微创冠状动脉旁路移植术的远期疗效分析

Long-term results of minimally invasive direct coronary artery bypass

目的·总结微创冠状动脉旁路移植术(minimally invasive direct coronary artery bypass,MIDCAB)诊治冠状动脉粥样硬化性心脏病的10年经验及随访结果,评估其疗效。方法·纳入2009年2月-2019年5月在上海交通大学医学院附属瑞金医院行MIDCAB的患者,根据患者是否达到完全再血管化(complete revascularization,CR)以及是否行冠状动脉杂交术(hybrid coronary revascularization,HCR)分为3组,分别为不完全再血管化(incomplete revascularization,IR)+最佳药物治疗(optimal medical therapy,OMT)组、MIDCAB(CR)组及HCR(CR)组。通过Kaplan-Meier曲线(K-M曲线)分析患者远期生存情况及免于主要心脑血管不良事件(major adverse cardiac and cerebrovascular events,MACCE)的生存情况。结果·共有425例患者纳入研究,中位随访时间为39.9个月(18.2~81.1个月)。HCR(CR)组的住院时间显著长于其余2组(均P=0.000),IR+OMT组的围术期死亡率(P=0.000)、围术期心肌梗死发生率(P=0.000)、围术期MACCE发生率(P=0.000)、术后48 h肌钙蛋白I(cardiac troponin I,cTnI)水平(P=0.011)、远期死亡率(P=0.000)、远期心肌梗死发生率(P=0.002)及远期MACCE发生率(P=0.005)均显著高于完成CR的2组患者。K-M曲线估算的总体10年生存率及10年免于MACCE的生存率分别为80.9%(95%CI 73.1%~88.7%)及70.5%(95%CI 62.1%~78.9%),IR+OMT组的远期生存率(P=0.000)及远期免于MACCE的生存率(P=0.001)显著低于完成CR的2组患者。结论·MIDCAB对于冠状动脉粥样硬化性心脏病患者有着良好的远期疗效,行MIDCAB的患者应尽可能完成CR,IR会造成患者远期的不良预后。

Objective·To summarize the experiences and follow-up results of minimally invasive direct coronary artery bypass(MIDCAB)for treating coronary atherosclerotic cardiopathy for 10 years and to evaluate the long-term effects of MIDCAB.Methods·The patients who underwent MIDCAB at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,from February 2009 to May 2019 were collected.According to whether the patients achieved complete revascularization(CR)or underwent hybrid coronary revascularization(HCR),the cases were divided into 3 groups:incomplete revascularization(IR)+optimal medical therapy(OMT)group,MIDCAB(CR)group and HCR(CR)group.The Kaplan-Meier(K-M)curve was used to analyze the long-term survival and the freedom from major adverse cardiac and cerebrovascular events(MACCE)of patients.Results·A total of 425 patients were enrolled in the study,with a median follow-up of 39.9 months(18.2-81.1 months).The hospital stay in the HCR(CR)group was significantly prolonged compared with the other two groups(P=0.000).The perioperative mortality(P=0.000),perioperative myocardial infarction(MI)rate(P=0.000),perioperative MACCE rate(P=0.000),cardiac troponin I(cTnI)levels in 48 h(P=0.011),long-term mortality(P=0.000),long-term MI rate(P=0.002),and long-term MACCE rate(P=0.005)in the IR+OMT group were significantly higher than those in the other two groups of patients who had CR.The overall 10-year survival rate and freedom from MACCE estimated by K-M curves were 80.9%(95%CI 73.1%-88.7%)and 70.5%(95%CI 62.1%-78.9%),respectively.The long-term survival(P=0.000)and freedom from MACCE(P=0.001)in IR+OMT group were significantly lower than those in the other two groups.Conclusion·MIDCAB has good long-term effects on patients with coronary atherosclerotic cardiopathy.Patients undergoing MIDCAB should complete CR,and IR can significantly affect the long-term prognosis of patients.