1198例非体外循环冠状动脉旁路移植术的早期临床分析

目的　总结分析非体外循环冠状动脉旁路移植术 (OPCAB)的早期临床结果和经验体会。方法　 1996年 10月至 2 0 0 2年 5月在国内 15个冠心病微创外科中心完成非体外循环冠状动脉旁路移植术 1198例 ,占同期冠心病手术的 79 5 % ,OPCAB实施率 (即OPCAB占单纯冠状动脉旁路移植术的百分比 )为 85 2 %。年龄平均 (6 1 6± 9 0 )岁 ,男性占 77 3%。 18 7%为左主干病变 ,76 9%为 3支病变。左心室射血分数平均 0 5 6± 0 17。其中二次手术者占 1 5 % ,急诊手术占 9 9%。结果　 2 2例为小切口单支病变旁路移植手术 ,其余均为正中切口、多支病变的OPCAB手术。远端吻合口为 (3 1± 0 9)个 ,乳内动脉桥占 6 5 6 % ,桡动脉桥占 18 0 % ;5 2 %病人使用主动脉内球囊反搏。住院死亡 14例 ,病死率 1 2 %。其中术后心跳骤停或室颤 7例 ,大出血 2例 ,昏迷伴肾功能衰竭 2例 ,大面积脑梗塞 2例 ,呼吸衰竭 1例。并发症中 ,围术期心肌梗死占 0 4% ,急性左心功能衰竭占 0 3% ,严重心律失常占 1 2 % ,呼吸系统并发症占 2 0 % ,器质性神经系统并发症占 1 2 % ,新发或加重的肾功能不全占 0 7% ,出血二次开胸占1 0 % ,胸骨愈合不良占 0 6 %。结论　OPCAB手术安全可行 ,早期效果满意 ,远期效果有待进一步观察。OPCAB具备一     

Risk-adjusted analysis of long-term outcomes after on- versus off-pump coronary artery bypass grafting

 Open in a separate windowOBJECTIVESRecent data suggested that off-pump coronary artery bypass (OPCAB) may carry a higher risk for mortality in the long term when compared to on-pump coronary artery bypass (ONCAB). We, therefore, compared long-term survival and morbidity in patients undergoing ONCAB versus OPCAB in a large single-centre cohort.METHODSA total of 8981 patients undergoing isolated elective/urgent coronary artery bypass grafting between January 2009 and December 2019 were analysed. Patients were stratified into 2 groups (OPCAB n = 6649/ONCAB n = 2332). The primary end point was all-cause mortality. Secondary endpoints included repeat revascularization, stroke and myocardial infarction. To adjust for potential selection bias, 1:1 nearest neighbour propensity score (PS) matching was performed resulting in 1857 matched pairs. Moreover, sensitivity analysis was applied in the entire study cohort using multivariable- and PS-adjusted Cox regression analysis.RESULTSIn the PS-matched cohort, 10-year mortality was similar between study groups [OPCAB 36.4% vs ONCAB 35.8%: hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.87–1.12; P = 0.84]. While 10-year outcomes of secondary endpoints did not differ significantly, risk of stroke (OPCAB 1.50% vs ONCAB 2.8%: HR 0.51, 95% CI 0.32–0.83; P = 0.006) and mortality (OPCAB 3.1% vs ONCAB 4.8%: HR 0.65, 95% CI 0.47–0.91; P = 0.011) at 1 year was lower in the OPCAB group. In the multivariable- and the PS-adjusted model, mortality at 10 years was not significantly different (OPCAB 34.1% vs ONCAB 35.7%: HR 0.97, 95% CI 0.87–1.08; P = 0.59 and HR 1.01, 95% CI 0.90–1.13; P = 0.91, respectively).CONCLUSIONSData do not provide evidence that elective/urgent OPCAB is associated with significantly higher risks of mortality, repeat revascularization, or myocardial infarction during late follow-up when compared to ONCAB. Patients undergoing OPCAB may benefit from reduced risks of stroke and mortality within the first year postoperatively.     

