单支或双支血管病变低危患者非体外循环与体外循环下心肌血运重建：一项多中心随机对照试验的围手术期结果
Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial.
作者信息
Gerola Luís Roberto, Buffolo Enio, Jasbik Waldir, Botelho Bruno, Bosco João, Brasil Luís A, Branco João Nelson R
机构信息
Division of Cardiovascular Surgery, Department of Surgery, Federal University of São Paulo Brasil, Sao Paolo, Brazil.
出版信息
Ann Thorac Surg. 2004 Feb;77(2):569-73. doi: 10.1016/S0003-4975(03)01353-5.
BACKGROUND
To evaluate hospital mortality and morbidity after myocardial revascularization in a prospective and multicenter study, comparing on-pump versus off-pump in a special subset of patients with lesions in the left descending artery, alone or associated with the right coronary artery.
METHODS
A multicenter prospective randomized study was performed. One hundred and sixty selected low-risk patients were enrolled; 80 patients were operated on-pump (coronary artery bypass grafting [CABG], group I) and 80 patients were operated off-pump (off-pump coronary artery bypass [OPCAB], group II). One hundred and five were male and ages ranged from 39 to 70 years old; mean 58.81 +/- 9.31 and median 59. Preoperative clinical characteristics were similar in both groups; only previous myocardial infarction was higher in the OPCAB group. Patients with severe left ventricular dysfunction (FE </= 35%), renal failure and lesions of the circumflex artery and its branches were excluded, as well as patients with significant comorbidities that were inappropriate for randomization because we selected them for OPCAB procedures.
RESULTS
Hospital mortality was 2.5%, three patients (3.7%) in group I (on-pump) and one patient (1.2%) in group II (off-pump) (ns). The number of grafts per patients in group I was 1.81 +/- 0.6, and 1.77 +/- 0.68 in group II (p = 0.833). There was no difference in the total operation time 205.10 +/- 54.30 minutes in group I and 189.50 +/- 55.44 in group II (ns). Six patients (7.5%) had myocardial infarction in group I and three (3.7%) in group II (ns). Bleeding in the postoperative period was 680.50 +/- 434.1 mL in the on-pump group and 678.6 +/- 357.0 mL in the off-pump group (ns). Three patients (3.7%) presented transient neurologic dysfunction in group I and six patients (7.5%) in group II (ns). Intensive care stay was 2.4 +/- 1.0 days in the CABG and 2.3 +/- 0.98 days in the OPCAB group (ns).
CONCLUSIONS
We did not find any statistical difference in hospital mortality and morbidity using on-pump or off-pump techniques for low-risk patients.
背景
在一项前瞻性多中心研究中，评估左前降支单独或合并右冠状动脉病变的特定患者亚组中行心肌血运重建术后的医院死亡率和发病率，比较体外循环与非体外循环手术。
方法
进行了一项多中心前瞻性随机研究。入选160例低风险患者；80例患者接受体外循环手术（冠状动脉旁路移植术[CABG]，I组），80例患者接受非体外循环手术（非体外循环冠状动脉旁路移植术[OPCAB]，II组）。105例为男性，年龄在39至70岁之间；平均58.81±9.31岁，中位数59岁。两组术前临床特征相似；仅OPCAB组既往心肌梗死发生率较高。排除严重左心室功能不全（射血分数≤35%）、肾衰竭、回旋支及其分支病变患者，以及因选择OPCAB手术而存在不适合随机分组的显著合并症患者。
结果
医院死亡率为2.5%，I组（体外循环）3例（3.7%），II组（非体外循环）1例（1.2%）（无统计学差异）。I组患者人均移植血管数为1.81±0.6，II组为1.77±0.68（p = 0.833）。I组总手术时间为205.10±54.30分钟，II组为189.50±55.44分钟，无差异（无统计学差异）。I组6例（7.5%）发生心肌梗死，II组3例（3.7%）（无统计学差异）。体外循环组术后出血量为680.50±434.1 mL，非体外循环组为678.6±357.0 mL（无统计学差异）。I组3例（3.7%）出现短暂性神经功能障碍，II组6例（7.5%）（无统计学差异）。CABG组重症监护病房停留时间为2.4±1.0天，OPCAB组为2.3±0.98天（无统计学差异）。
结论
对于低风险患者，使用体外循环或非体外循环技术在医院死亡率和发病率方面未发现任何统计学差异。
Zotero 插件