非体外循环紧急转为体外循环冠状动脉旁路移植术的分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Huiming , WU Ruobin , ZHENG Shaoyi

epartment of Adult Cardiac Surgery, Guangdong Provincial Cardiovascular Institute, Guangzhou 510100, P. R. China;

Corresponding author：

Keywords：

Off-pump coronary artery bypass grafting; Cardiopulmonary bypass; Complication

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To learn the predictive risk factors of acute conversion of off-pump coronary artery bypass grafting (off-pump CABG)to on-pump coronary artery bypass grafting (on-pump CABG), referring for making decision in operating. Methods During Jan. 2002 to May 2006, 546 patients underwent planned off-pump CABG were analyzed retrospectively, and cases of acute conversion of off-pump to on-pump CABG (converted group) were compared with unconverted to on-pump(off-pump group) by multivariate logistic regression. Results 24 patients of off-pump CABG were acutely converted to on-pump CABG because of ventricular fibrillation or unstable hemodynamics. The mortality in converted group was 16.7%(4/24), much higher than off-pump group ［27% (14/522) , P＜0.001］. By multivariable logistic regression, acute myocardial infarction (OR=3.142,P=0004), emergent CABG (OR=1.571,P=0.011) and right main coronary artery(RCA) stenosis less than 90% (OR=1922,P=0.024) were predictors of acute conversion of off-pump to on-pump. Conclusions The mortality in patients undergoing acute conversion of off-pump to on-pump coronary artery surgery is high. When applying off-pump CABG in patients with acute myocardial infarction, emergency CABG and right main RCA stenosis ≤90%, preventive set up of extracorporeal circulation is necessary.

Citation： GUO Huiming,WU Ruobin,ZHENG Shaoyi,HUANG Jingsong,XIE Bin,HUANG Keli,MAI Mingjie. 非体外循环紧急转为体外循环冠状动脉旁路移植术的分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2007, 14(6): 418-. doi: Copy

1.	El-Hamamsy I, Cartier R, Demers P, et al. Long-term results after systemic off-pump coronary artery bypass graft surgery in 1000 consecutive patients. Circulation, 2006, 114(1 Suppl):I486-I491.
2.	Mack MJ, Pfister A, Bachand D, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg, 2004, 127(1):167-173.
3.	Gal J, Grattan A, Kertai MD, et al. Coroanry revasculariation in transition from on-pump to off-pump: the effect of the off-pump coronary artery bypass on medium-term outcome. J Cardiovasc Surg (Torino), 2007, 48(1):67-72.
4.	Lahtinen J, Biancari F, Rimpilainen J, et al. Off-pump versus on-pump coronary artery bypass surgery in high-risk patients (EuroSCORE>/=6) . Thorac Cardiovasc Surg, 2007, 55(1):13-18.
5.	Rastan AJ, Eckenstein JI, Hentschel B, et al. Emergency coronary artery bypass graft surgery for acute coronary syndrome:　beating heart versus conventional cardioplegic cardiac arrest strategies. Circulation, 2006, 114(1 Suppl):I477-I485.
6.	Kerendi F, Puskas JD, Craver JM, et al. Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients. Ann Thorac Surg, 2005, 79(3):801-806.
7.	龚庆成，高泉鑫，杨王景, 等. 冠状动脉旁路移植术非体外循环改为体外循环的原因. 中华胸心血管外科杂志, 2005, 21 (1) : 18-20.
8.	Reeves BC, Ascione R, Caputo M, et al. Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery. Eur J Cardiothoracic Surg, 2006, 29(6):941-947.
9.	Jin R, Hiratzka LF, Grunkemeier GL, et al. Aborted off-pump coronary artery bypass patients have much worse outcomes than on-pump or successful off-pump patients. Circulation, 2005, 112(9 Suppl):I332-I337.
10.	Edgerton JR, Dewey TM, Magee MJ, et al. Conversion in off-pump coronary artery bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg, 2003, 76(4):1138-1142.
11.	Song HK, Petersen RJ, Sharoni E, et al. Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve. Eur J Cardiothoracic Surg, 2003, 24(6):947-952.
12.	Babatasi G, Massetti M, Bruno PG, et al. Pre-operative balloon counterpulsation and off-pump coronary surgery for high-risk patients. Cardiovasc Surg, 2003, 11(2):145-148.
13.	Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American college of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 2004, 110(9):1168-1176.
14.	Légaré JF, Buth KJ, Hirsch GM. Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial. Eur J Cardiothorac Surg, 2005, 27(2):296-301.
15.	Gurbuz AT, Hecht ML, Arslan AH. Intraoperative transesophageal echocardiography modifies strategy in off-pump coronary artery bypass grafting. Ann Thorac Surg, 2007, 83(3):1035-1040.

