Off-pump bilateral skeletonized internal thoracic artery grafting in patients with chronic kidney disease
Off-pump bilateral skeletonized internal thoracic artery grafting in patients with chronic kidney disease
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DOI：
10.1016/j.jtcvs.2015.04.058
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发表时间：
2015-08-01
影响因子：
6
通讯作者：
Suzuki, Tomoaki
中科院分区：
文献类型：
--
作者：
Kinoshita, Takeshi;Asai, Tohru;Suzuki, Tomoaki
背景资料：我们比较了倾向评分匹配的慢性肾脏病（CKD）患者接受非体外循环冠状动脉旁路移植术（双侧或单侧胸廓内动脉（ITA））的结局。在1254例接受隔离冠状动脉搭桥手术的连续患者中，（1248例采用非体外循环技术，未紧急转心肺转流），1203例接受单（n = 453）或双侧（n = 750）分流术，排除术前接受经皮心肺支持的6例患者和左冠状动脉区域仅有1条靶血管的75例患者后，入组ITA移植物。共有412对匹配使用倾向评分。Kaplan-Meier分析用于评估CKD分期的全因和心脏相关死亡率（通过肾小球滤过率[GFR]评估：60 mL/min/1.73 m（2））。多变量考克斯比例风险模型用于评估双侧移植与死亡率的相关性。测试双边ITA移植和估计GFR的相互作用carried.Results：没有显着差异，发现在发病率30天死亡率，中风，或深部胸骨感染的2组之间。虽然晚期CKD降低了总生存率，但双侧ITA移植对全因死亡率和心脏相关死亡率的获益发生在随访期相对较早的阶段，且不受CKD分期的影响。双侧ITA移植术与GFR估计值为
Background: We compared the outcomes in propensity score-matched patients who had chronic kidney disease (CKD) undergoing off-pump coronary bypass grafting, with either a bilateral or single skeletonized internal thoracic artery (ITA).Methods: Of 1254 consecutive patients undergoing isolated coronary bypass surgery (1248 by the off-pump technique without emergent conversion to cardiopulmonary bypass), the 1203 who received a skeletonized, single (n = 453) or bilateral (n = 750), ITA graft were enrolled, after excluding the 6 patients who received preoperative percutaneous cardiopulmonary support and the 75 who had only 1 target vessel in the left coronary area. A total of 412 pairs were matched using propensity scores. Kaplan-Meier analyses were used to assess all-cause and cardiac-related mortality, by CKD stage (assessed by glomerular filtration rate [GFR]: 60 mL/minute/1.73 m(2)). Multivariate Cox proportional hazard models were used to assess for association of bilateral grafting with mortality. A test for interaction of bilateral ITA grafting and estimated GFR was conducted.Results: No significant difference was found in the incidence of 30-day mortality, stroke, or deep sternal infection between the 2 groups. Although an advanced stage of CKD decreased overall survival, a benefit of bilateral ITA grafting for all-cause and cardiac-related mortality occurred relatively early in the followup period and was not influenced by CKD stage. Bilateral ITA grafting was independently associated with a lower risk of both all-cause and cardiac-related mortality in patients with an estimated GFR of