심한 좌심실 부전을 갖는 환자에서 시행한 Off-Pump CABG와 On-Pump CABG의 중단기 성적 비교

Abstract

Background: Off-pump coronary artery bypass grafting (OPCAB) has been proven to result in less morbidity. The patients who have left ventricular dysfunction may have benefits by avoiding the adverse effects of the cardiopulmonary bypass. The present study compared early and midterm outcomes of off-pump versus on-pump coronary artery bypass grafting (On pump CABG) in patients with severe left ventricular dysfunction.

Material and Method: Ninety hundred forth six patients underwent isolated coronary artery bypass grafting by one surgeon between January 2001 and Febrary 2005. Data were collected in 100 patients who had left ventricular ejection fraction (LVEF) less than 35% (68 OPCAB; 32 On pump CABG). Mean age of patients were 62.9±9.0 years in OPCAB group and 63.8±8.0 years in On pump CABG group. We compared the preoperative risk factors and evaluated early and midterm outcomes.

Result: In OPCAB and On pump CABG group, mean number of used grafts per patient were 2.75±0.72, 2.78±0.55 and mean number of distal anastomoses were 3.00±0.79, 3.16±0.72 respectively. There was one perioperative death in OPCAB group (1.5%). The operation time, ventilation time, ICU stay time, CK-MB on the first postoperative day, and occurrence rate of complications were significantly low in OPCAB group. Mean follow-up time was 26.6±12.8 months (4∼54 months). Mean LVEF of OPCAB and On pump CABG group improved significantly from 27.1±4.5% to 40.7±13.0% and 26.9±5.4% to 33.3±13.7%. The 4-year actuarial survival rate of OPCAB and On pump CABG group were 92.2%, 88.3% and the 4-year freedom rates from cardiac death were 97.7%, 96.4% respectively. There were no significant differences between two groups in 4 year freedom rate from cardiac event and angina.

Conclusion: OPCAB improves myocardial function and favors early and mid-term outcomes in patients with severe left ventricular dysfunction compared to On pump CABG group. Therefore, OPCAB is a preferable operative strategy even in patients with severe left ventricular dysfunction.