Puskas J D, Wright C E, Ronson R S, Brown W M, Gott J P, Guyton R A
Carlyle Fraser Heart Center, Crawford Long Hospital of Emory University, Atlanta, Georgia 30365, USA.
Heart Surg Forum. 1999;2(3):216-21.
This study compared clinical outcomes, length of stay, and hospital costs in patients having off-pump coronary bypass (OPCAB) versus conventional bypass surgery (CABG).
From November 1996 through April 9, 1999, OPCAB was performed for 125 consecutive patients and compared with a contemporaneous, matched control group of 625 CABG patients. Patients were matched according to age, gender, incidence of renal failure, diabetes, pulmonary disease, stroke (CVA), hypertension, peripheral vascular disease, and previous myocardial infarction. Follow-up in the OPCAB patients was 100% and averaged 15 months.
An average of 2.0 grafts per patient were performed in the OPCAB group (range 1-5). Ninety-four OPCAB patients (75.2%) had a total of 179 grafts assessed angiographically prior to hospital discharge. All but 4/179 grafts (2.2%) were patent, including 94 of 94 IMA grafts (100%). There were no in-hospital deaths in the OPCAB group compared to a mortality rate of 1.4% in the CABG group. OPCAB reduced postoperative hospital stay from 5.5 days in the traditional CABG group to 3.3 days (p=.002), with a decrease in hospital cost of 24% (p = .01). In addition, there was a significant reduction in the rate of transfusion in the OPCAB group (29.6%) compared to the CABG group (56.5%, p = .0001). Two OPCAB patients required postoperative intervention to improve graft patency during the follow-up period. No internal mammary grafts required revision. There was one perioperative CVA and one myocardial infarction in the OPCAB group.
OPCAB surgery reduces hospital cost, postoperative length of stay, and transfusion rate compared to CABG. OPCAB is safe, cost effective, and associated with excellent graft patency and clinical outcomes.
本研究比较了非体外循环冠状动脉搭桥术（OPCAB）与传统冠状动脉搭桥术（CABG）患者的临床结局、住院时间和住院费用。
从1996年11月至1999年4月9日，连续对125例患者实施OPCAB，并与同期625例CABG患者的匹配对照组进行比较。患者根据年龄、性别、肾衰竭、糖尿病、肺部疾病、中风（CVA）、高血压、外周血管疾病和既往心肌梗死的发生率进行匹配。OPCAB患者的随访率为100%，平均随访时间为15个月。
OPCAB组患者平均每人进行2.0次搭桥手术（范围为1 - 5次）。94例OPCAB患者（75.2%）在出院前接受了179次搭桥手术的血管造影评估。除179次搭桥手术中的4次（2.2%）外，其余均通畅，包括94次IMA搭桥手术中的94次（100%）。OPCAB组无院内死亡，而CABG组的死亡率为1.4%。OPCAB将术后住院时间从传统CABG组的5.5天缩短至3.3天（p = .002），住院费用降低了24%（p = .01）。此外，OPCAB组的输血率（29.6%）与CABG组（56.5%，p = .0001）相比显著降低。2例OPCAB患者在随访期间需要术后干预以改善搭桥通畅情况。没有需要翻修的胸廓内动脉搭桥。OPCAB组有1例围手术期CVA和1例心肌梗死。
与CABG相比，OPCAB手术降低了住院费用、术后住院时间和输血率。OPCAB安全、具有成本效益，且搭桥通畅情况良好，临床结局优良。
