• Journal of Chest Surgery
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• v.18 no.4
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• pp.753-758
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• 1985

Hemorrhage is an important complication after operation with cardiopulmonary bypass and sometimes necessitates a further emergency operation. Between July, 1962 and June, 1985, reoperation for hemorrhage was carried out on 81 patients [3.1%] out of a total 2634 patients who had previously undergone cardiopulmonary bypass surgery at the Department of Thoracic and Cardiovascular Surgery, Yonsei University Medical Center. There were 38 males and 43 females, with an average age of 25 years [ranging 6 months to 60 years] and an average body weight of 38 kg [ranging 5 to 77 kg].There were 43 patients of cyanotic heart disease, 32 patients of acquired valvular heart disease, 4 patients of coronary artery occlusive disease, 2 patients of ascending aorta aneurysm and annuloaortic ectasia. The average amount of blood loss in the case of cyanotic heart disease was 71.7140ml/kg, in acyanotic heart disease 45.16.3ml/kg, in acquired heart disease, 56.514.4ml/kg and in coronary artery occlusive disease, 50.618.7ml/kg during first post operative day. But there was no statistical difference [p>0.05]. The mean blood loss below 10 years old was 70.412.1 ml/kg. Those below 10 years old were believed to bleed more than any other group. But there was also no statistical difference [p>0.05]. Indications for reoperation were continued excessive blood loss [74%], cardiac tamponade or hypotension [23%] and radiological evidence of a large hematoma in the thorax and pericardium [2%]. Average bypass time was 2.10.1 hours [ranging 30 minutes to 5 hours]. The interval between operation and reoperation was as follows; less than 12 hours in 49 patients [60%], 12 to 24 hours in 20 patients [25%], 24 to 48 hours in 8 patients [10%], more than 48 hours in 4 patients [5%]. The commonest sites for bleeding were chest wall [36%], heart [34%], aorta [12%], pericardium [6%], thymus [5%] and others [6%]. But no definite source was found in ll patients [31%]. Twenty seven out of 81 patients [31%] had wound problems and 5 patients [6%] were expired. [Mean SEM]. In conclusion, in order to decrease the amount of blood loss after open heart surgery with cardiopulmonary bypass, shortening of bypass time and bleeding control at the wire suture site during chest wall closure were important. If the amount of blood loss was over 45 ml/kg or 8 m/kg/hour, reoperation should be considered as soon as possible. After operating, careful wound dressings were applied to prevent wound problems.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.193-204
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• 1985

During the period from February to March, 1984, we employed a partial left heart bypass [left atrium to ascending aorta] in 2 patients who could not weaned from cardiopulmonary bypass with inotropic agents and cardiac pacing after coronary bypass surgery. These two patients showed significant improvement in ventricular function 18 to 47 hours after inserting the left heart bypass and were able to wean from the left heart bypass under using inotropic agents. Two patients died of multiple organ failures 11 days and 15 days postoperatively. These results indicate that early institution of left heart bypass in ventricular failure patients after open heart surgery can provide satisfactory long-term result.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1209-1217
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• 1992

Triiodothyronine[T3] is an important regulator of the tissue metabolism, and may have potential use as an inotropic agent. The change of serum T3 level was studied in the pediatric age patients after cardiopulmonary by pass. Thyroid function was tested pre-operatively in 33 patients and total triiodothyronine[TT3] levels were serially measured during and after cardiopulmonary bypass[CPB]. After correction of dilutional effect, effects of various factors on the TT3 levels were analyzed. Abrupt fall of TT3 level was demonstrated at 15 minutes after CPB[80.1$\pm$5.9ng/dL] from the initial level of 133.6$\pm$5.3ng/dL, with some recovery at 6 hours[115.4$\pm$6.7ng/dL]. After then, gradual decrease occured reaching to the level of 77.2$\pm$4.2ng /dL at 24 hours. These falls of the TT3 after CPB were statistically significant. [p<0.01 ANOVA] Statistically significant correlation were found between the degree of hemodilution and TT3 concentration at 15 and 30 minutes after CPB[p<0.05]. But, other factors were analyzed to have no effect on TT3 levels. As the degree of the hemodilution increases, TT3 decreased less. This observation probably supports the fact that decrease of TT3 during CPB may be a result of sequestration of T3 into peripheral tissue. Although it was not statistically significant[p=0.08], the fall of TT3 was greater in the group to which plasmanate was added, than those not added. This finding seemed to be due to the increase of albumin and other thyroid-hormone-binding-proteins in the serum. Increase of these binding proteins might potentiate the sequestration of T3 into the liver and the kidney from serum, and as a consequence, decrese the serum TT3 level further.

