• Journal of Chest Surgery
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• v.27 no.6
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• pp.460-471
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• 1994

Between Feb. 1990 and Aug. 1993, 180 cases of the open heart surgery were performed under cardiopulmonary bypass in the Department of Thoracic & Cardiovascular surgery, Gil General Hospital. There were 83 cases with congenital heart diseases [CHD] and 97 cases with acquired heart diseases [AHD]. The CHD consisted of 78 acyanotic[mortality: 3.8 %] and 5 cyanotic cases with heart anomaly[mortality:l case]. The AHD were 97 cases, which contained 53 valvular, 27 ischemic heart diseases, 10 aortic diseases, 5 cases with myxoma, 1 case with post-infarct VSD, and 1 case with removal of infected pacing wire in right ventricle. In the 53 valvular heart diseases, there were 45 cases with valve replacement[MVR 27, AVR 9,MVR + AVR 9] and 8 cases with valvuloplasty. The number of the implanted prosthetic valves were 53. In MVR, 25 St. Jude, 6 Sorin, 3 Carpentier-Edward and 2 Intact medical valves were used. In aortic position, 13 St. Jude, 3 Sorin and 1 Intact medical valves were applied. The operative mortality was 5.6 % [3/53]. The annuloplasty applying artificial ring was performed in 17 patients[4 cases associated with MVR] and the number of the implanted ring was 19, which included 14 Duran ring[10 mitral, 4 tricuspid] and 5 Carpentier ring [3 mitral, 22 tricuspid]. In the 27 ischemic heart diseases, there were 9 cases with left main coronary artery lesions, 7 one vessel, 5 two vessels, and 6 three vessels. Average number of anastomosis was 2.8 per patient. The operative mortality was 14.3 % [4/27]. Among the 10 patients with aortic diseases, 7 cases were aortic dissection[type A: 5, type B: 2] and 3 cases were descending thoracic aortic aneurysm. The operative morality occurred in 3 cases. The overall mortality and the operative mortality of congenital and acquired heart disease was 7.8 %, 4.8% and 10.4%, respectively.

• Journal of Chest Surgery
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• v.17 no.1
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• pp.48-52
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• 1984

Total anomalous pulmonary venous connection [TAPVC] defines a group of congenital heart disease which have in common the entire pulmonary venous drainage returning directly or indirectly to the right atrium instead of to the left atrium. Although this disorder represents only 1.3% of cases of congenital heart disease, if untreated the resultant mortality is greater than 80% in the 1st year of life. And since there is no satisfactory palliative treatment, correction of TAPVC Is high on the list of indications for open heart surgery in the 1st year of life. This paper describes 10 patients who underwent surgical correction of this disorder at SNUH between 1978 and 1983. 1. 7 were males and 3 females, with ages ranging from 5 months to 24 years. 2. 7 were supracardiac type, 2 cardiac type, and 1 mixed type TAPVC. We didnt experience infracardiac type. 3. All showed some degree of pulmonary hypertension preoperatively. 4. In 4 cases of supracardiac type, total circulatory arrest was used in brief period during anastomosis between common pulmonary venous trunk and left atrium. In the other cases, usual cardiopulmonary bypass with moderate to deep hyperthermia was used. 5. There were 2 cases of mortality; 1 died at operation, and the other at 4 months due to congestive heart failure. 6. Mortality seemed not closely related to age, body weight, or severity of pulmonary hypertension.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.122-127
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• 1994

A retrospective study of 737 consecutive patients surviving the first 24 hours who underwent valve replacement surgery from July 1980 to June 1993 was undertaken to determine the prevalence, variables that could be used to predict outcome and results of therapy for postoperative acute renal failure[ARF]. Twenty-one patients[2.8 %] developed acute renal failure. Positive risk factors noted in the development of postoperative renal failure included age, New York Heart Association class III & IV, endocarditis and elevated preoperative concentration of serum creatinine. The duration of cardiopulmonary bypass, aortic cross-clamping and the total duration of the operation also closely correlated with the incidence of ARF. The mortality rate for established ARF was 38.1% and ARF was associated with a significant increase in the length of hospitalization, ventilator support and intensive care unit stay. The incidence and mortality rate of oliguric renal failure was 38.1% and 85.7%. The highest mortality rate was associated with two or more postoperative complications and serum creatinine value exceeded 5 mg/dl. We concluded that therapy should be aimed at prevention of oliguric renal failure, or at least its conversion to nonoliguric renal failure, and early institution of renal replacement therapy with intensive support probably gives the best chance for survival.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.232-239
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• 1992

