Velioglu Yusuf, Isik Mehmet
Department of Cardiovascular Surgery, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey.
Department of Cardiovascular Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.
Thorac Cardiovasc Surg. 2019 Oct;67(7):546-553. doi: 10.1055/s-0039-1679923. Epub 2019 Mar 5.
The current study analyzed and compared early-term outcomes of off-pump versus on-pump beating heart coronary artery bypass surgery.
From January 2011 to January 2018, a total of 736 patients underwent isolated first-time elective beating-heart coronary artery bypass surgery without the use of aortic cross-clamping and cardioplegic arrest at our institution, and they were included in this study. Data of patients were collected and retrospectively analyzed. Patients were divided into two groups according to the use of cardiopulmonary bypass during the operation, as off-pump group ( = 399) and on-pump beating-heart group ( = 337). Both groups were compared with each other in terms of preoperative, intraoperative, and postoperative data.
Groups were statistically similar with regard to baseline clinical characteristics and demographics. When compared with off-pump group, on-pump beating-heart group had a greater number of distal bypass, longer length of hospital stay, and lower postoperative hematocrit level, and received more blood product transfusion. No statistically significant differences were detected between the groups with respect to mortality and postoperative complications except for atrial fibrillation. Atrial fibrillation was significantly frequent in on-pump beating-heart group.
Our study suggested that off-pump and on-pump beating-heart coronary artery bypass procedures had similar early mortality and major complication rates except for atrial fibrillation. However, it seemed that off-pump procedure was superior to on-pump beating-heart procedure with regard to length of hospital stay, blood product transfusion, and atrial fibrillation development. Further prospective randomized studies with larger patient series are needed to support our research and attain more accurate data.
本研究分析并比较了非体外循环与体外循环心脏不停跳冠状动脉搭桥手术的早期结果。
2011年1月至2018年1月，共有736例患者在我院接受了首次择期非体外循环心脏不停跳冠状动脉搭桥手术，未使用主动脉交叉钳夹和心脏停搏液，这些患者被纳入本研究。收集患者数据并进行回顾性分析。根据手术中是否使用体外循环将患者分为两组，即非体外循环组（n = 399）和体外循环心脏不停跳组（n = 337）。对两组患者的术前、术中和术后数据进行比较。
两组在基线临床特征和人口统计学方面在统计学上相似。与非体外循环组相比，体外循环心脏不停跳组的远端搭桥数量更多、住院时间更长、术后血细胞比容水平更低，且接受的血制品输注更多。除房颤外，两组在死亡率和术后并发症方面未检测到统计学显著差异。体外循环心脏不停跳组房颤的发生率明显更高。
我们的研究表明，非体外循环和体外循环心脏不停跳冠状动脉搭桥手术除房颤外，早期死亡率和主要并发症发生率相似。然而，在住院时间、血制品输注和房颤发生方面，非体外循环手术似乎优于体外循环心脏不停跳手术。需要进一步进行更大样本量的前瞻性随机研究来支持我们的研究并获得更准确的数据。
