Li Dongjie, Guo Yulin, Gao Yingdi, An Xiangguang, Liu Yan, Gu Song, Zhang Xitao, Zhong Jiuchang, Gao Jie, Su Pixiong
Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Front Cardiovasc Med. 2021 Dec 17;8:755797. doi: 10.3389/fcvm.2021.755797. eCollection 2021.
Data on one-stop hybrid coronary revascularization (HCR) are limited. This study aimed to compare the early and midterm outcomes of one-stop HCR with off-pump coronary artery bypass grafting (OPCAB) in patients with multivessel coronary artery disease. From April 2018 to May 2021, 752 patients with multivessel coronary artery disease who underwent isolated one-stop HCR or OPCAB were retrospectively included in this analysis. After exclusion and propensity score matching, 151 patients who underwent HCR were matched with 151 patients who underwent OPCAB. The primary endpoints were midterm major adverse cardiovascular and cerebrovascular events (MACCE) after the procedure. The secondary endpoints were in-hospital complications and outcomes. The preprocedural characteristics were well balanced between the two groups after matching. The HCR group was associated with a lower rate of perioperative transfusion (23.8 vs. 53.0%, < 0.001) and new-onset atrial fibrillation (AF) (5.3 vs. 15.2%, = 0.004), shorter time of mechanical ventilation (h) [15 (16, 17) vs. 17 (16, 20), < 0.001], and shorter length of stay (LOS) in the hospital (days) [19 (16, 24) vs. 22 (18, 27), = 0.001]. Cumulated MACCE rates were similar between the two groups (15.9 vs. 14.0%, = 0.59) during a median follow-up of 20 months. One-stop HCR is safe and efficacious with less invasiveness and faster postoperative recovery in selected patients with multivessel coronary artery disease. Randomized controlled trials with larger sample sizes and long-term follow-up are warranted to confirm these findings.
一站式杂交冠状动脉血运重建术（HCR）的数据有限。本研究旨在比较一站式HCR与非体外循环冠状动脉旁路移植术（OPCAB）治疗多支冠状动脉疾病患者的早期和中期结果。2018年4月至2021年5月，对752例行单纯一站式HCR或OPCAB的多支冠状动脉疾病患者进行回顾性分析。经过排除和倾向评分匹配后，151例行HCR的患者与151例行OPCAB的患者进行匹配。主要终点是术后中期主要不良心血管和脑血管事件（MACCE）。次要终点是住院并发症和结局。匹配后两组术前特征均衡。HCR组围手术期输血率较低（23.8%对53.0%，<0.001），新发房颤（AF）发生率较低（5.3%对15.2%，=0.004），机械通气时间较短（小时）[15（16，17）对17（16，20），<0.001]，住院时间较短（天）[19（16，24）对22（18，27），=0.001]。在中位随访20个月期间，两组累积MACCE发生率相似（15.9%对14.0%，=0.59）。对于选定的多支冠状动脉疾病患者，一站式HCR安全有效，具有较小的侵入性和更快的术后恢复。需要进行更大样本量和长期随访的随机对照试验来证实这些发现。
