Weiss Marc Gjern, Nielsen Per Hostrup, James Stefan, Thelin Stefan, Modrau Ivy Susanne
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark.
Dept. of Medical Sciences, Uppsala University, Uppsala, Sweden.
Semin Thorac Cardiovasc Surg. 2023 Summer;35(2):228-236. doi: 10.1053/j.semtcvs.2021.12.002. Epub 2021 Dec 5.
Previous studies have demonstrated superior patency of no-touch as compared to conventional saphenous vein grafts in coronary artery bypass grafting. We aimed to compare mid-term clinical outcomes of both techniques in a large cohort of routine patients. We identified all patients undergoing nonemergent primary coronary artery bypass grafting with either no-touch or conventional saphenous vein grafts at our institution between 2000 and 2020. Propensity score matching was used to create adjusted cohorts based on 5288 eligible patients. The primary outcome was the combined endpoint of all-cause mortality and repeat revascularization. Secondary outcomes were individual rates of all-cause mortality and repeat revascularization, surgical complications, and short-term mortality. Propensity score matching resulted in cohorts of no-touch (n = 923) and conventional (n = 923) saphenous vein grafted patients with comparable baseline characteristics. Mean follow-up time was significantly shorter for the no-touch compared to the conventional cohort (4.9 ± 2.3 vs 8.3 ± 2.6 years, P < 0.001). Up to 7-year follow-up, neither the rate of the primary composite endpoint nor death differed significantly between the cohorts. The rate of repeat revascularization was significantly higher in patients in the no-touch cohort (12.9% vs 9.3% at 7-year follow-up, P = 0.022. Post-hoc analysis of percutaneous coronary intervention during follow-up revealed comparable rates of saphenous vein graft failure (no-touch 42/923 (4.6%) vs conventional 32/923 (3.5%), P = 0.286). In this large propensity score matched registry study, coronary artery bypass with no-touch compared to conventional saphenous vein grafting did neither enhance mid-term survival nor reduce the rate of repeat revascularization.
先前的研究表明，在冠状动脉旁路移植术中，非接触式隐静脉移植的通畅率优于传统隐静脉移植。我们旨在比较这两种技术在一大群常规患者中的中期临床结局。我们确定了2000年至2020年间在我们机构接受非急诊原发性冠状动脉旁路移植术且采用非接触式或传统隐静脉移植的所有患者。倾向评分匹配用于根据5288名符合条件的患者创建调整后的队列。主要结局是全因死亡率和再次血运重建的联合终点。次要结局是全因死亡率和再次血运重建的个体发生率、手术并发症和短期死亡率。倾向评分匹配产生了具有可比基线特征的非接触式（n = 923）和传统（n = 923）隐静脉移植患者队列。与传统队列相比，非接触式队列的平均随访时间明显更短（4.9±2.3年对8.3±2.6年，P<0.001）。长达7年的随访中，各队列之间的主要复合终点发生率和死亡率均无显著差异。非接触式队列患者的再次血运重建率显著更高（7年随访时为12.9%对9.3%，P = 0.022）。随访期间经皮冠状动脉介入治疗的事后分析显示，隐静脉移植失败率相当（非接触式42/923（4.6%）对传统32/923（3.5%），P = 0.286）。在这项大型倾向评分匹配登记研究中，与传统隐静脉移植相比，非接触式冠状动脉旁路移植术既未提高中期生存率，也未降低再次血运重建率。
