Xu Z F, Ling Y P, Cui Z Q, Zhao H, Gong Y C, Fu Y H, Yang H, Wan F
Department of Cardiac Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China.
Department of Cardiac Surgery, Peking University Third Hospital, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2020 Oct 18;52(5):863-869. doi: 10.19723/j.issn.1671-167X.2020.05.011.
To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery.
Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD).
There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% 3.52%), reoperation (2.34 3.52%), new-onset atrial fibrillation rate (4.70% 3.52%) or new-onset renal insufficiency rate (1.17% 0%) between MICS CABG group and OPCABG group (>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min . (246.8±56.9) min, < 0.05], while the time of ventilator supporting(16.9 h 29.6 h), hospitalization in ICU [(29.3±20.8) h (51.5±48.3) h] and total hospitalization [(18.3±3.2) d (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group ( < 0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) 3.61%(3/83), >0.05] in 1-year follow up.
The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.
探讨微创心脏手术冠状动脉搭桥术（MICS CABG）的可行性、安全性及中期疗效。
回顾性分析2015年11月至2017年11月在北京大学第三医院行MICS CABG手术患者的数据。将结果与同期行非体外循环冠状动脉搭桥术（OPCABG）的患者进行比较。两组根据年龄、性别、左心室射血分数、体重指数、冠状动脉疾病严重程度、吸烟、糖尿病、高血压、高脂血症、肾功能不全、脑血管意外史和慢性阻塞性肺疾病（COPD）史，采用倾向评分匹配法进行匹配。
MICS CABG组85例患者，其中男性68例（80.0%），女性17例（20%），平均年龄（63.8±8.7）岁；OPCABG组纳入451例患者，按倾向评分匹配85例患者作为对照组（OPCABG组）。一般临床特征差异无统计学意义（>0.05）。MICS CABG组和OPCABG组平均移植血管数分别为2.35±0.83和2.48±0.72（P=0.284）。MICS CABG组无中转开胸，两组均未使用体外循环。MICS CABG组与OPCABG组主要不良心血管事件（MACCEs，1.17%对3.52%）、再次手术（2.34%对3.52%）、新发房颤率（4.70%对3.52%）或新发肾功能不全率（1.17%对0%）差异无统计学意义（>0.05）。MICS CABG组手术时间长于OPCABG组[（282.8±55.8）分钟对（246.8±56.9）分钟，P<0.05]，而MICS CABG组呼吸机支持时间（16.9小时对29.6小时）、ICU住院时间[（29.3±20.8）小时对（51.5±48.3）小时]和总住院时间[（18.3±3.2）天对（25.7±4.2）天]短于OPCABG组（P<0.05）。术后MICS CABG的总通畅率（A+B级）为96.5%。1年随访时两组MACCEs率差异无统计学意义[1.18%（1/85）对3.61%（3/83），>0.05]。
MICS CABG手术安全可行，早期和中期随访临床效果良好。
