• Journal of Chest Surgery
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• v.35 no.9
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• pp.688-691
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• 2002

Takayasu's arteritis is a chronic inflammatory disease of unknown cause. It predominantly affects the aortic arch and its branches. Concomitant involvement of coronary and renal arteries is a rare entity. In this report, we described successful treatment of a patient with Takayasu's arteritis associated with coronary and renal arteries stenosis. A 23-year-old woman was presented with chest pain on exertion. Angiographic studies demonstrated left main coronary, bilateral renal, and left subclavian arteries stenosis. She underwent angioplasty and stenting of bilateral renal artery. After one week, coronary artery bypass grafting using greater saphenous veins and aorto-subclavian bypass with PTFE vascular graft were done simultaneously. She was discharged on the 13th postoperative day without any complications.

• Journal of Chest Surgery
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• v.31 no.2
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• pp.118-124
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• 1998

Minimally invasive coronary artery bypass grafting without using cardiopulmonary bypass (CPB) is a recently accepted modality of myocardial revascularization prcedures which is particularly suitable to the patients with lesions in the left anterior descending(LAD) and the right coronary arteries. Of the consecutive 35 patients of coronary artery bypass grafting performed at Sejong General Hospital from March to August 1996, six patients underwent minimally invasive coronary artery bypass grafting without CPB. All had stenotic lesions of the LAD more than 90%. Bypass grafting of the LAD was approached through midline sternotomy in one, through ministernotomy in two, and through limited left anterior thoracotomy in three patients, respectively. The internal mammary arteries were prepared without the use of thoracoscope. The mobilized mammary arteries were connected directly to the LAD in 5 patients, and the anastomosis required interposition of a segment of the radial artery in the remaining one. The diagonal branch was revascularized with the saphenous vein graft at the same time in one patient. No blood transfusion was necessary in 2 patients, and average blood required during surgery was 800ml in 4 patients. All patients were extubated from 4 to 14 hours(mean 9 hours) after operation. Early postoperative coronary angiography in 5 patients between 7 and 10 days after surgery has proved full patency of the grafts. With these limited clinical experiences, the clinical results demonstrated that minimally invasive coronary artery bypass grafting without CPB is an useful procedure especially in patients with isolated lesion in the proximal LAD.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.19 no.9
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• pp.146-155
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• 2018

This study was conducted to evaluate the clinical outcomes of coronary artery bypass surgery for ischemic heart disease according to use of a cardiopulmonary bypass machine. The subjects were 10,981 patients who underwent coronary artery bypass grafting for ischemic heart disease from July 2008 to June 2012. Analysis data were retrospectively collected using health insurance claims data. The results of the study showed that mean time to surgery (280 min vs 357 min, p<0.0001) and intubation time (about 24 hours vs 40 hours, p<0.0001) were significantly shorter in the Off-Pump CABG (OPCAB) group than in the On-Pump CABG (ONCAB) group. The rate of reoperation because of postoperative bleeding and hematoma was lower in the OPCAB group (2.7% vs 8.3%, p<.0001). The odds ratio of risk adjusted 30 days mortality rate was 0.339 (0.266-0.434) and the postoperative length of stay was decreased in the OPCAB (p<0.0001). Overall, the 30 days mortality and reoperation rates were lower in the OPCAB, as was the resources use.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.35-42
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• 2004

Background: For the treatment of isolated left main coronary artery disease, twelve arterial revascularizations with Y-composite grafts using left internal thoracic artery and radial artery or right gastroepiploic artery were peformed. This study was performed to investigate whether V-composite graft can satisfy the blood flow required to make myocardium act properly or not. Borderline stenotic lesions on the left main coronary artery, which are very prone to remodel the bypassed vessels due to competitive flows, were also considered. Material and Method: Among 247 patients who underwent coronary artery bypass grafting from March 2000 to April 2003, 12 patients (4.7%) who had received total arterial revascularizations for the isolated left main coronary artery disease were studied retrospectively. Result: left anterior descending arteries were bypassed with left internal thoracic artery by off-pump technique in all patients, however, 2 cases of left obtuse marginal branches were bypassed under on-pump beating heart. Except for one patient, who did not have an obtuse marginal branch more than 1 mm in diameter, 11 patients had gone through complete arterial revascularizations by use of the Y shape arterial graft. Among five patients who had less than 75% stenosis, one patient showed string sign on left internal thoracic artery grafted to left anterior descending artery. However, two grafts to obtuse marginal blanches were completely obstructed and one showed slender sign. There were no graft-dominant flow in patients with stenotic lesion less than 75%. On the contrary to the result of patients with stenotic lesions less than 75%, all the patients with stenotic lesions more than 90% showed graft-dominant blood flow. Conclusion: In conclusion, it is assumed that, when stenotic lesions are over 90%, coronary artery bypass grafting with an Y shape arterial graft could possibly give enough help to the obstructed coronary arteries in blood supplying to myocardium, which needs massive quantity of blood to act well. However, when patients have borderline stenoses, through scrupulous examinations, more prudent and flexible decisions are required in choosing the treatment methods, such as, direct anastomosis of vein or artery to aorta, or adding supplementary treatment methods like percutaneous coronary intervention, rather than choosing a fixed treatment methods.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.553-558
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• 2004

