• Journal of Chest Surgery
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• v.29 no.7
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• pp.753-758
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• 1996

From January 1987 to December 1994, twenty five patients with cancer of the esophagus were t eated surgically at the department of Thoracic and Cardiovascular Surgery, Tae Jeon Eul ll General Hospital. Among them, male was 24 cases, female was 1 case, with age ranged from 40 to 74 years, mean age was 60.4 years. The most common symptoms were dysphagia 92.0%, general weakness 28.0%, subsiernal pain 16.0%, weight loss 16.0 oyo , The tumor locations were the upper third in 2, middle third in 17, lower third in 6. Surgical treatment was done with transthoracic esophagectomy and esophagogastrostomy 1~4 cases, transthoracic esophagectomy and esophagocologastrostomy 5 cases, Transthoracic esophagectomy and jeT junal interposition 2 cases, palliative feeding gastrostomy 4 cases. The postoperative complications included anstomotic leakage in 3 cases, empyema in 3 cases, wound in- fection in 2 cases, atelectasis in 2 cases, pleural effusion in 1 case, hoarseness in 1 case, pneumothorax in 1 case, necrosis of jejunal loop in 1 case, aspiration pneumonia in 1 case. The operative mortal ty were 3 cases (12.0 %) and causes of death were aspiration pneumonia 1 case. sepsis and respiratory failure in each 1 . The mean survival period was 9.75 months. Recurrence of cancer revealed in 3 cases.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.146-153
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• 2004

As the experience of coronary artery bypass grafting (CABG) has been accumulated, the number of reoperation after CABG is increasing. We analyzed our clinical experience of redo-CABG. Material and Method: Fourteen patients who underwent redo-CABG between Jan. 1994 and Dec. 2002 were included in this study. The mean period from the first operation to reoperation was 66$\pm$56 (3∼157) months, and the average ages were 62.8$\pm$8.7 (51∼78) years. The survivors were followed up 39$\pm$29 (4∼101) months postoperatively. Indications of reoperation were stenosis or occlusion of previous grafts in 11 patients, progression of native coronary artery disease in one patient, and both etiologies in two patients. Result: There were two in-hospital mortalities (14.3%) resulting from low cardiac output syndrome, Postoperative morbidities were perioperative myocardiac infarction in 2 patients (14.3%), mediastinitis in one patient (7.2%), duodenal perforation in one patient, ischemic necrosis of the lower extremity in one patient, gastric perforation after mesenteric infarct in one patient, delayed brain infarct in one patient, and intraoperative splenic rupture in one patient. There was one late mortality at six months postoperatively during the follow up. There was no angina recurrence during the follow up. Conclusion: Although redo CABG demonstrated relatively high operative mortalities and morbidities, postoperative status and clinical outcome of the survivors were favorable.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.889-896
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• 1996

Aggressive revascularization of the ischemic lower extremities in atherosclerotic occlusive diseases or acute embolic arterial occusion due to cardiac valvular disease by thromboembolectomy or an arterial by- pass operation has been advocated by some authors. To evaluate clinical pattern and operative outcome of the ischemic lower extremity, surgical experience in 101 patients who were admitted to Dong-A Univer- sity Hospital between March 1990 and August 1995 was analyzed. The patients were 92 males and 9 females ranging fro 25 to 87 years of age. The underlying causes of arterial occlusive disease were atherosclerotic obliterances in 54 case, Buerger's disease in 20 cases, thromboembolism in 24 cases, vascular trauma in 3 cases and pseudoaneurysm in 3 cases. - The major arterial occlusive sites of atherosclerotic obliterance were femoral artery in 30 cases, iliac artery in 23 cases, popliteal artery in 10 cases, distal aorta in 6 cases and the major arterial occlusive sites of Buerger's disease were posterior tibial artery in 14 cases, anterior tibial artery in 8 cases, popliteal artery in 5 cases. The operative procedures of arterial occlusive disease were bypass graft operation in 61 cases, thromboembolectomy in 21 cases, sympathectomy in 20 cases. Arterial bypass operations with autogenous or artificial vascular prosthesis were done in 61 cases which Included femoro-popliteal bypass in 21 cases, femoro-femoral bypass in 15 cases, axillo-bifemoral bypass in 7 cases, aorto-bifemoral with inverted Y-gr ft In 3 cases, femoro-profundafemoral bypass in 3 cases, popliteo-tibial bypass in 2 cases, aorto-iliad bypass in 1 case Over all postoperative patency rates were 83.6 oyo at 1 year, 75.5% at 3 years and limb salvage rate was 86.8 oyo . Six patients died in the hospital following vascular surgery for ischemic lower extremities, although the causes of death were not directly related to the vascular reconstructive operative proccedures. The leading causes of death were in the order of multiple organ failure, acute renal failure, and sepsis.

