Sisillo Erminio, Marino Maria Rosaria, Juliano Glauco, Beverini Cristina, Salvi Luca, Alamanni Francesco
Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy.
Eur J Cardiothorac Surg. 2007 Jun;31(6):1076-80. doi: 10.1016/j.ejcts.2007.02.015. Epub 2007 Apr 3.
Cerebrovascular accidents (CVA) are devastating complications after coronary artery bypass grafting (CABG). The reported incidence of neurological complications after conventional CABG (CCABG) is 3-6%. Off-pump coronary bypass grafting (OPCAB) has been associated in recent studies to a decreased morbidity and risk of perioperative stroke. Nevertheless, uncertainty still surrounds the relative benefits of OPCAB. We investigated whether, in our experience, OPCAB was associated with lower neurological morbidity than conventional CABG approach.
Eight thousand and two patients underwent isolated CABG at our institution between January 1998 and January 2005. OPCAB operation was performed on 1415 patients. Data were prospectively collected. A multiple logistic regression analysis was used to evaluate the influence of the two different surgical techniques on the neurological outcomes.
Patients in the OPCAB group were significantly older (66.2 vs 63.5%, p<0.0001), had a higher incidence of renal injury (5.4 vs 2.4%, p<0.0001), and were more redo interventions (6.95 vs 1.53%, p<0.0001). The CCABG patients were more urgent at operation (5.46 vs 3.26, p=0.0007), were less hypertensive (57.6 vs 63% of the patients, p=0.0003) more diabetics (22 vs 20.6%, NS), and had an ejection fraction less than 0.40 (10.4 vs 9.6%, NS). CVA incidence was similar in both groups (Type I outcome: OPCAB=0.70% vs CCABG=0.68%, p=0.91; Type II outcome OPCAB=0.70% vs CCABG=0.83%, p=0.63).
In our experience patients undergoing CCABG were not exposed to a greater risk of neurological adverse events when compared to OPCAB patients.
脑血管意外（CVA）是冠状动脉旁路移植术（CABG）后极具破坏性的并发症。传统CABG（CCABG）后报道的神经并发症发生率为3% - 6%。近期研究表明，非体外循环冠状动脉旁路移植术（OPCAB）与围手术期卒中发病率降低及风险降低相关。然而，OPCAB的相对益处仍存在不确定性。我们根据自身经验研究了OPCAB与传统CABG方法相比是否神经发病率更低。
1998年1月至2005年1月期间，我院8002例患者接受了单纯CABG手术。1415例患者接受了OPCAB手术。数据前瞻性收集。采用多因素logistic回归分析评估两种不同手术技术对神经结局的影响。
OPCAB组患者年龄显著更大（66.2岁对63.5岁，p<0.0001），肾损伤发生率更高（5.4%对2.4%，p<0.0001），再次手术干预更多（6.95%对1.53%，p<0.0001）。CCABG患者手术时更紧急（5.46对3.26，p = 0.0007），高血压患者更少（57.6%对63%的患者，p = 0.0003），糖尿病患者更多（22%对20.6%，无显著差异），射血分数小于0.40的患者更多（10.4%对9.6%，无显著差异）。两组CVA发生率相似（I型结局：OPCAB = 0.70%对CCABG = 0.68%，p = 0.91；II型结局OPCAB = 0.70%对CCABG = 0.83%，p = 0.63）。
根据我们的经验，与OPCAB患者相比，接受CCABG的患者发生神经不良事件的风险并不更高。
