Sakakura Reo, Asai Tohru, Suzuki Tomoaki, Kinoshita Takeshi, Enomoto Masahide, Kondo Yasuo, Shiraishi Shoichiro
Division of Cardiovascular Surgery, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
Division of Cardiovascular Surgery, Kusatsu General Hospital, Kusatsu, Japan.
Gen Thorac Cardiovasc Surg. 2019 Jun;67(6):510-517. doi: 10.1007/s11748-018-1053-4. Epub 2018 Dec 17.
To assess the effects of concomitant coronary artery bypass grafting (CABG), we analyzed the outcomes after aortic valve replacement (AVR) for aortic stenosis (AS) with and without coronary artery bypass grafting (CABG) at our institution.
Between 2002 and 2014, 605 consecutive patients underwent AVR for AS. Of these, the 275 who received isolated AVR (Group A) and the 122 who received both AVR and CABG (Group AC) patients were enrolled, after the exclusion of 8 patients who underwent reoperation and 200 who received other concomitant surgery. AVR and all bypass anastomoses were performed under intermittent retrograde cold blood cardioplegia. Multivariate analysis was used to assess any association of concomitant CABG with morbidity and mortality. Kaplan-Meier analysis was used to assess all-cause mortality.
No significant difference in 30-day mortality was found between Group A and Group AC (1.5% vs. 0.8%, P = 1.000). Nor did post-discharge survival differ significantly between the two groups (P = 0.20). Likewise, multivariate analysis showed that concomitant CABG was not associated with significantly greater in-hospital or mid-term mortality. Operative morbidities were comparable between the two groups, in terms of stroke (1.8% vs. 3.3%, P = 0.466), prolonged ventilation (4.0% vs. 5.5%, P = 0.565), deep sternal infection (1.8% vs. 3.3%, P = 0.466), and acute renal failure (0.4% vs. 1.6% P = 0.176).
Concomitant CABG at the time of AVR was performed without increasing early- or mid-term mortality. This absence of increased risk deserves consideration when choosing between different treatment strategies.
为评估同期冠状动脉旁路移植术（CABG）的效果，我们分析了本院有或无冠状动脉旁路移植术（CABG）的主动脉瓣置换术（AVR）治疗主动脉狭窄（AS）后的结局。
2002年至2014年间，605例连续患者接受了AS的AVR治疗。其中，排除8例再次手术患者和200例接受其他同期手术患者后，纳入275例接受单纯AVR的患者（A组）和122例接受AVR及CABG的患者（AC组）。AVR和所有旁路吻合均在间歇性逆行冷血心脏停搏下进行。采用多变量分析评估同期CABG与发病率和死亡率之间的任何关联。采用Kaplan-Meier分析评估全因死亡率。
A组和AC组30天死亡率无显著差异（1.5%对0.8%，P = 1.000）。两组出院后生存率也无显著差异（P = 0.20）。同样，多变量分析显示同期CABG与院内或中期死亡率显著升高无关。两组手术发病率相当，在卒中方面（1.8%对3.3%，P = 0.466）、通气延长方面（4.0%对5.5%，P = 0.565）、深部胸骨感染方面（1.8%对3.3%，P = 0.466）以及急性肾衰竭方面（0.4%对1.6%，P = 0.176）。
AVR时同期进行CABG并未增加早期或中期死亡率。在选择不同治疗策略时，这种无风险增加的情况值得考虑。