心脏不停跳非体外循环冠状动脉旁路移植术的进展

近年来，随着手术器械的发展，心脏不停跳非体外循环下冠状动脉旁路移植术(OPCAB)逐渐被广泛接受和应用。与常规冠状动脉旁路移植术(CCABG)比较，OPCAB的主要优势为血液中多种炎性介质浓度明显降低，避免了体外循环(CPB)带来的全身系统性炎性损害，减少了并发症，降低了手术死亡率。特别对那些不能采用CPB或采用CPB有风险的高危患者优势更明显。CCABG的手术适应证同样适用于OPCAB，但OPCAB具有相对的禁忌证。OPCAB多采用胸骨正中切口，左前外侧切口适用于左前降支单支病变。OPCAB术后早期结果类似CCABG，但中远期结果有待进一步观察。OPCAB大多数旁路移植血管数低于CCABG，有不能完全再血管化的可能，对OPCAB是否会影响吻合的精确性和旁路血管的长期通畅率有不同意见。OPCAB的优势明确，但仍不能完全替代CCABG，手术的同时应作好CPB准备，必要时改行CCABG。     

不停跳冠状动脉旁路移植术联合同期肺切除术

目的总结不停跳冠状动脉旁路移植术联合同期肺切除术的经验。方法7例不稳定性心绞痛或心肌梗死合并可切除肺部病变患者,实施不停跳冠状动脉旁路移植术联合同期肺切除术。所有患者术前行冠状动脉造影证实不宜行冠状动脉成形术或支架植入术。采用胸骨正中切口,不停跳冠状动脉旁路移植术后行肺切除术。左上肺叶切除2例,右上肺叶切除1例,右上、中叶切除1例,右下肺叶切除1例,左侧肺减容术1例,双侧肺减容术1例。结果本组无住院死亡,但有1例后期死亡。术后并发症包括1例胸骨哆开再次开胸固定、1例房颤。病理检查结果5例肺部恶性肿瘤、2例慢性阻塞性肺气肿。患者随访2～31个月,所有患者术后没有再次出现心肌缺血症状,1例行右肺上、中叶切除患者术后19个月出现局部复发。结论胸骨正中切口不停跳冠状动脉旁路移植术联合同期肺切除术是安全有效的并能降低术后并发症。     

A coronary active perfusion system for off-pump coronary artery bypass grafting in an experimental porcine model: the relationship between flow rate and myocardial function

Abstract:  We developed a coronary active perfusion system (synchronized arterial flow ensuring system [SAFE-System]) to prevent myocardial ischemia during distal anastomosis in off-pump coronary artery bypass grafting (CABG). The purpose of this study was to identify the relationship between the flow rate of the SAFE-System and myocardial function. Studies were performed on pigs, which were divided into five groups: external shunt perfusion group (group A, n  = 6); 0.1 mL/beat flow rate for the SAFE-System group (group B, n  = 6); 0.2 mL/beat flow rate group (group C, n  = 6); 0.3 mL/beat flow rate group (group D, n  = 6); and 0.4 mL/beat flow rate group (group E, n  = 6). Regional myocardial blood flow and left ventricular function were monitored for 30 min. The regional myocardial blood flow in group A was severely decreased ( P  < 0.001), and was significantly lower than in the other groups ( P  <  0.001). The slope of the end-systolic pressure–volume relationship, and the slope of the preload recruitable stroke work relationship in groups A, D, and E were lower than in groups B and C. As compared with the use of a passive external shunt, a coronary active perfusion system provides adequate myocardial blood flow and hemodynamics. It was possible to maintain left ventricular function when using 0.1 or 0.2 mL/beat flow rate. The use of a coronary active perfusion system appears to make the off-pump CABG procedure safer and may increase the application of off-pump bypass grafting.     

Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study

Objective: The minimally invasive coronary artery bypass grafting (MICS CABG) operation performed via a small thoracotomy has not previously been examined in a direct comparison to sternotomy off-pump coronary artery bypass grafting (OPCAB). Methods: We matched, according to age, gender, left ventricular function, and median number of distal anastomoses, 150 patients who underwent MICS CABG via small left thoracotomy, and 150 patients who received sternotomy OPCAB. All operations were performed by the same surgeon. Results: There was no perioperative mortality (0/300). In the MICS CABG group, pump assistance was used in 28/150 (19%) patients, and conversion to sternotomy occurred in 10/150 (6.7%) patients. In the OPCAB group, conversion to on-pump occurred in 3/150 (2.0%) patients. There were four (2.7%) reoperations for bleeding and one (0.7%) for anastomotic revision in each group. The median hospital length of stay was 5 days for MICS CABG (average 5.4), and 6 days for OPCAB (average 7.2) (P = 0.02). New-onset atrial fibrillation occurred in 35 (23%) MICS CABG patients and in 42 (28%) OPCAB patients (P = 0.3). No wound infection occurred with MICS CABG versus six (4.0%) with OPCAB (P = 0.03). A self-limiting left pleural effusion developed in 22 (15%) MICS CABG patients and in six (4.0%) OPCAB patients (P = 0.002). The median time to return to full physical activity was 12 days in MICS CABG patients versus >5 weeks in OPCAB patients (P < 0.001). Conclusions: MICS CABG is a valuable alternative for patients in need of multivessel CABG. The operation appears at least as safe as OPCAB, and associated with shorter hospital length of stay, less wound infections, and faster postoperative recovery than OPCAB.     

The clinical outcome of off-pump coronary artery bypass surgery in the elderly patients

Objective: There has been a body of evidence showing that off-pump coronary artery bypass (OPCAB) may reduce morbidity and mortality in the elderly patients. We reviewed our experience, retrospectively, on elderly patients aged 75 years and older who were operated on using the OPCAB technique. We compared their outcome to a similar group of elderly patients who were operated on using conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) during the same period of time. Methods: Registry data and patients' notes and charts were reviewed for 56 consecutive elderly OPCAB patients (age 78.5±3.5 years) and 87 consecutive CPB patients (age 77.2±2.4 years, P=0.01). Both groups had similar risk factor profiles: Parsonnet score 17.4±4.4 (OPCAB) versus 16.6±5.2 (CPB), P=0.19. We studied in detail their preoperative and postoperative data in order to compare the outcomes of both techniques. Results: The length of stay in the intensive therapy unit (ITU) was 35.4±52.9 h for OPCAB patients and 77.6±144.9 h for CPB patients (P=0.0008). No patient died within 30 days in the OPCAB group, whilst ten (11%) CPB patients (P=0.0066) died within 30 days. The incidence of serious complications (including pulmonary oedema, septicaemia, permanent stroke and renal dysfunction requiring haemofiltration or haemodialysis) was one (2%) in the OPCAB group and 11 (13%) in the CPB group (P=0.028). CPB patients required a significantly higher number ten (12%) of intra-aortic balloon pumps (IABP) inserted compared to only one patient (2%) in the OPCAB group who required IABP insertion (P=0.05). Nine (11%) CPB patients were re-operated on for bleeding compared to no OPCAB patient (0%) needing re-operation, P=0.011. Conclusions: Although the mean age of the OPCAB group was significantly higher than the CPB group, the OPCAB group showed a significant reduction in postoperative serious morbidity, ITU stay and mortality. We believe that such a conclusion may have some effect on the decision-making and cost-effectiveness when performing coronary bypass surgery on the elderly population.     

