Department of Cardiothoracic Surgery, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University Bochum, Georgstrasse 11, 32545 Bad Oeynhausen, Germany.
Circulation. 2012 Sep 11;126(11 Suppl 1):S176-82. doi: 10.1161/CIRCULATIONAHA.111.084285.
This study aimed to assess if clampless off-pump coronary artery bypass grafting (CABG) decreases risk-adjusted mortality, stroke rate, and morbidity in unselected patients in comparison to conventional CABG.
Between July 2009 and November 2010, data of 1282 consecutive patients undergoing isolated CABG were prospectively recorded. In 30.8% (n=395), clampless off-pump revascularization was used, either with the PAS-Port automated central venous anastomosis system (n=310) or as total arterial revascularization without central anastomoses (n=85). Propensity score (PS) matching was performed based on 15 preoperative risk variables to correct for selection bias. In-hospital mortality and stroke rate as primary end point, as well as major complications and follow-up outcome of clampless off-pump (lessOPCAB) and conventional CABG (cCABG) were compared in 394 matched patient pairs (total: 788 patients). The clampless off-pump technique decreased the in-hospital rate of death (odds ratio, 0.25; 95% confidence interval, 0.05-1.18, P=0.080) and stroke (odds ratio, 0.36; 95% confidence interval, 0.13-0.99, P=0.048) significantly. Complications such as low cardiac output syndrome, prolonged ventilation and rethoracotomy were also reduced by lessOPCAB. Over a 2-year follow-up period overall survival, cerebrovascular and major adverse event rate were significantly lower in the lessOPCAB group, while the repeat revascularization rate was comparable.
In a retrospective PS-matched analysis, clampless off-pump CABG lowers mortality, stroke rate and other morbidity in an unselected group of patients with coronary artery disease.
本研究旨在评估无夹闭不停跳冠状动脉旁路移植术（off-pump CABG）与常规 CABG 相比，是否降低未经选择的患者的风险调整死亡率、卒中发生率和发病率。
2009 年 7 月至 2010 年 11 月，前瞻性地记录了 1282 例连续接受单纯 CABG 患者的数据。在 30.8%（n=395）的患者中，使用无夹闭 off-pump 血运重建，其中 310 例采用 PAS-Port 自动中心静脉吻合系统，85 例采用全动脉血运重建而无中心吻合。根据 15 项术前风险变量进行倾向评分（PS）匹配，以纠正选择偏倚。在 394 对匹配的患者中（总共有 788 例患者），比较了住院死亡率和卒中发生率作为主要终点，以及无夹闭 off-pump（lessOPCAB）和常规 CABG（cCABG）的主要并发症和随访结果。无夹闭 off-pump 技术显著降低了住院死亡率（比值比，0.25；95%置信区间，0.05-1.18，P=0.080）和卒中发生率（比值比，0.36；95%置信区间，0.13-0.99，P=0.048）。lessOPCAB 还减少了低心输出量综合征、延长通气和再次开胸等并发症。在 2 年的随访期间，lessOPCAB 组的总生存率、脑血管事件和主要不良事件发生率显著降低，而再次血运重建率相当。
在回顾性 PS 匹配分析中，无夹闭 off-pump CABG 降低了未经选择的冠心病患者的死亡率、卒中发生率和其他发病率。
