• Biomedical Science Letters
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• v.15 no.3
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• pp.207-215
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• 2009

We carried out this study to investigate differences of physiological variables between patients with (DM group) and without type II diabetes mellitus (Non-DM group) undergoing off-pump coronary artery bypass grafting (OPCABG). Postoperative $Mg^{++}$ and $Ca^{++}$ levels were lower, whereas $Na^+$ level was higher in DM group than those in Non-DM group. ICU (intensive care unit) stay time in DM group was longer than that of Non-DM group. Postoperative platelet counts tended to decrease, whereas C-reactive protein (CRP) and cardiac troponin-I (cTNI) levels tended to increase in DM group compared with Non-DM group. Postoperative albumin level was lower, while blood urea nitrogen (BUN) and creatinine levels were greater in DM group than those in Non-DM group. DM group had higher incidence of post-operative arrhythmias than Non-DM group. These results reveal that type II DM patients undergoing OPCAB may have higher incidences of postoperative hypomagnesemia, hypocalcemia and arrhythmias, and increases of CRP, cTNI, BUN, and creatinine levels than in Non-DM patients undergoing OPCAB. The perioperative check and control (supplement) of $Mg^{++}$ levels should be considered in cardiovascular surgery combined with DM.

• Biomedical Science Letters
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• v.17 no.2
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• pp.113-122
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• 2011

Several studies have reported a relation between serum levels of uric acid and a wide variety of cardiovascular conditions. But, the relationship between serum levels of uric acid and coronary artery disease (CAD) is still controversial. The present study was retrospectively designed to investigate whether CAD can be stratified by the level of uric acid and there are the relationships between preoperative levels of uric acid and perioperative biochemical markers in fifty-adult patients that underwent coronary artery bypass grafting surgery (CABG) and twenty-normal subjects. They were divided into the control, the unstable angina (UA-group) and the myocardial infarction group (MI-group). In preoperative levels of uric acid, the MI-group was higher than control and the UA-group. The MI-group had significantly higher correlations than the UA-group between preoperative levels of uric acid and left ventricular ejection fraction, cardiac markers (creatine kinase, lactate dehydrogenase and brain natriuretic peptide), renal markers (blood urea nitrogen and creatinine) or total leukocyte levels. At postoperative periods, the MI-group had higher relationships of uric acid with aspartate aminotransferase, blood urea nitrogen or creatinine levels. Although there was not statistically significant, the UA-group tended to have higher correlation coefficients than the MI-group between preoperative levels of uric acid and intensive care unit-stay (ICU), or postoperative mechanical ventilation time. These results reflect that increased levels of serum uric acid may be a tool for the diagnosis of coronary heart disease and may be considered as a good predictor in assessing the cardiac and renal functions in patients with myocardial infarction or unstable angina at the preoperative period. However, further studies should be performed in a large patient population.

• 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.

• Journal of Chest Surgery
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• v.45 no.5
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• pp.301-307
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• 2012

Background: Perioperative transfusion of red blood cell (RBC) may cause adverse effects. Bloodless-cardiac surgery has been spotlighted to avoid those problems. Off pump coronary artery bypass (OPCAB) surgery can decrease the transfusion. However, the risk factors of transfusions in OPCAB have not been investigated properly. Materials and Methods: One hundred and thirteen patients (male:female=35:78, mean age=$66.7{\pm}9.9$ years) who received isolated OPCAB were retrospectively analyzed from March 2006 to September 2007. The threshold of RBC transfusion was 28.0% of hematocrit. Bilateral internal thoracic arteries graft were used for 99 patients (87.6%). One hundred and three (91.1%) and 35 patients (31.5%) took aspirin and clopidogrel just before surgery. Results: Sixty-five patients (47.5%) received the RBC transfusion (mean $2.2{\pm}3.2$ units). Mortality and major complications were not different between transfusion and no-transfusion group. But, ventilator support time, intensive care unit stay and hospitalization period had been reduced in no-transfusion group (p<0.05). In multivariate analysis, patients risk factors for RBC transfusion were preoperative low hematocrit (<37.5%) and clopidogrel medication. Surgical risk factors were longer graft harvesting time (<75 minutes) and total operation time (<5.5 hours, p <0.05). Conclusion: We performed the transfusion according to transfusion guideline; over 40% cases could conduct the OPCAB without transfusion. There were no differences in major clinical results between transfusion and non-transfusion group. In addition, when used together with accurate understanding of transfusion risk factors, it is expected to increase the proportion of patients that do not undergo transfusions.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.38-44
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• 2000

Background: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. Material and Method : The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60$\pm$9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. Result: The mean number of grafts was 3.2$\pm$1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13$\pm$20 hours after the operation. Mean duration of stay in intensive care unit was 49$\pm$46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70$\pm$1.36 pack/patient. Conclusion: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.less cost.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.704-709
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• 2009

Background: We assessed the efficacy of intraoperative intra-aortic balloon pump therapy for achieving hemodynamic instability during off-pump coronary artery bypass surgery. Material and Method: We studied seven hundred ninety-six patients who underwent off-pump coronary artery bypass between January 2000 and December 2006. The patient were divided into group I (n=39), which received intraoperative intra-aortic balloon pump therapy, and group II (n=757), which did not receive intraoperative intra-aortic balloon pump therapy. Result: There were no differences in the operative mortalities (2.6%, 1/39 vs 0.8%, 6/757; p=0.195) and morbidities such as atrial fibrillation (p=0.691), stroke (p=0.908) and mediastinitis (p=0.781) between the 2 groups, although the ventilator support time, the length of the intensive care unit stay and the length of the hospital stay were longer in group I than in group II (p<0.05). Multivariate analysis failed to prove that group I was a high risk group for operative mortality (p=0.549). There were 3 intraoperative intra-aortic balloon pump-related complications in group I (7.9%). However, no longer complications occurred after 2003, when the surgeons began using a smaller sized 8 F catheter that was inserted using a sheathless technique. Conclusion: Intraoperative intra-aortic balloon pump therapy for achieving hemodynamic instability during off-pump coronary artery bypass surgery can be performed safely and it showed comparable clinical results to that of not using intraoperative intra-aortic balloon pump therapy.

