水囊封堵法对比Heartstring用于非体外循环冠状动脉旁路移植术近端吻合的早期疗效

Early efficacy of water sac blocking versus Heartstring for proximal anastomosis during off-pump coronary artery bypass grafting

目的对比水囊封堵法与Heartstring对合并钙化升主动脉行近端吻合的早期疗效。方法回顾性分析2022年1月至2022年6月期间北京安贞医院连续收治的择期行非体外循环冠状动脉旁路移植术(OPCABG)的400例患者临床资料。经术前胸部CT平扫及术中触诊,明确合并升主动脉钙化的患者46例,其中男40例,女6例;年龄53~73岁,平均(65.2±5.1)岁;根据近端吻合的方式,将患者分为水囊封堵法组(19例)和Heartstring组(27例)。统计两组术后卒中发生率,对比两种方法预防术后卒中的效果。通过术中检测大隐静脉旁路移植血管主干血流量及搏动指数,术后48 h内观察心电图、肌钙蛋白的动态变化,以及术后3个月复查冠状动脉CTA,比较两种方法用于近端吻合的疗效。结果全组均无围手术期死亡,术后4~13天出院。围手术期无卒中、恶性室性心律失常等不良事件发生。两组各有1例术后出现低心排血量综合征,放置IABP后均好转。Heartstring组术后1例出现急性下壁心肌梗死,放置IABP后好转。术后3个月复查冠状动脉CTA,两组均未发生近端吻合口狭窄。结论水囊封堵法和Heartstring在预防合并升主动脉钙化行OPCABG术后卒中的早期疗效上差异无统计学意义。和Heartstring相比,水囊封堵法并不会增加术后近端吻合口狭窄的风险。另外,水囊封堵法无需使用昂贵耗材,尤其适用于经费受限的患者,具有推广价值。

Objective To compare the early effect of water sac blocking and Heartstring for proximal anastomosis of the calcific ascending aorta.Methods The data of 400 consecutive patients undergoing elective off-pump coronary artery bypass grafting(OPCABG)in Beijing Anzhen Hospital from January 2022 to June 2022 were retrospectively analyzed.46 patients with calcific ascending aorta including 40 males and 6 females,with the age ranged from 53 to 73 years and an average of(65.2±5.1)years,who were revealed by preoperative chest CT scan and intraoperative palpation.According to the method of proximal anastomosis,the patients were divided into 2 groups:water sac blocking group(n=19)and Heartstring group(n=27).The effect of preventing postoperative stroke was compared by counting the incidence of postoperative stroke.The efficacy of the 2 methods was compared by detecting the flow and pulsatility fraction of the saphenous vein trunk during surgery,observing the dynamic changes of the electrocardiogram and cTnI level within 48h after the surgery,and reviewing the coronary CTA 3 months after discharge.Results There was no perioperative death,and all the patients were discharged 4-13 days postoperatively.No adverse events such as stroke and malignant ventricular arrhythmia occurred during perioperative period.1 patient in each group developed low cardiac output syndrome postoperatively,and both improved after IABP placement.1 patient in Heartstring group developed acute inferior myocardial infarction,which was improved after IABP placement.Coronary CTA 3 months after operation showed that there was no proximal anastomotic stenosis in both groups.Conclusion There is no significant difference between the 2 proximal anastomosis methods in preventing stroke after OPCABG in patients with ascending aortic calcification.Compared with Heartstring,water sac blocking does not increase the risk of proximal anastomotic stenosis.In addition,water sac blocking does not require expensive consumables,which is especially suitable for patients with limited funds and can be generalized.