1. 　El-Hamamsy I, Cartier R, Demers P, et al. Long-term results after systemic off-pump coronary artery bypass graft surgery in 1000 consecutive patients. Circulation, 2006, 114(1 Suppl):I486-I491.
2. 　Mack MJ, Pfister A, Bachand D, et al. Comparison of coronary bypass surgery with and without cardiopulmonary bypass in patients with multivessel disease. J Thorac Cardiovasc Surg, 2004, 127(1):167-173.
3. 　Gal J, Grattan A, Kertai MD, et al. Coroanry revasculariation in transition from on-pump to off-pump: the effect of the off-pump coronary artery bypass on medium-term outcome. J Cardiovasc Surg (Torino), 2007, 48(1):67-72.
4. 　Lahtinen J, Biancari F, Rimpilainen J, et al. Off-pump versus on-pump coronary artery bypass surgery in high-risk patients (EuroSCORE>/=6) . Thorac Cardiovasc Surg, 2007, 55(1):13-18.
5. 　Rastan AJ, Eckenstein JI, Hentschel B, et al. Emergency coronary artery bypass graft surgery for acute coronary syndrome:　beating heart versus conventional cardioplegic cardiac arrest strategies. Circulation, 2006, 114(1 Suppl):I477-I485.
6. 　Kerendi F, Puskas JD, Craver JM, et al. Emergency coronary artery bypass grafting can be performed safely without cardiopulmonary bypass in selected patients. Ann Thorac Surg, 2005, 79(3):801-806.
7. 　龚庆成，高泉鑫，杨王景, 等. 冠状动脉旁路移植术非体外循环改为体外循环的原因. 中华胸心血管外科杂志, 2005, 21 (1) : 18-20.
8. 　Reeves BC, Ascione R, Caputo M, et al. Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery. Eur J Cardiothoracic Surg, 2006, 29(6):941-947.
9. 　Jin R, Hiratzka LF, Grunkemeier GL, et al. Aborted off-pump coronary artery bypass patients have much worse outcomes than on-pump or successful off-pump patients. Circulation, 2005, 112(9 Suppl):I332-I337.
10. 　Edgerton JR, Dewey TM, Magee MJ, et al. Conversion in off-pump coronary artery bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg, 2003, 76(4):1138-1142.
11. 　Song HK, Petersen RJ, Sharoni E, et al. Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve. Eur J Cardiothoracic Surg, 2003, 24(6):947-952.
12. 　Babatasi G, Massetti M, Bruno PG, et al. Pre-operative balloon counterpulsation and off-pump coronary surgery for high-risk patients. Cardiovasc Surg, 2003, 11(2):145-148.
13. 　Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American college of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation, 2004, 110(9):1168-1176.
14. 　Légaré JF, Buth KJ, Hirsch GM. Conversion to on pump from OPCAB is associated with increased mortality: results from a randomized controlled trial. Eur J Cardiothorac Surg, 2005, 27(2):296-301.
15. 　Gurbuz AT, Hecht ML, Arslan AH. Intraoperative transesophageal echocardiography modifies strategy in off-pump coronary artery bypass grafting. Ann Thorac Surg, 2007, 83(3):1035-1040.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

非体外循环紧急转为体外循环冠状动脉旁路移植术的分析

Abstract Full text Figures/Tables Video References Cited by

Format

Content