초록접수 현황
| 20F-106 | 구연 발표 |
Redo Previous Wound-Sparing Off-Pump Coronary Artery Bypass Surgery: Single Institute Experiences
Doosang Kim, Hyuk Ahn
Department of Thoracic and Cardio-vascular Surgery, Veterans Health Service Medical Center, Seoul, Korea
Purpose : Redo CABG is still remained as a major concern to cardiac surgeons due to high morbidity and mortality. Off-pump technique and minimally invasive approach thru avoiding redo-sternotomy are a safe combination modality to treat repeated coronary artery atherosclerosis. Therefore, we evaluate the feasibility of redo OPCAB thru avoiding previous wound, and its results.
Methods : From April 1998 to September 2020, 774 patients underwent CABG. Among them, we conducted OPCAB in 329 patients (43%), redo CABG in 64 cases (8%) and redo OPCAB in 57 cases (7%). These 57 patients are the subjects of this study. Median age is 71 years old (range: 58-84) and all of them are male. Coronary access routes were Lt anterior small thoracotomy in 26, para-sternal vertical thoracotomy in 12, inverted U laparotomy in 9 and full-sternotomy (previous MICS) in 9. Time interval between 1st and redo is 9.6 years (range: 0.2-20.8 years). The timing of redo is early failure in 5 at median 8.4 months, midterm failure in 9 at 1.9 years and long-term failure in 40 at 10.6 years (range: 4.2-20.8 years). The reason of redo is newly-developed coronary lesion in 8 (14%), remained disease progression in 11 (20%) and previous graft failure in 39 (70%). Failed grafts were LIMA-to-LAD in 21, non-LAD arterial graft in 17 and non-LAD vein graft in 12.
Results : Median op time is 310 minutes (135-650), and there was no on-pump conversion during OPCAB surgery but intraoperative IABP support in 14 cases (25%). Postop ICU-stay and hospital-stay are 3 days and 15 days, respectively. There was 6 cases of 30-day operative mortality (11%) and 23 morbidities (41%). All-cause and cardiac death-free mean survival times are 13.018 (95% C.I. 10.960-15.076) and 15.479 years (14.096-16.863), respectively and 1-, 5-, 10-year survival rates of all cause and cardiac death-free are 80%, 77%, 77%, and 92%, 92%, 92%, respectively.
Conclusion : Conducting redo off-pump CABG surgery avoiding previous wound access is feasible and its results are acceptable.
Methods : From April 1998 to September 2020, 774 patients underwent CABG. Among them, we conducted OPCAB in 329 patients (43%), redo CABG in 64 cases (8%) and redo OPCAB in 57 cases (7%). These 57 patients are the subjects of this study. Median age is 71 years old (range: 58-84) and all of them are male. Coronary access routes were Lt anterior small thoracotomy in 26, para-sternal vertical thoracotomy in 12, inverted U laparotomy in 9 and full-sternotomy (previous MICS) in 9. Time interval between 1st and redo is 9.6 years (range: 0.2-20.8 years). The timing of redo is early failure in 5 at median 8.4 months, midterm failure in 9 at 1.9 years and long-term failure in 40 at 10.6 years (range: 4.2-20.8 years). The reason of redo is newly-developed coronary lesion in 8 (14%), remained disease progression in 11 (20%) and previous graft failure in 39 (70%). Failed grafts were LIMA-to-LAD in 21, non-LAD arterial graft in 17 and non-LAD vein graft in 12.
Results : Median op time is 310 minutes (135-650), and there was no on-pump conversion during OPCAB surgery but intraoperative IABP support in 14 cases (25%). Postop ICU-stay and hospital-stay are 3 days and 15 days, respectively. There was 6 cases of 30-day operative mortality (11%) and 23 morbidities (41%). All-cause and cardiac death-free mean survival times are 13.018 (95% C.I. 10.960-15.076) and 15.479 years (14.096-16.863), respectively and 1-, 5-, 10-year survival rates of all cause and cardiac death-free are 80%, 77%, 77%, and 92%, 92%, 92%, respectively.
Conclusion : Conducting redo off-pump CABG surgery avoiding previous wound access is feasible and its results are acceptable.
책임저자: Doosang Kim
Department of Thoracic and Cardio-vascular Surgery, Veterans Health Service Medical Center, Seoul, Korea
발표자: Doosang Kim, E-mail : mdksr@paran.com