• Journal of Chest Surgery
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• v.26 no.2
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• pp.141-147
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• 1993

A total of 40 patients having a diagnosis of atherosclerotic coronary arterial disease were analysed on the operative outcomes according to variables as follows: 1) preoperative risk factors such as age, sex, CCS (Canadian Cardiovascular Society) functional class, type of angina, number of diseased vessel, presence of left main coronary artery stenosis, previous history of habitual smoking and presence of other medical diseases (diabetes mellitus, essential hypertension), 2) preoperative management such as intravenous infusion of nitroglycerine, preoperative IABP (intra-aortic balloon pump) support and whether the operation was scheduled as emergency or not, 3) intraoperative variables such as infusion method and composition of cardioplegic solutions, number of distal anastomosis, use of internal mammary artery, total cardiopulmonary bypass time and total cross clamp time. Complications included operative death in 12.5％, perioperative myocardial infarction in 25.0％ and perioperative arrhythmia in 17.5％. Nineteen perioperative variables were analyzed to identify risk factors for these end points. For operative death, presence of left main coronary artery stenosis (p = 0.056) and cardiopulmonary bypass time (p = 0.029) were significant in the univariate analysis, but presence of left main coronary artery lesion (p = 0.011, $\chi$$^2$= 6.45) and abscence of preoperative of IABP support (p = 0.069, $\chi$$^2$ = 3.30) were independent predictor in multivariate analysis (stepwise linear logistic regression).

• Journal of Chest Surgery
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• v.29 no.2
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• pp.185-190
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• 1996

The effect of low-dose aprotinin on hemostasis in patients undergoing cardiopulmonary bypass (CPB) for repeat valve replacement and coronary artery bypass operations were investigated. Thirty patients undergoing elective CPB from February 1993 through February 1995 at Catholic Medical Center were studied. the patients were randomly divided into two groups(15 patients per group) : group 1, receive 1, 000, 000 KIU/kg aprotinin in the CPB priming volume and 20, 000 KIU/kg aprotinin intravenously each hour during CPB ; group 2, without aprotinin administration served as the controls. The result showed that the early postoperative (during the first 24 hours) and mean postoperative total blood loss of the aprotinin group were significantly reduced than the control group (317.2 $\pm$ 89.6ml in the aprotinin group versus 821.3 $\pm$ 441.2rnl in the control group, p<0.01 ; 767.2 $\pm$ 214.1 ml in the aprotinin group versus 1562.5 $\pm$ 735.2 rnl in the control gorup, p<0.01). Total use of packed red ells and fresh frozen plasma was higher in control group(1.22 $\pm$ 0.3 units versus 4.21 $\pm$ 1.7units of packed red cells, p<0.01 : and 2.37 $\pm$ 0.4units versus 6.72 $\pm$ 0.88uni1s of fresh prozen plasma, p<0.05). We conclude the low-dose aprotinin was positive influence on postoperative blood loss in undergoing highly bleeding potency cardiac operation.

• Biomedical Science Letters
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• v.10 no.3
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• pp.237-243
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• 2004

In recent, many cardiac centers have preferred off-pump coronary artery bypass grafting (CABG) to on-pump CABG to prevent the adverse effects of cardiopulmonary bypass. The present study was performed to prove beneficial effects of off-pump CABG. Sixty adult patients scheduled for elective CABG were randomly assigned to On-pump group (n=30) or Off-pump group (n=30). Arterial blood samples were drawn before and after the operation (Pre-OP and Post-OP, respectively) for measuring CBC, prothrombin time, activated thromboplastine time, blood gas analysis, creatine kinase-MB (CK-MB) level, and lactate dehydrogenase (LDH) level. Perioperative parameters including heparin and protamine usages, complications, blood components usages, blood loss, ventilation and ICU-staying time, and hospitalization were also evaluated. Platelet count at Post-OP was high in Off-pump group whereas CK-MB and LDH levels were low compared with On-pump group. Off-pump group had significantly lower heparin and protamine usages, lower total leukocyte count, higher hematocrit and hemoglobin levels, less blood loss, lower usages of blood components, shorter ventilation and ICU-staying time, and lower incidence of pleural effusion than On-pump group. Other variables did not significantly differ between two groups. These results showed that Off-pump CABG was a satisfactory technique with less inflammatory reaction, less cardiac damage, less postoperative complications, and less cost.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.601-605
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• 2004

Addisonian crisis, also commonly referred to as adrenal crisis, occurs when the cortisol produced by the adrenal gland is insufficient to meet the body's needs. Pituitary apoplexy usually occurs as hemorrhagic and ischemic necrosis in the presence of a pre-existing pituitary adenoma, and is a rare sequela of cardiovascular surgery. Most pituitary apoplexy that happens in cardiovascular surgery has been known to be related to harmful effects of the cardiopulmonary bypass. The case presented herein illustrates occult pituitary apoplexy that occurred after off-pump coronary artery bypass grafting. In this patient, . the initial signs of addisonian crisis was similar to those of septic shock, and were overlooked. However, once recognized, they were reduced dramatically with standard stress-dose cortisone.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.148-153
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• 1993

