An Analysis Of Predictors And Outcomes Of Emergency Conversion To On Pump From Off-pump Coronary Artery Bypass Grafting

Objective To analysis and evaluate the risk factors for emergency conversion to on pump from off-pump coronary artery bypass grafting (OPCAB) during the intraoperative period. To explore intraoperative risk factors that need to be emergency conversion to ONCAB form OPCAB, patients with these risk factors for the first time use ONCAB, in order to reduce the surgical mortality and postoperative complications of OPCAB patients. therefore, the purpose of this study is to determine risk factors from OPCAB surgery to ONCAB, and further to evaluate of the prognosis of these patients.Methods Retrospective analysis risk factors of off-pump coronary artery bypass grafting(OPCAB) in emergency into on-pump coronary artery bypass grafting (ONCAB), to explore intraoperative risk factors that need to be hurry to ONCAB from OPCAB. patients with these risk factors for the first time use ONCAB, in order to reduce the surgical mortality and postoperative complications. Therefore, the purpose of this study is to determine risk factors of conversion from OPCAB surgery to ONCAB, and further to evaluate of the prognosis of these patients. Between January2010and October2011, there are1520cases undergoing OPCAB patients with coronary heart disease (CHD) in this study in Tianjin Chest hospital cardiac surgery. Among them,1091cases of male,429cases of female, average age (63.67±7.21). In OPCAB group,1006cases of hypertension patients (67.9%),445patients with diabetes (29.9%),234patients with cerebrovascular disease (15.8%),32cases were converted to surgery under cardiopulmonary bypass, hypertension patients of17cases (54.8%),11cases (34.4%) of diabetic patients,5patients with cerebrovascular disease (15.6%), conversion rate was2.1%(32/1520) and1488patients completed the OPCAB. Index of the single factor analysis of P<0.05into the multi-factor logistic regression analysis, P<0.05is thought difference have statistical significance. This study would be the end of the interim cardiopulmonary bypass for observation. The multi-factor logistic regression analysis determines the risk factor for cardiopulmonary bypass. Logistic regression analysis is used to assess the existence of cardiopulmonary bypass and the relationship between the postoperative complications.In addition to being able to predict the risk of mortality, and is also used to evaluate convertion to cardiopulmonary bypass for death, perioperative myocardial infarction, prolonged the time of mechanical ventilation, renal failure, atrial fibrillation and care unit monitoring time, etc.Results There is1520cases of patients with undergoing OPCAB surgery,32people required intraoperation conversion, average age (64.59±8.77),26cases of men,6cases of women.The conversion rate is2.1%. The patients of convertion, on average, cardiopulmonary bypass time (95.34±43.16), there is no cardiac arrest. The cause of the urgent transfer to cardiopulmonary bypass:14patients with severe ventricular fibrillation,18cases with intraoperative hemodynamic instability (3patients after neutralization heparin,2patients with lower blood pressure continuous drops when the heart exposed right coronary artery). Preoperative application of Intra-aortic balloon pump (IABP) in1case,5cases used in operation, postoperative3cases. There was4people died, the mortality rate is12.5%, it is significantly higher than OPCAB group mortality (1.0%). Mortality in patients with transfer group was obviously higher than that of OPCAB group (0.22%:3.5%; P=0.001<0.01). Patients with postoperative mechanical ventilation time and ICU monitoring time increased significantly (P values were less than0.001), postoperative complications, perioperative myocardial infarction, kidney failure, cardiac arrest or ventricular fibrillation, low cardiac syndrom and large-scale application vascular active drugs, differences between two groups have statistical significance (P<0.05). The difference between two groups of patients with postoperative secondary tracheal intubation and tracheostomy and postoperative atrial fibrillation had not statistics significance. Logistic regression analysis showed that the right Coronary artery lesions (P<0.001), myocardial infarction time less than3weeks (P<0.001), and Percutaneous Coronary interention (Percutaneous Coronary Intervention, PCI) postoperatively (P=0.018<0.05), emergency surgery (P=0.008<0.01), number of grafts (P=0.004<0.01) was the risk factor for emergency to ONCAB form OPCAB.Conclusions The patients with coronary heart disease (CHD) had more postoperatively mortality and complications from OPCAB emergency into ONCAB.For emergency into ONCAB risk factors of coronary heart disease patients, plan to choose ONCAB, for reducing the surgical mortality and complications.