Sun Y X, Ding W J, Xia L M, Wang C S
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China.
Zhonghua Yi Xue Za Zhi. 2019 Apr 9;99(14):1058-1062. doi: 10.3760/cma.j.issn.0376-2491.2019.14.005.
To compare the advantages and disadvantages of total arterial revascularization (TAR) and conventional off-pump coronary artery bypass (OPCAB) grafting in patients with left ventricular dysfunction (LVD). Between January 2008 and March 2015, 76 patients who were scheduled to undergo selective OPCAB were selected for cardiac surgery in Zhongshan Hospital, Fudan University. The left ventricular ejection fraction of enrolled patients was less than 35%. Among those patients, 38 patients in TAR group underwent total arterial OPCAB with bilateral internal mammary artery, left and/or right radial artery, and another 38 patients in control group underwent conventional OPCAB with left internal mammary artery and great saphenous vein. The clinical data of all patients were collected. The follow-up was performed within 36 months. There was no significant difference in preoperative clinical data between the two groups (all 0.05). Additionally, there was no significant difference in the application rate of internal mammary artery, positive inotropic drugs and intra-aortic balloon pump (IABP) use between the two groups (all 0.05). The operation time of TAR group was longer than that of control group [(278.3±31.2) min vs (196.7±19.1) min, 0.01]. There was no significant difference in perioperative mortality between the two groups (5.3% vs 7.9%, 0.64). The volume of operative drainage and blood transfusion in TAR group increased significantly at 24 hours after operation [(895.0±236.2) ml vs (585.4±172.5) ml, (656.3±84.4) ml vs (433.3±62.9) ml, both 0.01]. There was no significant difference in perioperative complications such as heart, kidney and lung failure between the two groups (all 0.05). At 12 months after operation, there were no significant differences in survival rate, cardiac death rate, angina recurrence, myocardial infarction, re-treatment rate of revascularization, re-hospitalization rate from cardiac insufficiency, graft patency rate, cardiac function and echocardiographic data between the two groups (all 0.05). From 24 to 36 months after operation, all the above indexes in TAR group were better than those in control group except for echocardiographic data (all 0.05). For LVD patients, the early clinical efficacy of the two surgical methods is similar, but for the long-term outcomes, the whole arterial OPCAB operation is obviously superior. However, the shortcomings of total arterial OPCAB are that operative drainage and the use of blood products increased significantly after operation.
比较左心室功能不全（LVD）患者行全动脉血运重建（TAR）和传统非体外循环冠状动脉旁路移植术（OPCAB）的优缺点。2008年1月至2015年3月，复旦大学附属中山医院76例计划行选择性OPCAB的患者入选心脏手术。入选患者的左心室射血分数小于35%。其中，TAR组38例患者采用双侧乳内动脉、左和/或右桡动脉行全动脉OPCAB，对照组38例患者采用左乳内动脉和大隐静脉行传统OPCAB。收集所有患者的临床资料。随访36个月内进行。两组术前临床资料无显著差异（均P>0.05）。此外，两组乳内动脉应用率、正性肌力药物应用率和主动脉内球囊反搏（IABP）使用率无显著差异（均P>0.05）。TAR组手术时间长于对照组[（278.3±31.2）分钟对（196.7±19.1）分钟，P<0.01]。两组围手术期死亡率无显著差异（5.3%对7.9%，P=0.64）。TAR组术后24小时手术引流量和输血量显著增加[（895.0±236.2）毫升对（585.4±172.5）毫升，（656.3±84.4）毫升对（433.3±62.9）毫升，均P<0.01]。两组围手术期心脏、肾脏和肺部衰竭等并发症无显著差异（均P>0.05）。术后12个月，两组生存率、心源性死亡率、心绞痛复发率、心肌梗死、血运重建再治疗率、因心功能不全再住院率、移植血管通畅率、心功能及超声心动图数据无显著差异（均P>0.05）。术后24至36个月，除超声心动图数据外，TAR组上述所有指标均优于对照组（均P>0.05）。对于LVD患者，两种手术方法的早期临床疗效相似，但从长期结果看，全动脉OPCAB手术明显更优。然而，全动脉OPCAB的缺点是术后手术引流量和血制品使用量显著增加。
