Objective: To investigate and analyze the relationship between intraoperative graft flow measurements and the early mid-term outcomes after off-pump coronary artery bypass grafting (OPCAB).
Methods: Patients who underwent isolated OPCAB in the Department of Cardiac Surgery of Peking University People's Hospital from January 2013 to June 2016 were included. Perioperative characteristics, graft flow measurements and postoperative follow-up outcomes were retrospectively collected. Comparison was made between flow measurements of grafts and the early mid-term outcomes. Flow measurements of grafts included the mean flow (MF) and the pulsatility index (PI). The early outcomes included peri-operative myocardial infarction (PMI), use of an intra-aortic balloon pump (IABP), reoperation for all causes, new-onset atrial fibrillation and in-hospital or 30-day mortality.
Results: A total of 463 patients were included in the study. Mean age was (62.80±8.36) years, and 24.8% were females. The total number of grafts was 1 435, which averaged 3.10 grafts per patient. The MF and PI were separately (32.34±14.45) mL/min and 2.87±0.92. Of all the patients, 23(5%) had PMI, and 11 used IABP. Observed in-hospital or 30-day mortality was 0.86% (4 patients). Compared with non-PMI group, the MF was lower and the PI was higher in the PMI group (P<0.05). However, the differences of other early outcomes had no statistical significance between the PMI group and the non-PMI group. The lower MF (Wald=5.684, P=0.017, 95%CI: 0.894-0.989) and the higher PI (Wald=9.040, P=0.003, 95%CI: 1.252-2.903) were risk factors of PMI in multivariable Logistic regression modeling. The longest follow-up time was 37 months, and 7 patients died. The differences of graft flow measurements between the surviving group and the nonsurvivors had no statistical significance, but overall mid-term survival was lower in patients with poor left internal mammary artery (LIMA) to left anterior descending artery (LAD) graft flow (MF<10 mL/min; OR=9.6, P<0.05).
Conclusion: Intraoperative graft flow parameters during OPCAB can predict the early mid-term outcomes. The lower MF and the higher PI should increase the rate of PMI. A lower flow of LIMA to LAD graft (<10 mL/min) should increase the rate of midterm mortality, but further research will be needed to confirm and explore the findings.
目的: 对非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass,OPCAB)中测定的血流资料和术后近中期结果进行分析,探讨两者间的相关性。
方法: 回顾性收集2013年1月至2016年6月在北京大学人民医院行单纯OPCAB手术的患者资料,分析并对比患者术中测定的血流指标、术后早期临床事件及术后随访资料。术后早期临床事件包括围手术期心肌梗死、主动脉内球囊反搏(intra-aortic balloon pump,IABP)使用、再次手术、新发心房颤动及院内死亡。
结果: 共463例患者纳入研究,平均年龄(62.80±8.36)岁,其中女性115例(24.8%),平均吻合桥血管(3.10±0.81)支,共1 435支桥血管,术中血流测定结果显示移植血管平均血流量(mean flow,MF)为(32.34±14.45) mL/min,搏动指数(pulsatility index,PI)为2.87±0.92。23例(5%)患者发生围手术期心肌梗死,IABP使用者11例,术后30 d死亡患者4例。围手术期心肌梗死组的桥血管MF低于无心肌梗死组,而PI高于无心肌梗死组(P<0.05)。其他术后早期临床事件组间比较,其MF、PI值差异均无统计学意义。Logistic回归分析显示移植血管低MF(Wald=5.684,P=0.017,95%CI:0.894~0.989)、高PI(Wald=9.040,P=0.003,95%CI:1.252~2.903)是围手术期心肌梗死的危险因素。随访最长时间37个月,共7例患者死亡,死亡组与生存组间术中血流指标差异均无统计学意义。与动脉桥正常血流组比较,低MF组(MF<10 mL/min)随访期间死亡率较高,差异有统计学意义(OR=9.6,P<0.05)。
结论: 移植血管低MF、高PI会增加围手术期心肌梗死发生率,动脉桥MF<10 mL/min 会增加患者术后中期死亡率,但仍需进一步研究证实,术中血流测定技术对OPCAB术后近中期结果有一定的预测价值。