Dimberg Axel, Alström Ulrica, Janiec Mikael
Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, Uppsala, Sweden.
Department of Surgical Sciences, Section of Thoracic Surgery, Uppsala University, Uppsala, Sweden.
Interact Cardiovasc Thorac Surg. 2019 Feb 1;28(2):214-221. doi: 10.1093/icvts/ivy245.
Re-exploration for bleeding after cardiac surgery increases the risk of other severe postoperative complications and early mortality. Patients re-explored for bleeding after coronary artery bypass grafting are potentially subject to threats to graft patency. Our goal was to assess the effects of re-exploration for bleeding regarding the incidence of coronary angiographies, the need for coronary reintervention and mortality during long-term follow-up.
Within the SWEDEHEART registry, all isolated coronary artery bypass operations with a single internal mammary artery and saphenous vein graft in patients aged 40-80 between the years 2005 and 2015 were identified. Incidences of coronary angiography and the subsequent need for coronary reintervention were recorded, and multivariable adjusted hazard ratios (HRs) were calculated.
The study cohort consisted of 27 957 patients, and the mean follow-up time was 6.5 ± 3.1 years. The incidence of re-exploration for bleeding was 3.8% (n = 1071). The cumulative incidence [95% confidence interval (CI)] of a clinically occurring coronary angiography within 1 year after surgery was 7.8% (6.3-9.7) in re-explored and 4.8% (4.6-5.1) in non-re-explored patients, and the adjusted HR was 1.64 (1.31-2.06), (P < 0.001). The cumulative incidence of the need for coronary reintervention within 1 year (95% CI) was 4.9% (3.7-6.4) in re-explored and 2.6% (2.4-2.8) in non-re-explored patients, and the adjusted HR was 1.91 (1.43-2.56). No difference in incidence or hazard ratio was observed beyond the first year. Mortality rate was increased within but not beyond 90 days after surgery.
Re-exploration for bleeding is associated with an increased risk for the need of repeat coronary reintervention during the first year after coronary artery bypass surgery.
心脏手术后因出血进行再次手术会增加术后出现其他严重并发症及早期死亡的风险。冠状动脉旁路移植术后因出血进行再次手术的患者，其移植血管通畅性可能受到威胁。我们的目标是评估因出血进行再次手术对长期随访期间冠状动脉造影发生率、再次进行冠状动脉介入治疗的必要性及死亡率的影响。
在瑞典心脏注册研究中，确定了2005年至2015年间年龄在40 - 80岁、采用单根乳内动脉和大隐静脉移植进行单纯冠状动脉旁路移植手术的所有患者。记录冠状动脉造影的发生率及随后进行冠状动脉再次介入治疗的必要性，并计算多变量调整风险比（HRs）。
研究队列包括27957例患者，平均随访时间为6.5±3.1年。因出血进行再次手术的发生率为3.8%（n = 1071）。再次手术患者术后1年内临床发生冠状动脉造影的累积发生率[95%置信区间（CI）]为7.8%（6.3 - 9.7），未再次手术患者为4.8%（4.6 - 5.1），调整后的HR为1.64（1.31 - 2.06），（P < 0.001）。再次手术患者术后1年内需要进行冠状动脉再次介入治疗的累积发生率（95% CI）为4.9%（3.7 - 6.4），未再次手术患者为2.6%（2.4 - 2.8），调整后的HR为1.91（1.43 - 2.56）。术后第1年之后，在发生率或风险比方面未观察到差异。术后90天内死亡率升高，但90天之后未升高。
冠状动脉旁路移植术后第1年，因出血进行再次手术与再次进行冠状动脉介入治疗需求增加的风险相关。
