Division of Cardiac Surgery, Tor Vergata University Hospital, Viale Oxford 81, 00133 Rome, Italy.
Int J Environ Res Public Health. 2021 Dec 27;19(1):275. doi: 10.3390/ijerph19010275.
To evaluate the long-term outcomes of clampless off-pump coronary artery bypass grafting (C-OPCAB) compared with conventional on-pump double clamping coronary artery bypass grafting (C-CABG).
From October 2006 to December 2011, 366 patients underwent isolated coronary artery bypass grafting. After propensity score matching of preoperative variables, 143 pairs were selected who received C-OPCAB with the use of device-assisted PAS-Port proximal venous graft anastomoses or C-CABG, performed by the same surgeon experienced in both techniques. Data of the two groups of patients were retrospectively analyzed up to 14 years of follow-up.
As compared with C-OPCAB, in the C-CABG patients, the performed number of grafts per patient was higher (2.9 ± 0.5 vs. 2.6 ± 0.6, -value 0.0001). At 14 years, overall survival, including in-hospital death, was 64 ± 4.7% for the C-OPCAB vs. 55 ± 5.5% for the C-CABG, freedom from overall MACCEs 51 ± 6.2% vs. 41 ± 7.7%, and from late cardiac death 94 ± 2.4% vs. 96 ± 2.2% (-value not significant, for all comparisons). No significant statistical differences were observed in the actual rates of adverse events during follow-up. Independent predictors of survival were advanced age at operation (-value 0.001) and a lower mean value of preoperative left ventricular ejection fraction (-value 0.015).
Our single-center study analysis suggests that clampless OPCAB using device-assisted proximal anastomoses proved to be not inferior to double-clamping CABG in the long-term follow-up, provided that involved surgeons are familiar with both techniques. These conclusions are supported by a large and long-term follow-up period, eliminating potential bias, i.e., by means of the propensity score matching and analyzing single-surgeon experience.
评估无夹闭非体外循环冠状动脉旁路移植术（C-OPCAB）与传统体外循环双夹闭冠状动脉旁路移植术（C-CABG）的长期疗效。
2006 年 10 月至 2011 年 12 月，366 例患者接受了单纯冠状动脉旁路移植术。在对术前变量进行倾向评分匹配后，选择了 143 对接受 C-OPCAB 的患者，这些患者使用设备辅助 PAS-Port 近端静脉移植物吻合术或 C-CABG，由经验丰富的同一外科医生进行操作。回顾性分析两组患者的数据，随访时间长达 14 年。
与 C-OPCAB 相比，C-CABG 患者的每例患者搭桥数量更高（2.9±0.5 对 2.6±0.6，-值 0.0001）。在 14 年时，C-OPCAB 的总体生存率（包括住院期间死亡）为 64±4.7%，C-CABG 为 55±5.5%，总体 MACCE 无事件生存率为 51±6.2%对 41±7.7%，晚期心脏性死亡无事件生存率为 94±2.4%对 96±2.2%（-值无显著差异，所有比较）。在随访期间，实际不良事件发生率没有明显的统计学差异。生存的独立预测因素是手术时的高龄（-值 0.001）和术前左心室射血分数的平均值较低（-值 0.015）。
我们的单中心研究分析表明，使用设备辅助近端吻合的无夹闭 OPCAB 在长期随访中并不逊于双夹闭 CABG，前提是涉及的外科医生熟悉这两种技术。这些结论得到了一个大的、长期随访期的支持，消除了潜在的偏倚，即通过倾向评分匹配和分析单外科医生的经验。