• Journal of Chest Surgery
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• v.30 no.1
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• pp.27-33
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• 1997

Retrograde myocardial protection is widely accepted in CABG operation because of the limitations of the antegrade method in the coronary arterial stenosis lesions. We analyzed 76 c ses of retrograde myocardial protection among 96 cases of CABG operation performed between April 1994 and August 1995, There were 48 males and 25 females, and the mean age was 58.2 $\pm$ 8.3 years. 53 patients (70%) were operated for unstable angina, 14 (18%) for stable angina, 6 (8%) for post-infarct angina, 1 (1%) for acute myocardial infarction, and 2()%) for failed PTCA. Preoperative coronary angiography revealed 3-vessel disease in 42 cases, 2-vessel disease in 11, 1-vessel disease in 10, and left main disease in 13 cases. We used SVG(63 cases), LIMA(69 cases), RIMA(11 cases), radial artery(6 cases), and gastroepiploic artery(1 case) for the grafts. Mean anastomosis was 3.2 $\pm$ 1.1. We protected the myocardium with antegrade induction and retrograde maintenance in all the cases except a case of retrograde induction and maintenance. During the aortic cross-clamping, blood cardioplegia was administered intermittently in 19 cases, and continuously in 57 In 39 cases, we used retrograde ardioplegia and antegrade perfusion of RCA graft simultaneously. We had no operative motality. Perioperative complications were arrhythmia in 15 cases, perioperatve myocardial infarction in 10, low cardiac output syndrome In 8, transient neurologic problem in 7, transient psychiatric problem in 6, ARF in 3, bleeding in 2, pneumonia in 2, wound infection in 1, and duodenal ulcer perforation in 1 . In this report, we experienced 76 cases of CABG operation with retrograde myocardial protection under the acceptable operative risk without operative mortality.

• Journal of Chest Surgery
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• v.38 no.7 s.252
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• pp.489-495
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• 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
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• v.31 no.6
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• pp.560-566
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• 1998

Background: Bovine pericardial bioprosthesis treated with glutaraldehyde (GA) is one of the most popular prosthetic materials, but late calcific degeneration after implantation is a problem that remains unsolved. For the purpose of mitigating the calcific degeneration, we added MgCl2 into the 0.625% GA solution to compete with calcium for binding to the free aldehyde from GA and pretreated with the surfactants like sodium dodecyl sulfate (SDS) and Triton X-100 before GA fixation for preventing the phospholipid infiltration into the pericardial tissue, the first step of the calcific degeneration. Material and Method: 40 square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4g/L MgCl2 6H2O as a control group (group 1). 40 pieces pretreated with 1% SDS were also fixed in the same GA solution (group 2) and other 40 pieces pretreated with 1% Triton X-100 were prepared with the same method (group 3). After 1 month of fixation these were implanted into the belly of 40 Sprague-Dawley subdermally and extracted 1 month, 2 months, 3 months and 6 months after implantation. With atomic absorption spectrophotometry we measured the deposited calcium amount. Result: 1 month after implantation we could not find any differences between the three groups, but by the 2nd month calcium deposition was 0.921$\pm$0.121 mg/g in group 1, 0.481$\pm$0.037 mg/g in group 2 and 1.369$\pm$0.200 mg/g in group 3. By the 3rd month it was 0.786$\pm$0.080 mg/g in group 1, 0.584$\pm$0.054 mg/g in group 2 and 1.139$\pm$0.188 mg/g in group 3, and on the 6th month 1.623$\pm$0.601 mg/g in group 1,0.501$\pm$0.043 mg/g in group 2 and 1.625$\pm$0.382 mg/g in group 3, with statistical significance in group 2(p<0.05). Conclusion: Pretreatment with SDS showed meaningful calcium mitigation effects on subcutaneously implanted bovine pericardium in the rat models but the neutral type surfactant, Triton X-100, had no positive mitigation effect in this experiment.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.919-923
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• 1998

