Ji Qiang, Zhao Yun, Zhu Kai, Song Kai, Shen Jinqiang, Wang Yulin, Yang Ye, Ding Wenjun, Xia Limin, Wang Chunsheng
Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China.
J Thorac Dis. 2019 Apr;11(4):1325-1335. doi: 10.21037/jtd.2019.03.79.
Although complete revascularization (CR) has been a goal of surgical revascularization, comorbidities and anatomical variables often conspire against a successful surgical CR. Currently, incomplete revascularization (IR) has been also considered as an acceptable strategy of surgical revascularization in some categories of patients. In the past decade, off-pump coronary artery bypass grafting (CABG) became one of the mainstream procedures of CABG due to its low incidence of perioperative complications. However, the magnitude of the impacts of off-pump IR on clinical outcomes of patients with triple-vessel disease remained unclear.
Eligible patients who received isolated off-pump CABG with left internal mammary artery (LIMA) grafting to the left anterior descending coronary artery (LAD) in our institute from January 2011 to December 2013 were entered into an IR group or a CR group. The incidence of off-pump IR was investigated. In-hospital and follow-up outcomes were also evaluated by adjusting baseline characteristics using propensity score matching (1:1).
A total of 1,349 patients (268 in the IR group and 1,081 in the CR group) were analyzed. The off-pump IR rate was 19.9%. Using matching propensity scores, 234 pairs were successfully established in a 1:1 manner. The two matched groups had similar surgical mortality and major postoperative morbidity. Multivariate Cox regression analysis showed that IR was not an independent predictor of cardiac death at follow-up (HR =1.215; 95% CI, 0.883-2.164; P=0.371). The two matched groups received a similar cumulative survival freedom from repeat revascularization in Kaplan-Meier curves (χ=2.120, log-rank P=0.145).
CR can be achieved in the majority of off-pump CABG cases. Compared with off-pump CR, off-pump IR with the LIMA grafting to the LAD was associated with acceptable clinical outcomes.
尽管完全血运重建（CR）一直是外科血运重建的目标，但合并症和解剖学变量常常不利于成功实施外科完全血运重建。目前，不完全血运重建（IR）在某些类型的患者中也被视为外科血运重建的一种可接受策略。在过去十年中，非体外循环冠状动脉旁路移植术（CABG）因其围手术期并发症发生率低而成为CABG的主流手术方式之一。然而，非体外循环不完全血运重建对三支血管病变患者临床结局的影响程度仍不明确。
2011年1月至2013年12月在我院接受非体外循环下冠状动脉左前降支（LAD）孤立性CABG并采用左乳内动脉（LIMA）移植的符合条件患者被纳入不完全血运重建组或完全血运重建组。调查非体外循环不完全血运重建的发生率。还通过倾向评分匹配（1:1）调整基线特征来评估住院期间和随访结局。
共分析了1349例患者（不完全血运重建组268例，完全血运重建组1081例）。非体外循环不完全血运重建率为19.9%。使用匹配倾向评分，以1:1的方式成功建立了234对匹配组。两组匹配组的手术死亡率和主要术后发病率相似。多因素Cox回归分析显示，不完全血运重建不是随访时心脏死亡的独立预测因素（HR =1.215；95%CI，0.883 - 2.164；P =0.371）。在Kaplan-Meier曲线中，两组匹配组在免于再次血运重建方面的累积生存率相似（χ=2.120，对数秩检验P =0.145）。
大多数非体外循环CABG病例可实现完全血运重建。与非体外循环完全血运重建相比，采用LIMA移植至LAD的非体外循环不完全血运重建具有可接受的临床结局。
