• Journal of Chest Surgery
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• v.53 no.2
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• pp.64-72
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• 2020

Background: It is generally agreed that using a bilateral internal thoracic artery (BITA) composite graft improves long-term survival after coronary artery bypass grafting (CABG). Although the left internal thoracic artery (LITA)-based Y-composite graft is widely adopted, technical or anatomical difficulties necessitate complex configurations. We aimed to investigate whether BITA configuration impacts survival or patency in patients undergoing coronary revascularization. Methods: Between January 2006 and June 2017, 1,161 patients underwent CABG at Seoul National University Bundang Hospital, where the standard technique is a LITA-based Y-composite graft with the right internal thoracic artery (RITA) sequentially anastomosed to non-left anterior descending (LAD) targets. Total of 160 patients underwent CABG using BITA with modifications. Their medical records and imaging data were reviewed retrospectively to investigate technical details, clinical outcomes, and graft patency. Results: Modifications of the typical Y-graft (group 1, n=90), LITA-based I-graft (group 2, n=39), and RITA-based composite graft (group 3, n=31) were used due to insufficient RITA length (47%), problems using LITA (28%), and target vessel anatomy (25%). The overall 30-day mortality rate was 1.9%. Among 116 patients who underwent computed tomography or conventional angiography at a mean interval of 29.9±33.1 months postoperatively, the graft patency rates were 98.7%, 95.3%, and 83.6% for the LAD, left circumflex artery, and right coronary artery territories, respectively. Patency rates for the inflow, secondary, and tertiary grafts were 98.2%, 90.5%, and 80.4%, respectively. The RITA-based graft (group 3) had the lowest patency rate of the various configurations (p<0.011). Conclusion: LITA-based Y composite graft, showed satisfactory clinical outcomes and patency whereas modifications of RITA- based composite graft had the lowest patency and 5-year survival rates. Therefore, when using RITA-based composite graft, other options should be considered before proceeding atypical configurations.

• 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.38 no.3 s.248
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• pp.253-257
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• 2005

The patients with primary lung cancer who have symptoms of angina pectoris commonly have underwent coronary artery bypass grafting (CABG) prior to lung resection. Recently, there are attempts to conduct simultaneous operation of CABG and lung resection to reduce disadvantages of staged operation, such as repeated general anesthesia, two wound incisions and delay of lung operation. These attempts generally report good results. Three patients underwent lung resection and CABG simultaneously, and had good post operative status without recurrence of cancer and angina pectoris. We conceive these as worthy cases to report.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.525-531
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• 1999

Background: We analyzed five hundred patients who underwent either isolated or concomitant coronary artery bypass grafting(CABG) between November 1981 and June 1997. Material and Method: There were 330 males and 170 females with a mean age of 57.4$\pm$8.9 years. To evaluate the preoperative status, we performed electrocardiograghy, echocardiography, MIBI scan, Duplex sonogram, common blood test including CK and LDH and coronary angiography. Result: Preoperative clinical diagnoses were unstable angina in 282 (56.4%), stable angina in 141 (28.2%), postinfarction angina in 58 (11.6%), acute myocardial infarction in 8 (1.6%), variant angina in 7 (1.4%) and failed percutaneous transluminal coronary angioplasty in 4 (0.8%) patients. Preoperative angiographic diagnoses were three-vessel disease in 263 (52.6%), two-vessel disease in 93 (18.6%), one-vessel disease in 71 (14.2%), left main disease in 68 (13.6%), and others in 5 (1.0%) patients. Patients had various risk factors for coronary disease, and the frequency of the risk factors such as hypertension, diabetes and smoking showed increasing tendency year by year. We used saphenous vein grafts in 1143, internal thoracic artery grafts in 442, radial artery graft in 17, and gastroepiploic artery graft in 1 anastomosis. The mean number of grafts was 3.2$\pm$1.2 per patient. Concomitant operations were prosthetic valve replacement or valvuloplasty in 31, coronary endarterectomy and angioplasty in 27, left main coronary angioplasty in 13, carotid endarterectomy in 5, and neurologic problems, bleeding, and perioperative myocardial infarction. The mean follow-up period was 25$\pm$23 months and there were 5 cases of reoperation. Conclusion: We hope that the surgical results would improve with the accumulation of experience, application of new myocardial protection technique, and timely intervention of mechanical assisted devices.

• Journal of Yeungnam Medical Science
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• v.38 no.1
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• pp.74-77
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• 2021

Lymphorrhea is a rare but potentially severe complication that occurs after various surgical procedures. Untreated lymphorrhea may lead to wound dehiscence, infection, and prolonged hospital stay. Currently, there is no standard effective treatment. Early management usually includes leg elevation, drainage, and pressure dressing. However, these methods are associated with prolonged recovery and high recurrence rates. We report a case of lymphorrhea from a calf wound after endoscopic great saphenous vein (GSV) harvesting for coronary artery bypass grafting (CABG). The patient presented with intractable oozing from the postoperative wound on the right calf. Lymphorrhea persisted for 6 weeks despite negative-pressure wound therapy with a long-acting somatostatin. We performed unilateral pedal lymphangiography that confirmed wound lymphorrhea, followed by glue embolization. No recurrence was observed after 8 months of follow-up. This case report demonstrates the successful use of lymphangiography with glue embolization in the control of lymphorrhea after GSV harvesting for CABG.

