Imasaka Ken-Ichi, Tomita Yukihiro, Morita Shigeki, Shiose Akira
Department of Cardiovascular Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Department of Cardiovascular Surgery, Shimonoseki City Hospital, 1-13-1 Koyocho, Shimonoseki, 750-8520 Japan.
Indian J Thorac Cardiovasc Surg. 2020 Nov;36(6):572-579. doi: 10.1007/s12055-020-01013-z. Epub 2020 Aug 11.
We aimed to compare the surgical outcome between total arch replacement with coronary bypass surgery and that without.
Between 2008 and 2016, 157 consecutive patients underwent total arch replacement with antegrade cerebral perfusion and moderate hypothermic circulatory arrest using the proximal first approach. They were divided into two groups: total arch replacement with coronary bypass surgery (group 1, = 38) and that without (group 2, = 119).
Of the 38 patients in group 1, 37 (97%) were asymptomatic. The left internal thoracic artery and saphenous vein were used in one (2.6%) and 38 (100%) patients, respectively. The mean number of coronary anastomoses was 1.5 ± 1.0. In-hospital mortality rate was 3.8%. Cardiopulmonary bypass time and operation time in group 1 were significantly longer than those in group 2 (336 ± 52 min vs. 276 ± 38 min, < 0.0001 and 702 ± 122 min vs. 619 ± 94 min, < 0.0001, respectively). No differences in in-hospital mortality and perioperative myocardial infarction were found between the groups (5.3% vs. 3.4%, = 0.633 and 0% vs. 1.7%, = 1.000, respectively). In the multivariate analysis, age (odds ratio, 1.208; 95% confidence interval, 1.041-1.497; = 0.008) and cardiopulmonary bypass time (odds ratio, 1.019; 95% confidence interval, 1.001-1.041; = 0.041) were significant determinants of in-hospital mortality.
Although prolonged cardiopulmonary bypass time was a significant determinant of in-hospital mortality, total arch replacement with coronary bypass surgery could be safely performed with favorable outcomes.
我们旨在比较全弓置换联合冠状动脉搭桥手术与不联合冠状动脉搭桥手术的手术效果。
2008年至2016年期间，157例连续患者采用近端优先入路，在顺行脑灌注和中度低温循环停止下接受全弓置换。他们被分为两组：全弓置换联合冠状动脉搭桥手术组（第1组，n = 38）和不联合冠状动脉搭桥手术组（第2组，n = 119）。
第1组的38例患者中，37例（97%）无症状。分别有1例（2.6%）和38例（100%）患者使用了左胸廓内动脉和大隐静脉。冠状动脉吻合的平均数量为1.5±1.0。住院死亡率为3.8%。第1组的体外循环时间和手术时间显著长于第2组（分别为336±52分钟对276±38分钟，P<0.0001；702±122分钟对619±94分钟，P<0.0001）。两组之间在住院死亡率和围手术期心肌梗死方面未发现差异（分别为5.3%对3.4%，P = 0.633；0%对1.7%，P = 1.000）。在多因素分析中，年龄（比值比，1.208；95%置信区间，1.041 - 1.497；P = 0.008）和体外循环时间（比值比，1.019；95%置信区间，1.001 - 1.041；P = 0.041）是住院死亡率的重要决定因素。
尽管延长的体外循环时间是住院死亡率的重要决定因素，但全弓置换联合冠状动脉搭桥手术仍可安全进行，且效果良好。
