Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul Adventist Hospital, Seoul, Korea.
J Korean Med Sci. 2014 Jan;29(1):69-75. doi: 10.3346/jkms.2014.29.1.69. Epub 2013 Dec 26.
This study evaluated the outcomes of off-pump coronary artery bypass surgery (OPCAB) with severe left ventricular dysfunction using composite bilateral internal thoracic artery grafting. From January 2001 to December 2008, 1,842 patients underwent primary isolated OPCAB with composite bilateral internal thoracic artery grafting. A total of 131 of these patients were diagnosed with a severely depressed preoperative left ventricle ejection fraction (LVEF) (≤ 0.35). These patient outcomes were compared with the outcomes of 830 patients that had mildly or moderately depressed LVEF (0.36 to 0.59) and 881 patients with normal LVEF (>0.6). The early mortality for patients with severe LVEF was 2.3%. The 3-yr and 7-yr survival rate for patients with severe LV dysfunction was 86.0% and 82.8%, respectively. Multivariate analysis showed that severe LV dysfunction EF increased the risk of all-cause death (P=0.012; hazard ratio [HR],2.14; 95% confidence interval [CI],1.19-3.88) and the risk of cardiac-related death (P=0.008; HR,3.38; 95% CI, 1.37-8.341). The study identified positive surgical outcomes of OPCAB, although severe LVEF was associated with two-fold increase in mortality risk compared with patients who had normal LVEF.
这项研究评估了使用复合双侧内乳动脉移植进行重度左心室功能障碍的不停跳冠状动脉旁路移植术（OPCAB）的结果。2001 年 1 月至 2008 年 12 月，1842 例患者接受了原发性单纯 OPCAB 复合双侧内乳动脉移植。其中 131 例患者术前左心室射血分数（LVEF）严重降低（≤0.35）。将这些患者的结果与 830 例轻度或中度 LVEF 降低（0.36 至 0.59）患者和 881 例 LVEF 正常（>0.6）患者的结果进行比较。严重 LVEF 患者的早期死亡率为 2.3%。严重左心室功能障碍患者的 3 年和 7 年生存率分别为 86.0%和 82.8%。多变量分析显示，严重 LVEF 降低 EF 增加了全因死亡的风险（P=0.012；风险比[HR]，2.14；95%置信区间[CI]，1.19-3.88）和与心脏相关的死亡风险（P=0.008；HR，3.38；95% CI，1.37-8.341）。研究发现 OPCAB 的手术结果为阳性，尽管与 LVEF 正常的患者相比，严重 LVEF 与死亡率增加两倍相关。