冠状动脉硬化性心脏病合并左锁骨下动脉严重狭窄非体外循环下同期手术的临床经验

目的探讨非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路治疗冠状动脉硬化性心脏病(冠心病)合并锁骨下动脉重度狭窄的手术方法及效果.方法2003年1月～2004年5月,我院治疗须行冠状动脉旁路移植术同时合并左锁骨下动脉近端重度狭窄3例,术中先行主动脉-锁骨下动脉旁路,左乳内动脉获得满意的流量后,再行非体外循环冠状动脉旁路移植.结果手术时间210～340 min,平均283 min,出血量570～1 630 ml,平均963 ml.游离左乳内动脉后量杯测流量均＜5 ml/min,主动脉-锁骨下动脉旁路后量杯测流量均＞50 ml/min,乳内动脉远端与前降支吻合后流量仪测流量12～27 ml/min,平均20 ml/min.术后临床症状缓解,未发现冠脉-锁骨下动脉窃血综合征.3例随访3～6个月,平均5个月,无心绞痛发作.结论非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路手术是治疗冠心病合并锁骨下动脉重度狭窄简单而有效的方法.     

雷米芬太尼在非体外循环冠状动脉搭桥术"快通道"麻醉中的应用

目的 研究雷米芬太尼用于非体外循环下冠状动脉搭桥术"快通道"麻醉的临床效果.方法 48例行非体外循环下冠状动脉搭桥术患者随机均分为雷米芬太尼组(R组)和芬太尼组(F组).记录两组诱导前(T0)、插管后2 min(T1)、切皮后2 min(T2)、锯胸骨后2 min(T3)、关胸时(T4)、手术结束后30min(T5)的HR,MAP、CVP,肺小动脉楔压(PAWP)、肺毛细血管楔压(PCWP)、术后拔管时间、ICU停留时间和住院时间.结果 R组与F组比较血流动力学和住院时间差异无统计学意义.R组在拔管时间和ICU停留时间上显著短于F组(P<0.01).结论 雷米芬太尼用于非体外循环下冠状动脉搭桥术"快通道"麻醉安全性高、效果明显.     

非体外循环冠状动脉旁路移植术在高危冠心病中的应用

目的 探讨用非体外循环冠状动脉旁路移植术(OPCAB)的方法，以避免体外循环对冠心病高危因素患者产生的不良影响。方法 对100例冠心病患者行OPCAB，其中69例伴有冠心外科手术的高危因素。血管病变主要涉及左、右冠状动脉各分支。结果 手术死亡1例(1.4％)，手术转换2例(2．9％)，移植血管失功1例(1.4％)，术后非致命性心肌梗死4例(5．8％)，肾功能衰竭1例(1．4％)，胸骨感染1例(1．4％)，24小时内拔除气管内插管68例(98.6％)，接受输血17例(25．O％)。术后随访56例，随访时间1—13个月，死亡2例，心绞痛复发4例，充血性心力衰竭2例。术后无脑血管意外、再次手术止血、室性心律失常、下胶切口感染和呼吸衰竭等并发症发生。随访病例中14例做冠状动脉血管造影术，仅1例移植血管狭窄大于50％。所有乳内动脉血管桥均通畅。结论 对某些具有冠心外科手术高危因素的患者，采用OPCAB可降低并发症发生率和手术死亡率。然而，这种技术较适用于冠状动脉解剖条件较好的病例。远期结果需要长期随访进一步加以证实。     

Does multi-vessel off-pump coronary artery bypass grafting reduce post operative morbidity compared to on-pump CABG?

