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首页> 外文期刊>The Journal of Thoracic and Cardiovascular Surgery >Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump vers
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Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump vers

机译：非体外循环冠状动脉搭桥术提供了完整的血运重建，减少了心肌损伤，输血需求和住院时间：前瞻性随机比较了200名非体外循环患者

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OBJECTIVE: Retrospective comparisons of selected patients undergoing off-pump versus conventional on-pump coronary artery bypass grafting have yielded inconsistent results and raised concerns about completeness of revascularization in off-pump coronary artery bypass grafting. METHODS: Two hundred unselected patients referred for elective primary coronary artery bypass grafting were randomly assigned to undergo off-pump coronary artery bypass grafting with an Octopus tissue stabilizer (Medtronic, Inc, Minneapolis, Minn) or conventional coronary artery bypass grafting with cardiopulmonary bypass by a single surgeon. Revascularization intent determined before random assignment was compared with the revascularization performed. All management followed strict, unbiased, criteria-driven protocols. Patients and nonoperative care providers were blinded to surgical group. RESULTS: Baseline characteristics were similar. The number of grafts performed per patient (mean +/- SD 3.39 +/- 1.04 for off-pump coronary artery bypass grafting, 3.40 +/- 1.08 for conventional coronary artery bypass grafting) and the index of completeness of revascularization (number of grafts performedumber of grafts intended, 1.00 +/- 0.18 for off-pump coronary artery bypass grafting, 1.01 +/- 0.09 for conventional coronary artery bypass grafting) were similar. Likewise, the index of completeness of revascularization was similar between groups for the lateral wall. Combined hospital and 30-day mortalities and stroke rates were similar. Postoperative myocardial serum enzyme measures were significantly lower after off-pump coronary artery bypass grafting, suggesting less myocardial injury. Adjusted postoperative thromboelastogram indices, fibrinogen, international normalized ratio, and platelet levels all showed significantly less coagulopathy after off-pump coronary artery bypass grafting. Patients undergoing off-pump coronary artery bypass grafting received fewer units of blood, were more likely to avoid transfusion altogether, and had a higher hematocrit at discharge. Cardiopulmonary bypass was an independent predictor of transfusion (odds ratio 2.42, P =.0073) by multivariate analysis. More patients undergoing off-pump coronary artery bypass grafting were extubated in the operating room and within 4 hours. Postoperative length of stay (in days) was shorter for off-pump coronary artery bypass grafting (5.1 +/- 6.5 for off-pump coronary artery bypass grafting, 6.1 +/- 8.2 for conventional coronary artery bypass grafting, P =.005 by Wilcoxon test). One patient (in the conventional coronary artery bypass grafting group) required angioplasty for graft closure within 30 days. CONCLUSIONS: When compared with conventional coronary artery bypass grafting with cardiopulmonary bypass, off-pump coronary artery bypass grafting achieved similar completeness of revascularization, similar in-hospital and 30-day outcomes, shorter length of stay, reduced transfusion requirement, and less myocardial injury.
机译：目的：回顾性比较选择的非体外循环与传统的体外循环冠状动脉搭桥术的患者，结果不一致，并引起人们对非体外循环冠状动脉搭桥术血运重建完整性的担忧。方法：将未经选择的200例行择期冠状动脉搭桥术的患者随机分配到接受体外循环的八达通组织稳定剂（Medtronic，Inc，Minneapolis，Minn）或传统的冠状动脉搭桥术并经体外循环。一个外科医生。将随机分配之前确定的血运重建意图与进行的血运重建进行比较。所有管理人员均遵循严格，公正，标准驱动的协议。患者和非手术护理人员对手术组不知情。结果：基线特征相似。每位患者进行的移植数量（非体外循环冠状动脉搭桥术的平均值为±SD 3.39 +/- 1.04，常规冠状动脉搭桥术的平均值为3.40 +/- 1.08）和血运重建的完整性指数（移植数）进行的次数/预期的移植物数量，非体外循环冠状动脉搭桥术为1.00 +/- 0.18，常规冠状动脉搭桥术为1.01 +/- 0.09）相似。同样，侧壁之间的血运重建完成指数在各组之间相似。合并医院和30天死亡率和中风率相似。非体外循环冠状动脉搭桥术后，术后心肌血清酶的测定值明显降低，提示心肌损伤较小。调整后的血栓弹力图指数，纤维蛋白原，国际标准化比率和血小板水平均显示非体外循环冠状动脉搭桥术后的凝血病明显减少。进行非体外循环冠状动脉搭桥术的患者血液单位减少，完全避免输血的可能性更高，出院时的血细胞比容较高。通过多变量分析，心肺旁路是输血的独立预测因子（比值比为2.42，P = .0073）。在手术室和4小时内，有更多接受非体外循环冠状动脉搭桥术的患者拔管。非体外循环冠状动脉旁路移植术的术后住院时间（天）较短（非体外循环冠状动脉旁路移植术为5.1 +/- 6.5，传统冠状动脉旁路移植术为6.1 +/- 8.2，P = .005 Wilcoxon测试）。一名患者（在常规冠状动脉旁路移植术组中）需要进行血管成形术以在30天内关闭移植物。结论：与传统的体外循环冠状动脉搭桥术相比，非体外循环冠状动脉搭桥术具有相似的血运重建术，相似的住院和30天预后，更短的住院时间，减少的输血需求以及更少的心肌损伤。

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