• Journal of Chest Surgery
• /
• v.30 no.12
• /
• pp.1190-1196
• /
• 1997

Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100% , although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age($\geq$60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(< 1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05) . This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.

• Journal of Chest Surgery
• /
• v.38 no.7 s.252
• /
• pp.476-482
• /
• 2005

Recently, coronary artery obstructive disease and coronary artery bypass graft surgery have increased, and the operative result has been improved. We reviewed 154 cases of coronary artery bypass graft surgery from Jan. 1985 to Jun. 2004. Material and Method: We reviewed 148 patients, 154 cases of coronary artery bypass surgery from Jan. 1985 to Jun. 2004. This investigation is designed to illustrate the preoperative diagnosis, severity of disease, operative method, the kind of used bypass graft used, number of distal anasomosis, associated surgery, and postoperative morbidity and mortality. Result: There were 84 males, 64 females and the average age was $58.9\pm8.3$ years old. Preoperative clinical diagnosis were unstable angina in 97 cases $(63.0\%)$, stable angina in 31 cases $(20.1\%)$, acute myocardial infarction in 12 cases $(7.8\%)$ and postinfartion angina in 14 cases $(9.1\%)$. Preoperative angiographic diagnosis were three-vessel disease in 68 $(44.2\%)$, two-vessel disease in 39 $(25.3\%)$, one-vessel disease in 35$(22.7\%)$, and left main disease in 12$(7.8\%)$ cases. There were 78 cases of on-pump coronary artery bypass graft surgery and 76 cases of off-pump coronary artery bypass graft surgery. The total distal anastomoses number was 319, mean number of anastomoses was $2.06\pm0.96$. There were 10 concomitant procedures. Postoperative intra-aortic balloon pump was used in 21$(13.6\%)$ cases, but only 4 cases were used at off-pump coronary artery bypass surgery. Total early mortality was $7.8\%$. The mortality was decreased as $4.5\%$ from Jan. 2001 to Jun. 2004. Post operative complication was perioperative yocardial infarction in 9cases$(5.8\%)$, low cardiac output syndrome in 17 cases$(11\%)$, and arrhythmia in 30 cases$(19.5\%)$ cases. Conclusion: Since 1985, The result of coronary artery bypass graft surgery has been improved because of more refined technique, use of off-pump coronary artery bypass surgery, use of internal thoracic artery and radial artery as bypass graft. We should study the long-term follow up more for better operative results.

• Journal of Chest Surgery
• /
• v.29 no.11
• /
• pp.1218-1222
• /
• 1996

The reported incidence of postcardiotomy cardiogenic shock not responding to conventional therapy is still 0.1 to 0.8%. For this group of patients, more aggressive form of circulatory support must be employed. Centrifugal pumps are a ventricular assist device most commonly used on this purpose, due to low cost and easy availability. Currently, however, clinical experience of centrifugal pumps as a ventricular assist device is rarely reported in Korea. From January 1992 to January 1996, 2986 patients underwent cardiac operations on cardiopulmonary bypass at Seoul National University Hospital. Refractory postcardiotomy cardiac failure requring ventricular support with a Biomedicus centrifugal pump developed in ten of these patients. There were eight men and two women, ranged in age from nine years to 77 years with a mean of 50$\pm$20 years. The primary surgical procedures consisted of isolated coronary revascularization in four patients, combined coronary revascularization and aortic valve replacement in two, aortic dissection repair in two, pulmonary embolectomy in one, and heart transplantation in one. Of the ten patients, five had left ventricular assistance, one had right ventricular assistance, and four had biventricular assistance. Duration of ventricular assistance ranged from 24 to 175 hours, with a mean of 76$\pm$51 hours. Seven patients were weaned from ventricular assistance, and four of them discharged. The causes of death for nonsurvivors were progressive cardiac failure in two patients and multiorgan failure, intractable ventricular fibrillation, irreversible brain injury, and mechanical problem, respectively, in the other four. Survival was not predicted by time on cardiopulmonary bypass, aortic cross-clamp time, or duration of ventricular support. Major complications included bleeding(7), renal failure(6), infection(3) and neurologic complication(2). These results indicate that a centrifugal pump can provide reasonably satisfactory short-term circulatory support.

