• Journal of Chest Surgery
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• v.32 no.12
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• pp.1123-1126
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• 1999

Coronary artery bypass grafting (CABG) technique has been much developed but CABG under cardiopulmonary bypass has the unavoidable deficits such as generalized inflammatory reaction from cardiopulmonary bypass and myocardial ischemia from aortic-cross clamp. There has been remarkable advancement of CABG without cadiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass in two patients with multivessel coronary disease who were failed to intervene with percutaneous transluminal coronary angioplasty. We herein report the two cases.

• Journal of Biomedical Engineering Research
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• v.20 no.5
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• pp.609-616
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• 1999

심폐바이패스시 발생할 수 있는 튜브 마모 및 파쇄는 롤러펌프의 반복되는 압박에 의해 롤러펌프에 장착된 튜브 내벽에 균열이 생기고 이로 인해 미세한 비생물적 조각들이 혈액중으로 떨어져 나가는 현상을 말하는데, 임상적으로 치명적인 색전증을 초래할 수 있다. 그러나 아직 롤러펌프 튜브로 사용되는 PVC 및 실리콘 튜브 중 어느 쪽이 마모 및 파쇄 관점에서 더 우수한지는 체계적으로 밝혀지지 않고 있다. 이에 본 연구는 두 종류의 튜브를각각 일정 기간 롤러펌프에 장착하여 작동시킨 뒤 튜브내외면을 육안 및 주사형 전자현미경으로 관찰하였다. 즉 PVC 및 실리콘 튜브 (내경 1/2 인치의)들을 미리 정해진 폐쇄도 조절에 의해 폐쇄 회로 심폐비이패스 롤러펌프 헤드에 장착시키고 4.500ml/min에서 각각 4차례씩 1,2,4,6 시간 작동시켰다. 파쇄에 의한 색전 관찰 실험에서는 회로 중간에 동맥여과기를 설치하고 각각 6,9시간 씩 롤러펌프를 작동시켰다. 실험 후 튜브 및 여과기들을 수거한 후 육안 및 주사형 전자현미경 분석을 시행하였다. 실험후 튜브 및 여과기들을 수거한 후 육안 및 주사형 전자현미경을 분석을 시행하였다. 튜브 외부의 육안 관찰 결과 일반적으로 실라스틱 튜브에서의 외부 마모가 PVC 튜브에 비해 현저하였다. 주사형 전자현미경 관찰에서 PVC 튜브에서의 홈은 좁으면서 경계선이 뚜렷한 특징을 보였고 3시간 이상 롤러와 접촉한 튜브들에게서는 깊은 균열이 간헐적으로 관찰되었다. 반면, 실라스틱에서의 홈은 좁으면서도 경계선이 뚜렷한 특징을 보였고 3시간 이상 롤러와 접촉한 튜브들에게서는 깊은 균열이 간헐적으로 관찰되었다.반면 실라스틱에서의 튜브들에서는 홈이 상대적으로 넓고 경계가 덜 명확했으며, 특징적으로 V 자 모양의 융기부들이 간헐적으로 관찰되었다. 실라스틱 및 PVC 튜브 모두에서 50u 전후의 Craters 가 간헐적으로 관찰되었다. 여과기의 여과망에 대한 주사형 전자현미경 분석 결과 실라스틱과 PVC 튜브 실험군 모두에서 색전입자로 의심되는조각들이 발견되었으나 두군간 정량적 비교는 어려웠다. 결론적으로 롤러펌프에 의한 튜브 마모 및 파쇄현상은 실리콘 및 PVC 튜브의 재질에 따라 그 양상에는 차이가 있으나 임상적인 측면에서는 어느 쪽도 상대적인 우수성이 입증되지 못하였다.

• 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.34 no.12
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• pp.895-900
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• 2001

Background : This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease( 75％ stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction 35％). Material and Method : One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. Result : There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5$\pm$0.9 vs 3.4$\pm$0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. Conclusion : IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients

• Journal of Chest Surgery
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• v.30 no.5
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• pp.471-478
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• 1997

