Hu Z, Yuan X, Chen S P, Song Y H, Wang W, Wang S Y, Wang L Q, Feng W, Liu S, Sun H S
Department of Cardiovascular Surgery, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Information Center, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2021 Feb 24;49(2):158-164. doi: 10.3760/cma.j.cn112148-20200721-00576.
To compare the short-term outcomes between off-pump and on-pump coronary artery bypass graft (CABG) by experienced surgeons with similar surgical team in a single large-volume cardiac surgery center. A total of 31 075 patients with multivessel coronary disease who underwent isolated off-pump or on-pump CABG between January 1, 2009 and December 31, 2019 by experienced surgeons in Fuwai hospital were enrolled in this retrospective study. Patients was divided into on-pump CABG group and on-pump CABG group on an intention-to treat basis. Short term safety endpoints, including 30 days mortality, composite endpoint of major morbidity or mortality, prolonged postoperative length of stay (PLOS), and prolonged ICU length of stay (PICULOS), and distal anastomosis were compared between the two groups. Mortality was evaluated on 30 days post operation, other endpoints were collected before discharge. After 1∶1 propensity-score matching of baseline characteristics for on-pump and off-pump CABG, postoperative endpoints were compared with use of McNemar's test and further adjusted with the use of a logistic regression model. After propensity-score matching, 10 243 matched pairs of patients were included in the final analysis, there were 4 605(22.5%) females and mean age was (60.7±8.6) years. The standardized differences were less than 5% for all baseline variables in matched cohort. Univariate analysis indicated lower risk of 30 days mortality (0.2% vs. 0.7%, <0.001), major morbidity or mortality (5.7% vs. 8.8%, <0.001), PLOS (3.2% vs. 4.9%, <0.001), PICULOS (9.4% vs. 12.2, <0.001), and lower number of distal anastomosis ((3.3±0.8) vs. (3.6±0.8), <0.001) in off-pump CABG group than in on-pump CABG group. After adjustment of cofounders, multivariate analysis showed that off-pump CABG was still associated with a lower risk of 30 days mortality (=0.29, 95% 0.09-0.87, 0.027), composite endpoint of major morbidity or mortality (=0.60, 95% 0.53-0.68, <0.001), PLOS (=0.64, 95% 0.54-0.75, <0.001), PICULOS (=0.76, 95% 0.69-0.84, <0.001). Off-pump CABG is related with superior short-term safety outcomes than on-pump CABG by experienced surgeons in our center.
在一个大型心脏手术中心，由经验丰富的外科医生带领相似的手术团队，比较非体外循环冠状动脉旁路移植术（CABG）和体外循环冠状动脉旁路移植术的短期疗效。本回顾性研究纳入了2009年1月1日至2019年12月31日期间在阜外医院由经验丰富的外科医生进行孤立非体外循环或体外循环冠状动脉旁路移植术的31075例多支冠状动脉疾病患者。患者按意向性治疗原则分为体外循环冠状动脉旁路移植术组和非体外循环冠状动脉旁路移植术组。比较两组的短期安全终点，包括30天死亡率、主要发病率或死亡率的复合终点、术后住院时间延长（PLOS）、重症监护病房住院时间延长（PICULOS）以及远端吻合情况。死亡率在术后30天评估，其他终点在出院前收集。对体外循环和非体外循环冠状动脉旁路移植术的基线特征进行1∶1倾向评分匹配后，采用McNemar检验比较术后终点，并进一步使用逻辑回归模型进行调整。倾向评分匹配后，最终分析纳入了10243对匹配患者，其中女性4605例（22.5%），平均年龄为（60.7±8.6）岁。匹配队列中所有基线变量的标准化差异均小于5%。单因素分析表明，非体外循环冠状动脉旁路移植术组30天死亡率（0.2%对0.7%，<0.001）、主要发病率或死亡率的复合终点（5.7%对8.8%，<0.001）、PLOS（3.2%对4.9%，<0.001）、PICULOS（9.4%对12.2，<0.001）以及远端吻合数量（（3.3±0.8）对（3.6±0.8），<0.001）均低于体外循环冠状动脉旁路移植术组。在对混杂因素进行调整后，多因素分析显示非体外循环冠状动脉旁路移植术仍与较低的30天死亡率风险相关（=0.29，95% 0.09 - 0.87，0.027）、主要发病率或死亡率的复合终点（=0.60，95% 0.53 - 0.68，<0.001）、PLOS（=0.64，95% 0.54 - 0.75，<0.001）、PICULOS（=0.76，95% 0.69 - 0.84，<0.001）。在我们中心，经验丰富的外科医生进行的非体外循环冠状动脉旁路移植术与体外循环冠状动脉旁路移植术相比，具有更好的短期安全结局。
