Off-pump Minimally Invasive Direct Coronary Artery Bypass Surgery and Conventional Thoracotomy: A Comparative Study of Propensity Score Matching_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XULi-li ,  YOUBin , GAOFeng , LIPing , XUYi , LIUShuo

Department of Cardiac Surgery, Anzhen Hospital, Capital Medical University, Beijing 100029, P. R. China;

Corresponding author：

YOUBin, Email: dr_youbin@hotmail.com

Keywords：

Minimally invasive direct surgery; Off-pump coronary artery bypass surgery (CABG); Propensity score matching

DOI：

10.7507/1007-4848.20160030

Video：

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Objective To explore the difference between minimally invasive direct and conventional thoracotomy off-pump coronary artery bypass surgery (CABG). Methods We selected 276 patients underwent off-pump CABG surgery in our hospital from June 2005 through June 2014. There were 55 patients with minimally invasive off-pump CABG surgery and 221 patients conventional thoracotomy surgery. By using the method of peopensity score matching, we selected 55 conventional thoracotomy patients as a control group in our study. There were 41 males and 14 females at age of 60.8±10.5 years with minimally invasive off-pump CABG surgery, 44 males and 11 females at age of 60.6±12.5 years with conventional thoracotomy. Results There was no statistical difference in surgery time, stay in the intensive care unit (ICU) time between conventional thoracotomy surgery and minimally invasive off-pump CABG. Compared with conventional thoracotomy surgery, minimally invasive off-pump CABG patients had statistical improvement in post-operative hospital stay time (7.3±3.1 d vs. 8.8±3.9 d, P=0.01), postoperative drainage (684(0-2 790)ml vs. 739(50-4 460)ml, P=0.03), perioperative blood transfusion (1.91(0-20)U vs. 6.62(0-20)U, P=0.00), surgery incision length (5.6±1.1 cm vs. 26.3±4.5 cm, P=0.00). Conclusion Overlooking the learning curve, minimally invasive direct off-pump CABG surgery has more advantages than conventional thoracotomy surgery. It is a safe and effective procedure.

Citation： XULi-li, YOUBin, GAOFeng, LIPing, XUYi, LIUShuo. Off-pump Minimally Invasive Direct Coronary Artery Bypass Surgery and Conventional Thoracotomy: A Comparative Study of Propensity Score Matching. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(2): 133-136. doi: 10.7507/1007-4848.20160030 Copy

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12.	高长青, 张涛, 李伯君, 等. 中国人移植的乳内动脉平均流量测定及影响因素. 中国胸心血管外科临床杂志, 2004, 11(2): 84-87.
13.	Heres EK, Marquez J, Malkowski MJ, et al. Minimally invasive direct coronary artery bypass: anesthetic, monitoring, and pain control considerations. J Cardiothorac Vasc Anesth, 199812(4): 385-389.
14.	徐德军, 郑清, 郝兴海, 等. 微创非体外循环下冠状动脉旁路移植术的麻醉管理. 中国微创外科杂志, 2013, 13(3): 206-210.
15.	许李力, 尤斌, 高峰, 等. 直视微创心脏外科手术体外循环建立的经验. 心肺血管病杂志, 2013, 32(9): 586-589.
16.	Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
17.	Thiele H, Neumann-Schniedewind P, Jacobs S, et al. Randomized comparison of minimally invasive direct coronary artery bypass surgery versus sirolimus-eluting stenting in isolated proximal left anterior descending coronary artery stenosis. J Am Coll Cardiol, 2009, 53(25): 2324-2331.
18.	Detter C, Deuse T, Boehm DH, et al. Midterm results and quality of life after minimally invasive vs. conventional aortic valve replacement. Thorac Cardiovasc Surg, 2002, 50(6): 337-341.
19.	Blazek S, Holzhey D, Jungert C, et al. Comparison of bare-metal stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 10-year follow-up of a randomized trial. JACC Cardiovasc Interv, 2013, 6(1): 20-26.
20.	Benedetto U, Raja SG, Soliman RF, et al. Minimally invasive direct coronary artery bypass improves late survival compared with drug-eluting stents in isolated proximal left anterior descending artery disease: A 10-year follow-up, single-center, propensity score analysis. J Thorac Cardiovasc Surg, 2014, 148(4): 1316-1322.

