• Journal of Chest Surgery
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• v.53 no.1
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• pp.8-15
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• 2020

Background: We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. Methods: Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity-matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group). Results: Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group. Conclusion: A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications.

• Journal of Preventive Medicine and Public Health
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• v.57 no.3
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• pp.260-268
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• 2024

Objectives: Regional disparities in cardiovascular care in Korea have led to uneven patient outcomes. Despite the growing need for and access to procedures, few studies have linked regional service availability to mortality rates. This study analyzed regional variation in the utilization of major cardiovascular procedures and their associations with short-term mortality to provide better evidence regarding the relationship between healthcare resource distribution and patient survival. Methods: A cross-sectional study was conducted using nationwide claims data for patients who underwent coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), stent insertion, or aortic aneurysm resection in 2022. Regional variation was assessed by the relevance index (RI). The associations between the regional RI and 30-day mortality were analyzed. Results: The RI was lowest for aortic aneurysm resection (mean, 26.2; standard deviation, 26.1), indicating the most uneven regional distribution among the surgical procedures. Patients undergoing this procedure in regions with higher RIs showed significantly lower 30-day mortality (adjusted odds ratio [aOR], 0.73; 95% confidence interval, 0.55 to 0.96; p=0.026) versus those with lower RIs. This suggests that cardiovascular surgery regional availability, as measured by RI, has an impact on mortality rates for certain complex surgical procedures. The RI was not associated with significant mortality differences for more widely available procedures like CABG (aOR, 0.96), PCI (aOR, 1.00), or stent insertion (aOR, 0.91). Conclusions: Significant regional variation and underutilization of cardiovascular surgery were found, with reduced access linked to worse mortality for complex procedures. Disparities should be addressed through collaboration among hospitals and policy efforts to improve outcomes.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.433-437
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• 1999

Background: Left main coronary artery (LMCA) angioplasty is another option in the surgical treatment for LMCA disease because of its advantages over the conventional coronary artery bypass grafting (CABG). Material and Method: Between July 1994 and December 1997, 15 patients underwent left main coronary angioplasty for the stenoses of LMCA. There were 8 males and 7 females with the mean age of 53.3${\pm}$8.8 years. The locations of the LMCA stenoses were proximal one-third of the LMCA in 9, middle one-third in 1, distal one-third in 3, and the whole length of the LMCA in 2 cases. Nine patients had peripheral coronary lesions in addition to the LMCA stenosis. The LMCA was approached anteriorly with or without transsection of the main pulmonary artery. The angioplasty was performed with onlay patch widening using an autologous pericardium (14 cases) or saphenous vein (1 case). Additional graftings were required in 9 cases, and both LMCA angioplasty and right coronary ostial angioplasty were done in 1 case. Result: There was no operative mortality. One case needed redo CABG due to the stenosis of the angioplasty site which developed 4 months postoperatively. Coronary angiography was performed in 8 cases one year postoperatively, and revealed good patency of the angioplasty site except for one who showed 50% stenosis at the angioplasty site. No patient complained of angina with a mean follow up of 23${\pm}$11 months. Conclusion: Surgical angioplasty of the LMCA stenosis can be performed in selected cases with safety and good mid-term results.

• Journal of Chest Surgery
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• v.39 no.1 s.258
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• pp.28-34
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• 2006

Background: There has been an increase in the number of elderly patients considered for coronary artery bypass grafting (CABG). Recently, there were many satisfactory reports of coronary artery bypass grafting (CABG) in old age due to the development in operative technique and postoperative management. We evaluated operative and follow-up results of patients 70 years of age and older compared to 60 years old. Material and Method: We retrospectively studied the cases of 74 consecutive patients 70 years or older (group A) who underwent a elective CABG from January 2000 to December 2003 and compared that of relatively young age group (group B, 60-69 years old). We compared preoperative characteristics, operation technique, postoperative results that effect outcome, also we investigated late mortality and cardiac events at follow-up periods. Result: Preoperative demographic and clinical characteristics of two groups were not different, except preoperative renal dysfunction(serum creatinine: $\geq$1.4 mg/dl) (group A 17, 23$\%$ vs group B 14, 9$\%$) (p=0.024). There was no difference of the mean number of distal anastomosis and the left ventricular ejection fraction in group A decreased significantly from 53.7$\pm$13$\%$ preoperatively to 49.9$\pm$ 12$\%$ postoperatively (p=0.02), but not changed in group B. There was no difference at operative mortality rate and postoperative major morbidity rate, but wound problem of saphenous vein harvest site was significantly higher in group A than group B (6.8$\%$ vs 0.7$\%$, p=0.02). The mean follow up duration was 24.3$\pm$13 months and the cumulative survival were 95.4$\%$ at 2 year and 79.9$\%$ at 4 year in group A and 95.4$\%$ at 2 year and 90.1$\%$ at 4 year in group B (p=ns). Conclusion: We conclude that age is not a factor of determination when we decide about operation because coronary artery bypass grafting in elderly more than 70 years old can be performed with a low mortality rate and acceptable morbidity rate.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.776-780
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• 1998

