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一站式杂交冠状动脉血运重建与非体外循环下冠状动脉旁路移植术。

One-Stop Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting.

机构信息

Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University.

出版信息

Int Heart J. 2022;63(3):441-446. doi: 10.1536/ihj.21-705.

DOI:10.1536/ihj.21-705
PMID:35650145
Abstract

One-stop hybrid coronary revascularization (HCR) is a promising revascularization strategy for treating multivessel coronary artery disease (MVCAD). However, its safety and feasibility remain controversial. Therefore, we introduced our experience with midterm follow-up of HCR in patients with MVCAD and compared it with conventional off-pump coronary artery bypass grafting (CABG).Patients with MVCAD undergoing one-stop HCR at Beijing Chaoyang Hospital between March 2018 and December 2020 were retrospectively enrolled. These patients were matched in a 1:2 ratio to patients treated with off-pump CABG at the same period via a propensity score analysis with the nearest neighbor matching algorithm.In the adjusted analysis, no significant difference was found in the rate of perioperative myocardial infarction, stroke, death, prolonged ventilation, reoperation for bleeding, and renal failure between the HCR group and the CABG group. No in-hospital repeated revascularization occurred in either group. HCR was associated with lower blood transfusion rate (HCR 11.0% versus CABG 22.8%; P = 0.006) and shorter postoperative length of stay (> 10 days: 31.5% versus 81.0%; P < 0.001) compared with CABG. After the median 21-month follow-up, no significant difference was found in the major adverse cardiac and cerebrovascular events (MACCE), death, myocardial infarction, repeated revascularization, and stroke rate. Besides, the freedom-from MACCE survival rate was similar between the two groups.One-stop HCR seemed to be a safe and feasible revascularization strategy in patients with MVCAD, with faster recovery and similar outcomes when compared with off-pump CABG.

摘要

一站式杂交冠状动脉血运重建 (HCR) 是治疗多支冠状动脉疾病 (MVCAD) 的一种有前途的血运重建策略。然而,其安全性和可行性仍存在争议。因此,我们介绍了我们在 MVCAD 患者中应用中期随访的 HCR 经验,并将其与传统的非体外循环冠状动脉旁路移植术 (CABG) 进行了比较。

回顾性纳入 2018 年 3 月至 2020 年 12 月在北京朝阳医院行一站式 HCR 的 MVCAD 患者。这些患者与同期行非体外循环 CABG 的患者进行倾向评分分析,采用最近邻匹配算法进行 1:2 配对。

在调整分析中,HCR 组与 CABG 组之间围手术期心肌梗死、卒中和死亡、延长通气、再次因出血而手术、肾衰竭的发生率无显著差异。两组均无院内再次血运重建。HCR 组与 CABG 组相比,输血率较低(HCR 11.0%对 CABG 22.8%;P = 0.006),术后住院时间较短(> 10 天:31.5%对 81.0%;P < 0.001)。中位 21 个月随访后,两组间主要不良心脑血管事件(MACCE)、死亡、心肌梗死、再次血运重建和卒中等发生率均无显著差异。此外,两组间 MACCE 无事件生存率相似。

一站式 HCR 似乎是 MVCAD 患者安全可行的血运重建策略,与非体外循环 CABG 相比,恢复更快,结果相似。

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