Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Availability of the Skeletonized Gastroepiploic Artery as a Free Graft for Coronary Artery Bypass Grafting

관상동맥 우회로 조성술에 있어 유리 이식편으로 사용된 골격화 우위대망 동맥의 효용성

  • Ryu Sang-Wan (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Ahn Byong-Hee (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Hong Seong-Beom (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Song Sang-Yun (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Jung In-Suk (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Beom Min-Sun (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Park Jung-Min (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Lee Kyo-Sun (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Ryu Sang-Woo (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Yoon Ju-Sik (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University) ;
  • Kim Sang-Hyung (Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School University)
  • 류상완 (전남대학교 의과대학 흉부외과학교실) ;
  • 안병희 (전남대학교 의과대학 흉부외과학교실) ;
  • 홍성범 (전남대학교 의과대학 흉부외과학교실) ;
  • 송상윤 (전남대학교 의과대학 흉부외과학교실) ;
  • 정인석 (전남대학교 의과대학 흉부외과학교실) ;
  • 범민선 (전남대학교 의과대학 흉부외과학교실) ;
  • 박정민 (전남대학교 의과대학 흉부외과학교실) ;
  • 이교선 (전남대학교 의과대학 흉부외과학교실) ;
  • 류상우 (전남대학교 의과대학 흉부외과학교실) ;
  • 윤주식 (전남대학교 의과대학 흉부외과학교실) ;
  • 김상형 (전남대학교 의과대학 흉부외과학교실)
  • Published : 2005.09.01
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Abstract

Background: To maximize the histological advantage and minimize the physiological disadvantage, we have been using the skeletonized gastroepiploic artey (GEA) as a free graft for total arterial revascularization. The aims of the current study was to assess the efficacy of the skeletonized GEA as a composite or extended graft for total arterial revascularization. Material and Method: Between January 2000 and Feburary 2005, 133 patients (43 female, mean age=61.8 yrs) undergoing coronary artery bypass grafting (CABG) with a skeletonized GEA as free graft (22 extended, 107 composite and 4 others) were enrolled in this study. Coronary angiograms were performed in the immediate (median 44 days, n=86), early (median 366 days, n=56) and midterm (median 984 days, n=29) postoperative periods. Result: There were 3 ($2.2\%$) early and 4 ($3.3\%$) late cardiac-related deaths. The mean number of distal anastomoses per patient was 3.34 for total graft and 1.92 for GEA graft. The immediate, early, and midterm GEA patency were 157/159 ($98.7\%$), 106/142 ($94.6\%$), and 53/56 ($94.6\%$), respectively. During follow-up, four patients required percutaneous intracoronary intervention because of GEA and target coronary artery stenosis or competitive flow. Conclusion: These data demonstrate satisfactory clinical and angiographic results in the skeletonized GEA as free graft for total arterial revascularizatioh. Although we need a careful longer follow-up, the skeletonized GEA as a free graft will be a valuable option 'to be' for CABG.

배경: 조직학적 장점과 생리학적 단점을 최소화하기 위해 저자들은 완전동맥도관 관상동맥우회로 조성술 시행 시에 골격화 방식으로 체취한 우위대망동맥을 유리 이식편으로 사용해 오고 있다. 본 연구는 골격화된 우위대망동맥을 조합도관이나 연장도관으로 사용하는 것의 효용성에 대해 알아보기 위해 수행되었다. 대상 및 방법: 2000년 1월부터 2005년 2월까지 골격화 우위대망동맥을 유리 이식편(연장도관 22명, 조합도관 107명, 기타 4명)으로 사용하여 관상동맥 우회로 조성술을 시행했던 133명 (43 여자, 평균연령 61.8세)을 대상으로 하였다. 관상동맥 조영술을 수술 직후(중간값 14일, 86명), 초기(중간값 366일, 56명) 그리고 중기(중간값 984일, 29명)에 각각 시행하였다. 결과: 조기 사망 3명 ($2.2\%$)이었고 만기 질환 연관성 사망이 4명($3.3\%$)였다. 환자 당 평균 문합수는 전체 3.34개였으며 우위대망동맥은 1.92개였다. 수술직후, 초기, 중기의 우위대망동맥 개통률은 각각 157/159 ($98.7\%$), 105/112 ($93.7\%$), 50/56 ($89.3\%$)였다. 외래 관찰 중 4명의 환자가 우위대망동맥의 문합부 협착 또는 경쟁혈류에 의해 경피적 관상동맥 성형술이 필요하였다. 결론: 골격화 우위대망동맥 유리 이식편은 개통률 및 임상적인 면에서 만족스러운 결과를 보여주었다. 비록 대상환자들의 장기적인 관찰이 필요하겠지만 저자들은 골격화 우위대망 동맥 유리 이식편이 관상동맥우회로 조성술에 있어 효용성 있는 선택방법이 될 수 있을 것으로 생각한다.

Keywords

References

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