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：

楊文鋼 ,  薛松 , 黃日太 , 連鋒 , 徐根興

上海交通大學醫學院附屬仁濟醫院心血管外科（上海 200127）;

Corresponding?author：

薛松, Email: xuesong64@163.com

Keywords：

不停跳冠狀動脈旁路移植術; 缺血事件; 右冠狀動脈

DOI：

10.7507/1007-4848.201611040

Video：

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目的總結冠心病行不停跳冠狀動脈旁路移植術（OPCAB）中，右冠狀動脈突發急性缺血事件的處理經驗。方法 2010 年 5 月至 2015 年 5 月我院共行 OPCAB 1 568 例，術中出現右冠狀動脈急性缺血事件 22 例，其中男 16 例、女 6 例，年齡（66.5±9.7）歲。結果 11 例患者于緊急右冠狀動脈旁路移植術后、開放橋血管后 ST 段可以逐漸恢復正常，右心功能恢復，心律失常明顯減少或消失。2 例患者右冠狀動脈旁路移植后仍有右心功能不全表現，但經積極藥物處理以及主動脈內球囊反搏（IABP）應用后逐步脫離危險期。1 例患者術后循環仍不穩定，最終于術后 2 d 死亡。總死亡率 4.5%。發生圍術期心肌梗死 6 例，全組患者 IABP 應用 3 例。結論 OPCAB 術中右冠狀動脈突發缺血事件更多表現為心律失常，發生率雖低，但在無雜交手術室的情況下能夠及時判斷并正確處理右冠狀動脈突發急性缺血事件至關重要，對患者術后及預后都有較積極的影響。

Citation： 楊文鋼, 薛松, 黃日太, 連鋒, 徐根興. 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. 喬樹賓. 主編. 心血管介入治療高級培訓教程. 北京: 人民衛生出版社, 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, 主編. 內科學. 北京: 人民衛生出版社, 2013. 159.
8. 楊有東, 孟澤軍, 顧成圻. IVUS 和 FFR 在冠狀動脈臨界病變治療中的應用價值. 中西醫結合心腦血管病雜志, 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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