非体外循环冠状动脉旁路移植术在左主干重度狭窄患者中的应用

Off-pump coronary artery bypass grafting in patients with the severe left main coronary artery stenosis

目的总结左主干重度狭窄冠心病患者行非体外循环下冠状动脉旁路移植术（OPCAB）的治疗效果和临床经验。方法回顾分析2005年1月至2012年6月，83例左主干狭窄〉70％的患者接受了非体外循环下冠状动脉旁路移植术，其中27例急诊手术，三支病变62例，两支病变21例，术中改为体外循环5例；使用主动脉内球囊反搏7例。结果远端吻合口平均（3．34±0．83）个，死亡2例（2．4％）。随访2个月至2年，仅1例心绞痛复发，余者均未出现心绞痛症状。手术效果及手术并发症的发生与非左主干病变组差异无统计学意义（P〉0．05）。结论左主干重度狭窄行非体外循环下冠状动脉旁路移植术临床效果良好。

Objective To study the efficacy and clinical experience of off-pump coronary artery bypass grafting in the patients with severe left main coronary artery stenosis. Methods Eighty-three patients with a left main coronary artery stenosis 〉70% underwent off-pump coronary artery bypass graft between January 2005 and June 2012. The average age was 62.5 years. Emergency surgical revascularization was performed in 27 patients, 62 cases with triple vessel disease, 21 cases with double vessel disease and 5 patients were converted to cardiopul- monary bypass （CPB）. Intra-aortic balloon pump was used in 7 cases. Results The number of distal anastomosis was 3.34±0.83. There were 3 postoperative deaths （2.4%）. During follow-up of 2 months to 2 years, only 1 case had recurrent angina,. There was no significant difference in outcome data between LMS Group and non-LMS Group （P〉0.05）. Conclusion It is effective to perform off-pump coronary artery bypass grafting in patients with severe left main coronary artery stenosis.