Jiang Yefan, Xu Li, Liu Yuqi, Deng Bowen, Dong Nianguo, Chen Si
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
The First Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Thorac Dis. 2021 Jul;13(7):4185-4194. doi: 10.21037/jtd-21-268.
Beating-heart on-pump coronary artery bypass grafting (CABG), otherwise known as BH-ONCAB, can reduce myocardial injury by preserving native coronary blood flow while maintaining hemodynamic stability by the effective support of cardiopulmonary bypass (CPB). This study aimed to identify whether BH-ONCAB confers a survival, mortality, or morbidity benefit over off-pump CABG (OPCAB).
A systematic literature review identified 18 studies incorporating 5,615 patients (1,548 BH-ONCAB and 4,067 OPCAB cases) who satisfied the inclusion criteria. Outcome measures were meta-analyzed using random-effects modeling. Between-study heterogeneity was investigated through quality assessment and risk of bias analysis.
The results demonstrated comparable early mortality and long-term survival between BH-ONCAB and OPCAB coronary revascularization with no significant statistical differences. The incidences of stroke, renal failure, blood loss, and arrhythmias were significantly higher in patients who underwent BH-ONCAB than patients who underwent OPCAB. However, BH-ONCAB conferred lower rates of incomplete revascularization and greater numbers of distal anastomoses.
BH-ONCAB is a safe and comparable alternative to OPCAB in terms of early mortality and late survival. BH-ONCAB may confer particular advantages in preventing incomplete revascularization and allowing more distal anastomoses compared to OPCAB. However, BH-ONCAB was associated with more postoperative complications due to the use of CPB. Future work should focus on larger matched studies and multicenter randomized controlled trials to optimize our surgical revascularization strategies.
心脏不停跳体外循环冠状动脉旁路移植术（CABG），又称BH-ONCAB，可通过保留冠状动脉血流来减少心肌损伤，同时通过体外循环（CPB）的有效支持维持血流动力学稳定。本研究旨在确定BH-ONCAB与非体外循环冠状动脉旁路移植术（OPCAB）相比，是否在生存、死亡率或发病率方面具有优势。
一项系统的文献综述纳入了18项研究，共5615例患者（1548例BH-ONCAB和4067例OPCAB病例），这些患者均符合纳入标准。采用随机效应模型对结果指标进行荟萃分析。通过质量评估和偏倚风险分析来研究研究间的异质性。
结果表明，BH-ONCAB和OPCAB冠状动脉血运重建术的早期死亡率和长期生存率相当，无显著统计学差异。接受BH-ONCAB的患者中风、肾衰竭、失血和心律失常的发生率显著高于接受OPCAB的患者。然而，BH-ONCAB的血管重建不完全率较低，远端吻合数量较多。
在早期死亡率和晚期生存率方面，BH-ONCAB是一种安全且与OPCAB相当的替代方法。与OPCAB相比，BH-ONCAB在预防血管重建不完全和允许更多远端吻合方面可能具有特殊优势。然而，由于使用CPB，BH-ONCAB术后并发症更多。未来的工作应侧重于更大规模的匹配研究和多中心随机对照试验，以优化我们的手术血运重建策略。
