Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
Thorac Cardiovasc Surg. 2020 Dec;68(8):679-686. doi: 10.1055/s-0039-1677834. Epub 2019 Feb 6.
Emergency coronary artery bypass grafting (CABG) in the setting of acute coronary syndrome (ACS) has been associated with increased morbidity and mortality. Avoiding cardiopulmonary bypass might be advantageous, but the role of off-pump CABG (OPCAB) remains controversial, as it has been associated with incomplete revascularization in several studies. The objective of this study was to evaluate the feasibility, efficacy, and outcome of OPCAB surgery in ACS patients.
We performed a retrospective review of ACS patients who underwent on-pump CABG (ONCAB) or OPCAB, either emergently or delayed, at our institution.
Between January 2015 and December 2016, a total of 205 consecutive ACS patients underwent either ONCAB (109 patients, 53.2%) or OPCAB surgery (96 patients, 46.8%). EuroSCORE II levels (5.6 ± 7.2 vs 4.9 ± 6.5, = 0.226) and demography were comparable between groups.A trend towards lower postoperative mortality was observed in OPCAB patients (2.1 vs 5.5%). The incidence of postoperative stroke and low cardiac output syndrome, as well as the duration of inotropic support and the need for re-sternotomy, was significantly lower in the OPCAB group ( < 0.05).CABG performed instantly in an emergency situation was not associated with increased mortality or morbidity when compared with delayed procedures, and OPCAB surgery in emergency patients was associated with lower postoperative morbidity and shorter stays in the intensive care unit ( < 0.05).There were no differences in completeness of revascularization between groups (median 1 [1-1.33;0.33-1.67] OPCAB versus median 1 (1-1.33;0.67-2) ONCAB, = 0.617), even in the emergency setting.
OPCAB surgery is safe and effective in ACS and may be considered in hemodynamically stable patients in the emergency setting.
急性冠状动脉综合征（ACS）患者行急诊冠状动脉旁路移植术（CABG）与较高的发病率和死亡率相关。避免体外循环可能具有优势，但非体外循环 CABG（OPCAB）的作用仍存在争议，因为几项研究表明其与不完全血运重建相关。本研究旨在评估 ACS 患者行 OPCAB 手术的可行性、疗效和结果。
我们对我院行急诊或择期 OPCAB 或 ONCAB 的 ACS 患者进行回顾性分析。
2015 年 1 月至 2016 年 12 月，共有 205 例 ACS 患者连续行 ONCAB（109 例，53.2%）或 OPCAB 手术（96 例，46.8%）。EuroSCORE II 评分（5.6±7.2 比 4.9±6.5， = 0.226）和患者特征在两组间相似。OPCAB 组术后死亡率呈下降趋势（2.1%比 5.5%）。OPCAB 组术后卒中、低心排综合征的发生率，以及正性肌力药物支持时间和再次开胸的需求明显较低（ < 0.05）。即刻行 CABG 急诊手术与择期手术相比，不增加死亡率或发病率，且急诊患者行 OPCAB 手术与较低的术后发病率和较短的 ICU 入住时间相关（ < 0.05）。两组间血运重建完全性无差异（中位数 1 [1-1.33；0.33-1.67] OPCAB 比中位数 1 [1-1.33；0.67-2] ONCAB， = 0.617），即使在急诊情况下也是如此。
OPCAB 手术在 ACS 中是安全有效的，并且在血流动力学稳定的患者中可考虑在急诊情况下施行。