Background: In patients with coronary artery disease, dysfunctional hypoperfused myocardium at rest may represent either nonviable or viable hibernating myocardium. Two-dimensional echocardiography can detect regional wall motion abnormalities resulting from myocardial ischemia by dobutamine infusion. The purpose of the present study was to identify the prediction of improvement of regional left ventricular(LV) function after surgical revascularization. Materials and methods: Sixteen patients with chronic regional LV dysfunction underwent dobutamine stress echocardiography(DSE) (dobutamine: baseline, 5, 10, 20$\mu$g/kg/min) before coronary artery bypass grafting(CABG) and underwent echocardiography at least 2 months after CABG. Results: All patients were male with mean age of 58 years ranging from 42 to 73 years. The mean LV ejection fraction was 41.8% with a range from 19% to 55%. During DSE, there were no complications, also, there were no operative morbidities or mortalities. Improvement of wall motion within the dysfunctional myocardium was found in 8(50%) of 16 patients in DSE. Among them, 6 patients(75%) showed functional recovery after CABG. Another 8 patients did not show improvement of wall motion in DSE. But among them, 3 patients(38%) showed functional recovery after CABG. 84 dysfunctional segments were found in 256 segments of 16 patients. Improvement of wall motion was found in 34 of 84 segments in DSE. Among them, 23 segments(74%) showed functional recovery after CABG. Another 53 segments did not show improvement of wall motion in DSE. But among them, 12 segments(23%) showed functional recovery after CABG. The sensitivity and specificity of DSE for the prediction of postoperative improvement of segmental wall motion were 66% and 84%, respectively. The positive and negative predictive value of DSE were 74% and 77%, respectively. In patients with chronic regional LV dysfunction, think that DSE is a good predictor of the improvement of dysfunctional segments after CABG.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.22-27
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• 2009

Background: Coronary artery bypass grafting (CABG) is the standard surgical treatment for coronary artery disease. Although there are many clinical reviews of the long term results after CABG in the Western countries, not many such studies have been done for Korea. Therefore, we reviewed the long term clinical results for the patients who underwent CABG at our hospital. Material and Method: We retrospectively reviewed the medical records of 342 patients who underwent CABG at our hospital from February 1984 to December 2006, which is when CABG was first performed in our institution. A total of 286 patients (83.6%) were able to be followed-up, and the mean follow-up period was $75.7{\pm}46.1$ months. Result: The early mortality rate was 5.6%, and late mortality rate was 23.1%. The one-year survival rate, the five-year survival rate, the ten-year survival rate and the fifteen-year survival rate were 91.5%, 82.1%, 60.7% and 50.0%, respectively. The survival rate was significantly lower for the patients over the age of 60 (p=0.002) and for those with diabetes mellitus (p=0.000), hypertension (p=0.002), multivessel disease (p=0.006) and left ventricular dysfunction (p=0.015). No significant difference was observed between the genders. Multivariate analysis showed that the statistically significant risk factors were diabetes mellitus (p=0.001), age (p=0.005) and those cases for which the left internal thoracic artery was not used (p=0.037). Conclusion: CABG is the effective method of treatment for coronary artery disease. Therefore, active usage of the internal thoracic artery and appropriate medical treatment after surgery, and especially for diabetes mellitus patients, are mandatory for achieving good long-term survival.

