• Journal of Chest Surgery
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• 제50권4호
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• pp.247-254
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• 2017

Background: Hybrid coronary revascularization (HCR) was developed to combine the advantages of coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI). However, it is still controversial whether it is more optimal to perform CABG or PCI first. The purpose of this study was to compare the clinical outcomes of these 2 approaches. Methods: Eighty patients who underwent HCR from May 2010 to December 2015 were enrolled in this retrospective analysis. The CABG-first group comprised 12 patients and the PCI-first group comprised 68 patients. Outcomes of interest included in-hospital perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and the incidence of repeated revascularization, especially for the target vessel lesion. Results: No significant difference was found in the amount of postoperative bleeding (p=0.239). The incidence of MACCEs was similar between the CABG-first and PCI-first groups (1 of 12 [8.3%] vs. 5 of 68 [7.4%], p>0.999). Repeated revascularization was performed on 3 patients (25%) in the CABG-first and 9 patients (13.2%) in the PCI-first group (p=0.376). Conclusion: There were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR.

• Journal of Chest Surgery
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• 제52권1호
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• pp.16-24
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• 2019

Background: Optimal graft selection for coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction remains debatable. We report an analysis of our experiences of isolated CABG in patients with severe LV dysfunction and the impact of graft strategy on long-term outcomes. Methods: We analyzed 209 patients with severe LV dysfunction (ejection fraction [EF] <30%) who underwent primary isolated CABG. Of these, 169 were revascularized with a bilateral internal thoracic arterial (ITA) graft (BITA group) and 40 were revascularized with a single ITA graft (SITA group). The mean follow-up duration was $22{\pm}32$ months. Results: There were 18 early deaths (8.6%). Overall survival at 5 years was 66.7%. The rate of freedom from cardiac-related death at 5 years was 74.1%, and was significantly higher in patients who underwent off-pump CABG (p=0.005) and in the BITA group (p=0.023). Multivariate analysis demonstrated that old age (hazard ratio [HR], 2.548; 95% confidence interval [CI], 1.134-5.762; p=0.024), off-pump CABG (HR, 0.245; 95% CI, 0.090-0.661; p=0.006), and BITA grafts (HR, 0.333; 95% CI, 0.146-0.757; p=0.009) were correlated with cardiac mortality. Conclusion: CABG in patients with severe LV dysfunction (EF <30%) showed reasonable long-term outcomes. The rate of freedom from cardiac-related death was significantly higher in patients who underwent off-pump CABG and in the BITA group. Off-pump BITA grafting strategies can be accepted as a viable primary option in patients with severe LV dysfunction if performed by an experienced surgeon.

• Journal of Chest Surgery
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• 제47권3호
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• pp.225-232
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• 2014

Background: Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality as compared to the first-time operation. Further, the application of the off-pump technique to redo CABG is limited due to technical difficulties. The aim of this retrospective study was to analyze early and midterm results after redo CABG and compare the outcome of redo on-pump and off-pump CABG. Methods: From June 1996 to October 2011, elective redo CABG was performed in 32 patients. Mean age was 64.8 years (on pump 64.3 years vs. off pump 65.5 years; p=0.658), and 21 patients were male. Among these patients, 14 (43.8%) underwent on-pump CABG, and 18 (56.2%) underwent off-pump CABG. Results: Internal thoracic artery was used in 22 patients (68.8%), and total arterial revascularization was achieved in 17 patients (53.1%). The average number of distal anastomoses was 2.13, and the rate of incomplete revascularization was 43.8%. The rate of total arterial revascularization was higher in the off-pump group (14.3% vs. 83.3%, p<0.001), and the use of saphenous vein graft was more in the on-pump group (78.6% vs. 16.7%, p<0.001). Overall hospital mortality was 3.1% (n=1) and was comparable in both groups (on pump 7.1% vs. off pump 0%; p=0.249). Postoperative complications occurred in 9 patients (64.2%), and the rate of complications was high in the on-pump group without statistical significance (64.2% vs. 33.3%, p=0.082). The mean follow-up duration was 5.4 years, and overall survival at 10 years was $86.0%{\pm}10.5%$. There was no significant difference in the 10-year survival rate between the two groups (79.6% vs. 100%, p=0.225). Conclusion: Redo CABG can be safely performed with acceptable mortality. Redo off-pump coronary artery bypass is feasible with low mortality and morbidity, comparable target vessel bypass grafting, and long-term survival. The off-pump technique might be considered a safe option for redo CABG in high-risk patients.