Background Cardiopulmonary bypass (CPB) may contribute to the complications and it is assumed that eliminating cardiopulmonary bypass has the potential of reducing post operative morbidity after coronary artery bypass grafting (CABG). The study was carried out to compare mortality and morbidity in the off-pump and on-pump CABG groups. Methods We prospectively analysed 200 patients undergoing CABG. Group A consists of 100 patients underwent multi-vessel off-pump CABG and group B consists of 100 patients underwent CABG with CPB. The incidence of complications (mortality, re-exploration for bleeding, myocardial infarction, atrial fibrillation, neurological events, new onset renal failure (s. creatinine>1.6 mg/dL) pulmonary complications, length of ICU stay and hospital stay were recorded, analysed and compared. Results OPCAB patients received 2.73±0.61 grafts/patient and on-pump CABG patients received 3.39±0.75 grafts/patient (p value<0.00001). There was no significant statistical difference in mortality, incidence of stroke between OPCAB and CABG with CPB patients. Length of ICU stay was 32.84±4.22 vs 44.85±7.18 hrs (p value<0.00001) and hospital stay was 6.52±0.69 vs 7.94±0.92 days (p value<0.00001) between group A and group B respectively. Incidence of atrial fibrillation was less in OPCAB group 7% vs 12% although it was statistically not significant (p value 0.33). It was observed in our study that there was no significant deference in worsening of existing renal failure between on-pump CABG and OPCAB 6% vs 2% (P value 0.28). Blood utilization was significantly less in OPCAB group (p value<0.001). Conclusion There was no statistically significant difference in terms of mortality, incidence of stroke and new onset renal failure in both groups. But there was lesser incidence of post operative atrial fibrillation, worsening of existing renal failure in off-pump group though statistically not significant. There was significant reduction in blood utilization, length of ICU and hospital stay in OPCAB group.     

Symmetry主动脉吻合器在心脏不停跳冠状动脉旁路移植术中的应用

目的　总结非体外循环心脏不停跳冠状动脉旁路移植术 (Off-pumpcoronaryarterybypassgrafting ,OPCAB)中使用Symmetry主动脉吻合器的近期效果。　方法　 2 0 0 2年 9月～ 2 0 0 3年 6月 ,2 0 4例冠心病行OPCAB ,其中 16 7例使用大隐静脉移植物 ,应用Symmetry主动脉吻合器 10 0例。　结果　使用吻合器 14 2个 ,吻合失败弃用 2个 ,3个吻合口漏血需手工修补 ,成功率 96 5 % (137 14 2 ) ,近端吻合口 (1 4± 0 5 )个 例 ,远端吻合口 (3 5± 0 8)个 例。近端吻合口血流量 (46 5± 2 2 3)ml min。吻合器安装时间 (4 0± 1 1)min ,吻合口完成时间均在 10s以内 ,手术时间 (3 2± 0 4 )h。手术死亡率 1% (1 10 0 ) ,无围手术期心肌梗塞、脑卒中等并发症 ,出血二次开胸 1例 ,但非吻合口出血。术后引流量 (5 4 1± 2 74 )ml,输血率 36 0 % (36 10 0 )。术后住院 (7 8± 1 6 )天。　结论　Symmetry主动脉吻合器可安全有效地应用于CABG术 ,近期临床效果满意 ,可缩短吻合时间和手术时间 ,避免主动脉钳夹 ,降低卒中并发症     

冠心病患者非体外循环冠状动脉旁路移植术后新发房颤与血清微小RNA-146a、微小RNA-499的关系

目的:探讨血清微小RNA(miR)-146a、miR-499与冠心病患者非体外循环冠状动脉旁路移植术(OPCABG)后新发房颤的关系。方法:选取郑州大学第一附属医院2019年8月至2021年8月收治的118例冠心病患者作为研究对象,所有患者均行OPCABG术治疗,术后接受为期7 d观察,将观察期间发生房颤患者纳入发生组...     

