Razavi Allen A, Malas Jad, Salam Aminah, Emerson Dominic A, Bowdish Michael E
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Semin Thorac Cardiovasc Surg. 2025 Spring;37(1):43-47. doi: 10.1053/j.semtcvs.2024.12.001. Epub 2024 Dec 25.
Off-pump coronary artery bypass grafting (CABG), developed to avoid the potential complications of cardiopulmonary bypass, remains a subject of debate. Studies have demonstrated that off-pump CABG is associated with higher rates of incomplete revascularization, inferior graft patency, and increased reintervention rates compared to on-pump CABG, leading to worse outcomes. The theoretical neuroprotective and renal-protective benefits associated with off-pump CABG have not been definitively proven, with stroke and renal failure rates similar to those of on-pump CABG in both short- and long-term follow-up. Off-pump CABG presents technical challenges, contributing to a steep learning curve, and its effectiveness is dependent on surgeon and center experience. Lower-volume centers and surgeons performing off-pump CABG have shown increased rates of mortality and reintervention. Despite the potential cost savings by avoiding cardiopulmonary bypass, the need for repeat interventions and associated complications can lead to higher long-term healthcare costs. This paper advocates for a more selective use of off-pump CABG while maintaining on-pump CABG as the standard approach for patients with coronary artery disease.
非体外循环冠状动脉旁路移植术（CABG）旨在避免体外循环的潜在并发症，但其仍然是一个存在争议的话题。研究表明，与体外循环CABG相比，非体外循环CABG的血管再通不完全率更高、移植血管通畅性较差且再次干预率增加，导致预后更差。非体外循环CABG相关的理论神经保护和肾脏保护益处尚未得到明确证实，在短期和长期随访中，其卒中率和肾衰竭率与体外循环CABG相似。非体外循环CABG存在技术挑战，导致学习曲线较陡，其有效性取决于外科医生和中心的经验。进行非体外循环CABG的低手术量中心和外科医生的死亡率和再次干预率有所增加。尽管避免体外循环可能节省成本，但重复干预的需求和相关并发症可能导致更高的长期医疗费用。本文主张更有选择性地使用非体外循环CABG，同时将体外循环CABG作为冠心病患者的标准治疗方法。