Acute renal failure is a well known serious complication following open heart surgery and is associated with a significant increase in morbidity and mortality rate. From 1984 to 1990, 33 patients who had acute renal failure following cardiopulmonary bypass received renal replacement therapy. PD[Peritonial dialysis] was employed in 11 patients and CAVH[continous arteriovenous hemofiltration] was employed in 22 patients. Their age ranged from 3 months to 64 years[mean 25.5$\pm$7.8 years]. The disease entities included congenital cardiac anomaly in 18, valvular heart disease in 15 and aorta disease in 2 cases. Low cardiac output was thought as a primary cause of ARF except two redo valve cases who showed severe Aemolysis k depressed renal function preoperatively. Mean serum BUN and creatinine level at the onset renal replacement therapy were 65$\pm$8 mg/dl and 3.5$\pm$0.4 mg/dl respectively, declining only after reaching peak level 7&10 days following the onset of therapy. Overall hospital mortality was 72.7%[24/33]; 81%[9/11] in PD group and 68.2% [15/22] in CAVH group respectively. The primary cause of death was low cardiac output & hemodynamic depression in all the cases. The fatal complications included multiorgan failure in 7, disseminated intravascular coagulation and sepsis in 6, neurologic damage in 4 and mediastinitis in 3 cases. No measurable differences were observed between CAVH and PD group upon consequence of acute renal failure and disease per se. The age at operation, BUN/Cr level at the onset of bypass and highest BUN/Cr level and the consequence of low output status were regarded as important risk factors, determining outcome of ARF and success of renal replacement therapy. Thus, we concluded that althoght the prognosis is largely determined by severity of low cardiac output status and other organ complication, early institution of renal replacement therapy with other intensive supportive measures could improve salvage rate in established ARF patients following CPB.

• Journal of Chest Surgery
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• v.24 no.7
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• pp.647-655
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• 1991

The efficacy of cold blood potassium cardioplegia during periods of ischemic arrest was assessed in 88 patients undergoing open heart surgical procedures at Chonnam National University Medical School from December, 1987 to January, 1989. The purpose of this study was to determine if the aortic cross clamping time[ACCT] over 120 minutes correlated with operative mortality, incidence of postoperative ventricular tachyarrhythmias, needs of postoperative inotropic support and serum enzyme levels. The patients were divided according to aortic cross clamping time[less than 120 minutes and 120 minutes or greater]. The results were as follows: 1. The operative mortality was 3.2% in ACCT<120min group and 7.7% in ACCT>120 min group. 2. The incidence of postoperative ventricular tachyarrhythmia was 1.6% in ACCT <120min group and 11.5% in ACCT>120min group[p<0.05]. 3. The incidence of postoperative inotropic support in congenital heart disease was 13.0Fo in ACCT<120min group and 45.0%o in ACCT>120min group[p<0.05]. The incidence in acquired heart disease was 26.0% in ACCT<120min group and 40.0% in ACCT> 120min group. 4. After cardiopulmonary bypass, serum GOT, LDH, CPK and CPK - MB were elevated prominently. Children showed higher value of the enzymes examined than adults did before and after cardiopulmonary bypass. In congenital heart diseases, postoperative serum GOT, LDH, CPK and CPK - MB levels of ACCT>120min group were significantly higher than those of ACCT<120min group. Postoperative serum GOT, LDH and CPK - MB levels of ACCT>=120min group were significantly higher than those of ACCT<120min group also in acquired heart diseases. The results suggest that the myocardial protective effect with cold blood potassium cardioplegic solutions was not sufficient when the aortic cross clamping time was over 120 minutes.

• Journal of Chest Surgery
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• v.57 no.4
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• pp.380-386
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• 2024

Background: Type A aortic dissection (AD) and intramural hematoma (IMH) are critical medical conditions. Emergency surgery is typically performed under cardiopulmonary bypass immediately after diagnosis, which involves lowering the body temperature to induce total circulatory arrest. Selection of the arterial cannulation site is a critical consideration in cardiac surgery and becomes more challenging in patients with AD. This study explored the strengths and weaknesses of different cannulation methods by comparing each cannulation strategy and analyzing the reasons for patients' outcomes, especially mortality and cerebrovascular accidents (CVAs). Methods: This retrospective study reviewed the medical records of patients who underwent surgery for type A AD or IMH between 2008 and 2023, using the moderate hypothermic circulatory arrest approach at a single center. Results: Among the 146 patients reviewed, 32 underwent antegrade cannulation via axillary, innominate artery, aortic, or transapical cannulation, while 114 underwent retrograde cannulation via the femoral artery. The analysis of surgical outcomes revealed a significant difference in the total surgical time, with 356 minutes for antegrade and 443 minutes for retrograde cannulation (p<0.001). The mean length of stay in the intensive care unit was significantly longer in the retrograde group (5±16 days) than in the antegrade group (3±5 days, p=0.013). Nevertheless, no significant difference was found between the groups in the 30-day mortality or postoperative CVA rates (p=0.2 and p=0.7, respectively). Conclusion: Surgeons should consider an appropriate cannulation strategy for each patient instead of adhering strictly to a specific approach in AD surgery.