Avoiding cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CAB G) has been known to reduce early mortality and morbidity. Diabetes Mellitus is a significant risk factor for adverse early and late outcomes after CABG. We compared the clinical results of off-pump CABG versus on-pump CABG in diabetes 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. Data were collected 242 patient who had diabetes. Among them, 154 patients underwent off-pump CABG and 90 patients underwent on-pump CABG. We analyzed the preoperative risk factors and postoperative results between 2 groups. Result: Two groups did not show statistical differences in age, sex, coronary and operative risk factors. Operative time was significantly shorter in off-pump CABG, however, number of grafts was fewer in off-pump CABG. Postoperative inotropic usage was lower in off-pump CABG. Postoperative CK-MB level was lower in off-pump CABG, and ICU stay and ventilation time was significantly shorter in off-pump CABG. However, there was no statistical difference between 2 groups in operative mortality, reoperation rate, perioperative myocardial infarction, wound infection, renal failure, neurological complications and hospital stay. Conclusion: Off-pump CABG group showed less myocardial damage and early recovery. We concluded that off-pump CABG is the more reasonable technique in diabetes patients although two techniques showed good results. The long-term follow up and prospective study may be warranted.

• 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.

• Journal of Chest Surgery
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• v.32 no.10
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• pp.883-890
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• 1999

Long term patency of arterial graft has been better than venous graft and redo coronary artery bypass grafting has been increasing, therefore, there has been an increasing need for alternative arterial grafts except internal thoracic artery(ITA). Material and Method: Right gastroepiploic arteries(RGEA) were harvested from 100 patients who had received gastrectomy for gastric cancer or ulcer. ITAs were obtained from 10 patients undergoing coronary artery bypass grafting. The length of RGEA was measured from the pyloric ring. Items of the morphometric and histologic study at the pyloric ring and sites of the 10cm and 20cm RGEA from the pyloric ring were luminal diameter, intimal thickness, medial thickness, wall thickness, degree of intimal hyperplasia, intimal thickness, medial thickness, wall thickness, degree of intimal hyperplasia, intimal thickness index, medial thickness index, and the number of discontinuities of the internal elastic lamina. Similar items were applied to the proximal site of ITAs. Result: The length of RGEA was 23${\pm}$2.7cm(range 17∼31cm). Comparing the 20cm RGEA with ITA, intimal thickness, medial thickness, wall thickness, and degree of intimal hyperplasia did not show any difference(p>0.05). However, 20cm RGEA was greater than ITA at the luminal diameter, intimal thickness index, and the number thickness and wall thickness in each site of the RGEA(pyloric ring, 10cm, 20cm) decreased from the pyloric ring to the distal sites(p<0.05). The degree of intimal hyperplasia and the number of discontinuities of the internal elastic lamina did not show any difference between the pyloric ring and 10cm, however, those of 20cm were smaller than these sites(p<0.05). RGEA had more number of discontinuities of the internal elastic lamina and rich smooth muscle cells in the media than ITA. Conclusion: The length and diameter of RGEA is good enough to reach most of the coronary arteries. Moreover, long term patency of RGEA may be improved, if anastomosed in the distal site.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.106-116
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• 2021

