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Off-pump coronary artery bypass grafting: simple concept but potentially sublime scientific value

机译：非体外循环冠状动脉搭桥术：概念简单，但有潜在的升华科学价值

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This review discusses the available scientific evidence of the physiological changes and clinical outcomes with off-pump coronary artery bypass grafting.Off-pump coronary artery bypass grafting is more technically demanding, and its prognostic advantage has not been clearly elucidated. This paper examines the evolution of off-pump coronary artery bypass grafting and the technical challenges of ‘bypassing’ the cardiopulmonary bypass machine. A search of the Medline database of English-language literature yielded a huge number of articles from which those relating to physiological and biochemical changes, and clinical outcomes of coronary artery bypass grafting were selected for this review. There are few prospective randomized trials, mostly studying physiological and biochemical changes, and assessing specific clinical outcomes. Avoidance of cardiopulmonary bypass results in a significantly reduced systemic inflammatory response. Myocardial, renal and neurological functions, amongst others, are better preserved. A rapid advance in beating heart surgery technology occurred in the past 5 yrs enabling off-pump multivessel coronary bypass grafting to be performed with relative technical ease, thereby offsetting the propensity to incomplete revascularization which can be a major setback. The clinical outcome of patients with varying surgical risks who have off-pump coronary artery bypass grafting are comparable to those who have surgical revascularization with cardiopulmonary bypass. With the technical challenges of off-pump coronary bypass grafting surmounted, the simple concept of avoiding cardiopulmonary bypass can yield impressive results that would help to establish the routine use of this technique for myocardial revascularization.
机译：这篇综述讨论了非体外循环冠状动脉旁路移植术的生理学变化和临床结果的可用科学证据。非体外循环冠状动脉旁路移植术的技术要求更高，其预后的优势尚未明确阐明。本文探讨了非体外循环冠状动脉搭桥术的发展以及“绕过”体外循环机的技术挑战。对英语文献的Medline数据库的搜索产生了大量文章，其中包括与生理和生化变化有关的文章，并选择了冠状动脉搭桥术的临床结局进行本评价。几乎没有前瞻性随机试验，主要研究生理和生化变化，并评估特定的临床结果。避免体外循环会明显降低全身炎症反应。心肌，肾脏和神经系统功能尤其得以更好地保存。在过去的5年中，心脏跳动手术技术取得了飞速的发展，能够在相对容易的条件下进行非体外循环多支血管冠状动脉搭桥术，从而抵消了不完全血运重建的趋势，这可能是一个重大的挫折。进行非体外循环冠状动脉搭桥术的具有不同手术风险的患者的临床结局与采用体外循环进行外科血运重建的患者的临床结局相当。面对非体外循环冠状动脉搭桥术的技术挑战，避免心肺旁路的简单概念可以产生令人印象深刻的结果，这将有助于确立该技术在心肌血运重建中的常规应用。

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