泵外与泵内心脏跳动冠状动脉旁路移植术的比较。

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Thoracic and Cardiovascular Surgeon Pub Date : 2024-09-01 Epub Date: 2024-01-05 DOI:10.1055/a-2239-1810
Kazuki Matsuhashi, Yoshiyuki Takami, Atsuo Maekawa, Koji Yamana, Kiyotoshi Akita, Kentaro Amano, Yasushi Takagi
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引用次数: 0

摘要

背景:尽管冠状动脉旁路移植术(CABG)是通过三种不同的技术进行的,即传统的、泵上心脏跳动CABG(ONBHCAB)或泵外CABG(OPCAB),但比较ONBHCAB和OPCAB的数据是有限的:我们回顾性调查了2008年2月至2022年9月期间接受孤立ONBHCAB或OPCAB的806名患者的术后心脏生物标志物、肌酸激酶-MB(CK-MB)和肌钙蛋白I(cTnI)、早期和晚期预后。为了消除不同组间的偏差,我们进行了倾向得分匹配以验证研究结果:结果:经过匹配后,每个研究组共有270名患者。在完整组和匹配组中,包括发病率和死亡率在内的早期结果相似。然而,ONBHCAB术后的cTnI和CK-MB水平明显高于OPCAB术后,匹配队列的cTnI峰值中位数为9.85纳克/毫升,而OPCAB术后为4.60纳克/毫升;CK-MB峰值中位数为48.45纳克/毫升,而匹配队列为17.10纳克/毫升。在 73 ± 45 个月的随访中,ONBHCAB 和 OPCAB 患者的总体精算存活率相似(在匹配队列中,5 年的存活率分别为 86% 和 87%,10 年的存活率分别为 64% 和 68%):尽管术后心脏生物标志物升高较高,但ONBHCAB可能是OPCAB的一种可比替代方案,其早期和晚期结果相似。与 OPCAB 相比,ONBHCAB 能提供更有效的血流动力学支持,提供更好的手术视野,同时降低血管再通不全的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison between Off-Pump and On-Pump Beating Heart Coronary Artery Bypass Grafting.

Background:  Although coronary artery bypass grafting (CABG) is performed via three different techniques, conventional, on-pump beating heart CABG (ONBHCAB), or off-pump CABG (OPCAB), data are limited to compare ONBHCAB with OPCAB.

Methods:  We retrospectively investigated the postoperative cardiac biomarkers, creatine kinase-MB (CK-MB), and troponin I (cTnI), and early and late outcomes in 806 patients undergoing isolated ONBHCAB or OPCAB between February 2008 and September 2022. To eliminate the bias between different groups, propensity score matching was conducted to validate the findings.

Results:  After matching, the number of each study group totaled 270 patients. In both complete and matched cohorts, early outcomes, including morbidities and mortalities, were similar. However, cTnI and CK-MB levels were significantly higher after ONBHCAB than after OPCAB with median peak cTnI of 9.85 versus 4.60 ng/mL and median peak CK-MB of 48.45 versus 17.10 ng/mL in the matched cohort, which were quite low, below the threshold for values defining perioperative myocardial infarction. At follow-up of 73 ± 45 months, the overall actuarial survival rates were similar between the ONBHCAB and OPCAB patients (86 vs. 87% at 5 years and 64 vs. 68% at 10 years, respectively, in the matched cohort).

Conclusion:  ONBHCAB may be a comparable alternative to OPCAB with similar early and late outcomes, despite higher elevation of postoperative cardiac biomarkers. ONBHCAB provides more efficient hemodynamic support, providing a better surgical visual field, than OPCAB while reducing the risk of incomplete revascularization.

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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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