Management experience of right coronary artery resulting in ischemic event in off-pump coronary artery bypass grafting_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

杨文钢 ,  薛松 , 黄日太 , 连锋 , 徐根兴

上海交通大学医学院附属仁济医院心血管外科（上海 200127）;

Corresponding author：

薛松, Email: xuesong64@163.com

Keywords：

不停跳冠状动脉旁路移植术; 缺血事件; 右冠状动脉

DOI：

10.7507/1007-4848.201611040

Video：

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目的总结冠心病行不停跳冠状动脉旁路移植术（OPCAB）中，右冠状动脉突发急性缺血事件的处理经验。方法 2010 年 5 月至 2015 年 5 月我院共行 OPCAB 1 568 例，术中出现右冠状动脉急性缺血事件 22 例，其中男 16 例、女 6 例，年龄（66.5±9.7）岁。结果 11 例患者于紧急右冠状动脉旁路移植术后、开放桥血管后 ST 段可以逐渐恢复正常，右心功能恢复，心律失常明显减少或消失。2 例患者右冠状动脉旁路移植后仍有右心功能不全表现，但经积极药物处理以及主动脉内球囊反搏（IABP）应用后逐步脱离危险期。1 例患者术后循环仍不稳定，最终于术后 2 d 死亡。总死亡率 4.5%。发生围术期心肌梗死 6 例，全组患者 IABP 应用 3 例。结论 OPCAB 术中右冠状动脉突发缺血事件更多表现为心律失常，发生率虽低，但在无杂交手术室的情况下能够及时判断并正确处理右冠状动脉突发急性缺血事件至关重要，对患者术后及预后都有较积极的影响。

Citation： 杨文钢, 薛松, 黄日太, 连锋, 徐根兴. Management experience of right coronary artery resulting in ischemic event in off-pump coronary artery bypass grafting. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(12): 1002-1004. doi: 10.7507/1007-4848.201611040 Copy

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11.	Schirmer U, Calzia E, Lindner KH, et al. Right ventricular function after coronary artery bypass grafting in patients with and without revascularization of the right coronary artery. J Cardiothorac Vasc Anesth, 1995, (19): 659-664.

1. Tomoaki S, Tohru A. The current status of multi-arterial off-pump coronary artery bypass grafting. Surg Today, 2016, 46: 1-12.
2. Kern MJ, Samady H. Current concepts of integrated coronary physiology in the catheterization laboratory. J Am Coll Cardiol, 2010, 55(3): 173-185.
3. Briguori C, Anzuini A, Airoldi F, et al. Intravascular criteria for the assessment of the functional significan mediate coronary artery stenoses and comparison wiflow reserve. Am J Cardiol, 2001, 87: 136-141.
4. Patwa HP, Weissman NJ, Boppart SA, et al. Assessment ocoronary plaque with optical coherence tomogralchy and high-frequency ultrasound. Am J Cardiol, 2000, 85(5): 641-644．.
5. 乔树宾. 主编. 心血管介入治疗高级培训教程. 北京: 人民卫生出版社, 2011. 357-365.
6. Tobis J, Azarbal B, Slavin L. Assessment of intermediate severity coronary lesions in the catheterization laboratory. J Am Coll Cardiol, 2007, 49(8): 839-848.
7. 葛均波, 徐永健, 主编. 内科学. 北京: 人民卫生出版社, 2013. 159.
8. 杨有东, 孟泽军, 顾成圻. IVUS 和 FFR 在冠状动脉临界病变治疗中的应用价值. 中西医结合心脑血管病杂志, 2016, 14(9): 1012-1014.
9. Shim JK, Bang SO, Lee JH, et al. Effect of intracoronary shunt on right ventricular function during off-pump grafting of dominant right coronary artery with poor. J Korean Med Sci, 2008, 23: 373-377.
10. Lee YK, Hong YW. The effect of right coronary artery stenosis on right ventricular function in patients undergoing off pump coronary artery bypass surgery:O-18. Korean J Anesthesiol, 2005, 49(6): 810.
11. Schirmer U, Calzia E, Lindner KH, et al. Right ventricular function after coronary artery bypass grafting in patients with and without revascularization of the right coronary artery. J Cardiothorac Vasc Anesth, 1995, (19): 659-664.

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