Miao Na, Yang Feng, Du Zhongtao, Jiang Chunjing, Hao Xing, Wang Jinhong, Jiang Yu, Yang Xiaofang, Xie Haixiu, Hou Xiaotong
Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anding Road, Chaoyang District, Beijing 100029, China.
Perfusion. 2017 Oct;32(7):554-560. doi: 10.1177/0267659117705193. Epub 2017 Apr 20.
A number of large-scale retrospective studies revealed that off-pump coronary artery bypass (OPCAB) was superior to on-pump coronary artery bypass (ONCAB). The aim of the study was to investigate risk factors for mortality when OPCAB is converted to ONCAB.
Patients who underwent OPCAB conversion to ONCAB at the Beijing Anzhen Hospital between January 2003 and January 2013 were assigned to the non-survivor and survivor groups. Background demographics, illness history and preoperative, intraoperative and postoperative variables were compared.
Of the 247 cases, 15.4% of the patients died. Patients in the non-survivor group were older and more frequently had diabetes mellitus (DM), arrhythmia, myocardial infarction (MI) in the past 30 days (all p<0.05) and MI combined with mitral regurgitation (p<0.0001); they more frequently had bigger left ventricular end-diastolic dimension (p=0.0019), greater fall in blood pressure, ventricular fibrillation for longer periods, longer conversion time and bypass graft occlusion. All patients in the non-survivor group received intra-aortic balloon pump compared to 89.5% in the survivor group and extracorporeal membrane oxygenation was more common. Left main coronary artery disease (OR=4.431, 95%CI: 2.440-8.048, p<0.0001), blood pressure decline ⩽40 mmHg (OR=0.509, 95%CI: 0.447-0.580, p<0.0001) and time for conversion to ONCAB ⩾20 min were independently associated with mortality. Rates of postoperative complications, such as renal failure, cerebral infarction or hemorrhage, MI and redo sternotomy, were higher in the non-survivor group.
Conversion from OPCAB to ONCAB is associated with high mortality. Risk factors include left main artery disease and duration of blood pressure decline >40 min.
多项大规模回顾性研究表明，非体外循环冠状动脉搭桥术（OPCAB）优于体外循环冠状动脉搭桥术（ONCAB）。本研究旨在探讨OPCAB转为ONCAB时的死亡危险因素。
将2003年1月至2013年1月在北京安贞医院接受OPCAB转为ONCAB手术的患者分为非存活组和存活组。比较两组患者的基本人口统计学特征、病史以及术前、术中和术后变量。
247例患者中，15.4%死亡。非存活组患者年龄更大，更常患有糖尿病（DM）、心律失常、过去30天内心肌梗死（MI）（所有p<0.05）以及MI合并二尖瓣反流（p<0.0001）；他们更常出现左心室舒张末期内径更大（p=0.0019）、血压下降幅度更大、室颤持续时间更长、转换时间更长以及旁路移植血管闭塞。非存活组所有患者均接受了主动脉内球囊反搏，而存活组为89.5%，且体外膜肺氧合更常见。左主干冠状动脉疾病（OR=4.431，95%CI：2.440-8.048，p<0.0001）、血压下降≤40 mmHg（OR=0.509，95%CI：0.447-0.580，p<0.0001）以及转为ONCAB的时间≥20分钟与死亡率独立相关。非存活组术后并发症发生率更高，如肾衰竭、脑梗死或出血、MI以及再次开胸手术。
OPCAB转为ONCAB与高死亡率相关。危险因素包括左主干动脉疾病和血压下降持续时间>40分钟。
