• Journal of Chest Surgery
• /
• v.37 no.9
• /
• pp.762-767
• /
• 2004

With the developement of non-invasive surgical techeniques, coronary artery bypass graft without cardiopulmonary bypass has become popular. We compared the preoperative risk factors and in-hospital outcomes of patients having off-pump CABG with these having on-pump CABG. Material and Method： From January 2001 to June 2003, 87 patients underwent CABG. Thirty-sin patients underwent on-pump CABG, fifty-one patients under-went off-pump CABG. Preoperative risk factors, extent of coronary disease, operative time, postoperative endotracheal intubation time, duration of ICU stay & hospital stay, the amount of bleeding and postoperative levels of cardiac enzymes were compared in both groups, Result: The were no differences in their sex ratios, ages, preoperative risk factors, preoperative Ml, Canadian classes, extent of coronary artery diseases and, echocardio-graphic ejection fraction between Off-pump CABG and On-pump CABG groups. Off-pump CABG group had significantly lower mean operative time (270$\pm$79.3 min vs 372$\pm$142.2 min, p＜0.001), mean ventilation time (17.1$\pm$13.4 hr vs 24.3$\pm$17.8 hr) and CK-MB level (8,9$\pm$18.7 IU/L vs 25.7$\pm$8.4 IU/L) than on-pump CABG groups, On-pump CABG group had more distal grafts (2.2$\pm$0.5 vs 1.7$\pm$0.71 than Off-pump CABG groups did. There were no differences in their postoperative complications and outcomes including amount of postoperative bleeding for 24 hrs, reoperation for bleeding control, mean in-hospital days, postoperative infection, renal failure and neurologic complications between Off-pump CABG and On-pump CABG groups. Conclusion: This study showed that patients who underwent Off-pump CABG had less operation time & intubation time and lower CK-MB level; however, they also have less distal graft. Even though CABG without CPB provided satisfactory results, more clinical experience & longer follow-up is required.

• Journal of Chest Surgery
• /
• v.38 no.1 s.246
• /
• pp.1-12
• /
• 2005

The primary responsibility of a perfusionist is to operate the heart-lung bypass machine during open heart surgery, which is vital for the successful operative outcome. However, despite the perfusionist's crucial role on the cardiac surgical team, no relevant studies have not yet been conducted in our country. In this regard, this study was performed about the current status of perfusionists in Korea with comparative analysis on the certification and education system of perfusionists in foreign countries. Material and Method: We analyzed the demographic data on the Korean perfusionists conducted in 1994 and 2003, with comparison of recent data on the perfusionists of the nineteen foreign countries. Result and Conclusion: Although all agree that professionalism and responsibility of the perfusionist are essential in conducting a cardiac procedure and bringing about successful outcome, the formally approved training and certification system for perfusionists have not yet been established in Korea. Adequate measures should be done as soon as possible in order to try to obtain the adequate recognition of the profession.

• Journal of Yeungnam Medical Science
• /
• v.4 no.1
• /
• pp.65-74
• /
• 1987

This study deals with the changes in the concentrations of blood glucose and electrolytes during open heart surgery. Blood glucose and electrolytes in connection with age, disease and anesthetic period were measured in 25 patients about to undergo heart surgery which were performed between June 1986 and August 1986 in Yeungnam University Hospital. Because glucose solution is commonly used as priming solution, and the priming solution is hyperglycemic and hyperosmolar, glucose level of priming solution in this study was adjusted to 100-200mg% level to minimize hyperglycemic and hyperosmolar effect. The following results were obtained. 1. Glucose level of priming solution before extracorporeal circulation was $151.6{\pm}3.13mg%$. 2. With body cooling, blood glucose level was elevated. As duration of extracorporeal circulation is prolonged, blood glucose level was elevated more, but no difference between age and diseases were observed. On warming, blood glucose level was progressively lowered. 3. Despite the low serum potassium level during by pass, the potassium level was progressively elevated following by-pass, cut the serum potassium level was low compared to control values. Elevated calcium level was maintained during by pass.

