초록접수 현황
| 14F-118 | 구연 발표 |
Should bilateral internal thoracic artery grafting be advocated for all comers? – comparison of bilateral versus single internal thoracic artery grafting in a 10-year single center experience
Suryeun Chung, Yoon-Cheol Shin, Dong Jung Kim, Jun Sung Kim, Cheong Lim, Kay-Hyun Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
목적 : Previous studies have shown that use of bilateral internal thoracic arteries (ITA) may be a superior strategy compared with myocardial revascularization using single left ITA plus multiple vein grafts. However, widespread use of bilateral ITA is hindered by the concerns of increased wound infection and technical difficulty. We investigated our own experience to compare the clinical outcomes of CABG between single (SITA) versus bilateral ITA (BITA) grafting.
방법 : By retrospective review of the 840 patients who underwent isolated CABG in our center from January 2003 through December 2012, we compared the early and long-term rates of mortality, morbidity, and target vessel revascularization between SITA (n=232) and BITA (n=608) groups.
결과 : SITA group had significantly more patients who underwent emergency operation (SITA 18.5% vs BITA 5.1%, p<0.001) and who required IABP preoperatively (SITA 19.8% vs BITA 8.4%, p=0.01). As for the postoperative outcome, there was no difference between groups in terms of early (30-day + in-hospital) mortality rate (SITA 3.0% vs BITA 1.3%, p=0.29), length of postoperative ICU and hospital stays (p=0.14), and incidence of deep sternal and/or mediastinal infection (SITA 0.9% vs BITA 1.0%, p=0.87). During the mean follow-up period of 45 months, there was also no difference in the rate of late death resulting in similar 5-year survival rates; SITA 87.1± 0.03% vs BITA 88.2±0.02%, p=0.76 (Figure 1). However, 5-year rate of freedom from target vessel revascularization was significantly higher in BITA group; SITA 94.4±0.02% vs BITA 97.1±0.01%, p=0.04 (Figure 2).
결론 : Compared with CABG using bilateral ITA, use of single ITA did not show inferior early and mid-term outcomes even with higher proportion of emergency operation. However, target vessel revascularization rate was higher after SITA grafting than after BITA grafting. In view of the excellent graft patency and no increase of wound infection rate, use of BITA is considered a better option for improving the long-term outcome after CABG.
방법 : By retrospective review of the 840 patients who underwent isolated CABG in our center from January 2003 through December 2012, we compared the early and long-term rates of mortality, morbidity, and target vessel revascularization between SITA (n=232) and BITA (n=608) groups.
결과 : SITA group had significantly more patients who underwent emergency operation (SITA 18.5% vs BITA 5.1%, p<0.001) and who required IABP preoperatively (SITA 19.8% vs BITA 8.4%, p=0.01). As for the postoperative outcome, there was no difference between groups in terms of early (30-day + in-hospital) mortality rate (SITA 3.0% vs BITA 1.3%, p=0.29), length of postoperative ICU and hospital stays (p=0.14), and incidence of deep sternal and/or mediastinal infection (SITA 0.9% vs BITA 1.0%, p=0.87). During the mean follow-up period of 45 months, there was also no difference in the rate of late death resulting in similar 5-year survival rates; SITA 87.1± 0.03% vs BITA 88.2±0.02%, p=0.76 (Figure 1). However, 5-year rate of freedom from target vessel revascularization was significantly higher in BITA group; SITA 94.4±0.02% vs BITA 97.1±0.01%, p=0.04 (Figure 2).
결론 : Compared with CABG using bilateral ITA, use of single ITA did not show inferior early and mid-term outcomes even with higher proportion of emergency operation. However, target vessel revascularization rate was higher after SITA grafting than after BITA grafting. In view of the excellent graft patency and no increase of wound infection rate, use of BITA is considered a better option for improving the long-term outcome after CABG.
책임저자: Cheong Lim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine
연락처 : Suryeun Chung , Tel: 031-787-7140 , E-mail : suryeun.chung@gmail.com