• Journal of Chest Surgery
• /
• v.30 no.5
• /
• pp.528-532
• /
• 1997

After early surgical repair of ventricular septal rupture complicated by myocardial infarction, newly developed ventricular septal defects were discovered on the 7th and the 40th postoperative day in 2 cases. We reoperated these patients for closure of newly developed ventricular septal defects with Dacron patch successfully on the 77th and the loth day after discovery of those defects. From these results we conclude that early surgical rep ir for ruptured ventricular septum following myocardial infarction is an appropriate approach with low risk and that remnant or recurred ventricular septal defect can be corrected rather safely with proper myocardial preservation and unrestricted application of intraaortic balloon pump or other ventricular assist device.

• Journal of Chest Surgery
• /
• v.36 no.5
• /
• pp.363-366
• /
• 2003

Background: Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

• Journal of Chest Surgery
• /
• v.38 no.7 s.252
• /
• pp.489-495
• /
• 2005

In the surgical treatment of aortic dissection, aortic arch replacement under total circulatory arrest is often performed after careful inspection to determine the severity of disease progression. Under circulatory arrest, antegrade or retrograde cerebral perfusion is required for brain protection. Recently, antegrade cerebral perfusion has been used more, because of the limitation of retrograde cerebral perfusion. This study is to compare these two methods especially in the respect to neurological complications. Material and Method: Forty patients with aortic dissection involving aortic arch from May 2000 to May 2004 were enrolled in this study, and the methods of operation, clinical recovery, and neurological complications were retrospectively reviewed. Result: In the ACP (antegrade cerebral perfusion) group, axillary artery cannulation was performed in 10 out of 15 cases. In the RCP (retrograde cerebral perfusion) group, femoral artery Cannulation was performed in 24 out of 25 cases. The average esophageal and rectal temperature under total circulatory arrest was $17.2^{\circ}C\;and\;22.8^{\circ}C$ in the group A, and $16.0^{\circ}C\;and\;19.7^{\circ}C$ in the group B, respectively. Higher temperature in the ACP group may have brought the shorter operation and cardiopulmonary bypass time. However, the length of period for postoperative clinical recovery and admission duration did not show any statistically significant differences. Eleven out of the total 15 cases in the ACP group and thirteen out of the total 25 cases in the RCP group showed neurological complication but did not show statistically significant difference. In each group, there were 5 cases with permanent neurological complications. All 5 cases in the ACP group showed some improvements that enabled routine exercise. However all 5 cases in RCP group did not show significant improvements. Conclusion: The Antegrade, cerebral perfusion, which maintains orthordromic circulation, brings moderate degree of hypothermia and, therefore, shortens the operation time and cardiopulmonary bypass time. We concluded that Antegrade cerebral perfusion is safe and can be used widely under total circulatory arrest.

• Journal of Chest Surgery
• /
• v.40 no.6 s.275
• /
• pp.448-450
• /
• 2007

The mortality of left ventricular free wall rupture after acute myocardial infarction is high; however, subactue myocardial rupture can be diagnosed by echocardiogram and the use of the intraaortic balloon pump reduces the incidence of re-rupture. Bleeding from subacute myocardial rupture can be managed by employing fibrin glue and several patches. We report here on a case of successfully managed case of subactue left ventricular free wall rupture after acute myocardial infarction with using the sutureless technique and fibrin glue.