• Journal of Chest Surgery
• /
• v.35 no.2
• /
• pp.118-126
• /
• 2002

배경: 체외순환에 의해 생성되는 염증매개체는 소아 환자에서 술 후 다기관 기능부전과 연관이 있다. 본 연구에서는 선천성 신장질환 소아환자에서 체외순환에 의한 전염증성 사이토카인과 케모카인의 유전자 발현 특성에 대해 알아보고자 하였다. 대상 및 방법: 개심술을 시행한 18명의 소아 환자의 요골 동맥에서 마취유도 후(기준치), 체외순환(0시간), 체외순환 2시간 후 24시간 후, 48시간 후에 혈액을 채취하였다. 모든 환자에서 인터루킨-1알파, 인터루킨-1베타 인터루킨-6, 인터루킨-8, 종양괴사자인자-알파, 인터루킨-15,인터페론 감마의 mRNA의 유전자 발현 정도를 반정량적으로 역전사 중합효소 연쇄반응으로 측정하였다. 6명의 환자에서 인터루킨-6단백치는효소결합면역흡착검사로 측정하였다. 결과: 전신적인 인터루킨-6 mRNA와 비슷한 양상을 보였으나 최고치는 인터루킨-6보다 낮은 값을 보였다. 인터루킨-1알파와 인터루킨-1베타의 mRNA의 발현은 체외순환 2시간 후에 최고치를 나타내었고 체외순환 2시간 후에 최고치를 나타내었고 체외순환 48시간 후에 감소하였다. 종양괴사자인자-알파는 체외 순환 24시간 후에 최고치를 나타내었고 체외순환 48시간 후에 감소하였다. 인터루킨-15 mRNA 발현은 체외순환 전후와 비교하여 유의한 변화가 없었다. 인터페론-감마는 시간이 지남에 따라 감소하였다. 결론: 선천성 심장질환으로 개심술을 시행한 소아환자의 혈청 내 인터루킨-6, 인터루킨-8, 인터루킨-1알파, 인터루킨-베타, 종양괴사자인자-알파의 유전자 발현은 체외 순환 전후로 유의한 변화를 보였다. 인터루킨-15는 유의한 변화가 없었고 인터페론-감마는 반대 양상의 변화를 보였다. 체외순환 후 전염증성 사이토카인과 케모카인의 높은 혈중 농도는 술 후 조직 손상과 연관되리라 생각한다.

• Korean Journal of Clinical Laboratory Science
• /
• v.54 no.4
• /
• pp.293-297
• /
• 2022

In 2022, Korea reported a total of 224 perfusionists, employing nurses or clinical laboratory technologists (also known as medical technologists) to provide hospital self-education or reliable education. In 2021, the total number of perfusionists in Japan was 2,100, mainly supported by clinical engineering technologists. During the same period, the number of perfusionists reported in the United States was 4,212, who had received training in the master's program, post-bachelor certificate program, and bachelor's program. Most personnel in the USA were graduates of healthcare sciences or life sciences. Perfusionists must be knowledgeable in heart anatomy, physiology, pharmacology, pathology, hemodynamics, laboratory analysis, and quality assurance, as well as techniques to operate the cardiopulmonary bypass machine (heart-lung bypass machine). These are jobs similarly handled by clinical laboratory technologists. The importance of perfusionists became more prominent during two major crises: the MERS-CoV and COVID-19 pandemic. Currently, perfusionists play a significant role in the rapidly expanding field of extracorporeal membrane oxygenation (ECMO) and extracorporeal circulation during cardiac surgery. Results of the current study indicate that hospitals offering cardiac surgery and infectious disease hospitalization need to be institutionalized to secure a certain number of qualified perfusionists. In the future, we look forward to establishing a perfusion technology association under the Korean Society for Clinical Laboratory Physiology to provide academic exchanges.

• Journal of Yeungnam Medical Science
• /
• v.14 no.2
• /
• pp.350-358
• /
• 1997

We studied the effects of adding a single bolus(500 mg) of sodium thiopental to a continuous infusion of low-dose fentanyl on plasma beta-endorphin immunoreactivity(iBE) responses to cardiopulmonary bypass(CPB) in 28 patients undergoing elective coronary artery bypass grafting or valve procedures. Thiopental was injected just prior to the initiation of CPB. The iBE levels and the hemodynamic indices such, as mean arterial pressure, cardiac output and systemic vascular resistance were measured before CPB, at 30 min and again at 60 min after the initiation of the bypass. The results were as follows. After the initiation of CPB, iBE levels increased at 30 min and 60 min(P=0.006, P=0.004 respectively) in the control group, but not in the thiopental group. There were significant differences in the changes of iBE levels between the groups(F=8.7, G-G=0.002, P=0.001). The hemodynamic indices were similar in both groups. In conclusion, pretreatment with thiopental just before the initiation of CPB prevents the stress-induced beta-endorphin response to CPB.

