Taggart David P
Department of Cardiovascular Surgery, University of Oxford, Oxford, UK.
J Thorac Dis. 2016 Nov;8(Suppl 10):S829-S831. doi: 10.21037/jtd.2016.10.104.
Although popularised over two decades ago off-pump coronary artery bypass grafting (OPCABG) has seen a decrease in utilisation especially over the last decade. This has been due to publication of a number of trials which suggested inferior outcomes with OPCABG. However, the validity of the findings in these trials has been questioned on the basis of doubts over operator experience as witnessed by large numbers of cross-overs. Two more recent large randomised trials have shown very similar outcomes between on and off-pump surgery up to 1- and 5-year outcomes are imminently due. Furthermore several meta-analyses have reported that OPCABG reduces mortality, myocardial infarction and major morbidity in higher risk patients. Consequently there is a clear rationale for OPCABG in certain cohorts of patients and especially when combined with a no touch aortic technique in those with significant disease of the ascending aorta. The article discusses the importance of routine performance of OPCABG if it is to produce high quality results and especially in higher risk patients.
尽管非体外循环冠状动脉旁路移植术(OPCABG)在二十多年前就已普及,但近年来其应用率有所下降,尤其是在过去十年。这是因为一些试验结果表明OPCABG的预后较差。然而,这些试验结果的有效性受到质疑,原因是大量交叉病例显示手术医生的经验存在疑问。最近的两项大型随机试验表明,体外循环和非体外循环手术的预后非常相似,1年和5年的结果即将公布。此外,多项荟萃分析报告称,OPCABG可降低高危患者的死亡率、心肌梗死发生率和主要并发症发生率。因此,对于某些特定患者群体,尤其是升主动脉严重病变患者采用非接触主动脉技术时,OPCABG具有明确的理论依据。本文讨论了要获得高质量结果,常规开展OPCABG的重要性,尤其是对于高危患者。