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首页> 外文期刊>Innovations: technology and techniques in cardiothoracic and vascular surgery >Increasing surgical experience with off-pump coronary surgery does not mitigate the morbidity of emergency conversion to cardiopulmonary bypass
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Increasing surgical experience with off-pump coronary surgery does not mitigate the morbidity of emergency conversion to cardiopulmonary bypass

机译：非体外循环冠状动脉手术的手术经验增加并不能减轻紧急转为体外循环的发病率

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OBJECTIVE: Emergency conversion during off-pump coronary artery bypass (OPCAB) confers significant morbidity. We sought to determine whether the outcomes in these patients have changed as our experience with off-pump techniques has increased. METHODS: Between January 1999 and December 2010, 4763 patients underwent coronary artery surgery. An off-pump strategy was attempted in 4415 cases (92.7%). The results of the most recent 50 patients who required emergency conversion were compared with the preceding 50 conversions and with patients who underwent either OPCAB (n = 2737) or on-pump coronary surgery (coronary artery bypass grafting) (n = 268) during the same time frame. RESULTS: The emergency conversion rate was 2.27% (n = 100), being 2.97% for the first 50 cases and 1.77% for the subsequent 50 patients. The two sequential groups of emergency conversions had similar indications and timing of conversion and comparable outcomes. When compared with patients who underwent OPCAB, the more recent 50 conversions had higher mortality (P = 0.002) and more frequent sternal wound infection (P = 0.036), hemorrhage requiring reoperation (P = 0.003), respiratory failure (P < 0.0001), and all-cause sepsis (P = 0.001). Compared with the on-pump group, the more recent conversions had higher mortality (P = 0.055) and a greater rate of postoperative sepsis (P = 0.002). CONCLUSIONS: The incidence of emergency conversion during OPCAB has decreased with increasing surgical experience; however, the morbidity in these patients remains essentially unchanged. The outcomes in these patients remain worse than those in nonconverted patients. Safer bailout strategies during OPCAB are still warranted.
机译：目的：在非体外循环冠状动脉搭桥术（OPCAB）期间进行紧急转换可带来明显的发病率。我们试图确定这些患者的结局是否随着我们对非体外循环技术经验的增加而改变。方法：1999年1月至2010年12月，进行了4763例冠状动脉手术。尝试了4415例（92.7％）的非常规策略。将最近50例需要紧急转换的患者的结果与之前的50例转换以及在手术期间接受OPCAB（n = 2737）或泵上冠状动脉手术（冠状动脉搭桥术）（n = 268）的患者进行比较。相同的时间范围。结果：紧急转换率为2.27％（n = 100），前50例为2.97％，其后50例为1.77％。紧急转换的两个连续组具有相似的指示和转换时间以及可比较的结果。与接受OPCAB的患者相比，最近的50次转化具有更高的死亡率（P = 0.002）和更常见的胸骨伤口感染（P = 0.036），需要再次手术的出血（P = 0.003），呼吸衰竭（P <0.0001），和全因败血症（P = 0.001）。与泵上治疗组相比，更新的治疗组死亡率更高（P = 0.055），术后败血症发生率更高（P = 0.002）。结论：随着手术经验的增加，OPCAB期间紧急转换的发生率有所降低。然而，这些患者的发病率基本上保持不变。这些患者的转归仍然比未转化患者差。仍然需要在OPCAB期间采取更安全的救助策略。

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