• Journal of Chest Surgery
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• v.50 no.4
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• pp.242-246
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• 2017

Background: Patent ductus arteriosus (PDA) ligation is usually performed by congenital cardiac surgeons. However, due to the uneven distribution of congenital cardiac surgeons in South Korea, many institutions depend solely on adult cardiac surgeons for congenital cardiac diseases. We report the outcomes of PDA ligations performed by adult cardiac surgeons at our institution. Methods: The electronic medical records of 852 neonates at Chung-Ang University Hospital, Seoul, South Korea from November 2010 to May 2014 were reviewed to identify patients with PDA. Results: Of the 111 neonates with a diagnosis of PDA, 26 (23%) underwent PDA ligation. PDAs were ligated within 28 days of birth (mean, $14.5{\pm}7.8days$), and the mean gestational age of these patients was $30.3{\pm}4.6weeks$ (range, 26 to 40 weeks) with a mean birth weight of $1,292.5{\pm}703.5g$ (range, 480 to 3,020 g). No residual shunts through the PDA were found on postoperative echocardiography. There was 1 case of 30-day mortality (3.8%) due to pneumonia, and 6 cases of in-hospital mortality (23.1%) after 30 days, which is comparable to results from other centers with congenital cardiac surgery programs. Conclusion: Although our outcomes may not be generalizable to all hospital settings without a congenital cardiac surgery program, in select centers, PDA ligations can be performed safely by adult cardiac surgeons if no congenital cardiac surgery program is available.

• Journal of Yeungnam Medical Science
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• v.40 no.2
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• pp.187-192
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• 2023

Background: This study aimed to present the short- and midterm outcomes after complete atrioventricular canal defect (CAVC) repair using a single-patch technique. Methods: This study included 30 children who underwent surgical correction of the CAVC using a single-patch technique. Results: The median age of the patients was 5.7 months (interquartile range [IQR], 5.0-7.5 months), and 23 patients (76.7%) had type A CAVC. Fourteen patients (46.7%) were female and 17 (56.7%) had been diagnosed with Down syndrome. The in-hospital mortality rate was 0%. No deaths were observed during a median follow-up of 4 years (IQR, 3.5-5.0 years). Patients without Down syndrome were associated with late moderate mitral regurgitation (MR) (p=0.02). Late MR less than moderate degree was observed in 96.6%, 78.5%, and 50% of patients after 2, 4, and 5 years of follow-up, respectively, while late tricuspid valve regurgitation less than moderate degree was observed in 96.7%, 85.9%, and 59.0% of patients after 2, 4, and 6 years of follow-up, respectively. After a median follow-up of 4 years, only one patient had required surgical repair of a left ventricular outflow tract obstruction, which occurred 26 months after the first operation. Multivariable logistic regression analysis adjusted for the type of CAVC, sex, Down syndrome, age, and weight revealed that the absence of Down syndrome was a risk factor for late moderate MR (MR-2) (odds ratio, 0.05; 95% confidence interval, 0.006-0.50; p=0.01). Conclusion: A single-patch technique for CAVC surgical repair is a safe method with acceptable short- and midterm results.

• Journal of Chest Surgery
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• v.56 no.6
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• pp.456-459
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• 2023

Penetrating chest trauma may result in significant intracardiac injury. A traumatic ventricular septal defect is a rare complication that requires surgical management, particularly if heart failure ensues. We report a case of delayed repair of an outlet-type ventricular septal defect and perforation of the aortic and pulmonary valve leaflets following a stab wound. This report highlights diagnostic and surgical considerations and also presents an opportunity to review the conotruncal anatomy, which may be relatively unfamiliar to many adult cardiac surgeons.

• Journal of Chest Surgery
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• v.54 no.3
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• pp.179-185
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• 2021

Background: The use of ProGlide as a percutaneous vascular closure device in cardiac surgery remains inconclusive. This study investigated the clinical outcomes of using ProGlide in the percutaneous cannulation of femoral vessels in adult cardiac surgery. Methods: From September 2017 to July 2018, 131 consecutive patients underwent femoral vessel cannulation during cardiac surgery. The ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) with percutaneous cannulation was used in 118 patients (mean age, 55.7±15.5 years). The accessibility of femoral cannulation was evaluated through preoperative computed tomography. For cannulation, sonography was routinely used. The postoperative ankle-brachial index (ABI) was used to evaluate femoral artery stenosis. Results: Of the 118 patients, 112 (94.9%) and 6 (5.1%) underwent minimally invasive cardiac surgery and median sternotomy, respectively. Most femoral cannulations were performed on the right side (98.3%) using 15F to 19F arterial cannulas. The technical success rate of cannulation with ProGlide was 99.2%, with no delayed bleeding or cannulation site-related complications during hospitalization. During follow-up, only 1 patient showed femoral artery stenosis with claudication and was treated with interventional balloon angioplasty. The postoperative ABI revealed no significant difference in functional stenosis between the cannulation and non-cannulation sides (n=86; cannulation vs. non-cannulation, 1.2±0.1 vs. 1.1±0). Conclusion: Percutaneous femoral cannulation with ProGlide was safe and feasible in adult cardiac surgery. This technique may be a good alternative option in patients requiring femoral vessel cannulation for cardiac surgery.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.729-733
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• 2000

