Discussion On The Factors Of Beating Heart Coronary-artery Bypass Grafting

Objective:To explore the factors affecting the operation of coronary artery bypass grafting and improve the effect of the operation.Methods:From January 2012 to June 2016,898 patients with coronary heart disease who received cardiovascular surgery in the Second Affiliated Hospital of Jilin University were analyzed retrospectively.All patients underwent coronary artery bypass grafting only.All patients were cabled under beating heart.The off-pump coronary artery bypass grafting(off-pump coronary-artery bypass grafting,OPCABG)group concluded 797 cases;Another 101 cases were beating heart coronary artery bypass grafting(on-pump beating heart coronary-artery bypass grafting,OPBH)group.Operation method: After heparin(1mg/kg,3mg/kg,in OPBH),we used apical fixation and myocardial fixator to keep the heart and the location of the myocardium,anastomosis of the internal mammary artery with the anterior descending branch at first,and then we performed the bypasses: Great saphenous vein-RCA-LCX-Diagonal branch in sequential method.Results:The average number of bypasses in group OPCABG were 3.36±0.74.And the group OPBH were 3.71±0.69,and there was no significant difference between them.The postoperative ventilator ventilation time,ICU time,hospitalization time,mortality,the utilization rate of IABP and ECMO were significantly different.The total mortality of all 898 cases was 1.68%(12 cases),and the total bloodless operation ratio was 91.3%.Conclusion:The results showed that most patients achieved good results with the help of apical fixation and myocardial fixator,surgical techniques and methods,good anesthesia management,flexible and accurate use of vasoactive drugs.But extracorporeal circuIation are necessary in the cases of large left ventricle,low EF and hypotension after moving heart.