Emmert Maximilian Y, Emmert Lorenz S, Martinez Eliana C, Lee Chuen N, Kofidis Theo
Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, Singapore.
Heart Surg Forum. 2010 Jun;13(3):E136-42. doi: 10.1532/HSF98.20091178.
A severely decreased ejection fraction (EF) of < or =25% is an established risk factor for a worse outcome after heart surgery and therefore has been incorporated into the EuroSCORE risk-stratification model. We compare clinical outcomes after off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting in patients with a severely compromised EF.
We compared 112 patients with a low EF (< or =25%) who underwent myocardial revascularization between 2003 and 2008. Forty-four patients underwent OPCAB (group A), and 68 patients underwent on-pump surgery (group B). We compared demographics, intraoperative parameters, intraoperative outcomes, and the completeness of revascularization for the 2 groups.
Demographic and EuroSCORE data were comparable for groups A and B. The 2 groups appeared to be similar with respect to mortality rate during the first 30 days (2.2% and 8.8%, respectively; P = .11) and the rate of major complications such as stroke (2.2% and 2.9%, respectively; P = 0.83). The patients in group A had fewer pulmonary complications (7% versus 25%, P < .01), received fewer blood transfusions (15.9% versus 47.0%, P < .01), required fewer postoperative pacing procedures (atrial, 11.4% versus 39.7%; ventricular, 13.6% versus 47.1%; P < .01), and had fewer wound infections (2.2% versus 16.1%, P = .02). The numbers of diseased vessels were comparable, and although the OPCAB patients received more arterial grafts (1.05 +/- 0.43 versus 0.84 +/- 0.37, P < .01), the total number of grafts per patient was lower among these patients (2.50 +/- 0.88 versus 3.53 +/- 0.92, P = .03). Similarly, complete revascularization was achieved less frequently within this group (80% versus 94%, P = .02).
A standardized OPCAB approach in patients with a severely decreased EF is safe and may benefit this subset of patients with respect to fewer postoperative complications. Although complete revascularization is the optimal approach for these patients, they benefit from avoiding cardiopulmonary bypass.
射血分数（EF）严重降低至≤25%是心脏手术后预后较差的既定危险因素，因此已被纳入欧洲心脏手术风险评估系统（EuroSCORE）风险分层模型。我们比较了射血分数严重受损患者非体外循环冠状动脉旁路移植术（OPCAB）和体外循环冠状动脉旁路移植术后的临床结局。
我们比较了2003年至2008年间112例接受心肌血运重建的低EF（≤25%）患者。44例患者接受OPCAB（A组），68例患者接受体外循环手术（B组）。我们比较了两组的人口统计学、术中参数、术中结局和血运重建的完整性。
A组和B组的人口统计学和EuroSCORE数据具有可比性。两组在前30天的死亡率（分别为2.2%和8.8%；P = 0.11）以及中风等主要并发症发生率（分别为2.2%和2.9%；P = 0.83）似乎相似。A组患者的肺部并发症较少（7%对25%，P < 0.01），输血较少（15.9%对47.0%，P < 0.01），术后起搏程序较少（心房起搏，11.4%对39.7%；心室起搏，13.6%对47.1%；P < 0.01），伤口感染较少（2.2%对16.1%，P = 0.02）。病变血管数量相当，虽然OPCAB患者接受的动脉移植物更多（1.05±0.43对0.84±0.37，P < 0.01），但这些患者中每位患者的移植物总数较低（2.50±0.88对3.53±0.92，P = 0.03）。同样，该组实现完全血运重建的频率较低（80%对94%，P = 0.02）。
对于射血分数严重降低的患者，标准化的OPCAB方法是安全的，并且在减少术后并发症方面可能使这部分患者受益。虽然完全血运重建是这些患者的最佳方法，但他们受益于避免体外循环。
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