• Journal of Chest Surgery
• /
• v.37 no.9
• /
• pp.755-761
• /
• 2004

We evaluated the efficacy of Dor procedure in patients with ischemic left ventricular dysfunction. Material and Method: Between April 1998 and December 2002, 45 patients underwent the Dor procedure con-comitant with coronary artery bypass grafting (CABG). Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic/end-systolic volumes (LVEDV/LVESV) were measured by echocardiography, myocardial SPECT, and cardiac catheterization and angiography performed at the sequence of preoperative, early postoperative, and one year postoperative stage. Result: Cardiopulmonary bypass and aortic clamp times were mean 141$\pm$64, 69$\pm$24 minutes, respectively. Intraaortic balloon pump (IABP) therapy was required in 19 patients (42%; 7 preoperatively, 9 intraoperatively, 3 postoperatively). Operative mortality rate was 2.2% (1/45). Postoperative morbidities were low cardiac output syndrome (12), atrial fibrillation (5), acute renal failure (4), and postoperative bleeding (4). Functional class (NYHA) was improved from classes 2.8 to 1.1 (p < 0,01). When we compared between the preoperative and early postoperative values, LVEF was improved from 32$\pm$9% to 52$\pm$11% (p<0.01). The asynergy portion decreased from 57$\pm$12% to 22$\pm$9%, and LVEDV/LVESV indexes improved from 125$\pm$39 mL/$m^2$, 85$\pm$30 mL/$m^2$ to 66$\pm$23 mL/$m^2$, 32$\pm$16 mL/$m^2$ (p<0.01). Although these changes in volumes were relatively preserved at postoperative one year, the left ventricular volumes showed a tendency to increase. Conclusion: After the Dor procedure for ischemic left ventricular dysfunction, LVEF improvement and left ventricular volume reduction were maintained till postoperative one year. The tendency for left ventricular volume to increase at postoperative one year suggested the requirement of strict medical management.

• Journal of Chest Surgery
• /
• v.35 no.7
• /
• pp.542-547
• /
• 2002

Background: Postpneumonectomy empyema(PPE) is an infrequent but potentially life-threatening complication. To date, various surgical efforts have been made to manage this complication. We reviewed our 20-year surgical experience of PPE and long-term follow-up data. Material and Method: Total of 37 patients who were treated for PPE between fan, 1980 and Jun, 2000 were included. Various clinical factors such as micro-organism, operative method and timing, presence of bronchopleural fistula(BPF), underlying disease and fate of empyema cavity were retrospectively reviewed and analyzed. Result: Majority of patients(34) underwent Eloesser operation for effective drainage. There was only one operative mortality. The causative organisms were Staphylococcus species and Pseudomonas species in 46% BPF was found in 20 cases, among which spontaneous closures took place in 4 cases. The chest wall was closed in 40%(8/20) of patients with BPF, compared to 59%(10/17) without BPF. The closure rate was statistically better in patients without BPF(p=0.006). Even though the patients with benign disease showed higher closure rate(50%) than those with lung cancer (31%), the difference was not significant(p=0.25). Conclusion: Eloesser procedure was an effective method for initial drainage of PPE cavity with low operative mortality. Given the findings of low spontaneous closure rate of BPF, aggressive approach to close the BPF is mandatory to achieve the final goal of chest wall closure. It was found that majority of patients still left their chest cavity opened, even after controlling the active inflammation of the empyema cavity. More aggnessive approach for chest wall closure is recommended in all patents with benign disease and in selective patients with lung cancer if there is no evidence of recurrence at several years after the initial operation.

• Journal of Chest Surgery
• /
• v.34 no.12
• /
• pp.901-908
• /
• 2001

Background : Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. Material and Methold : Clinical data of 31(4.1％) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98％) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84％) and first degree of Rentrop classification(16 cases, 52％) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9${\pm}$0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7${\pm}$3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9 ${\pm}$ 1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysrmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5% . Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5${\pm}$11.6%, p 0.001) as compared with preoperative left ventricular ejection fraction(25.3${\pm}$2.3%). The follow up period of out patient was 25. 3 months. Conclusion: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.