초록접수 현황

17F-169 포럼 발표

Outcomes of Coronary Artery Bypass Graft after Extracorporeal Life Support in Patients with Ischemic Heart Disease Complicated with Refractory Cardiogenic Shock : A Single Center Experiences
Young Hwan Kim, Hee Moon Lee, Yang Hyun Cho, Dong Seop Jeong, Kiick Sung, Pyo Won Park, Young Tak Lee, Wook Sung Kim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Purpose : Despite recent advances in treatment of ischemic heart disease with refractory cardiogenic shock, the mortality rate remains high. Extracorporeal life support (ECLS) has been used for bridging to revascularization, and we reviewed our experiences of coronary artery bypass graft(CABG) after ECLS in patients with ischemic heart disease complicated with refractory cardiogenic shock.

Methods : From May 2006 to February 2017, we retrospectively reviewed 23 patients who required ECLS support for ischemic heart disease complicated by refractory cardiogenic shock before CABG.

Results : Median age was 65 (Q1-Q3: 58-77) years. ECMO-assisted cardiopulmonary resuscitations (E-CPR) were performed in 12 patients (52%). CPR to ECMO time was 25 (Q1-Q3:18.5-28.5) min. We conduted on pump beating CABG in 13 patients and conventional CABG in 10 patients. Two patients required reoperation due to bleeding. Other complications were gastrointestinal bleeding in one patient, limb ischemia in one patient, acute kidney injury requiring CRRT in nine patients, stroke in one patient. The rate of weaning success was 91%. In-hospital mortality was 6 (26.1%). Four patients died of myocardial dysfunction after successful ECMO weaning. Two patients died of pneumonia and hypoxic brain damage, respectively. All survivors were discharged without neurologic deficits. Median follow-up duration was 20.8 (Q1-Q3: 0.5-47.0) months. There were 2 late mortalities. Freedom from 5-year late mortality was 74.3%

Conclusion : Effective resuscitation with ECLS followed by CABG resulted in reliable clinical outcomes. Weaning success rate was high and all survivors were discharged without neurologic deficits. CABG after ECLS can be a viable treatment option for advanced IHD with refractory cardiogenic shock.


책임저자: Wook Sung Kim
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
발표자: Young Hwan Kim, E-mail : funny.kim@samsung.com

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