Attaran Saina, Shaw Matthew, Bond Laura, Pullan Mark D, Fabri Brian M
Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool L14 3PE, UK.
Interact Cardiovasc Thorac Surg. 2010 Oct;11(4):442-6. doi: 10.1510/icvts.2010.237040. Epub 2010 Jul 9.
Coronary artery revascularization with cardiopulmonary bypass (ONCAB) has been reported to carry several risks for patients with poor left ventricular (LV) function (ejection fraction <30%). Off-pump CABG (OPCAB) has been proposed to result in a better outcome, but mid- and long-term survival rates have never been compared. The aim of this study is to assess the effect of cardiopulmonary bypass on this group of patients.
In a 10-year period, a total of 934 patients with poor LV function undergoing isolated first-time coronary artery bypass graft were studied. They were divided into two groups, the ONCAB group, with 528 patients, and the OPCAB group with 406 patients. The EuroSCORE was significantly higher in the OPCAB group (P=0.049). After adjusting for the preoperative characteristics, postoperative complications, in-hospital mortality, mid-term survival rate (five years), and long-term survival rate (10 years) were compared.
The average number of grafts was 3.7 in the ONCAB group and 3.1 in the OPCAB group (P<0.001). Postoperative complications of ONCAB and OPCAB groups such as; atrial fibrillation (29.6% vs. 28.6%), renal failure (9.3% vs. 9.6%), stroke (2.3% vs. 0.7%), and perioperative myocardial infarction (MI) (3.8% vs. 2.0%), were comparable between groups. Length of intensive care unit stay, hospital stay and ventilation time were considerably shorter in the OPCAB group (P<0.05). The incidence of wound infection was also lower in the OPCAB patients (P<0.05). After adjusting for the preoperative characteristics the incidence of most postoperative complications remained the same between the two groups, except for MI, which was lower in the OPCABs (P<0.04). Despite a lower number of proximal anastomoses in the OPCAB patients, the rate of stroke remained the same between the OPCAB and ONCAB patients (0.09% vs. 1.6%). In-hospital mortality was higher in ONCAB compared to OPCAB (7.8% vs. 5.7%), but this difference did not reach statistical significance (P=0.21). Likewise, mid-term and long-term survival rates were similar even with matched preoperative characteristics. However, re-intervention rate was found to be higher in the OPCABs (P<0.001).
Despite the reported benefits of OPCAB, there was no significant influence on the in-hospital mortality, mid-term survival or long-term survival in patients with LV dysfunction. With adequate myocardial protection in ONCAB and complete revascularization in OPCAB, similar results are achievable.
据报道，对于左心室（LV）功能较差（射血分数<30%）的患者，体外循环冠状动脉血运重建术（ONCAB）存在多种风险。非体外循环冠状动脉搭桥术（OPCAB）被认为能带来更好的结果，但尚未对其中期和长期生存率进行比较。本研究的目的是评估体外循环对这组患者的影响。
在10年期间，共研究了934例首次接受单纯冠状动脉搭桥术且LV功能较差的患者。他们被分为两组，ONCAB组528例患者，OPCAB组406例患者。OPCAB组的欧洲心脏手术风险评估系统（EuroSCORE）显著更高（P=0.049）。在对术前特征进行调整后，比较术后并发症、院内死亡率、中期生存率（五年）和长期生存率（十年）。
ONCAB组平均搭桥数量为3.7个，OPCAB组为3.1个（P<0.001）。ONCAB组和OPCAB组的术后并发症，如房颤（29.6%对28.6%）、肾衰竭（9.3%对9.6%）、中风（2.3%对0.7%）和围手术期心肌梗死（MI）（3.8%对2.0%），两组之间具有可比性。OPCAB组的重症监护病房停留时间、住院时间和通气时间明显更短（P<0.05）。OPCAB患者的伤口感染发生率也较低（P<0.05）。在对术前特征进行调整后，除MI外，两组大多数术后并发症的发生率保持不变，OPCAB组的MI发生率较低（P<0.04）。尽管OPCAB患者的近端吻合数量较少，但OPCAB组和ONCAB组患者的中风发生率保持相同（0.09%对1.6%）。ONCAB组的院内死亡率高于OPCAB组（7.8%对5.7%），但这一差异未达到统计学意义（P=0.21）。同样，即使术前特征匹配，中期和长期生存率也相似。然而，发现OPCAB组的再次干预率更高（P<0.001）。
尽管报道了OPCAB的益处，但对LV功能障碍患者的院内死亡率、中期生存或长期生存没有显著影响。通过ONCAB中充分的心肌保护和OPCAB中完全的血运重建，可以取得相似的结果。
