From the Internal Medicine Residency Program, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
Section of Cardiology, University of Chicago Medical Center, Chicago, Illinois.
ASAIO J. 2020 Jan;66(1):32-37. doi: 10.1097/MAT.0000000000000956.
Left ventricular assist devices (LVADs) have become a mainstay of therapy for advanced heart failure. Although selected patients undergo concomitant coronary artery bypass grafting (CABG) at the time of LVAD implantation, the detailed implication of this combined surgical approach is not yet well studied. In this study, all ischemic cardiomyopathy patients who underwent concomitant CABG during LVAD implantation between 2010 and 2016 were enrolled. A control group matching for age, gender, and device type, were selected. Of 79 LVAD patients finally included, 28 patients underwent concomitant CABG (CABG group); whereas 51 did not (non-CABG group). There was no difference in the baseline characteristics between groups. There was a trend toward longer cardiopulmonary bypass time in the CABG group (169 vs. 147 min; p = 0.09). One month survival in the CABG group was significantly lower than the non-CABG group (75.0% vs. 94.1%; p = 0.014). No difference in the occurrence of ventricular arrhythmias was detected between the groups, nor was there a difference in the incidence or severity of right ventricular failure. Concomitant CABG surgery during LVAD implantation may carry significant perioperative mortality, and addition of CABG to LVAD surgery may be performed only in strictly selected cases.
左心室辅助装置（LVAD）已成为治疗晚期心力衰竭的主要方法。虽然一些患者在植入 LVAD 时同时进行冠状动脉旁路移植术（CABG），但这种联合手术方法的详细影响尚未得到很好的研究。在这项研究中，纳入了 2010 年至 2016 年间植入 LVAD 时同时进行 CABG 的所有缺血性心肌病患者。选择了年龄、性别和装置类型匹配的对照组。最终纳入 79 例 LVAD 患者，其中 28 例患者同时进行 CABG（CABG 组）；而 51 例患者未进行 CABG（非 CABG 组）。两组间基线特征无差异。CABG 组体外循环时间较长（169 分钟 vs. 147 分钟；p = 0.09）。CABG 组术后 1 个月生存率明显低于非 CABG 组（75.0% vs. 94.1%；p = 0.014）。两组间室性心律失常的发生率无差异，右心衰竭的发生率或严重程度也无差异。LVAD 植入时同时进行 CABG 手术可能会导致显著的围手术期死亡率，并且仅在严格选择的病例中才可以将 CABG 术式加入 LVAD 手术中。
