Wang Chen, Jiang Yefan, Song Yu, Wang Qingpeng, Tian Rui, Wang Dashuai, Dong Nianguo, Jiang Xionggang, Chen Si, Chen Xinzhong
Department of Cardiovascular Surgery, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China.
Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Front Cardiovasc Med. 2022 Aug 1;9:965648. doi: 10.3389/fcvm.2022.965648. eCollection 2022.
This study was to determine whether coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG, OPCAB) could reduce early postoperative mortality and major complications compared with conventional coronary artery bypass grafting with cardiopulmonary bypass (on-pump CABG, ONCAB) by experienced surgeons.
From January 2016 to June 2020, isolated CABG was performed in 1200 patients (ONCAB 429, OPCAB 771) in Wuhan Union Hospital. The propensity score matching was used to adjust for differences in baseline characteristics between the ONCABG and OPCABG groups. After 1:1 matching, 404 pairs for each group were selected to compare outcomes within 30 days after surgery. All the operations were completed by experienced surgeons that had completed more than 500 on-pump and 200 off-pump CABG, respectively.
After propensity matching, the two groups were comparable in terms of preoperative characteristics. The OPCAB group had less vein graft (2.5 ± 1.0 vs. 2.7 ± 0.9; < 0.001) and a higher rate of incomplete revascularization (12.4 vs. 8.2%; < 0.049) than the ONCAB group. There was no significant difference in early postoperative mortality between ONCAB and OPCAB groups (2.2 vs. 2.2%; = 1.00). However, patients in the OPCAB group had a lower risk of postoperative stroke (1.5 vs. 4.7%; = 0.008), new-onset renal insufficiency (8.9 vs. 18.8%; < 0.001), respiratory failure (2.2 vs. 7.2%; = 0.001), reoperation for bleeding (0.5 vs. 2.7%; = 0.001), and required less ventilator assistance time (33.4 ± 37.9 h vs. 51.0 ± 66.1 h; < 0.001) and intensive care unit (ICU) time (3.7 ± 2.7 days vs. 4.8 ± 4.3 days; < 0.001).
In our study, patients undergoing OPCAB had fewer postoperative complications and a faster recovery. It is a feasible and safe surgical approach to achieve revascularization when performed by experienced surgeons.
本研究旨在确定与由经验丰富的外科医生进行的传统体外循环冠状动脉搭桥术（on-pump CABG，ONCAB）相比，非体外循环冠状动脉搭桥术（off-pump CABG，OPCAB）是否能降低术后早期死亡率和主要并发症。
2016年1月至2020年6月，武汉协和医院对1200例患者进行了单纯冠状动脉搭桥术（ONCAB 429例，OPCAB 771例）。采用倾向评分匹配法来调整ONCABG组和OPCABG组之间基线特征的差异。1:1匹配后，每组选取404对进行术后30天内结局的比较。所有手术均由分别完成超过500例体外循环和200例非体外循环冠状动脉搭桥术的经验丰富的外科医生完成。
倾向匹配后，两组术前特征具有可比性。OPCAB组的静脉桥数量少于ONCAB组（2.5±1.0对2.7±0.9；<0.001），且完全血运重建率高于ONCAB组（12.4%对8.2%；<0.049）。ONCAB组和OPCAB组术后早期死亡率无显著差异（2.2%对2.2%；P=1.00）。然而，OPCAB组患者术后发生中风的风险较低（1.5%对4.7%；P=0.008），新发肾功能不全的风险较低（8.9%对18.8%；<0.001），呼吸衰竭的风险较低（2.2%对7.2%；P=0.001），因出血再次手术的风险较低（0.5%对2.7%；P=0.001），且需要的呼吸机辅助时间较短（33.4±37.9小时对51.0±66.1小时；<0.001），重症监护病房（ICU）住院时间较短（3.7±2.7天对4.8±4.3天；<0.001）。
在我们的研究中，接受OPCAB的患者术后并发症较少且恢复较快。由经验丰富的外科医生进行时，这是一种实现血运重建的可行且安全的手术方法。