• Journal of Chest Surgery
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• 제39권3호
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• pp.184-193
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• 2006

배경: 심장박동 상태에서 시행하는 관상동맥우회술(Off pump coronary artery bypass grafting, OPCAB) 은 심폐체외순환 하에서 시행하는 관상동맥우회술(On pump coronary artery bypass grafting, On pump CABG)에 비해 합병증이 다소 적은 것으로 보고되고 있다. 저자들은 좌심실 기능이 저하된 환자들에서 OPCAB과 On pump CABG의 단기 및 중기 성적을 평가하여 OPCAB의 유용성을 확인하였다. 대상 및 방법: 2001년 1월부터 2005년 2월까지 동반수술을 시행 받지 않고 관상동맥우회술만을 시행 받은 946명 중 좌심실 박출계수가 $35\%$ 이하인 100명을 대상으로 하였다(OPCAB군 : On pump CABG군 =68명: 32명). 평균 연령은 두 군이 OPCAB군과 On pump CABG군이 각각 62.9$\pm$9.0세와 63.8 $\pm$ 8.0로 두 군의 차이가 없었다. 두 군의 수술 전 위험요인을 분석하고, 수술 결과 및 추적결과를 평가 및 비교하였다. 결과: OPCAB군은 평균 2.75$\pm$0.72개, On pump CABG군은 2.78$\pm$0.55개의 도관을 획득하여, 각각 3.00$\pm$0.79개, 3.16$\pm$0.72개의 원위문합을 시행하였다. 수술 후 사망은 OPCAB군에서만 1명 ($1.5\%$) 발생하였으나 두 군간의 통계적 유의성은 없었다. 수술시간, 수술 후 1일째 CK-MB, 수술 후 기계 환기 시간, 중환자실 체류기간, 합병증 발생률이 통계적으로 유의하게 OPCAB군에서 더 낮았다. 평균 추적 기간은 26.6$\pm$12.8개월(4${\~}$54개월)이었으며, 추적 기간 중 좌심실 박출계수는 OPCAB군과 On pump CABG군이 각각 $27.1\pm4.5\%$와 $26.9\pm5.4\%$에서 $40.7\pm13.0\%$와 $33.3\pm13.7\%$로 통계적으로 유의하게 각각 증가하였다. 4년 생존율은 OPCAB군과 On pump CABG군이 각각 $92.2\%,\;88.3\%$, 심장관련 사망에 있어서 4년 freedom rate은 각각 $97.7\%,\;96.4\%$로 두 군간의 차이는 없었으며, 심장관련 합병증과 협심증 발생의 freedom rate도 두 군간의 차이는 없었다. 결론: 좌심실 기능이 저하된 환자들에서 심장박동 상태에서 시행하는 관상동맥우회술은 심장기능을 향상시키고 On pump CABG군에 비해 우수한 수술결과를 보였다. 특히 On pump CABG군에 비해 우수한 단기 성적을 보였으나 중기성적은 차이가 없었다. 따라서 좌심실 기능이 저하된 환자들에 있어서 심장박동 상태에서 시행하는 관상동맥우회술은 안전하고 효과적으로 사용될 수 있는 수술방법이라고 생각한다.

• 대한의생명과학회지
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• 제10권3호
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• pp.237-243
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• 2004

In recent, many cardiac centers have preferred off-pump coronary artery bypass grafting (CABG) to on-pump CABG to prevent the adverse effects of cardiopulmonary bypass. The present study was performed to prove beneficial effects of off-pump CABG. Sixty adult patients scheduled for elective CABG were randomly assigned to On-pump group (n=30) or Off-pump group (n=30). Arterial blood samples were drawn before and after the operation (Pre-OP and Post-OP, respectively) for measuring CBC, prothrombin time, activated thromboplastine time, blood gas analysis, creatine kinase-MB (CK-MB) level, and lactate dehydrogenase (LDH) level. Perioperative parameters including heparin and protamine usages, complications, blood components usages, blood loss, ventilation and ICU-staying time, and hospitalization were also evaluated. Platelet count at Post-OP was high in Off-pump group whereas CK-MB and LDH levels were low compared with On-pump group. Off-pump group had significantly lower heparin and protamine usages, lower total leukocyte count, higher hematocrit and hemoglobin levels, less blood loss, lower usages of blood components, shorter ventilation and ICU-staying time, and lower incidence of pleural effusion than On-pump group. Other variables did not significantly differ between two groups. These results showed that Off-pump CABG was a satisfactory technique with less inflammatory reaction, less cardiac damage, less postoperative complications, and less cost.

