초록접수 현황
| 16F-027 | 구연 발표 |
Myocardial Protective effect of Antegrade Cardioplegic Cardiac Arrest Versus Ventricular Fibrillation during Cardiopulmonary Bypass on Immediate Post-operative and Mid-term Left Ventricular Function
Sang Yoon Kim, MD¹, Sungkyu Cho, MD¹, Ji-Hyun Lee, MD², Jin-Tae Kim, PhD², Woong-Han Kim, PhD¹
¹Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea, ²Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Background : The objective of this study is to compare the myocardial protective effect of antegrade cardioplegic cardiac arrest(ACC) to that of ventricular fibrillation(VF) on short-term and mid-term left ventricular(LV) function in right ventricular outflow tract(RVOT) surgery.
Methods : RVOT operations from January 2006 to December 2015 were reviewed. The number of cases using ACC only was 71 and that of cases using VF only was 49. Post-operative mortality and morbidity were compared between the two groups. Before and after propensity score matching, left ventricular ejection fraction(LVEF) and left ventricular end-systolic/-diastolic diameter(LVESD/LVEDD) in echocardiography were compared immediate postoperatively and at mid-term follow up between postoperative 6 and 24 month.
Results : There were no perioperative mortality or cerebrovascular accident. There was no statistically significant difference of ventricular and atrial arrhythmia. In overall patient group, LVESD was significantly decreased in ACC group compared to the increase in VF group at immediate postoperative follow up (ACC: -0.39 ± 3.54 vs. VF: 1.60 ± 4.82, p-value=0.020). Mid-term follow up data demonstrated that LVEF at midterm was superior in ACC group than in VF group (ACC: 64.85 ± 7.66 vs. VF: 61.12 ± 7.25, p-value=0.027). However, the increase amount compared to preoperative value was difference of only marginal significance group (ACC: 1.94 ± 12.65 vs. VF: -2.94 ± 9.41, p-value=0.059).
After propensity score matching, the LVEF is significantly improved in ACC group compared to the decrease of LVEF in VF group at midterm follow up (ACC: 7.25 ± 10.04 vs. VF: -6.18 ± 9.13, p-value=0.001). Multiple linear regression model demonstrated that lower preoperative LVEF and ACC rather than VF are prognostic factor for improvement of LVEF at mid-term follow up.
Conclusion : Myocardial protection using ACC is safe and more beneficial in LV function recovery till mid-term follow up after PVR and other RVOT procedures.
Methods : RVOT operations from January 2006 to December 2015 were reviewed. The number of cases using ACC only was 71 and that of cases using VF only was 49. Post-operative mortality and morbidity were compared between the two groups. Before and after propensity score matching, left ventricular ejection fraction(LVEF) and left ventricular end-systolic/-diastolic diameter(LVESD/LVEDD) in echocardiography were compared immediate postoperatively and at mid-term follow up between postoperative 6 and 24 month.
Results : There were no perioperative mortality or cerebrovascular accident. There was no statistically significant difference of ventricular and atrial arrhythmia. In overall patient group, LVESD was significantly decreased in ACC group compared to the increase in VF group at immediate postoperative follow up (ACC: -0.39 ± 3.54 vs. VF: 1.60 ± 4.82, p-value=0.020). Mid-term follow up data demonstrated that LVEF at midterm was superior in ACC group than in VF group (ACC: 64.85 ± 7.66 vs. VF: 61.12 ± 7.25, p-value=0.027). However, the increase amount compared to preoperative value was difference of only marginal significance group (ACC: 1.94 ± 12.65 vs. VF: -2.94 ± 9.41, p-value=0.059).
After propensity score matching, the LVEF is significantly improved in ACC group compared to the decrease of LVEF in VF group at midterm follow up (ACC: 7.25 ± 10.04 vs. VF: -6.18 ± 9.13, p-value=0.001). Multiple linear regression model demonstrated that lower preoperative LVEF and ACC rather than VF are prognostic factor for improvement of LVEF at mid-term follow up.
Conclusion : Myocardial protection using ACC is safe and more beneficial in LV function recovery till mid-term follow up after PVR and other RVOT procedures.
책임저자: Woong-Han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
발표자: Sang Yoon Kim, E-mail : sangyun87@gmail.com