Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

The Comparison of Clinical Study of Off Pump and On Pump CABG

On Pump-CABG와 Off Pump-CABG의 임상적 고찰에 관한 비교연구

  • 유경종 (연세대학교 의과대학 심장혈관병원 심장혈관외과) ;
  • 임상현 (연세대학교 의과대학 심장혈관병원 심장혈관외과) ;
  • 송석원 (연세대학교 의과대학 심장혈관병원 심장혈관외과) ;
  • 김치영 (연세대학교 의과대학 심장혈관병원 심장혈관외과) ;
  • 홍유선 (연세대학교 의과대학 심장혈관병원 심장혈관외과) ;
  • 장병철 (연세대학교 의과대학 심장혈관병원 심장혈관외과)
  • Published : 2002.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

In an attempt to avoid the adverse effects of the cardiopulmonary bypass, off pump coronary artery bypass grafting(Off pump CABG) that has recently been rediscovered and refined. We compared the preoperative risk factors and in-hospital outcomes of patients done Off pump with those done On pump CABG. Material na Method: One hundred seventy eight patients was underwent CABG between January 2001 and July 2001 12 patients whom underwent associated valvular or left ventricular volume reduction surgery were excluded in this study Data were collected for 52 Off pump CABG and 114 On pump CABG for patient and disease risk factors, extent of coronary disease, and in-hospital outcomes. Result: Off pump CABG and On pump CABG groups did not show any differences in their patient and disease risk factors, and extent of coronary disease. Off pump CABG group had significantly lower mean operation time(234 $\pm$ 37 min vs 290 $\pm$ 48 min, p<0.001), lower mean CK-MB level(10.1 $\pm$ 13.5 IU/L vs 33.1 $\pm$ 18.2 IU/L, p<0.001) and mean ventilation time(14.8 $\pm$ 3.5 hours vs 16.2 $\pm$ 4.9 hours, p=0.048) than On pump CABG groups. On pump CABG group had significantly more distal grafts(3.4 $\pm$ 0.9 vs 2.6 $\pm$ 0.8, p<0.001) than Off pump CABG groups. There were no operative mortality in two groups. Off pump) CABG and On pump CABG groups did not show any differences in their postoperative complications and outcomes including perioperative myocardial infarction, stroke, respiratory failure, renal failure, reoperation, the amount of bleeding, the need of intraaortic balloon pump, the need of inotropics, and the stay of intensive care unit and hospital. Two patients were converted to On pump CABG. Conclusion: This study showed that patients having Off pump CABG are not exposed to a greater risks of adverse outcomes and also provided evidence that patients having Off pump CABG have significantly lower operation time, CK-MB, ventilation time and less distal grafts. Although there may be potential benefits to Off pump CABG, further studies must be directed to determine those patients who would benefit from Off pump CABG.

배경 및 목적; 심폐체외순환의 부작용을 피하기 위해 최근 들어 심폐체외순환 없이 시행하는 관상동맥우회로술(Off pump CABG)이 시도되고 있다. 이 연구는 Off pump CABG와 심폐체외순환하에서 시행하는 관상동맥우회로술(On Pump CABG) 의 수술 전 위험요소와 수술 후 결과를 비교하였다. 방법; 2001년 1월부터 2001년 7월까지 CABG를 시행 받았던 178명중에서 판막수술이나 심실절제술 등 동반 수술이 없었던 166명을 대상으로 하였다. 이 중 Off Pump CABG환자는 52명이었고 On Pump CABG환자가 114명이었으며, 이 환자들을 대상으로 수술전 위험인자와 관상동맥 질환의 정도 및 수술 후 결과를 비교하였다. 결과; 두 군간의 연령, 남녀 비, 수술전 당뇨, 고혈압, 흡연력, 고지질증, 가족력 등 위험요소에 대한 통계적인 유의성은 없었으며, 폐쇄성 폐 질환이나 말초 동맥혈관 협착증 및 뇌경색의 기왕력, 심근경색의 기왕력이나 흉통의 정도(Canadian Class),관상동맥 질환의 정도 및 심박출계수도 통계적인 차이를 보이지 않았다. 수술시간은 Off Pump CABG에서 통계적으로 유의하게 짧았고(234 $\pm$ 37 min vs 290 $\pm$ 48 min, p<0.001), 이 식편수는 On Pump CABG에서 유의하게 많았다(3.4 $\pm$ 0.9개 vs 2.6 $\pm$ 0.8개, p<0.001). 수술 후 사망은 없었으며, 수술 후 측정한 CK-MB는 Off Pump CABG에서 통계적으로 유의하게 낮았고(10.1 $\pm$ 13.5 IU/L vs 33.1 $\pm$ 18.2 lU/L, p<0.001) 호흡기 사용시간도 통계적으로 유의하게 낮았다(14.8 $\pm$ 3.5 hours vs 16.2 $\pm$ 4.9 hours, p=0.048). 그 외 24시간 출혈량, 출혈로 인한 재수술, 중환자실 입원 기간, 수술 후 심근경색증, 감염, 신부전증, 신경과적 합병증 및 수술 후 입원 기간 등 수술 후 결과와 유병율에는 두 군간의 통계적 유의성이 없었다. 결론; Off Pump CABG는 On Pump CABG에 비해 수술시간의 단축과 수술 후 심근 손상의 정도가 낮고, 호흡기 사용시간이 짧게 나타났으나 On Pump CABG에 비해 이식편수가 적었다. 대체로 Off Pump CABG는 On Pump CABG에 비해 수술 후 결과에서 약간의 장점을 보여주었으나 Off Pump CABG의 장점을 알아보기 위해서는 더 많은 연구가 있어야 할 것으로 생각된다.

