Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical outcome of coronary artery bypass surgery according to using cardiopulmonary bypass machine

심폐기 사용여부에 따른 관상동맥우회술의 임상성과

  • Received : 2018.06.01
  • Accepted : 2018.09.07
  • Published : 2018.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

This study was conducted to evaluate the clinical outcomes of coronary artery bypass surgery for ischemic heart disease according to use of a cardiopulmonary bypass machine. The subjects were 10,981 patients who underwent coronary artery bypass grafting for ischemic heart disease from July 2008 to June 2012. Analysis data were retrospectively collected using health insurance claims data. The results of the study showed that mean time to surgery (280 min vs 357 min, p<0.0001) and intubation time (about 24 hours vs 40 hours, p<0.0001) were significantly shorter in the Off-Pump CABG (OPCAB) group than in the On-Pump CABG (ONCAB) group. The rate of reoperation because of postoperative bleeding and hematoma was lower in the OPCAB group (2.7% vs 8.3%, p<.0001). The odds ratio of risk adjusted 30 days mortality rate was 0.339 (0.266-0.434) and the postoperative length of stay was decreased in the OPCAB (p<0.0001). Overall, the 30 days mortality and reoperation rates were lower in the OPCAB, as was the resources use.

본 연구는 허혈성심장질환으로 관상동맥우회술을 받은 환자에서 심폐바이패스 여부에 따른 임상성과를 확인하고자 시행하였다. 연구대상은 2008년 7월부터 2012년 6월까지 4년 동안 허혈성심장질환으로 관상동맥우회술을 받은 환자 전수이며, 총 10,981명이었다. 분석 자료는 건강보험심사평가원 청구명세서를 이용하여 후향적으로 수집하였다. 연구결과, 무심폐기 관상동맥우회술(Off Pump CABG, OPCAB) 환자 그룹이 고식적 관상동맥우회술(On Pump CABG, ONCAB) 환자 그룹에서보다 평균 수술소요시간(280분 vs 357분, p<.0001) 및 기관 내 삽관 후 발관까지 평균 소요시간이 짧았고(약 24시간 vs 40시간, p<.0001), 수술 후 출혈 및 혈종 등으로 인한 재수술률이 낮았다(2.7% vs 8.3%, p<.0001). 위험요인 통제 하에 심폐기 사용 여부에 따른 30일내 사망률과 재원일수를 분석한 결과, 고식적 관상동맥우회술(ONCAB) 대비 무심폐기 관상동맥우회술(OPCAB)의 사망 위험비는 0.339(0.266-0.434)이고, 재원일수는 -0.29229로 감소하였다(p<.0001). 이상의 결과 심폐기를 사용하지 않은 경우에서 30일내 사망률과 재수술률이 낮았고, 평균 수술소요시간, 기관 내 삽관 후 발관까지 소요시간, 재원일수가 짧았음을 확인하였다.

