Zusammenfassung
Hintergrund
Ziel dieser Untersuchung war es zu beurteilen, ob durch die Anwendung der Clampless-off-pump(less OPCAB)-Technik Letalität und Schlaganfallrate sowie andere schwere Komplikationen in der Koronarchirurgie gesenkt werden können.
Patienten und Methoden
Zwischen Juli 2009 und November 2010 erfassten wir die Daten von 1282 Patienten, die sich einer isolierten Bypassoperation unterziehen mussten, prospektiv in einer Datenbank. In 30,8% der Fälle wurden die Prozeduren vollständig ohne Klemmen der Aorta durchgeführt. Dabei wurden die zentral venösen Anastomosen entweder mit dem PAS-Port-System automatisch hergestellt, oder es wurde komplett arteriell ohne das Anlegen von zentralen Anastomosen revaskularisiert. Um für eine Unausgewogenheit zwischen den Gruppen (Selektionsbias) zu korrigieren, wurde auf der Basis von 15 Variablen, die das Risikoprofil der Patienten abbilden, eine Propensity-Score(PS)-Analyse durchgeführt. Letalität, Schlaganfallrate und weitere Komplikationen sowie Ressourcenverbrauch verglichen wir zwischen der Less-OPCAB- und der konventionellen Gruppe (cCABG).
Ergebnisse
Insgesamt konnten 788 Patienten (394 Paare) erfolgreich gematcht werden. Durch die Less-OPCAB-Technik konnten Letalität (OR: 0,25, 95%-KI: 0,05–1,17) und Schlaganfallrate (OR: 0,35, 95%-KI: 0,12–0,98) signifikant gesenkt werden. Komplikationen wie Low-output-Syndrom, Langzeitbeatmung oder die Rate der Rethorakotomien waren in der Less-OPCAB-Gruppe ebenfalls reduziert.
Schlussfolgerung
In dieser retrospektiven Propensity-Score-Analyse senkt die Clampless-OPCAB-Technik Letalität, Schlaganfallrate und andere Morbiditätsfaktoren in einem nicht selektionierten Kollektiv koronarchirurgischer Patienten.
Abstract
Background
This study aimed to assess whether the use of the clampless off-pump coronary artery bypass grafting (CABG) technique decreases risk-adjusted mortality, stroke rate, and morbidity in an unselected patient population.
Patients and methods
Between July 2009 and November 2010, data of 1,282 consecutive patients undergoing isolated CABG were prospectively recorded in a clinical database. In 30.8% (n=395), the procedures were completed clampless off-pump, either using the PAS-Port automated central venous anastomosis system or as total arterial revascularization without central anastomoses. Propensity score (PS) matching was performed based on 15 variables representing preoperative risk factors to correct for selection bias. Procedural mortality, stroke rate, major complications, and resources utilization of clampless off-pump (lessOPCAB) and conventional CABG (cCABG) were compared.
Results
A total of 788 patients (394 pairs) undergoing CABG were able to be successfully matched. The clampless off-pump technique significantly decreased the rates of death (OR: 0.25, 95%-CI: 0.05–1.17) and stroke (OR: 0.35, 95%-CI: 0.12–0.98). Complications, including low output syndrome, prolonged ventilation, and reoperation, were also reduced by less OPCAB.
Conclusion
In a retrospective PS-matched analysis, less OPCAB lowers mortality, stroke rate, and other morbidity in an unselected group of patients with coronary artery disease.
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Interessenkonflikt
Der korrespondierende Autor weist auf folgende Beziehung hin: Dr. Börgermann ist als Referent für die Firma Medtronic, Meerbusch, Deutschland tätig.
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Börgermann, J., Kuss, O., Hakim, K. et al. Reduktion von perioperativer Letalität und Morbidität in der Koronarchirurgie mit Clampless-off-pump-Technik. Z Herz- Thorax- Gefäßchir 25, 6–12 (2011). https://doi.org/10.1007/s00398-010-0820-z
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DOI: https://doi.org/10.1007/s00398-010-0820-z