1. 胡盛寿. 冠心病外科的风雨历程. 医学研究杂志, 2013, 42(11): 4-6.
2. McGinn JT Jr, Usman S, Lapierre H, et al. Minimally invasive coronary artery bypass grafting: dual-center experience in 450 consecutive patients. Circulation, 2009, 120(11 Suppl): S78-S84.
3. Leacche M, Byrne JG, Solenkova NS, et al. Comparison of 30-day outcomes of coronary artery bypass grafting surgery verus hybrid coronary revascularization stratified by SYNTAX and euroSCORE. J Thorac Cardiovasc Surg, 2013, 145(4): 1004-1012.
4. Wang TK, Li AY T, Ramanathan T, et al. Comparison of society of thoracic surgeon's risk models with EuroSCORE and EuroSCORE Ⅱ at adverse outcome prediction after coronary artery bypass grafting. Heart, Lung & Circulation, 2014, 23: e44.
5. Rogers CA, Reeves BC, Caputo M, et al. Control chart methods for monitoring cardiac surgical performance and their interpretation. J Thorac Cardiovasc Surg, 2004, 128(6): 811-899.
6. Holzhey DM, Jacobs S, Walther T, et al. Cumulative sum failure analysis for eight surgeons performing minimally invasive direct coronary artery bypass. J Thorac Cardiovasc Surg, 2007, 134(3): 663-669.
7. Kuss O, von Salviati B, Börgermann J, et al. Off-pump versus on-pump coronary artery bypass grafting: a systematic review and meta-analysis of propensity score analyses. J Thorac Cardiovasc Surg, 2010, 140(4): 829-835.
8. Murzi M, Caputo M, Aresu G, et al. On-pump and off-pump coronary artery bypass grafting in patients with left main stem disease: a propensity score analysis. J Thorac Cardiovasc Surg, 2012, 143(6): 1382-1388.
9. 宝辉, 苗懿德, 孙家玲, 等. 高龄老年人群动脉弹性的影响因素. 中国循环杂志, 2011, 26(6): 450-453.
10. Ferrari ER, Von Segesser LK. Arterial grafting for myocardial revascularization: how better is it? Curr Opin Cardiol, 2006, 21(6): 584-588.
11. Pevni D, Mohr R, Lev-Ran O, et al. Technical aspects of composite arterial grafting with double skeletorized internal thoracic arteries. Chest, 2003, 123(5):1348-1354.
12. 高长青, 张涛, 李伯君, 等. 中国人移植的乳内动脉平均流量测定及影响因素. 中国胸心血管外科临床杂志, 2004, 11(2): 84-87.
13. Heres EK, Marquez J, Malkowski MJ, et al. Minimally invasive direct coronary artery bypass: anesthetic, monitoring, and pain control considerations. J Cardiothorac Vasc Anesth, 199812(4): 385-389.
14. 徐德军, 郑清, 郝兴海, 等. 微创非体外循环下冠状动脉旁路移植术的麻醉管理. 中国微创外科杂志, 2013, 13(3): 206-210.
15. 许李力, 尤斌, 高峰, 等. 直视微创心脏外科手术体外循环建立的经验. 心肺血管病杂志, 2013, 32(9): 586-589.
16. Mohr FW, Morice MC, Kappetein AP, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet, 2013, 381(9867): 629-638.
17. Thiele H, Neumann-Schniedewind P, Jacobs S, et al. Randomized comparison of minimally invasive direct coronary artery bypass surgery versus sirolimus-eluting stenting in isolated proximal left anterior descending coronary artery stenosis. J Am Coll Cardiol, 2009, 53(25): 2324-2331.
18. Detter C, Deuse T, Boehm DH, et al. Midterm results and quality of life after minimally invasive vs. conventional aortic valve replacement. Thorac Cardiovasc Surg, 2002, 50(6): 337-341.
19. Blazek S, Holzhey D, Jungert C, et al. Comparison of bare-metal stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery: 10-year follow-up of a randomized trial. JACC Cardiovasc Interv, 2013, 6(1): 20-26.
20. Benedetto U, Raja SG, Soliman RF, et al. Minimally invasive direct coronary artery bypass improves late survival compared with drug-eluting stents in isolated proximal left anterior descending artery disease: A 10-year follow-up, single-center, propensity score analysis. J Thorac Cardiovasc Surg, 2014, 148(4): 1316-1322.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Off-pump Minimally Invasive Direct Coronary Artery Bypass Surgery and Conventional Thoracotomy: A Comparative Study of Propensity Score Matching

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