Mazzei Valerio, Nasso Giuseppe, Salamone Giovanni, Castorino Filippo, Tommasini Antonello, Anselmi Amedeo
Division of Cardiac Surgery, Ospedale Papardo, Messina, Italy.
Circulation. 2007 Oct 16;116(16):1761-7. doi: 10.1161/CIRCULATIONAHA.107.697482. Epub 2007 Sep 17.
We aimed to evaluate the clinical results and biocompatibility of the minimal extracorporeal circulation system (MECC) compared with off-pump coronary revascularization (OPCABG).
In a prospective randomized study, 150 patients underwent coronary surgery with the use of MECC and 150 underwent OPCABG. End points were (1) circulating markers of inflammation and organ injury, (2) operative results, and (3) outcome at 1-year follow-up. Operative mortality and morbidity were comparable between the groups. Release of inflammatory markers was similar between groups at all time points (peak interleukin-6 167.2+/-13.5 versus 181+/-6.5 pg/mL, P=0.14, OPCABG versus MECC group, respectively). Peak creatine kinase was 419.3+/-103.5 versus 326+/-84.2 mg/dL (P=0.28), and peak S-100 protein was 0.13+/-0.08 versus 0.29+/-0.1 pg/mL (P=0.058, OPCABG versus MECC group, respectively). Length of hospital stay and use of blood products were similar between groups. Two cases of angina recurrence at 1 year in the MECC group were observed versus 5 cases observed in the OPCABG group (P=0.44). A residual perfusion defect at myocardial nuclear scan was less frequent among patients in the MECC group (3 versus 9 cases, P=0.14; odds ratio 0.32, 95% confidence interval 0.07 to 1.32). Six (OPCABG group) versus 3 (MECC group) coronary grafts were occluded or severely stenotic at 1 year (P=0.33, odds ratio 0.47, 95% confidence interval 0.09 to 2.14).
Clinical results of coronary revascularization with MECC are optimal when this procedure is performed by experienced teams. Postoperative morbidity is comparable to that with OPCABG. MECC is associated with little pump-related systemic and organ injury. It may achieve the benefits of OPCABG (less morbidity in high-risk patients) while facilitating complete revascularization in the case of complex lesions unsuitable for OPCABG.
我们旨在评估与非体外循环冠状动脉搭桥术（OPCABG）相比，最小体外循环系统（MECC）的临床效果和生物相容性。
在一项前瞻性随机研究中，150例患者接受了使用MECC的冠状动脉手术，150例接受了OPCABG。终点指标为：（1）炎症和器官损伤的循环标志物；（2）手术结果；（3）1年随访结果。两组的手术死亡率和发病率相当。各时间点两组间炎症标志物的释放相似（峰值白细胞介素-6，OPCABG组与MECC组分别为167.2±13.5与181±6.5 pg/mL，P = 0.14）。峰值肌酸激酶为419.3±103.5与326±84.2 mg/dL（P = 0.28），峰值S-100蛋白为0.13±0.08与0.29±0.1 pg/mL（P = 0.058，OPCABG组与MECC组分别）。两组间住院时间和血制品使用情况相似。MECC组1年时有2例心绞痛复发，OPCABG组有5例（P = 0.44）。MECC组患者心肌核素扫描时残余灌注缺损的发生率较低（3例对9例，P = 0.14；比值比0.32，95%置信区间0.07至1.32）。1年时，OPCABG组有6支冠状动脉移植物闭塞或严重狭窄，MECC组有3支（P = 0.33，比值比0.47，95%置信区间0.09至2.14）。
当由经验丰富的团队进行MECC冠状动脉血运重建术时，临床效果最佳。术后发病率与OPCABG相当。MECC与很少的与泵相关的全身和器官损伤相关。它可能实现OPCABG的益处（高危患者发病率较低），同时在复杂病变不适合OPCABG时便于实现完全血运重建。
