Seki Tatsuya, Yoshida Toshihito
Department of Cardiovascular Surgery, Japan Community Health Care Organization (JCHO) Hokkaido Hospital, Sapporo, Hokkaido, Japan.
Ann Thorac Cardiovasc Surg. 2017 Jun 20;23(3):141-148. doi: 10.5761/atcs.oa.16-00302. Epub 2017 Apr 19.
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.
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.
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).
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.
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。
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。
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)。
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。