Background: Recent trends suggest that minimally invasive cardiac surgery reduces postoperative morbidity and offers a cosmetic benefit. This study was performed to evaluate the CPB time, ACC time, OP time, ICU stay and postoperative hospital stay following a lower partial sternotomy and those of the median sternotomy. Material and Method: A group of 26 adult patients who underwent cardiac surgery through lower partial sternotomy from August 1997 to July 1999(A group) were compared to 45 adult patients who underwent cardiac surgery through median sternotomy from January 1996 to July 1997(B group). The mean ages(46.4$\pm$14.6 years, A group and 46.8$\pm$13.2 years, B group) were similar. Operations were performed with central cannula and antegrade/retrograde blood cardioplegia. Result: There was no death in each group. No differences were found in CPB time, ACC time, OP time, ICU stay and postoperative hospital stay. Postoperative complications were sternal splitting in a patient in group A and a patient with bleeding that required reoperation and a patient with delayed wound closure in group B. Conclusion: The lower partial sternotomy offered a cosmetic benefit, but does not significantly reduced the length of operative time and hospital stay. Minimally invasive cardiac surgery will be applied increasing because of the suggested advantage and choosing a proper operative technique will be helpful.

• Journal of Chest Surgery
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• v.56 no.3
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• pp.206-212
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• 2023

Background: Delayed sternal closure (DSC) is a useful option for patients with intractable bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely used for sternal wound problems, but only rarely for DSC, and its efficacy for mediastinal drainage immediately after cardiac surgery has not been well established. Therefore, we evaluated the usefulness of DSC using VAC in adult cardiac surgery. Methods: We analyzed 33 patients who underwent DSC using VAC from January 2017 to July 2022. After packing sterile gauze around the heart surface and great vessels, VAC was applied directly without sternal self-retaining retractors and mediastinal drain tubes. Results: Twenty-one patients (63.6%) underwent emergency surgery for conditions including type A acute aortic dissection (n=13), and 8 patients (24.2%) received postoperative extracorporeal membrane oxygenation support. Intractable bleeding (n=25) was the most common reason for an open sternum. The median duration of open sternum was 2 days (interquartile range [25th-75th pertentiles], 2-3.25 days) and 9 patients underwent VAC application more than once. The overall in-hospital mortality rate was 27.3%. Superficial wound problems occurred in 10 patients (30.3%), and there were no deep sternal wound infections. Conclusion: For patients with an open sternum, VAC alone, which is effective for mediastinal drainage and cardiac decompression, had an acceptable superficial wound infection rate and no deep sternal wound infections. In adult cardiac surgery, DSC using VAC may be useful in patients with intractable bleeding or unstable hemodynamics with myocardial edema.

• Journal of Chest Surgery
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• v.28 no.4
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• pp.365-370
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• 1995

We studied blood salvage effect of Cell Saver Apparatus[CSA with adult cardiac patients. This study compares blood salvage in two groups of patients undergoing valve replacement or congenital cardiac operation.Group 1 is composed with 60 patients operated during 1991-1992 using CSA. Group 2 is composed with 60 patients operated during 1990-1991. No special effort was made to salvage blood in Group 2. The average requirements in Group 1 were approximately one-fourth the amount of RBC products by Group 2. The hospital course, blood chemistry level were comparable for the two groups. CSA produced blood was concentrated, well oxygenated blood and the average amount was 830 ml. Any complication was not detected in transfusion of CSA produced blood. This study shows that CSA allows safe and practical blood salvage during adult cardiac operations.

