体外循环与非体外循环冠状动脉旁路移植术治疗多支冠状动脉血运重建
On-pump versus off-pump coronary artery bypass surgery for multi-vessel coronary revascularization.
作者信息
Zubarevich Alina, Kadyraliev Bakytbek, Arutyunyan Vagram, Chragyan Vahe, Askadinov Magomedganipa, Sozkov Artem, Ponomarev Danil, Zyazeva Irina, Oliveira Sá Michel Pompeu Barros, Osswald Anja, Tsagakis Konstantinos, Wendt Daniel, Ruhparwar Arjang, Weymann Alexander, Zhigalov Konstantin
机构信息
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
Department of Cardiovascular Surgery, S.G. Sukhanov Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical University, Perm, Russian Federation.
出版信息
J Thorac Dis. 2020 Oct;12(10):5639-5646. doi: 10.21037/jtd-20-1284.
BACKGROUND
This study aims to compare the operative and postoperative results of on-pump (ONCAB) and off-pump (OPCAB) coronary artery bypass surgery (CABG) for multi-vessel coronary revascularization (≥4 anastomoses).
METHODS
From May 2018 to August 2019, a total of 120 patients (22.5% women, mean age 61.5±8.4 years) received either ONCAB (Group 1, n=60) or OPCAB (Group 2, n=60) for multi-vessel coronary artery disease (CAD). Preoperative left ventricular (LV) ejection fraction (EF) was 53.1%±8.4%. Median EuroSCORE II was 1.59 (interquartile range, 1.01-2.54). The median number of performed coronary anastomoses was 4 (interquartile range, 4-5), with equal distribution in both groups (P=0.4). All procedures were performed by highly experienced surgeons. The primary endpoints were overall survival at 30 days and freedom from severe adverse events (SAE), which included myocardial infarction (MI), coronary artery re-operation, and re-thoracotomy, caused by bleeding and stroke.
RESULTS
The overall survival in both groups was 100% with no intraoperative OPCAB-to-on-pump conversion. The median procedure time was 169 min (interquartile range, 150-179 min) for Group 1 and 183 min (interquartile range, 169-205 min) for Group 2 (P<0.001). The overall freedom from SAE numbered 93.3% (98.3% 88.3%, P=0.030). Postoperative MI rate was 2.5% (n=3) with no significant difference for either group (0 5.0%, P=0.100). One MI patient underwent a re-operation, and two other patients received a conservative treatment. A total of 2.5% (n=3) of patients underwent a re-thoracotomy on account of bleeding (0 5.0%, P=0.100); no anastomosis-related bleeding was detected. Blood transfusion was applied in 31.7% of patients (38.3% 25.0%, P=0.090). A total of 1.7% of patients (1.7% 1.7%, P=0.800) developed a stroke. Ventilation time, intensive care unit stay, and hospital stay were similar in both groups.
CONCLUSIONS
ONCAB showed superior freedom from SAE and shorter procedure times when compared to OPCAB for multi-vessel coronary artery revascularization.
背景
本研究旨在比较体外循环冠状动脉搭桥术（ONCAB）和非体外循环冠状动脉搭桥术（OPCAB）用于多支冠状动脉血运重建（≥4个吻合口）的手术及术后结果。
方法
2018年5月至2019年8月，共有120例患者（女性占22.5%，平均年龄61.5±8.4岁）因多支冠状动脉疾病（CAD）接受了ONCAB（第1组，n = 60）或OPCAB（第2组，n = 60）治疗。术前左心室（LV）射血分数（EF）为53.1%±8.4%。欧洲心脏手术风险评估系统（EuroSCORE）II中位数为1.59（四分位间距，1.01 - 2.54）。所进行的冠状动脉吻合口数量中位数为4（四分位间距，4 - 5），两组分布相同（P = 0.4）。所有手术均由经验丰富的外科医生进行。主要终点为30天总体生存率和无严重不良事件（SAE），严重不良事件包括心肌梗死（MI）、冠状动脉再次手术以及因出血和中风导致的再次开胸手术。
结果
两组总体生存率均为100%，且术中无OPCAB转为体外循环的情况。第1组手术时间中位数为169分钟（四分位间距，150 - 179分钟），第2组为183分钟（四分位间距，169 - 205分钟）（P < 0.001）。总体无严重不良事件发生率为93.3%（98.3%对88.3%，P = 0.030）。术后MI发生率为2.5%（n = 3），两组间无显著差异（0对5.0%，P = 0.100）。1例MI患者接受了再次手术，另外2例患者接受了保守治疗。共有2.5%（n = 3）的患者因出血接受了再次开胸手术（0对5.0%，P = 0.100）；未检测到与吻合口相关的出血。31.7%的患者接受了输血（38.3%对25.0%，P = 0.090）。共有1.7%（1.7%对1.7%，P = 0.800）的患者发生了中风。两组的通气时间、重症监护病房停留时间和住院时间相似。
结论
对于多支冠状动脉血运重建，与OPCAB相比，ONCAB显示出更低的严重不良事件发生率和更短的手术时间。
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