Bristol Heart Institute, University of Bristol, School of Clinical Sciences, Bristol, United Kingdom.
Academic Cardiac Surgery Group, National Heart & Lung Institute, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, United Kingdom.
Int J Cardiol. 2017 Nov 1;246:32-36. doi: 10.1016/j.ijcard.2017.04.087. Epub 2017 May 9.
We sought to compare the incidence of incomplete revascularization (IR) and long-term survival (up to 20years) after off-pump (OPCAB) versus on-pump (ONCAB) coronary artery bypass in a high OPCAB volume centre where OPCAB was introduced in 1996 and has become the preferred strategy over the years.
From 1996 to 2015 a total of 7,427 OPCAB and 7128 ONCAB procedures were performed at Bristol Heart Institute, United Kingdom. We obtained 5423 propensity matched pairs for final comparison. Mixed effect Cox model accounting for clustering due to different surgeon was used to investigate the treatment effect on mortality.
OPCAB was associated with higher rate of incomplete revascularization 13.3% versus 6.7%; P<0.0001). Mean follow-up time was 7.8±4.6year [max 17.3]. At 12years OPCAB was associated with a marginal but significant +3% increase in overall mortality (67.4%[95%CI 65.8-69.1] vs 64.4%[95%CI 62.7-66.2]; stratified log-rank P=0.03). When compared to ONCAB with complete revascularization, OPCAB with IR (HR 1.74;95%CI 1.53-1.99; P<0.001) and ONCAB with IR (HR 1.29; 95%CI 1.06-1.57; P=0.01) but not OPCAB with complete revascularization (HR 1.02;95%CI 0.94-1.11; P=0.63) were associated with increased risk of late mortality.
Despite completeness of revascularization was achieved in the majority of OPCAB cases, OPCAB remained associated with a significantly higher rate of incomplete revascularization. This translated into a marginal but significant reduction in late survival rates after OPCAB when compared to ONCAB.
我们旨在比较 1996 年引入并在多年后成为首选策略的非体外循环冠状动脉旁路移植术（OPCAB）与体外循环冠状动脉旁路移植术（ONCAB）后不完全血运重建（IR）的发生率和长期生存（最长 20 年）。
1996 年至 2015 年，英国布里斯托尔心脏研究所共进行了 7427 例 OPCAB 和 7128 例 ONCAB 手术。我们获得了 5423 对最终比较的倾向匹配对。使用混合效应 Cox 模型，考虑到不同外科医生的聚类，调查了死亡率的治疗效果。
OPCAB 与更高的不完全血运重建率相关（13.3% vs 6.7%；P<0.0001）。平均随访时间为 7.8±4.6 年[最长 17.3 年]。在 12 年时，OPCAB 与整体死亡率增加了 3%（67.4%[95%CI 65.8-69.1] vs 64.4%[95%CI 62.7-66.2]；分层对数秩 P=0.03）。与完全血运重建的 ONCAB 相比，IR 的 OPCAB（HR 1.74；95%CI 1.53-1.99；P<0.001）和 IR 的 ONCAB（HR 1.29；95%CI 1.06-1.57；P=0.01），而不是完全血运重建的 OPCAB（HR 1.02；95%CI 0.94-1.11；P=0.63），与晚期死亡率增加相关。
尽管 OPCAB 手术中的大多数患者都实现了血运重建的完整性，但 OPCAB 仍与更高的不完全血运重建率显著相关。与 ONCAB 相比，这导致 OPCAB 后晚期生存率略有下降。
