化冠脉搭桥8例,同期行一根乳内动脉和静脉做常规非体外循环冠脉搭桥248例,比较不同手术方式的死亡率、并发症、桥血管数目和近中期疗效等。结果全动脉化非体外循环冠脉搭桥术后仅1例患者因胸骨感染死亡,34例症状明显改善顺利出院,随访效果均良好,无心绞痛发作,心功能明显改善。结论全动脉化非体外循环冠状动脉旁路移植术临床效果较好,并发症及死亡率较体外循环下搭桥少,总的风险更低,但因患者病变、病情及各种因素,本术仍不能完全取代冠状动旁路移植术。

Clinical application and effect of complete arterial revascularization to Off-pump Coronary Artery Bypass Grafting

Objective To investigate the surgical technique, safety and early metaphase clinical result of complete arterial revascularization to Off-pump Coronary Artery Bypass Grafting. Methods There were 35 patients underwent complete arterial revascularization to Off-pump CABG. Internal mammary artery, radial artery were considered for artery grafts. There were 30 cases treated with routine Off-pump CABG in and 5 cases with minimally invasive direct CABG. At same period, 8 patients underwent complete arterial revascularization to On-pump CABG, 248 patients underwent traditional revascularization using left internal mammary artery and veins. The purpose was to compare the mortality rate, complications, grafts number and operative results between different groups. Results Only one case died in hospital because of infection of breast bone, 34 patients were discharged from the hospital. The following-up results showed all patients had no postoperative angina, heart function all improved. Conclusion The early metaphase clinical result of complete arterial revascularization to Off-pump CABG is good, complications and the mortality rate is less and patience rate is higher than vein grafts.