Hirose Hitoshi, Noguchi Chiaki, Inaba Hirotaka, Tambara Keiichi, Yamamoto Taira, Yamasaki Motoshige, Kikuchi Keita, Amano Atsushi
Department of Cardiovascular Surgery, Juntendo University Hospital, Bunko-ku, Tokyo, 113-8421, Japan.
Interact Cardiovasc Thorac Surg. 2010 May;10(5):771-6. doi: 10.1510/icvts.2009.226803. Epub 2010 Jan 26.
European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been used to predict the postoperative mortality rate for patients undergoing open-heart surgery. The contributions of EuroSCORE in off-pump coronary artery bypass grafting (CABG) has not yet clearly elucidated.
Consecutive patients of isolated off-pump CABG performed from 2000 when we start performing 'routine' off-pump procedures were stratified using the additive EuroSCORE. Incidence of postoperative mortality, morbidity, and recovery were assessed, and compared to an historical cohort of on-pump procedures performed between 1991 until 1998 when CABG had been routinely performed under on-pump.
There were 1318 patients in the off-pump and 1162 patients in the on-pump group. EuroSCORE of the off-pump group was significantly higher than that of the on-pump group. In both the on- and off-pump groups, mortality, total incidence of major complications, heart failure, and renal failure, and three parameters of recovery time were well correlated with EuroSCORE; however, the discriminatory power of the EuroSCORE model was always better in the on-pump group than in the off-pump group. Stroke was correlated with EuroSCORE only in the on-pump group. Pneumonia, mediastinitis postoperative myocardial infarction, or mediastinitis was not correlated with EuroSCORE in either group. In the off-pump group, postoperative major complication was reduced and postoperative recovery was shortened significantly, compared to those in the on-pump group.
In off-pump CABG, EuroSCORE can, but not as good as in on-pump CABG, predict mortality, certain major postoperative complications, and postoperative recovery. This suggests off-pump technique appears to modify the risk stratification of the patients undergoing CABG.
欧洲心脏手术风险评估系统（EuroSCORE）已被用于预测接受心脏直视手术患者的术后死亡率。EuroSCORE在非体外循环冠状动脉旁路移植术（CABG）中的作用尚未明确阐明。
对自2000年我们开始进行“常规”非体外循环手术以来连续接受单纯非体外循环CABG的患者，使用累加式EuroSCORE进行分层。评估术后死亡率、发病率和恢复情况，并与1991年至1998年期间进行的体外循环手术的历史队列进行比较，当时CABG常规在体外循环下进行。
非体外循环组有1318例患者，体外循环组有1162例患者。非体外循环组的EuroSCORE显著高于体外循环组。在体外循环组和非体外循环组中，死亡率、主要并发症总发生率、心力衰竭和肾衰竭以及恢复时间的三个参数均与EuroSCORE密切相关；然而，EuroSCORE模型在体外循环组中的辨别能力始终优于非体外循环组。卒中仅在体外循环组中与EuroSCORE相关。两组中肺炎、纵隔炎、术后心肌梗死或纵隔炎均与EuroSCORE无关。与体外循环组相比，非体外循环组术后主要并发症减少，术后恢复明显缩短。
在非体外循环CABG中，EuroSCORE可以预测死亡率、某些主要术后并发症和术后恢复情况，但不如在体外循环CABG中预测得好。这表明非体外循环技术似乎改变了接受CABG患者的风险分层。