Background: Calcific degeneration is unavoidable in either homo- or heterografts implanted in the human body. We have developed a calcification-resistant cardiovascular tissue patch using a novel technique of anticalcification. Materials and methods: Fresh bovine pericardium was harvested at the slaughter house and transfered to the laboratory in Hank's solution. After trimming and fixing the pericardium, it was embedded in 4$^{\circ}C$ 0.65% glutaraldehyde for a week and then washed by phosphate-buffered saline(PBS) of pH 7.4. This prepared pericardium was then stored in 2.5% sulphonated polyethyleneoxide(PEO-SO3) solution for 2 days at room temperature and reversed by 4$^{\circ}C$ NaBH4 solution for 16 hours. To evaluate the calcification-resistance of surface modified bovine pericardium with PEO-SO3, either glutaraldehyde- treated(GA group, n=4) or PEO-SO3-treated pericardial patch(PEO-SO3 group, n=4) was implanted into adult mongrel dog to reconstruct the main pulmonary artery and the descending aorta using a partial clamp technique. After 1 month follow-up, the implanted patches were retrieved to evaluate the pathologic findings and the content of calcium and phosphorous. Results: The PEO-SO3 group showed substantially less retraction and significantly less calcium deposition than the GA group in both aortic(7.10$\pm$1.05 vs. 13.81$\pm$2.33 mg/g of dried tissue) and pulmonary positions(1.55$\pm$0.29 vs. 6.72$\pm$0.70 mg/g)(p<0.01). Phosphorous contents were also less in the PEO-SO3 group than the GA group significantly, 8.11$\pm$1.07 mg/g vs. 19.33$\pm$4.31 mg/g in the aortic and 2.58$\pm$0.40 vs. 12.60$\pm$3.40 mg/g in thepulmonary position(p<0.01). Conclusions: These findings suggest that PEO-SO3 modified bovine pericardium is highly calcification-resistant but further study is needed to evaluate the long-term biological safety and compatibility of the prosthesis.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.34-40
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• 2008

Background: Off-pump coronary artery bypass grafting (OPCAB) shows fewer side effects than cardiopulmonary by. pass, and other benefits include myocardial protection, pulmonary and renal protection, coagulation, inflammation, and cognitive function. We analyzed the clinical results of our cases of OPCAB. Material and Method: From May 1999 to August 2007, OPCAB was performed in 100 patients out of a total of 310 coronary artery bypass surgeries. There were 63 males and 37 females, from 29 to 82 years old, with a mean age of $62{\pm}10$ years. The preoperative diagnoses were unstable angina in 77 cases, stable angina in 16, and acute myocardial infarction in 7. The associated diseases were hypertension in 48 cases, diabetes in 42, chronic renal failure in 10, carotid artery disease in 6, and chronic obstructive pulmonary disease in 5. The preoperative cardiac ejection fraction ranged from 26% to 74% (mean $56.7{\pm}11.6%$). Preoperative angiograms showed three-vessel disease in 47 cases, two-vessel disease in 25, one-vessel disease in 24, and left main disease in 23. The internal thoracic artery was harvested by the pedicled technique through a median sternotomy in 97 cases. The radial artery and greater saphenous vein were harvested in 70 and 45 cases, respectively (endoscopic harvest in 53 and 41 cases, respectively). Result: The mean number of grafts was $2.7{\pm}1.2$ per patient, with grafts sourced from the unilateral internal thoracic artery in 95 (95%) cases, the radial artery in 62, the greater saphenous vein in 39, and the bilateral internal thoracic artery in 2. Sequential anastomoses were performed in 46 cases. The anastomosed vessels were the left anterior descending artery in 97 cases, the obtuse marginal branch in 63, the diagonal branch in 53, the right coronary artery in 30, the intermediate branch in 11, the posterior descending artery in 9 and the posterior lateral branch in 3. The conversion to cardiopulmonary bypass occurred in 4 cases. Graft patency was checked before discharge by coronary angiography or multi-slice coronary CT angiography in 72 cases, with a patency rate of 92.9% (184/198). There was one case of mortality due to sepsis. Postoperative arrhythmias or myocardial in-farctions were not observed. Postoperative complications were a cerebral stroke in 1 case and wound infection in 1. The mean time of respirator care was $20{\pm}35$ hours and the mean duration of stay in the intensive care unit was $68{\pm}47$ hours. The mean amounts of blood transfusion were $4.0{\pm}2.6$ packs/patient. Conclusion: We found good clinical outcomes after OPCAB, and suggest that OPCAB could be used to expand the use of coronary artery bypass grafting.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.324-330
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• 2009

