Calafiore Antonio M, Di Giammarco Gabriele, Teodori Giovanni, Iacò Angela L, Pano Marco, Contini Marco, Vitolla Giuseppe, Di Mauro Michele
Division of Cardiac Surgery, University Hospital, Torino, Italy.
J Thorac Cardiovasc Surg. 2005 Aug;130(2):340-5. doi: 10.1016/j.jtcvs.2004.11.053.
We sought to evaluate whether early and late results in patients who underwent off-pump or on-pump myocardial revascularization with bilateral internal thoracic artery grafting were similar.
From November 1994 through December 2001, 1835 patients underwent isolated myocardial revascularization with bilateral internal thoracic artery grafting. By applying propensity score pairwise matching, 1194 patients were selected and operated on either off pump (n = 597) or on pump (n = 597).
The overall 30-day mortality was 1.5% (1.2% in the off-pump group and 1.8% in the on-pump group, P = .342). There was no difference for all the other complications between the 2 groups. Mean follow-up was 5.2 +/- 1.8 years. Forty-two patients died over the follow-up period (22 in the off-pump group and 20 in the on-pump group), 15 of them of cardiac causes (7 in the off-pump group and 8 in the on-pump group). Six-year outcomes (freedom from death, cardiac death, acute myocardial infarction and reoperation in all or in the grafted area, target cardiac events, and any other event) were similar for both categories. After a mean of 30.7 +/- 20.1 months, 202 patients had a postoperative angiography showing similar results.
Our results with extensive arterial revascularization clearly show that with the technical improvements achieved in the most recent years, off-pump operations can be performed safely with the same quality of late results as those obtained with on-pump operations.
我们试图评估接受非体外循环或体外循环下双侧胸廓内动脉移植心肌血运重建术的患者的早期和晚期结果是否相似。
从1994年11月至2001年12月，1835例患者接受了双侧胸廓内动脉移植的单纯心肌血运重建术。通过倾向评分配对匹配，选择了1194例患者，分别接受非体外循环手术（n = 597）或体外循环手术（n = 597）。
总的30天死亡率为1.5%（非体外循环组为1.2%，体外循环组为1.8%，P = 0.342）。两组间所有其他并发症无差异。平均随访时间为5.2±1.8年。随访期间有42例患者死亡（非体外循环组22例，体外循环组20例），其中15例死于心脏原因（非体外循环组7例，体外循环组8例）。两类患者的六年结局（全因死亡、心源性死亡、急性心肌梗死以及全部或移植区域再手术、目标心脏事件和任何其他事件的发生率）相似。平均30.7±20.1个月后，202例患者进行了术后血管造影，结果相似。
我们广泛动脉血运重建的结果清楚地表明，随着近年来技术的改进，非体外循环手术可以安全地进行，晚期结果与体外循环手术相同。
