초록접수 현황
| 15F-122 | 구연 발표 |
Predictors of Left Ventricular Systolic Functional Recovery after Total Arterial Off-pump Coronary Artery Bypass Grafting in Patients with Severe Left Ventricular Dysfunction
Jeong-Won Kim, Hyung Tae Sim, Hyoung Woo Chang, Jae Suk Yoo, Dong Jin Kim, Kwang Ree Cho
세종병원 흉부외과
Background : The role of coronary artery bypass grafting in patients with severe left ventricular (LV) dysfunction and heart failure has not been clearly established yet. We tried to find any predictor for improvement of LV systolic function after total arterial off-pump coronary bypass grafting (OPCAB) in patients with severe LV dysfunction.
Methods : From January 2013 to July 2015, 68 patients underwent isolated OPCAB with severe LV dysfunction [ejection fraction (LVEF) of 0.35 or less]. Preoperative transthroacic echocardiography was compared with immediate and 3-month follow-up studies. Immediate and 3 months postoperative echocardiograms were available in 67/68 (99%) and 47/68 (69%), respectively. Minimum 5% improvement of LV ejection fraction was considered as improvement of LV function. Multivariate analysis to find any predictors for LV functional recovery was done.
Results : Mean age was 65.6±10.8 years and 28 patients (41%) were presented with an angina. Mean preoperative LVEF was 28.1±5.5%. In-hospital mortality occurred in 3 patients (4%). Mean number of anastomosis was 3.3 ± 1.1. Complete revascularization was made in 60/68 patients (88%). Twenty-four (35%) patients showed an improvement of LV function in the immediate postoperative periods (mean 6.7±2.4 days). Of remaining 43 patients, 22 patients (51%) had an improvement of LV function at 3-month follow-up echocardiography. During the follow-up periods, LVEF systolic and diastolic dimensions of left ventricle, E/A ratio and E/E’ ratio representing diastolic left ventricular function, and pulmonary artery systolic pressure were significantly improved (p<0.05). Multivariate analysis revealed complete revascularization and preoperative left ventricular end systolic dimension were independent predictors of improvement of LVEF (OR 10.31, 95% CI 1.77 to 60.06, p=0.009; OR 0.97 95% CI 0.93 to 0.99, p=0.049).
Conclusion : The total arterial OPCAB could improve the systolic and diastolic function in patients with severe LV dysfunction. Complete revascularization was important predictor for LV systolic functional improvement. However, enlarged LV end systolic dimension had negative effect on the improvement of LV function.
Methods : From January 2013 to July 2015, 68 patients underwent isolated OPCAB with severe LV dysfunction [ejection fraction (LVEF) of 0.35 or less]. Preoperative transthroacic echocardiography was compared with immediate and 3-month follow-up studies. Immediate and 3 months postoperative echocardiograms were available in 67/68 (99%) and 47/68 (69%), respectively. Minimum 5% improvement of LV ejection fraction was considered as improvement of LV function. Multivariate analysis to find any predictors for LV functional recovery was done.
Results : Mean age was 65.6±10.8 years and 28 patients (41%) were presented with an angina. Mean preoperative LVEF was 28.1±5.5%. In-hospital mortality occurred in 3 patients (4%). Mean number of anastomosis was 3.3 ± 1.1. Complete revascularization was made in 60/68 patients (88%). Twenty-four (35%) patients showed an improvement of LV function in the immediate postoperative periods (mean 6.7±2.4 days). Of remaining 43 patients, 22 patients (51%) had an improvement of LV function at 3-month follow-up echocardiography. During the follow-up periods, LVEF systolic and diastolic dimensions of left ventricle, E/A ratio and E/E’ ratio representing diastolic left ventricular function, and pulmonary artery systolic pressure were significantly improved (p<0.05). Multivariate analysis revealed complete revascularization and preoperative left ventricular end systolic dimension were independent predictors of improvement of LVEF (OR 10.31, 95% CI 1.77 to 60.06, p=0.009; OR 0.97 95% CI 0.93 to 0.99, p=0.049).
Conclusion : The total arterial OPCAB could improve the systolic and diastolic function in patients with severe LV dysfunction. Complete revascularization was important predictor for LV systolic functional improvement. However, enlarged LV end systolic dimension had negative effect on the improvement of LV function.
책임저자: Kwang Ree Cho
세종병원 흉부외과
연락처 : Jeong-Won Kim, Tel: 010-2950-7137 , E-mail : sweetmartin@hanmail.net
