Formica Francesco, Tata Giuseppe, Singh Gurmeet, Mariani Serena, D'Alessandro Stefano, Messina Luigi Amerigo, Sangalli Fabio, Paolini Giovanni
Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Via G.B. Pergolesi 33, 20052, Monza, MB, Italy.
Cardiac Surgery Unit, Niguarda Hospital, Milano, Italy.
Heart Vessels. 2018 Jun;33(6):595-604. doi: 10.1007/s00380-017-1106-0. Epub 2017 Dec 12.
This study aimed to assess if clampless off-pump coronary artery bypass grafting (OPCAB) decreases the incidence of perioperative stroke (POS) rate and in-hospital mortality. The secondary aim was to evaluate 12-year rates of overall mortality. Between January 2003 to December 2015, data of 645 consecutive patients undergoing isolated CABG were retrospectively collected. 363 underwent aortic no-touch OPCAB (No-touch group) and 282 underwent OPCAB with the Heartstring device (HS group). In-hospital mortality and perioperative stroke rate as primary endpoint, as well as long-term follow-up outcome were analysed. In-hospital mortality was lower into No-touch group compared with HS group but without significant statistical difference (1.7 vs. 3.2%, p = 0.19, respectively); the rate of postoperative stroke was higher in No-touch group compared with HS group, although this difference did not reach statistically significance. Delirium was reported with higher presentation rate in HS group (3.9 vs. 0.8%, p = 0.01). Blood transfusions rate was higher in HS subjects (23.4 vs. 16.1%, p = 0.01). Intubation time, ICU, and hospital length of stay were increased in the HS group (p = 0.008, p = 0.001 and p = 0.003, respectively). Over a 12-year follow-up period, survival probabilities at 1, 5, and 10 years were 93.6 ± 1.3 vs. 93.2 ± 1.5, 80.4 ± 2.6 vs. 80.3 ± 2.2, and 57.9 ± 5 vs. 58.4 ± 3.8% in the No-touch and HS group, respectively (p = 0.97). In this retrospective study, clampless off-pump CABG lowers perioperative stroke rate whose incidence is, however, not inferior compared with No-touch technique, and no statistically significance was detected. Delirium has a higher presentation rate in clampless off-pump CABG.
本研究旨在评估非体外循环冠状动脉旁路移植术（OPCAB）无钳夹操作是否能降低围手术期卒中（POS）发生率和院内死亡率。次要目的是评估12年总体死亡率。在2003年1月至2015年12月期间，回顾性收集了645例连续接受单纯冠状动脉旁路移植术患者的数据。363例行主动脉非接触式OPCAB（非接触组），282例行使用Heartstring装置的OPCAB（HS组）。分析院内死亡率和围手术期卒中率作为主要终点，以及长期随访结果。非接触组的院内死亡率低于HS组，但无显著统计学差异（分别为1.7%对3.2%，p = 0.19）；非接触组术后卒中率高于HS组，尽管这种差异未达到统计学显著性。HS组谵妄发生率较高（3.9%对0.8%，p = 0.01）。HS组患者输血率较高（23.4%对16.1%，p = 0.01）。HS组插管时间、重症监护病房（ICU）和住院时间均延长（分别为p = 0.008、p = 0.001和p = 0.003）。在12年的随访期内，非接触组和HS组1年、5年和10年的生存概率分别为93.6±1.3%对93.2±1.5%、80.4±2.6%对80.3±2.2%、57.9±5%对58.4±3.8%（p = 0.97）。在这项回顾性研究中，非体外循环冠状动脉旁路移植术无钳夹操作可降低围手术期卒中率，但其发生率与非接触技术相比并不低，且未检测到统计学显著性。非体外循环冠状动脉旁路移植术无钳夹操作谵妄发生率较高。
