Kim Do Jung, Lee Seung Hyun, Joo Hyun-Chel, Yoo Kyung-Jong, Youn Young-Nam
Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine.
Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine.
Int Heart J. 2019 May 30;60(3):593-600. doi: 10.1536/ihj.17-283. Epub 2019 Apr 25.
Severe aortic atherosclerosis is a risk factor for stroke during coronary artery bypass grafting (CABG). The purpose of this study was to evaluate the incidence of postoperative neurologic complications after off-pump CABG (OPCAB) with a proximal seal system (Heartstring).From January 2011 to December 2014, 729 patients underwent isolated OPCAB. The cohort was divided into two groups (Heartstring [HS] and aortic no-touch [NT]). The severity of aortic atherosclerosis (Katz grade) was evaluated by intraoperative epiaortic ultrasonography (EUS). The primary endpoints were postoperative neurologic complications (early stroke and minor events (delirium, transient ischemic attack, and syncope) ), and the secondary endpoints were late major adverse cardiac and cerebrovascular events (MACCEs) and death.The mean age of all patients was 65.1 ± 9.5 years, and a severe Katz grade (IV or V) was demonstrated to be an independent risk factor of long-term mortality (HR 3.53; 95% CI 1.06-11.75; P = 0.04) and MACCEs (HR 2.41; 95% CI 1.19-4.92; P = 0.02), but no significant differences were found for early stroke (0.9% versus 1.7%; P = 0.53) and minor neurologic complications (14.6% versus 9.9%; P = 0.05) between the groups regardless of the Katz grade. The 5-year overall survival rate did not differ significantly between the groups (90.9% versus 87.6%; P = 0.61).Although a higher Katz grade was identified as an independent risk factor of death and MACCEs, the HS group was not inferior in terms of neurologic complications regardless of the Katz grade. Therefore, the Heartstring system might be safely and efficiently used with EUS to decrease the incidence of neurologic complications.
严重主动脉粥样硬化是冠状动脉旁路移植术（CABG）期间发生卒中的一个危险因素。本研究的目的是评估使用近端封闭系统（Heartstring）的非体外循环冠状动脉旁路移植术（OPCAB）术后神经并发症的发生率。2011年1月至2014年12月，729例患者接受了单纯OPCAB。该队列被分为两组（Heartstring [HS]组和主动脉免接触[NT]组）。通过术中主动脉超声（EUS）评估主动脉粥样硬化的严重程度（Katz分级）。主要终点是术后神经并发症（早期卒中以及轻微事件（谵妄、短暂性脑缺血发作和晕厥）），次要终点是晚期主要不良心脑血管事件（MACCEs）和死亡。所有患者的平均年龄为65.1±9.5岁，Katz分级严重（IV级或V级）被证明是长期死亡率（HR 3.53；95%CI 1.06 - 11.75；P = 0.04）和MACCEs（HR 2.41；95%CI 1.19 - 4.92；P = 0.02）的独立危险因素，但无论Katz分级如何，两组之间早期卒中（0.9%对1.7%；P = 0.53）和轻微神经并发症（14.6%对9.9%；P = 0.05）均未发现显著差异。两组之间的5年总生存率无显著差异（90.9%对87.6%；P = 0.61）。尽管较高的Katz分级被确定为死亡和MACCEs的独立危险因素，但无论Katz分级如何，HS组在神经并发症方面并不逊色。因此，Heartstring系统与EUS联合使用可能安全有效地降低神经并发症的发生率。
