主动脉内球囊反搏辅助下的非体外循环冠状动脉旁路移植术

Off-Pump Coronary Artery Bypass Grafting Assisted by Intra-Aortic Balloon Pump

目的 :分析讨论主动脉内球囊反搏 (IABP)辅助下进行非体外循环冠状动脉旁路移植术 (OPCAB)的可行性和临床疗效。 方法 :12例OPCAB使用IABP辅助 ,包括术前顽固心绞痛 2例 ,急性心肌梗死 (心梗 ) 2例 ,左心室射血分数(LVEF)低下 5例 ,心梗恢复期心功能Ⅳ级 2例 ,心脏明显扩大 1例 ,所有患者术中不易搬动心脏。 结果 :12例OPCAB全部成功 ,远端吻合口数 3 7± 0 6个。术后IABP辅助时间平均 2 2 3± 9 5小时。 1例术后8天死于高钾心跳骤停。有 1例拔除IABP管后出现局部血肿。其他患者顺利恢复。 结论 :IABP辅助下进行OPCAB是可行而安全的。对于低LVEF、急性心梗和心脏明显扩大等术中不易搬动心脏的情况 ,IABP有助于扩大OPCAB的适应证范围。

Objective:To discuss the feasibility and outcome of off-pump coronary artery bypass (OPCAB) procedure assisted by intra-aortic balloon pump(IABP). Methods:Twelve cases underwent OPCAB assisted by IABP,including 2 cases with refractory angina,2 cases with acute myocardial infarction,5 cases with low left ventricular ejection fraction(LVEF),2 cases of NYHA Ⅳ following subacute myocardial infarction and 1 case with enlarged heart.All patients could not tolerate manipulating heart. Results:All the 12 cases of OPCAB were successfully performed.The mean number of the distal anastomose was 3.7±0.6.The mean IABP time after operation was 22.3±9.5.One died of heart arrest due to hyperpotassium 8 days after operation.No severe complications related to IABP happened. Conclusions:IABP is helpful in widening the indications of OPCAB,especially in the conditions such as low LVEF,acute myocardial infarction and facing difficulty in moving a dilated heart during surgery.