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目的 探讨冠脉搭桥术中更改术式对心脏不停跳冠脉搭桥术死亡率的影响以及术中更改术式的发生率和危险因素.方法 接受冠脉搭桥的患者207例,根据术中是否更改术式分为二组,术中未更改术式191例,更改术式16例.分析冠脉搭桥术中更改术式对心脏不停跳冠脉搭桥术死亡率的影响,以及术中更改术式的发生率和危险因素.结果 术中更改术式组死亡率为25.0%,未更改术式组为1.0%,术中更改术式最常见的原因是在钝缘支搭桥时出现血流动力学紊乱.多元Logistic回归分析显示,左主干病变、二尖瓣返流、高EuroSCORE Ⅱ评分是术中更改术式的独立危险因素.结论 冠脉搭桥术中更改术式是心脏不停跳冠脉搭桥术死亡率增高的独立危险因素.识别术中术式更改的高危人群有助于改善预后.“,”Objective To analyze the incidence,risk factors,and impact of intraoperative conversion on the mortality in patients undergoing off-pump coronary artery bypass grafting.Methods This retrospective observational study included 207 patients undergoing off-pump coronary artery bypass grafting.According to whether intraoperative conversion,207 patients were randomly divided into intraoperative unchanged group(191 cases)and intraoperative changed group(16 cases).The incidence,patient characteristics,cause of intraoperative conversion,and its impact on outcome were studied.Results Intraoperative conversion increases odds for mortality to 25.0%,while the other group was 1.0%.The most common cause for intraoperative conversion was hemodynamic disturbances during grafting to the obtuse marginal artery.On multivariate logistic regression analysis,left main disease,mitral regurgitation and higher EuroSCORE II independently predicted intraoperative conversion.Conclusion Intraoperative conversion to on-pump coronary artery bypass grafting is independently associated with higher mortality in patients undergoing off-pump coronary artery bypass grafting.Identification of high risk group of intraoperative conversion may improve the outcome.