We aimed to quantify the effect of avoiding cardiopulmonary bypass on outcomes in high-risk patients. Of the 2079 consecutive CABG's performed by three surgeons between April 1997 and September 2002, 389 were classified as high-risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification, with a score of >5. The off-pump group had 196 patients and the on-pump group had 193 patients. Multivariate logistic regression was used to assess the effect of off-pump on in-hospital outcomes, while adjusting for treatment selection bias with a propensity score. The incidence of hypertension, hypercholesterolaemia, and renal dysfunction were higher in the off-pump group. The median EuroSCORE for off-pump patients was 7 (6-8), while for the on-pump patients was 7 (6-8; P=0.31). After adjusting for the propensity score, off-pump patients were less likely to have stroke (OR 0.17; P=0.041), renal failure (OR 0.35; P=0.029), blood transfusion (OR 0.12; P<0.001), prolonged mechanical ventilation (OR 0.36; P=0.021), and inotrope support (OR 0.35; P<0.001). Off-pump patients also had significantly shorter post-operative hospital stays. There was no significant difference between off-pump and on-pump patients in terms of in-hospital and mid-term mortality. Off-pump CABG is justified in EuroSCORE high-risk cases.

译文

我们旨在量化避免体外循环对高危患者预后的影响。根据欧洲心脏手术风险评估系统 (EuroSCORE) 风险分层,在三名外科医生在1997年4月至2002年9月之间连续进行的2079例CABG中,有389例被归类为高风险,得分> 5。非体外循环组有196例患者,体外循环组有193例患者。多因素logistic回归用于评估非体外循环对院内结局的影响,同时用倾向评分调整治疗选择偏倚。非体外循环组高血压,高胆固醇血症和肾功能不全的发生率较高。非体外循环患者的中位EuroSCORE为7 (6-8),而在体外循环患者的中位EuroSCORE为7 (6-8; P = 0.31)。调整倾向评分后,非体外循环患者较少发生卒中 (或0.17; P = 0.041) 、肾功能衰竭 (或0.35; P = 0.029) 、输血 (或0.12; P<0.001) 、长时间机械通气 (或0.36; P = 0.021),和inotrope支持 (或0.35; P<0.001)。非体外循环患者的术后住院时间也明显缩短。在住院和中期死亡率方面,非体外泵和体外泵患者之间没有显着差异。在EuroSCORE高风险病例中,非体外循环CABG是合理的。

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