Keywords

References

  1. J Thorac Cardivasc Surg v.54 Mammary artery-coronary artery anastomosis as method of treatment of angina pectoris. Kolessov VI.
  2. Thorac Cardiovasc Surg v.33 Direct myocardial revascularization without cardiopulmonary bypass. Buffolo E;Andrade JCS;Succi JE(et al)
  3. Experience in 700 patients. Chest. v.100 Direct myocardial revascularization without extracorporeal circulation. Benetti FJ;Naselli G;Wood M.;Geffner L.
  4. Ann Thorac Surg v.63 Predictors of stroke risk in coronary artery bypass patients. Mckhann GM;Goldsborough WA;Borowicz LM(et al) https://doi.org/10.1016/S0003-4975(97)83384-X
  5. Ann Thorac Surg v.55 Inflammatory response to cardiopulmonary bypass. Butler J;Rocker GM;Westby S. https://doi.org/10.1016/0003-4975(93)91048-R
  6. Ann Thorac Surg v.67 Multiple arterial conduits without cardiopulmonary bypass: early angiographic results. Calafiore AM;Teodori G;Vitolla G(et al) https://doi.org/10.1016/S0003-4975(98)01194-1
  7. Ann thorac Surg v.63 Less invasive arterial CABG on a beating heart. Subramanian VA. https://doi.org/10.1016/S0003-4975(97)00417-7
  8. Herat Surg Forum v.3 no.4 Pitfalls and results of immediate angiography after off-pump coronary artery bypass grafting Zehr KJ;Handa N;Bonilla LF;Abel MD;Holmes DRJ.
  9. JAMA v.223 Aorto-coronary bypass with saphenous graft: 7 years follow-up. Garrett HE;dennid EW;Debakey ME. https://doi.org/10.1001/jama.223.7.792
  10. Ann Thorac Surg v.70 Pro: beating heart surgery for coronary revascularization: is it the most important development since the introduction of the heart-lung machine? Mack MJ. https://doi.org/10.1016/S0003-4975(00)02053-1
  11. Ann thorac Surg v.68 Off-pump revascularization of the circumflex artery: technical aspect and short-term results. Cartier R;Blain R. https://doi.org/10.1016/S0003-4975(99)00463-4
  12. 대흉외지 v.33 심폐비이패스 없이 시행하는 관상동맥 우회술 김기봉;임흥국;허재학;안혁;함병문
  13. Ann Thorac Surg v.72 In-Hospital outcomes of Off pump Versus On-pump Coronary Artery Bypass Procedures: A multicenter Experience. Hernandez F;Cohn WE;Baribeau YR(et al) https://doi.org/10.1016/S0003-4975(01)03202-7
  14. Ann Thorac Surg v.71 Clinical outcomes, angiographic patency, and resource utilization in 200 consecutive off-pump coronary bypass patients. Puskas JD;Thourani VH;Marshall JJ(et al) https://doi.org/10.1016/S0003-4975(01)02473-0
  15. Ann Thorac Surg v.70 Con: beating heart surgery for coronary revascularization: is it the most important development since the introduction of the heart-lung machine? Cooley DA https://doi.org/10.1016/S0003-4975(00)02052-X
  16. Br Heart J v.73 Coronary surgery without cardiopulmonary bypass. Westaby S.
  17. Ann Thorac Surg v.63 Minimally invasvie coronary artery bypass grafting on a beating heart. Calafiore AM;Teodori G;Di Giammarco G(et al) https://doi.org/10.1016/S0003-4975(97)00426-8
  18. N Engl J Med v.335 Adverse cerebral outcomes after coronary artery bypass surgery. Roach GW;Kanchuger M;Mora Mangano CM(et al) https://doi.org/10.1056/NEJM199612193352501
  19. Ann Thorac Surg v.68 Beating heart surgery. Murkin JM;Boyd WD;Ganapathy S;Adams SJ;Peterson RC https://doi.org/10.1016/S0003-4975(99)00953-4
  20. J CArdiol Vasc Anesth v.13 Neurophysiological monitoring and outcomes in cardiovascular surgery. Stump DA;Jones TJJ;Rorie KD. https://doi.org/10.1016/S1053-0770(99)90017-4