• Journal of Chest Surgery
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• v.54 no.6
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• pp.554-557
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• 2021

Surgeons are increasingly using the right mini-thoracotomy approach to perform aortic valve surgery. This approach has shown better results in terms of blood loss and length of hospital stay than the sternotomy approach. For selected patients requiring aortic root and ascending aorta surgery, a right mini-thoracotomy approach may prove beneficial. In our technique, we placed a 5-cm horizontal skin incision in the right second intercostal space. Femoro-femoral cardiopulmonary bypass was established. A valved aortic conduit was used for aortic root replacement. The patient's postoperative course was uneventful, with a short hospital stay. This technique offers a minimally invasive approach to aortic root and ascending aorta surgery with easy adaptability and reduced costs.

• Journal of Chest Surgery
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• v.55 no.2
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• pp.174-176
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• 2022

Mediastinal paragangliomas are rare tumors that have only been reported in individual cases or limited case series. Surgical resection of these tumors can be challenging, as they are highly vascular and intimately related to the great vessels. Surgery is usually performed via median sternotomy with or without cardiopulmonary bypass. We present the case of a mediastinal paraganglioma that was resected via a left-sided posterolateral thoracotomy. Histopathology revealed a completely resected 38-mm paraganglioma with a positive station 5 lymph node, indicative of locally aggressive disease. Hereditary paragangliomas are associated with malignant transformation; therefore, genetic testing is important. These tumors do not respond well to chemoradiotherapy, and consequently lifelong surveillance for early detection of recurrence is recommended.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.98-100
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• 2022

Unilateral pulmonary edema after minimally invasive cardiac surgery is a rare, but potentially life-threatening condition. However, the exact causes of unilateral pulmonary edema remain unclear. We experienced aggressive unilateral pulmonary edema followed by redo-resection of recurrent left atrial myxoma through a right mini-thoracotomy. Intraoperative veno-venous extracorporeal membrane oxygenation was applied after the termination of cardiopulmonary bypass, and separate mechanical ventilation using a double-lumen endotracheal tube was applied after surgery. The patient was successfully treated and discharged uneventfully.

• Journal of Chest Surgery
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• v.55 no.6
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• pp.478-481
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• 2022

The innominate artery is an uncommon site for an aneurysm, and tracheal compression caused by an innominate artery aneurysm is a very rare occurrence. An innominate artery aneurysm can cause catastrophic complications, such as rupture or thromboembolism. The most common surgical approach for open repair is median sternotomy with cardiopulmonary bypass, but cerebral ischemic injury and thromboembolism can occur during surgery. We present the case of a male patient who had an isolated giant innominate artery aneurysm causing tracheal compression, which was successfully managed by surgical repair.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.247-255
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• 2007

Background: Lung injury that follows bypass has been well described. It is manifested as reduced oxygenation and lung compliance and, most importantly, increased pulmonary vascular resistance reactivity; this is a known cause of morbidity and mortality after repair of congenital heart disease. Injury to the pulmonary vascular endothelium, and its associated alterations of endothelin-1, is considered to be a major factor of bypass-induced lung injury. Removing endothelin-1 after bypass may attenuate this response. This study measured the concentration of serum and peritoneal effluent endothelin-1 after performing bypass to determine if endothelin-1 can be removed via peritoneal dialysis. Material and Method: From March 2005 to March 2006, 18 patients were enrolled in this study Peritoneal catheters were placed at the end of surgery. Serum samples were obtained before and after bypass, and peritoneal effluents were obtained after bypass. Endothelin-1 was measured by enzyme linked immunosorbent assay (ELISA). Result: In the patients with a severe increase of the pulmonary artery pressure or flow, the mean preoperative plasma endothelin-1 concentration was significantly higher than that in the patients who were without an increase of their pulmonary artery pressure or flow (4.2 vs 1.8 pg/mL, respectively, p<0.001). The mean concentration of plasma endothelin-1 increased from a preoperative value of $3.61{\pm}2.17\;to\;5.33{\pm}3.72 pg/ml$ immediately after bypass. After peritoneal dialysis, the mean plasma endothelin-1 concentration started to decrease. Its concentration at 18 hours after bypass was significantly lower than the value obtained immediately after bypass (p=0.036). Conclusion: Our data showed that the plasma endothelin-1 concentration became persistently decreased after starting peritoneal dialysis, and this suggests that peritoneal dialysis can remove the circulating plasma endothelin-1.

