Ascione R, Iannelli G, Lim K H, Imura H, Spampinato N
Department of Cardiovascular Surgery, University Federico II of Naples, Italy.
Ann Thorac Surg. 2001 Sep;72(3):768-74; discussion 775. doi: 10.1016/s0003-4975(01)02798-9.
The aim of this study was to compare hospital, early, and late clinical outcomes for patients undergoing one-stage, coronary and abdominal aortic surgical intervention with and without cardiopulmonary bypass.
From March 1990 to September 1999, 42 consecutive patients underwent combined operations at a single institution. Cardiopulmonary bypass and cardioplegic arrest were used during coronary revascularization in the first 20 patients (on-pump group), and the next 22 patients received the one-stage operations on the beating heart (off-pump group).
Baseline characteristics were similar between groups. Three cardiac-related hospital deaths occurred in the on-pump group and one such death in the off-pump group (p = 0.25). Cardiac-related events, pulmonary complications, inotropic support, blood loss and transfusion requirements, intensive care unit stay, and hospital stay were significantly reduced in the off-pump group (all, p < 0.05). The actuarial survival rates in the on-pump and off-pump groups were 80% and 95%, respectively, at 1 year (p = 0.13) and 75% and 89%, respectively, at 3 years (p = 0.22). Freedom from cardiac-related events at 1-year follow-up was 91% in the off-pump group and 65% in the on-pump group (p < 0.05). No difference in cardiac-related events between groups was observed at 3 years.
Off-pump coronary surgical procedures decrease postoperative complications in high-risk patients undergoing simultaneous coronary and abdominal aortic operations compared with the conventional one-stage procedure. The early benefits achieved with off-pump surgical intervention are not at the expense of the long-term clinical outcome.
本研究旨在比较接受一期冠状动脉和腹主动脉手术干预且使用或不使用体外循环的患者的院内、早期和晚期临床结局。
1990年3月至1999年9月，42例连续患者在同一机构接受联合手术。前20例患者在冠状动脉血运重建期间使用体外循环和心脏停搏（体外循环组），后22例患者在心脏跳动下接受一期手术（非体外循环组）。
两组间基线特征相似。体外循环组发生3例与心脏相关的院内死亡，非体外循环组发生1例此类死亡（p = 0.25）。非体外循环组的心脏相关事件、肺部并发症、血管活性药物支持、失血量和输血需求、重症监护病房停留时间和住院时间均显著减少（均p < 0.05）。体外循环组和非体外循环组1年时的精算生存率分别为80%和95%（p = 0.13），3年时分别为75%和89%（p = 0.22）。非体外循环组1年随访时无心脏相关事件的比例为91%，体外循环组为65%（p < 0.05）。3年时两组间未观察到心脏相关事件的差异。
与传统的一期手术相比，非体外循环冠状动脉手术可降低同时接受冠状动脉和腹主动脉手术的高危患者的术后并发症。非体外循环手术干预所取得的早期益处并不会以长期临床结局为代价。
