| Objective:To compare the clinical effects of aortic anastomotic assist device(Enclose Ⅱ)and side-biting clamp in off-pump coronary artery bypass grafting(OPCAB).Methods :The 318 patients with off-pump coronary artery bypass grafting were enrolled in the study and statistical analysis was performed,according to the inclusion criteria and exclusion criteria.The relevant data are from the Registration system of Chinese Cardiovascular surgery(Chinese Cardiac Surgery Registry,CCSR)and the Medical Records Department of the people’s Hospital of Zhengzhou University.At the Department of Cardiovascular Surgery,the operation of all patients was completed by the same surgeon and surgical team.According to the use of proximal aortic anastomosis device to complete the root anastomosis of ascending aorta(Ascending Aorta,AAO),the patients were divided into two groups: using Enclose Ⅱ auxiliary anastomosis device(group A)and using side-biting clamp(group B).There were 150 cases in group A and 168 cases in group B.The preoperative history,the number of intraoperative bypass,the number of intraoperative aortic proximal anastomosis,intraoperative IABP insertion,intraoperative blood transfusion,postoperative IABP insertion,postoperative blood transfusion,postoperative new arrhythmia,postoperative new myocardial infarction,postoperative new stroke,postoperative renal failure,postoperative incision infection,intensive care unit stay time,ventilation time,postoperative hospital time,postoperative drainage,secondary operation and clinical outcome etc.were compared and analyzed.Results:There was no significant difference between the two groups in preoperative general clinical data including gender composition,age,proportion of patients over65 years of age,smoking history,diabetes,hypertension,hyperlipidemia,COPD,chronic renal failure,peripheral vascular disease,cerebrovascular accidents,bilateral carotid artery stenosis,arrhythmias,composition of heart failure grading,previous myocardial infarction,previous PCI,left main coronary artery(LMCA)lesions,three coronary artery lesions(Triple Vessel Disease,TVD),preoperative left ventricular ejection fraction,etc.(P>0.05).The patients in both groups electively underwent coronary artery bypass grafting without extracorporeal circulation.There was no significant difference in the number of bypass grafts between the two groups(3.5±0.9in group A and 3.6±0.8 in group B,P=0.670).There was no significant difference in the number of arterial root anastomosis(P=0.073).There was no significant difference in the ratio of blood input in group A and group B(P>0.05),but there was a difference in fresh frozen plasma between the two group(Group A 288.1 ± 229.1ml,Group B 646.0 ± 560.9 ml,P = 0.007),and the difference was statistically significant.After the operation,one patient in group A died of multiple organ failure,one patient in group B died of pericardial tamponade,and one patient died of multiple organ failure.There was no significant difference in hospital mortality(group A 0.7%,group B 1.2 %,P=0.999).There was no significant difference in the incidence of postoperative complications such as low cardiac output syndrome,reopening,new arrhythmia,new arrhythmia,new renal failure,stroke,and surgical incision infection(P>0.05).There was no significant difference between group A and group B in the duration of ventilation(P>0.05).The average ICU stay in group A was longer than that in group B,but the difference was not statistically significant(group A60.1±44.2h,group B 54.7±34.1h,P=0.228);There was no significant difference in the average postoperative hospital stay between group A and group B(9.9±3.9 days in group A,10.0±3.6 days in group B,P=0.700);There was no significant difference in the ratio of postoperative blood transfusion to group B(P>0.05),but there was a difference in blood transfusion composition between group B and group A.The plasma transfusion in group A was less than that in group B(A Group 966.4±801.7ml,Group B 1256.2±937.8ml,P= 0.007),and the difference was statistically significant,Group A and Group B had a larger cumulative drainage volume after surgery.(group A 1245.0 ± 652.9ml,group B 998.6 ± 526.5ml,P <0.05),and the difference was statistically significant.Conclusion:The aortic assisted anastomosis device EncloseⅡ has obvious practical value for patients receiving off-pump coronary artery bypass grafting,and it is a safe and effective device.Compared with the side-biting clamp,the aortic auxiliary anastomosis device Enclose Ⅱ can reduce the amount of plasma transfusion during and after operation,but the cumulative drainage volume is large after operation.When the aortic anastomosis device Enclose Ⅱ is 1 or 2 aortic anastomoses,it has no obvious superiority compared with the side-bitting clamp. |
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