• Journal of Chest Surgery
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• v.34 no.12
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• pp.901-908
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• 2001

Background : Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. Material and Methold : Clinical data of 31(4.1％) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98％) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84％) and first degree of Rentrop classification(16 cases, 52％) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9${\pm}$0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7${\pm}$3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9 ${\pm}$ 1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysrmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5% . Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5${\pm}$11.6%, p 0.001) as compared with preoperative left ventricular ejection fraction(25.3${\pm}$2.3%). The follow up period of out patient was 25. 3 months. Conclusion: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.

• Journal of Chest Surgery
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• v.48 no.1
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• pp.33-39
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• 2015

Background: This study aimed to investigate sternal healing over time and the incidence of poor sternal healing in patients undergoing coronary artery bypass graft (CABG) surgery using bilateral internal thoracic arteries. Methods: This study enrolled 197 patients who underwent isolated CABG using skeletonized bilateral internal thoracic arteries (sBITA) from 2006 through 2009. Postoperative computed tomography (CT) angiography was performed on all patients at monthly intervals for three to six months after surgery. In 108 patients, an additional CT study was performed 24 to 48 months after surgery. The axial CT images were used to score sternal fusion at the manubrium, the upper sternum, and the lower sternum. These scores were added to evaluate overall healing: a score of 0 to 1 reflected poor healing, a score of 2 to 4 was defined as fair healing, and a score of 5 to 6 indicated complete healing. Medical records were also retrospectively reviewed to identify perioperative variables associated with poor early sternal healing. Results: Three to six months after surgery, the average total score of sternal healing was $2.07{\pm}1.52$ and 68 patients (34.5%) showed poor healing. Poor healing was most frequently found in the manubrium, which was scored as zero in 72.6% of patients. In multivariate analysis, the factors associated with poor early healing were shorter post-surgery time, older age, diabetes mellitus, and postoperative renal dysfunction. In later CT images, the average sternal healing score improved to $5.88{\pm}0.38$ and complete healing was observed in 98.2% of patients. Conclusion: Complete sternal healing takes more than three months after a median sternotomy for CABG using sBITA. Healing is most delayed in the manubrium.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.861-866
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• 1996

Surgical angioplasty of isolated stenosis of the left main coronary artery(LMCA) restores a more physiologic flow to the myocardium, allows percutdneous transluminal coronary angioplasty (PTCA) of distal coronary stenoses at a later stage, and is a less time consuming and convenient procedure than the conventional coronary artery bypass grafting(CABG) . Between Jul. 1994 and Dec. 1995, 7 surgical angioplasty had been performed. LMCA stenoses involved ostium in 2 patients, middle third in 3, and dis- tal third in 2. In 2 patients, the origin of left anterior descending coronary artery was involved in conjunction with LMCA. T e additional coronary artery stenoses were found in 2 cases. One patient was emergently operated after coronary angiography following his cardiac arrest. LMCA was approached anteriorly in all patients. The pulmonary artery was transected in 3 patients for a better exposure. The onlay patch consisted or autologous or bovine pericardium. There was no postoperative myocardial infarction or mortality. Left ventricular functions were well preserved in all patients. Postoperative coronary angiography revealed widely patent LMCA in 5 cases, and mild narrowing of distal anastomotic sites in 2 cases. Provided that well defined indications are followed correctly, surgical angioplasty can be a safe alternative to conventional CABG.

• Journal of Chest Surgery
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• v.46 no.4
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• pp.289-292
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• 2013

Through the use of a dual chamber (DDD) pacemaker, we achieved a cardiac resynchronization effect in a 51-year-old female patient who was transferred to our hospital from another hospital for an operation for three-vessel coronary artery disease. Her electrocardiogram showed a left bundle branch block (LBBB) and a prolonged QRS interval of 166 milliseconds. Severe left ventricle (LV) dysfunction was diagnosed via echocardiography. Coronary artery bypass grafting (CABG) was then performed. In order to accelerate left atrial activation and reduce the conduction defect, DDD pacing using right atrial and left and right ventricular pacing wires was initiated postoperatively. The cardiac output was measured immediately, and one and twelve hours after arrival in the intensive care unit. The cardiac output changed from 2.8, 2.4, and 3.6 L/min without pacing to 3.5, 3.4, and 3.5 L/min on initiation of pacing. The biventricular synchronization using DDD pacing was turned off 18 hours after surgery. She was transferred to a general ward with a cardiac output of 3.9 L/min. In patients with coronary artery disease, severe LV dysfunction, and LBBB, cardiac resynchronization therapy can be achieved through DDD pacing after CABG.