非体外循环冠状动脉旁路移植术中升主动脉近端吻合器的使用。

Device Use for Proximal Anastomosis on Ascending Aorta in Off-Pump Coronary Artery Bypass Grafting.

机构信息

Division of Cardiovascular Surgery, Sakura Medical Center, Toho University, Chiba, Japan.

Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.

出版信息

Ann Thorac Surg. 2021 Jun;111(6):1909-1915. doi: 10.1016/j.athoracsur.2020.08.016. Epub 2020 Oct 13.

DOI:10.1016/j.athoracsur.2020.08.016

PMID:33065052

Abstract

BACKGROUND

We recently reported early postoperative results comparing the use of an anastomosis-assist device with a side-biting clamp for ascending aorta during coronary artery bypass grafting (CABG). Transient neurological complications occurred less often with the device. Here, we evaluated the perioperative safety of the device compared with the aorta no-touch technique (no-touch).

METHODS

We evaluated patients listed in the Japan Adult Cardiovascular Surgery Database who received isolated off-pump CABG with either the device or the no-touch approach from 2014 to 2016. We performed a one-to-one matched analysis based on a propensity score modeled from patient demographics, comorbidities, cardiac conditions, and procedural characteristics. We compared early outcomes in both groups using Pearson's chi-square or Wilcoxon rank sum test as appropriate; P less than .05 was statistically significant.

RESULTS

Among 9546 device and 6890 no-touch patients, we found 5012 patient matches for each group. The device operation time was significantly longer (293 versus 281 minutes; P < .001) and homologous transfusion was significantly greater (56.9% versus 51.0%; P < .001) than with no-touch. Thirty-day operative mortality (1.5% versus 1.7%; P = .34), morbidity and mortality (6.8% versus 7.5%; P = .17), and stroke (0.9% versus 1.1%; P = .36) were similar in both groups. New-onset atrial fibrillation (11.9% versus 10.3%; P = .01) occurred significantly more often with the device. Newly initiated dialysis (1.4% versus 1.9%; P = .051) was more frequent with no-touch whereas reoperation for graft occlusion was more frequent with the device (1.0% versus 0.6%; P = .06) but was not significant for either outcome.

CONCLUSIONS

The clinical safety of use of the device in CABG was comparable to no-touch for mortality and morbidity. Hemostasis may be a key issue for accomplishing higher-level quality control when devices are used in proximal anastomosis of CABG.

摘要

背景

我们最近报告了比较使用吻合辅助装置与侧咬钳在冠状动脉旁路移植术（CABG）中处理升主动脉的早期术后结果。使用装置的患者发生短暂性神经并发症的情况较少。在这里，我们评估了与主动脉非接触技术（非接触）相比，该装置的围手术期安全性。

方法

我们评估了 2014 年至 2016 年期间在日本成人心血管外科学数据库中接受单纯非体外循环 CABG 的患者，他们使用该装置或非接触方法。我们根据患者人口统计学、合并症、心脏状况和手术特征建立的倾向评分进行一对一匹配分析。我们使用 Pearson's chi-square 或 Wilcoxon 秩和检验比较两组的早期结果；P 值小于.05 表示具有统计学意义。

结果

在 9546 例使用装置的患者和 6890 例使用非接触的患者中，我们为每组找到了 5012 例患者匹配。装置手术时间明显较长（293 分钟比 281 分钟；P <.001），同源输血明显较多（56.9%比 51.0%；P <.001）。30 天手术死亡率（1.5%比 1.7%；P =.34）、发病率和死亡率（6.8%比 7.5%；P =.17）以及卒中（0.9%比 1.1%；P =.36）在两组之间相似。装置组新发心房颤动（11.9%比 10.3%；P =.01）更常见。非接触组新开始透析的比例（1.4%比 1.9%；P =.051）更高，而装置组因移植闭塞再次手术的比例（1.0%比 0.6%；P =.06）更高，但这两种结果都没有统计学意义。