Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Feasibility of Off-Pump Coronary Artery Bypass Grafting Using Bilateral Skeletonized Internal Thoracic Arteries

양측 내흉동맥을 이용한 관상동맥 우회술의 임상적 분석

  • Lee, Jun-Wan (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae-Won (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong-Woo (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choo, Suk-Joong (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Hyun (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Rheu, Sang-Wan (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong-Wook (Dept. of Thoracic and Cardiovascular Surgery, Kang Neug Asan Medical Center) ;
  • Park, Jong-Bin (Dept. of Thoracic and Cardiovascular Surgery, Kang Neug Asan Medical Center) ;
  • Song, Meong-Gun (Dept. of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • 이준완 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 이재원 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 김종우 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 주석중 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 송현 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 류상완 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 김종욱 (강릉아산병원 흉부외과) ;
  • 박종빈 (강릉아산병원 흉부외과) ;
  • 송명근 (울산대학교 의과대학 서울아산병원 흉부외과)
  • Published : 2003.10.01
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Abstract

Background: The aim of the current study was to assess the effects of total arterial myocardial revascularization (TAMR) with bilateral internal mammary arteries. Material and Method: 139 consecutive patients who underwent off pump coronary artery bypass surgery from January 2000 to December 2001 were included in the current retrospective study. Patients were divided into those receiving bilateral internal mammary artery, BITA (n=85) and those receiving single internal mammary artery, SITA (n=54). Result: There was only one death in each group. No significant differences were noted in the total ICU and hospital stay; 2.4$\pm$1.7 and 11.2$\pm$17.7 days, in the BITA group, respectively and 2.8$\pm$2.7 and 9.7$\pm$7.1 days in the SITA group, respectively (P>0.05). The mean number of distal anastomosis of 3.9$\pm$0.7 was slightly higher in the SITA group compared to the SITA group, which was 3.1$\pm$0.8. Myocardial infarction occurred in 7 patients (BITA group: 2, SITA group: 5) and deep sternal infection necessitating reoperation occurred in 4 patients (BITA group: 3, SITA group: 1). Coronary angiogram was performed in the immediate postoperative period in 104 patients (BITA group: 64/85, SITA group: 40/54). Of these patients, stenosis in the LAD anastomosis site occurred in 4 patients (BITA group: 2, SITA group: 2). A total of 8 anastomotic sites were stenotic in the entire series of which percutaneous intervention was performed in 3 patients and none required reoperative coronary artery bypass. Conclusion: The results of the current data did not show a significant difference in patiency rate with bilateral internal mammary artery use for CABG supporting the feasibility of its use as a viable alternative method for TAMR.

동맥편만을 이용한 관상동맥 우회술을 위한 한 방법으로 양측성 내흉동맥을 이용한 관상동맥우회술의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 2000년 1월부터 2001년 12월까지 서울아산병원 흉부외과에서 심폐바이패스를 사용하지 않는 관상동맥 우회술을 시행받은 139명의 환자를 대상으로 의무기록을 이용한 후향적 분석을 시행하였다. 전체환자를 양측성 내흉동맥을 사용한 환자군을 양측 내흉동맥군(bilateral internal thoracic artery; BITA group, n=85), 단일 내흉동맥을 사용한 환자군을 단일 내흉동맥군(single internal thoracic artery; SITA group, n=54)으로 나누었고 수술결과를 비교하였다. 결과: 수술에 따른 사망은 양 군에서 각각 1예씩 발생하였다. 중환자실 재원일 및 퇴원기간은 양 군 간에 차이를 보이지 않았다(BITA군: 2.4$\pm$1.7일, 11.2$\pm$17.7일, SITA군 2.8$\pm$2.7일, 9.7$\pm$7.1일, p>0.05). 문합혈관수는 BITA군이 3.9$\pm$0.7개, SITA군이 3.1$\pm$0.8개로 BITA군이 더 많았다. 술 후 심근경색은 7예(BITA군 2예, SITA군 5예)에서 발생하였고 심부 흉골감염이 4예(BITA군 3예, SITA군 1예)발생하여 재수술이 시행되었다. 수술 직후 104명의 환자에서(BITA군 64/85, SITA군 40/54명) 관상동맥 조영술이 시행되었고 좌전하행지로의 문합부위 협착이 4예(BITA군: 2예, SITA군: 2예)에서 관찰되었다. 전체 관찰기간 동안의 문합부위 협착 발생은 총 8예였고 이 중 3명의 환자에서 경피적 관상동맥 성형술이 시행되었으며 관상동맥 우회술을 재시행한 경우는 얼었다. 걸론: 관상동맥 우회술 시행시 양측 내흉동맥의 사용은 수술 전후 이환율에서 큰 차이 없이 만족할 만한 개통률을 얻으면서 동맥편만을 이용한 관상동맥 우회술을 가능케 하는 유용한 대안이 될 수 있으리라 생각한다.

Keywords

References

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