多支动脉桥非体外循环冠状动脉旁路移植术的远期疗效

Long-term outcomes of multiple arterial off-pump coronary artery bypass grafting

目的评价多支动脉桥非体外循环冠状动脉旁路移植术(OPCAB)在左主干或多支冠状动脉病变患者中的远期疗效。方法纳入2006年1月至2018年6月在上海交通大学医学院附属瑞金医院心脏外科行多支动脉桥OPCAB术的左主干或多支冠状动脉病变患者共329例,男303例,女26例,年龄(55.1±9.1)岁。分析患者的临床特点、围手术期及远期临床结果,通过Kaplan-Meier曲线分析患者免于主要不良心脑血管事件(MACCE)的生存情况及总体生存情况,使用Cox回归模型分析MACCE发生的独立危险因素。结果手术死亡率为0.9%(3/329)。随访时间65(22,126)个月,共有302例(91.8%)患者获得随访,远期MACCE发生率为13.9%,死亡发生率为4.6%,心因性死亡发生率为1.3%,心肌梗死发生率为3.6%,脑卒中发生率为6.0%,靶血管血运重建发生率为6.0%,纽约心功能分级(NYHA)Ⅰ级占存活患者的51.3%,80.9%的存活患者无心绞痛复发。5年和10年生存率分别为97.3%和93.1%,5年和10年免于MACCE生存率分别为91.5%和78.0%。高龄(OR=1.058,95%CI:1.020~1.097,P=0.002)与既往心肌梗死史(OR=2.200,95%CI:1.131~4.412,P=0.021)是远期MACCE的独立危险因素。结论多支动脉桥OPCAB术是一种安全的手术方式,在左主干或多支冠状动脉病变患者中具有良好的远期疗效。

Objective To evaluate the long-term clinical outcomes of multiple arterial off-pump coronary artery bypass grafting (OPCAB) on left main coronary artery or multivessel disease. Methods A total of 329 patients [303 males and 26 females, with a mean age of (55.1±9.1) years old] with left main coronary artery or multivessel disease who underwent isolated multiple arterial OPCAB in Ruijin Hospital between January 2006 and June 2018 were included. The baseline characteristics, perioperative and long-term outcomes were analyzed. Kaplan-Meier analysis was applied for estimation of freedom from major adverse cardiac and cerebrovascular events (MACCE) and overall survival. Independent predictors of MACCE were assessed by Cox regression analysis. Results The perioperative mortality was only 0.9%(3/329). The median follow-up time was 65(22, 126) months, and 302 (91.8%) patients were followed up. The long-term MACCE rate, mortality, cardiac mortality, myocardial infarction (MI) rate, stroke rate and target vessel revascularization (TVR) rate were 13.9%, 4.6%, 1.3%, 3.6%, 6.0% and 6.0%, respectively. Among the alive patients, 51.3% were in New York Heart Association (NYHA)Ⅰ class and 80.9% had no recurrence of angina pectoris. The estimated 5-year and 10-year overall survival rates were 97.3% and 93.1%, respectively. The estimated 5-year and 10-year freedom from MACCE survival rates were 91.5% and 78.0%, respectively. Senility (OR=1.058, 95%CI: 1.020-1.097, P=0.002) and history of MI (OR=2.200, 95%CI: 1.131-4.412, P=0.021) were the independent risk factors for late MACCE. Conclusion Multiple arterial OPCAB appears to be safe and with excellent clinical outcomes in treating left main coronary artery or multivessel disease.