• Journal of Chest Surgery
• /
• v.34 no.7
• /
• pp.524-533
• /
• 2001

Background: Hyperoxemic cardiopulmonary bypass (CPB) has been recognized as a safe technique and is widely used in cardiac surgery. However, hyperoxemic CPB may produce higher toxic oxygen species and cause more severe oxidative stress and ischemia/reperfusion injury than normoxemic CPB. This study was undertaken to compare inflammatory responses and myocardial injury between normoxemic and hyperoxemic CPB and to examine the beneficial effect of normoxemic CPB. Material and method: Thirty adult patients scheduled for elective cardiac surgery were randomly divided into normoxic group (n=15), who received normoxemic CPB (about Pa $O_{2}$ 120 mmHg), and hyperoxic group (n=15), who received hyperoxemic CPB (about Pa $O_{2}$ 400 mmHg). Myeloperoxidase (MPO), malondialdehyde (MDA), adenosine monophosphate (AMP), and troponin-T (TnT) concentrations in coronary sinus blood were determined at pre- and post-CPB. Total leukocyte and neutrophil counts in arterial blood were measured at the before, during, and after CPB. Lactate concentration in mixed venous blood was analyzed during CPB, and cardiac index (Cl) and pulmonary vascular

• Journal of Chest Surgery
• /
• v.34 no.8
• /
• pp.591-596
• /
• 2001

Coronary artery bypass graft with cardiopulmonary bypass is a conventional method of operative revascularization of coronary artery disease. Because of many troubles of cardiopulmonary bypass such as systemic inflammatory reaction, mechanical trauma of blood components and coagulopathy, coronary artery bypass graft without cardiopulmonary bypass has been popularized. Material and Method: From March 1999 to September 2000, 35 patients under went CABG at our institution. Among them, 14 patients received CABG without the use of CPB and 21 patients under went CABG with the use of CPB. Mean operative time, mean postoperative tracheal intubation time, mean ICU stay, mean hospital stay, the amount of transfusion, postoperative use of inotropic agents, and postoperative changes of cardiac enzymes were compared in both groups. Result: There were differences between the CABG without CPB group and CABG with CPB group with regard to mean tracheal intubation time, the amount of transfusion and the elevation of postoperative cardiac enzymes(p<0.05). Conclusion: While CABG without CPB provided satisfactory results, more long term follow-up is required.

• Journal of Chest Surgery
• /
• v.43 no.2
• /
• pp.164-167
• /
• 2010

Extracorporeal membrane oxygenation (ECMO) during acute respiratory failure due to any cause aids in the recovery of respiratory function. The use of ECMO for acute respiratory failure due to near drowning was reported to be a successful therapeutic option in those patients who do not respond to optimal conventional therapies. We performed veno-venous ECMO for 2 acute respiratory failures due to near-drownings. All cannulations were performed percutaneously via both femoral veins. The 2 patients were successfully weaned off ECMO, but one patient experienced diffuse hypoxic brain damage and a subarachnoid hemorrhage.

• Journal of Chest Surgery
• /
• v.31 no.10
• /
• pp.952-963
• /
• 1998

Background: Cardiopulmonary bypass(CPB)-induced hemostatic defects may result increased possibility of excessive hemorrhage and additional multiple transfusion reactions or reoperation. Particularly, fibrinolytic activation and decreased platelet count and function by CPB were proposed as a predictor of hemorrhage during postoperative periods in several reports. Materials and methods: Present study, which was conducted in 20 adult patients undergoing CPB, was prospectively designed to examine the hematologic changes, including fibrinolytic activation during and after CPB and to clarify the relationships between these changes and the magnitude of the postoperative nonsurgical blood loss. The serial blood samples for measurment of hematologic parameters were taken during operation and postoperative periods. Blood loss was respectively counted via thoracic catheter drainage at postoperative 3, 6, 12, 24, 48 hours and total period. Results: The results were obtained as follows:Platelet count rapidly declined following CPB(p<0.01), which its decreasing rate was an inverse proportion to total bypass time(TBT, r=0.55, p=0.01), And platelet count in postoperative 7th day was barely near to its control value. Fibrinogen degradating product(FDP) and D-dimer level significantly increased during CPB(p<0.0001, p<0.0001, respectively), and both of fibrinogen and plasminogen concentration correlatively decreased during CPB(r=0.57, p<0.01), implying activation of fibrinolytic system. Postoperative bleeding time (BT), postoperative activated partial thromboplastin time(aPTT) and postoperative prothrombin time (PT) were significantly prolonged as compare with each control value (p=0.05, p<0.0001, p<0.0001, respectively). Total blood loss was positively correlated with patient's age, aortic clamping time (ACT) and TBT, while there was negative correlation between platelet count and blood loss at pre-CPB, CPB-off and the 1st postoperative day, and in some periods. Postoperative aPTT and postoperative PTwere positively related to postoperative 6 hr and 48 hr blood loss(r=0.53, p=0.02; r=0.43, p=0.05) but not to total blood loss, whereas there was no relationship between postoperative BT and blood loss at any period. Conclusions: These observations suggest that CPB results various hematologic changes, including fibrinolytic activation and severe reduction in platelet count. Diverse factors such as age, platelet count, ACT, TBT and postoperative aPTT and PT may magnify the postoperative bleeding. This study will be a basic reference in understanding CPB-induced hemostatic injuries and in decreasing the postoperative hemorrhage