Impact of multiple arterial grafts in off-pump and on-pump coronary artery bypass surgery

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• 作者：Umberto Benedetto ; MD ; PhD^a ; ^{umberto.benedetto@bristol.ac.uk} ; Massimo Caputo ; MD^a ; Giovanni Mariscalco ; PhD^b ; Mario Gaudino ; MD^c ; Pierpaolo Chivasso ; MD^a ; Alan Bryan ; MD^a ; Gianni D. Angelini ; MD^a
• 关键词：off-pump coronary artery bypass grafting ; multiple arterial grafting ; survival ; propensity score
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：153
• 期：2
• 页码：300-309.e6
• 全文大小：1859 K
• 卷排序：153

文摘

There is growing concern that off-pump coronary artery bypass (OPCAB) is associated with reduced long-term survival compared with traditional on-pump coronary artery bypass (ONCAB); however, most of available comparisons between OPCAB and ONCAB focus on single-artery (SA) revascularization. We sought to investigate the impact of using multiple arterial (MA) conduits in the comparison between OPCAB versus ONCAB by performing a single-center, long-term propensity score base analysis.MethodsThe study population included 5195 SA-ONCAB, 1208 MA-ONCAB, 4412 SA-OPCAB, and 1818 MA-OPCAB procedures. Late survival was available for all cases (100%). Inverse propensity score weighting and a time-segmented Cox model were used for multiple treatments comparison.ResultsNo significant differences were found between the 4 groups in terms of 30-day mortality, postoperative cerebrovascular accident, and renal replacement therapy. After a mean follow-up time of 8.2 ± 4.7 years, in the propensity score−weighted sample, survival probabilities at 10 years were 74.5 ± 0.4, 79.7 ± 0.4, 73.4 ± 0.5, and 79.0 ± 0.5 in the SA-ONCAB, MA-ONCAB, SA-OPCAB, and MA-OPCAB groups respectively. Propensity-weighted analysis confirmed that MA-OPCAB (hazard ratio, 0.81; 95% confidence interval, 0.69-0.98) and MA-ONCAB (hazard ratio, 0.81; 95% confidence interval, 0.65-0.99) were associated with a lower late mortality compared with standard SA-ONCAB.ConclusionsOPCAB with multiple arterial grafts is as safe as the conventional ONCAB and achieves excellent long term survival rates which are superior to those observed after standard SA-ONCAB and comparable with MA-ONCAB.