Halbersma Wouter Bas, Arrigoni Sara Camilla, Mecozzi Gianclaudio, Grandjean Jan Gerard, Kappetein Arie Pieter, van der Palen Job, Zijlstra Felix, Mariani Massimo Alessandro
Thoraxcenter Twente, Enschede, the Netherlands.
Ann Thorac Surg. 2009 Sep;88(3):796-801. doi: 10.1016/j.athoracsur.2009.04.104.
A retrospective, single-center 4-year clinical study of the off-pump coronary artery bypass grafting no-touch technique with arterial conduits (Y-graft) was compared with the Syntax trial.
Four hundred consecutive patients ("all-comers") who underwent coronary surgery between 2004 and 2008 at the Thorax Center Twente (TCT) formed the study group. The primary end point was in-hospital and 12-month major cardiovascular or cerebrovascular event (MACCE). Event rates of MACCE were based on life tables, and overall MACCE was determined by Kaplan-Meier analysis.
In-hospital mortality was 0.2%. Cumulative 1-year survival was 98.2%, and freedom from MACCE was 94.7% +/- 1.1%. Cumulative 4-year survival and freedom from MACCE were 91.2% +/- 2.4% and 82.1% +/- 3.0%, respectively. There were no significant differences in the baseline characteristics between the patients of the TCT group and the surgical arm of the Syntax trial. Repeat revascularization, MACCE, and symptomatic graft occlusion in the TCT group were significantly lower than in the Syntax trial. The event rate of myocardial infarction and all-cause death in the TCT group were significantly lower than those of the percutaneous coronary intervention arm of the Syntax trial. There was a clear trend toward a reduction of the event rate of stroke in the TCT group (0.8%) compared with the surgical arm of the Syntax trial (2.2%). There was no significant difference of stroke rate between the TCT group and the percutaneous coronary intervention arm of the Syntax trial.
A state-of-the-art surgical technique such as off-pump coronary artery bypass grafting no-touch can further improve the advantage of surgical treatment with respect to percutaneous coronary intervention. Off-pump coronary artery bypass grafting no-touch surgery can be the treatment of choice for patients with three-vessel disease and left main stenosis.
一项回顾性、单中心、为期4年的临床研究，对采用动脉血管桥（Y型桥）的非体外循环冠状动脉搭桥无接触技术与SYNTAX试验进行了比较。
2004年至2008年期间在特温特胸科中心（TCT）接受冠状动脉手术的400例连续患者（“所有患者”）组成了研究组。主要终点是住院期间和12个月时的主要心血管或脑血管事件（MACCE）。MACCE的事件发生率基于生命表，总体MACCE通过Kaplan-Meier分析确定。
住院死亡率为0.2%。1年累积生存率为98.2%，无MACCE的比例为94.7%±1.1%。4年累积生存率和无MACCE的比例分别为91.2%±2.4%和82.1%±3.0%。TCT组患者与SYNTAX试验手术组患者的基线特征无显著差异。TCT组的再次血运重建、MACCE和有症状的移植血管闭塞显著低于SYNTAX试验。TCT组的心肌梗死和全因死亡率显著低于SYNTAX试验的经皮冠状动脉介入治疗组。与SYNTAX试验手术组（2.2%）相比，TCT组（0.8%）的卒中发生率有明显降低趋势。TCT组与SYNTAX试验经皮冠状动脉介入治疗组之间的卒中发生率无显著差异。
非体外循环冠状动脉搭桥无接触等先进的外科技术可进一步提高手术治疗相对于经皮冠状动脉介入治疗的优势。非体外循环冠状动脉搭桥无接触手术可作为三支血管病变和左主干狭窄患者的首选治疗方法。
