65岁以上老年患者行体外循环与非体外循环冠脉旁路移植术远期疗效对比分析

Comparison of long-term outcomes between on and off-pump coronary artery bypass grafting in patients aged over 65 years

目的对比分析65岁以上老年患者行体外循环(CCABG)与非体外循环冠脉旁路移植术(OPCAB)远期疗效,探索65岁以上老年患者冠脉旁路移植术(CABG)合理化手术方案。方法 2000年1月至2013年12月632例65岁以上老年患者由同一术者完成CABG,其中CCABG)组共147例,OPCAB组共485例。根据所有术前变量以1∶1的配对比例在OPCAB组与CCABG组患者中进行配对(n=140)。统计死亡率、术后并发症发生率、重症监护病房(ICU)时间以及机械通气时间等近期结果。出院后随访包括全因死亡及主要心脑血管不良事件(MACCE)(全因死亡、心肌梗死、脑血管事件、重复再血管化)。结果 CCABG组随访成功率为95.00%,随访时间为2~204(122.15±31.73)个月,OPCAB组随访成功率为94.28%,随访时间为6~199(111.59±32.97)个月。10年生存率CCABG组为64.1%,OPCAB组为67.2%,差异无统计学意义(P=0.137),10年MACCE事件免除率CCABG组为52.5%,OPCAB组为60.8%,差异同样无统计学意义(P=0.375),COX回归分析同样显示是否使用OPCAB技术并不会影响老年患者的远期疗效。结论 OPCAB避免了体外循环对老年患者全身脏器的影响,近期效果令人满意,与CCABG相比,并不会降低老年患者远期的全因死亡率、MACCE事件发生率。

Objective To make contrastive analysis of long-term outcomes of on-pump coronary artery bypass grafting（ CCABG） and off-pump coronary artery bypass grafting（ OPCAB） in patients aged over 65 years and to explore the reasonable operation scheme in patients aged over 65 years. Methods Six hundred and thirty-two consecutive patients aged over 65 years receiving CABG at our center between November 2000 and November 2013 were enrolled in our study. One hundred and forty seven patients received CCABG and 485 patients received OPCAB,and all of the operations were performed by the same surgeon. Meanwhile,we matched 147 patients as CCABG group by 1 ∶ 1 rate from the 485 patients who received OPCAB with all preoperative variables comparable. The perioperative data,including mortality rate,incidence of postoperative complications,length of ICU stay and duration of mechanical ventilation were analyzed. The follow-up data of the patients were also analyzed including all-cause mortality rate and major adverse cardiac and cerebral events（ MACCE）,myocardial infarction,cerebrovascular events,and repeated revascularization. Results One hundred and forty pairs were matched successfully. Among the 140 patients in CCABG group,133（ 95.00%） of them were available for follow-up for（ 2-204） months（ with a median of 122.15±31.73 months）. Among the 140 patients in OPCAB group,132（ 94.28%） of them were available for follow-up for（ 6-199） months（ with a median of 111.59±32.97 months）. There were no significant differences in comparation of 10-year survival rate（ CCABG： 64. 1% OPCAB： 67. 2%,P = 0. 137） and 10-year MACCE-free survival rate（ CCABG： 52.5% OPCAB： 60. 8%,P = 0. 375）. The COX regression analysis of long-term outcomes showed that off-pump technique did not influence the incidence of MACCE and survival rate. Conclusion OPCAB has a satisfactory short-term outcome because it avoids the influence of extracorporeal circulation on organs in elderly patients. But OPCAB is not beneficial to the long-term outcomes compared with CCABG.