초록접수 현황
| 15F-215 | 구연 발표 |
No-touch Saphenous Vein Composite Grafts for Coronary Artery Bypass; Early Outcomes and 1-year Angiographic Results
김기봉, 김용한, 오홍철, 황호영
서울대학교 의과대학 서울대학교병원 흉부외과학교실
Background : Patency of the saphenous vein graft (SVG) in coronary artery bypass grafting (CABG) is known to be influenced by harvesting method and endothelial preservation. The purpose of this study was to evaluate clinical outcomes and 1-year angiographic patency rates in patients who used SVG harvested by no-touch technique, compared with minimally manipulated technique.
Methods : Off-pump CABG patients who used SVG as a Y-composite graft anastomosed to the left internal thoracic artery were included in this study. Patients who were enrolled in the SAVE RITA trial between 2008 and 2011 used the minimally manipulated SVG (MM group, n=109), and patients who underwent operation from October 2013 to July 2014 used the SVG harvested by no-touch technique (NT group, n=69). The NT group were older (67.7±9.5 years vs 63.2±7.8 years, p=0.001), had higher EuroSCORE (5.8±6.6 vs 2.6±2.2, p=0.001) and lower left ventricular ejection fraction (53.4±14.1% vs 57.8±9.8%, p=0.023), compared with the MM group. Postoperative early (1.4±1.1 days) coronary angiography was performed in all patients, and 1-year angiograms (12.7±2.0 months) were followed up in 160 patients (106 from MM group, 54 from NT group).
Results : There was one early mortality (≤30 days) in the NT group. No significant differences were found in postoperative morbidities including atrial fibrillation, acute kidney injury, mediastinitis, and stroke, between the 2 groups. Early angiography showed 99.0% (383/387) overall patency rate in the MM group, and 100% (254/254) in the NT group (p=0.943). At 1 year, the overall graft patency was 97.6% in the MM group, and 96.0% in the NT group (p=0.283). As for the patency of SVG, early patency rates were 98.4% (248/252) and 100% (181/181) in the MM and NT groups (p=0.943), whereas 1 year patency rates were 96.3% (235/244) and 95.1% (135/142) in the MM and NT groups (p=0.555), respectively. Redo-CABG was performed in 1 patient (MM group) at 21 months postoperatively due to progression of native coronary artery disease, and percutaneous intervention was performed in 1 patient (NT group) at 12 months because of occlusion of the SVG on 1 year coronary angiography.
Conclusion : The SVG harvested by the no-touch technique may further improve patency rates by enhanced preservation of endothelial integrity, vasa vasorum and surrounding tissue support of the vein, although statistically insignificant in this study. While early results are encouraging when using the no-touch technique, the long-term patency follow-up is warranted.
Methods : Off-pump CABG patients who used SVG as a Y-composite graft anastomosed to the left internal thoracic artery were included in this study. Patients who were enrolled in the SAVE RITA trial between 2008 and 2011 used the minimally manipulated SVG (MM group, n=109), and patients who underwent operation from October 2013 to July 2014 used the SVG harvested by no-touch technique (NT group, n=69). The NT group were older (67.7±9.5 years vs 63.2±7.8 years, p=0.001), had higher EuroSCORE (5.8±6.6 vs 2.6±2.2, p=0.001) and lower left ventricular ejection fraction (53.4±14.1% vs 57.8±9.8%, p=0.023), compared with the MM group. Postoperative early (1.4±1.1 days) coronary angiography was performed in all patients, and 1-year angiograms (12.7±2.0 months) were followed up in 160 patients (106 from MM group, 54 from NT group).
Results : There was one early mortality (≤30 days) in the NT group. No significant differences were found in postoperative morbidities including atrial fibrillation, acute kidney injury, mediastinitis, and stroke, between the 2 groups. Early angiography showed 99.0% (383/387) overall patency rate in the MM group, and 100% (254/254) in the NT group (p=0.943). At 1 year, the overall graft patency was 97.6% in the MM group, and 96.0% in the NT group (p=0.283). As for the patency of SVG, early patency rates were 98.4% (248/252) and 100% (181/181) in the MM and NT groups (p=0.943), whereas 1 year patency rates were 96.3% (235/244) and 95.1% (135/142) in the MM and NT groups (p=0.555), respectively. Redo-CABG was performed in 1 patient (MM group) at 21 months postoperatively due to progression of native coronary artery disease, and percutaneous intervention was performed in 1 patient (NT group) at 12 months because of occlusion of the SVG on 1 year coronary angiography.
Conclusion : The SVG harvested by the no-touch technique may further improve patency rates by enhanced preservation of endothelial integrity, vasa vasorum and surrounding tissue support of the vein, although statistically insignificant in this study. While early results are encouraging when using the no-touch technique, the long-term patency follow-up is warranted.
책임저자: 김기봉
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 김기봉, Tel: 02-2072-3482 , E-mail : kimkb@snu.ac.kr
