Early Outcome of On-pump Versus Off-pump Elective Surgical Revascularization in Patients with Prior ST-Segment Elevation Myocardial Infarction.

Mymensingh medical journal : MMJ Pub Date : 2024-04-01
S I Jahan, M K Hassan, A S M Khan, M Z Islam, M K Hasan, A M Z Haque, K S S Rushel, A K M Alam, A H Sium, F Sazzad
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Abstract

Coronary artery bypass graft surgery (CABG) is a proven treatment for coronary artery disease. History of a ST-elevation myocardial infarction (STEMI) is considered an independent risk factor for CABG irrespective of timing for an emergency or elective surgery. Patients with STEMI are candidates for both On-pump and Off-pump CABG procedures. This paper discusses the possible best option for elective surgical revascularization in patients with prior STEMI. This prospective clinical trial of 60 eligible patients with prior STEMI was conducted in a Tertiary Care Hospital from April 2018 to March 2019. Among them, 30 patients underwent off-pump (Group A) and 30 patients underwent on-pump (Group B) CABG procedures. Outcomes between both groups were observed from surgery to 1 month postoperatively. Data was analysed by the software statistical program for social science (SPSS 25.0 Inc). The surgery was successful in both groups of patients. Differences were observed by mean number of grafts per patient (2.77±0.43 vs. 3.10±0.71) and duration of operation (4.41±0.35 hours vs. 5.71±0.48 hours). An improvement in Left Ventricular Ejection Fraction (LVEF %) was observed in both groups postoperatively (17.98% vs. 10.98%) and the postoperative LVEF% at different time points were found statistically significant (p<0.05) over preoperative LVEF%. Multivariable stepwise logistic regression analysis correlated on-pump CABG with prolonged need for ionotropic support, need for blood transfusion, longer hospital stay and less improvement in LVEF%. The study supports the Off-pump CABG as a better surgical option over on-pump CABG in patients with prior STEMI.

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对既往 ST 段抬高心肌梗死患者进行泵上与泵下择期手术血管重建的早期疗效。
冠状动脉旁路移植手术(CABG)是治疗冠状动脉疾病的一种行之有效的方法。无论急诊手术还是择期手术,ST段抬高型心肌梗死(STEMI)病史都被认为是冠状动脉旁路移植手术的独立风险因素。STEMI 患者既可接受 "泵上"(On-pump)CABG 手术,也可接受 "泵下"(Off-pump)CABG 手术。本文讨论了既往 STEMI 患者进行择期手术血运重建的最佳选择。这项前瞻性临床试验于 2018 年 4 月至 2019 年 3 月在一家三甲医院进行,共有 60 名符合条件的既往 STEMI 患者参加。其中,30 名患者接受了非泵(A 组)CABG 手术,30 名患者接受了泵上(B 组)CABG 手术。观察两组患者从手术到术后1个月的疗效。数据采用社会科学统计程序软件(SPSS 25.0 Inc)进行分析。两组患者的手术都很成功。每名患者的平均移植物数量(2.77±0.43 对 3.10±0.71)和手术时间(4.41±0.35 小时对 5.71±0.48小时)存在差异。两组患者术后左心室射血分数(LVEF %)均有改善(17.98% vs. 10.98%),术后不同时间点的左心室射血分数均有统计学意义(P<0.05)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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