非体外循环冠状动脉旁路移植术治疗左主干冠状动脉疾病：一项单中心前瞻性注册研究。
Off-pump CABG surgery in left main coronary artery disease: a single-center prospective registry.
作者信息
Bana Ajeet, Sangal Anuj, Mehta Navneet, Jaiswal Saurabh, Tirkey Sundeep, Yadav Vimal Kant, Sharma Krishna Kumar, Gupta Rajeev
机构信息
Eternal Heart Care Centre & Research Institute, Jawahar Nagar, Jaipur, 302017 India.
Department of CTVS, Eternal Heart Care Centre & Research Institute, Jawahar Nagar, Jaipur, 302017 India.
出版信息
Indian J Thorac Cardiovasc Surg. 2023 Sep;39(5):446-452. doi: 10.1007/s12055-023-01526-3. Epub 2023 Jun 13.
BACKGROUND AND OBJECTIVE
The treatment of left main (LM) coronary artery disease (CAD) requires complex decision-making. Patients with left main multi-vessel coronary artery disease (LM CAD) have concerns regarding incomplete revascularization and reduced survival with off-pump (OPCAB) when compared with on-pump (ONCAB) coronary bypass surgery. To evaluate outcomes among high-risk LM CAD patients undergoing OPCAB, we performed a registry-based prospective study.
METHODS
We performed 4868 coronary artery bypass graft (CABG) surgeries from Jan 2013 to Jun 2019 with 4662 (95.8%) OPCAB. In OPCAB cohort, we had 1323 patients (28.4%) with significant LM (> 50%) triple vessel CAD. Data regarding clinical features, extent of CAD, operative details, in-hospital outcomes, and 3-year follow-up were obtained. Descriptive statistics are reported.
RESULTS
The study cohort ( = 1323) was aged 63 ± 9 years with men 88.4%. Tobacco use was in 328 (24.8%), diabetes 598 (45.2%), previous myocardial infarction 463 (35.0%), previous coronary intervention 40 (3.0%), and congestive heart failure in 54 (4.1%). All patients had LM (100.0%) with triple vessel disease in 99.4% (LAD, left anterior descending 100.0%; LCX, left circumflex 99.4%; RCA, right coronary artery 78.7%). Vessels bypassed/patient were 2.7 ± 0.4 with 3.2 ± 0.7 total grafts and 2.1 ± 0.8 venous grafts. In total, 1278 (96.5%) patients received left internal mammary artery (LIMA), 63(4.7%) bilateral internal mammary artery (BIMA), and 74 (5.6%) radial artery grafts. There was no patient with conversion from OPCAB to ONCAB. In-hospital major adverse cardiovascular events (MACE: all-cause deaths, myocardial infarction, and stroke) were in 21 (1.6%). At 3-year follow-up ( = 1041), MACE rates were in 84 (8.1%) and cardiovascular deaths in 28 (2.7%).
CONCLUSIONS
This study shows that off-pump CABG surgery is safe in patients with LM CAD. There is low in-hospital mortality and MACE and 3-year outcomes are similar to the published data of LM CAD patients who undergo on-pump CABG.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12055-023-01526-3.
背景与目的
左主干（LM）冠状动脉疾病（CAD）的治疗需要复杂的决策。与体外循环冠状动脉搭桥术（ONCAB）相比，左主干多支冠状动脉疾病（LM CAD）患者担心非体外循环冠状动脉搭桥术（OPCAB）会导致血运重建不完全以及生存率降低。为了评估接受OPCAB的高危LM CAD患者的预后，我们进行了一项基于注册登记的前瞻性研究。
方法
2013年1月至2019年6月，我们共进行了4868例冠状动脉搭桥术（CABG），其中4662例（95.8%）为OPCAB。在OPCAB队列中，我们纳入了1323例（28.4%）患有严重LM（>50%）三支血管CAD的患者。收集了有关临床特征、CAD范围、手术细节、住院结局和3年随访的数据，并进行描述性统计。
结果
研究队列（n = 1323）的年龄为63±9岁，男性占88.4%。328例（24.8%）有吸烟史，598例（45.2%）患有糖尿病，463例（35.0%）有既往心肌梗死史，40例（3.0 %）有既往冠状动脉介入史，54例（4.1%）有充血性心力衰竭。所有患者均有LM（100.0%），99.4%为三支血管病变（左前降支100.0%；左旋支99.4%；右冠状动脉78.7%）。每位患者搭桥的血管数为2.7±0.4，共植入3.2±0.7支移植血管，其中静脉移植血管2.1±0.8支。共有1278例（96.5%）患者接受了左乳内动脉（LIMA）移植，63例（4.7%）接受了双侧乳内动脉（BIMA）移植，74例（5.6%）接受了桡动脉移植。没有患者从OPCAB转为ONCAB。住院期间主要不良心血管事件（MACE：全因死亡、心肌梗死和中风）发生率为21例（1.6%）。在3年随访时（n = 1041），MACE发生率为84例（8.1%），心血管死亡28例（2.7%）。
结论
本研究表明，OPCAB手术对于LM CAD患者是安全的。住院死亡率和MACE发生率较低，3年结局与已发表的接受ONCAB的LM CAD患者的数据相似。
补充信息
在线版本包含可在10.1007/s12055-023-01526-3获取的补充材料。
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