摘要
背景:非体外循环冠状动脉搭桥术(OPCAB)目前被用作传统“体外循环”手术外的替代选择,但有关其远期效果的数据很少。本研究旨在回顾应用系统性OPCAB方面的长期经验。方法和结果:1996—2004年间共系统性地实施了1000次OPCAB手术,占同期所有冠状动脉血运重建治疗的95%,其中97%接受了完整随访。患者的平均年龄为64±10岁,778例男性,222例女性。73%的患者有三支血管病变。
BACKGROUND -Off-pump coronary artery bypass surgery(OPCAB) is currently used as an alternative to conventional “on-pump”surgery, but there are very little data available on long-term follow-up. The aim of this study was to review our long-term experience with the use of systematic OPCAB. METHODS AND RESULTS -1000 consecutive OPCAB surgeries were systematically performed between 1996 and 2004, representing 95%of all coronary revascularization during that same time frame, with a 97% complete follow-up. Average age of the patients was 64±10 years(778 men and 222 women). Seventy-three percent had triple-vessel disease. Operative 30-day mortality was 1.6%. Overall survival at 96 months was 74±3.5%and cardiac survival was 94±1.3%. By Cox regression analysis, age(odds ratio[OR], 1.07), congestive heart failure(CHF)(OR, 1.90), peripheral vascular disease(OR, 1.74), chronic renal insufficiency(OR, 2.04), previous myocardial infarction(MI)(OR, 1.60), and New York Heart Association functional class(OR, 1.60) were risk factors for long-term mortality. Survival free of any cardiac events(cardiac death, MI, unstable angina, heart failure, or reintervention) was 80±3.4%. Survival free of any type of reintervention alone was 90±3%. By Cox regression analysis, mitral regurgitation(OR, 2.3), peripheral vascular disease(OR, 2.1), and diffuse coronary disease(OR, 2.3) were significant predictors of recurrent cardiac events. Conversion to “on-pump”(OR, 14.3) was predictor of long-term need for repeat revascularization. CONCLUSION -In this series, systematic OPCAB surgery was shown to be an acceptable alternative to conventional “on-pump”coronary artery bypass graft for the treatment of coronary artery disease.
