Objective ;Cardiopulmonary bypass (CPB) with aortic cross-clamping and cardioplegic arrest remains the method of choice for patients requiring standard myocardial revascularization. Therefore, very high-risk patients presenting with acute coronary syndrome, unstable angina, onset of cardiac decompensation and requiring multiple myocardial revascularization, can have a poor outcome. The on-pump beating heart technique can reduce the mortality and the morbidity in such a selected group of patients and this report describes our clinical experience. Methods: Out of 1030 patients operated for CABG from January 2008 to January 2011, 64 (6. 2% ) selected high-risk patients suffering from life threatening coronary syndrome and requiring multiple myocardial revascularization, underwent on-pump beating heart surgery. The mean pre-operative left ventricle e-jection fraction (LVEF) was (32 ± 5)%. The majority of them (88%) suffered of tri-vessel coronary disease and 33 (52% ) had a left main stump disease. Seven patients (11%) were on the state of severe cardiac failure and received a pre-operative intra-aortic balloon pump. Results: All patients underwent on-pump-beating heart coronary revascularization. The mean number of graft/patient was 2.8 ± 0.7 and the internal mammary artery was used in 53patients (82.8% ). The mean CPB time was (72 ± 14) minutes. Three patients died during the recovery stay in the intensive care unit, and there was no postoperative myocardial infarctionamong the survivors. Transitorily renal failure oceoured in five patients and another 3 patients developed pulmonary in-fection. The mean hospital stay was (14 ±6) days. The follow-up was complete for all 61 patients survived at surgery and the mean follow-up time was (12 ± 2) months. One patient died during the follow-up period for cardiac arrest. One year after surgery they all took a standard trans-thoracic echocardiogram showing a mean LVEF rate of (38 ±8)%. Conclusion; Standard coronary surgery has higher mortality and morbidity for the patients with high risk. The on-pump beating heart myocardial revascularization seems to be a valid alternative for them.%[目的]:探讨危重冠心病患者进行体外循环下,心脏不停跳冠状动脉搭桥术的可行性.[方法]:2008年1月至2011年1月间1030例冠状动脉搭桥术(CABG)中,选择64例(6.2％)进行体外循环下心脏不停跳CABG的患者进行回顾性分析.其中,常规手术组36例,19例为急诊行CABG,9例为非体外不停跳CABG紧急改为体外下不停跳CABG.术前观察其一般情况、心肌缺血情况、左心室射血分数(LVEF)及是否患有3支冠状动脉病变、左主于病变、术前是否放置主动脉内球囊反搏(IABP)等.[结果]:64例患者术前LVEF为(32±5)％,均进行了体外循环下不停跳CABG.平均体外循环(CPB)时间为(72±14)min,移植桥血管平均数为(2.8±0.7)根,其中53例(82.8％)使用了左乳内动脉.住院期间死亡3例(4.7％),均为紧急建立体外循环者,原因为严重心律失常或心力衰竭.其余患者无围术期心肌梗死发生,5例患者(7.8％)发生肾功能不全,3例(4.7％)发生肺部感染.平均住院时间为(14±6)d.61例患者全部随访,平均随访时间为(12±2)个月.随访期内1例患者死于严重心律失常,其余患者无心绞痛主诉或心衰表现.术后1年行超声心动图检查,平均LVEF为(38±8)％.[结论]:对于危重冠心病患者,CABG有较高的风险.体外循环下心脏不停跳CABG,是一种更安全可靠的方法.
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