Off-pump coronary artery bypass grafting decreases morbidity and mortality in a selected group of high-risk patients

被引:22
作者
Bittner, HB
Savitt, MA
机构
[1] Univ Minnesota, Dept Surg, Div Cardiothorac Surg, Minneapolis, MN 55455 USA
[2] Providence St Vincent Heart Inst & Med Ctr, Albert Starr Acad Ctr, Portland, OR USA
关键词
D O I
10.1016/S0003-4975(02)03646-9
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. The ideal indication for off-pump coronary artery bypass grafting (OPCABG) has yet to be defined. High-risk surgical patients may benefit the most when cardiopulmonary bypass (CPB), aortic cross clamping, and cardioplegic arrest are avoided. The aim of this study was to determine whether off-pump coronary artery bypass grafting might decrease the operative morbidity and mortality in a select group of high-risk patients with multivessel. coronary artery disease. Methods. Utilizing a Parsonnet risk stratification model we analyzed prospectively collected data on a cohort of high-risk coronary artery disease patients, which were operated on with beating-heart technology by the same group of surgeons in a tertiary care university medical center. High-risk patients were defined as those with a Parsonnet score of 15 or greater. Results. Fifty-seven multivessel disease OPCABG patients (over a period of 2 years) had markedly increased Parsonnet scores (24.3 +/- 10.6). The average ejection fraction of the patients was 42% (+/-12.3) and their age ranged from 52 to 85 years (mean 70.6 +/- 10.4, 26% women). Unstable angina was present in 42 patients (74%) and 10 patients underwent OPCABG within 24 hours of the occurrence of acute myocardial infarction. In addition to severe coronary artery disease 32% of the patients presented with congestive heart failure, insulin-dependent diabetes (18%), renal failure (22%), peripheral vascular disease (31%), pulmonary disease (18%), and neurologic disorders (14%). An average of 2.6 +/- 0.9 grafts/patient were performed and the posterior descending artery or marginal branches of the circumflex artery or both were grafted in 90%. The 30-day mortality rate was 3.5% (n = 2). Conclusions. OPCABG can be performed with a reasonable low morbidity and mortality in this select group of high-risk patients. OPCABG is a reasonable, and might even be preferable, operative strategy in this high-risk group of patients. (C) 2002 by The Society of Thoracic Surgeons.
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页码:115 / 118
页数:4
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