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391 patients experienced coronary artery bypass grafting


Central, CABG, 2 routine OPCAB, 4 patients died. The cause of death in 1 case of ventricular septal perforation before surgery, 1 case of postoperative hemorrhage, 2 patients with severe symptoms of low cardiac comprehensive platform. We believe that such surgery in the CPB down more secure. First, take the bridge through the vascular infarction. Cardioplegia perfusion via the bridge. Were far, the proximal anastomosis I: 1 do so only after open aortic myocardial perfusion may be more favorable. In addition, all using the great saphenous vein bypass graft, faster, and on myocardial ischemia reperfusion blood flow more,[link widoczny dla zalogowanych], you can quickly restore the function of ischemic myocardium. 3.3 Off-pump coronary artery bypass surgery in recent years, the superiority of non-pump coronary artery bypass grafting technique (OPCAB) has become more sophisticated, for the surgical treatment of coronary heart offers new choices and opportunities. As to avoid the use of OPCAB surgical bypass, leaving inflammatory factor, the complement system is not activated, and avoid organ function caused by cardiopulmonary bypass injury, such as perfusion lung, acute renal failure, hypoxic encephalopathy and so on. At the same time, because to avoid the blood clotting system activation and consumption of coagulation factors, and after cardiopulmonary bypass to avoid disturbance of clotting mechanism, thus reducing the amount of operative bleeding and blood transfusion. In addition,[link widoczny dla zalogowanych], because of avoiding cardiopulmonary bypass in the ascending aorta cannulation and piping systems to ~) PCAB after microembolization and cerebral vascular accidents decreased compared with CABG. On the other hand, OPCAB surgical procedures,[link widoczny dla zalogowanych], because myocardial blood supply has not been interrupted, so there is no myocardial ischemia and reperfusion injury. Preoperative low left ventricular systolic function severe cases, OPCAB CABG surgical technique than the traditional style has more advantages _3. In fact,[link widoczny dla zalogowanych], the second half of 1999 units from the starting line OPCAB, 2001 70% of patients choose OPCAB,[link widoczny dla zalogowanych], mainly with mature technology, complete revascularization can be done about. There were 2 cases of early exposure to hemodynamic instability rotary support needs into circulation. Latter two methods: ① Open the diaphragm on the right chest (WilliamCohn's method _4) to the phrenic nerve, the right to hold up to the chest room suddenly, so that hemodynamic stability. ② The EF <30%, CTR ≥ 0.65 for patients, put some selected preoperative I. ABP, moving heart surgery, the blood flow dynamics not affected. OP-CAB group, 5 cases were handled this way, all recovering well. l cases of 5o-year-old patient, P heart restenosis, LVEF20%, CTR = 070, post-anesthesia nRP, then PP / PS from 0.70 down to 0.5, reduced pulmonary wedge pressure by the 3OnmlHg 25mC-lg , and the line OPCAB (3 bridge) after PP / PS reduced to 0.3, normal blood pressure. OPCAB 3 patients died. 2 cases of acute myocardial infarction preoperative left ventricular failure with pulmonary edema, postoperative low cardiac output is still 1 side, 1 patient died of intracerebral hemorrhage; 1 patient died of renal failure. Overall, patients recover faster after OPcAB, save medical costs (5000 ~ l0000 million), greater benefit critically ill patients. Although the group does not decrease mortality compared with CABG, the initial results showed that OPCAB compared with conventional CAB (; has some advantages, but still need more more rigorous controlled clinical trials confirmed.
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