• Journal of Life Science
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• v.18 no.11
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• pp.1493-1498
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• 2008

We defined factors affecting the postoperative outcome in adult cardiac surgery with cardiopulmonary bypass (CPB). Thirty-two adult patients scheduled for elective cardiac surgery participated in this study. Levels of leukocyte, glutamic oxaloacetic transaminase (GOT), troponin-I (cTNI), interleukin-6 (IL-6), D-dimer and neuron-specific enolase (NSE) were significantly elevated, whereas platelet count declined in cardiac surgery with CPB. GOT and D-dimer levels at CPB-off each had a positive significant correlation significantly with 24 hrs-bleeding, total bleeding, mechanical ventilatory assist time, ICU stay time and length of hospitalization. BUN levels at CPB-off were directly related to total bleeding, mechanical ventilatory assist time, ICU stay time and length of hospitalization. Platelet count at CPB-off was inversely related to mechanical ventilatory assist time, ICU stay time and length of hospitalization. Creatinine concentration at CPB-off interrelated positively with mechanical ventilatory assist time and ICU stay time. NSE levels at CPB-off had a positive relationship with postoperative 24 hrs-bleeding. The length of hospitalization was prolonged proportionally to the elevation of cTNI levels in cardiac surgery. Aortic cross-clamping and total CPB times also related with increase of 24 hrs and total bleeding volumes and the length of hospitalization. IL-6 and ET-1 had no mutual relation with any postoperative outcome. These data suggest that GOT, BUN, creatinine, D-dimer and platelet levels are the most important factors affecting postoperative outcomes and patient's recovery in adult cardiac surgery with CPB.

• Biomedical Science Letters
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• v.10 no.4
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• pp.459-465
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• 2004

The use of hemofiltration has been proposed to reduce excessive body fluid and inflammatory mediators produced during cardiac surgery with cardiopulmonary bypass (CPB) in infants and children. This study was undertaken to evaluate the efficacy of hemofiltration in adult cardiac surgery using (CPB). Twenty adult patients scheduled for elective cardiac surgery were randomly assigned to control group without hemofiltration (n=10) or hemofilter group with hemofiltration during CPB (n=lO). CBC and serum levels of interleukin-6 (IL-6), D-dimer, endothelin-l (ET-1), and cortisol were measured at before the initiation and immediately after the termination of CPB (Pre-CPB and End-CPB, respectively). Clinical data were assessed at postoperative period. In hemofilter group hematocrit was significantly higher (30.04±2.63％ vs 23.30±2.71％, P=0.0014) whereas total leukocyte count was lower than in control group (7.71±1.78×10³/㎣ vs 16.01 ±3.12x10³/㎣, P=0.021) at End-CPB. Increased rate of IL-6 (311.56±97.31％ vs 825.45±102.56％, P=0.012) and D-dimer levels (154.55±89.04％ vs 308.33±157.64％, P=0.026) at End-CPB were significantly less in hemofilter group than in control group. Postoperative blood transfusion in hemofilter group was low compared with that of control group (741.00±38.07 ml vs 1,137.50±169.82 ml, P=0.037). There were no significant differences between two groups in platelet count, ET -1, cortisol, pulmonary index, mechanical ventilation, postoperative blood loss, ICU-stay and hospitalization. Hemofiltration technique applied in the present study provided partly beneficial effect in adult cardiac surgery.

• Journal of Chest Surgery
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• v.28 no.8
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• pp.747-753
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• 1995

Patients over 14 years of age who have undergone a surgical correction of a congenital cardiac malformations during period of August 1959 through December 1993 have been reviewed. During this period, there were 6894 cases of congenital cardiac lesions consisting of 4576 acyanotic and 2318 cyanotic cases. Among them, a total of 1389 adults [20.1%with various congenital cardiac malformations, 1126 acyanotic group and 263 cyanotic group were operated on. 677 patients were male and 712 patients were female. There were 444 patients under 20 years of age, 365 patients between 20-24 years, 220 patients between 25-29 years, 138 patients between 30-34 years and 222 patients over 34 years. The most common defects were atrial septal defect which accounted for 500 cases [36.0%and another common malformations were ventricular septal defect [276 cases, 19.9% , patent ductus arteriosus [207 cases, 14.9% , tetralogy of Fallot [185 cases, 13.3%and pulmonary stenosis [44 cases, 3.2%in order of incidence. Overall operative mortality for this series was 2.7% [1.5% of acyanotic group and 7.9% of cyanotic groupcompared with 4.6% of operative mortality of total cases of congenital cardiac malformations [2.9% of acyanotic group and 16.7% of cyanotic group . This reviewed series reveals the incidence of operable congenital heart defects appearing in any adult life and demonstrates that surgical repair can be accomplished with a satisfactory low mortality rate.