Postoperative inotropic drug used.

Objective
Conventional coronary artery bypass grafting (CABG) or on-pump arrested heart CABG (ONCAB) is a standard and simple technique. However, adverse effects can occur due to the use of aortic cross-clamp and cardiopulmonary bypass. Performing off-pump CABG (OPCAB) aims to avoid these adverse effects but may result in incomplete revascularization. On-pump beating heart CABG (ONBHCAB) combines the benefits of both ONCAB and OPCAB. This study focuses on comparing the short- and long-term outcomes of different CABG techniques.
Method
Retrospective observational cohort included 2,028 patients who underwent ONCAB, OPCAB, and ONBHCAB. The short-term outcomes including postoperative ischemic injury, hemodynamic functions, and adverse events were compared. The long-term outcomes were overall survival and the occurrence of major adverse cardiovascular events (MACE). Propensity score matching ensured comparability among the three patient groups.
Results
After matching, there were no differences in baseline characteristics. Regarding ischemic injury, OPCAB showed the lowest peak cardiac enzyme levels (all p≤0.001). There were no statistically significant differences in the change of hemodynamic function (cardiac index) between the three groups (p = 0.158). Ten-year survival for OPCAB, ONBHCAB, and ONCAB were 80.5%, 75.9%, and 73.7%, respectively. OPCAB was associated with a significant reduction in mortality risk and MACE when compared to others (Mortality HR = 0.33, p = 0.001, MACE HR = 0.52, p = 0.004).
Conclusion
OPCAB implementation resulted in a lower occurrence of postoperative ischemic injury than ONCAB and ONBHCAB. No differences in postoperative hemodynamic function in all three techniques were observed. OPCAB respectively were preferable techniques beneficial for long-term outcomes.

研究目标
传统冠状动脉旁路移植术（coronary artery bypass grafting, CABG）或称体外循环停跳心脏CABG（on-pump arrested heart CABG, ONCAB）是一类成熟简便的术式，但因需使用主动脉阻断钳与体外循环，可能引发不良并发症。非体外循环冠状动脉旁路移植术（off-pump CABG, OPCAB）旨在规避上述不良事件，但可能存在血管重建不完全的问题。体外循环下心脏不停跳冠状动脉旁路移植术（on-pump beating heart CABG, ONBHCAB）则融合了ONCAB与OPCAB的双重优势。本研究旨在对比不同CABG术式的短期与远期预后效果。

研究方法
本研究为回顾性观察队列研究，共纳入2028名分别接受ONCAB、OPCAB与ONBHCAB治疗的患者。研究对比了三组患者的短期预后指标，包括术后缺血性损伤、血流动力学功能与不良事件；远期预后指标则包括总体生存率与主要不良心血管事件（major adverse cardiovascular events, MACE）的发生情况。通过倾向性评分匹配确保三组患者的基线特征具有可比性。

研究结果
倾向性评分匹配后，三组患者的基线特征无显著差异。在缺血性损伤方面，OPCAB组的心肌酶峰值水平最低（所有p≤0.001）。三组患者的血流动力学指标（心脏指数）变化无统计学差异（p=0.158）。OPCAB、ONBHCAB与ONCAB组的10年生存率分别为80.5%、75.9%与73.7%。与另外两组相比，OPCAB组的死亡风险与MACE发生风险均显著降低（死亡风险比（Hazard Ratio, HR）=0.33，p=0.001；MACE风险比（HR）=0.52，p=0.004）。

研究结论
相较于ONCAB与ONBHCAB，OPCAB术式可降低术后缺血性损伤的发生率。三种术式的术后血流动力学功能无显著差异。综上，OPCAB是更有利于患者远期预后的优选术式。