To compare two methods of mammary pedicle graft preparations with free internal mammary artery flow, we studied 31 patients who had the left internal mammary artery harvested for coronary artery bypass grafting. The free flow was measured at the transected opening of 2 to 3 cm distal to the point of bifurcation on mean arterial pressure of 50 to 55 mmHg during cardiopulmonary bypass. Group I comprised 14 patients, whose grafts were sprayed and wrapped in sponges soaked in diluted papaverine solution (60 mg in 40 ml Hartmann's solution). An average 80 minutes after the preparations, free flow of the internal mammary artery ranged from 20 to 80 ml/min (mean 37.7 ml/min). Group II comprised 17 patients, who had internal mammary artery takedown under the exact conditions used in group I. The grafts were sprayed and wrapped in sponges soaked in the diluted papaverine solution as in group I. After an average of 28 minutes, free flow ranged from 8 to 28 ml/min (mean 17.6 ml/min). Intraluminal papaverine of the same dilution was then injected without any hydrostatic dilatation and flows increased upto 37 to 150 ml/min (mean 74.7 ml/min). This study shows that intraluminal papaverine preparation method markedly increases free mammary artery flow which is inadequate with external papaverine preparation.

• Journal of Chest Surgery
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• v.33 no.3
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• pp.221-229
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• 2000

Background: Thromboxane A2 and endothelin-1 are the potent vasoconstrictors affecting pulmonary pathophysiology in response to whole body inflammatin following CPB. Aprotinin, as an antiiflammatory agent, may decrease the release of such vasoactive substance from pulmonary tissues, preventing pulmonary hypertension after cardiopulmonary bypass. Material and Method: Ten mongrel dogs(Bwt. ac. 20kg) were subjected to cardioupulmonary bypass for 2 hours and postbypass pulmonary vascular resistance(0, 1, 2, 3 hours) were compared with prebypass level. The dogs were divided into 2 groups; control group(n-5) and aprotinin group(n=5). In the aprotinin group, aprotinin was administered as follows; 50,000 KIU/kg mixed in pump priming solution, 50,000 KIU/kg prebypass intravenous infusion over 30 minutes, 10,000 KIU/kg/hour postbypass continuous infusion. Prebypass and postbypass 0, 1, 2, 3 hour pulmonary vascular resistance were measured. At prebypass and postbypass 0, 90, 180 minutes, blood samples were obtained from pulmonary arterial and left atrial catherers for the assay of plasma thromboxane B2 a stable metabolite of thromboxane A2, and endothelin-1 concentrations. Result: The ratios of pustbypass over prebypass pulmonary vascular at postbypass 0, 1, 2, 3 hours were 1.28$\pm$0.20, 1.82$\pm$0.23, 1.90$\pm$0.19, 2.14$\pm$0.18 in control group, 1.58$\pm$0.18, 1.73$\pm$0.01, 1.66$\pm$0.10, 1.50$\pm$0.08 in aprotinin group ; the ratios gradually increased in control group while decreased or fluctuated after postbypass 1 hour in aprotinin group. There was statistically significant difference between control group and aprotinin group at postbypass 3 hours(P=0.014). Pulmonary arterial plasma concentration of thromboxane B2(pg/ml) at prebypass, postbypass 0, 90, 180 minutes were 346.4$\pm$61.9, 529.3$\pm$197.6, 578.3$\pm$255.8, 493.3$\pm$171.3 in control group, 323.8$\pm$118.0, 422.6$\pm$75.6, 412.3$\pm$59.9, 394.5$\pm$154.0 in aprotinin group. Left atrial concentrations were 339.3$\pm$89.2, 667.0$\pm$65.7, 731.2$\pm$192.7, 607.5$\pm$165.9 in control group, 330.0$\pm$111.2, 468.4$\pm$190.3, 425.4$\pm$193.6, 4.7.3$\pm$142.8 in aprotinin group. These results showed decrement of pulmonary thromboxane A2 generation in aprotinin group. Pulmonary arterial concentrations of endothelin-1(fmol/ml) at the same time sequence were 7.84$\pm$0.31, 13.2$\pm$0.51, 15.0$\pm$1.22, 16.3$\pm$1.73 in control group, 7.76$\pm$0.12, 15.3$\pm$0.71, 22.6$\pm$6.62, 14.9$\pm$1.11 in aprotinin group. Left atrial concentrations were 7.61$\pm$17.2, 57.1$\pm$28.4, 18.9$\pm$18.2, 31.5$\pm$20.5 in control group, 5.61$\pm$7.61, 37.0$\pm$26.2, 28.6$\pm$21.7, 37.8$\pm$30.6 in aprotinin group. These results showed that aprotinin had no effect on plasma endothelin-1 concentration after cardiopulmonary bypass. Conclusion: Administration of aprotinin during cardiopulmonary bypass could attenuate the increase in pulmonary vascular resistance after bypass. Inhibition of pulmonary thromboxane A2 generation was thought to be one of the mechanism of this effect. Aprotinin had no effect on postbypass endothelin-1 concentration.

