Off-Pump Bilateral Versus Single Skeletonized Internal Thoracic Artery Grafting in Patients With Diabetes
Off-Pump Bilateral Versus Single Skeletonized Internal Thoracic Artery Grafting in Patients With Diabetes
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DOI：
10.1016/j.athoracsur.2010.05.048
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发表时间：
2010-10-01
影响因子：
4.6
通讯作者：
Matsubayashi, Keiji
中科院分区：
文献类型：
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作者：
Kinoshita, Takeshi;Asai, Tohru;Matsubayashi, Keiji
背景我们比较了倾向评分匹配的糖尿病患者接受非体外循环冠状动脉旁路移植术的结果，使用分叉的双侧或单侧胸廓内动脉（ITA），并评估了双侧ITA移植术对结果的任何益处。在770例接受隔离冠状动脉旁路移植术的连续患者中（99.2%采用非体外循环技术，未转为体外循环），423例患者患有糖尿病。在排除年龄大于85岁（n = 10）或左冠状动脉区域仅有一条靶血管（n = 9）的患者后，使用基于12个术前因素创建的倾向评分匹配170对。除1例患者外，双侧ITA均与左冠状动脉系统闭塞。两组患者术后血糖控制良好。两组之间深部胸骨感染的发生率相似。平均观察期为3.2年。双侧与单侧ITA移植的5年无死亡生存率分别为87.5%和70.8%（对数秩检验p = 0.01）。无心源性死亡的发生率分别为92.1%和78.7%（p = 0.01）。无心脏事件的发生率分别为91.0%和72.6%（p = 0.01）。在多变量考克斯模型中，双侧ITA移植与总体死亡风险降低显著相关（风险比，0.45; 95%置信区间，0.22 - 0.89; p = 0.02），心源性死亡（危险比，0.43; 95%可信区间，0.21 ~ 0.87; p = 0.02）和心脏事件（危险比，0.42; 95%可信区间，0.20 ~ 0.85; p = 0.02）。与单次ITA移植相比，非体外循环下单侧ITA移植的中期结局更好，而不会增加深部胸骨感染的风险。(Ann Thorac Surg 2010;90：1173-9）（c）2010年，胸外科医师协会
Background. We compared the outcomes in propensity score-matched patients with diabetes undergoing off-pump coronary artery bypass grafting using skeletonized bilateral or single internal thoracic artery (ITA) and assessed any benefit of bilateral ITA grafting for outcomes.Methods. Among 770 consecutive patients undergoing isolated coronary artery bypass graft surgery (99.2% by off-pump technique without conversion to cardiopulmonary bypass), 423 patients had diabetes mellitus. After excluding patients who were older than 85 years of age (n = 10) or had only one target vessel at the left coronary area (n = 9), 170 pairs were matched using propensity scores created on the basis of 12 preoperative factors.Results. Except for 1 patient, bilateral ITA was anastomosed to the left coronary system. Postoperative serum glucose was well controlled in both groups. The rate of deep sternal infection was similar between the groups. The mean observation period was 3.2 years. The 5-yearsurvival free from overall death in bilateral versus single ITA grafting was 87.5% versus 70.8% (log-rank test p = 0.01). For freedom from cardiac death, the respective rate was 92.1% versus 78.7% (p = 0.01). For freedom from cardiac event, the respective rate was 91.0% versus 72.6% (p = 0.01). In multivariate Cox models, bilateral ITA grafting was significantly associated with a lower risk for overall death (hazard ratio, 0.45; 95% confidence interval, 0.22 to 0.89; p = 0.02), cardiac death (hazard ratio, 0.43; 95% confidence interval, 0.21 to 0.87; p = 0.02), and cardiac event (hazard ratio, 0.42; 95% confidence interval, 0.20 to 0.85; p = 0.02).Conclusions. Off-pump skeletonized left-sided bilateral ITA grafting is associated with better mid-term outcomes than single ITA grafting, without increasing the risk of deep sternal infection. (Ann Thorac Surg 2010;90:1173-9) (c) 2010 by The Society of Thoracic Surgeons