Li Sen, Gong Wenhui, Qi Quan, Yuan Zezhe, Chen Anqing, Liu Jun, Cai Junfeng, Zhou Mi, Wang Zhe, Ye Xiaofeng, Zhao Qiang
Department of Cardiac Surgery, Ruijin Hospital, Shanghai Jiao Tong University School, Shanghai 200025, China.
Ann Transl Med. 2016 Sep;4(18):340. doi: 10.21037/atm.2016.08.49.
Currently, off-pump coronary artery bypass (OPCAB) grafting has been the standard procedure for surgical revascularization in patients with coronary artery disease (CAD). This study aimed to examine the safety and applicability of OPCAB compared with on-pump coronary artery bypass (ONCAB) in patients with severely dilated left ventricle.
A retrospective study of giant left ventricle patients [left ventricular end diastolic diameter (LVEDD) ≥ VE mm] undergoing coronary bypass grafting from 2009 through 2015 at a single center was conducted. Preoperative and intraoperative risk factors, and postoperative outcomes were analyzed. Survival analysis was carried to analyze survival rate during follow-up.
A total of 24 patients underwent ONCAB, and 26 underwent OPCAB. Both groups had similar preoperative profiles. Two cases from each group died during in-hospital time. In comparison to OPCAB, there was longer operation and post-surgery intubation time and more renal dysfunction in ONCAB group (P<0.05). One-year survival between OPCAB and ONCAB were not significantly different (87.5% . 92.3%, P>0.05).
OPCAB is a safe and feasible alternative for CAD patients with giant left ventricle, offering a significant advantage over ONCAB with regards to renal function, operation duration and length of ventilation.
目前，非体外循环冠状动脉搭桥术（OPCAB）已成为冠心病（CAD）患者外科血运重建的标准术式。本研究旨在探讨在左心室严重扩张的患者中，OPCAB与体外循环冠状动脉搭桥术（ONCAB）相比的安全性和适用性。
对2009年至2015年在单中心接受冠状动脉搭桥术的巨大左心室患者[左心室舒张末期内径（LVEDD）≥VE mm]进行回顾性研究。分析术前和术中危险因素及术后结果。进行生存分析以分析随访期间的生存率。
共有24例患者接受ONCAB，26例接受OPCAB。两组术前情况相似。每组各有2例患者在住院期间死亡。与OPCAB相比，ONCAB组手术时间和术后插管时间更长，肾功能不全更多（P<0.05）。OPCAB和ONCAB的1年生存率无显著差异（87.5%对92.3%，P>0.05）。
对于巨大左心室的CAD患者，OPCAB是一种安全可行的替代方案，在肾功能、手术持续时间和通气时间方面比ONCAB具有显著优势。