• Journal of Chest Surgery
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• v.19 no.2
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• pp.181-187
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• 1986

The changes of serum creatine phosphokinase [CPK], serum lactic dehydrogenase [LDH], serum glutamic oxaloacetic transaminase [GOT] and serum glutamic pyruvic transaminase [GPT] were studied in a total of 82 cases who underwent open heart operation under the cardiopulmonary bypass at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. The results were as follows 1. The average values of CPK and COT after the operation were reached to the maximal values on the first postoperative day, which were returned to the normal range until the fifth postoperative day. The average values of LDH and CPT after the operation were reached to the maximal values on the first and second postoperative day respectively, which were significantly increased until the seventh postoperative day. 2. In the relationship of the serum enzymes and duration of the extracorporeal circulation, the values on the group over 90 minute of the extracorporeal circulation were more increased than on the group below 90 minute of the extracorporeal circulation. 3. In the relationship of the changes of the serum enzymes and congenital heart diseases and acquired heart diseases, there were no significantly differences in the values between the two groups.

• Biomedical Science Letters
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• v.12 no.3
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• pp.289-301
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• 2006

Cardiopulmonary bypass (CPB) for cardiac surgery triggers the production and release of numerous chemotactic substances and cytokines, ensuing systemic inflammatory response that leads to postoperative major organ dysfunction. Traditionally, corticosteroids (steroid) have been administered to patients undergoing cardiac surgery to ward off these detrimental physiologic alterations. However, the majority of the studies have been performed on adult patients with high-dose steroid. We carried out a randomized, prospective, double-blind study to compare the efficacy of low-dose steroid with that of high-dose steroid and to determine the adequate dose of pretreated-steroid for prophylactic effects in pediatric cardiac surgery. Thirty pediatric patients scheduled for elective cardiac surgery were randomly assigned to two groups; fifteen patients received low-dose methylprednisolone (10mg/kg intravenously, n=15, low-dose group) and the others received high-dose methylprednisolone (30mg/kg intravenously, n=15, high-dose group) 1 hour prior to CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after start of CPB (CPB-10), and immediately after CPB-end (CPB-OFF) for measuring total leukocyte counts (T-WBC) and diff-counts, platelet counts, interleukin-6 (IL-6), myeloperoxidase (MPO), total antioxidant (TAO), neuron-specific enolase (NSE), troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and blood urea nitrogen (BUN) levels. Other parameters such as volumes of urine output, pulmonary index $(PI,\;PaO_2/FiO_2)$, mechanical ventilating period, intensive care unit (ICU)-staying period, postoperative complications (fever, wound problem), postoperative 24 hrs and total volumes in blood loss, and hospitalized days were also assessed. All parameters were compared between two groups. There were no significant differences in T-WBC counts, monocyte fraction, platelet counts, TA levels, NSE levels, creatinine levels, BUN levels, the volumes of total urine output, PI, the incidences of fever and wound problem, postoperative 24hrs- and total-blood loss volumes and ICU-staying period between two groups (P>0.05). At CPB-OFF, neutrophil fraction, MPO level, TNI level, and AST level were higher in the high-dose group than in the low-dose group (P<0.05). IL-6 level at CPB-10 was higher in the high dose-group than in the low-dose group (P<0.05). Furthermore, mechanical ventilating periods and hospitalized days of the high-dose group were significantly longer than those of low-dose group (P<0.05). The high-dose group had significantly low lymphocyte fi-action at CPB-OFF compared with the low-dose group (P<0.001). These findings suggest that pretreatment of high-dose steroid is not superior to that of low-dose steroid regrading its potential benefits in pediatric cardiac surgery. Therefore, the conventional strategy of steroid treatment, high-dose pretreatment, should be modified in the cardiac surgery with CPB. However, further studies must be performed on the larger number of patients in as much as small number of patients in this study.

• 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.

• Journal of Life Science
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• v.18 no.11
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• pp.1551-1560
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• 2008

Cytokines play a pivotal role in systemic inflammatory response following cardiac surgery with cardiopulmonary bypass (CPB). The purpose of this study was to investigate the perioperative changes in proinflammatory [tumor necrosis factor-$\alpha$ (TNF-$\alpha$) and interleukin-6 (IL-6)] and antiinflammatory cytokines [interleukin-10 (IL-10)], and each correlation between the cytokines and other variables in valvular heart surgery with CPB. Serum IL-6 and IL-10 levels and leukocyte counts significantly increased following CPB. CPB caused hepatic, renal and myocardial dysfunctions. IL-6 levels had positive correlations with IL-10 levels at postoperative periods. TNF-$\alpha$ levels had correlations with leukocyte counts and myocardial marker levels at postoperative 24 hr (PO-24 h). Furthermore, IL-6 or IL-10 levels had positive correlations with other variable such as hepatic, renal or myocardial marker at postoperative periods. These results showed that balance between proinflammatory and antiinflammatory cytokines is maintained during cardiac surgery with CPB, and that these cytokines exert postoperatively inflammatory and antiinflammatory reactions.