Keywords

References

  1. Y. T. Lee, K. H. Park, "Concise Coronary Artery Bypass Grafting", Korea Med Books Publishing Company, Korea, 2008.
  2. K. J. Yoo, S. H. Lim, S. W. Song, C. Y. Kim, Y. S. Hong, B. C. Chang, "The comparison of Clinical Study of Off Pump and On Pump CABG", Korean J Thorac Cardiovasc Surg, Vol.35, No.4, pp.261-266, 2002.
  3. G. M. Mckhann, W. A. Goldsborough, L. M. Borowicz, E. D. Mellits, R. Brookmeyer, S. A. Quaskey, W. A. Baumgartner, D. E. Cameron, R. S. Stuart, T. J. Gardner, "Predictors of Stroke Risk in Coronary Artery Bypass Patients", The Annals of Thoracic Surgery, Vol.63, No.2, pp.516-521, 1997. DOI: https://dx.doi.org/10.1016/S0003-4975(97)83384-X
  4. V. Zamvar, D. Williams, J. Hall, N. Payne, C. Cann, K. Young, S. Karthikeyan, J. Dunne, "Assessment of neurocognitive impairment after off-pump and on-pump techniques for coronary artery bypass graft surgery: prospective randomized controlled trial" BMJ, Vol.325, No.7375, pp.1268-1272, 2002. DOI: https://dx.doi.org/10.1136/bmj.325.7375.1268
  5. A. M. Calafiore, G. Teodori, G. Di Giammarco, G. Vitolla, N. Maddestra, L. Paloscia, M. Zimarino, V. Mazzei, "Multiple arterial conduits without cardiopulmonary bypass: early angiographic results", The Annals of Thoracic Surgery, Vol.67, No.2, pp.450-456, 1999. DOI: https://dx.doi.org/10.1016/S0003-4975(98)01194-1
  6. Subramanian VA, Less invasive arterial CABG on a beating heart. Ann Thorac Surg 1997;63:S67-S71. https://doi.org/10.1016/S0003-4975(97)80222-6
  7. K. J. Zehr, N. Handa, L. F. Bonilla, M. D. Abel, D. R. Holmes Jr., "Pitfalls and results of immediate angiography after off-pump coronary artery bypass grafting", Herat Surg Forum, Vol.3, No.4, pp.293-299, 2000.
  8. K. B. Kim, H. G. Lim, J. H. Huh, H. Ahn, B. M. Ham, "Off-Pump Coronary Artery Bypass Grafting", Korean J Thorac Cardiovasc Surg, Vol.33, No.1, pp.38-44, 2000.
  9. Y. N. Youn, K. J. Yoo, K. J. Lee, M. K. Bae, Y. H. Shim, "The comparison study of early and midterm clinical outcome of Off Pump versus On Pump CABG in patients with Severe Left Ventricular Dysfunction(LVEF$\leqq $35%)", Korean J Thorac Cardiovasc Surg, Vol.39, No.3, pp.184-193, 2006.
  10. J. K. Shin, J. W. Kim, J. P. Jung, C. R. Park, S. E. Park, "Clinical Outcome of Off Pump Coronary Artery Bypass Grafting", Korean J Thorac Cardiovasc Surg, Vol.41, No.1, pp.34-40, 2008.
  11. C. Lim, W. I. Chang, K. B. Kim, Y. Kim, "Financial Impact of Off-Pump Coronary Artery Bypass", Korean J Thorac Cardiovasc Surg, Vol.35, No.5, pp.365-368, 2002.
  12. A. Diegeler, J. Borgermann, U. Kappert, M. Breuer, A. Boning, A. Ursulescu, A. Rastan, D. Holzhey, H. Treede, F. C. Riess, P. Veeckmann, A. Asfoor, W. Reents, M. Zacher, M. Hilker, "Off-pump versus on-pump coronary-artery bypass grafting in elderly patients", New England Journal of Medicine, Vol.368. No.13, pp.1189-1198, 2013. DOI: https://dx.doi.org/10.1056/NEJMoa1211666
