• Journal of Chest Surgery
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• v.30 no.12
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• pp.1190-1196
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• 1997

Between July 1994 and August 1995, 78 patients underwent coronary artery bypass graft at Seoul National University Hospital. Coronary angiogram was performed one year after coronary artery bypass graft in 49 patients(62.8%) for evaluation of the graft patency and analysis of the risk factors for graft occlusion. The patency rates of both the internal mammary artery and the radial artery grafts were 100% , although three internal mammary artery grafts(5.0%) were narrowed(string sign). And that of the saphenous vein grafts were 85.2%. Multivariate analysis for the preoperative, operative, and postoperative factors was done between the widely patent and the narrowed internal mammary artery graft groups, and between the patent and the occluded saphenous vein graft groups by the general linear models procedure. Patient's age($\geq$60 years), postoperative intraaortic balloon pump insertion, bleeding, and acute renal failure were found to be the significant risk factors for internal mammary artery graft narrowing, and coronary artery size(< 1.5 mm) was the significant risk factor for the saphenous vein graft occlusion (p<0.05) . This study confirms that the arterial graft is superior to the vein graft at one-year patency rate, and suggests the risk factors for graft occlusion during the first postoperative year. Knowledge of this study may provide a basis for estimating the risk factors for graft occlusion, and thereby modifying surgical strategy and postoperative surveillance.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.307-314
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• 1992

The internal mammary artery has been advocated for use in bypass grafting owing to its superior long-term patency when compared to saphenous vein grafts. Concern exists that the flow through internal mammary artery may be inadequate during periods of peak myocardial demand when the internal mammary artery graft was used for proximal left anterior descending artery stenosis. This flow adequacy was investigated in 13 consecutive patients with a mean proximal left anterior descending artery stenosis of 84.2% who were selected for coronary bypass using internal mammary artery. We checked flow and diameter of left internal mammary artery without intraluminal dilatation just before anastomosis to left anterior descending artery during cardiopulmonary bypass. Clinical results were evaluated postoperatively with clinical symptoms, echocardiographies, stress tests, and coronary angiographies. The mean internal mammary artery flow measured just before anastomosis was 38ml/ min[range of 20 to 80ml /min] and its mean internal diameter 1.4mm. Maximal workload was improved from preoperative value of 6.3$\pm$2.5METS to postoperative value of 9.1$\pm$1.4 METS in 9 patients who Paired-test can be used. Cardiac symptoms recurred in two patients after bypass surgery, but they were not related to left internal mammary artery grafts. All patients were discharged in postoperatively 9.3 days[range of 7 to 20 days] after operation without mortality. Thus, on the basis of these findings, the internal mammary artery is a reasonable graft that we can routinely use for proximal left descending artery stenosis if internal diameter of the internal mammary artery is more than 1.0mm and its flow is more than 20ml /min at mean arterial pressure of 50 to 60mmHg during cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.33 no.5
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• pp.428-431
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• 2000

In the mid 1980's, the ITA(internal thoracic artery) graft was clearly recognized to be superior to the sapheonous vein graft in respect to long term patency. Therefore, there has been growing interest in the arterial conduit with the possibility of improving the long term result. We have been performing CABG with GEA since 1998 with the same purpose. For mid-term and long-term follow up, we have been performing postoperative coronary angiography. In this paper, a case of GEA spasm, a purported drawback of this conduit, during postoperative coronary anigiography and relieved by direct infusion of 200$\mu\textrm{g}$ isoket into the GEA is reported. The current case which exemplifies the spastic nature of RGEA is accompanied with coronary angiography.

