초록접수 현황
| 15F-232 | 구연 발표 |
Recycling of Patent Previous Arterial Grafts for Redo Coronary Artery Bypass Grafting
오홍철, 최재웅, 김용한, 황호영, 김기봉
서울대학교 의과대학 서울대학교병원 흉부외과학교실
Background : In situ internal thoracic arterial (ITA) grafts have been proven to have long-term patency and improve outcomes. The recycling of patent previous arterial grafts showed excellent clinical results in selected patients who underwent redo coronary artery bypass grafting (CABG). We analyzed clinical outcomes and 1-year angiographic results in patients who underwent redo CABG using the recycling of patent previous arterial grafts.
Methods : Of 73 patients who underwent redo CABG between January 2000 and February 2015, 22 patients used the recycling of patent arterial grafts. Mean age at reoperation was 65.3±8.4 years and the mean time to reoperation was 8.4 ± 4.9 years. The recycled patent grafts included left ITA (n=18, 81.8%), in situ GEA (n=1, 4.5%). In addition, the second-limb arterial grafts based on the left ITA were used for recycling in 3 patients (2 right gastroepiploic artery Y-composite grafts and 1 right ITA Y-composite graft). Grafts used for redo revascularization were saphenous vein (n=20) and right ITA (n=2), which were anastomosed to the previous patent arterial grafts as a Y-composite graft. The average number of distal anastomoses was 1.8±0.6. Thirteen patients underwent off-pump CABG and 9 patients underwent on-pump beating CABG. Postoperative 1-year coronary angiograms were performed in 16 patients.
Results : There was no operative mortality. Postoperatvie morbidities included stroke (n=1), perioperative myocadial infarction (n=1), acute kidney injury (n=1), and pneumonia (n=1). There was no reoperation for bleeding. Stroke developed in a patient who underwent on-pump beating CABG. There were 3 occlusions (3/40, 7.5%) at 1-year angiogram.
Conclusion : The recycling of previous arterial grafts during redo CABG produced satisfactory outcomes in selected patients. Off-pump technique using the recycling of previous arterial grafts may further avoid neurological complications.
Methods : Of 73 patients who underwent redo CABG between January 2000 and February 2015, 22 patients used the recycling of patent arterial grafts. Mean age at reoperation was 65.3±8.4 years and the mean time to reoperation was 8.4 ± 4.9 years. The recycled patent grafts included left ITA (n=18, 81.8%), in situ GEA (n=1, 4.5%). In addition, the second-limb arterial grafts based on the left ITA were used for recycling in 3 patients (2 right gastroepiploic artery Y-composite grafts and 1 right ITA Y-composite graft). Grafts used for redo revascularization were saphenous vein (n=20) and right ITA (n=2), which were anastomosed to the previous patent arterial grafts as a Y-composite graft. The average number of distal anastomoses was 1.8±0.6. Thirteen patients underwent off-pump CABG and 9 patients underwent on-pump beating CABG. Postoperative 1-year coronary angiograms were performed in 16 patients.
Results : There was no operative mortality. Postoperatvie morbidities included stroke (n=1), perioperative myocadial infarction (n=1), acute kidney injury (n=1), and pneumonia (n=1). There was no reoperation for bleeding. Stroke developed in a patient who underwent on-pump beating CABG. There were 3 occlusions (3/40, 7.5%) at 1-year angiogram.
Conclusion : The recycling of previous arterial grafts during redo CABG produced satisfactory outcomes in selected patients. Off-pump technique using the recycling of previous arterial grafts may further avoid neurological complications.
책임저자: 김기봉
서울대학교 의과대학 서울대학교병원 흉부외과학교실
연락처 : 오홍철, Tel: 02-2067-3898 , E-mail : elmion@hanmail.net