非体外循环冠状动脉旁路移植术治疗重症冠状动脉粥样硬化性心脏病

目的探讨非体外循环冠状动脉旁路移植术治疗重症冠状动脉粥样硬化性心脏病(冠心病)的可行性. 方法回顾分析2002年1月～12月37例重症冠心病的临床资料.均采用全麻,胸骨正中切口,游离左乳内动脉及大隐静脉.心脏稳定器局部固定心肌,显露目标冠状动脉,切开后置入冠状动脉内血液分流器.一般先做左乳内动脉与左冠状动脉前降支的吻合,其余血管桥先做桥血管与主动脉的近心端吻合,然后再做桥血管与冠状动脉的吻合. 结果全组病例均在非体外循环下完成手术,搭桥1～6支,(3.2±0.5)支.术后10 d死亡1例,其余36例未发生围术期心肌梗死,无呼吸功能不全、肾功能不全、脑血管意外等严重并发症. 结论在成熟的手术技术和严格的围手术期管理的条件下,非体外循环冠状动脉旁路移植术治疗重症冠心病可行.     

非体外循环冠状动脉搭桥术的近期疗效评价

目的　分析非体外循环 (OPCAB)与常规体外循环下冠状动脉搭桥术 (cCABG)后监护特点和近期疗效。　方法　比较OPCAB组 (6 0例 )和cCABG组 (6 2例 )术后引流量和输血量、血管活性药物的使用、一般监护治疗和恢复情况及近期临床疗效。　结果　OPCAB组术后引流量小于 4 0 0ml的例数明显多于cCABG组 (χ2 =7.316 ,P <0 .0 1) ,而大于 80 0ml的例数明显少于cCABG组 (χ2 =13.2 16 ,P <0 0 0 1)。OPCAB组术后未输血例数明显多于cCABG组 (χ2 =37.793,P <0 0 0 1)。OPCAB组使用硝普钠的例数较cCABG组多 (χ2 =12 .0 0 6 ,P <0 .0 0 1) ,而使用多巴胺的例数明显少于cCABG组 (χ2 =32 .198,P<0 .0 0 1) ,且未使用多巴酚丁胺。OPCAB组术后辅助通气 (5 .9± 3.3)h ,心电监测 (4.8± 1.7)d ,术后(18 1± 4 .1)h坐起 ,(15 .2± 5 .0 )h开始进食 ,平均 (2 .3± 0 .9)d拔除引流管 ,均明显短于cCABG组 (t =14 .0 2 5 ,5 .4 71,5 .791,8.95 3,5 .80 0 ,P <0 .0 1)。OPCAB组死亡 1例 ,围术期心肌梗死 1例 ,心律失常 4例 ,使用IABP 1例 ,较cCABG组少 ,但差别均无显著性 (χ2 =1.776 ,1.776 ,1.937,1.77,P >0 .0 5 )。　结论　OPCAB术后循环稳定 ,创伤小 ,恢复快 ,体现出微创手术的优越性     

Early results of off-pump coronary artery bypass

Objective: The purpose of this study is to compare the operative results of off-pump coronary artery bypass (OPCAB) and on-pump (conventional) coronary artery bypass (CCAB), to clarify qualitative problems and whether OPCAB is less invasive or not. Methods: OPCAB was consecutively performed in 63 patients and CCAB in 63 patients between July 1998 and December 2003. Results: The mean number of bypass grafts was 2.43 ±0.82 in the OPCAB group and 2.70±0.71 in the CCAB group (p=0.096). In-hospital mortality was 0% in the OPCAB group and 3.2% in the CCAB group. The incidence of perioperative myocardial infarction was 0% in the OPCAB group and 3.2% in the CCAB group. The incidence of postoperative major complications was significantly lower in the OPCAB group than in the CCAB group (OPCAB group=4 complications, CCAB group=13 complications). Cerebrovascular accidents occurred in 1.6% of patients in both groups. The incidence of sternal infection or mediastinitis was 0% in the OPCAB group and 3.2% in the CCAB group. The early patency rate of graft was 94.0% in the OPCAB group and 92.8% in the CCAB group, and was not significantly different (p=0.822). Conclusion: Operative mortality and major complications after surgery in OPCAB were lower than that in CCAB. The early patency rate in OPCAB was as good as that in CCAB. It is considered that OPCAB is less invasive and the quality of bypass in OPCAB is as good as that in CCAB.     

