• Journal of Chest Surgery
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• v.37 no.6
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• pp.492-498
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• 2004

Background: In this study, we investigated the risk factors for the development or progression of aortic regurgitation(AR) in patients with type I ventricular septal defect (VSD) to determine the optimal surgical timing and strategy. Material and Method: Three-hundred and ten patients with type I VSD with or without AR were included. The mean of age was 73.7$\pm$114.7 (1-737) months. One hundred and eighty six patients (60%) had no AR, 83 (27%) had mild AR, 25 (8%) had moderate AR and 16 (5%) had severe AR. Aortic valve was repaired in 5 patients and replaced in 11 patients with closure of VSD in the first operation. Four patients required redo aortic valve repair and 11 patients required redo aortic valve replacement. Age at operation, association with aortic valve prolapse, Qp/Qs, systolic pulmonary arterial pressure, VSD size and systolic pulmonary artery to aortic pressure ratio(s[PAP/AP］) were included as risk factors analysis for the development of AR. The long-term result of aortic valve repair and aortic valve replacement were compared. Result: Older age at operation, association with aortic valve prolapse, high Qp/Qs, and s[PAP/AP] were identified as risk factors for the development of AR (p<0.05, Table 2). The older the patient at the time of operation, the higher the severity of preoperative AR and the incidence of postoperative AR (p<0.05, Table 1, Fig. 1). For the older patients at operation, aortic valve repair had higher occurrence of AR compared to those who had aortic valve replacement (p<0.05, Fig. 2). Conclusion: From the result of this study, we can concluded that early primary repair is recommended to decrease the progression of AR. Aortic valve repair is not always a satisfactory option to correct the aortic valve pathology, which may suggest that aortic valve replacement should be considered when indicated.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.123-131
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• 2005

Background: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing. Elderly patients are at increased risk for a variety of perioperative complications and mortality. We identified determinants of operative complications and mortality in elderly patients undergoing CABG. Material and Method: Between January 1995 and July 2003, 91 patients older than 75 years underwent isolated CABG at Asan Medical Center. There were 67 men and 24 women with mean age of $77.0\pm2.4$ years. Thirty clinical or hemodynamic variables hypothesized as predictors of operative mortality were evaluated. Result: CABG was performed under emergency conditions in 5 patients. The internal thoracic artery was used in 85 patients and 10 patients received both internal thoracic arteries. The mean number of distal anastomosis was 3.7 per patient. Operative mortality was $3.3\%$. Twenty-two patients had at least one major postoperative complication. Low cardiac output syndrome was the most common complication, followed by reoperation for bleeding, pulmonary dysfunction, perioperative myocardial infarction, stroke, acute renal failure, ventricular arrhythmia, upper gastrointestinal bleeding, infection, and delayed sternal closure. None were the predictors of mortality. Renal failure, peripheral vascular disease, emergency operation, recent myocardial infarction, congestive heart failure, New York Heart Association (HYHA) class III or IV, Canadian Cardiovascular Society (CCS) angina scale III or IV, and low left ventricle ejection fraction below $40\%$ were univariate predictors of overall complications. Actuarial probability of survival was $94.9\%,\;89.8\%,\;and\;83.5\%$ at postoperative 1, 3 and 5 years respectively. During the follow-up period $93.3\%$ of patients were in NYHA class I, or II and $91.1\%$ were free from angina. Conclusion: Although operative complication is increased, CABG can be performed with an acceptable operative mortality and excellent late results in patients older than 75 years.

• Journal of Gastric Cancer
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• v.5 no.4 s.20
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• pp.266-272
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• 2005

Purpose: Recurrence occurs in various forms and in different organs after a curative resection of gastric cancer. The most common location for hematogenous recurrence is the liver. The aim of this study was to evaluate the clinicopathological risk factors associated with hepatic recurrence after surgical treatment of gastric cancer. Materials and Methods: We reviewed the medical records of 838 patients who had taken radical surgery for primary gastric cancers at Chonbuk National University Hospital between January 1992 and December 1999. According to the medical records, we retrospectively investigated the association between the clinicopathologic variables and hepatic recurence. Results: Recurrence of gastric cancer was documented in 201 out of the 838 patients (23.98%). Hepatic recurrences were found in 59 out of 201 patients (29.35%). Multiple logistic regression analysis identified the following as independent risk factors of hepatic recurrence: Lauren's Intestinal type (OR, 6.60; 95% Cl, 1.53 to 28.9; p=0.011) and proximal resection of margin below 6 cm (OR, 3.76; 95% Cl, 1.03 to 13.67; P=0.045). Conclusion: Various studies on clinocopathologic risk factors of liver recurrence with molecular biologic research should make possible the prediction of recurrence and help high-risk patients to find appropriate management.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.387-391
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• 2002

