Piątek Jacek, Kędziora Anna, Konstanty-Kalandyk Janusz, Kiełbasa Grzegorz, Olszewska Marta, Wróbel Krzysztof, Song Bryan HyoChan, Darocha Tomasz, Wróżek Marcin, Kapelak Bogusław
Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland.
Postepy Kardiol Interwencyjnej. 2017;13(4):320-325. doi: 10.5114/aic.2017.71614. Epub 2017 Nov 29.
Coronary artery disease is nowadays responsible for approximately 15% of hospitalizations in Poland. Minimally invasive coronary artery bypass (MIDCAB) represents an attractive alternative to a sternotomy, and at the same time provides better life quality and facilitates quick rehabilitation.
To evaluate whether MIDCAB can be performed with similar early and mid-term results as off-pump coronary artery bypass (OPCAB) and therefore can be considered as a safe stage in hybrid revascularization.
In a retrospective cohort study, we analyzed 73 consecutive patients who underwent coronary artery bypass grafting (left internal mammary artery to left anterior descending artery) between 2013 and 2016 in the Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow. Thirty-eight (52.1%) MIDCAB and 35 (47.9%) OPCAB patients were enrolled.
Short-term results did not significantly differ between groups and similar 30-day mortality was observed (MIDCAB 2.6% vs. OPCAB 2.9%, = 1). The median follow-up period was 21 months. There were no statistical differences in terms of overall survival or cardiac mortality between groups (94.7% vs. 88.6%, = 0.42; 2.6% vs. 2.9%, = 1, respectively). The rate of hospitalization due to cardiac causes was similar in both groups (7.9% vs. 5.1%, = 1) and there were no differences in current exacerbation of angina or heart failure, with median NYHA class I and CCS class I in both groups.
Despite higher technical difficulty, MIDCAB procedures can be performed with similar safety results as OPCAB procedures. No differences in terms of mortality, repeat revascularization or recurrent angina are observed.
如今在波兰，冠状动脉疾病导致的住院病例约占15%。微创冠状动脉搭桥术（MIDCAB）是胸骨切开术的一种有吸引力的替代方案，同时能提供更好的生活质量并促进快速康复。
评估MIDCAB是否能取得与非体外循环冠状动脉搭桥术（OPCAB）相似的早期和中期结果，从而被视为杂交血运重建中一个安全的阶段。
在一项回顾性队列研究中，我们分析了2013年至2016年间在克拉科夫约翰·保罗二世医院心血管外科与移植科连续接受冠状动脉搭桥术（左乳内动脉至左前降支动脉）的73例患者。纳入了38例（52.1%）接受MIDCAB的患者和35例（47.9%）接受OPCAB的患者。
两组的短期结果无显著差异，观察到相似的30天死亡率（MIDCAB为2.6%，OPCAB为2.9%，P = 1）。中位随访期为21个月。两组在总生存率或心脏死亡率方面无统计学差异（分别为94.7%对88.6%，P = 0.42；2.6%对2.9%，P = 1）。两组因心脏原因住院的发生率相似（7.9%对5.1%，P = 1），且在心绞痛或心力衰竭的当前加重情况方面无差异，两组的纽约心脏协会（NYHA）分级中位数均为I级，加拿大心血管学会（CCS）分级中位数均为I级。
尽管技术难度较高，但MIDCAB手术能取得与OPCAB手术相似的安全结果。在死亡率、再次血运重建或复发性心绞痛方面未观察到差异。
