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在冠状动脉旁路移植术中比较静脉桥血管内镜和开放获取法的随机试验
Randomized Trial of Endoscopic or Open Vein-Graft Harvesting for Coronary-Artery Bypass


Marco A. Zenati ... 心脑血管疾病 • 2019.01.10
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REGROUP内镜获取静脉桥血管结果与传统认知相反

 

杨溢,朱云鹏,赵强*

上海交通大学医学院附属瑞金医院心外科

*通讯作者

 

日前,心脏外科又一项重磅成果——REGROUP研究在2018年度美国心脏学会(American Heart Association,AHA)年会上发布,并同步发表于《新英格兰医学杂志》(NEJM1

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摘要


背景

隐静脉桥血管是冠状动脉旁路移植术(CABG)中最常用的桥血管。静脉桥血管获取技术对远期临床结局的影响尚未明确。

 

方法

我们将对在美国退伍军人事务部(Veterans Affairs)16家心脏手术中心接受CABG的患者进行随机分组,分别应用静脉桥血管开放获取法或内镜获取法。主要结局是主要心脏不良事件(包括全因死亡、非致死性心肌梗死和再次血运重建)构成的复合结局。本研究还评估了腿部切口并发症。

 

结果

共有1,150例患者接受随机分组。在2.78年的中位随访期内,开放获取组和内镜获取组分别有89例患者(15.5%)和80例患者(13.9%)发生主要结局(风险比,1.12;95%置信区间 [CI],0.83~1.51;P=0.47)。开放获取组和内镜获取组分别有46例患者(8.0%)和37例患者(6.4%)死亡(风险比,1.25;95% CI,0.81~1.92);分别有34例患者(5.9%)和27例患者(4.7%)发生了心肌梗死(风险比,1.27;95% CI,0.77~2.11);分别有35例患者(6.1%)和31例患者(5.4%)发生了血运重建(风险比,1.14;95% CI,0.70~1.85)。开放获取组和内镜获取组分别有18例患者(3.1%)和8例患者(1.4%)发生了腿部切口感染(相对危险度,2.26;95% CI,0.99~5.15)。

 

结论

在接受CABG的患者中,我们发现在主要心脏不良事件的风险方面,静脉桥血管开放获取法和内镜获取法无显著差异(由美国退伍军人事务部研究与发展办公室合作研究项目[Cooperative Studies Program, Office of Research and Development, Department of Veterans Affairs]资助;REGROUP在ClinicalTrials.gov注册号为NCT01850082)。





作者信息

Marco A. Zenati, M.D., Deepak L. Bhatt, M.D., M.P.H., Faisal G. Bakaeen, M.D., Eileen M. Stock, Ph.D., Kousick Biswas, Ph.D., J. Michael Gaziano, M.D., Rosemary F. Kelly, M.D., Elaine E. Tseng, M.D., Jerene Bitondo, P.A.-C., Jacquelyn A. Quin, M.D., M.P.H., G. Hossein Almassi, M.D., Miguel Haime, M.D., Brack Hattler, M.D., Ellen DeMatt, M.A., Alexandra Scrymgeour, M.S., Pharm.D., and Grant D. Huang, M.P.H., Ph.D. for the REGROUP Trial Investigators*
From the Divisions of Cardiac Surgery (M.A.Z., J.A.Q., M.H.) and Cardiology (D.L.B., J.M.G.), Veterans Affairs (VA) Boston Healthcare System and Harvard Medical School, the Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School (M.A.Z., J.A.Q., M.H.), Brigham and Women’s Hospital Heart and Vascular Center and Harvard Medical School (D.L.B.), and Massachusetts General Hospital (J.B.) — all in Boston; the Departments of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland (F.G.B.); the VA Pittsburgh Healthcare System, Pittsburgh (F.G.B.); the Cooperative Studies Program Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Perry Point, MD (E.M.S., K.B., E.D.); Minneapolis VA Medical Center and University of Minnesota, Minneapolis (R.F.K.); San Francisco VA Medical Center and University of California, San Francisco, San Francisco (E.E.T.); Zablocki VA Medical Center and Medical College of Wisconsin, Milwaukee (G.H.A.); VA Eastern Colorado Healthcare System, Denver (B.H.); the Cooperative Studies Program Pharmacy Coordinating Center, Department of Veterans Affairs, Albuquerque, NM (A.S.); and the Cooperative Studies Program Central Office, Office of Research and Development, Department of Veterans Affairs, Washington, DC (G.D.H.). Address reprint requests to Dr. Zenati at the Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System, 1400 VFW Parkway, Boston, MA 02132, or at marco_zenati@hms.harvard.edu. *A complete list of the REGROUP Trial Investigators is provided in the Supplementary Appendix, available at NEJM.org.

 

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