Application Of Off-pump Coronary Artery Bypassing In Senile Patients

BackgroundWith China's population aging,cardiovascular disease,especially coronary heart disease risks for human health has become the primary non-infectious diseases. Coronary artery bypass grafting is an effective method of treatment of coronary artery disease.Coronary pulmonary bypass under cardiac arrest can cause systemic inflammatory response,as well as heart,lung,brain,kidney and gastrointestinal dysfunction.Off-pump coronary artery bypass grafting was first reported by Kolessov in 1964. However,due to OPCABG technique in beating heart surgery,there are difficulties in surgical field showing and vascular operations,so it has not been widely used.With the development of surgical techniques and the application of new medical devices,in the past the operation showing the site difficult can also be operated,more and more people use OPCAB.In 1990s early,Benetti and Buffolo in two South America Heart Centers had successful carried more than 1000 cases of off-pump coronary artery bypass grafting,and supplied valuable experience for the operation of the world use. In June 1996,Fu Wai Hospital in Beijing firstly carried the operation in the middle of the sternal incision.Then,a number of hospitals in China have also started the operation of clinical research and practice.With the expansion of the elderly population,the number of elderly patients with coronary artery disease to receive coronary artery bypass grafting continues to grow. However,many elderly patients with coronary heart disease also combined with systemic diseases,even decreasing in organ reserve capacity,so advanced age become a high-risk factor in coronary artery bypass grafting.In theory,the result of OPCAB CPB due to myocardial ischemia-reperfusion injury and cardiopulmonary bypass injury can be avoided or mitigated,is expected to achieve with conventional CABG the same or better results,especially applicable to a number of senior citizens. However,the lack of clinical effects of the bulk of cases,it is not able to confirm the theory in practice inferred.To prove this,the article summarizes the past 6 years in our old age line CABG surgery in patients,discusses the difference between short-term efficacy of OPCAB and CPB-CABG surgery,to provide a basis for programs of elderly surgical patients with coronary heart disease treatment.Objectives1.Discuss the preparatory work,operation techniques,postoperative care, postoperative complications and prognosis of off-pump coronary artery bypass grafting(OPCABG).2.Summarize of the characteristics and benefits off-pump coronary artery bypass grafting(OPCABG).Subjects and MethodsIn a fine-designed hospital-based study,we recruit our subjects in the Chinese People's Liberation No.88 Army Hospital from October 2001 to March 2007.This study selected a total of 184 subjects,of which 92 cases were in Group A,and 92 cases in Group B.We also collected the indicators of research subjects before and after operation:preoperative indicators such as age,diabetes history,history of hypertension,chronic obstructive pulmonary disease history,the history of emergency CABG,vascular bridge number,history of myocardial infarction,history of cerebrovascular accident,left Room ejection fraction,cardiac function classâ…¢orâ…£, etc.;after positive indicators include the use of drugs,IABP use,perioperative myocardial infarction,respiratory failure,atrial fibrillation,pulmonary infections, ventilator time,ICU time,length of stay in hospital and so on.We applied generalized linear regression analysis to control possible confounding factors related to explore the impact of numerical indicator variable factors.ResultsA group(OPCAB group) is greater emphasis on pre-operative condition than the B group patients(CPB-CABG group),manifested in the history of myocardial infarction, cerebrovascular accident,chronic obstructive pulmonary disease,carotid artery disease and cardiac function were significantly worse than B group.However,sources suggest that postoperative complications A Group B Group rather than to reduce:low cardiac output,perioperative myocardial infarction,pulmonary complications, complications of the brain were lower than the B group,ICU length of stay and time to live The operative mortality was significantly lower than the B group(4.8%/ 10.2%),fully OPCAB surgery for the elderly were more the superiority of coronary heart disease.However,the needs of elderly patients regained consciousness after a long time,cardiopulmonary function,as well as changes in organ function would be more hidden,after the slow physical recovery,so patients need to be more careful guardianship,which is to reduce post-operative complications,and promote the early resumption of an important significance.ConclusionsOur study has shown that off-pump coronary artery bypass surgery in elderly patients can significantly reduce the surgical mortality and postoperative complications, elderly patients with coronary artery disease should be the preferred method of surgical treatment.