Moore Graham J, Pfister Albert, Trachiotis Gregory D
Department of Surgery, George Washington University and Veterans Affairs Medical Centers, USA.
Heart Surg Forum. 2005;8(1):E19-22. doi: 10.1532/HSF98.20041148.
The outcomes of off-pump coronary artery bypass (OPCAB) and conventional coronary artery bypass grafting with cardiopulmonary bypass (cCABG) have been compared in detail. Similarly, several reports have examined outcomes of high-risk subsets of patients in OPCAB as a selection strategy for reducing morbidity and mortality compared to cCABG. We undertook a retrospective study comparing outcomes from the early years in our experience of beating-heart surgery in high-risk patients selected for OPCAB compared to low-risk patients having OPCAB. This study was premised on strict selection criteria in an era prior to stabilizing devices and cardiac positioners.
A total of 384 patients underwent OPCAB over a 10-year period. Clinical outcomes were compared for 280 low-risk patients and 104 high-risk patients (redo CABG, CABG with simultaneous carotid endarterectomy, or renal insufficiency/failure).
The high-risk group patients were significantly older than the low-risk group patients (64.3 +/- 10.5 years versus 61.5 +/- 11.7 years, respectively, P = .048). The high-risk group also had a greater degree of left ventricular dysfunction (P < .001), a higher incidence of diabetes (P = .046), and a higher proportion of patients with peripheral vascular disease (P = .009). There was no significant difference in the number of grafts created, but there was a statistical difference in the type of graft used. The high-risk group received fewer internal thoracic artery grafts (P = .005) and more saphenous vein grafts (P = .041). The high-risk group had slightly prolonged median lengths of stay in the intensive care unit (2.2 versus 1.4 days, P < .001) and hospital (11 versus 8 days, P < .001) and a higher proportion of patients requiring blood transfusions (48% versus 24%, P < .001), yet there was no significant difference in major adverse outcomes.
In this retrospective and historical review, OPCAB was found to be equally safe in carefully selected high- and low-risk patients. These results provided for the enthusiasm and innovation to expand the usage of OPCAB in patients with coronary artery disease.
非体外循环冠状动脉搭桥术（OPCAB）与传统体外循环冠状动脉搭桥术（cCABG）的结果已得到详细比较。同样，有几份报告研究了OPCAB中高危亚组患者的结果，作为与cCABG相比降低发病率和死亡率的一种选择策略。我们进行了一项回顾性研究，比较了我们在为OPCAB选择的高危患者与低危患者的心脏跳动手术早期经验中的结果。这项研究基于在稳定装置和心脏定位器出现之前的时代的严格选择标准。
在10年期间，共有384例患者接受了OPCAB。比较了280例低危患者和104例高危患者（再次冠状动脉搭桥术、同期颈动脉内膜切除术的冠状动脉搭桥术或肾功能不全/衰竭）的临床结果。
高危组患者比低危组患者年龄显著更大（分别为64.3±10.5岁和61.5±11.7岁，P = 0.048）。高危组还存在更严重的左心室功能障碍（P < 0.001）、更高的糖尿病发病率（P = 0.046）以及更高比例的外周血管疾病患者（P = 0.009）。所搭建的移植血管数量没有显著差异，但所使用的移植血管类型存在统计学差异。高危组接受的胸廓内动脉移植血管较少（P = 0.005），大隐静脉移植血管较多（P = 0.041）。高危组在重症监护病房（2.2天对1.4天，P < 0.001）和医院（11天对8天，P < 0.001）的中位住院时间略有延长，且需要输血治疗的患者比例更高（48%对24%，P < 0.001），但主要不良结局没有显著差异。
在这项回顾性和历史性综述中，发现OPCAB在精心挑选的高危和低危患者中同样安全。这些结果为在冠状动脉疾病患者中扩大OPCAB的应用提供了热情和创新依据。
