Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
J Thorac Cardiovasc Surg. 2012 Jun;143(6):1382-8. doi: 10.1016/j.jtcvs.2011.07.035. Epub 2011 Aug 16.
This study compared safety and efficacy between off-pump coronary artery bypass grafting (OPCAB), a relatively new technique, and conventional on-pump coronary artery bypass grafting (CCAB) in patients with left main stem disease.
In a retrospective, observational, cohort study of prospectively collected data on 2375 consecutive patients with left main stem disease undergoing isolated CABG (1297 OPCAB, 1078 CCAB) between April 1996 and December 2009 at the Bristol Heart Institute, 548 patients undergoing OPCAB were matched with 548 patients undergoing CCAB by propensity score.
After propensity matching, groups were comparable in preoperative characteristics. Relative to CCAB, OPCAB was associated with lower in-hospital mortality (0.5% vs 2.9%; P = .001), incidence of stroke (0% vs 0.9%; P = .02), postoperative renal dysfunction (4.9% vs 10.8%; P = .001), pulmonary complications (10.2% vs 16.6%; P = .002), and infectious complications (3.5% vs 6.2%; P = .03). The OPCAB group received fewer grafts than did the CCAB group (2.7 ± 0.7 vs 3 ± 0.7; P = .001) and had a lower rate of complete revascularization (88.3% vs 92%; P = .04). In multivariable analysis, cardiopulmonary bypass was confirmed to be an independent predictor of in-hospital mortality (odds ratio, 5.74; P = .001). Survivals at 1, 5, and 10 years were similar between groups (OPCAB, 96.8%, 87.3%, and 71.7%; CCAB, 96.8%, 88.6%, and 69.8%).
OPCAB in patients with left main stem disease is a safe procedure with reduced early morbidity and mortality and similar long-term survival to conventional on-pump revascularization.
本研究比较了非体外循环冠状动脉旁路移植术（OPCAB）与传统体外循环冠状动脉旁路移植术（CCAB）在左主干病变患者中的安全性和疗效。
在布里斯托尔心脏研究所对 2009 年 12 月前连续 2375 例接受单纯冠状动脉旁路移植术（CABG）治疗的左主干病变患者进行前瞻性观察队列研究，其中 1297 例行 OPCAB，1078 例行 CCAB。通过倾向评分，将 548 例行 OPCAB 的患者与 548 例行 CCAB 的患者进行匹配。
倾向性匹配后，两组患者的术前特征无差异。与 CCAB 相比，OPCAB 术后院内死亡率较低（0.5%比 2.9%，P=0.001），卒中发生率较低（0%比 0.9%，P=0.02），术后肾功能不全发生率较低（4.9%比 10.8%，P=0.001），肺部并发症发生率较低（10.2%比 16.6%，P=0.002），感染并发症发生率较低（3.5%比 6.2%，P=0.03）。OPCAB 组的移植血管数少于 CCAB 组（2.7±0.7 比 3±0.7，P=0.001），完全血运重建率较低（88.3%比 92%，P=0.04）。多变量分析证实体外循环是院内死亡的独立预测因素（比值比，5.74；P=0.001）。两组患者 1、5 和 10 年的生存率相似（OPCAB 组 96.8%、87.3%和 71.7%，CCAB 组 96.8%、88.6%和 69.8%）。
左主干病变患者行 OPCAB 是一种安全的术式，可降低早期发病率和死亡率，且长期生存率与传统体外循环血运重建相似。
