非体外循环与体外循环冠状动脉旁路移植血管中远期通畅率比较

Comparison of the long-term graft patency of on-pump versus off-pump coronary artery bypass grafting

目的 比较非体外循环不停跳与体外循环冠状动脉旁路移植手术后中远期移植血管的通畅率.方法 对同一术者行冠状动脉旁路移植手术后5年以上病例50例.按手术方式分为两组.第1组采用传统体外循环下进行冠状动脉旁路移植（体外循环组,25例）;第2组采用非体外循环不停跳技术进行冠状动脉旁路移植（非体外循环组,25例）.对所有病例进行冠状动脉造影随访,比较两组移植血管的通畅情况.结果 两组均男21例,女4例.第1组手术年龄（55.4±8.9）岁;随访70～110个月,平均（86.52±12.48）个月;移植血管共83支,其中动脉移植血管41支,静脉移植血管42支,平均移植血管（3.32±0.63）支/例;随访移植血管通畅61支,狭窄6支,闭塞16支,动脉移植物通畅率为78.05%,静脉通畅率69.05%,总通畅率73.49%.第2组手术年龄（58.2±9.09）岁;移植血管共65支,其中动脉移植血管31支,静脉移植血管34支,平均移植血管（2.52±0.71）支/例,随访64～99个月,平均（82.68±12.48）个月;随访移植血管通畅47支,狭窄4支,闭塞14支,动脉移植物通畅率为74.19%,静脉通畅率70.59%,总通畅率72.31%.结论 非体外循环不停跳冠状动脉旁路移植手术移植血管中远期通畅率与传统体外循环手术一致,均可达到较好的中远期疗效.

Objective Off-pump coronary artery bypass grafting （OPCAB） is used more widely in recent years in China. However, there is an argument on benefits and risks of off-pump surgery. Many studies shown that OPCAB had more benefits in short-term outcomes than conventional coronary artery bypass grafting（CCABG）. But evidences from other studies suggested that OPCAB resulted in less long-term graft patency as compared with on-pump surgery. This study examined the longterm graft patency of OPCAB and CCABG performed by one surgeon. Methods 50 patients who had received surgical revascularization by a surgeon for more than 5 years were reviewed, 25 patients received conventional coronary artery bypass grafting （ group 1 ） and 25 patients received OPCAB （ group 2）. All patients had angiograms for compareing the graft patency between the two groups. Results Among 25 patients in group 1,21 were male and 4 were female. The mean age of patients at surgery was （55.4 ±8.9） years. 15 cases had unstable angina, 16 patients had old myocardial infarction and 6 cases had diabetes.The ejection fraction （EF） was 0.58 ±0.14. The mean number of bypasses per patient was 3.32 ±0.63. Mean duration of operation was （3.58 ± 0. 82） hours. Mean follow-up duration was （ 86.52 ± 12.48） months. 83 grafts were evaluated for patency （ open vs. closed） and were graded by Fitzgibbon as grade A （ excellent graft）, B （ impaired graft, with a stenosis of ≥50%, or a diameter less than 50% of the grafted artery）, or O （ completely occluded）. The graft patency was 73.49%, 61grafts were graded as Fitzgibbon A, 6 grafts as Fitzgibbon B and 16 grafts as Fitzgibbon 0. 25 patients were in group 2, 21males and 4 females. The mean age of patients at procedure was （58.2 ± 9.09） years, 11 patients had unstable angina, 13 patients had old myocardial infarction and 6 cases had diabetes. The ejection fraction （EF） was 0.59 ± 0. 14. Conclusion No 2011.03.013 difference in long-term graft patency was identified between on-pump and off-pump coronary artery bypass grafting. Off-pump oronary artery bypass grafting preformed by an experienced surgeon may gain similar long-term graft patency to that of conventional bypass.