Raja Shahzad G, Salhiyyah Kareem, Navaratnarajah Manoraj, Rafiq Muhammad Umar, Felderhof Jeremy, Walker Christopher P, Ilsley Charles D, Amrani Mohamed
Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
Heart Surg Forum. 2012 Jun;15(3):E136-42. doi: 10.1532/HSF98.20111087.
Despite increasing recognition that off-pump coronary artery bypass surgery and sequential grafting strategy individually are associated with improved outcomes, concerns persist regarding the safety and efficacy of combining these 2 techniques. We compared in-hospital and midterm outcomes for off-pump multivessel sequential and conventional coronary artery bypass grafting.
From September 1998 to September 2008, 689 consecutive patients received off-pump multivessel sequential coronary artery bypass grafting performed by a single surgeon. These patients were propensity matched to 689 patients who underwent off-pump coronary artery bypass grafting without sequential anastomoses. A retrospective analysis of prospectively collected perioperative data was performed. In addition, medical notes and charts of all the study patients were reviewed. The mean duration of follow-up was 5.1 ± 2.0 years.
The major in-hospital clinical outcomes in the sequential and control groups were found to be similar. After adjusting for clinical covariates, sequential grafting was not an independent predictor of in-hospital adverse events (odds ratio [OR], 1.18; 95% confidence interval [CI], 0.86-1.50; P = .31), medium-term mortality (hazard ratio [HR], 1.26; 95% CI, 1.06-1.32; P = .92), and readmission to hospital (HR, 1.12; 95% CI, 0.96-1.20; P = .80). Sequential grafting was an independent predictor of receiving more than 3 distal anastomoses (OR, 7.46; 95% CI, 4.27-11.45; P < .0001). Risk-adjusted survival was 89% for sequential grafting patients and 88% for conventional grafting patients (P = .96) during the medium-term follow-up.
Our analysis confirms the short- and midterm safety and efficacy of off-pump sequential coronary artery bypass grafting.
尽管越来越多的人认识到非体外循环冠状动脉搭桥手术和序贯移植策略各自都与改善预后相关，但对于将这两种技术结合起来的安全性和有效性仍存在担忧。我们比较了非体外循环多支血管序贯和传统冠状动脉搭桥术的院内及中期预后。
从1998年9月至2008年9月，689例连续患者接受了由单一外科医生实施的非体外循环多支血管序贯冠状动脉搭桥术。这些患者与689例接受非体外循环冠状动脉搭桥术但未进行序贯吻合的患者进行倾向匹配。对前瞻性收集的围手术期数据进行回顾性分析。此外，还查阅了所有研究患者的病历和图表。平均随访时间为5.1±2.0年。
序贯组和对照组的主要院内临床结局相似。在对临床协变量进行调整后，序贯移植不是院内不良事件（优势比[OR]，1.18；95%置信区间[CI]，0.86 - 1.50；P = 0.31）、中期死亡率（风险比[HR]，1.26；95% CI，1.06 - 1.32；P = 0.92）和再次入院（HR，1.12；95% CI，0.96 - 1.20；P = 0.80）的独立预测因素。序贯移植是接受超过3个远端吻合的独立预测因素（OR，7.46；95% CI，4.27 - 11.45；P < 0.0001）。在中期随访期间，序贯移植患者的风险调整后生存率为89%，传统移植患者为88%（P = 0.96）。
我们的分析证实了非体外循环序贯冠状动脉搭桥术的短期和中期安全性及有效性。
