Uva Miguel Sousa, Rodrigues Vanessa, Monteiro Nuno, Pereira Florbela, Bervens Dirk, Caria Rui, Mesquita Armindo, Pedro Albino, Bau José, Matias Fernando, Magalhães Manuel Pedro
Departamento da Circulação Hospital da Cruz Vermelha, Lisboa.
Rev Port Cardiol. 2004 Apr;23(4):517-30.
To compare 4 methods of myocardial protection in GABG in terms of markers of myocardial ischemia, mortality, morbidity and mid-term results.
MATERIAL & METHODS: Retrospective study of 241 consecutive patients undergoing isolated > 1 CABG using one of 4 methods: off-pump (OFF, n = 108), cardiopulmonary bypass (CPB) and cardioplegia (CARD, n = 66), CPB and beating heart (BEAT, n = 47), or CPB and ventricular fibrillation (FIBR, n = 20). Mean age was 65.7 +/- 9.3 years and mean EuroSCORE was 3.2 +/- 2.3. The groups were similar in terms of age, gender distribution, body mass index, incidence of smoking, hypertension, renal insufficiency, CCS class, ventricular function and mean EuroSCORE. Serial blood samples were collected for CK-MB and troponin T, preoperatively and 1, 6, 12 and 24 hours after the procedure.
Mean number of distal anastomoses was 3.27 BEAT, 2.98 CARD, 2.90 FIBR and 2.55 OFF (p < 0.05 OFF vs. the other 3 groups). Six patients died in hospital (2.5%), 2/47 BEAT (4.2%), 1/66 CARD (1.5%), 1/20 FIBR (5.0%), 2/108 (1.9% OFF) (p = 0.1). The incidence of atrial fibrillation, stroke/TIA and blood transfusion and length of stay were similar between groups (p = 0.1) but there was a tendency for increased incidence of Q-wave MI (p = 0.08) in OFF and combined adverse events in FIBR (p = 0.07). At 12 hours postoperatively, CK-MB and troponin T were significantly higher in FIBR than in CARD or OFF (p < 0.05) and at 24 hours, troponin T remained higher in FIBR than in all other groups (p < 0.05). After a mean follow-up of 19 months, no significant difference was observed between groups in mortality or relief of angina.
We were unable to demonstrate the superiority of any one revascularization method over another in terms of mortality, morbidity or length of stay. As shown by lower levels of myocardial markers of ischemia, better myocardial protection was obtained with OFF, BEAT and CARD compared to FIBR. Mid-term survival and relief of angina were similar between groups.
通过心肌缺血标志物、死亡率、发病率及中期结果，比较冠状动脉旁路移植术（CABG）中4种心肌保护方法。
对241例连续接受单支以上冠状动脉旁路移植术的患者进行回顾性研究，采用4种方法之一：非体外循环（OFF，n = 108）、体外循环（CPB）加心脏停搏（CARD，n = 66）、体外循环加心脏跳动（BEAT，n = 47）或体外循环加心室颤动（FIBR，n = 20）。平均年龄为65.7±9.3岁，平均欧洲心脏手术风险评估系统（EuroSCORE）评分为3.2±2.3。各组在年龄、性别分布、体重指数、吸烟率、高血压、肾功能不全、加拿大心血管学会（CCS）分级、心室功能及平均EuroSCORE方面相似。术前及术后1、6、12和24小时采集系列血样检测肌酸激酶同工酶（CK-MB）和肌钙蛋白T。
远端吻合口的平均数量在BEAT组为3.27个，CARD组为2.98个，FIBR组为2.90个，OFF组为2.55个（OFF组与其他3组比较，p < 0.05）。6例患者在医院死亡（2.5%），BEAT组47例中有2例（4.2%），CARD组66例中有1例（1.5%），FIBR组20例中有1例（5.0%），OFF组108例中有2例（1.9%）（p = 0.1）。各组间房颤、中风/短暂性脑缺血发作（TIA）、输血发生率及住院时间相似（p = 0.1），但OFF组Q波心肌梗死（MI）发生率有增加趋势（p = 0.08），FIBR组合并不良事件发生率有增加趋势（p = 0.07）。术后12小时，FIBR组的CK-MB和肌钙蛋白T显著高于CARD组或OFF组（p < 0.05），术后24小时，FIBR组的肌钙蛋白T仍高于所有其他组（p < 0.05）。平均随访19个月后，各组间在死亡率或心绞痛缓解方面未观察到显著差异。
在死亡率、发病率或住院时间方面，我们未能证明任何一种血运重建方法优于其他方法。与FIBR组相比，OFF组、BEAT组和CARD组缺血心肌标志物水平较低，提示心肌保护更好。各组间中期生存率和心绞痛缓解情况相似。
