Xia LiMin, Ji Qiang, Song Kai, Shen JinQiang, Shi YunQing, Ma RunHua, Ding WenJun, Wang ChunSheng
Shanghai Cardiovascular Disease Research Institute, 180 Fenglin Rd., Shanghai, 200032, People's Republic of China.
Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 1609 XieTu Rd., Shanghai, 200032, People's Republic of China.
J Cardiothorac Surg. 2017 Feb 23;12(1):11. doi: 10.1186/s13019-017-0572-x.
Limited experiences of applying an on-pump beating-heart technique for surgical revascularization in patients with severe left ventricular dysfunction have been reported. Which strategy, either off-pump coronary artery bypass grafting (CABG) or on-pump beating-heart CABG surgery, is the best strategy for surgical revascularization in patients with severe left ventricular dysfunction is still controversial. This single-center study aimed to evaluate the impacts of an on-pump beating-heart versus an off-pump technique for surgical revascularization on the early clinical outcomes in patients with a left ventricular ejection fraction (LVEF) of 35% or less to explore which technique would be more suitable for surgical revascularization in patients with severe left ventricular dysfunction.
A total of 216 consecutive patients with an echocardiographic estimated LVEF of 35% or less who underwent non-emergency, primary, isolated CABG from January 2010 to December 2014 were included in this study and were divided into either an ONBEAT group (patients who received on-pump beating-heart CABG surgery, n = 88) or an OFF group (patients who received off-pump CABG surgery, n = 128). The early clinical outcomes were investigated and compared.
Patients in the ONBEAT group compared to the OFF group had a significant higher early postoperative LVEF (35.6 ± 2.9 vs. 34.8 ± 3.3%, p = 0.034) but shared a similar baseline LVEF (31.0 ± 2.8 vs. 31.0 ± 2.9%, p = 0.930). Patients in the ONBEAT group compared to the OFF group received a greater number of grafts and an increased amount of drainage during the first 24 h (3.7 ± 0.8 vs. 2.8 ± 0.6, p <0.001; 715 ± 187 ml vs. 520 ± 148 ml, p <0.001, respectively), without evidence of worse in-hospital mortality or major postoperative morbidity. Additionally, logistic regression analysis showed that surgical technique (on-pump beating-heart CABG vs. off-pump CABG) had no independent influence on in-hospital mortality or major postoperative morbidity in patients with preoperative LVEF of 35% or less.
The on-pump beating-heart technique may be an acceptable alternative to the off-pump technique for surgical revascularization in patients with an estimated LVEF of 35% or less.
关于在严重左心室功能不全患者中应用体外循环心脏跳动技术进行手术血运重建的经验报道有限。对于严重左心室功能不全患者，非体外循环冠状动脉旁路移植术（CABG）或体外循环心脏跳动CABG手术哪种策略是最佳的手术血运重建策略仍存在争议。这项单中心研究旨在评估体外循环心脏跳动与非体外循环技术用于手术血运重建对左心室射血分数（LVEF）为35%或更低的患者早期临床结局的影响，以探索哪种技术更适合严重左心室功能不全患者的手术血运重建。
本研究纳入了2010年1月至2014年12月期间连续216例经超声心动图评估LVEF为35%或更低且接受非急诊、初次、孤立性CABG的患者，并将其分为ONBEAT组（接受体外循环心脏跳动CABG手术的患者，n = 88）或OFF组（接受非体外循环CABG手术的患者，n = 128）。对早期临床结局进行调查和比较。
与OFF组相比，ONBEAT组患者术后早期LVEF显著更高（35.6±2.9 vs. 34.8±3.3%，p = 0.034），但基线LVEF相似（31.0±2.8 vs. 31.0±2.9%，p = 0.930）。与OFF组相比，ONBEAT组患者在术后最初24小时内接受的移植血管数量更多，引流量增加（分别为3.7±0.8 vs. 2.8±0.6，p<0.001；715±187 ml vs. 520±148 ml，p<0.001），且没有住院死亡率增加或术后主要并发症加重的证据。此外，逻辑回归分析显示，手术技术（体外循环心脏跳动CABG与非体外循环CABG）对术前LVEF为35%或更低的患者的住院死亡率或术后主要并发症没有独立影响。
对于估计LVEF为35%或更低的患者，体外循环心脏跳动技术可能是非体外循环技术用于手术血运重建的可接受替代方案。