Background: Postoperative morbidity and mortality in destroyed lung are relatively high. We tried to identify the prognostic factors affecting postoperative morbidity and mortality in destroyed lung through a retrospective study. Material and method: The retrospective study was undertaken in 112 patients who had undergone pneumonectomy or pleuropneumonectomy for destroyed lung at Severance Hospital from 1970 to 2000. We analyzed the correlation between postoperative morbidity and mortality and etiology, duration of disease, preoperative FEV1, presence or absence of peroperative empyema, operation timing, the side of operation, duration of operation, and operation type. Result: There were 55 men and 57 women, aged 20 to 81 years (mean 44 years). Etiologic diseases were tuberculosis in 86 patients(76.8%) including tuberculos empyema in 20 and tuberculous bronchiectasis in 4, pyogenic empyema in 12(10,7%), bronchiectasis in 12(10.7%), and lung abscess in 2(1.8%). Postoperative morbidity were 25%(n=28) and postoperative mortality was 6%(n=7). The presence of preoperative empyema(p=0.016), pleuropneumonectomy(p=0.037) and preoperative FEV1 of less than 1.75 L(P=0.048) significantly increased the postoperative morbidity, If operation time was less than 300min, postoperative morbidity(p=0.002) and mortality(p=0.03) were significantly low. Conclusion: Postoperative morbidity and mortality in destroyed lung were acceptable. Postoperative morbidity and mortality were significantly low when operation time was less than 300 min. Preoperative existence of empyema, pleuropneumonectomy and preoperative FEV1 of less than 1.75 L significantly increased postoperative morbidity.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.524-529
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• 2004

Background: Since the Nuss procedure for the correction of pectus excavatum is in its early stage, there have been problems that need to be solved. We examined complications in a single-institute experience of the Nuss technique in order to develop possible solutions to prevent them. Material and Method: 335 consecutive patients, who underwent the modified Nuss procedure between August 1999 and October 2002, were studied retrospectively. Median age was 8 years (range 1 to 46). 264 patients (78.8%) were in pediatric group (age$\leq$15) and 71 patients (21.2%) were in adult group (age> 15). 193 patients (57.6%) had symmetric and 142 patients (42.4%) had asymmetric pectus configurations. Risk factors predicting postoperative complications were analyzed using multi-variate logistic regression. Result: Postoperative complication rates were 18.9% (61/335) in total patients. Frequent complications were pneumothorax 24 (7.5%), bar displacement 11 (3.4%), and wound seroma 10 (3.1%) in order. Early complications (within a month, 49 cases, 15.2%) were pneumothorax (n=23, 6.9%), wound seroma (n=12, 3.6%), and bar displacement (n=8, 2.4%). Late complications (after a month, 12 cases, 3.7%) were pericarditis and pericardial effusion (n=5, 1.5%), bar displacement (n=4, 1.2%), and hemothorax (n=3, 0.9%). Techniques were modified to prevent complications especially in bar shaping and fixation, which led to decrease complication rate in later experience (Operation Date 1: 15/51 (29.4%) vs Operation Date 2: 34/284 (12.0%), p=0.004). Grand Canyon type (eccentric long canal type) showed higher complication rate than other types (GC type: 12/30(40%) vs Others: 37/305 (12.1%), p<0.001). Major risk factors are severity of pectus (OR=2.88, p=0.038), Grand Canyon type (OR=2.82, p=0.044), and Op. Date 1 (OR=4.05, p=0.001). Conclusion: Major complications were related to severe eccentric type of pectus configuration (Grand Canyon type) and lack of surgeon's experience (Op. Date 1). Com-plication rate was reduced with accumulation of experience and advancement of surgical techniques. The Nuss procedure can be performed at a low risk of complications with our current technique.

• Journal of Chest Surgery
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• v.30 no.1
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• pp.67-71
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• 1997

Though thymoma is considered benign In a histopathologic specimen, its unusual behavior makes it important for surgeons to manage this neoplasm as cancerous lesion. Hence we clinically analysed the surgical cases of thymoma in our hospital, And we suggest the risk factors for its prognosis From January 1987 to December 1994, we experienced 41 surgical cases of thymoma, excluding thymic carcinoma and cysts. There were 21 male and 20 female; age ranged from 16 to 64 years. Among them, myasthenia gratis was present in 22 patients(53.7%). Surgical treatment consisted of complete resection in 31 patients, partial resection In 7 patients, and biopsy only in 3 patients. According to Masaoka's classification, there were 27 patients in milage 1, 4 patients in stage II, and 10 patients In stage III. Histopathology was of epithelial type in 14 patients, Iymphocytic type in 11, and mixed type in 19. Eleven patients had adjuvant radiotherapy, chemotherapy, or b th and there was no surgical mortality. Postoperative follow-up ranged from 1 to 88 months (mean )6 months) and three patients died and 5 patients suffered recurrences during the follow-up period. Postoperative risk factors were advanced Masaoka stage, invasiveness, and surgical method.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.462-469
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• 2006

