Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Intra-aortic Balloon Pump Therapy for Hemodynamic Instability during Off-pump Coronary Artery Bypass Surgery

심폐바이패스를 사용하지 않는 관상동맥우회술 중 발생한 혈역학적 불안정에 대한 대동맥내 풍선펌프 치료

  • Jeong, Dong-Seop (Department of Thoracic and Cardiovascular Surgery, Boramae Medical Center) ;
  • Kim, Ki-Bong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Choi, Eun-Seok (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • 정동섭 (서울시립보라매병원 흉부외과) ;
  • 김기봉 (서울대학교 의과대학 서울대학교병원 흉부외과학교실) ;
  • 최은석 (서울대학교 의과대학 서울대학교병원 흉부외과학교실)
  • Published : 2009.12.05
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Abstract

Background: We assessed the efficacy of intraoperative intra-aortic balloon pump therapy for achieving hemodynamic instability during off-pump coronary artery bypass surgery. Material and Method: We studied seven hundred ninety-six patients who underwent off-pump coronary artery bypass between January 2000 and December 2006. The patient were divided into group I (n=39), which received intraoperative intra-aortic balloon pump therapy, and group II (n=757), which did not receive intraoperative intra-aortic balloon pump therapy. Result: There were no differences in the operative mortalities (2.6%, 1/39 vs 0.8%, 6/757; p=0.195) and morbidities such as atrial fibrillation (p=0.691), stroke (p=0.908) and mediastinitis (p=0.781) between the 2 groups, although the ventilator support time, the length of the intensive care unit stay and the length of the hospital stay were longer in group I than in group II (p<0.05). Multivariate analysis failed to prove that group I was a high risk group for operative mortality (p=0.549). There were 3 intraoperative intra-aortic balloon pump-related complications in group I (7.9%). However, no longer complications occurred after 2003, when the surgeons began using a smaller sized 8 F catheter that was inserted using a sheathless technique. Conclusion: Intraoperative intra-aortic balloon pump therapy for achieving hemodynamic instability during off-pump coronary artery bypass surgery can be performed safely and it showed comparable clinical results to that of not using intraoperative intra-aortic balloon pump therapy.

배경: 본 연구는 심폐바이패스를 사용하지 않는 관상동맥우회술 중 발생한 혈역학적 불안정에 대한 대동맥내 풍선펌프 치료의 유용성을 평가하고자 하였다. 대상 및 방법: 2000년 1월부터 2006년 12월까지 심폐바이패스를 사용하지 않는 관상동맥우회술을 받은 796명의 환자를 대상으로 하였다. 수술중 대동맥내 풍선펌프 삽입이 필요했던 환자들을 I군(n=39), 삽입하지 않았던 환자들을 II군(n=757)으로 분류하였다. 결과: 두 군간에 수술 사망률(2.6%, 1/39 vs. 0.8%, 6/757; p=0.195)과 심방 세동(p=0.691), 뇌졸중(p=0.908), 종격동염(p=0.781) 이환율의 차이는 없었다. 인공호흡기 치료 시간, 중환자실 및 병원 재원 기간은 I군에서 II군보다 길었다 (p<0.05). 다변량 분석에서 수술 중 대동맥내 풍선 펌프 삽입이 수술 사망률을 유의하게 증가시키진 않았다(p=0.549). I군에서 대동맥내 풍선 펌프 치료와 관련하여 수술적 치료가 필요했던 합병증이 3예 있었으나(7.9%), 대동맥내 풍선 펌프 삽입 술기를 변형한 2003년 이후에는 발생하지 않았다. 결론: 심폐바이패스를 사용하지 않는 관상동맥우회술 중 혈역학적 불안정이 발생한 경우 대동맥내 풍선펌프를 이용하여 비교적 적은 합병증으로 관상동맥우회술을 시행할 수 있었다.

