National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia.
Department of Pharmacology and Clinical Pharmacology, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia.
Medicina (Kaunas). 2023 Nov 2;59(11):1943. doi: 10.3390/medicina59111943.
: Surgical revascularisation of patients with atherosclerosis of the ascending aorta remains a challenge. Different surgical strategies have been described in coronary surgical patients to offer alternative revascularisation strategies other than the conventional surgical revascularisation in patients unsuitable for it. The aim of this study is to compare the real-world outcomes between two groups of patients who underwent off-pump surgery (left internal mammary artery graft to the left anterior descending artery) or a hybrid with a percutaneous revascularisation procedure at a later stage. : This is a single-centre retrospective observational study. Between the years 2010 and 2021, 91/6863 patients (1.33%) were diagnosed with severe atherosclerosis of the ascending aorta. All the patients were treated with off-pump revascularisation (91 patients), and the cardiologist would decide at a later stage whether the rest of the vessels would be treated with percutaneous revascularisation (25 patients). : There was no statistical difference in the various preoperative characteristics, except for coronary artery left main disease (30.30% vs. 64%; = 0.0043). The two groups had no statistical differences in the perioperative characteristics and postoperative complications. The 1-, 5-, and 10-year mortality rates in the two groups were 6.1% vs. 0%, 59% vs. 80%, and 93.9% vs. 100%, respectively (off-pump vs. hybrid with percutaneous revascularisation procedure, = 0.1958). : Both strategies have high long-term comparable mortality. The off-pump surgery and the HCR procedure at a later stage may be solutions for these high-risk patients, but the target treatment should be complete HCR revascularisation during the index hospitalization.
: 升主动脉粥样硬化患者的外科血运重建仍然是一个挑战。在冠状动脉外科患者中，已经描述了不同的手术策略，以提供除不适合传统手术血运重建的患者以外的其他替代血运重建策略。本研究的目的是比较两组接受非体外循环手术（左内乳动脉移植至左前降支）或后期行经皮血运重建术的杂交手术患者的真实世界结局。 : 这是一项单中心回顾性观察性研究。在 2010 年至 2021 年期间，91/6863 例患者（1.33%）被诊断为升主动脉严重粥样硬化。所有患者均接受非体外循环血运重建（91 例），并由心脏病专家决定后期其余血管是否采用经皮血运重建（25 例）。 : 除左主干冠状动脉疾病（30.30%比 64%； = 0.0043）外，两组患者的各种术前特征均无统计学差异。两组患者的围手术期特征和术后并发症无统计学差异。两组患者的 1 年、5 年和 10 年死亡率分别为 6.1%比 0%、59%比 80%和 93.9%比 100%（非体外循环组与后期行经皮血运重建术的杂交手术组， = 0.1958）。 : 两种策略的长期死亡率均较高。非体外循环手术和后期行杂交手术可能是这些高危患者的解决方案，但目标治疗应是在指数住院期间进行完全的 HCR 血运重建。