  13. A. Lamy, P. J. Devereaux, D. Prabhakaran, D. P. Taggart, S. Hu, E. Paolasso, Z. Straka, L. S. Piegas, A. R. Akar, A. R. Jain, N. Noiseux, C. Padmanabhan, J. C. Bahamondes, R. J. Novick, P. Vaijyanath, S. Reddy, L. Tao, P. A. Olavegogeascoechea, B. Airan, T. A. Sulling, R. P. Whitlock, Y. Ou, J. Ng, S. Chrolavicius, S. Yusuf, "Off-pump or on-pump coronary-artery bypass grafting at 30 days", New England Journal of Medicine, Vol.366, No.16, pp.1489-1497, 2012. DOI: https://dx.doi.org/10.1056/NEJMoa1200388
  14. S. Al-Ruzzeh, K. Nakamura, T. Athanasiou, T. Modine, S. George, M. Yacoub, C. Ilsley, M. Amrani, "Does off-pump coronary artery bypass (OPCAB) surgery improve the outcome in high-risk patients?: a comparative study of 1398 high-risk patients", European Journal of Cardio-Thoracic Surgery, Vol.23, No.1, pp.50--55, 2003. DOI: https://dx.doi.org/10.1016/S1010-7940(02)00654-1
  15. V. Dhurandhar, A. Saxena, R. Parikh, M. P. Vallely, M. K. Wilson, J. K. Butcher, D. A. Black, L. Tran, C. M. Reid, P. G. Bannon, "Outcomes of On-Pump versus Off-Pump Coronary Artery Bypass Graft Surgery in the High Risk(AusSCORE > 5)", Heart, Lung and Circulation, Vol.24, No.12, pp.1216-1224, 2015. DOI: https://dx.doi.org/10.1016/j.hlc.2015.02.009
  16. A. L. Shroyer, F. L. Grover, B. Hattler, J. F. Collins, G. O. McDonald, E. Kozora, J. C. Lucke, J. H. Baltz, D. Novitzky, "On-Pump versus Off-Pump Coronary-Artery Bypass Surgery", New England Journal of Medicine, Vol.361, No.19, pp.1829-1837, 2009. DOI: https://dx.doi.org/10.1056/NEJMoa0902905
  17. J. C. Cleveland Jr., A. L. Shroyer, A. Y. Chen, E. Peterson, F. L. Grover, "Off-pump coronary artery bypass grafting decreases risk-adjusted mortality, and morbidity", The Annals of Thoracic Surgery, Vol.72, No.4, pp.1282-1289, 2001. DOI: https://dx.doi.org/10.1016/S0003-4975(01)03006-5
  18. M. E. Plomondon, J. C. Cleveland Jr., S. T. Ludwig, G. K. Grunwald, C. I. Kiefe, F. L. Grover, A. L. Shroyer, "Off-pump coronary artery bypass is associated with improved risk adjusted outcomes", The Annals of Thoracic Surgery, Vol.72, No.1, pp.114-119, 2001. DOI: https://dx.doi.org/10.1016/S0003-4975(01)02670-4
  19. F. Hernandez, W. E. Cohn, Y. R. Baribeau, J. F. Tryzelaar, D. C. Charlesworth, R. A. Clough, J. D. Klemperer, J. R. Morton, B. M. Westbrook, E. M. Olmstead, G. T. O'Connor, "In-hospital outcomes of off-pump versus on-pump coronary artery bypass procedures: a multicenter experience", The Annals of Thoracic Surgery, Vol.72, No.5, pp.1528-1534, 2001. DOI: https://dx.doi.org/10.1016/S0003-4975(01)03202-7
  20. S. Al-Ruzzeh, G. Ambler, G. Asimakopoulos, R. Z. Omar, R. Hasan, B. Fabri, A. El-Gamel, A. DeSouza, V. Zamvar, S. Griffin, D. Keenan, U. Trivedi, M. Pullan, A. Cale, M. Cowen, K. Taylor, M. Amrani, "Off-pump coronary artery bypass (OPCAB) surgery reduces risk stratified morbidity and mortality: a United Kingdom multicenter comparative analysis of early clinical outcome", Circulation, Vol.108, No.10(Suppl 1), pp.II1-8, 2003. DOI: https://dx.doi.org/10.1161/01.cir.0000087440.59920.a1
  21. J. F. Legare, K. J. Buth, S. King, J. Wood, J. A. Sullivan, F. C. Hancock, J. Lee, K. Stewart, G. M. Hirsch, "Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump", Circulation, Vol.109, No.7, pp.887-892, 2004. DOI: https://dx.doi.org/10.1161/01.CIR.0000115943.41814.7D