Background: The long term patency of the free saphenous vein graft, which is the most commonly used conduit, anastomosed to the ascending aorta has been reported to be lower than that of arterial grafts. We evaluated early clinical outcome and the angiographic patency of the saphenous vein composite graft based on the left internal thoracic artery, and compared these results with those of using arterial composite grafts. Material and Method: From September 2006 to October 2008, 419 patients underwent off-pump coronary revascularization. Among those, 295 patients (70.4%) were revascularized using composite grafts (group I: saphenous vein composite graft, n=71, group II: arterial composite graft, n=224). The clinical results were compared between the 2 groups. Early postoperative coronary angiograms were performed in all the patients. ($1.6{\pm}1.6$ days) Result: The number of the distal anastomosis per patient was $3.5{\pm}1.0$ and $3.1{\pm}0.8$ in group I and II, respectively (p=.002). The operative mortality (n=2, 0.7%) and postoperative complications such as atrial fibrillation (n=73, 24.7%), perioperative myocardial infarct (n=6, 2.0%), acute renal failure (n=6, 2.0%), reoperation for bleeding (n=5, 1.7%), cerebrovascular accident (n=3, 1.0%), and mediastinitis (n=1, 0.3%) were not related with the use of saphenous vein graft. Early coronary angiograms revealed a 96.9% (126/130) for the saphenous vein grafts and a 98.8% (479/485) for the composite graft in group II (p=.231). Conclusion: Our data suggested that a saphenous vein graft might be used as analtemative conduit to the arterial graft for constructing a composite graft, as based on our early clinical and angiographic results. Further study is required to establish the long-term efficacy of using a saphenous vein as a composite graft.

• Journal of Chest Surgery
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• v.30 no.5
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• pp.479-485
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• 1997

We investigated changes of the size of neoaortic annulus, root, and aortic anastomosis after arterial switch operation for complete transposition of the great arteries performed in infancy. A total of 23 patients were included in this study. Age ranged from 6 to 153 days. Body weight averaged 3.9$\pm$0.8kg and 17 patients were male. The preoperative angiocardiographic dimensions of the pulmonary annulus, the pulmonary root, and the sinotubular junction, standardized to the diameter of descending aorta at the level of diaphragm, were compared to the size of postoperative measurements of the neoaortic annulus, the neoaortic root, and the aortic an stomosis at a mean interval of 17.2$\pm$ 9.4 months. Mean dimensions of the neoaortic annulus and the neoaortic root were significantly increased postoperatively(n=23, annulus; p<0.01, root; p<0.01), however, those of the aortic anastomosis did not reveal significant change(n=23, p=0.06). There were no significant differences in changes of diameters of the neoaortic annulus, the root, and the aortic anastomosis between patients with(n=8) and without(n=15) postoperative neoaortic regurgitation(annulus; p=0.32, root; p=0.29, anastomosis; p=0.86). Postoperative dimensions of the neoaortic root and annulus between patients with ventricular septal defect(n: 10) and without ventricular septal defect(ni 13) were not significantly changed compared to the preoperative measurements(annulus; p=0.09, root; p=0.07) but mean diameters of the aortic anastomosis decreased significantly after operation in patients with ventricular septal defect(p=0.04). This study revealed that the site of the aortic an stomosis grows in proportion to patient's somatic growth after arterial switch operation. Although we could not demonstrate the relation between the aortic root dilatation and the postoperative neoaortic regurgitation in this study, a continuous close follow-up might be necessary to detect a possible progression of the aortic root dilatation and the resulting significant aortic valve regurgitation.