Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Early & Midterm Results after Redo Coronary Artery Bypass Grafting

관상동맥우회술 후 재수술의 단기 및 증기 성적

  • 김준성 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 김홍관 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실) ;
  • 장우익 (일산백병원 흉부외과, 인제대학교 의과대학 흉부외과학교실) ;
  • 김기봉 (서울대학교병원 흉부외과, 서울대학교 의과대학 흉부외과학교실)
  • Published : 2004.02.01
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Abstract

As the experience of coronary artery bypass grafting (CABG) has been accumulated, the number of reoperation after CABG is increasing. We analyzed our clinical experience of redo-CABG. Material and Method: Fourteen patients who underwent redo-CABG between Jan. 1994 and Dec. 2002 were included in this study. The mean period from the first operation to reoperation was 66$\pm$56 (3∼157) months, and the average ages were 62.8$\pm$8.7 (51∼78) years. The survivors were followed up 39$\pm$29 (4∼101) months postoperatively. Indications of reoperation were stenosis or occlusion of previous grafts in 11 patients, progression of native coronary artery disease in one patient, and both etiologies in two patients. Result: There were two in-hospital mortalities (14.3%) resulting from low cardiac output syndrome, Postoperative morbidities were perioperative myocardiac infarction in 2 patients (14.3%), mediastinitis in one patient (7.2%), duodenal perforation in one patient, ischemic necrosis of the lower extremity in one patient, gastric perforation after mesenteric infarct in one patient, delayed brain infarct in one patient, and intraoperative splenic rupture in one patient. There was one late mortality at six months postoperatively during the follow up. There was no angina recurrence during the follow up. Conclusion: Although redo CABG demonstrated relatively high operative mortalities and morbidities, postoperative status and clinical outcome of the survivors were favorable.

관상동맥우회술의 경험이 축적됨에 따라 관상동맥우회술의 재수술은 증가하는 추세이나 아직까지 국내 보고는 미흡한 수준이다. 저자들은 관상동맥 재수술의 사망률, 유병률 등의 임상경험을 정리하고 분석하였다. 대상 및 방법: 1994년 1월부터 2002년 12월까지 관상동맥우회술의 재수술을 시행 받은 14명의 환자를 대상으로 하였다. 최초 수술 후 재수술까지의 기간은 평균 66$\pm$56 (3∼157)개월이었고 재수술 시 평균연령은 62.8$\pm$8.7 (51∼78)세였다. 2003년 6월 30일을 추적관찰 종료시점으로 하여 평균추적관찰 기간은 43$\pm$29 (8∼105)개월이었다. 재수술의 적응증은 이식편의 협착 또는 완전폐쇄가 11예(78.6%), 관상동맥질환의 진행이 1예, 그리고 두 가지 병리가 혼재한 경우가 2예였다. 결과: 입원기간 중 사망은 2예(14.3%)가 발생하였고 사망원인은 저심박출증이었다. 술 후 합병증은 총 7명(50.0%)의 환자에서 8예가 발생하였는데, 수술 전후 심근경색이 2예(14.3%), 종격동염이 1예(7.2%), 십이지장 궤양천공 1예, 허혈성 하지괴사 1예, 장간막경색에 따른 위장관 천공 1예, 지연 뇌경색 1예, 비장출혈 1예 등이었다. 조기사망 2예를 제외한 12명의 환자를 추적 관찰한 결과 만기사망은 1예가 발생하였고 추적관찰 종료시점에서 협심증을 호소하는 환자는 없었으며 모든 환자가 Canadian협심증분류 1급 또는 2급의 양호한 경과를 보였다. 결론: 관상동맥 재수술은 비교적 높은 유병률과 사망률을 보였으나 퇴원 후 환자상태는 양호하였으며 향후 경험의 축적과 노력이 요망된다.

