非体外循环冠状动脉旁路移植术中桥血管血流对术后近中期预后的影响

doi:10.19723/j.issn.1671-167X.2019.05.010

Abstract

Abstract:

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 non-survivors 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.

Key words: Coronary artery bypass, off-pump, Monitoring, intraoperative, Coronary circulation, Flow measurement, Postoperative period

CLC Number:

R541.4

Wen-qiang SUN,Zhou ZHAO,Qing GAO,Zeng-qiang HAN,Wei YANG,Bo LIAN,Gang LIU,Sheng-long CHEN,Yu CHEN. Effects of intraoperative graft flow measurements on the early mid-term outcomes after off-pump coronary artery bypass grafting[J].Journal of Peking University(Health Sciences), 2019, 51(5): 851-855.

Figures/Tables 3

Table 1

Characteristics of the patients"

Items	All patients (n=463)
Age/years, $x ?$ ±s	62.80±8.36
Female, n(%)	115 (24.8)
BMI, $x ?$ ±s	25.71±3.25
AMI, n(%)	129 (27.9)
LM, n(%)	109 (23.5)
NYHA class Ⅲ-Ⅳ, n(%)	82 (18.1)
Hypertension, n(%)	289 (62.4)
DM, n(%)	175 (37.8)
PVD, n(%)	13 (2.8)
CVD, n(%)	63 (13.6)
History of smoking, n(%)	193 (41.7)
LVEF/%	61.91±10.10

Table 1

Table 2

Comparison of correlation factors between PMI and non-PMI group"

Items	PMI group (n=23)	Non-PMI group (n=440)	P
Age/years, $x ?$ ±s	62.96±8.61	62.80±8.36	0.931
Female, n(%)	3 (13)	112 (25.5)	0.179
BMI, $x ?$ ±s	24.66±2.93	25.77±3.26	0.119
AMI, n(%)	7 (30.4)	122 (27.8)	0.783
LM, n(%)	4 (17.4)	105 (23.9)	0.476
NYHA class Ⅲ-Ⅳ, n(%)	1 (4.5)	81 (18.9)	0.157
Hypertension, n(%)	14 (60.9)	275 (62.5)	0.875
DM, n(%)	5 (21.7)	170 (38.6)	0.103
CVD, n(%)	2 (8.7)	61 (13.9)	0.692
MF/(mL/min) , $x ?$ ±s	22.52±12.76	32.85±14.36	0.001
PI, $x ?$ ±s	3.80±1.69	2.82±0.84	0.011

Table 2

Table 3

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Effects of intraoperative graft flow measurements on the early mid-term outcomes after off-pump coronary artery bypass grafting

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