非体外循环与体外循环冠状动脉旁路移植术的中期结果比较。

Comparison of off-pump and on-pump coronary artery bypass grafting in midterm results.

作者信息

Ishida Michiko, Kobayashi Junjiro, Tagusari Osamu, Bando Ko, Niwaya Kazuo, Nakajima Hiroyuki, Fukushima Satsuki, Kitamura Soichiro

机构信息

Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan.

出版信息

Jpn J Thorac Cardiovasc Surg. 2004 May;52(5):240-6. doi: 10.1007/s11748-004-0117-9.

DOI:10.1007/s11748-004-0117-9

PMID:15195746

Abstract

OBJECTIVE

Off-pump coronary artery bypass grafting (OPCAB) has become a procedure of choice for surgical treatment of coronary artery disease. Although early advantages of OPCAB were confirmed in comparison with conventional on-pump coronary artery bypass grafting (CABG), late cardiac complications are still controversial. We examined midterm results of OPCAB compared with standard CABG.

METHODS

Between July 1997 and April 2002, 736 consecutive patients who underwent isolated CABG were retrospectively reviewed. The OPCAB group (Group I) comprised 357 patients (49%), and the on-pump CABG group (Group II) 379 patients (51%). Their preoperative, intraoperative, and follow-up data were analyzed.

RESULTS

The mean number of distal anastomoses and the early graft patency were not greatly different between the two groups. The actuarial survival rate at 3 years was not significantly different between Group I (98.3%) and Group II (98.2%) (p = 0.71). The frequency of cardiac events was 4.2%/patient-year in Group I and 2.6%/patient-year in Group II (p = 0.12). The actuarial event free rates were not different between the two groups (p = 0.61). The cardiac event free rates at 3 years were significantly (p = 0.011) higher in patients with complete revascularization (96.7%) than without complete revascularization in Group I (69.2%) and in Group II (92.7% versus 85.9%, p = 0.026).

CONCLUSIONS

Midterm clinical outcome in OPCAB is as good as conventional on-pump CABG. Incomplete revascularization caused cardiac events more frequently than complete revascularization both in OPCAB and on-pump CABG in the intermediate follow-up.

摘要

目的

非体外循环冠状动脉搭桥术（OPCAB）已成为冠状动脉疾病外科治疗的首选术式。尽管与传统的体外循环冠状动脉搭桥术（CABG）相比，OPCAB的早期优势已得到证实，但其晚期心脏并发症仍存在争议。我们比较了OPCAB与标准CABG的中期结果。

方法

回顾性分析1997年7月至2002年4月间连续接受单纯CABG的736例患者。OPCAB组（I组）357例患者（49%），体外循环CABG组（II组）379例患者（51%）。分析其术前、术中和随访数据。

结果

两组间远端吻合口的平均数量及早期移植血管通畅率差异不大。I组3年实际生存率为98.3%，II组为98.2%，差异无统计学意义（p = 0.71）。I组心脏事件发生率为4.2%/患者年，II组为2.6%/患者年（p = 0.12）。两组无事件实际发生率差异无统计学意义（p = 0.61）。完全血运重建患者的3年无心脏事件发生率在I组显著高于未完全血运重建患者（96.7% 对69.2%，p = 0.011），在II组也显著高于未完全血运重建患者（92.7% 对85.9%，p = 0.026）。