摘要
目的比较在单一高手术量心脏外科中心,有经验术者行体外循环和非体外循环冠状动脉旁路移植术(coronary artery bypass graft,CABG)的近期安全性结果。方法本研究为单中心回顾性研究,连续选取2009年1月至2019年12月共31075例在阜外医院由有经验术者(既往CABG完成超过100例)完成CABG的多支血管病变冠心病患者。根据意向治疗方式将患者分为体外循环CABG组和非体外循环CABG组。收集患者的年龄、性别、合并症、心功能状态等基线临床资料,研究终点包括:30 d死亡率、主要并发症或死亡复合终点、住院时间延长(prolonged length of stay,PLOS)、术后重症监护室停留时间延长(prolonged length of intensive care unitstay,PICULOS)、远端吻合口数目等。死亡率通过术后30 d随访完成,其他研究终点均为住院期间收集。采用倾向性评分1∶1匹配体外循环和非体外循环CABG组的基线资料。在匹配后的队列,使用McNemar检验对每一项终点指标进行单因素分析,并通过按配对分层的logistic回归进行多因素校正。结果在倾向性评分匹配后,共10243组(共计20486例)患者完成配对,其中女性4605例(22.5%),年龄(60.7±8.6)岁。体外循环和非体外循环两组间基线变量的标准化差值均<5%。单因素分析结果显示,非体外循环CABG组30 d死亡率(0.2%比0.7%)、主要并发症或死亡复合终点(5.7%比8.8%)、PLOS(3.2%比4.9%)、PICULOS(9.4%比12.2%)、远端吻合口数目[(3.3±0.8)个比(3.6±0.8)个],均低于体外循环CABG组(P均<0.001)。多因素校正后,使用非体外循环手术仍为术后30 d死亡率(OR=0.29,95%CI 0.09~0.87,P=0.027)、主要并发症或死亡复合终点(OR=0.60,95%CI 0.53~0.68,P<0.001)、PLOS(OR=0.64,95%CI 0.54~0.75,P<0.001)、PICULOS(OR=0.76,95%CI 0.69~0.84,P<0.001)的保护因素。结论对于有经验术者,相较于体外循环CABG,采用非体外循环CABG可能与更优的近期安全性结局相关。
Objective To compare the short-term outcomes between off-pump and on-pump coronary artery bypass graft(CABG)by experienced surgeons with similar surgical team in a single large-volume cardiac surgery center.Methods A total of 31075 patients with multivessel coronary disease who underwent isolated off-pump or on-pump CABG between January 1,2009 and December 31,2019 by experienced surgeons in Fuwai hospital were enrolled in this retrospective study.Patients was divided into on-pump CABG group and on-pump CABG group on an intention-to treat basis.Short term safety endpoints,including 30 days mortality,composite endpoint of major morbidity or mortality,prolonged postoperative length of stay(PLOS),and prolonged ICU length of stay(PICULOS),and distal anastomosis were compared between the two groups.Mortality was evaluated on 30 days post operation,other endpoints were collected before discharge.After 1∶1 propensity-score matching of baseline characteristics for on-pump and off-pump CABG,postoperative endpoints were compared with use of McNemar′s test and further adjusted with the use of a logistic regression model.Results After propensity-score matching,10243 matched pairs of patients were included in the final analysis,there were 4605(22.5%)females and mean age was(60.7±8.6)years.The standardized differences were less than 5%for all baseline variables in matched cohort.Univariate analysis indicated lower risk of 30 days mortality(0.2%vs.0.7%,P<0.001),major morbidity or mortality(5.7%vs.8.8%,P<0.001),PLOS(3.2%vs.4.9%,P<0.001),PICULOS(9.4%vs.12.2,P<0.001),and lower number of distal anastomosis((3.3±0.8)vs.(3.6±0.8),P<0.001)in off-pump CABG group than in on-pump CABG group.After adjustment of cofounders,multivariate analysis showed that off-pump CABG was still associated with a lower risk of 30 days mortality(OR=0.29,95%CI:0.09-0.87,P=0.027),composite endpoint of major morbidity or mortality(OR=0.60,95%CI:0.53-0.68,P<0.001),PLOS(OR=0.64,95%CI 0.54-0.75,P<0.001),PICULOS(OR=0.76,95%CI:0.69-0.84,P<0.001).Conclusions Off-pump CABG is related with superior short-term safety outcomes than on-pump CABG by experienced surgeons in our center.
作者
胡展
袁昕
陈斯鹏
宋云虎
王巍
王水云
王立清
凤玮
刘盛
孙寒松
Hu Zhan;Yuan Xin;Chen Sipeng;Song Yunhu;Wang Wei;Wang Shuiyun;Wang Liqing;Feng Wei;Liu Sheng;Sun Hansong(Department of Cardiovascular Surgery,National Clinical Research Center of Cardiovascular Diseases,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Information Center,National Clinical Research Center of Cardiovascular Diseases,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;不详)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2021年第2期158-164,共7页
Chinese Journal of Cardiology
