Department of Cardiac Surgery, Hospital da Cruz Vermelha Portuguesa, Lisbon 1549-008, Portugal.
Eur Heart J. 2010 Oct;31(20):2492-9. doi: 10.1093/eurheartj/ehq210. Epub 2010 Jul 1.
Uncertainty persists regarding the impact of the off-pump technique on coronary bypass graft patency. The primary objective of this study was to assess coronary artery bypass graft patency in patients randomized to off-pump and on-pump multivessel coronary artery bypass grafting (CABG). Secondary objectives were clinical outcomes and neuropsychological functioning.
One hundred and fifty patients were randomized to off-pump (n = 75) or on-pump CABG (n = 75). Graft patency was assessed by multidetector computed tomography 5 weeks after surgery. The two groups were similar regarding patients' characteristics and logistic Euroscore (3.6 vs. 3.7%). Mean number of grafts performed was 3.5 ± 0.6 and 3.5 ± 0.6 in off-pump and on-pump, respectively (P = 0.7). Raw graft patency rate was 89.9% in off-pump and 95.0% in on-pump (OR 2.2, 95% CI 1.07-4.44; P = 0.03). Nineteen (27%) off-pump and 9 (13%) on-pump patients had at least one occluded graft (P = 0.04) and the proportion of patent grafts per patient was 0.91 ± 0.2 in off-pump vs. 0.96 ± 0.1 in on-pump (P = 0.06). However, after adjusting by heparin dose, graft patency was not statistically different between groups (OR 0.87, 95% CI 0.25-2.98, P = 0.83). At 30 days, there was no statistically significant difference in major adverse events and neuropsychological functioning between off-pump and on-pump groups. One-year follow-up showed similar functional class and positive treadmill exercise tests.
Under the conditions this trial was conducted, CABG performed off-pump had lower overall graft patency rate than on-pump, which was not statistically different after controlling for total heparin dose. Thirty-day complications, neuropsychological functioning, and one-year clinical and functional outcomes were not statistically different between the two techniques.
关于非体外循环技术对冠状动脉旁路移植术通畅性的影响，目前仍存在不确定性。本研究的主要目的是评估随机接受非体外循环和体外循环多支冠状动脉旁路移植术（CABG）的患者的冠状动脉旁路移植术通畅性。次要目标是临床结果和神经心理学功能。
150 名患者被随机分为非体外循环组（n=75）或体外循环 CABG 组（n=75）。术后 5 周通过多排螺旋 CT 评估吻合通畅情况。两组患者的特征和逻辑 Euroscore（3.6 vs. 3.7%）相似。非体外循环组和体外循环组的平均吻合数分别为 3.5±0.6 和 3.5±0.6（P=0.7）。非体外循环组的吻合通畅率为 89.9%，体外循环组为 95.0%（OR 2.2，95%CI 1.07-4.44；P=0.03）。19 名（27%）非体外循环组和 9 名（13%）体外循环组至少有一条吻合闭塞（P=0.04），每名患者的通畅吻合数分别为非体外循环组 0.91±0.2 和体外循环组 0.96±0.1（P=0.06）。然而，在校正肝素剂量后，两组之间的吻合通畅率无统计学差异（OR 0.87，95%CI 0.25-2.98，P=0.83）。30 天时，非体外循环组和体外循环组之间在主要不良事件和神经心理学功能方面无统计学差异。1 年随访显示，两种技术的功能分级和阳性跑步机运动试验相似。
在本试验进行的条件下，非体外循环 CABG 的总体吻合通畅率低于体外循环，但在校正总肝素剂量后无统计学差异。两组之间 30 天并发症、神经心理学功能以及 1 年临床和功能结果无统计学差异。