Keywords

References

  1. Kim KB, Kang CH, Chang WI, et al. Off-pump coronary artery bypass with complete avoidance of aortic manipulation. Ann Thorac Surg 2002;74:S1377-82 https://doi.org/10.1016/S0003-4975(02)04060-2
  2. Puskas JD, Williams WH, Duke PG. Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: a prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting. J Thorac Cardiovasc Surg 2003;125:797-808 https://doi.org/10.1067/mtc.2003.324
  3. Stamou SC, Jablonski KA, Hill PC, Bafi AS, Boyce SW, Corso PJ. Coronary revascularization without cardiopulmonary bypass versus the conventional approach in high-risk patients. Ann Thorac Surg 2005;79:552-7 https://doi.org/10.1016/j.athoracsur.2004.07.075
  4. Burfeind WR, Duhaylongsod FG, Samuelson D, Leone BJ. The effects of mechanical cardiac stabilization on left ventricular performance. Eur J Cardiothorac Surg 1998;14:285- 9 https://doi.org/10.1016/S1010-7940(98)00199-7
  5. Grundeman PF, Borst C, Verlaan CW, Meijburg H, Mouës CM, Jansen EWL. Exposure of circumflex branches in the tilted, beating porcine heart: echocardiographic evidence of right ventricular deformation and the effect of right or left heart bypass. J Thorac Cardiovasc Surg 1999;118:316-23 https://doi.org/10.1016/S0022-5223(99)70222-9
  6. Chang WI, Kim KB, Kim JH, Ham BM, Kim YL. Hemodynamic changes during posterior vessel off-pump coronary artery bypass: comparison between deep pericardial suture and vacuum-assisted apical suction device. Ann Thorac Surg 2004;78:2057-62 https://doi.org/10.1016/j.athoracsur.2004.05.059
  7. Christenson JT, Simonet F, Badel P, Schmuziger M. Evaluation of preoperative intraaortic balloon pump support in high risk coronary patients. Eur J Cardiothorac Surg 1997; 11:1097-103 https://doi.org/10.1016/S1010-7940(97)00087-0
  8. Kim KB, Lim C, Ahn H, Yang JK. Intraaortic balloon pump therapy facilitates posterior vessel off-pump coronary artery bypass grafting in high-risk patients. Ann Thorac Surg 2001;71:1964-8 https://doi.org/10.1016/S0003-4975(01)02638-8
  9. Etienne PY, Papadatos S, Glineur D, et al. Reduced mortality in high-risk coronary patients operated off pump with preoperative intraaortic balloon counterpulsation. Ann Thorac Surg 2007;84:498-502 https://doi.org/10.1016/j.athoracsur.2007.03.080
  10. Kim KB, Cho KR, Chang WI, et al. Bilateral skeletonized internal thoracic artery graftings in off-pump coronary artery bypass: early result of Y versus in situ grafts. Ann Thorac Surg 2002;74:S1371-6 https://doi.org/10.1016/S0003-4975(02)03974-7
  11. Grundeman PF, Borst C, van Herwaarden JA, Verlaan CWJ, Jansen EWL. Vertical displacement of the beating heart by the octopus tissue stabilizer: influence on coronary flow. Ann Thorac Surg 1998;65:1348-52 https://doi.org/10.1016/S0003-4975(98)00226-4
  12. Vassiliades TA, Nielsen JL, Lonquist JL. Hemodynamic collapse during off-pump coronary artery bypass grafting. Ann Thorac Surg 2002;73:1874-9 https://doi.org/10.1016/S0003-4975(02)03592-0
  13. Edgerton JR, Dewey TM, Magee MJ, et al. Conversion in off-pump coronary bypass grafting: an analysis of predictors and outcomes. Ann Thorac Surg 2003;76:1138-43 https://doi.org/10.1016/S0003-4975(03)00747-1
  14. Reeves BC, Ascione R, Caputo M, Angelini GD. Morbidity and mortality following acute conversion from off-pump to on-pump coronary surgery. Eur J Cardiothorac Surg 2006; 29:941-7 https://doi.org/10.1016/j.ejcts.2006.03.018
  15. Cohen M, Dawson MS, Kopistansky C, McBride R. Sex and other predictors of intra-aortic balloon counter pulsation- related complications: prospective study of 1119 consecutive patients. Am Heart J 2002;139:282-7
  16. Kang N, Edwards M, Larbalestier R. Preoperative intraaortic balloon pumps in high-risk patients undergoing open heart surgery. Ann Thorac Surg 2001;72:54-7 https://doi.org/10.1016/S0003-4975(01)02700-X
  17. Meharwal ZS, Trehan N. Vascular complications of intra- aortic balloon insertion in patients undergoing coronary revascularization: analysis of 911 cases. Eur J Cardiothorac Surg 2002;21:741-7 https://doi.org/10.1016/S1010-7940(02)00034-9