Hu Sheng-Shou, Xiong Hui, Zheng Zhe, Gao Peixian, Zhang Changwei, Gao Runlin, Li Lihuan, Yuan Jinqing, Xu Bo
Department of Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Heart Surg Forum. 2012 Feb;15(1):E18-22. doi: 10.1532/HSF98.20111004.
The purpose of this study was to evaluate the feasibility, safety, and midterm outcomes of a simultaneous hybrid revascularization strategy for left main coronary artery disease (LMCAD), compared with conventional off-pump coronary artery bypass grafting (OPCAB).
We compared the in-hospital and midterm outcomes of a simultaneous hybrid revascularization strategy (minimally invasive direct coronary bypass grafting of the left anterior descending coronary artery [LAD] and percutaneous intervention to non-LAD lesions) in 20 patients with LMCAD in an enhanced operating room. These patients were matched by propensity score to a group of 20 control patients who underwent standard OPCAB between September 2007 and December 2009.
All baseline clinical characteristics of the 2 groups were similar. All of the patients in the 2 groups underwent surgery uneventfully without conversion to on-pump coronary artery bypass grafting. Compared with OPCAB, the patients in the hybrid group had shorter lengths of stay in the intensive care unit (34.8 ± 37.6 hours versus 50.7 ± 34.5 hours, P = .01). Transfusion requirements were reduced in the hybrid patients compared with the OPCAB patients (5% versus 40%, P = .01). The 2 groups did not differ with respect to the occurrence of other important morbidities. During the mean (±SD) follow-up of 18.5 ± 9.8 months, the group of patients who underwent the simultaneous hybrid procedure experienced an incidence of major adverse cardiac or cerebrovascular events that was similar to that of the OPCAB control group (100% versus 90%, respectively; P = .31).
The midterm follow-up indicated that the simultaneous hybrid revascularization procedure for LMCAD is feasible, safe, and effective. These promising early findings warrant further prospective investigations.
本研究旨在评估与传统非体外循环冠状动脉搭桥术（OPCAB）相比，同期杂交血运重建策略治疗左主干冠状动脉疾病（LMCAD）的可行性、安全性及中期疗效。
我们比较了20例LMCAD患者在强化手术室中采用同期杂交血运重建策略（左前降支冠状动脉[LAD]微创直接冠状动脉搭桥术及非LAD病变的经皮介入治疗）后的住院及中期疗效。这些患者通过倾向评分与2007年9月至2009年12月期间接受标准OPCAB的20例对照患者进行匹配。
两组的所有基线临床特征相似。两组所有患者均顺利完成手术，未转为体外循环冠状动脉搭桥术。与OPCAB相比，杂交组患者在重症监护病房的住院时间更短（34.8±37.6小时对50.7±34.5小时，P = 0.01）。杂交组患者的输血需求较OPCAB组减少（5%对40%，P = 0.01）。两组在其他重要并发症的发生方面无差异。在平均（±标准差）18.5±9.8个月的随访期间，接受同期杂交手术的患者发生主要不良心脏或脑血管事件的发生率与OPCAB对照组相似（分别为100%对90%；P = 0.31）。
中期随访表明，LMCAD同期杂交血运重建手术可行、安全且有效。这些有前景的早期发现值得进一步进行前瞻性研究。
