Seese Laura, Sultan Ibrahim, Wang Yisi, Navid Forozan, Kilic Arman
Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Card Surg. 2020 Aug;35(8):1793-1801. doi: 10.1111/jocs.14688. Epub 2020 Jul 6.
This study evaluates the longitudinal impacts of off-pump coronary artery bypass (OPCAB) surgery in patients with reduced left ventricular ejection fraction (LVEF).
Adults with LVEF ≤ 30% undergoing coronary artery bypass grafting between 2011 and 2020 were included. Patients were stratified based on the utilization of cardiopulmonary bypass into OPCAB or on-pump coronary artery bypass (ONCAB) groups. Primary outcomes included survival and hospital readmissions. Secondary outcomes evaluated postoperative morbidities. Multivariable regression evaluated risk-adjusted mortality and readmission. Propensity score matching was utilized to reduce bias.
A total of 660 low LVEF patients were included, of which 28.5% (n = 188) were OPCAB and 71.5% (n = 472) were ONCAB. The rates of complete revascularization were similar between the groups (80.3% vs 82.0%; P = .67). Early survival between the unmatched groups was similar at 1-year follow-up (86.2% vs 87.9%; P = .53); however, at 5 years OPCABs had significantly worse survival compared with ONCABs (71.5% vs 64.2%; P = .02). These findings persisted in the matched cohort where survival at 1 year was comparable (86.8% vs 85.7%; P = .80), but 5-year survival was better for ONCABs (64.1% vs 69.9%; P = .03). The rates of readmission were similar between the unmatched and matched groups at all time intervals, including readmissions for cardiac-related and heart failure-related events (all, P > .05).
In contemporary patients with reduced LVEF, survival after OPCAB was similar at 1 year but lower at 5-year follow-up compared with ONCAB, despite similar rates of complete revascularization. These findings suggest that there may be other factors influencing longitudinal mortality in the low LVEF cohort, beyond the use of cardiopulmonary bypass.
本研究评估了非体外循环冠状动脉搭桥术（OPCAB）对左心室射血分数（LVEF）降低患者的长期影响。
纳入2011年至2020年间接受冠状动脉搭桥术且LVEF≤30%的成年人。根据是否使用体外循环将患者分为OPCAB组或体外循环冠状动脉搭桥术（ONCAB）组。主要结局包括生存率和再次入院情况。次要结局评估术后发病率。多变量回归评估风险调整后的死亡率和再次入院率。采用倾向评分匹配以减少偏倚。
共纳入660例低LVEF患者，其中28.5%（n = 188）为OPCAB组，71.5%（n = 472）为ONCAB组。两组的完全血运重建率相似（80.3%对82.0%；P = 0.67）。在1年随访时，未匹配组之间的早期生存率相似（86.2%对87.9%；P = 0.53）；然而，在5年时，OPCAB组的生存率显著低于ONCAB组（71.5%对64.2%；P = 0.02）。这些结果在匹配队列中仍然存在，1年时的生存率相当（86.8%对85.7%；P = 0.80），但ONCAB组的5年生存率更高（64.1%对69.9%；P = 0.03）。在所有时间间隔内，未匹配组和匹配组的再次入院率相似，包括心脏相关和心力衰竭相关事件的再次入院率（所有P>0.05）。
在当代LVEF降低的患者中，尽管完全血运重建率相似，但OPCAB术后1年生存率与ONCAB相似，但5年随访时较低。这些发现表明，除了使用体外循环外，可能还有其他因素影响低LVEF队列的长期死亡率。
