目的:内镜静脉采集(EVH)是获得大隐静脉用于冠状动脉旁路移植术(CABG)手术的替代技术。我们旨在评估CABG中EVH患者的早期和中期预后。
方法:本队列研究采用倾向评分匹配方法,纳入2020年7月至2022年12月南京市第一医院连续分离的CABG患者。根据静脉采集方法将患者分为EVH组和开放静脉采集(OVH)组。主要结果是全因死亡,次要结局是主要不良心血管事件(MACEs),包括心血管死亡,心力衰竭,心肌梗死和血运重建和无症状生存随访。
结果:共1247例患者纳入研究,OVH组849例,EVH组398例。EVH患者更多是女性,糖尿病,较高的体重指数,多血管和左主要疾病。匹配后形成308对。院内死亡率无显著差异(EVH与OVH,2.3%vs.1.3%,P=0.543)。在3年的随访中,EVH移植物被认为不逊于OVH移植物,全因死亡没有发现差异[8.5%vs.5.0%,风险比(HR)1.565,95%置信区间(CI):0.77-3.17,P=0.21],MACE(8.1%与7.1%,HR1.165,95CI:0.51-2.69,P=0.71)和无症状生存率(66.7%vs.72.5%,HR1.117,95CI:0.65-1.92,P=0.68)。
结论:在CABG术后3年的随访中,EVH移植物被认为与OVH移植物相当。
OBJECTIVE: Endoscopic vein harvesting (EVH) is an alternative technique to obtain the saphenous vein for coronary artery bypass grafting (CABG) surgery. We aimed to evaluate the early and mid-term outcomes of patients with EVH in CABG.
METHODS: This cohort study included consecutive isolated CABG patients in Nanjing First Hospital from July 2020 to December 2022 using propensity score matching methods. Patients were classified to EVH group and open vein harvesting (OVH) group according to the vein harvesting methods. The primary outcome was the all-cause death, and the secondary outcomes were major adverse cardiovascular events (MACEs) including cardiovascular death, heart failure, myocardial infarction and revascularization and asymptomatic survival in the follow-up.
RESULTS: Totally 1247 patients were included in the study with 849 in OVH group and 398 in EVH group. Patients with EVH were more female, diabetes, higher body mass index, more multi-vessel and left main diseases. 308 pairs were formed after the matching. There was no significant difference in the rates of in-hospital death (EVH vs. OVH, 2.3% vs. 1.3%, P = 0.543). During the 3 years follow-up, EVH grafts were considered not inferior to OVH grafts, no differences were found in all-cause death [8.5% vs. 5.0%, hazard ratio (HR) 1.565, 95% confidence interval (CI): 0.77-3.17, P = 0.21], MACEs (8.1% vs. 7.1%, HR 1.165, 95CI: 0.51-2.69, P = 0.71) and asymptomatic survival (66.7% vs. 72.5%, HR 1.117, 95%CI: 0.65-1.92, P = 0.68).
CONCLUSIONS: EVH grafts were considered comparable to OVH grafts in patients following CABG in the 3 years follow-up.