Keywords

References

  1. J Thorac Cardiovasc Surg v.110 Determinants of operative mortality in reoperative coronary artery bypass grafting He G-W;Acuff TE;Ryan WH;He Y-H;Mack MJ https://doi.org/10.1016/S0022-5223(05)80164-3
  2. J Thorac Cardiovasc Surg v.93 Fifeen hundred coronary reoperations Lytle BW;Loop FD;Cosgroove DM, et al.
  3. Korean J Thorac Cardiovasc Surg v.35 Clinical experiences of re-do CABG Lim,S.H.;Kwak,Y.T.;Lee,S. et al.
  4. J Am Coll Cardiol v.28 Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years Fitzgibbon GM;Kafka HP;Leach AJ;Keon WJ;Hooper GD;Burton JR https://doi.org/10.1016/S0735-1097(96)00239-2
  5. J Thorac Cardiovasc Surg v.92 Predictors of reoperation after myocardial revascularization Cosgrove DM;Loop FD;Lytle BW, et al.
  6. J Thorac Cardiovasc Surg v.107 Influence of arterial coronary bypass grafts on the mortality in coronary reoperations Lytle BW;McElroy D;McCarthy P, et al.
  7. Ann Thorac Surg v.64 Minimally invasive direct coronary artery bypass grafting: two-year clinical experience Subramanian VA;McCabe JC;Geller CM https://doi.org/10.1016/S0003-4975(97)01099-0
  8. J Thorac Cardiovasc Surg v.120 Late angiographic result of using the right gastroepiploic artery as a graft Suma H;Isomura T;Horii T;Sato T https://doi.org/10.1067/mtc.2000.108690
  9. J Thorac Cardiovasc Surg v.100 Reoperative coronary surgery: Comparative analysis of 6591 patients undergoing primary bypass and 508 patients undergoing reoperative coronary artery bypass Salomon NW;Page US;Bigelow JC;Krause AH;Okies JE;Metzdorff MT
  10. Ann Thorac Surg v.42 Management during reoperation of aortocoronary saphenous vein grafts with minimal atherosclerosis by angiography Marshall WG;Saffitz J;Kouchoukos NT https://doi.org/10.1016/S0003-4975(10)60511-5
  11. J Thorac Cardiovasc Surg v.107 Experience and early results of second reoperations for coronary artery disease: Should patent vein grafts be replaced during reoperation? Noyez L;Werf V;Klinkenberg TJ;Janssen DP;Kaan GL;Lacquet LK
  12. J Thorac Cardiovasc Surg v.98 Catastrophic consequences of internal mammary artery hypoperfusion Jones EL;Lattouf OM;Weintraub WS
  13. Ann Thorac Surg v.65 Should angiographically disease-free sahenous vein grafts be replaced at the time of redo coronary artery bypass grafting? Mehta ID;Weinberg J;Jones MF, et al. https://doi.org/10.1016/S0003-4975(97)01192-2
  14. J Thorac Cardiovasc Surg v.84 Perioperative myocaridal infarction caused by atheroembolism Keon WJ;Heggtveit HA;Leduc J
  15. Circulation v.88 Reoperative coronary artery bypass surgery: Improved preservation of myocardial function with retrograde cardioplegia Rosengart TK;Krieger K;Lang SJ, et al.
  16. J Thorac Cardiovasc Surg v.121 Reoperative coronary bypass surgery: Effect of patent grafts and retrograde cardioplegia Borger MA;Rao V;Weisel RD, et al. https://doi.org/10.1067/mtc.2001.111382
  17. Ann Thorac Surg v.55 Is coronary reoperation without the pump an advantage? Cosgrove DM https://doi.org/10.1016/0003-4975(93)90990-Y
  18. Ann Thorac Surg v.55 Reoperative coronary artery bypass grafting without cardiopulmonary bypass Fanning WJ;Kakos GS;Williams TE https://doi.org/10.1016/0003-4975(93)91025-I
  19. Ann Thorac Surg v.69 Beating heart versus conventional single-vessel reoperative coronary artery bypass Stamou SC;Pfister AJ;Dangas G, et al. https://doi.org/10.1016/S0003-4975(00)01177-2
  20. Korean J Thorac Cardiovasc Surg v.33 Off-pump coronary artery bypass grafting Kim,K.B.;Lim,H.K.;Huh,J.H.;Ahn,H.;Ham,B.M.
  21. J Thorac Cardiovasc Surg v.120 The changing pattern of reoperative coronary surgery: Trends in 1230 consecutive reoperations Yau TM;Borger MA;Weisel RD;Ivanov J https://doi.org/10.1067/mtc.2000.106983
  22. J Thorac Cardiovasc Surg v.105 The effect of coronary reoperation on the survival of patients with stenoses in saphenous vein bypass grafts to coronary arteries Lytle BW;Loop FD;Taylor PC, et al.