非体外循环与体外循环再次冠状动脉旁路移植术：系统评价和荟萃分析。

Off-pump versus on-pump redo coronary artery bypass grafting: a systematic review and meta-analysis.

机构信息

Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.

Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.

出版信息

Perfusion. 2021 Oct;36(7):724-736. doi: 10.1177/0267659120960310. Epub 2020 Oct 4.

DOI:10.1177/0267659120960310

PMID:33016239

Abstract

BACKGROUND

Redo coronary artery bypass grafting (redo CABG) is associated with increased mortality and morbidity. The aim of this study was to systematically evaluate the evidence comparing the outcomes of off-pump with on-pump redo CABG.

METHODS

Studies were systematically searched and identified using PubMed, EMBASE, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) by two researchers independently. The primary outcome was 30-day mortality, and the secondary outcomes were in-hospital mortality, post-operative complications, completeness of revascularization, blood transfusion rate, duration of mechanical ventilation, intensive care unit and hospital stays.

RESULTS

The 21 studies including 4,889 patients were enrolled in our meta-analysis. Compared with on-pump, the off-pump technique was associated with significantly reduced 30-day mortality (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.26-0.72, p = 0.001). Moreover, a notably decreased in-hospital mortality (OR = 0.55, 95% CI = 0.39-0.76, p = 0.0004) and incidence of post-operative new-onset atrial fibrillation, myocardial infarction, acute kidney injury, low cardiac output state, blood transfusion rate (OR = 0.46, 95% CI = 0.35-0.60, p < 0.00001; OR = 0.54, 95% CI = 0.38-0.78, p = 0.0007; OR = 0.51, 95% CI = 0.37-0.70, p < 0.0001; OR = 0.31, 95% CI = 0.20-0.47, p < 0.00001; OR = 0.29, 95% CI = 0.14-0.61, p = 0.001) and significantly shortened duration of mechanical ventilation, intensive care unit and hospital stays (mean difference [MD] = -8.21 h, 95% CI = -11.74 to -4.68, p < 0.00001; MD = -0.77 d, 95% CI = -0.81 to -0.73, p < 0.00001; MD = -2.24 d, 95% CI = -3.17 to -1.32, p < 0.00001) could be observed when comparing the outcomes of off-pump with on-pump redo CABG. There was nonsignificant difference between off-pump and on-pump redo CABG in completeness of revascularization.

CONCLUSION

In patients undergoing redo CABG surgery, the off-pump technique was associated with decreased mortality, less post-operative complications when compared to on-pump.

摘要

背景

再次冠状动脉旁路移植术（redo CABG）与死亡率和发病率增加有关。本研究旨在系统评估比较非体外循环与体外循环 redo CABG 结果的证据。

方法

两名研究人员使用 PubMed、EMBASE、Cochrane 图书馆和国际临床试验注册平台（ICTRP）系统地搜索和确定研究。主要结果是 30 天死亡率，次要结果是住院死亡率、术后并发症、再血管化完整性、输血率、机械通气时间、重症监护病房和住院时间。

结果

共纳入 21 项研究，包括 4889 例患者。与体外循环相比，非体外循环技术显著降低了 30 天死亡率（比值比 [OR] = 0.43，95%置信区间 [CI] = 0.26-0.72，p = 0.001）。此外，住院死亡率显著降低（OR = 0.55，95%CI = 0.39-0.76，p = 0.0004），术后新发心房颤动、心肌梗死、急性肾损伤、低心输出量状态、输血率（OR = 0.46，95%CI = 0.35-0.60，p < 0.00001；OR = 0.54，95%CI = 0.38-0.78，p = 0.0007；OR = 0.51，95%CI = 0.37-0.70，p < 0.0001；OR = 0.31，95%CI = 0.20-0.47，p < 0.00001；OR = 0.29，95%CI = 0.14-0.61，p = 0.001），机械通气、重症监护病房和住院时间明显缩短（平均差值 [MD] = -8.21 h，95%CI = -11.74 至 -4.68，p < 0.00001；MD = -0.77 d，95%CI = -0.81 至 -0.73，p < 0.00001；MD = -2.24 d，95%CI = -3.17 至 -1.32，p < 0.00001），当比较非体外循环与体外循环 redo CABG 的结果时。非体外循环与体外循环 redo CABG 之间在再血管化完整性方面无显著差异。