관상동맥우회술 시 요골동맥의 근위부 문합방법에 따른 조기결과

Background: There are many different opinions regarding the proximal anastomotic sites of radial artery in coronary artery bypass surgery. Therefore, we compared the clinical and angiographic findings according to anastomosis of radial artery to develop a guideline. Material and Method: From January 2003 to December 2004, 48 patients who underwent coronary artery bypass surgery using radial artery in Kangdong Sacred Heart Hospital were studied for clinical and coronary angiographic findings and were divided into group I for radial artery that anastomsed to aorta independently and group II that anastomosed to left internal mammary artery. Result: Patients in group I were 33 (men 26, women 7; mean age 61.93$\pm$6.56) and group II were 15 (men 13, women 2; mean age 59.53$\pm$6.02) and there was no difference in preoperative characteristics. Patients in group I had longer cardiopulmonary bypass time (169.36$\pm$40.28 versus 139.40$\pm$20.45, p=0.026) and patients in group II had more sequential grafts with RA per patients (5/33 versus 11/15, p < 0.05). Patients in group I used more vein graft for distal anatstomosis (47/117 ($40\%$) versus 9/48 ($18\%$), p=0.011) and there was no difference in perioperative outcome and overall survival. Mean follow-up time was 15.87$\pm$7.33 (1 to 28) months in patients of the group I and 21.40$\pm$2.85 (17 to 25) months in group II. Postoperative coronary angiography was performed 17/33 ($51.5\%$) in group I and 14/15 ($93.3\%$) in group II. Early perfect patency rate was not statistically different in left anterior descending artery (15/17 ($88.2\%$) versus 2/14 ($85.7\%$), p=1.00) and radial artery (17/20 ($85\%$) versus 30/30 ($100\%$), p=0.058). Late mortality was 1/33 ($3.0\%$) in group I and 1/15 ($6.7\%$) in group II. Conclusion: There was no difference in terms of clinical and postoperative angiographic findings except in cardiopulmonary bypass time, the number of sequential grafts with the RA per patients and the number of the used vein graft. 배경: 관상동맥우회술에서 동맥이식편의 장기개통률이 우수하다는 사실이 알려지면서 요골동맥의 사용이 늘어나는 가운데 근위부 문합방법에 따른 차이에 대해 논의가 분분하다. 이에 본 교실에서는 요골동맥 문합방법에 따른 임상적, 영상적 차이를 비교하였다. 대상 및 방법: 강동성심병원 흉부외과에서 2003년 1월부터 2004년 12월까지 요골동맥을 사용하여 관상동맥우회술을 시행받은 환자 48명을 대상으로 요골동맥을 독립적으로 대동맥에 근위부 문합을 시행하여 관상동맥우회술을 시행받은 환자들(독립절편군, 1군)과 좌속 가슴동맥에 요골동맥을 문합하여 관상동맥우회술을 시행받은 환자들(복합절편군, II군)과의 임상결과 및 관상동맥조영술 결과를 비교하였다. 결과: 48예 중 I군은 33예(남 26예, 여 7예, 평균연령 61.93$\pm$6.56세), II군은 15예(남 13예, 여 2예, 평균연령 59.53$\pm$6.02세)였고 두 그룹 간 술 전 변수에 따른 유의한