Kirmani Bilal H, Brazier Andrew, Sriskandarajah Sanjeevan, Alshawabkeh Zeyad, Gurung Lokesh, Azzam Raed, Keenan Daniel J M, Hasan Ragheb, Abunasra Haitham
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Department of Cardiothoracic Surgery, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
Ann Thorac Surg. 2016 Jul;102(1):22-7. doi: 10.1016/j.athoracsur.2016.04.003. Epub 2016 Jun 1.
The aim of this study was to compare the long-term survival rates of patients undergoing isolated first-time coronary artery bypass grafting (CABG) by off-pump CABG with the long-term survival rates in patients undergoing CABG using cardioplegic cardiopulmonary bypass techniques.
All patients undergoing isolated CABG at a single center (Manchester Heart Centre, Manchester, United Kingdom) between 2000 and 2014 were included. Propensity score matching was performed on the basis of on demographic variables. The in-hospital morbidity and long-term all-cause mortality rates for matched patients were compared.
A total of 8,055 patients were identified, with a median follow-up of 7.0 years. With patients matched for preoperative patient characteristics, there was no significant difference in long-term survival between cardiopulmonary bypass and off-pump CABG (n = 2,082 each; 11.5 years vs 11.3 years; p = 0.178). In the off-pump CABG group, there were significantly fewer in-hospital cerebrovascular complications (0.5% vs 1.1%; p = 0.017), and mean length of stay was shorter (7.6 days vs 8.1 days; p < 0.0001). Arterial conduit use was significantly higher in the off-pump group, with more right mammary artery grafts (16.3% vs 4.3%; p < 0.0001) and sequential grafts (27.1% vs 13.5%; p < 0.0001). The mean number of grafts was higher in the on-pump group (3.28 ± 0.94 vs 3.10 ± 1.10; p < 0.0001).
Long-term survival after off-pump CABG is not inferior to long-term survival after on-pump CABG despite a lower mean number of grafts. A statistically significant difference in cerebrovascular complications may be related to conduit choice and reduced aortic manipulation.
本研究旨在比较首次单纯冠状动脉旁路移植术（CABG）采用非体外循环CABG患者的长期生存率与采用心脏停搏体外循环技术进行CABG患者的长期生存率。
纳入2000年至2014年期间在单一中心（英国曼彻斯特曼彻斯特心脏中心）接受单纯CABG的所有患者。根据人口统计学变量进行倾向评分匹配。比较匹配患者的院内发病率和长期全因死亡率。
共识别出8055例患者，中位随访时间为7.0年。术前患者特征匹配的患者中，体外循环和非体外循环CABG的长期生存率无显著差异（每组n = 2082例；11.5年对11.3年；p = 0.178）。在非体外循环CABG组中，院内脑血管并发症显著较少（0.5%对1.1%；p = 0.017），平均住院时间较短（7.6天对8.1天；p < 0.0001）。非体外循环组动脉移植物的使用显著更高，右乳内动脉移植物更多（16.3%对4.3%；p < 0.0001），序贯移植物更多（27.1%对13.5%；p < 0.0001）。体外循环组的平均移植物数量更高（3.28 ± 0.94对3.10 ± 1.10；p < 0.0001）。
尽管平均移植物数量较少，但非体外循环CABG后的长期生存率并不低于体外循环CABG后的长期生存率。脑血管并发症的统计学显著差异可能与移植物选择和主动脉操作减少有关。
