Abstract：
OBJECTIVE: This study compared perioperative outcomes after off-pump revascularization through a thoracoscopic-assisted (non-robotic) minimally invasive approach (Endo-CAB) or sternotomy approach (OPCAB) for patients with single vessel left anterior descending (LAD) disease.
METHODS: In this retrospective, propensity matched cohort study, 266 consecutive patients were included in the Endo-CAB group (n = 136) and OPCAB group (n = 130). After propensity score matching 116 Endo-CAB and 116 OPCAB patients were compared. \'Textbook outcome\' was defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischemia, cardiac tamponade, cerebrovascular events, wound infection, new-onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (> 7 days). Multivariable regression analysis was performed to identify independent predictors for textbook outcome.
RESULTS: Textbook outcome occurred significantly more frequent in the Endo-CAB group compared to the OPCAB group (81.9% vs. 59.5%, p < 0.001). Patients undergoing Endo-CAB surgery had shorter hospital admission (3.0 [3.0-4.0] vs. 5.0 [4.0-6.0] days, p < 0.001), less blood loss (225 [150-355] vs. 450 [350-600] mL, p < 0.001). Other perioperative outcomes were comparable for both groups. Regression analysis demonstrated that Endo-CAB approach was an independent positive predictor for textbook outcome (OR 3.02, 95% CI 1.61-5.66, p < 0.001).
CONCLUSIONS: Our study suggests that patients undergoing Endo-CAB surgery have improved perioperative outcome resulting in higher rates of textbook outcome for the treatment of single vessel CAD. This technique could be widely available since routine thoracoscopic instruments are used.
METHODS: In this retrospective, propensity matched cohort study, 266 consecutive patients were included in the Endo-CAB group (n = 136) and OPCAB group (n = 130). After propensity score matching 116 Endo-CAB and 116 OPCAB patients were compared. \'Textbook outcome\' was defined as the absence of 30-day mortality, re-exploration for bleeding, postoperative ischemia, cardiac tamponade, cerebrovascular events, wound infection, new-onset arrhythmias, pneumonia, placement of chest drains and prolonged hospital stay (> 7 days). Multivariable regression analysis was performed to identify independent predictors for textbook outcome.
RESULTS: Textbook outcome occurred significantly more frequent in the Endo-CAB group compared to the OPCAB group (81.9% vs. 59.5%, p < 0.001). Patients undergoing Endo-CAB surgery had shorter hospital admission (3.0 [3.0-4.0] vs. 5.0 [4.0-6.0] days, p < 0.001), less blood loss (225 [150-355] vs. 450 [350-600] mL, p < 0.001). Other perioperative outcomes were comparable for both groups. Regression analysis demonstrated that Endo-CAB approach was an independent positive predictor for textbook outcome (OR 3.02, 95% CI 1.61-5.66, p < 0.001).
CONCLUSIONS: Our study suggests that patients undergoing Endo-CAB surgery have improved perioperative outcome resulting in higher rates of textbook outcome for the treatment of single vessel CAD. This technique could be widely available since routine thoracoscopic instruments are used.
摘要：
目的：本研究比较了通过胸腔镜辅助（非机器人）微创入路（Endo-CAB）或胸骨切开术（OPCAB）行非体外循环血运重建术后的围手术期结果。
方法：在本回顾性研究中，倾向匹配队列研究，266例连续患者被纳入Endo-CAB组（n=136）和OPCAB组（n=130）。在倾向评分匹配后，对116例Endo-CAB和116例OPCAB患者进行了比较。“教科书结果”被定义为没有30天的死亡率，重新探查出血,术后缺血,心脏填塞,脑血管事件，伤口感染,新发心律失常,肺炎,放置胸腔引流管和延长住院时间（>7天）。进行多元回归分析以确定教科书结果的独立预测因子。
结果：与OPCAB组相比，Endo-CAB组的教科书结局发生频率明显更高（81.9％vs.59.5%,p<0.001)。接受Endo-CAB手术的患者住院时间较短（3.0[3.0-4.0]vs.5.0[4.0-6.0]天，p<0.001)，少失血（225[150-355]vs.450[350-600]毫升,p<0.001)。两组的其他围手术期结局具有可比性。回归分析表明Endo-CAB方法是教科书结局的独立阳性预测因子（OR3.02，95％CI1.61-5.66，p<0.001）。
结论：我们的研究表明，接受Endo-CAB手术的患者改善了围手术期结果，从而提高了单血管CAD治疗的教科书结果。由于使用了常规的胸腔镜器械，因此该技术可以广泛使用。
方法：在本回顾性研究中，倾向匹配队列研究，266例连续患者被纳入Endo-CAB组（n=136）和OPCAB组（n=130）。在倾向评分匹配后，对116例Endo-CAB和116例OPCAB患者进行了比较。“教科书结果”被定义为没有30天的死亡率，重新探查出血,术后缺血,心脏填塞,脑血管事件，伤口感染,新发心律失常,肺炎,放置胸腔引流管和延长住院时间（>7天）。进行多元回归分析以确定教科书结果的独立预测因子。
结果：与OPCAB组相比，Endo-CAB组的教科书结局发生频率明显更高（81.9％vs.59.5%,p<0.001)。接受Endo-CAB手术的患者住院时间较短（3.0[3.0-4.0]vs.5.0[4.0-6.0]天，p<0.001)，少失血（225[150-355]vs.450[350-600]毫升,p<0.001)。两组的其他围手术期结局具有可比性。回归分析表明Endo-CAB方法是教科书结局的独立阳性预测因子（OR3.02，95％CI1.61-5.66，p<0.001）。
结论：我们的研究表明，接受Endo-CAB手术的患者改善了围手术期结果，从而提高了单血管CAD治疗的教科书结果。由于使用了常规的胸腔镜器械，因此该技术可以广泛使用。
