초록접수 현황
| 17F-189 | 구연 미채택시 포럼 발표 |
Effect of Total Arterial Revascularization on Long-term Clinical Outcomes in Off-pump Coronary Artery Bypass; at 10 Years Follow-up
Do Jung Kim, Hyun-Chel Joo, Seung Hyun Lee, Kyung-Jong Yoo, Young-Nam Youn
Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Purpose : Total arterial revascularization (TAR) has been associated with incremental survival benefits when compared to conventional coronary artery bypass grafting (CABG). The purpose of this study was to evaluate the long-term clinical outcomes after OPCAB in the presence of multi-vessel coronary artery disease.
Methods : Between January 2007 and December 2014, 1017 consecutive patients underwent isolated primary OPCAB by 2 experienced surgeons. Propensity-matched analysis in a population with triple vessel disease was performed to compare TAR technique (Group1; n=615) with a conventional revascularization [Left internal mammary artery (LIMA) plus additional saphenous vein grafts (SVG); Group 2: n=555]. Two groups of 309 patients were obtained after matching. The mean follow-up duration was 5.2±2.7 years.
Results : The 10-year overall survival (84.9% in Group 1 versus 80.5% in Group 2, p=0.197) and freedom from MACCEs (71.8% versus 72.9%, p=0.170) were similar between matched groups. In multivariate analysis, the independent predictors of long-term mortality were age (HR[CI]; 1.062[1.021-1.105], p=0.003), female (0.481[0.259-0.892], p=0.020), and NYHA≥III (1.729[1.013-2.954], p=0.045). The independent predictors of MACCEs were NYHA≥III (1.557[1.038-2.335], p=0.033) and incomplete revascularization (1.644[1.085-2.491], p=0.019). However, using of total arterial grafts not found to be a significant risk factor of long-term mortality and MACCEs. Results from subgroup analysis suggested that the overall survival rate was superior in NYHA I-II (Group1; 89.1% versus Group2; 79.9%, p=0.008).
Conclusion : Our results showed that there was no difference in long-term clinical outcomes between TAR and LIMA/SVG after OPCAB. However, in patients with NYHA I-II, a more extensive use of arterial grafting could be improved survival benefits.
Methods : Between January 2007 and December 2014, 1017 consecutive patients underwent isolated primary OPCAB by 2 experienced surgeons. Propensity-matched analysis in a population with triple vessel disease was performed to compare TAR technique (Group1; n=615) with a conventional revascularization [Left internal mammary artery (LIMA) plus additional saphenous vein grafts (SVG); Group 2: n=555]. Two groups of 309 patients were obtained after matching. The mean follow-up duration was 5.2±2.7 years.
Results : The 10-year overall survival (84.9% in Group 1 versus 80.5% in Group 2, p=0.197) and freedom from MACCEs (71.8% versus 72.9%, p=0.170) were similar between matched groups. In multivariate analysis, the independent predictors of long-term mortality were age (HR[CI]; 1.062[1.021-1.105], p=0.003), female (0.481[0.259-0.892], p=0.020), and NYHA≥III (1.729[1.013-2.954], p=0.045). The independent predictors of MACCEs were NYHA≥III (1.557[1.038-2.335], p=0.033) and incomplete revascularization (1.644[1.085-2.491], p=0.019). However, using of total arterial grafts not found to be a significant risk factor of long-term mortality and MACCEs. Results from subgroup analysis suggested that the overall survival rate was superior in NYHA I-II (Group1; 89.1% versus Group2; 79.9%, p=0.008).
Conclusion : Our results showed that there was no difference in long-term clinical outcomes between TAR and LIMA/SVG after OPCAB. However, in patients with NYHA I-II, a more extensive use of arterial grafting could be improved survival benefits.
책임저자: Young-Nam Youn
Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
발표자: Do Jung Kim, E-mail : sky_20@naver.com