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体外循环与非体外循环冠状动脉旁路移植术中期移植血管通畅率的比较

Comparison of Mid-Term Graft Patency between On-Pump and Off-Pump Coronary Artery Bypass Grafting.

作者信息

Seki Tatsuya, Yoshida Toshihito

机构信息

Department of Cardiovascular Surgery, Japan Community Health Care Organization (JCHO) Hokkaido Hospital, Sapporo, Hokkaido, Japan.

出版信息

Ann Thorac Cardiovasc Surg. 2017 Jun 20;23(3):141-148. doi: 10.5761/atcs.oa.16-00302. Epub 2017 Apr 19.

Abstract

BACKGROUND

Multiple studies have compared on-pump coronary artery bypass (ONCAB) grafting with off-pump coronary artery bypass (OPCAB) grafting, but the optimal surgical strategy has yet to be established. Furthermore, there is limited evidence regarding mid-term graft patency rates.

METHODS

Between April 2001 and March 2014, 365 consecutive patients underwent isolated coronary artery bypass grafting (CABG; male: 75%; mean age: 69 ± 10 years). After propensity-score-matched analysis, we assessed the results of 67 patients in each group (ONCAB: group A, OPCAB: group B). The mean follow-up period of graft patency and survival rate was 35 ± 37 months and 54 ± 47 months, respectively.

RESULTS

There were no significant differences in baseline characteristics between the two groups. There was a trend for an increased number of distal anastomoses in group B as compared to group A (group A vs. group B: 3.8 ± 1.1 vs. 4.1 ± 1.6, P = 0.17). The total graft patency rate was tend to be lower in group A, but not statistically significant (group A: 156 months, 45.2%; group B: 96 months, 72.6%; P = 0.21). There was no difference for survival and major-adverse-cardiac-and-cerebrovascular-events (MACCE) free rate (P = 0.42 and 0.76, respectively).

CONCLUSION

Propensity-score-matched analysis revealed no difference in mid-term survival rate, MACCE free rate, graft patency rates, and number of distal anastomoses between ONCAB and OPCAB groups.

摘要

背景

多项研究已对体外循环冠状动脉搭桥术(ONCAB)与非体外循环冠状动脉搭桥术(OPCAB)进行了比较,但最佳手术策略尚未确立。此外,关于中期移植血管通畅率的证据有限。

方法

在2001年4月至2014年3月期间,365例连续患者接受了单纯冠状动脉搭桥术(CABG;男性:75%;平均年龄:69±10岁)。经过倾向评分匹配分析后,我们评估了每组67例患者的结果(ONCAB:A组,OPCAB:B组)。移植血管通畅率和生存率的平均随访期分别为35±37个月和54±47个月。

结果

两组之间的基线特征无显著差异。与A组相比,B组的远端吻合数量有增加趋势(A组与B组:3.8±1.1对4.1±1.6,P = 0.17)。A组的总移植血管通畅率趋于较低,但无统计学意义(A组:156个月,45.2%;B组:96个月,72.6%;P = 0.21)。生存率和无重大不良心脑血管事件(MACCE)发生率无差异(分别为P = 0.42和0.76)。

结论

倾向评分匹配分析显示,ONCAB组和OPCAB组在中期生存率、无MACCE发生率、移植血管通畅率和远端吻合数量方面无差异。

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