再次冠状动脉旁路移植术的中期结果及血管造影通畅情况：非体外循环与体外循环手术的比较
Mid-Term Outcomes and Angiographic Patency of Redo Coronary Artery Bypass Grafting: A Comparison between Off-Pump and On-Pump Surgery.
作者信息
Sohn Suk Ho, Kim Seung Hyun, Hwang Ho Young, Kim Ki-Bong
机构信息
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
出版信息
J Chest Surg. 2021 Apr 5;54(2):106-116. doi: 10.5090/jcs.20.122.
BACKGROUND
We evaluated the mid-term outcomes and angiographic patency of redo coronary artery bypass grafting (CABG).
METHODS
Of 2,851 patients who underwent isolated CABG at Seoul National University Hospital from 2000 to 2017, 88 underwent redo CABG. Patients' mean age at redo CABG was 66.0±8.0 years. The mean interval between the first-time and redo CABG was 113.0±62.4 months. The mean follow-up duration was 86 months. Early and mid-term clinical outcomes were evaluated. Angiographic patency rates were evaluated early (1-2 days), 1 year, and 5 years after surgery. Comparative analyses between on-pump and off-pump CABG were also performed.
RESULTS
The culprits for reoperation were previous grafts (65.6%), native coronary vessels (17.8%), and both (16.7%). Off-pump CABG was performed in 75 cases (85.2%), and the mean number of distal anastomoses was 1.8±0.8. The saphenous vein (39.7%) was used most frequently, followed by the right internal thoracic artery (28.4%), right gastroepiploic artery (21.3%), left internal thoracic artery (7.8%), and radial artery (2.8%). Operative mortality was 1.1%. The overall survival, cumulative incidence of cardiac death, and cumulative incidence of major adverse cardiac events were 71.3%,12.0%, and 23.3% at 5 years after surgery, respectively. The overall angiographic patency rates were 95.7%, 90.1%, and 92.2% on early, 1-year, and 5-year angiograms, respectively. The angiographic patency rates of saphenous vein grafts were 93.1%, 85.6%, and 91.3% on early, 1-year, and 5-year angiograms, respectively. No significant differences in clinical outcomes or angiographic patency rates were observed between the on-pump (n=13) versus off-pump (n=75) groups. Multivariable analysis revealed that age (hazard ratio [HR], 1.07; p=0.005) and chronic kidney disease (HR, 3.85; p=0.001) were risk factors for all-cause mortality.
CONCLUSION
Redo CABG could mostly be performed using the off-pump technique and did not show increased operative mortality and morbidities.
背景
我们评估了再次冠状动脉旁路移植术（CABG）的中期结果和血管造影通畅率。
方法
在2000年至2017年于首尔国立大学医院接受单纯CABG的2851例患者中，88例接受了再次CABG。再次CABG时患者的平均年龄为66.0±8.0岁。首次CABG与再次CABG之间的平均间隔时间为113.0±62.4个月。平均随访时间为86个月。评估了早期和中期临床结果。在术后早期（1 - 2天）、1年和5年评估血管造影通畅率。还对体外循环和非体外循环CABG进行了比较分析。
结果
再次手术的原因是既往移植血管（65.6%）、自身冠状动脉血管（17.8%）以及两者皆有（16.7%）。75例（85.2%）患者接受了非体外循环CABG，远端吻合口的平均数量为1.8±0.8个。大隐静脉（39.7%）使用最为频繁，其次是右胸廓内动脉（28.4%）、右胃网膜动脉（21.3%）、左胸廓内动脉（7.8%）和桡动脉（2.8%）。手术死亡率为1.1%。术后5年的总生存率、心源性死亡累积发生率和主要不良心脏事件累积发生率分别为71.3%、12.0%和23.3%。早期、1年和5年血管造影的总体通畅率分别为95.7%、90.1%和92.2%。大隐静脉移植血管在早期、1年和5年血管造影时的通畅率分别为93.1%、85.6%和91.3%。体外循环组（n = 13）与非体外循环组（n = 75）之间在临床结果或血管造影通畅率方面未观察到显著差异。多变量分析显示年龄（风险比[HR]，1.07；p = 0.005）和慢性肾脏病（HR，3.85；p = 0.001）是全因死亡率的危险因素。
结论
再次CABG大多可采用非体外循环技术进行，且未显示手术死亡率和发病率增加。
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