• Proceedings of the KTCVS Conference
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• 1996.04a
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• pp.24-27
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• 1996

• Journal of Chest Surgery
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• v.34 no.8
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• pp.591-596
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• 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
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• v.37 no.1
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• pp.1-10
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• 2004

Background: Currently, the cardiopulmonary machine with non-pulsatile pumps, which are low in internal circuit pressure and cause little damage to blood cells, is widely used. However, a great number of experimental studies shows that pulsatile perfusions are more useful than non-pulsatile counterparts in many areas, such as homodynamic, metabolism, organ functions, and micro-circulation. Yet, many concerns relating to pulsatile cardiopulmonary machines, such as high internal circuit pressure and blood cell damage, have long hindered the development of pulsatile cardiopulmonary machines. Against this backdrop, this study focuses on the safety and effectiveness of the pulsatile cardiopulmonary machines developed by a domestic research lab. Material and Method: The dual-pulsatile cardiopulmonary bypass experiment with total extracorporeal circulation was conducted on six calves, Extracorporeal circulation was provided between superior/inferior vena cava and aorta. The membrane oxygenator, which was placed between the left and right pumps, was used for blood oxygenation. Circulation took four hours. Arterial blood gas analysis and blood tests were also conducted. Plasma hemoglobin levels were calculated, while pulse pressure and internal circuit pressure were carefully observed. Measurement was taken five times; once before the operation of the cardiopulmonary bypass, and after its operation it was taken every hour for four hours. Result: Through the arterial blood gas analysis, PCO2 and pH remained within normal levels. PO2 in arterial blood showed enough oxygenation of over 100 mmHg. The level of plasma hemoglobin, which had total cardiopulmonary circulation, steadily increased to 15.87 $\pm$ 5.63 after four hours passed, but remained below 20 mg/㎗. There was no obvious abnormal findings in blood test. Systolic blood pressure which was at 97.5$\pm$5.7 mmHg during the pre-circulation contraction period, was maintained over 100 mmHg as time passed. Moreover, diastolic blood pressure was 72.2 $\pm$ 7.7 mmHg during the expansion period and well kept at the appropriate level with time passing by. Average blood pressure which was 83$\pm$9.2 mmHg before circulation, increased as time passed, while pump flow was maintained over 3.3 L/min. Blood pressure fluctuation during total extracorporeal circulation showed a similar level of arterial blood pressure of pre-circulation heart. Conclusion: In the experiment mentioned above, pulsatile cardiopulmonary machines using the doual-pulsatile structure provided effective pulsatile blood flow with little damage in blood cells, showing excellence in the aspects of hematology and hemodynamic. Therefore, it is expected that the pulsatile cardiopulmonary machine, if it becomes a standard cardiopulmonary machine in all heart operations, will provide stable blood flow to end-organs.

• Journal of Chest Surgery
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• v.32 no.12
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• pp.1127-1130
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• 1999

Percutaneous coronary intervention including intracoronary stenting is currently an accepted treatment modality in the treatment of coronary artery disease and is widely performed to treat the patient with multivessel disease with decreased morbidities and less cost compared with conventional coronary rtery bypass grafting(CABG), Repeated interventions due to restenosis even after successful angioplasty are the major disadvantage of the angioplsty especially when the lesion is located inthe left anterior descending artery(LAD) Recently CABG through left anterior small thoracotomy using the left internal thoracic artery to revascularize the LAD territory without cardiopulmonary bypass so called Minimally Invasive Direct Coronary Artery Bypass(MIDCAB) was intrduced and performed with comparable early outcomes. In this regard the integrated approach with percutaneous coronary intervention and minimally invasive direct coronary artery bypass surgery so called 'Hybrid CABG' was suggested to be an effective treatment in suitable patients with multivessel coronary artery disease. We report three cases of Hybrid CABG.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.834-838
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• 2003