• Journal of Chest Surgery
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• v.52 no.1
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• pp.16-24
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• 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 Chest Surgery
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• v.38 no.3 s.248
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• pp.191-196
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• 2005

We analysed the characteristics of anastomotic sites after coronary artery bypass grafting (CABG) using coronary angiographies (CAGs) performed at one and five years postoperatively in the same patient population. Material and Method: Among the 219 patients who underwent isolated CABGs between January 1995 and December 1997, follow-up coronary angiograms were performed in 149 ($75.3\%$) patients at one year and in 115 ($58.1\%$) patients at five years postoperatively. FitzGibbon grading system was used to evaluate the anastomotic sites. Result: The patency rates of arterial grafts at one- and five-year were $96.5\%$ (192/199) and $93.1\%$ (134/144), which were higher than those of saphenous vein grafts (SVGs) ($82.9\%$ (224/270) and $77.5\%$ (141/182), respectively) (p=0.01). Although there were significant decreases in the patency rates between one- and five-year CAGs of both arterial and venous grafts, the proportion of FitzGibbon grade B among the SVGs was increased from $5.2\%$ (one-year) to $8.2\%$ (five-year), suggesting the progression of vein graft disease (p < 0.01). Conclusion: The patency rate of the arterial graft was higher than that of SVG in both one- and five-year CAGs. The attrition rate of saphenous vein graft was higher than arterial grafts.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.354-358
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• 2006

Background: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of $T-PLS^{TM}$ through the comparison of clinical effects of $T-PLS^{TM}$ (pulsatile pump) and $Bio-pump^{TM}$ (non-pulsatile pump) used for coronary bypass surgery. Material and Method: The comparison was made on 40 patients who had coronary bypass using $T-PLS^{TM}\;and\;Bio-pump^{TM}$ (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. Result: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with $T-PLS^{TM}\;(46{\pm}15\;mmHg\;in\;T-PLS^{TM}\;vs\;35{\pm}13\;mmHg\;in\;Bio-pump^{TM},\;p<0.05)$. The $T-PLS^{TM}$-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant $(9.7{\pm}3.9\;cc/min\;in\;T-PLS^{TM}\;vs\;8.9{\pm}3.6\;cc/min\;in\;Bio-pump^{TM},\;p=0.20)$. There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with $T-PLS^{TM}\;(24.5{\pm}21.7\;mg/dL\;in\;T-PLS^{TM}\;versus\;46.8{\pm}23.0mg/dL\;in\;Bio-pump^{TM},\;p<0.05)$. There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with $T-PLS^{TM}$, but the death rate was not statistically significant. Conclusion: Coronary bypass was operated with $T-PLS^{TM}$ (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which $Bio-pump^{TM}$ was used. In addition, $T-PLS^{TM}$ used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of $T-PLS^{TM}$.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.115-122
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• 2011

Background: The intramural coronary artery has been known as a risk factor for early death after an arterial switch operation (ASO). We reviewed the morphological characteristics and evaluated the early and mid-term results of ASO for patients with an intramural coronary artery. Materials and Methods: From March 1994 to September 15th 2010, 158 patients underwent ASO at Dong-A and Pusan National University Hospitals for repair of transposition of the great arteries and double outlet right ventricle. Among these patients, 14 patients (8.9%) had an intramural coronary artery. Mean age at operation was $13.4{\pm}10.2$ days (4 to 39 days) and mean body weight was $3.48{\pm}0.33$ kg (2.88 to 3.88 kg). All patients except one were male. Eight patients had TGA/IVS and 4 patients had an aortic arch anomaly. Two patients (14.3%) had side-by-side great artery relation, of whom one had an intramural right coronary artery and the other had an intramural left anterior descending coronary artery. Twelve patients had anterior-posterior relation, all of whom had an intramural left coronary artery (LCA). The aortocoronary flap technique was used in coronary transfer in 8 patients, of whom one patient required a switch to the individual coronary button technique 2 days after operation because of myocardial ischemia. An individual coronary button implantation technique was adopted in 6, of whom 2 patients required left subclavian artery free graft to LCA during the same operation due to LCA injury during coronary button mobilization and LCA torsion. Results: There was 1 operative death (7.1%), which occurred in the first patient in our series. This patient underwent an aortocoronary flap procedure for coronary transfer combining aortic arch repair. Overall operative mortality for 144 patients without an intramural coronary artery was 13.2% (19/144). There was no statistical difference in operative mortality between the patients with and without an intramural coronary artery (p>0.1). There was no late death. The mean follow-up duration was $52.1{\pm}43.0$ months (0.5 to 132 months). One patient who had a subclavian artery free graft required LCA stenting 6.5 years after surgery for LCA anastomotic site stenosis. No other surviving patient needed any intervention for coronary problems. All patients had normal ventricular function at latest echocardiography and were in NYHA class 1. Conclusion: The arterial switch operation in Transposition of Great Arteries or Double Outlet Right Ventricle patients with intramural coronary can be performed with low mortality; however, there is a high incidence of intraoperative or postoperative coronary problems, which can be managed with conversion to the individual coronary button technique and a bypass procedure using a left subclavian free graft. Both aortocoronary flap and individual coronary button implantation techniques for coronary transfer have excellent mid-term results.

