초록접수 현황
| 16F-084 | 구연 발표 |
Reoperation for Coronary Artery Stenosis after Arterial Switch Operation
Joon Chul Jung, Ji Hyun Bang, Eung Re Kim,Jae Gun Kwak, Woong-han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Background : Coronary artery stenosis can be a cause of reoperation after arterial switch operation (ASO). We investigated freedom from reoperation, risk factors for reoperation and results of reoperation.
Methods : Between 2003 and 2016, 82 patients underwent arterial switch operation. We reviewed their diagnosis, coronary artery pattern, coronary artery anomaly, coronary artery transfer technique for risk factor analysis. Total 6 patients underwent reoperation for coronary artery stenosis. We analyzed reoperation techniques and operative results.
Results : Freedom from reoperation at 5-year and 10-year were 93.9% and 89.4%. In univariate and multivariate analysis, intramural LMCA and high take-off LMCA were significant risk factors for reoperation (relative hazard ratio 14.8 (95% CI 2.2-99.5, p=0.006) and 37.4 (95% CI 2.8-495.9, p=0.006)). Reoperation techniques included coronary artery ostium un-roofing (3 patients, 57.1%), ostioplasty (2 patients, 28.6%), cut-back angioplasty (1 patient, 14.3%). All patients who underwent un-roofing for intramural LMCA and cut-back angioplasty had no acute complications, death, or restenosis during follow-up period (23.0-62.6 months). However 2 patients who underwent ostioplasty needed additional reoperation for coronary artery restenosis within 2 months. In first patient, bovine pericardium used in first reoperation was suspected to cause peel formation by xenograft rejection. After second ostioplasty using pulmonary autograft, coronary artery patency had been maintained during 34.4 months of follow-up period. In second patient, nevertheless aorta autograft flap was used for first ostioplasty to prevent peel formation, acute perfusion angle from ascending aorta due to high take-off LMCA was suspected to cause diffuse restenosis of LMCA. After cut-back angioplasty, LMCA was widened enough. However long-term follow up is needed.
Conclusion : In arterial switch operation, intramural LMCA and high take-off LMCA were significant risk factors for reoperation. The results of reoperation were good with un-roofing and cut-back angioplsaty techniques. When perform ostioplasty, autograft rather than xenograft can be helpful to prevent restenosis.
Methods : Between 2003 and 2016, 82 patients underwent arterial switch operation. We reviewed their diagnosis, coronary artery pattern, coronary artery anomaly, coronary artery transfer technique for risk factor analysis. Total 6 patients underwent reoperation for coronary artery stenosis. We analyzed reoperation techniques and operative results.
Results : Freedom from reoperation at 5-year and 10-year were 93.9% and 89.4%. In univariate and multivariate analysis, intramural LMCA and high take-off LMCA were significant risk factors for reoperation (relative hazard ratio 14.8 (95% CI 2.2-99.5, p=0.006) and 37.4 (95% CI 2.8-495.9, p=0.006)). Reoperation techniques included coronary artery ostium un-roofing (3 patients, 57.1%), ostioplasty (2 patients, 28.6%), cut-back angioplasty (1 patient, 14.3%). All patients who underwent un-roofing for intramural LMCA and cut-back angioplasty had no acute complications, death, or restenosis during follow-up period (23.0-62.6 months). However 2 patients who underwent ostioplasty needed additional reoperation for coronary artery restenosis within 2 months. In first patient, bovine pericardium used in first reoperation was suspected to cause peel formation by xenograft rejection. After second ostioplasty using pulmonary autograft, coronary artery patency had been maintained during 34.4 months of follow-up period. In second patient, nevertheless aorta autograft flap was used for first ostioplasty to prevent peel formation, acute perfusion angle from ascending aorta due to high take-off LMCA was suspected to cause diffuse restenosis of LMCA. After cut-back angioplasty, LMCA was widened enough. However long-term follow up is needed.
Conclusion : In arterial switch operation, intramural LMCA and high take-off LMCA were significant risk factors for reoperation. The results of reoperation were good with un-roofing and cut-back angioplsaty techniques. When perform ostioplasty, autograft rather than xenograft can be helpful to prevent restenosis.
책임저자: Woong-han Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
발표자: Joon Chul Jung, E-mail : junbare3@hanmail.net