Background Although coronary artery bypass grafting (CABG) is performed via three different techniques, conventional, on-pump beating heart CABG (ONBHCAB), or off-pump CABG (OPCAB), data are limited to compare ONBHCAB with OPCAB.

Methods We retrospectively investigated the postoperative cardiac biomarkers, creatine kinase-MB (CK-MB), and troponin I (cTnI), and early and late outcomes in 806 patients undergoing isolated ONBHCAB or OPCAB between February 2008 and September 2022. To eliminate the bias between different groups, propensity score matching was conducted to validate the findings.

Results After matching, the number of each study group totaled 270 patients. In both complete and matched cohorts, early outcomes, including morbidities and mortalities, were similar. However, cTnI and CK-MB levels were significantly higher after ONBHCAB than after OPCAB with median peak cTnI of 9.85 versus 4.60 ng/mL and median peak CK-MB of 48.45 versus 17.10 ng/mL in the matched cohort, which were quite low, below the threshold for values defining perioperative myocardial infarction. At follow-up of 73 ± 45 months, the overall actuarial survival rates were similar between the ONBHCAB and OPCAB patients (86 vs. 87% at 5 years and 64 vs. 68% at 10 years, respectively, in the matched cohort).

Conclusion ONBHCAB may be a comparable alternative to OPCAB with similar early and late outcomes, despite higher elevation of postoperative cardiac biomarkers. ONBHCAB provides more efficient hemodynamic support, providing a better surgical visual field, than OPCAB while reducing the risk of incomplete revascularization.

背景 尽管冠状动脉旁路移植术 (CABG) 是通过三种不同的技术进行的，即传统的体外循环心脏搭桥术 (ONBHCAB) 或非体外循环心脏搭桥术 (OPCAB)，但比较 ONBHCAB 与 OPCAB 的数据有限。

方法 我们回顾性调查了 2008 年 2 月至 2022 年 9 月期间接受单独 ONBHCAB 或 OPCAB 的 806 例患者的术后心脏生物标志物肌酸激酶 MB (CK-MB) 和肌钙蛋白 I (cTnI) 以及早期和晚期结果。在不同群体之间进行倾向评分匹配以验证研究结果。

结果 经匹配后，各研究组人数共计270例。在完整队列和匹配队列中，早期结果（包括发病率和死亡率）相似。然而，ONBHCAB 后的 cTnI 和 CK-MB 水平显着高于 OPCAB 后，匹配队列中 cTnI 中位峰值分别为 9.85 ng/mL 和 4.60 ng/mL，CK-MB 中位峰值分别为 48.45 ng/mL 和 17.10 ng/mL，均相当低。低于定义围术期心肌梗塞的阈值。在 73 ± 45 个月的随访中，ONBHCAB 和 OPCAB 患者的总体精算生存率相似（在匹配队列中，5 年时分别为 86% 对 87%，10 年时分别为 64% 对 68%）。

结论 ONBHCAB 可能是 OPCAB 的替代方案，尽管术后心脏生物标志物升高较高，但具有相似的早期和晚期结果。与 OPCAB 相比，ONBHCAB 提供更有效的血流动力学支持，提供更好的手术视野，同时降低不完全血运重建的风险。