高危患者（欧洲心脏手术风险评估系统评分≥6）的非体外循环与体外循环冠状动脉搭桥手术

Off-pump versus on-pump coronary artery bypass surgery in high-risk patients (EuroSCORE >/= 6).

作者信息

Lahtinen J, Biancari F, Rimpiläinen J, Kytökorpi R, Mosorin M, Rainio P, Cresti R, Juvonen T, Lepojärvi M

机构信息

Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Oulu University Hospital, Oulu, Finland.

出版信息

Thorac Cardiovasc Surg. 2007 Feb;55(1):13-8. doi: 10.1055/s-2006-924484.

DOI:10.1055/s-2006-924484

PMID:17285468

Abstract

OBJECTIVE

The aim of this study was to review the results of off-pump (OPCAB) versus conventional on-pump coronary artery bypass surgery (CCAB) in high-risk patients.

METHODS

In a cohort of patients with an additive EuroSCORE >/= 6, 67 underwent OPCAB and 112 underwent CCAB.

RESULTS

Thirty-day postoperative death and stroke rates were 7.5 % and 6.0 % for the OPCAB group, and 5.4 % ( P = 0.75) and 8.0 % ( P = 0.77) for the CCAB group, respectively. No significant differences were observed for other major outcome endpoints other than cardiac troponin I (OPCAB: 117 +/- 428 ng/ml vs. CCAB: 58 +/- 99 ng/ml, P = 0.028), a result which was probably due to preoperative massive myocardial infarction in two very high-risk patients who underwent OPCAB. A similar outcome was also observed among propensity score-matched pairs. Congestive heart failure ( P = 0.006, OR: 6.366, 95 % CI: 1.682 - 24.093) and baseline cardiac index ( P = 0.018, OR: 0.171, 95 % CI: 0.040 - 0.735) were independent predictors of 30-day postoperative mortality.

CONCLUSIONS

OPCAB can be safely performed in high-risk patients with results as satisfactory as those achieved with CCAB.

摘要

目的

本研究旨在回顾高危患者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（CCAB）的结果。

方法

在一组欧洲心脏手术风险评估系统（EuroSCORE）累加值≥6的患者中，67例行OPCAB，112例行CCAB。

结果

OPCAB组术后30天死亡率和卒中率分别为7.5%和6.0%，CCAB组分别为5.4%（P = 0.75）和8.0%（P = 0.77）。除心肌肌钙蛋白I外，其他主要结局终点未观察到显著差异（OPCAB组：117±428 ng/ml，CCAB组：58±99 ng/ml，P = 0.028），这一结果可能归因于两名接受OPCAB的极高危患者术前发生了大面积心肌梗死。在倾向评分匹配的配对患者中也观察到了类似的结果。充血性心力衰竭（P = 0.006，比值比：6.366，95%置信区间：1.682 - 24.093）和基线心脏指数（P = 0.018，比值比：0.171，95%置信区间：0.040 - 0.735）是术后30天死亡率的独立预测因素。