Al-Ruzzeh Sharif, George Shane, Bustami Mahmoud, Wray Jo, Ilsley Charles, Athanasiou Thanos, Amrani Mohamed
National Heart and Lung Institute, Imperial College of Science, Technology, and Medicine, Harefield Hospital, Middlesex UB9 6JH.
BMJ. 2006 Jun 10;332(7554):1365. doi: 10.1136/bmj.38852.479907.7C. Epub 2006 Jun 1.
To compare the clinical, angiographic, neurocognitive, and quality of life outcomes of off-pump coronary artery bypass surgery with conventional coronary artery bypass grafting surgery using cardiopulmonary bypass.
Randomised controlled clinical trial.
Tertiary cardiothoracic centre in Middlesex, England.
168 patients (27 women) requiring primary isolated coronary artery bypass grafting surgery.
Patients were randomised to conventional coronary artery bypass grafting surgery using cardiopulmonary bypass (n = 84) or off-pump coronary artery bypass surgery (n = 84), carried out by one surgeon. Angiographic examination was carried out at three months postoperatively. Neurocognitive tests were carried out at baseline and at six weeks and six months postoperatively.
Clinical outcome, graft patency at three months, neurocognitive function at six weeks and six months, and health related quality of life.
Graft patency was evaluated by angiography in 151 (89.9%) patients and was similar between the cardiopulmonary bypass and off-pump groups (risk difference - 1%, 95% confidence interval - 5% to 4%), with the off-pump group considered the treatment group. Patients in the off-pump group required fewer blood transfusions (1.7 units v 1.0 unit, P = 0.02), shorter duration of mechanical ventilation (7.7 hours v 3.9 hours, P = 0.03), and shorter hospital stay (10.8 days v 8.9 days). Scores for neurocognitive function showed a significant difference in three memory subtests at six weeks and two memory subtests at six months in favour of the off-pump group.
Patients who underwent off-pump coronary artery bypass surgery showed similar patency of grafts, better clinical outcome, shorter hospital stay, and better neurocognitive function than patients who underwent conventional coronary artery bypass grafting surgery using cardiopulmonary bypass.
比较非体外循环冠状动脉搭桥手术与使用体外循环的传统冠状动脉搭桥手术在临床、血管造影、神经认知及生活质量方面的结果。
随机对照临床试验。
英国米德尔塞克斯郡的三级心胸中心。
168例（27名女性）需要进行初次单纯冠状动脉搭桥手术的患者。
患者被随机分为使用体外循环的传统冠状动脉搭桥手术组（n = 84）或非体外循环冠状动脉搭桥手术组（n = 84），均由一名外科医生实施手术。术后三个月进行血管造影检查。在基线、术后六周和六个月进行神经认知测试。
临床结果、术后三个月移植血管通畅情况、术后六周和六个月的神经认知功能以及健康相关生活质量。
151例（89.9%）患者通过血管造影评估了移植血管通畅情况，体外循环组和非体外循环组相似（风险差异 -1%，95%置信区间 -5%至4%），非体外循环组被视为治疗组。非体外循环组患者输血较少（1.7单位对1.0单位，P = 0.02），机械通气时间较短（7.7小时对3.9小时，P = 0.03），住院时间较短（10.8天对8.9天）。神经认知功能评分显示，术后六周时三个记忆子测试以及术后六个月时两个记忆子测试存在显著差异，非体外循环组表现更优。
与接受使用体外循环的传统冠状动脉搭桥手术的患者相比，接受非体外循环冠状动脉搭桥手术的患者移植血管通畅情况相似，但临床结果更好、住院时间更短且神经认知功能更佳。
