Objectives

In Japan, off-pump coronary artery bypass (OPCAB) is more common than on-pump coronary artery bypass. Superior early results of OPCAB have been reported; however, long-term results were still unclear. Purpose of this study is to evaluate the clinical outcomes of OPCAB in Japan using Japan Adult Cardiovascular Surgery Database.

Methods

Between 2008 and 2010, 23,633 patients who underwent isolated coronary artery bypass were reported in database. We selected the cases from the hospital with mean annual coronary surgery volume of more than 50. Among the total of 7724 cases at 41 institutions, 2150 (31.2%) on-pump coronary artery bypass (ONCAB) and 5574 (68.8%) OPCAB cases were included. Propensity score (PS) matching was performed using PS developed from patient characteristics and preoperative factors resulting in 2007 cases matched pairs. Long-term follow-up data on patients’ mortality and stroke were collected.

Results

In-hospital mortality was significantly lower in OPCAB (ONCAB 1.1%, OPCAB 0.4% p = 0.01). Stroke was low in OPCAB group (ONCAB 1.7%, OPCAB 0.8%, p = 0.01). There was no statistically significant difference between OPCAB and ONCAB regarding 7-year overall survival (86.1% vs 88.1% respectively), composite outcomes (72.0% vs 73.9% respectively), or cardiac deaths (97.3% vs 97.1% respectively). Subgroup analysis (more than 75 years old) showed a worse trend in OPCAB group. Only in OPCAB group, incomplete revascularization significantly influenced 7-year survival.

Conclusions

OPCAB is associated with early prognostic benefits; however, it might be less favorable outcomes in the long term when patients are older or with incomplete revascularization.

中文翻译：

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使用日本全国心血管外科数据库比较非体外循环和非体外循环冠状动脉旁路移植术的长期结果

目标

在日本，非体外循环冠状动脉搭桥术 (OPCAB) 比体外循环冠状动脉搭桥术更常见。已经报道了 OPCAB 的早期结果。然而，长期结果仍不清楚。本研究的目的是使用日本成人心血管外科数据库评估日本 OPCAB 的临床结果。

方法

2008 年至 2010 年间，数据库中报告了 23,633 名接受单纯冠状动脉搭桥术的患者。我们从医院中选择年均冠状动脉手术量超过 50 例的病例。在 41 家机构的 7724 例病例中，2150 例 (31.2%) 体外循环冠状动脉搭桥术 (ONCAB) 和 5574 例 (68.8%) OPCAB 病例被包括在内。使用从患者特征和术前因素开发的 PS 进行倾向评分 (PS) 匹配，产生 2007 例匹配对。收集了有关患者死亡率和中风的长期随访数据。

结果

OPCAB 的住院死亡率显着降低（ONCAB 1.1%，OPCAB 0.4% p  = 0.01）。OPCAB 组的卒中发生率较低（ONCAB 1.7%，OPCAB 0.8%，p  = 0.01）。OPCAB 和 ONCAB 在 7 年总生存率（分别为 86.1% 和 88.1%）、复合结局（分别为 72.0% 和 73.9%）或心脏死亡（分别为 97.3% 和 97.1%）方面没有统计学上的显着差异。亚组分析（超过 75 岁）显示 OPCAB 组的趋势更差。仅在 OPCAB 组中，不完全血运重建显着影响 7 年生存率。

结论

OPCAB 与早期预后益处相关；然而，从长远来看，当患者年龄较大或血运重建不完全时，结果可能不太有利。