• Journal of Chest Surgery
• /
• 제52권1호
• /
• pp.16-24
• /
• 2019

Background: Optimal graft selection for coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction remains debatable. We report an analysis of our experiences of isolated CABG in patients with severe LV dysfunction and the impact of graft strategy on long-term outcomes. Methods: We analyzed 209 patients with severe LV dysfunction (ejection fraction [EF] <30%) who underwent primary isolated CABG. Of these, 169 were revascularized with a bilateral internal thoracic arterial (ITA) graft (BITA group) and 40 were revascularized with a single ITA graft (SITA group). The mean follow-up duration was $22{\pm}32$ months. Results: There were 18 early deaths (8.6%). Overall survival at 5 years was 66.7%. The rate of freedom from cardiac-related death at 5 years was 74.1%, and was significantly higher in patients who underwent off-pump CABG (p=0.005) and in the BITA group (p=0.023). Multivariate analysis demonstrated that old age (hazard ratio [HR], 2.548; 95% confidence interval [CI], 1.134-5.762; p=0.024), off-pump CABG (HR, 0.245; 95% CI, 0.090-0.661; p=0.006), and BITA grafts (HR, 0.333; 95% CI, 0.146-0.757; p=0.009) were correlated with cardiac mortality. Conclusion: CABG in patients with severe LV dysfunction (EF <30%) showed reasonable long-term outcomes. The rate of freedom from cardiac-related death was significantly higher in patients who underwent off-pump CABG and in the BITA group. Off-pump BITA grafting strategies can be accepted as a viable primary option in patients with severe LV dysfunction if performed by an experienced surgeon.

• Journal of Korean Biological Nursing Science
• /
• 제9권1호
• /
• pp.5-31
• /
• 2007

Purpose: The purpose of this study was to explore the knowledge and learning needs on cardiac rehabilitation of coronary artery bypass graft(CABG) patients. Method: The subjects consisted of 100 CABG patients at A hospital in Seoul. Data were collected by the two different kind of questionnaires which measure knowledge and learning needs on cardiac rehabilitation of CABG patients. The subjects responded the questionnaire on knowledge before CABG and that on learning needs before their discharge. Result: The mean score of knowledge on cardiac rehabilitation was 68.54. Knowledge on risk factor, nature of disease, diet, daily activity, medication, post operative care were great in order. The mean score of learning needs on cardiac rehabilitation was 4.28. Learning needs on diet, medication, nature of disease, post operative care, daily activity, risk factor were great in order. There were significant differences in knowledge according to occupation, economic status and family history(p=.021, p=.017, p=.023). There was a positive correlation between knowledge and learning needs(r=.3009, p=.002). Conclusion: Level of knowledge on cardiac rehabilitation of CABG patients is low and knowledge on postoperative care is the lowest, and learning needs are great in ail categories.

• Journal of Chest Surgery
• /
• 제54권2호
• /
• pp.117-126
• /
• 2021

Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG. Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison. Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01-5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively). Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

• Journal of Chest Surgery
• /
• 제32권5호
• /
• pp.480-483
• /
• 1999

심폐바이패스와 심정지액을 이용하여 심장을 완전히 정지시킨 상태에서 원위부 관상동맥 문합을 시행하는 방법이 현재 관상동맥우회술에서 널리 사용되고 있다. 하지만, 심정지액을 이용한 심정지하의 관상동맥우회술은, 특히 고위험군 환자에서 수술중 심근의 허혈성 손상을 완전히 배제하지는 못하고 있다. 이런 측면에서 볼 때, 심폐바이패스를 사용치 않는 방법이 관상동맥우회술중 심근의 허혈성 손상을 방지하고 심폐바이패스의 합병증을 줄이기 위한 이상적인 방법이라 할 수 있겠지만, 이는 기술적으로 항상 가능한 것은 아니다. 이에 저자들은 좌심실 구출률이 25%로 좌심실 기능 저하가 심했던 경우와, 경피적 관상동맥확장술 중에 심인성 쇼크가 초래된 경우 등의 고위험군 환자에서 시행한 심폐바이패스하의 심박동상태에서의 관상동맥우회술 2례를 보고하는 바이다

• International Journal of Vascular Biomedical Engineering
• /
• 제3권1호
• /
• pp.1-5
• /
• 2005

Background: Coronary atherosclerosis artery disease is the leading cause of morbidity and mortality. Coronary artery bypass grafting (CABG) which utilizes the saphenous vein graft, has helped in alleviating the suffering of these patients. Newer techniques are being developed to improve upon the techniques. Still there is significant number of failures, leading to re-grafting or re-vascularization. Some studies have helped in identifying the high and low shear stress regions. Further studies based on their realistic models are required. Material, methods and results: we developed the realistic model of fully blocked right coronary with bypass graft placed at angle of $5^0$ with curvature similar to that of artery. Pulsatile flow of birefringent solution through this model by polarized light was visualized. The images of complete flow field in the model were recorded and analyzed. Regions of high flow disturbances which are prone to further changes are identified. Existence of recirculation in the blocked coronary may initiate new blood-tissue interactions deleterious to bypass graft. Conclusion: Our study shows that by selecting the procedure to place bypass graft at minimum angle with curvature similar to that of artery and smooth sutures may improve the life span of the graft. This study also identified that coronary blocked regions contributing by recirculation flow at the proximal and distal regions of bypass which may require further studies.

