Long term results of off-pump coronary artery bypass surgery using Japanese National Database

Research Project

Project/Area Number	17K10734
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Research Field	Cardiovascular surgery
Research Institution	Kyoto Prefectural University of Medicine
Principal Investigator	Numata Satoshi 京都府立医科大学, 医学(系)研究科(研究院), 講師 (80735689)
Co-Investigator(Kenkyū-buntansha)	本村昇東邦大学, 医学部, 教授 (40332580) 夜久均京都府立医科大学, 医学(系)研究科(研究院), 教授 (50295648) 宮田裕章慶應義塾大学, 医学部(信濃町), 教授 (70409704)
Project Period (FY)	2017-04-01 – 2021-03-31
Project Status	Completed (Fiscal Year 2020)
Budget Amount *help	¥4,680,000 (Direct Cost: ¥3,600,000、Indirect Cost: ¥1,080,000) Fiscal Year 2019: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000) Fiscal Year 2018: ¥1,040,000 (Direct Cost: ¥800,000、Indirect Cost: ¥240,000) Fiscal Year 2017: ¥2,860,000 (Direct Cost: ¥2,200,000、Indirect Cost: ¥660,000)
Keywords	冠動脈バイパス術 / 低侵襲手術 / 冠動脈バイパス / 人工心肺 / 低侵襲治療 / 傾向スコアマッチング / 長期成績 / 日本心臓血管外科データベース / 日本心臓血管外科手術データベース / 心臓血管外科 / 冠動脈疾患
Outline of Final Research Achievements	Between 2008 and 2010, 23633 patients who underwent isolated coronary artery bypass were reported in JCVSD. Propensity score matching was performed for preoperative risk adjustment. Consequently, 2007 cases in each group (off-pump coronary artery bypass surgery (OPCAB) and on-pump coronary artery bypass surgery (ONCAB)) were selected. Rate of discharge death (OPCAB: 0.4%, ONCAB: 1.1%, p=0.01) and postoperative stroke within 30days (OPCAB: 0.8%, ONCAB: 1.7%, p=0.01) were significantly lower in OPCAB. Rate of acute myocardial infarction within 30 days was similar (OPCAB: 0.5%, ONCAB: 0.4%, p=0.64). Kaplan-Meier analysis showed there was no　significant differences between two groups with respect to the overall survival (OPCAB: 86.1%, ONCAB: 88.1%, p=0.18) and the composite outcomes (OPCAB: 97.3%, ONCAB: 97.1%, p=0.50) at 7 years. In patients 75 years of age or older, there was trends towards poorer results in OPCAB with regard to the overall survival and the composite outcome.
Academic Significance and Societal Importance of the Research Achievements	人工心肺を使用しない冠動脈バイパス術（OPCAB）は人工心肺を使用する従来の冠動脈バイパス術（ONCAB）に比し、低侵襲な手術法として広く行われるようになった。一方、低侵襲性を重視することにより手術の質が従来より低下しているのではないかとの懸念があった。今回日本心臓血管外科データベースを使用した７年までの長期成績の比較では、OPCABの早期成績の優位性が示され、長期成績では両群間に差を認めなかった。