期刊
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
卷 33, 期 12, 页码 3331-3339出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.jvca.2019.07.126
关键词
Cross Clamp Fibrillation; Cardioplegia; CABG
Objective: Myocardial management during on-pump coronary artery bypass grafting (CABG) surgery includes aortic cross-clamping followed by fibrillation (XCF) and aortic cross-clamping followed by diastolic cardioplegia (cardioplegia). The authors wished to compare in-hospital and survival outcomes between these procedures. Design: A retrospective observational study utilizing propensity matching. Setting: Tertiary Referral Centre for Heart Surgery. Participants: A total of 8,875 consecutive patients undergoing CABG surgery between August 1999 and February 2018. Interventions: After 1:1 matching, the authors had 3,340 patients in the cardioplegia group and 3,340 in the XCF group. Measurements and Main Results: Baseline characteristics were not significant between the matched cardioplegia and XCF groups. The XCF group had shorter pump times (61.8 minutes +/-26.8 v 74.7 minutes +/-29.5, p < 0.0001) and shorter cross-clamp times (27.80 minutes +/-10.5 v 44.44 minutes +/-18.0, p < 0.0001) compared with the cardioplegia group despite a similar median number of distal anastomoses (3 v 3, p = 0.08). After surgery, atrial arrhythmias (32% v 36%, p = 0.01) and inotropic requirement (25% v 28%, p = 0.006) were less in the XCF group compared with the cardioplegia group, respectively. Other postoperative outcomes (such as mortality and cerebrovascular events) were not statistically different. There was a mean survival advantage in using cardioplegia compared with XCF (15.4 years versus 14.7 years, log-rank, p = 0.014; 10-year survival 64% v 61% and 18-year survival 38% v 34%). Conclusion: This is the largest analysis of XCF. XCF does not adversely affect in-hospital outcomes. Long-term results demonstrate cardioplegic arrest may convey a survival advantage that would preclude routine XCF in the modern era. (C) 2019 Elsevier Inc. All rights reserved.
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