• Journal of Chest Surgery
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• v.46 no.6
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• pp.444-448
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• 2013

Background: We aimed to investigate the preoperative, operative, and postoperative factors affecting intra-aortic balloon pump (IABP) insertion in patients undergoing isolated on-pump coronary artery bypass grafting (CABG). We also investigated factors affecting morbidity, mortality, and survival in patients with IABP support. Methods: Between January 2002 and December 2009, 1,657 patients underwent isolated CABG in Izmir Katip Celebi University Ataturk Training and Research Hospital. The number of patients requiring support with IABP was 134 (8.1%). Results: In a multivariate logistic regression analysis, prolonged cardiopulmonary bypass time and prolonged operation time were independent predictive factors of IABP insertion. The postoperative mortality rate was 35.8% and 1% in patients with and without IABP support, respectively (p=0.000). Postoperative renal insufficiency, prolonged ventilatory support, and postoperative atrial fibrillation were independent predictive factors of postoperative mortality in patients with IABP support. The mean follow-up time was $38.55{\pm}22.70$ months and $48.78{\pm}25.20$ months in patients with and without IABP support, respectively. The follow-up mortality rate was 3% (n=4) and 5.3% (n=78) in patients with and without IABP support, respectively. Conclusion: The patients with IABP support had a higher postoperative mortality rate and a longer length of intensive care unit and hospital stay. The mid-term survival was good for patients surviving the early postoperative period.

• Journal of Chest Surgery
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• v.52 no.2
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• pp.78-84
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• 2019

Background: Pulmonary thromboembolism (PTE) is a life-threatening disease with high mortality. This study aimed to assess the outcomes of surgical embolectomy and to clarify the sustained long-term effects of surgery by comparing preoperative, postoperative, and long-term follow-up echocardiography outcomes. Of 22 survivors, 21 were followed up for a mean (median) period of $6.8{\pm}5.4years$ (4.2 years). Methods: We retrospectively reviewed 27 surgical embolectomy cases for massive or submassive acute PTE from 2003 to 2016. Immediate and long-term follow-up outcomes of surgical embolectomy were assessed on the basis of 30-day mortality, long-term mortality, postoperative complications, right ventricular systolic pressure, and tricuspid regurgitation grade. Results: The 30-day and long-term mortality rates were 14.8% (4 of 27) and 4.3% (1 of 23), respectively. Three patients had major postoperative complications, including hypoxic brain damage, acute kidney injury, and endobronchial b leeding, respectively (3.7% each). Right ventricular systolic pressure (median [range], mm Hg) decreased from 62.0 (45.5-78.5) to 31.0 (25.7-37.0, p<0.001). The tricuspid valve regurgitation grade (median [range]) decreased from 1.5 (0.63-2.00) to 0.50 (0.50-1.00, p<0.05). The improvement lasted until the last echocardiographic follow-up. Conclusion: Surgical embolectomy revealed favorable mortality and morbidity rates in patients with acute massive or submassive PTE, with sustained long-term improvements in cardiac function.

• Child Health Nursing Research
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• v.26 no.4
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• pp.454-462
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• 2020

Purpose: Sudden unexplained infant death (SUID) is a major contributor to infant mortality, and pediatric nurses have the responsibility to educate parents on SUID-reducing strategies. This study was conducted to measure pediatric nurses' knowledge of SUID-related safe sleep practices (K-SSSP) and infant cardiopulmonary resuscitation (K-ICPR). Methods: In total, 136 pediatric nurses were administered a survey including K-SSSP (13 items), K-ICPR (5 items), confidence in K-SSSP education (1 item; 5 points), and other factors relating to SUID experiences or education. Results: The correct answer rates of the K-SSSP and K-ICPR were 62.6% and 62.5%, retrospectively. The mean score for confidence in K-SSSP education was 2.6±0.9. Only 18 nurses (13.2%) responded that they educated parents on the content of the K-SSSP, while 76 nurses had received education on SUID. Positive relationships were observed between K-SSSP scores and higher education, between K-ICPR scores and having own child(ren) and clinical experience, and between confidence in K-SSSP education and higher education or having one's own child(ren). Nurses caring for newborns performed more SUID education than nurses working in other units. Conclusion: There is a profound need to implement a systemic educational program on SUID and strategies to reduce SUID for pediatric nurses.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.227-230
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• 2002

The vasodilatory shock after cardiopulmonary bypass is defined as the condition involving severe and persistent form of hypotension, tachycardia, normal or increased cardiac output and decreased systemic vascular resistance. Because of the unsuccessful response to infusion of fluids or catecholamine vasopressors, a sustained systemic shock state occurs and results in a high morbidity and mortality. We successfully treated this syndrome of 3 patients after open heart surgery with low dose of arginine vasopressin(AVP). Therefore, we report these cases with a review of related articles.