Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Ann Thorac Surg. 2014 Apr;97(4):1335-41. doi: 10.1016/j.athoracsur.2013.10.045. Epub 2014 Jan 7.
Currently, off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (ONCAB) are 2 well-established therapeutic strategies for patients with coronary artery disease, and debate regarding which strategy provides superior graft patency is ongoing. The current study is a meta-analysis of randomized controlled trials that compared the graft patency between OPCAB and ONCAB.
Data sources were PubMed, the Cochrane Library, Google Scholar, and ISI Web of Knowledge (1966-2013). We identified studies comparing graft patency after the 2 procedures as the primary intervention for patients with multivessel coronary artery disease and conducted a meta-analysis of randomized controlled trials on graft patency.
A literature search yielded 12 randomized controlled trials, for a total of 3,894 and 4,137 grafts performed during OPCAB and ONCAB procedures, respectively. Meta-analysis of these studies showed an increased risk of occlusion of all grafts (risk ratio [RR], 1.35; 95% confidence interval [CI], 1.16-1.57) and saphenous vein grafts (SVGs) (RR, 1.41; 95% CI, 1.24-1.60) in the OPCAB group, whereas there was no significant difference in graft occlusion of left internal mammary artery (LIMA) (RR, 1.15; 95% CI, 0.83-1.59) and radial artery (RR, 1.37; 95% CI, 0.76-2.47) grafts between OPCAB and ONCAB.
Meta-analysis of currently available randomized controlled trials on graft patency shows that ONCAB reduces the incidence of SVG graft occlusion significantly but does not affect LIMA and radial artery graft patency compared with OPCAB.
目前，非体外循环冠状动脉旁路移植术（OPCAB）和体外循环冠状动脉旁路移植术（ONCAB）是治疗冠心病的两种成熟的治疗策略，关于哪种策略提供更通畅的移植物的争论仍在继续。本研究是对比较两种策略的桥血管通畅性的随机对照试验的荟萃分析。
数据来源为 PubMed、Cochrane 图书馆、Google 学术和 ISI Web of Knowledge（1966-2013 年）。我们检索了比较两种手术桥血管通畅性的研究，这些研究将多支血管病变的患者作为主要干预对象，并对桥血管通畅性的随机对照试验进行了荟萃分析。
文献检索共得到 12 项随机对照试验，OPCAB 组共进行了 3894 例手术，ONCAB 组共进行了 4137 例手术。对这些研究的荟萃分析显示，OPCAB 组的所有移植物（风险比 [RR]，1.35；95%置信区间 [CI]，1.16-1.57）和大隐静脉移植物（SVGs）（RR，1.41；95% CI，1.24-1.60）闭塞的风险增加，而左内乳动脉（LIMA）（RR，1.15；95% CI，0.83-1.59）和桡动脉（RR，1.37；95% CI，0.76-2.47）移植物闭塞的风险在 OPCAB 和 ONCAB 组之间无显著差异。
对目前关于桥血管通畅性的随机对照试验的荟萃分析显示，与 OPCAB 相比，ONCAB 显著降低了 SVG 移植物闭塞的发生率，但不影响 LIMA 和桡动脉移植物的通畅性。
