동맥 도관만을 이용하여 체외심폐순환 없이 시행한 관상동맥우회술

Abstract

Background: Arterial conduits using in coronary artery bypass grafting (CABG) have been known a great long term patency rates, and improved short and long term clinical outcomes. It has been reported that Off pump CABG has better clinical results than CABG using cardiopulmonary bypass. To evaluate the advantage of arterial conduits over venous conduits and to avoid the adverse effects of cardiopulmonary bypass, we performed total arterial Off pump CABG. Material and Method: From January 2001 to October 2004, Off pump CABG using only arterial conduits was performed on 325 patients with a mean age of 59.3±11.9 years (36∼83). Mean ejection fraction was 55.4±14.0% (15∼86). Angiography showed left main disease or triple-vessel disease in 81.9% of the patients. Indications of using arterial conduits was stenosis ≥50% of left anterior descending artery, stenosis ≥80% of branches of left circumflex artery, and stenosis ≥90% of right coronary artery and its branches. Multi-slice computed tomography was performed on 194 patients to evaluate the short term patency rates. Result: A total of 928 distal anastomoses were performed and the average anastomoses per a patient were 2.86±0.78. There was 1 operative mortality. Postoperative complications were mediastinitis in 6 patients (1.8%), renal failure in 4 patients (1.2%), perioperative myocardial infarction in 3 patients (0.9%), reoperation for bleeding in 3 patients (0.9%). There was no postoperative stroke. Patency rate of arterial conduits was 99.3% (581/585). There were 4 stenoses or competitive flows in 2 radial arteries and 2 right internal mammary arteries. Conclusion: Total arterial Off pump CABG appears to be safe, showing a low surgical mortality and morbidity and excellent short term patency rates of arterial conduits.