Background: Deairing from the heart after open heart surgery(cardiopulmonary bypass) is a very important procedure. Artificial arteriovenous fistula was used to remove air, and the efficiency was evaluated by transesophageal echocardiography. Material and Method: Just before termination of cardiopulmonary bypass, a standard pressure transducer line is connected between the stopcocks of the connections in the arterial and venous circuits, creating a small controlled arteriovenous fistula between the arterial and venous cannulas. The degree of intracardiac air and air removal time were evaluated either by transesophageal echocardiography or direct vision of pressure transducer line. Result: By simple procedure, cardiopulmonary time was shortened and air clearing can be confirmed using echocardiography in a few minutes. Conclusion: Creation of arteriovenous fistula using small connecting line between aortic and venous cannula is a very simple and effective method of deairing and preventing of air embolism after open heart surgery.

• Journal of Chest Surgery
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• v.25 no.5
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• pp.458-468
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• 1992

With the aid of extracorporeal circulation, nine dogs underwent orthotopic cardiopulmonary transplantation after preservation of the donor heart in a hypothermic amino acid[glutamate, aspartate] enriched high potassium extracellular solution, and preservation of the donor lung with hypothermic low potassium dextran solution from June 1990 to May 1991. The mean body weights of dogs were 20kg and the recipients` preoperative hematologic and hemodynamic pictures were within normal range except slightly decreased level of albumin and total protein, which was supposed to be due to malnutrition. The following modifications of the original Stanford technique were emphasized: [1] the posterior mediastinum is dissected as little as possible with meticulous hemostasis; [2] the surgical procedure is kept away from the phrenic and vagus nerves; [3] the tracheal anastomosis may be wrapped with recipient`s pulmonary artery flap or surrouding soft tissues. A combination of Cyclosporine, Azathioprine, corticosteroid was used as perioperative immunosuppressive therapy. Postoperatively all recipients could be weaned from extracorporeal circulation, showing favorable vital signs, but within 24 hours, irreversible congetive heart failure, ascites, arrhythmias developed with a mean survival time 13.6$\pm$6.6[n=9, range=6~26] hours. Hemoglobin and platelet counts were significantly[p<0.05] decreased postoperatively, which is thought to be attributed to blood damage by cardiopulmonary bypass and hemodilution. Postmortem finding included multiple subendocardial patch hemorrhage in both atrial and ventricular cavities, pulmonary and liver congestion, and all tracheal anastomoses were intact. Further consideration about quality control of the animal, infection, rejection, the effect of cardiopulmonary bypass on the experimental animal is required to improve the results.

• Journal of Chest Surgery
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• v.14 no.1
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• pp.1-8
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• 1981

Alterations in serum enzymes were studied in twenty-five patients who underwent open heart surgery in N.M.C. during the period from June 1979, to Feb. 1980. There were fifteen congenital and ten acquired heart diseases. In all patients, Rygg-Kyvsgaard five head roller pump and Polystan bubble oxygenator were used and serial determination of total level of Creatine phosphokinase [CPK], Lactic dehydrogenase [LDH], Glutamic oxaloacetic transaminase [SGOT] were made preoperatively, operation day [just after aortic clamp release, 2 hrs later, 4 hrs later, 6 hrs later], and postoperative days up to 5th day. Immediate postoperative clinical courses were also evaluated. Twenty-five patients were divided into two groups: Group A[13] was cardiopulmonary bypass time more than 95 minutes and aortic clamp time more than 45 minutes. Group B[12] was cardiopulmonary bypass time less than 95 minutes and aortic clamp time less than 45 minutes. The peak levels of SGOT, LDH in Group A were more significantly elevated than Group B [P<0.05]. But peak levels of CPK were not significant between two groups. In the view of clinical evaluation, poor clinical courses were more frequent in Group A [54%] than Group B[8%].