• Journal of Chest Surgery
• /
• 제37권9호
• /
• pp.749-754
• /
• 2004

심장박동 상태에서 시행하는 관상동맥우회술 (Off-Pump CABG)은 심폐체외순환을 이용한 관상 동맥우회술 (On-Pump CABG)보다 낮은 위험률과 빠른 회복을 가져오는 것으로 알려져 있으며, 특히 수술 전 고위험인자를 가진 환자에서 심폐체외순환의 부작용을 피할 수 있는 이점이 있다. 저자들은 수술 전 고위험인자를 가진 환자들에 있어서 Off-Pump CABG와 On-Pump CABG의 수술성적을 비교하여 고위험군에서 Off-Pump CABG의 효율성에 대해 알아보고자 하였다. 대상 및 방법: 2001년 1월부터 2003년 6월까지 관상동맥우회술만을 시행한 환자 682명(Off-Pump CABG군: 424명, On-Pump CABG: 258명) 중 수술 전 고위험인자를 가진 환자를 대상으로 그 결과를 분석하였다. 수술 전 심장 박출계수 35% 이하, 70세 이상 고령의 환자, 뇌경색의 과거력, 최근 심근경색의 과거력, 과거 관상동맥우회술을 시행받았던 환자, 경동맥 및 말초동맥의 협착, 심부전증의 기왕력이 있는 환자, 신부전증환자 및 만성폐쇄성폐질환 환자 등 9가지 위험인자 중에서 한 가지 이상을 가지고 있는 환자를 고위험군으로 분류하여 대상으로 삼았다. 대상 환자는 Off-Pump CABG군이 192명, On-Pump CABG군이 100명으로, 각 군의 수술 전 위험인자 및 수술 후 결과를 비교하였다. 결과: 남녀 비, 연령 및 수술 전 고혈압 등의 위험요소는 두 군에서 차이를 보이지 않았다. Off-Pump CABG군에서 On-Pump CABG군에 비해 더 많은 동맥편을 사용하였으며, 수술시간, 수술 후 측정한 CK-MB, 뇌경색의 발생률, 강심제사용빈도, 호흡기의 사용시간 및 입원기간이 Off-Pump CABG군에서 통계적으로 유의하게 낮았으며, 이식편수는 On-Pump CABG군에서 유의하게 많았다. 수술 후 사망은 Off-Pump CABG와 On-Pump CABG를 시행 받았던 군에서 각각 0.5% 및 2%로 두 군간의 유의성은 없었으나 Off-Pump CABG를 시행 받았던 군에서 더 낮은 경향을 보여주었다. 그러나 출혈로 인한 재수술, 수술 후 심근경색증, 감염 및 신부전증 등은 두 군간에 통계적 유의성이 없었다. 결론: Off-Pump CABG는 On-Pump CABG 에 비해 수술 후 심근손상을 줄이고, 합병증을 감소시키며 빠른 회복을 보여 주었다. 따라서 고위험 군 환자들의 관상동맥우회술은 Off-Pump CABG로 시행하는 것이 더 좋은 수술방법이 될 것으로 생각한다. 그러나 전향적인 연구 등 더 많은 연구가 필요하리라 생각한다.

• Journal of Chest Surgery
• /
• 제49권3호
• /
• pp.177-184
• /
• 2016

Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Several therapeutic and preventive strategies have been introduced for postoperative AF, but the treatment and prophylaxis of AF remain controversial. We aimed to compare the efficacy of intravenous amiodarone and oral propafenone in the treatment of AF after coronary artery bypass grafting (CABG). Methods: This was a randomized controlled trial performed in two hospitals in Shiraz, Iran from 2009 to 2012. We included all patients who underwent elective CABG and developed AF postoperatively. The patients were randomly assigned to receive propafenone or amiodarone. The duration of AF, the success rate of the treatment, the need for cardioversion, the frequency of repeated AF, and the need for repeating the treatment were compared. Results: The duration of the first (p=0.361), second (p=0.832), and third (p=0.298) episodes of AF, the need for cardioversion (p=0.998), and the need to repeat the first and second doses of drugs (p=0.557, 0.699) were comparable between the study groups. Repeated AF was observed in 17 patients (30.9%) in the propafenone group and 23 patients (34.3%) in the amiodarone group (p=0.704). Conclusion: Oral propafenone and intravenous amiodarone are equally effective in the treatment and conversion of recent-onset AF after CABG.

