관상동맥질환의 수술적 치료

Abstract

The main goals of coronary artery bypass grafting (CABG) are to relieve chest pain and to improve quality of life by bypassing all coronary artery segments with severe stenosis. It is a common surgical procedure on the heart. Until recently, most surgeons have used cardiopulmonary bypass (CPB) to provide a motionless and bloodless operation field to accomplish optimal microvascular anastomoses. However, CPB may have adverse sequelae, such as cerebrovascular accident, renal failure, and higher intellectual impairment, because of an inflammatory response caused by the blood circulating through the extracorporeal circuit and the formation of microemboli. In recent years, advances in retractor-stabilizer systems and in operative techniques that allow an access to all coronary artery segments have brought a growing attention to beating heart surgery without CPB (offpump coronary artery bypass grafting, OPCAB). OPCAB significantly lowers in-hospital morbidity and mortality compared with CABG. Heart failure after myocardial infarction poses a growing medical challenge as the life expectancy continues to increase. Recently it affects 0.4~1% of the overall population and 5% of elderly subjects. Although cardiac transplantation, a gold standard surgery for heart failure, provides excellent therapeutic outcomes in some patients with terminal stage of the disease, the overall outcomes are limited by the scarcity of donor organs, reduced long-term survival, and co-morbid conditions. Recently the efficacies of left ventricular volume reduction surgery, mitral valve repair, and bone marrow cell transplantation in improving the heart function in infracted myocardium of a failing heart have been extensively evaluated and were shown to result in good outcomes.