Introduction: The use of rabbits as a cardiopulmonary bypass(CPB) animal model is extremely dif%cult mainly due to technical problems. On the other hand, deep hypothermic circulatory arrest(CA) is used to facilitate surgical repair in a variety of cardiac diseases. Although steroids are generally known to be effective in the treatment of cerebral edema, the protective effects of steroids on the brain during CA are not conclusively established. Objectives of this study are twofold: the establishment of CPB technique in rabbits and the evaluation of preventive effect of steroid on the development of brain edema during CA. Material '||'&'||' Methods: Fifteen New Zealan white rabbits(average body weight 3.5kg) were divided into three experimental groups; control CA group(n=5), CA with Trendelenberg position group(n=5), and CA with Trendelenberg position + steroid(methylprednisolone 30 mglkg) administration group(n=5). After anesthetic induction and tracheostomy, a median sternotomy was performed. An aortic cannula(3.3mm) and a venous ncannula(14 Fr) were inserted, respectively in the ascending aorta and the right atrium. The CPB circuit consisted of a roller pump and a bubble oxygenator. Priming volume of the circuit was approximately 450m1 with 120" 150ml of blood. CPB was initiated at a flow rate of 80~85ml/kg/min, Ten min after the start of CPB, CA was established with duration of 40min at $20^{\circ}C$ of rectal temperature. After CA, CPB was restarted with 20min period of rewarming. Ten min after weaning, the animal was sacrif;cod. One-to-2g portions of the following tissues were rapidly d:ssected and water contents were examined and compared among gr ups: brain, cervical spinal cord, kidney, duodenum, lung, heart, liver, spleen, pancreas. stomach. Statistical significances were analyzed by Kruskal-Wallis nonparametric test. Results: CPB with CA was successfully performed in all cases. Flow rate of 60-100 mlfkgfmin was able to be maintained throughout CPB. During CPB, no significant metabolic acidosis was detected and aortic pressure ranged between 35-55 mmHg. After weaning from CPB, all hearts resumed normal beating spontaneously. There were no statistically significant differences in the water contents of tissues including brain among the three experimental groups. Conclusion: These results indicate (1) CPB can be reliably administered in rabbits if proper technique is used, (2) the effect of steroid on the protection of brain edema related to Trendelenburg position during CA is not established within the scope of this experiment.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.551-556
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• 2005

Background: Complete arterial off-pump coronary artery bypass grafting (OPCAB) by sequential anastomoses with one or two arterial grafts provides favorable outcomes. However, problems of insufficient graft length, hypopefusion, kinking of graft, and unfavorable course of graft may be encountered. To solve these problems, we have used different technique with multiple arterial Y composite graft to allow end-to-side rather than sequential anastomoses and evaluated the results of this method. Material and Method: Between February 2003 and October 2004, If patients underwent total arterial OPCAB using multiple arterial V composite grafts with left internal mammary artery (LIMA), radial artery (RA), and right internal mammary artery (RIMA). We divided RA into multiple segments by number of distal target site after measuring of individual proper length and constructed arterial composite graft. One of segments was sutured end-to-side to LIMA and other segment was sutured end-to-side to the previously constructed radial graft. Postoperative graft patency was evaluated in 6f patients by multi-slice computed tomegraphy. Result: An average of $2.5\pm0.6$ arteries and $3.7pm0.7$ distal anastomoses per patient were done. There was no perioperative myocardial infarction, clinical hypoperfusion syndromes, and operative mortality. Postoperative mean CK-MB level was $17.4pm29.7\;IU/L.$Overall graft patency was $99.1\%\;(214/216)(LIMA:\;100\%,\;RA:\;98.4\%,\;RIMA:\;100\%).$ Conclusion: This technique allows total arterial OPCAB without technical problems and provides excellent early clinical results and graft patency. We believe that this technique is more convenient in the obtuse marginal area compared to sequential technique, and helpful in patients who require complex arterial grafting.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.553-559
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• 1998

Introduction: The most dramatic application of hypothermia in cardiac surgery is in deep hypothermic circulatory arrest(DHCA). Because man in natural circumstances is never exposed to this extreme hypothermic condition, one of the controversial aspects of clinical hypothermia is appropriate acid-base management($\alpha$-stat versus pH-stat). This study aims to compare $\alpha$-stat with pH-stat for: (1) brain cooling and re-warming speed during hypothermia induction and re-warming by cardiopulmonary bypass (CPB); (2) cerebral perfusion, metabolism, and their coupling; and (3) the extent of development of cerebral edema after circulatory arrest, in young pigs. Materials & Methods: Fourteen young pigs were assigned to one of two strategies of gas manipulation. Cerebral blood flow was measured with a cerebral venous outflow technique. After a median sternotomy, CPB was established. Core cooling was initiated and continued until nasopHaryngeal temperature fell below $20^{\circ}C$. The flow rate was set at 2,500 ml/min. Once their temperatures were below $20^{\circ}C$, the animals were subjected to DHCA for 40 mins. During cooling, acid-base balance was maintained according to either $\alpha$-STAT or pH-STAT strategies. After DHCA, the body was re-warmed to normal body temperature. The animals were then sacrificed, and their brains measured for edema. Cerebral perfusion and metabolism were measured before the onset of CPB, before cooling, before DHCA, 15 mins after re-warming, and upon completion of re-warming. Results & Conclusion: Cooling time was significantly shorter with $\alpha$-stat than with pH-stat strategy, while there were no significant differences in rewarming time between the two groups. Nosignificant differences were found in cerebral blood flow, metabolic rate, or flow/ metabolic rate ratio between two groups. Temperature-related differences were significant in cerebral blood flow, metabolic rate, and flow/metabolic rate ratio within each group. Brain water content showed no significant differences between two groups.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.125-130
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• 1997

