| Objective: To explore the safety and efficacy of 2-staged hybrid coronary artery revascularization in the treatment of multivessel coronary artery disease,by comparing the clinical results of 2-staged hybrid coronary revascularization(HCR)and off-pump coronary artery bypass grafting((OPCAB))in the treatment of multivessel coronary artery disease during the perioperative period and within 3 years follow-up.Methods:From January 2013 to January 2017,the clinical data and results of 60 patients with coronary artery multivessel disease treated by 2-staged hybrid coronary artery revascularization in the heart center of Qingdao municipal hospital were analyzed retrospectively.60 patients who underwent off-pump coronary artery bypass grafting in the heart center of Qingdao municipal hospital were matched according to the proportion of 1:1 at the same time.After 3 years follow-up,the major adverse cardiac and cerebrovascular events(MACCE),including all-cause death,cerebrovascular accident,myocardial infarction and revascularization were compared between the two groups.SPSS25.0 statistical software was used to analyze the data,GraphPad Prism 8.0 software was used to visualize the data,Kaplan-Meier method was used to analyze the cumulative survival rate and the incidence of MACCE-free events,and the survival curve was drawn,Log-Rank test was used to test the difference between the two groups of data.P<0.05,the difference was statistically significant.Results: There was no significant difference in preoperative data between the two groups.The operation time of HCR group was shorter than that of OPCAB group(210.5±67.2min VS 252±53.8min,P=0.0035),the trauma of surgical incision was less(6.3±0.9cm VS 17.3±2.5cm,P<0.0001),and the amount of intraoperative blood loss wasless(136.7±86.9ml VS 260.2±175.8ml,P<0.0001).The thoracic drainage volume in HCR group was less in 24 hours after operation(198.5±63.6ml VS 382.3±139.3ml,P<0.0001).Compared with the OPCAB group,the HCR group had less blood transfusion needs,percentage of transfusion cases(35% VS 68.3%,P=0.0003),the amount of red blood cells(1.2 ± 0.9U VS 2.8 ± 1.1U,P<0.0001),and the amount of plasma input(233.2 ±127.2ml VS 533.1 ± 266.3ml,P<0.0001).In HCR group,the duration of ventilator-assisted ventilation was shorter(5.6 ± 0.8h vs 9.3 ± 8.1h,P = 0.0067),the hospitalization time in cardiac surgery intensive care unit was shorter(28.1 ± 10.6h vs54.7 ± 25.3h,P < 0.0001),and the total length of stay was shorter(18.5 ± 3.8d vs 23.3 ±7.9d,P = 0.0006).There was no significant difference between the two groups in perioperative adverse events,such as perioperative MACCE events(including all-cause death,cerebrovascular accident,myocardial infarction,revascularization),postoperative renal failure,postoperative new atrial fibrillation,secondary thoracotomy hemostasis,and surgical incision healing.However,the total incidence of adverse events in HCR group was lower(38.3% VS 96.7%,P<0.0001),and there was significant difference.There was no significant difference in the incidence of MACCE events(including all-cause death,cerebrovascular accident,myocardial infarction and revascularization)between the two groups in the 3 years follow-up.The Kaplan-Meier method was used to analyze the cumulative survival rate and the incidence of MACCE-free events,and the survival curves were drawn,P(log-rank)values were 0.65 and 0.36,respectively,with no statistical significance.Conclusions: 2-staged hybrid coronary revascularization is safe and feasible in the treatment of multivessel coronary artery disease.Compared with off-pump coronary artery bypass grafting,it has better perioperative performance and can provide similar medium-term follow-up results. |
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