• Journal of Chest Surgery
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• v.28 no.3
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• pp.247-252
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• 1995

The isolated coronary ostial stenosis is rare and a critical lesion which requires urgent surgical intervention. Recently direct angioplasty is assumed as a preferable approach to conventional bypass grafting. From Mar. 1990 to Aug. 1993, six patients underwent direct angioplasty in Sejong Heart Institute. The mean age of 6 patients was 48 years [range 37 to 63 and they consisted with 5 females and one male. All had severe angina [class III or IV of short duration [mean 5.3 months and a low incidence of risk factors. Despite the crucial location of the lesion, most patients had well preserved left ventricular function and normal wall motion. We performed direct angioplasty with autologous pericardium via anterior approach except one patient who underwent direct angioplasty and CABG. One patient died 4 hours after angioplasty probably due to acute coronary dissection. The survived 5 patients maintain normal life without symptoms during 26.2 months follow up [range 5 to 47 months .Our preliminary results suggest that angioplasty of isolated coronary ostial stenosis in highly selected patient can be carried out with good results and relatively low operative risks.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.260-267
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• 1990

During a eight month period[from December, 1988 to July, 1989], a series of 35 adults undergoing redo-valve replacement or coronary artery bypass grafting was selected to an autotransfusion group[n=10] or a control group[n=25]. The Cell Saver System[Haemonetics Corp., Graintree, Mass] was employed for autotransfusion. With this system, all blood shed in the operative field before and after cardiopulmonary bypass and remained in cardiotomy reservoir after cardiopulmonary bypass was aspirated by means of a locally heparinized collecting system. After the salvaged blood was centrifuged, the resulting red cell concentrate subsequently reinfused. The patients receiving autologous blood required significantly less banked homologous blood than their controls[3213k1020 ml and 506051931 ml, respectively: p=0.001] There were no clinical infections in the autotransfusion group, although 40% of the cultures of processed blood were positive. And there was no apparent intergroup difference of the clinical and the hematologic and hemostatic laboratory findings. We conclude that autotransfusion using cell saver is effective for saving the homologous blood transfusion in cardiac surgery.

• Journal of Chest Surgery
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• v.33 no.2
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• pp.190-192
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• 2000

A 53-year-old male patient who had suffered from acute myocardial infarction before a week was admitted due to postinfarction angina A mobile pedunculated left ventricular thrombus of 2.0-cm diameter which was overlooked in cardiac catheterization and ventriculographic study was diagnosed with transthoracic two-dimensional echocardiography. There was no exact clinical finding of left ventricular aneurysm and the thrombus was placed in the akinetic and hypokinetic apical portion. For preventing systemic embolism that was removed through a left ventriculotomy just prior to coronary artery bypass grafting.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.749-754
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• 2004

Off-pump coronary artery bypass grafting (Off-Pump CABG) has been proven to have less morbidity and to facilitate early recovery. High-risk surgical patients may have benefitted by avoiding the adverse effects of the cardiopulmonary bypass. We compared the effectiveness of Off-Pump CABG with that of coronary artery bypass using cardiopulmonary bypass (On-Pump CABG) in high-risk patients. Material and Method: 682 patients (424 Off-Pump CABG and 258 On-Pump CABG) underwent isolated coronary artery bypass grafting between January 2001 and June 2003. Patients who were considered high risk were selected High risk is defined as the presence of one or more of nine adverse prognostic factors. Data were collected from 492 patients in Off-Pump CABG and 100 in On-Pump CABG for risk factors, extent of coronary disease, and in-hospital outcomes. Result： Off-Pump CABG group and On-Pump CABG group did not show differences in their preoperative risk factors. We used more arterial grafts in Off-Pump CABG group (p < 0.05). Postoperative results showed that operative mortality (0.5% in Off-Pump CABG versus 2.0% in On-Pump CABG), renal failure (2.6% in Off-Pump CABG versus 7.0% in On-Pump CABG), and perioperative myocardial infarction (1.5% in Off-Pump CABG versus 1.0% in On-Pump CABG) did not differ significantly. However, Off-Pump CABG had shorter mean operation time (p<0.05), lower mean CK-MB level (p <0.05), lower rate of usage of inotropics (p < 0.05), shorter mean ventilation time (p <0.05), lower perioperative stroke (0% versus 2.0%), and shorter length of stay (p < 0.05) than On-Pump CABG. On-Pump CABG had more distal grafts (p<0.05) than Off-Pump CABG. Although Off-Pump CABG and On-Pump CABG did not show statistical differences in mortality and morbidity was more frequent in CABG. Conclusion: Off-Pump CABG reduces morbidity and favors hospital outcomes. Therefore, Off-Pump CABG is safe, reasonable and may be a preferable operative strategy for high-risk patients.

• Journal of Chest Surgery
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• v.46 no.5
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• pp.353-356
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• 2013

A 74-year-old man was diagnosed with aortic root aneurysm and two-vessel coronary disease. Echocardiographic assessment revealed an enlarged sinus of Valsalva 60 mm in diameter with mild aortic regurgitation. Florida sleeve repair was performed using a vascular graft combined with coronary artery bypass grafting. The postoperative course was uncomplicated and follow-up echocardiographic evaluations showed an aortic root diameter of 38 mm without aortic insufficiency up to 1 year after surgery.