Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Clinical Results of 100 Cases of Coronary Artery Bypass Grafting without Cardiopulmonary Bypass

심폐바이패스 없이 시행한 관상동맥 우회술 100예의 임상적 고찰

  • 방정희 (동아대학교 의과대학 흉부외과학교실) ;
  • 우종수 (동아대학교 의과대학 흉부외과학교실)
  • Published : 2004.04.01
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Abstract

Coronary artery bypass grafting on the beating heart is no longer a new methods for any cardiac surgeon. We evaluated the application of the off-pump coronary artery bypass procedure relative to safety and efficiency as measured by postoperative complication and operative mortality. Material and Method: We used our retrospective database to compare the patients having off-pump coronary surgery (n=100) with those having on-pump coronary surgery (n=100) between June, 1999 and August, 2002. Patients whom underwent associated valvular or aortic aneurysmal operation were excluded. Result: Neither groups showed any differences in the patient's risk factors and extent of coronary disease. Off-pump CABG group did not have significantly less mean operation time (295$\pm$73 min vs 323$\pm$83 min, p=ns) and mean hospital day (15.34$\pm$6.02 day vs 13.80$\pm$4.95 day, p=ns). However, off-pump CABG group had significantly shorter mean ventilation time (17.3$\pm$11.27 hour vs 24.98$\pm$16.1 hour, p＜0.05). No patients were converted to on-pump CABG in off-pump CABG. Intraoperative hemodynamic instability in off-pump CABG were 6 cases, of whom 2 cases were in lateral wall approach and 4 cases in right coronary anastomosis. Postoperative mortality was 1 case in off-pump CABG and 2 cases in on-pump CABG. Intra-aortic ballon pump (IABP) was applied in 1 case with off-pump CABG and in 2 cases with on-pump CABG. No patients presented postoperative cerebral infarction ＆ stroke in off-pump CABG but 2 patients in on-pump CABG. Postoperative arrhythmia presented in 4 cases with off-pump CABG and in 6 cases with on-pump CABG. Acute renal failure (ARF) was complicated in 3 cases with off-pump CABG and in 2 cases with on-pump CABG. Conclusion: This study documented the immediate safety and efficiency of the off-pump CABG procedure.

심폐바이패스 없이 시행하는 관상동맥 우회술은 이제 심장수술자에게 일반적인 시술이 되었다. 저자들은 이 수술방법의 합병증 및 사망률을 분석하여 수술의 안정성 및 효능성을 알아보고자 했다. 대상 및 방법: 1999년 6월부터 2002년 8월까지의 심폐바이패스 없이 시행한 관상동맥 우회로술 100예와 심폐바이패스하의 관상동맥 우회로술 100예를 대상으로 했으며 관상동맥 수술 외에 다른 수술을 동반한 경우는 제외하였다. 결과: 양 그룹에서 술 전 위험요소나 관상동맥 질환 정도의 차이는 없었다. 심폐바이패스 없이 시행한 관상동맥 우회술에서 심폐바이패스하의 관상동맥 우회술보다 평균수술 시간(295$\pm$73분 vs 323$\pm$83분, p＞0.05)과 평균 입원 기간(15.34$\pm$6.02일 vs 13.80$\pm$4.95일, p＞0.05)은 유의한 차이가 없었으나, 평균 인공 호흡기 거치 시간은 심폐바이패스 없이 수술한 경우에 의미 있게 짧았다. (17.3$\pm$11.27시간 vs 24.98$\pm$16.1시간, p＜0.05) 심폐바이패스 없이 시행한 관상동맥 우회술 중 술 중 심폐바이패스로 전환한 예는 없었다. 술 중 혈역학적인 불안정을 보인 경우는 6예에서 있었는데 2예는 둔각분지 시 4예는 우관상동맥 문합 시 생겼다. 술 후 사망은 심폐바이패스 없이 시행한 관상동맥 우회술 시 1예, 심폐바이패스하의 관상동맥 우회술 시 2예가 있었다. 대동맥 내 풍선펌프는 각각 1예와 2예가 있었다. 술 후 뇌경색은 심폐바이패스 없이 시행한 관상동맥 우회술에서는 없는 반면 심폐바이패스하의 관상동맥 우회술에서는 2예가 있었다. 술 후 심부정맥은 각각 4예와 6예 있었으며 급성 신기능 부전은 각각 3예와 2예가 있었다. 결론: 심폐바이패스 없이 시행한 관상동맥 우회로술은 술 후 합병증 및 사망률, 환자의 회복과정에서 안전하고 효율적인 수술방법으로 생각된다.

Keywords

References

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