Artikel
Beating versus arrested heart coronary revascularization: randomized controlled trial in 596 unselected patients (3cab-study)
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Autoren
Veröffentlicht: | 15. März 2007 |
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Gliederung
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Objective
So far, no studies have distinguished the specific contribution of surgical trauma, extracorporeal circulation, and ischemia/reperfusion to clinical outcome in coronary revascularization. This prospective randomized study aimed to assess the impact of each of the above noxious mechanism in an unselected patient population.
Methods
A total of 596 consecutive unselected patients scheduled for isolated coronary revascularization were randomized into three groups: OPCAB (off-pump coronary artery bypass grafting, n=199), CPB-CABG (on-pump revascularization with cardioplegic arrest, n=201), and PACAB (pump-assisted beating heart procedure, n=196). The only exclusion criteria were re-operation or emergency procedures. The following events served as primary endpoints: death within 30 days, stroke, myocardial infarction, low-output syndrome, duration of artificial ventilation ≥ 24h, or new requirement for hemodialysis. Data analysis was based on the intention-to-treat principle.
Results
Mean patient age was 67 years, 76% of patients were male, the median EuroSCORE was 3 points. Intraoperative conversion to a different technique was required in 5.5% of patients. We observed 42 events (21.1%) in the OPCAB, 33 (16.4%) in the CPB, and 43 (21.9%) in the PACAB group, a non-significant treatment difference (p=0.33). The relative risk associated with OPCAB was 1.29 (95%-CI: [0.85;1.94]), and with PACAB 1.34 (95%-CI: [0.89;2.01], both compared to CPB).
Conclusion
Comparison of the operative techniques OPCAB, CPB-CABG, and PACAB revealed that all three are associated with identical in-hospital outcome and identical 30 day lethality. One can conclude that the noxious mechanisms do not appear to have additive effects; the clinical outcome is rather determined by the surgical trauma alone.