Palmer George, Herbert Morley A, Prince Syma L, Williams Janet L, Magee Mitchell J, Brown Phillip, Katz Marc, Mack Michael J
Central Florida Regional Hospital, Sanford, Florida, USA.
Ann Thorac Surg. 2007 Mar;83(3):986-91; discussion 991-2. doi: 10.1016/j.athoracsur.2006.10.057.
The Coronary Artery Revascularization (CARE) study is a multicenter observational registry of coronary revascularization by percutaneous and surgical techniques. As a substudy of this registry, we analyzed the current practice and outcomes of on-pump and off-pump coronary artery bypass graft (CABG) surgery.
Procedural and outcomes data were prospectively collected for all patients undergoing isolated CABG in eight community-based hospitals in the HCA Hospital System between February 1 and July 31, 2004. Twelve-month follow-up was obtained by patient contact, phone, questionnaire, and the National Death Index.
Isolated coronary artery revascularization procedures were done in 1251 patients, with 12-month follow-up data available on 1149 (91.8%); 654 patients (52.3%) were operated on-pump and 597 (47.7%) had off-pump procedures. On-pump versus off-pump results were mean number of grafts, 3.4 +/- 1 versus 2.9 +/- 1.2 (p < 0.001); operative mortality, 1.7% versus 1.7% (p = 1.00); permanent stroke, 0.9% versus 0.7% (p = 0.51); reoperation for bleeding, 2.6% versus 1.0% (p = 0.037); prolonged ventilation, 10.0% versus 3.4% (p < 0.001); atrial fibrillation, 23.8% versus 14.9% (p < 0.001); need for transfusion, 51.0% versus 34.9% (p < 0.001); intensive care unit length of stay, 68.1 +/- 97.0 hours versus 59.3 +/- 109.4 hours (p = 0.16); and hospital length of stay, 7.5 days versus 6.2 days (p < 0.001). At 12 months, there was no difference in total cardiac mortality on-pump versus off-pump (4.9% versus 4.6%, p = 0.88), myocardial infarction (1.0% versus 0.7%, p = 0.76), need for repeat revascularization (2.8% versus 4.1%, p = 0.70), or total overall major adverse cardiac outcomes (8.7 versus 9.4, p = 0.69).
Current approaches to coronary revascularization using both on-pump and off-pump techniques at individual surgeon discretion, which varies significantly in the community setting, leads to acceptable outcomes. Although perioperative complications were less off-pump, mortality was the same, both in the perioperative period and at 12 months. Fewer grafts in the off-pump group appeared to be related to disease burden and not incomplete revascularization. Cardiac death, myocardial infarction, and the need for repeat revascularization were equal at 12 months.
冠状动脉血运重建（CARE）研究是一项关于经皮和外科技术进行冠状动脉血运重建的多中心观察性登记研究。作为该登记研究的一项子研究，我们分析了体外循环和非体外循环冠状动脉旁路移植术（CABG）的当前实践及结果。
前瞻性收集2004年2月1日至7月31日期间在HCA医院系统的八家社区医院接受单纯CABG手术的所有患者的手术过程及结果数据。通过患者联系、电话、问卷调查和国家死亡指数获得12个月的随访数据。
1251例患者接受了单纯冠状动脉血运重建手术，其中1149例（91.8%）有12个月的随访数据；654例患者（52.3%）接受体外循环手术，597例（47.7%）接受非体外循环手术。体外循环与非体外循环的结果比较如下：平均移植血管数量，分别为3.4±1和2.9±1.2（p<0.001）；手术死亡率，分别为1.7%和1.7%（p = 1.00）；永久性卒中，分别为0.9%和0.7%（p = 0.51）；因出血再次手术，分别为2.6%和1.0%（p = 0.037）；通气时间延长，分别为10.0%和3.4%（p<0.001）；心房颤动，分别为23.8%和14.9%（p<0.001）；输血需求，分别为51.0%和34.9%（p<0.001）；重症监护病房住院时间，分别为68.1±97.0小时和59.3±109.4小时（p = 0.16）；住院时间，分别为7.5天和6.2天（p<0.001）。在12个月时，体外循环与非体外循环的总心脏死亡率无差异（分别为4.9%和4.6%，p = 0.88），心肌梗死发生率无差异（分别为1.0%和0.7%，p = 0.76），再次血运重建需求无差异（分别为2.8%和4.1%，p = 0.70），或总的主要不良心脏结局无差异（分别为8.7和9.4，p = 0.69）。
目前在社区环境中，个体外科医生可自行决定采用体外循环和非体外循环技术进行冠状动脉血运重建，其结果是可接受的。尽管非体外循环的围手术期并发症较少，但无论是围手术期还是12个月时，死亡率相同。非体外循环组移植血管较少似乎与疾病负担有关，而非血运重建不完全。12个月时心脏死亡、心肌梗死和再次血运重建需求相当。
