Clinic for Thoracic- and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany -
Clinic for Thoracic- and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany.
J Cardiovasc Surg (Torino). 2024 Aug;65(4):398-405. doi: 10.23736/S0021-9509.24.13031-5.
Coronary artery disease is a global cause of morbidity and mortality, often managed by coronary artery bypass grafting (CABG). This study addresses a critical decision-making dilemma in CABG procedures for patients with severe asymptomatic carotid stenosis, comparing off-pump and on-pump techniques.
We conducted a retrospective single-center analysis, employing propensity scored matched-pair methodology to compare perioperative outcomes in patients with asymptomatic severe carotid stenosis undergoing off-pump or on-pump CABG. The primary endpoint was the occurrence of perioperative stroke. Secondary endpoints included postoperative delirium, intrahospital mortality, intensive care unit stay, length of hospitalization and long-term survival.
The study involved 243 patients with asymptomatic severe carotid stenosis operated between July 2009 and October 2018, subsequently propensity score matched into two groups of 78 patients each (off-pump and on-pump). The incidence of perioperative stroke was significantly higher in the On-Pump group compared to the off-pump group (10.3% vs. 1.3%, P=0.03). However, secondary endpoints, such as intrahospital mortality and length of hospitalization, showed no significant differences between the two groups. Long-term survival rates were also comparable.
Our findings indicate that off-pump CABG significantly reduces the risk of perioperative stroke in patients with severe asymptomatic carotid stenosis compared to on-pump CABG, without compromising long-term outcomes. These results support the preference for off-pump CABG in this high-risk patient population, highlighting the need for tailored surgical approaches based on individual patient risk profiles.
冠心病是一种全球性的发病率和死亡率原因，通常通过冠状动脉旁路移植术（CABG）进行治疗。本研究针对严重无症状颈动脉狭窄患者的 CABG 手术中面临的一个关键决策困境，比较了非体外循环和体外循环技术。
我们进行了回顾性单中心分析，采用倾向评分匹配对接受非体外循环或体外循环 CABG 的无症状严重颈动脉狭窄患者的围手术期结果进行比较。主要终点是围手术期卒中的发生。次要终点包括术后谵妄、院内死亡率、重症监护病房停留时间、住院时间和长期生存。
该研究纳入了 2009 年 7 月至 2018 年 10 月间接受无症状严重颈动脉狭窄手术的 243 例患者，随后按照倾向评分匹配分为两组，每组 78 例（非体外循环和体外循环组）。与非体外循环组相比，体外循环组围手术期卒中的发生率明显更高（10.3%比 1.3%，P=0.03）。然而，次要终点，如院内死亡率和住院时间，两组之间无显著差异。长期生存率也相似。
我们的研究结果表明，与体外循环 CABG 相比，非体外循环 CABG 可显著降低严重无症状颈动脉狭窄患者围手术期卒中的风险，而不影响长期结果。这些结果支持在这种高风险患者群体中优先选择非体外循环 CABG，并强调了根据患者个体风险特征制定个体化手术方法的必要性。