• Journal of Chest Surgery
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• v.38 no.12 s.257
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• pp.828-834
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• 2005

Background: Off-pump coronary artery bypass grafting (OPCAB) has shown better outcome in chronic renal failure (CRF) patients by avoiding the effects of cardiopulmonary bypass. We evaluated renal function after OPCAB in CRF patients. Material and Method: 656 patients underwent OPCAB between January, 2001 and December, 2004. Data were collected in 26 CRF patients (Cr > 1.7 mg/dL). Preoperative/postoperative creatinine (Cr) levels, creatinine clearance and postoperative data were evaluated. We divided the patients into group 1 (Cr < 3 mg/dL) and group 2 (Cr $\geq$ 3 mg/dL). Result: Three patients started dialysis after surgery. Preoperative mean creatinine level (4.19$\pm$3.4 mg/dL) was elevated to 4.36$\pm$2.7 mg/dL at the third postoperative day and decreased below Preoperative level at the fifth postoperative day. In group 1 (mean Cr level=1.87$\pm$0.25 mg/dL), Cr level reached its peak level of 2.19$\pm$0.52 mg/dL at the fourth postoperative day (p=0.017), with subsequent decrease. Patients without pre- or postoperative dialysis (n=15) showed peak Cr elevation on postoperative day four (p=0.017) and subsequent decrease (p=0.01). Postoperative creatinine clearance showed reverse correlation with creatinine level. Conclusion: Creatinine level was elevated at third/fourth postoperative day, but decreased 5 days after surgery. Thus, if urgent dialysis is not indicated, postoperative renal replacement therapy in CRF patients may be better to be considered after four days observation.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.416-422
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• 2004

Acute renal failure (ARF) is a common postoperative complication after the cardiac surgery. Postoperative ARF have various causes, and are combined with other complications rather than being the only a complication. It deteriorates the general condition of the patient, and makes it difficult to manage the combined complications by disturbing the adequate medication and fluid therapy. We have planned this study to evaluate the effects of postoperative ARF after the on-pump coronary artery bypass surgery (CABG) on the recovery of patients and identify the risk factors. Method and Material: We reviewed the medical records of patients who underwent CABG with cardiopulmonary bypass by a single surgeon from Jan. 2000 to Dec. 2002, We checked the preoperative factors; sex, age, history of previous serum creationism over 2.0 mg/㎗, preoperatively last checked serum creatinine, diabetes, hypertension, left ventricular ejection fraction, intraoperative factors; whether the operation is an emergent case or not, cardiopulmonary bypass time, aortic cross clamp time, the number of distal anastomosis, postoperative factors: IABP. Then we have studied the relations of these factors and the cases of postoperative peak serum creatinine over 2.0 mg/㎗. Result: There were 19 cases with postoperative peak serum creatinine over 2.0 mg/㎗ in a total 97 cases. Dialysis were done in 3 cases for ARF with pulmonary edema and severely reduced urine output. There were 8 cases (42.1%) with combined complications among the 19 patients. This finding showed a significant difference from the 5 cases (6,4%) in the patients whose creatinine level have not increased over 2.0 mg/㎗. The mortalities are different as 1.3% to 10.5%. The risk factors that are related with postoperative serum creatinine increment over 2.0 mg/㎗ are diabetes, the history of previous serum creatinine over 2.0 mg/㎗ and left ventricular ejection fraction. Conclusion: Postoperative ARF after the on-pump CABG is related with preoperative diabetes, the history of previous serum creatinine over 2,0 mg/㎗ and left ventricular ejection fraction. Postoperative ARF could De the reason for increased rate of complications and mortality after on-pump CABG. Therefore, in the patients with these risk factors, the efforts to prevent postoperative ARF like off-pump CABG should be considered.