• Clinical and Experimental Pediatrics
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• v.51 no.5
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• pp.462-467
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• 2008

Kawasaki disease is a systemic vasculitis of unknown etiology, usually occurring in infants and young children. Although the etiology of Kawasaki disease remains uncertain, its serious complicationssuch as giant aneurysm formation, coronary arterial stenotic lesions, and thrombotic occlusionhave been proven to cause myocardial ischemia or infarction in patients with Kawasaki disease. To prevent and treat these complications, several modes of therapyincluding long-term anticoagulation, interventional catheterization, and surgical treatmenthave been gradually developed. In this article, we review the cardiovascular complications following Kawasaki disease and the management thereof, which includes thrombolytic therapy, catheter intervention, and coronary artery bypass graft.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.551-556
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• 2005

Background: Complete arterial off-pump coronary artery bypass grafting (OPCAB) by sequential anastomoses with one or two arterial grafts provides favorable outcomes. However, problems of insufficient graft length, hypopefusion, kinking of graft, and unfavorable course of graft may be encountered. To solve these problems, we have used different technique with multiple arterial Y composite graft to allow end-to-side rather than sequential anastomoses and evaluated the results of this method. Material and Method: Between February 2003 and October 2004, If patients underwent total arterial OPCAB using multiple arterial V composite grafts with left internal mammary artery (LIMA), radial artery (RA), and right internal mammary artery (RIMA). We divided RA into multiple segments by number of distal target site after measuring of individual proper length and constructed arterial composite graft. One of segments was sutured end-to-side to LIMA and other segment was sutured end-to-side to the previously constructed radial graft. Postoperative graft patency was evaluated in 6f patients by multi-slice computed tomegraphy. Result: An average of $2.5\pm0.6$ arteries and $3.7pm0.7$ distal anastomoses per patient were done. There was no perioperative myocardial infarction, clinical hypoperfusion syndromes, and operative mortality. Postoperative mean CK-MB level was $17.4pm29.7\;IU/L.$Overall graft patency was $99.1\%\;(214/216)(LIMA:\;100\%,\;RA:\;98.4\%,\;RIMA:\;100\%).$ Conclusion: This technique allows total arterial OPCAB without technical problems and provides excellent early clinical results and graft patency. We believe that this technique is more convenient in the obtuse marginal area compared to sequential technique, and helpful in patients who require complex arterial grafting.

• Journal of Chest Surgery
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• v.36 no.10
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• pp.734-740
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• 2003

Increasing interest in the use of arterial conduits is based on the better patency of left internal thoracic artery (LITA) than that of saphenous vein (SV) graft and radial artery (RA) is emerging as one of them. We compared the early result of coronary artery bypass grafting (CABG) using UTA and RA (RA group) with CABG using UTA and SV only (SV group). Material and Method: We compared the early operative results of 45 cases in RA group with 45 cases in SV group selected from 165 cases who had CABG between January 2000 and December 2002. The two groups had similar profiles of age, sex, NYHA functional class, left ventricular ejection fraction and coronary angiographic anatomy. We analysed each group on the preoperative risk factors and operative results. Result: There were no statically signigicant difference between groups in operative mortality and each morbidities (stroke, IABP insertion, perioperative MI), respectively. However, the overall incidence of mortality and morbidities was lower in RA group compared to SV group (p < 0.05). RA group (2.93$\pm$0.62 days) had shorter duration of ICU stay than SV group (3.55$\pm$0.95 days) (p<0.001). The patency on postoperative coronary angiography at 7∼14 days after operation in RA group patients were 100% of LITA and RA and 94.9% of SV. Conclusion: We had better early operative results in RA group compared with SV group.