Ji Qiang, Xia Li Min, Shi Yun Qing, Ma Run Hua, Shen Jin Qiang, Ding Wen Jun, Wang Chun Sheng
Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai, 180 Fenglin Rd, Shanghai, 200032, People's Republic of China.
Shanghai Institute of Cardiovascular Disease, 1609 Xietu Road, Shanghai, 200032, People's Republic of China.
J Cardiothorac Surg. 2017 Oct 10;12(1):87. doi: 10.1186/s13019-017-0651-z.
Few studies focused on evaluating the impacts of preoperative severe left ventricular dysfunction on clinical outcomes of patients undergoing off-pump coronary artery bypass grafting surgery (OPCAB). This single center retrospective study aimed to evaluate the impacts of severe left ventricular dysfunction on in-hospital and mid-term clinical outcomes of Chinese patients undergoing first, scheduled, and isolated OPCAB surgery.
From January 2010 to December 2014, 2032 eligible patients were included in this study and were divided into 3 groups: a severe group (patients with preoperative left ventricular ejection fraction (LVEF) of ≤35%, n = 128), an impaired group (patients with preoperative LVEF of 36-50%, n = 680), and a normal group (patients with preoperative LVEF of >50%, n = 1224). In-hospital and follow-up clinical outcomes were investigated and compared.
Patients in the severe group compared to the other 2 groups had higher in-hospital mortality and higher incidences of low cardiac output and prolonged ventilation. Kaplan-Meier curves showed a similar cumulative follow-up survival between the severe group and the impaired group (χ = 1.980, Log-rank p = 0.159) and between the severe group and the normal group (χ = 2.701, Log-rank p = 0.102). Multivariate Cox regression indicated that grouping was not a significant variable related to mid-term all-cause mortality. No significant difference was found in the rate of repeat revascularization between the severe group (2.4%) and the other 2 groups.
Patients with preoperative LVEF of ≤35% compared to preoperative LVEF of >35% increased the risk of in-hospital death and incidences of postoperative low cardiac output and prolonged ventilation, but shared similar mid-term all-cause mortality and repeat revascularization after OPCAB surgery.
很少有研究关注术前严重左心室功能不全对非体外循环冠状动脉搭桥手术（OPCAB）患者临床结局的影响。这项单中心回顾性研究旨在评估严重左心室功能不全对首次接受计划性孤立OPCAB手术的中国患者的住院期间及中期临床结局的影响。
2010年1月至2014年12月，本研究纳入了2032例符合条件的患者，并将其分为3组：严重组（术前左心室射血分数（LVEF）≤35%的患者，n = 128）、受损组（术前LVEF为36 - 50%的患者，n = 680）和正常组（术前LVEF>50%的患者，n = 1224）。对住院期间及随访的临床结局进行调查和比较。
与其他两组相比，严重组患者的住院死亡率更高，低心排血量和通气时间延长的发生率更高。Kaplan-Meier曲线显示，严重组与受损组之间（χ = 1.980，对数秩检验p = 0.159）以及严重组与正常组之间（χ = 2.701，对数秩检验p = 0.102）的累积随访生存率相似。多因素Cox回归表明，分组不是与中期全因死亡率相关的显著变量。严重组（2.4%）与其他两组之间的再次血运重建率无显著差异。
术前LVEF≤35%的患者与术前LVEF>35%的患者相比，住院死亡风险增加，术后低心排血量和通气时间延长的发生率增加，但在OPCAB术后的中期全因死亡率和再次血运重建方面相似。