• Journal of Chest Surgery
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• v.38 no.12 s.257
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• pp.821-827
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• 2005

Background: Hemodilution after priming of the cardiopulmonary bypass is known to increase the possibility of bleeding and homologous transfusion in adult cardiac surgery. We investigated the effects of retrograde autologous priming (RAP) to see whether it would decrease postoperative bleeding and homologous transfusion. Material and Method: We retrospectively reviewed 34 patients wpho underwent RAP and 46 patients who did not. Retrograde autologous priming consisted of arterial lire drainage, venous reservoir and oxygenator drainage and venous line drainage. We compared the amount of priming solution and RAP volume, perioperative hematocrit, postoperative bleeding and transfusion requirements in the two groups. Resuit: Mean withdrawal volume in RAP group was 613.5$\pm$160.6 mL and initial priming volume was 1381.9$\pm$37.2 mL. Hemoatocrits ($\%$) in RAP and control groups were 25.0$\pm$3.7 vs 20.9$\pm$3.6 (5 minutes after CPB), 25.9$\pm$3.7 vs 22.5$\pm$3.6 (30 minutes after CPB), 25.9$\pm$3.4 vs 23.8$\pm$2.8 (60 minutes after CPB), 31.9$\pm$3.9 vs 31.5$\pm$4.5 (postoperative 1 hour), 32.4$\pm$4.4 vs 32.1$\pm$4.5 (postoperative 6 hours), 33.4$\pm$5.0 vs 31.7$\pm$5.1 (postoperative 1 day)[repeated measures ANOVA, p < 0.05]. Chest tube drainages (mL) in the two groups were 357.2$\pm$177.1 vs 411.7$\pm$279.5 (postoperative 6 hours), 599.4$\pm$145.6 vs 678.8$\pm$256.4 (postoperative 24 hours)[t-test, p < 0.05]. Homologous transfusion was performed in 7 out of 34 patients in RAP group (20.6$\%$), and 16 out of 46 (34.8$\%$) in control group (p < 0.05). Conclusion: This study suggests that the effects of reducing the priming volume during cardiopulmonary bypass may result in lesser bleeding and homologous transfusion. Retrograde autologous priming would be used to reduce postoperative bleeding and chance of transfusion after adult cardiac surgery.

• Journal of Chest Surgery
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• v.34 no.7
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• pp.524-533
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• 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
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• v.36 no.5
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• pp.343-347
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• 2003

Background: The femoral artery is the most common site of canuulation for cardiopulmonary bypass in surgery for type A aortic dissection. Recently, many surgeons prefer the axillary artery to the femoral artery as the arterial cannulation site for several benefits. We evaluated the safety and usefulness of axillary artery cannulation in surgery for acute type A aortic dissection. Material and Method: Between Oct. 1995 and Sep. 2001, 71 patients underwent operations for acute type A aortic dissection. The arterial cannula was inserted into the axillary artery in 31 patients (AXILLARY group, mean age=56), and into the femoral artery in 40 patients (FEMORAL group, mean age=57). We retrospectively compared the incidence of mortality, morbidities, and hospital course. Result: The mean duration of cardiopulmonary bypass and circulatory arrest were significantly shorier in the AXILLARY group (207 min and 39min, respectively) than in the FEMORAL group (263min and 49 min, respectively; P<0.05). Postoperative hospital stay was significantly shorter in the AXILLARY group than in the FEMORAL group (mean 15 days vs. 35 days, p<0.05). Although there was no difference in the incidence of new-onset permanent neurological dysfunction (3.2%, in the AXILLARY group, 2.5% in the FEMORAL group), the incidence of transient neurological dysfunction was significantly lower in the AXILLARY group (12.9% vs. 25%, p<0.05). In the FEMORAL group, two patients needed urgent conversion to cannulation site due to arch vessel malperfusion. In the AXILLARY group, there was only one patient who had a complication related to the cannulation, i.e., median nerve injury. Conclusion: Axillary artery cannulation was safe and helpful in decreasing the cerebral ischemic time and incidence of transient neuroligcal dysfunction in surgery for acute type A aortic dissection, It enabled us to approach the patients with aortic arch pathology more aggressively.