  22. W. Karolak, G. Hirsch, K. Buth, J. F. Legare, "Medium-term outcomes of coronary artery bypass graft surgery on pump versus off pump: Results from a randomized controlled trial", American Heart Journal, Vol.153, No.4, pp.689-695, 2007. DOI: https://dx.doi.org/10.1016/j.ahj.2007.01.033
  23. R. Kaushish, M. K. Unni, M. Luthra, "Beating Heart versus Conventional Coronary Bypass Surgery : Our Experience", Medical Journal Armed Forces India, Vol.66, No.4, pp.357-361, 2010. DOI: https://dx.doi.org/10.1016/S0377-1237(10)80018-8
  24. M. J. Magee, K. A. Jablonski, S. C. Stamou, A. J. Pfister, T. M. Dewey, M. Dullum, J. R. Edgerton, S. L. Prince, T. E. Acuff, P. J. Corso, M. J. Mack, "Elimination of cardiopulmonary bypass improves early survival for multivessel coronary artery bypass patients", The Annals of Thoracic Surgery, Vol.73, No.4, pp.1196-1203, 2002. DOI: https://dx.doi.org/10.1016/S0003-4975(01)03587-1
  25. G. Filardo, P. A. Grayburn, C. Hamilton, R. F. Hebeler Jr., W. B. Cooksey, B. Hamman, "Comparing Long-Term Survival Between Patients Undergoing Off-Pump and On-Pump Coronary Artery Bypass Graft Operations", The Annals of Thoracic Surgery, Vol.92, No.2, pp.571-578, 2011. DOI: https://dx.doi.org/10.1016/j.athoracsur.2011.03.100
  26. D. Fudulu, U. Benedetto, G. G. Pecchinenda, P. Chivasso, V. D. Bruno, F. Rapetto, A. Bryan, G. D. Angelini, "Current outcomes of off-pump versus on-pump coronary artery bypass grafting: evidence from randomized controlled trials", Journal of Thoracic Disease, Vol.8, No.S10, pp.S758-S771, 2016. DOI: https://dx.doi.org/10.21037/jtd.2016.10.80
  27. T. H. Won, S. Y. Choi. I. S. Yang, "Early Result of Off-Pump Coronary Artery Bypass", The Ewha Medical Journal, Vol.25, No.1, pp.27-32, 2005. DOI: https://dx.doi.org/10.12771/emj.2005.28.1.27
  28. H. Takagi, T. Tanabashi, N. Kawai, T. Kato, T. Umemoto, "Off-pump coronary artery bypass graft patency: meta-analysis of randomized trials", The Journal of Thoracic and Cardiovascular Surgery, Vol.133, No.1, pp.e2-e3, 2007. DOI: https://dx.doi.org/10.1016/j.jtcvs.2006.08.062
  29. L. Yu, T. Gu, E. Shi, C. Wang, Q. Fang, Y. Yu, X. Zhao, C. Qian, "Off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel disease and enlarged ventricles", Annals of Saudi Medicine, Vol.34, No.3, pp.222-228, 2014. DOI: https://dx.doi.org/10.5144/0256-4947.2014.222
  30. D. van Dijk, A. P. Nierich, F. D. Eefting, E. Buskens, H. M. Nathoe, E. W. Jansen, C. Borst, J. T. Knape, J. J. Bredee, E. O. Robles de Medina, D. E. Grobbee, J. C. Diephuis, P. P. de Jaegere, "The Octopus Study: Rationale and Design of Two Randomized Trials on Medical Effectiveness, Safety, and Cost-Effectiveness of Bypass Surgery on the Beating Heart", Controlled Clinical Trials, Vol.21, No.6, pp.595-609, 2000. DOI: https://dx.doi.org/10.1016/S0197-2456(00)00103-3
  31. J. M. Brown, R. S. Poston, J. S. Gammie, M. G. Cardarelli, K. Schwartz, A. H. Sikora, S. Yi, R. N. Pierson, B. P. Griffith, "Off-Pump Versus On-Pump Coronary Artery Bypass Grafting in Consecutive Patients: Decision-Making Algorithm and Outcomes", The Annals of Thoracic Surgery, Vol.81, No.2, pp.555-561, 2006. DOI: https://dx.doi.org/10.1016/j.athoracsur.2005.06.081