Separating the patient from hypothermic cardiopulmonary bypass(CPB) before achieving adequate rewarming often results in afterdrop, which can predispose to electrolyte disturbances, arrhythmia, hemodynamic alterations, and shivering-induced increase of oxygen consumption. In an attempt to find an adequate end point temperature of rewarming after hypothermic CPB, 50 pediatric cardiac surgical patients were r ndomly assigned for end point temperature of rewarming of 35.5$^{\circ}C$ (Group 1) or 37t (Group 2), rectal temperature. Thereafter the rectal temperature was measured half, one, four, eight, and 16 hour after arrival to the intensive care unit(ICU), with heart rate and blood pressure. Additionally the rectal temperature was compared with esophageal temperature during CPB, and axillary temperature luring stay in the ICU. Nonpulsatile perfusion with a roller pump was used in all patients and a membrane or bubble oxygenator was used for oxygenation. Both groups were comparable with respect to age, sex, body surface area, total bypass time, and rewarming time. There was no afterdrop in both groups, and there were no statistical differences in the rectal temperatures between two groups. There were also no statistical dilyerences with respect to the heart rate and blood pressure between two groups. At the end of rewarming the esophageal temperature was higher than the rectal temperature. The axil ary temperature measured in ICU was always lower than the rectal temperature. No shivering was noted in all patients. In conclusion, with restoration of rectal temperature above 35.5$^{\circ}C$ at the end of CPB in pediatric patients, we did not observe an afterdrop.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.366-375
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• 2006

Background: Hypomagnesemia is a common complication after cardiac surgery with cardiopulmonary bypass. The purpose of this study was to assess the clinical beneficial effect of administration of magnesium sulfate in cardiac surgery. Material and Method: Thirty five patients scheduled for elective cardiac surgery were randomly assigned to magnesium group (n=20) which received magnesium sulfate in priming solution (1 g) and cardioplegic solution (1 g) or control group (n=15) which did not receive it. Arterial blood samples were drawn for measuring $Mg^{++}$ and electrolytes contents, blood gas analysis, CBC, total protein, albumin, blood urea nitrogen (BUN), creatinine, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, tumor necrosis factor-${\alpha}$ $(TNF-{\alpha})$, interleukin-6 (IL-6), interleukin-10 (IL-10), creatine phosphokinase (CpK), creatine kinase-MB (CK-MB), lactate dehydrogenase(LDH), troponin-1 (TNI), prothrombin time (PT) and activated pratial thromboplastin time level (aPTT). Venous blood samples were drawn before and after the operation for measuring activated clotting time level (ACT). Result: $Mg^{++}$ levels in magensium group were higher than those of control group at intraoperative and post-operative periods (p<0.05). dysrhythmias were lower in magnesium group (8 cases out of 17 patients, 46.4%) than in control group (10 cases out of 10, 100%, p=0.050). Conclusion: These results showed that administration of low dose magnesium sulfate during cardiac surgery prevented hypomagnesemia and lowered incidence of dysrhythmia.

• Journal of Chest Surgery
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• v.37 no.11
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• pp.951-954
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• 2004

Bronchial artery aneurysm is a rare but life-threatening disease when it ruptures, and it requires prompt treatment to prevent from catastrophic ruptures. A 78-year-old woman was referred to our hospital to evaluate mediastinal massfound on chest computed tomography. We did a selective bronchial artery angiography and diagnosed as bronchial artery aneurysm. Aneurysmectomy with division of afferent and efferent arteries was performed through standard thoracotomy without cardiopulmonary bypass. The patient recovered uneventfully and was discharged on postoperative 8th day without any complications.