Shirasaka Tomonori, Arayawudhikul Nuttapon, Tantraworasin Apichat, Chartrungsan Angsu, Sakboon Boonsap, Cheewinmethasiri Jaroen, Kamiya Hiroyuki
Division of Cardiac Surgery, Asahikawa Medical University Hospital, Hokkaido, Japan.
Division of Cardiothoracic Surgery, Lampang Hospital, Lampang, Thailand.
Surg Open Sci. 2022 Jan 29;8:27-32. doi: 10.1016/j.sopen.2022.01.002. eCollection 2022 Apr.
Off-pump coronary artery bypass grafting has not been standardized in Southeastern Asian countries because it is technically demanding. However, this method could be suitable for economically disadvantaged institutions because it saves cost on the heart-lung machine. We summarized our results to assess the validity of our early introduction of this method.
We reviewed the data from 750 patients who underwent off-pump coronary artery bypass grafting at our institution. Before the introduction of off-pump coronary artery bypass grafting, experts from Japan were enlisted to teach our surgeons technicalities of the procedure. The primary outcome was in-hospital mortality, and secondary outcomes included any major adverse cardiac or cerebrovascular event.
The in-hospital mortality rate was 1.5%. The rates of survival and freedom from major adverse cardiac or cerebrovascular event 3 years after the operation were 92.5% ± 1.8% and 90.7% ± 2.2%, respectively. In the multivariable analysis, the independent risk factors for major adverse cardiac or cerebrovascular event were chronic obstructive pulmonary disease (adjusted hazard ratio = 2.35, 95% confidence interval = 1.35-4.10, P = .003) and renal insufficiency (adjusted hazard ratio = 2.70, 95% confidence interval = 1.52-4.80, P = .001), whereas risk factors for in-hospital death were pump conversion (relative risk = 17.4, 95% confidence interval = 1.63-4.41, P < .001).
Successful introduction of off-pump coronary artery bypass grafting provided a favorable outcome almost equal to that in high-volume centers in developed countries.
非体外循环冠状动脉旁路移植术在东南亚国家尚未标准化，因为该技术要求较高。然而，这种方法可能适用于经济条件较差的机构，因为它节省了体外循环机的成本。我们总结了我们的结果，以评估我们早期引入这种方法的有效性。
我们回顾了在我们机构接受非体外循环冠状动脉旁路移植术的750例患者的数据。在引入非体外循环冠状动脉旁路移植术之前，邀请了日本的专家来教授我们的外科医生该手术的技术细节。主要结局是住院死亡率，次要结局包括任何重大心脏或脑血管不良事件。
住院死亡率为1.5%。术后3年的生存率和无重大心脏或脑血管不良事件发生率分别为92.5%±1.8%和90.7%±2.2%。在多变量分析中，重大心脏或脑血管不良事件的独立危险因素是慢性阻塞性肺疾病（调整后风险比=2.35，95%置信区间=1.35-4.10，P=0.003）和肾功能不全（调整后风险比=2.70，95%置信区间=1.52-4.80，P=0.001），而住院死亡的危险因素是转为体外循环（相对风险=17.4，95%置信区间=1.63-4.41，P<0.001）。
成功引入非体外循环冠状动脉旁路移植术取得了与发达国家大容量中心几乎相当的良好效果。
