1. Hybrid Off-Pump Revascularization; Early & Midterm Results 서울대학교병원 흉부외과 황 호영, 조 광리, 김 기봉

2. SNUH Thoracic and Cardiovascular Surgery Background Hybrid CABG CABG + PCI To achieve Complete revascularization w/ minimally invasive surgery

3. SNUH Thoracic and Cardiovascular Surgery Aims of This Study To evaluate Indications Early & Midterm results of hybrid CABG

4. SNUH Thoracic and Cardiovascular Surgery Patient Profiles 1998.01 - 2004.07 25 / 782 of total OPCAB pt (3.2%) Age (yr) 62.6  9.6 Sex (M : F)17 : 8 Unstable : Stable angina19 : 6 Three-vessel disease17 Combined left main stenosis6

5. SNUH Thoracic and Cardiovascular Surgery Patient Co-morbidity Hypertension14 DM10 CRF 4 Hypercholesterolemia 4 CVA9 Carotid artery stenosis1

6. SNUH Thoracic and Cardiovascular Surgery Hybrid CABG OPCAB w/ total arterial grafts Periop PCI Preop PCI (n=8)3.9  4.3 (d) Postop PCI (n=17)1.7  2.2 (d)

7. SNUH Thoracic and Cardiovascular Surgery Indication of Hybrid (I) Preop PCI + OPCAB N=8 Complete revasularization w/ minimally invasive surgery7 Emergent PCI for culprit lesion1

8. SNUH Thoracic and Cardiovascular Surgery Indication of Hybrid (II) OPCAB + postop PCIN=17 Unable to revascularize externallyn=9 1. Diffuse coronary atherosclerosis5 2. No more arterial conduit w/ ascending aorta calcification3 3. Intramyocardial coroanry artery1 Borderline lesion (70-90%) in big RCAn=8

9. SNUH Thoracic and Cardiovascular Surgery Coronary Lesions Treated by CABG Target Lesions# LAD24 OM or Ramus20 Diagonal9 PDA4 Total 57 (2.3  1.0/ pt)

10. SNUH Thoracic and Cardiovascular Surgery Coronary Lesions Treated by PCI Target Lesions# Left coronary territory9 LCX 7 OM 1 LM 1 Right coronary territory21 Proximal RCA 13 Mid RCA 3 Distal RCA 5 Total 30(1.2  0.4 /pt)

11. SNUH Thoracic and Cardiovascular Surgery Strategy Of Antipletelet Therapy Preop PCI + OPCAB Pre. PCI#1PCI #0-PreopPreop #1OpPostop #1- ASA 100mg CPD 600mg ASA 100mg CPD 75 mg Heparinization Intraop Heparin ASA 100mg CPD 75 mg OPCAB + Postop PCI PreopPreop #1OpPostop #1 (PCI)Maintain ASA 300mgHeparinization Intraop heparin ASA 100mg CPD 600mg ASA 100mg CPD 75 mg

12. SNUH Thoracic and Cardiovascular Surgery Results

13. SNUH Thoracic and Cardiovascular Surgery Postop Results Mortality0% (0/25) Complications related to surgery Transient Af5 Periop MI1 Transient ARF1 Complications related to PCI Periprocedural MI1

14. SNUH Thoracic and Cardiovascular Surgery Early Postop CAG Postop 1.8  1.6 (d) Graft patency: 100%(57/57) stenosis (>60%): none PCIrestenosis : 1 / 9 preop PCI : reballoon done

15. SNUH Thoracic and Cardiovascular Surgery Midterm Results F/U : 25.4  25.5 Mo Late death: 1 (d/t CHF) Follow up CAG 16/17 pt (F/U > 6 Mo) 9.6  3.0 Mo after hybrid CABG OPCAB patency100% (35/35) String sign of arterial graft (n = 1) Stent restenosis n = 2

16. SNUH Thoracic and Cardiovascular Surgery PCI Restenosis PCI#Restenosis Balloon only20 Bare metal stent122 (16.7%) DES50 Total192 (10.5%)

17. SNUH Thoracic and Cardiovascular Surgery Conclusions Hybrid OPCAB Combined procedures taking merits of CABG and PCI Effective method to obtain complete myocardial revascularization and excellent mid-term patency