Amano A, Hirose H, Takahashi A, Nagano N
Department of Cardiovascular Surgery, Shin-Tokyo Hospital, 473-1 Nemoto, Matsudo City, Chiba 271-0077, Japan.
Jpn J Thorac Cardiovasc Surg. 2001 Jan;49(1):67-78. doi: 10.1007/BF02913127.
Off-pump coronary artery bypass grafting (CABG) on the beating heart has become popular procedure in cardiac surgery and its initial results appeared favorable. We report our early and mid-term results of off-pump CABG performed at Shin-Tokyo Hospital.
Medical records of patients undergoing off-pump or conventional on-pump CABG from September 1, 1996, to August 31, 1999 were retrospectively reviewed. Patients underwent off-pump CABG were further classified into 2 groups; MIDCAB (Off-pump CABG for single vessel revascularization via a small skin incision) and OPCAB (off-pump CABG mainly approached via midline sternotomy) group. Their preoperative, perioperative, and follow-up data were collected and analyzed.
Among a total of 995 cases of CABG, 194 cases were off-pump CABG (male/female 142/52, mean age 66.9). The mean number of distal anastomoses in off-pump CABG was 1.9 +/- 0.9 (1.0 +/- 0.0 in MIDCAB and 2.3 +/- 0.7 in OPCAB), which was significantly fewer than in on-pump CABG (3.6 +/- 1.1), with p < 0.0001. Intubation time (5.3 +/- 5.7 hours in off-pump CABG vs 13.1 +/- 24.2 hours in on-pump CABG), ICU stay (1.7 +/- 1.1 vs 3.2 +/- 3.0 days), and postoperative hospital stay (14.0 +/- 7.9 vs 18.1 +/- 12.1 days) in off-pump CABG were significantly shorter than in on-pump CABG (p < 0.0001). In the off-pump CABG group, there were no in-hospital deaths and 14 major complications, fewer than in on-pump CABG (8 hospital deaths and 114 major complications). Postoperative angiography before hospital discharge was conducted in 80 patients (41.2%) and showed 2 occlusions, giving a graft patency rate of 98.6% in the off-pump group. During follow-up (0.9 +/- 0.6 year) period, there were 5 non-cardiac deaths and 20 cardiac events in the off-pump group. The actuarial survival rate at 36 months was 94.6% for off-pump CABG, showing no significant difference from the rate for conventional CABG patients (95.2% at 36 month, p = NS) The event-free rate was 84.0% at 36 months in off-pump CABG patients; however, which was less favorable than on-pump CABG patients (88.0% at 36 months, p < 0.05).
Both in-hospital and mid-term results for off-pump CABG patients were acceptable. Isolated CABG can thus be safely performed without cardiopulmonary bypass. Advances in coronary stabilization have contributed to these improved results. The observed long-term cardiac events may be related to incomplete revascularization.
非体外循环冠状动脉旁路移植术（CABG），即心脏跳动下的冠状动脉搭桥手术，已成为心脏外科中一种常用的手术方式，其初期效果似乎良好。我们报告在新东京医院进行的非体外循环CABG的早期和中期结果。
回顾性分析1996年9月1日至1999年8月31日期间接受非体外循环或传统体外循环CABG患者的病历。接受非体外循环CABG的患者进一步分为两组；微创直接冠状动脉搭桥术（MIDCAB，即通过小切口皮肤进行单支血管血运重建的非体外循环CABG）和非体外循环冠状动脉搭桥术（OPCAB，主要通过正中胸骨切开术进行的非体外循环CABG）组。收集并分析他们的术前、围手术期和随访数据。
在总共995例CABG病例中，194例为非体外循环CABG（男/女142/52，平均年龄66.9岁）。非体外循环CABG的远端吻合平均数量为1.9±0.9（MIDCAB为1.0±0.0，OPCAB为2.3±0.7），明显少于体外循环CABG（3.6±1.1），p<0.0001。非体外循环CABG的插管时间（5.3±5.7小时，而体外循环CABG为13.1±24.2小时）、重症监护病房停留时间（1.7±1.1天对3.2±3.0天）和术后住院时间（14.0±7.9天对18.1±12.1天）均明显短于体外循环CABG（p<0.0001）。在非体外循环CABG组中，无院内死亡病例，有14例主要并发症，少于体外循环CABG（8例院内死亡和114例主要并发症）。80例患者（41.2%）在出院前进行了术后血管造影，结果显示2例闭塞，非体外循环组的移植血管通畅率为98.6%。在随访（0.9±0.6年）期间，非体外循环组有5例非心脏死亡和20例心脏事件。非体外循环CABG在36个月时的精算生存率为94.6%，与传统CABG患者的生存率（36个月时为95.2%，p=无显著性差异）无显著差异。非体外循环CABG患者在36个月时的无事件发生率为84.0%；然而，这比体外循环CABG患者（36个月时为88.0%，p<0.05）要差。
非体外循环CABG患者的院内和中期结果均可接受。因此，单纯CABG可以在不进行心肺转流的情况下安全进行。冠状动脉稳定技术的进步促成了这些改善的结果。观察到的长期心脏事件可能与血运重建不完全有关。