微创冠状动脉旁路移植手术33例报告

目的探讨微创冠状动脉旁路移植手术(minimally invasive direct coronary artery bypass graft,MIDCABG)的可靠性及安全性. 方法 2001年3月～2003年9月,我院在全麻、非体外循环、心脏不停跳下进行了33例单支MIDCABG.14例采用左前外侧小切口,19例采用胸骨下段正中切口.31例行左乳内动脉至前降支旁路移植,1例使用大隐静脉行主动脉根部至前降支旁路移植,1例行胃网膜右动脉至后降支旁路移植. 结果全组无手术死亡.术中出血量(163±120)ml,术后引流量(193±169)ml,术后拔管时间(6.4±5.5)h,ICU时间(17.8±4.4)h.随访(14.7±7.4)月,无死亡. 结论 MIDCABG安全可靠,具有创伤小、出血量少、并发症少的优点.     

Association of incomplete revascularization with long-term survival after off-pump coronary artery bypass grafting

Background

We evaluated the effect of incomplete revascularization (IR) on the long-term outcomes after off-pump coronary artery bypass grafting.

Materials and methods

Of 1553 patients with triple-vessel disease who had undergone consecutive off-pump coronary artery bypass grafting, 1351 (87.0%) had complete revascularization (CR) and 202 had IR (13.0%). After propensity score patient matching, we had 200 patients in each group. Cardiac survival and major adverse cardiac and cerebrovascular events (MACCE) were assessed before and after patient matching. Subgroup analysis was performed to evaluate the interaction between the left ventricular ejection fraction (LVEF) and the completeness of revascularization. The follow-up duration was 60 mo.

Results

In the all-patient analysis, the CR group had a lower incidence of in-hospital mortality, cardiac mortality, and MACCE (P = 0.033, P < 0.001, and P = 0.003, respectively). The 5-year cardiac survival was 96.5% ± 0.6% in the CR group and 88.9% ± 2.5% in the IR group (P < 0.001), with a freedom from MACCE rate of 85.4% ± 1.2% and 78.8% ± 3.4%, respectively (P = 0.015). After patient matching, the CR group showed superior 5-year cardiac survival compared with the IR group (96.2% ± 1.4% versus 88.8% ± 2.5%, P = 0.022), with a similar freedom from MACCE rate. IR was identified as an independent predictor of cardiac death (hazard ratio 2.76, 95% confidence interval 1.62–4.70; P < 0.001). IR predicted cardiac death more distinctly in patients with a low LVEF (hazard ratio 5.29, 95% confidence interval 1.71–16.39; P = 0.004) than in those with a preserved LVEF (hazard ratio 2.04, 95% confidence interval 1.02–4.08; P = 0.045).

Conclusions

CR in off-pump coronary artery bypass grafting was related to superior cardiac survival after 5 years of follow-up compared with IR. The benefit of CR was more distinct in those with a low LVEF. CR should be achieved whenever possible, especially in patients with a low LVEF.     

Safety and efficacy of off-pump coronary artery bypass grafting in chronic dialysis patients

Off-pump coronary artery bypass grafting (CABG) has been recently revived, because cardiopulmonary bypass (CPB) appears to worsen the multiple organ dysfunction after conventional CABG. To evaluate the safety and efficacy of the off-pump CABG in chronic dialysis patients, we compared the perioperative morbidity and mortality between 15 dialysis patients who underwent off-pump CABG at our center over the past 8 years with that of a concurrent group of 19 patients who underwent conventional CABG. Patients were selected for off-pump CABG only when complete revascularization was technically feasible. We found that off-pump CABG is as safe and effective as conventional CABG in selected dialysis patients. It might even be beneficial, because it is associated with less hematocrit drop and blood product use, a lower catabolic rate, and fewer dialysis requirements after surgery. However, the impact of off-pump technique on the long-term clinical outcome and resource utilization in renal patients requires further investigation.