Background: We evaluated the mid-term outcomes and angiographic patency of redo coronary artery bypass grafting (CABG). Methods: Of 2,851 patients who underwent isolated CABG at Seoul National University Hospital from 2000 to 2017, 88 underwent redo CABG. Patients' mean age at redo CABG was 66.0±8.0 years. The mean interval between the first-time and redo CABG was 113.0±62.4 months. The mean follow-up duration was 86 months. Early and mid-term clinical outcomes were evaluated. Angiographic patency rates were evaluated early (1-2 days), 1 year, and 5 years after surgery. Comparative analyses between on-pump and off-pump CABG were also performed. Results: The culprits for reoperation were previous grafts (65.6%), native coronary vessels (17.8%), and both (16.7%). Off-pump CABG was performed in 75 cases (85.2%), and the mean number of distal anastomoses was 1.8±0.8. The saphenous vein (39.7%) was used most frequently, followed by the right internal thoracic artery (28.4%), right gastroepiploic artery (21.3%), left internal thoracic artery (7.8%), and radial artery (2.8%). Operative mortality was 1.1%. The overall survival, cumulative incidence of cardiac death, and cumulative incidence of major adverse cardiac events were 71.3%,12.0%, and 23.3% at 5 years after surgery, respectively. The overall angiographic patency rates were 95.7%, 90.1%, and 92.2% on early, 1-year, and 5-year angiograms, respectively. The angiographic patency rates of saphenous vein grafts were 93.1%, 85.6%, and 91.3% on early, 1-year, and 5-year angiograms, respectively. No significant differences in clinical outcomes or angiographic patency rates were observed between the on-pump (n=13) versus off-pump (n=75) groups. Multivariable analysis revealed that age (hazard ratio [HR], 1.07; p=0.005) and chronic kidney disease (HR, 3.85; p=0.001) were risk factors for all-cause mortality. Conclusion: Redo CABG could mostly be performed using the off-pump technique and did not show increased operative mortality and morbidities.

• Journal of Chest Surgery
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• v.46 no.4
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• pp.265-273
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• 2013

Background: The safety and efficacy of arterial composite grafts for total arterial revascularization have been demonstrated. The saphenous vein (SV) is a widely used graft because of its accessibility, sufficient length, and ease of manipulation. Our aim was to compare mid-term outcomes of saphenous vein Y-grafts with radial artery Y-grafts joined by anastomosis to the left internal thoracic artery. Materials and Methods: Records of off-pump coronary artery bypass grafting with composite Y-grafts based on the left internal thoracic artery technique in 552 patients were analyzed retrospectively. After propensity score matching, 79 radial arterial (RA) composite grafts (RA group) and 79 saphenous vein composite grafts (SV group) were compared. The duration of mean follow-up was $24.6{\pm}14.6$ months (range, 1 to 55 months). Results: There were no differences in surgical mortality, all-cause mortality, or morbidity among the groups. Rates of 4-year survival were 91.7% and 96.3% in the RA and SV groups, respectively (p=0.519). The coronary reintervention-free survival rate and freedom from major adverse cardiovascular or cerebrovascular events were similar in the two groups (p=0.685, p=0.564). Conclusion: Construction of composite Y-grafts using the radial artery or saphenous vein showed similar mid-term results. Long-term follow-up and randomized trials will be needed to confirm our present conclusions.

• Journal of Chest Surgery
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• v.26 no.2
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• pp.148-153
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• 1993

To compare two methods of mammary pedicle graft preparations with free internal mammary artery flow, we studied 31 patients who had the left internal mammary artery harvested for coronary artery bypass grafting. The free flow was measured at the transected opening of 2 to 3 cm distal to the point of bifurcation on mean arterial pressure of 50 to 55 mmHg during cardiopulmonary bypass. Group I comprised 14 patients, whose grafts were sprayed and wrapped in sponges soaked in diluted papaverine solution (60 mg in 40 ml Hartmann's solution). An average 80 minutes after the preparations, free flow of the internal mammary artery ranged from 20 to 80 ml/min (mean 37.7 ml/min). Group II comprised 17 patients, who had internal mammary artery takedown under the exact conditions used in group I. The grafts were sprayed and wrapped in sponges soaked in the diluted papaverine solution as in group I. After an average of 28 minutes, free flow ranged from 8 to 28 ml/min (mean 17.6 ml/min). Intraluminal papaverine of the same dilution was then injected without any hydrostatic dilatation and flows increased upto 37 to 150 ml/min (mean 74.7 ml/min). This study shows that intraluminal papaverine preparation method markedly increases free mammary artery flow which is inadequate with external papaverine preparation.