Background: Pneumonectomy for inflammatory lung disease has been of major concern because of its associated morbidity and mortality, particularly with respect to pleuropneumonectomy. The purpose of this study is to evaluate the surgical outcomes, and identify the risk factors contributing to postoperative complications in patients undergoing pleuropneumonectomy. Material and Method: Ninety-eight patients underwent pneumonectomy for benign inflammatory lung disease were retrospectively analyzed. Pleuropneumonectomy (Group A) was done in 48 patients and standard pneumonectomy (Group B) was done in 50 patients. Clinical characteristics, postoperative complications were examined and compared between 2 groups. In pleuropneumonectomy group, postoperative risk factors affecting morbidity were evaluated. Result: There was one in-hospital death. Twenty-three major postoperative complications occurred in 21 patients (21.4%). The common complications were empyema and bronchopieural fistula (BPF) in 8 (8.4%), re-exploration due to bleeding in 8. At least one postoperative complication occurred in 14 of 48 patients from Group A (29.2%) and in 7 of 50 patients from Group B (14%). In Group A, empyema and BPF encountered in 6 and re-exploration for bleeding in 6 were the most common complication. In univariate analysis, right pneumonectomy, completion pneumonectomy, large amount of blood loss (>1,000 mL), and intrapleural spillage were risk factors contributing to postoperative complications in Group A. In multivariate analysis, intrapleural contamination during operation was a risk factor of postoperative complication. Conclusion: The morbidity and mortality rates of pneumonectomy for chronic inflammatory lung disease are acceptably. However, we confirm that pleuropneumonectomy is a real technical challenge and a high-risk procedure and technically demanding. Meticulous surgical techniques are very important in preventing serious and potentially lethal complications.

• Journal of Chest Surgery
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• v.37 no.6
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• pp.539-542
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• 2004

Not only morphology of pulmonary artery or pulmonary artery resistance, but major aortopulmonary collateral arteries are risk factors of Fontan procedure. We report a successful Fontan procedure after rehabilitation of pulmonary arteries by unifocalization and systemic to pulmonary shunt in a high risk Fontan candidate with functional single ventricle combined with hypoplastic pulmonary arteries and major aortopulmonary collateral arteries supplying most of the bilateral lung field.

• Journal of Chest Surgery
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• v.36 no.9
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• pp.678-682
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• 2003

Video-assisted thoracoscopic surgery is good indication of secondary spontaneous pneumothorax. This method usually required general anesthesia and single-lung ventilation with collapse of other lung. But, risks of general anesthesia and single-lung ventilation must be considered in high-risk patients. Material and Method: Between September f999 and August 2001, 15 high-risk patients were treated by video-assisted thoracoscopic surgery under epidural anesthesia. Result: Video assisted thoracoscopic surgery was successfully performed in 15 patients. Duration of postoperative air-leakage was 4.3days, Significance of complication was none, No recurrence of pneumothorax was encountered. Conclusion: Video-assisted thoracoscopic surgery can be performed safely under epidural anesthesia for treatment of secondary spontaneous pneumothorax in high-risk patients.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.4
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• pp.1728-1736
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• 2013

The purpose of this study is to identify prognostic predictors of postoperative acute renal failure(ARF) for the patient undergoing cardiac surgery. Retrospectively review the electronic hospital database at a A hospital from Jan 2008 to Dec. 2011. 483 patients were included in this study. They were divided into a occurrence of ARF group(n=59) and a non occurrence of ARF group(n=424). ARF occurred in 59 cases (12.2%). Multi-variable logistic regression analysis identified that preoperative risk factors include creatinine(OR 3.92, p=<.001), advanced age(OR 2.142, p=.015), female(OR 2.165, p=.015), hypertension(OR 2.513, p=.005), NYHA(New York Heart Association) class II(OR 3.081, p=.003), and III(OR 6.759, p=.004), and intraoperative risk factor includes blood transfusion(OR 3.753, p=<.001), and postoperative factors include bilirubin(OR 4.541, p=.028), creatine(OR 8.554, p=.003), and cardiac output(OR 0.214, p=.033) as a prognostic predictors. The development of postoperative ARF could be a reason for increase in rate of complication and mortality after cardiac surgery. therefore the prevention of ARF is of paramount importance and treatment strategies are urgently needed.