• Journal of Chest Surgery
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• 제32권5호
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• pp.480-483
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• 1999

심폐바이패스와 심정지액을 이용하여 심장을 완전히 정지시킨 상태에서 원위부 관상동맥 문합을 시행하는 방법이 현재 관상동맥우회술에서 널리 사용되고 있다. 하지만, 심정지액을 이용한 심정지하의 관상동맥우회술은, 특히 고위험군 환자에서 수술중 심근의 허혈성 손상을 완전히 배제하지는 못하고 있다. 이런 측면에서 볼 때, 심폐바이패스를 사용치 않는 방법이 관상동맥우회술중 심근의 허혈성 손상을 방지하고 심폐바이패스의 합병증을 줄이기 위한 이상적인 방법이라 할 수 있겠지만, 이는 기술적으로 항상 가능한 것은 아니다. 이에 저자들은 좌심실 구출률이 25%로 좌심실 기능 저하가 심했던 경우와, 경피적 관상동맥확장술 중에 심인성 쇼크가 초래된 경우 등의 고위험군 환자에서 시행한 심폐바이패스하의 심박동상태에서의 관상동맥우회술 2례를 보고하는 바이다

• Journal of Chest Surgery
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• 제35권7호
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• pp.553-555
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• 2002

경복부 접근법은 관상동맥우회술후 재수술시 정중 흉골절개에 동반될 수 있는 위험성을 피할 수 있다는 장점 때문에 선택적으로 적용될 수 있는 접근법 중의 하나이다. 관상동맥우회술 후 협심증이 재발한 59세 여자 환자에서 경복부 접근법을 통하여 심폐바이패스를 이용하지 않는 관상동맥우회술을 시행하였다. 검상돌기하 부위 에 경복부 절개술을 시행하고 개복한 후 이식혈관으로 우위 대망동맥을 준비하였으며, 우심실과 횡격막 사이의 유착을 박리한 뒤, 심폐바이패스를 이용하지 않고 심박동하에서 우위대망동맥을 우관상동맥에 문합하였다. 술후 1일째 시행한 관상동맥조영술에서 문합부위에 이상이 없음을 확인하였고, 합병증 없이 술 후 4일째 퇴원하였다. 정중 흉골절개가 아닌 경복부 접근법을 통해 심폐바이패스를 이용하지 않는 관상동맥 우회 재수술을 시행하고 만족할 만한 결과를 얻었기에 이 증례를 보고하는 바이다.

• Journal of Chest Surgery
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• 제33권2호
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• pp.186-189
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• 2000

In an attermpt to aviod the deleterious effects of cardiopulmonary by pass such as pulmonary complication neurologic complication and renal failure off-pump CABG has been rediscovered and developed. We experienced off-pump CABG in 2 cases with unstable angina complicated with COPD and report herein the cases with review of literature.

• 대한간호학회지
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• 제37권7호
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• pp.1159-1165
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• 2007

Purpose: The purpose of this study was to investigate the stages of change in smoking cessation after a Coronary Artery Bypass Graft(CABG) and to identify the related factors. Methods: The subjects (n=157) were patients who underwent a CABG in a university hospital from March 1998 to October 2005 and were smokers before the CABG. Data was collected viachart review and a telephone interview, and analyzed with descriptive statistics, $X^2$ test, one-way ANOVA, and Kruskal-Wallis procedure by the SPSS/PC win 12.0 program. Results: The subjects smoked for an average of 34 years (21 cigarettes per day) before surgery. Eleven percent of the subjects were in pre-contemplation, 6.4% in contemplation, 13.5% in preparation, 4.5% in action, and 64.5% in the maintenance stage. Nicotine dependence and self-efficacy were different among the groups with different stages of change in smoking cessation. Nicotine dependence was the lowest (p=0.00) and self-efficacy was the highest (p=0.00) in the maintenance stage. The number of subjects in pre-contemplation and contemplation significantly increased 6 years after surgery(p=0.05). Conclusions: To implement effective smoking cessation interventions for CABG patients, the intervention should be developed to accommodate individual readiness for smoking cessation, especially so for those who had a CABG more than 6 years previously.

• Journal of Chest Surgery
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• 제52권2호
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• pp.70-77
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• 2019

Background: Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock. Methods: We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%). Results: The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%). Conclusion: CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.