• Journal of Chest Surgery
• /
• 제49권3호
• /
• pp.171-176
• /
• 2016

Background: A previous percutaneous coronary intervention (PCI) may affect the outcomes of patients who undergo coronary artery bypass grafting (CABG). The objective of this study was to compare the early in-hospital postoperative outcomes between patients who underwent CABG with or without previous PCI. Methods: The present study included 160 patients who underwent isolated elective on-pump CABG at the department of cardiothoracic surgery, Minia University Hospital from January 2010 to December 2014. Patients who previously underwent PCI (n=38) were compared to patients who did not (n=122). Preoperative, operative, and early in-hospital postoperative data were analyzed. The end points of the study were in-hospital mortality and postoperative major adverse events. Results: Non-significant differences were found between the study groups regarding preoperative demographic data, risk factors, left ventricular ejection fraction, New York Heart Association class, EuroSCORE, the presence of left main disease, reoperation for bleeding, postoperative acute myocardial infarction, a neurological deficit, need for renal dialysis, hospital stay, and in-hospital mortality. The average time from PCI to CABG was $13.9{\pm}5.4$ years. The previous PCI group exhibited a significantly larger proportion of patients who experienced in-hospital major adverse events (15.8% vs. 2.5%, p=0.002). On multivariate analysis, only previous PCI was found to be a significant predictor of major adverse events (odds ratio, 0.16; 95% confidence interval, 0.03 to 0.71; p=0.01). Conclusion: Previous PCI was found to have a significant effect on the incidence of early major adverse events after CABG. Further large-scale and long-term studies are recommended.

• Journal of Chest Surgery
• /
• 제56권2호
• /
• pp.99-107
• /
• 2023

Background: The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a novel predictive marker of cardiovascular disease. However, its prognostic role in patients under-going coronary artery bypass grafting (CABG) is unclear. This study aimed to determine the association between the preoperative NLR and early mortality in patients undergoing CABG. Methods: Cardiac surgery was performed in 2,504 patients at Seoul St. Mary's Hospital from January 2010 to December 2021. This study retrospectively reviewed 920 patients who underwent isolated CABG, excluding those for whom the preoperative NLR was unavailable. The primary endpoints were the 30- and 90-day mortality after isolated CABG. Risk factor analysis was performed using logistic regression analysis. Based on the optimal cut-off value of preoperative NLR on the receiver operating characteristic curve, high and low NLR groups were compared. Results: The 30- and 90-day mortality rates were 3.8% (n=35) and 7.0% (n=64), respectively. In the multivariable analysis, preoperative NLR was significantly associated with 30-day mortality (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.17-1.39; p<0.001) and 90-day mortality (OR, 1.17; 95% CI, 1.07-1.28; p<0.001). The optimal cut-off value of the preoperative NLR was 3.4. Compared to the low NLR group (<3.4), the high NLR group (≥3.4) showed higher 30- and 90-day mortality rates (1.4% vs. 12.1%, p<0.001; 2.8% vs. 21.3%, p<0.001, respectively). Conclusion: Preoperative NLR was strongly associated with early mortality after isolated CABG, especially in patients with a high preoperative NLR (≥3.4). Further studies with larger cohorts are necessary to validate these results.

• 한국산학기술학회논문지
• /
• 제19권9호
• /
• pp.146-155
• /
• 2018

본 연구는 허혈성심장질환으로 관상동맥우회술을 받은 환자에서 심폐바이패스 여부에 따른 임상성과를 확인하고자 시행하였다. 연구대상은 2008년 7월부터 2012년 6월까지 4년 동안 허혈성심장질환으로 관상동맥우회술을 받은 환자 전수이며, 총 10,981명이었다. 분석 자료는 건강보험심사평가원 청구명세서를 이용하여 후향적으로 수집하였다. 연구결과, 무심폐기 관상동맥우회술(Off Pump CABG, OPCAB) 환자 그룹이 고식적 관상동맥우회술(On Pump CABG, ONCAB) 환자 그룹에서보다 평균 수술소요시간(280분 vs 357분, p<.0001) 및 기관 내 삽관 후 발관까지 평균 소요시간이 짧았고(약 24시간 vs 40시간, p<.0001), 수술 후 출혈 및 혈종 등으로 인한 재수술률이 낮았다(2.7% vs 8.3%, p<.0001). 위험요인 통제 하에 심폐기 사용 여부에 따른 30일내 사망률과 재원일수를 분석한 결과, 고식적 관상동맥우회술(ONCAB) 대비 무심폐기 관상동맥우회술(OPCAB)의 사망 위험비는 0.339(0.266-0.434)이고, 재원일수는 -0.29229로 감소하였다(p<.0001). 이상의 결과 심폐기를 사용하지 않은 경우에서 30일내 사망률과 재수술률이 낮았고, 평균 수술소요시간, 기관 내 삽관 후 발관까지 소요시간, 재원일수가 짧았음을 확인하였다.