择期“分站式”冠状动脉血运杂交重建治疗冠状动脉多支病变

Selective Two-staged Hybrid Coronary Revascularization for Patients with Multivessel Coronary Artery Disease

目的探讨择期"分站式"冠状动脉血运杂交重建(hybrid coronary revascularization,HCR)治疗冠状动脉多支血管病变的安全性、可行性。方法选取2012年5月~2014年8月在我院行择期"分站式"冠状动脉血运杂交重建的73例资料,以同期、同一术者完成的择期非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass,OPCAB)383例作为对照,进行回顾性研究。2组一般资料差异无显著性。比较2组围术期及随访结果。结果与OPCAB组相比,HCR组手术时间短[(152.9±43.8)min vs.(262.6±51.8)min,t=-16.993,P=0.000],术后总引流量少[中位数460(20~2070)ml vs.980(130~8770)ml,Z=-8.232,P=0.000],输血少[12例(16.4%)vs.200例(52.2%),χ2=31.555,P=0.000],机械通气时间短[(9.4±7.4)h vs.(19.0±18.3)h,t=-4.391,P=0.000]。术后HCR组随访73例(100%),OPCAB组随访360例(94.0%)。2组随访时间差异无显著性[(25.0±9.6)月vs.(22.8±10.6)月,t=1.693,P=0.091]。2组主要心脑血管不良事件(major adverse cardiac or cerebrovascular events,MACCE)发生率无显著性差异[4例(5.5%)vs.10例(2.8%),χ~2=0.684,P=0.408],生存曲线也无显著性差异(log-rankχ~2=1.041,P=0.308)。结论 "分站式"冠状动脉血运杂交重建术与OPCAB相比手术时间短,引流量少,输血少,机械通气时间短,随访结果显示其MACCE发生率与OPCAB相近。因此认为,"分站式"冠状动脉血运杂交重建术是一种安全、有效的手术方式。

Objective To discuss and investigate the safety and feasibility of two-staged hybrid coronary revascularization（ HCR） technique to treat multivessel coronary artery disease. Methods A total of 73 patients who underwent two-staged hybrid technique in our heart center because of coronary multivessel lesions from May 2012 to August 2014 were included retrospectively.Another 383 patients who underwent conventional off-pump coronary artery bypass（ OPCAB） by the same surgeon at the same period were selected as the control. There was no significant difference in preoperative situation between the two groups. Perioperative period and follow-up results were compared between the two groups. Results As compared to the OPCAB group,the HCR group had less operation duration [（ 152. 9 ± 43. 8） min vs.（ 262. 6 ± 51. 8） min,t =- 16. 993,P = 0. 000],bleeding [median,460（ rang,20-2070） ml vs. 980（ 130- 8770） ml,Z =- 8. 232,P = 0. 000],blood transfusion [12 cases（ 16. 4%） vs. 200 cases（ 52. 2%）,χ~2= 31. 555,P = 0. 000],and mechanical ventilation [（ 9. 4 ± 7. 4） h vs.（ 19. 0 ± 18. 3） h,t =- 4. 391,P = 0. 000]. The HCR group was followed in 73 cases（ 100%）,and the OPCAB group was followed in 360 cases（ 94. 0%）. There was no significant difference in follow-up time between the two groups [（ 25. 0 ± 9. 6） months vs.（ 22. 8 ± 10. 6） months,t = 1. 693,P = 0. 091]. The incidence of major adverse cardiac or cerebrovascular events（ MACCE） rate was similar between the two groups [4 cases（ 5. 5%） vs.10 cases（ 2. 8%）,χ~2= 0. 684,P = 0. 408]. The survival curve was similar between the two groups（ log-rank χ~2= 1. 041,P =0. 308）. Conclusion The two-staged hybrid coronary revascularization technique is safe and feasible for the treatment of multivessel coronary artery disease.