重做 CABG 时的多动脉移植:动脉导管类型和患者性别决定获益情况。

IF 4.9 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Thoracic and Cardiovascular Surgery Pub Date : 2024-10-17 DOI:10.1016/j.jtcvs.2024.10.018
Gabriele M Iacona, Jules J Bakhos, Penny L Houghtaling, Aaron E Tipton, Richard Ramsingh, Nicholas G Smedira, Marc Gillinov, Kenneth R McCurry, Edward G Soltesz, Eric E Roselli, Michael Z Tong, Shinya G Unai, Haytham J Elgharably, Marijan J Koprivanac, Lars G Svensson, Eugene H Blackstone, Faisal G Bakaeen
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引用次数: 0

摘要

目的评估在孤立的再做 CABG 手术中,多动脉移植是否比单动脉移植带来更多益处:从1980年1月1日至2020年7月7日,6559名成人接受了6693例孤立的CABG再手术。接受多动脉移植术的患者与接受单动脉移植术的患者进行了倾向得分匹配,无论是否进行了额外的静脉移植,结果有2005对患者匹配成功。终点是院内术后并发症、住院死亡率和长期死亡率。中位随访时间为10年,25%的随访时间超过17年。多变量多相危险模型和非参数随机生存森林用于确定多动脉移植对哪些患者最有利:在倾向匹配的患者中,多动脉移植与单动脉移植的术后并发症分别为:再次手术50例(2.5%)对65例(3.2%);肾功能衰竭73例(3.6%)对55例(2.7%);中风44例(2.2%)对38例(1.9%);胸骨深部感染36例(1.8%)对25例(1.2%)。住院死亡率为1.7%(35人)对2.8%(56人)(P=0.03)。多动脉移植与单动脉移植相比,1 年和 3 年的存活率分别为 95% 对 94% 和 92% 对 88%,5 年、15 年和 20 年的存活率分别为 87%、49% 和 31% 对 82%、42% 和 25%。多动脉移植后存活率较高的患者仅限于胸内动脉移植2处通畅的男性(PConclusions:与单动脉移植术相比,多动脉移植术可降低院内死亡率和主要发病率。长期存活率较高,尤其是使用 2 条胸内动脉移植物的男性患者。
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Multiarterial Grafting in Redo CABG: Type of Arterial Conduit and Patient Sex Determine Benefit.

Objective: To evaluate whether multiarterial grafting provides incremental benefit above single arterial grafting in isolated redo CABG.

Methods: From 1/1980 to 7/2020, 6559 adults underwent 6693 isolated CABG reoperations. Patients undergoing multiarterial grafting were propensity-score matched with those undergoing single arterial grafting, with or without additional vein grafts, yielding 2005 well-matched pairs. Endpoints were in-hospital postoperative complications, hospital mortality, and long-term mortality. Median follow-up was 10 years with 25% followed >17 years. Multivariable multiphase hazard modeling and nonparametric random survival forests for survival were used to identify patients for whom multiarterial grafting was most beneficial.

Results: Among propensity-matched patients, postoperative complications for multiarterial versus single arterial grafting were any reoperation, 50 (2.5%) versus 65 (3.2%); renal failure, 73 (3.6%) versus 55 (2.7%); stroke, 44 (2.2%) versus 38 (1.9%); and deep sternal infection, 36 (1.8%) versus 25 (1.2%). Hospital mortality was 1.7% (n=35) versus 2.8% (n=56) (P=.03). Comparing multiarterial to single arterial grafting, survival at 1 and 3 years was 95% versus 94% and 92% versus 88%, and at 5, 15, and 20 years, survival was 87%, 49%, and 31% versus 82%, 42%, and 25%. Better survival after multiarterial grafting was confined to males with 2 patent internal thoracic artery grafts (P<.0001).

Conclusions: Redo CABG with multiarterial grafting can be performed with lower in-hospital mortality and similar major morbidity to single arterial grafting. It is associated with better long-term survival, particularly in males when 2 internal thoracic artery grafts are used.

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来源期刊
CiteScore
11.20
自引率
10.00%
发文量
1079
审稿时长
68 days
期刊介绍: The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.
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