• Journal of Korean Academy of Nursing
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• v.42 no.3
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• pp.424-433
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• 2012

Purpose: To investigate the accuracy, precision and validity of fever detection of tympanic membrane (TM), temporal artery (TA) and axillary temperature (AT) compared with pulmonary artery temperature (PA). Methods: Repeated-measures design was conducted for one year on 83 adult cardiac care unit patients with pulmonary artery catheters after open heart surgery. Sequential temperature measurements were taken three times at 20-minute intervals. Accuracy, precision, repeatability, and validity of fever detection were analyzed. Results: Mean pulmonary artery temperature was $37.04^{\circ}C$ (SD $0.70^{\circ}C$). The mean (SD) offsets from PA, with the mean reflecting accuracy and SD reflecting precision, were $-1.31^{\circ}C$ ($0.75^{\circ}C$) for TA, $-0.20^{\circ}C$ ($0.24^{\circ}C$) for TM, and $-0.97^{\circ}C$ ($0.64^{\circ}C$) for AT. Percentage of pairs with differences within ${\pm}0.5^{\circ}C$ was 9.6% for TA, 19.7% for AT, and 91.6% for TM. Repeated measurements with all three methods had mean SD values within $0.04^{\circ}C$. Sensitivity, specificity, and positive and negative predictive values of tympanic measurements were 0.76, 1.0, and 1.0, and 0.90, respectively. Conclusion: Results show that TM best reflects PA, and is most consistent, accurate, and precise. AT tends to underestimate PA, and TA is least accurate and precise. Therefore tympanic membrane measurement is a reliable alternative to other non-invasive methods of measuring temperatures.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.604-610
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• 2006

Background: Recent improvements in interventional procedure and medical therapy for congestive heart failure result in an increase of number of patients with ischemic cardiomyopathy considered for coronary artery bypass grafting. We retrospectively review the results of CABG in these patients with decreased LV function to know the early and mid-term follow-up results. Material and Method: Between January 2001 and June 2005, 1,143 patients underwent coronary artery bypass grafting and 144 of these patients had preoperative left ventricular function of equal to or less than 35% ${(LVEF{\leq}\;35%)}$. There were off-pump coronary artery bypass grafting (OPCAB) in 66 cases (45.8%), on-pump beating heart coronary artery bypass grafting in 34 cases (23.6%) and conventional coronary artery bypass grafting in 44 cases (30.6%). The combined operations including mitral annuloplasty were 48 cases in thirty five patients (24.3%). Result: The mean number of dstal anastomosis were $3.5{\pm}1.3$. The median postoperative duration of stay in intensive care unit and hospital was 2 days and 8 days, respectively. There were 6 early death (4.2%) and causes of deaths were ventricular tachycardia in 5 patients, small bowel infarction in one patient. Mean follow-up time was $21{\pm}14$ months $(4{\sim}54\;months)$. The 1-year was $95{\pm}2%$ and 3-year survival rate was $83{\pm}7%$, the 1-year and 3-year cardiac event-free survival were ${88{\pm}3%\;and\;69{\pm}7%}$, respectively. Conclusion: Based on satisfactory early and mid-term results in our study, CABG should be carried out as actively as possible in patients with ischemic cardiomyopathy. Postoperative aggressive management for ventricular arrhythmia would be helpful for better results.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.34-40
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• 2008

Background: Off-pump coronary artery bypass grafting (OPCAB) shows fewer side effects than cardiopulmonary by. pass, and other benefits include myocardial protection, pulmonary and renal protection, coagulation, inflammation, and cognitive function. We analyzed the clinical results of our cases of OPCAB. Material and Method: From May 1999 to August 2007, OPCAB was performed in 100 patients out of a total of 310 coronary artery bypass surgeries. There were 63 males and 37 females, from 29 to 82 years old, with a mean age of $62{\pm}10$ years. The preoperative diagnoses were unstable angina in 77 cases, stable angina in 16, and acute myocardial infarction in 7. The associated diseases were hypertension in 48 cases, diabetes in 42, chronic renal failure in 10, carotid artery disease in 6, and chronic obstructive pulmonary disease in 5. The preoperative cardiac ejection fraction ranged from 26% to 74% (mean $56.7{\pm}11.6%$). Preoperative angiograms showed three-vessel disease in 47 cases, two-vessel disease in 25, one-vessel disease in 24, and left main disease in 23. The internal thoracic artery was harvested by the pedicled technique through a median sternotomy in 97 cases. The radial artery and greater saphenous vein were harvested in 70 and 45 cases, respectively (endoscopic harvest in 53 and 41 cases, respectively). Result: The mean number of grafts was $2.7{\pm}1.2$ per patient, with grafts sourced from the unilateral internal thoracic artery in 95 (95%) cases, the radial artery in 62, the greater saphenous vein in 39, and the bilateral internal thoracic artery in 2. Sequential anastomoses were performed in 46 cases. The anastomosed vessels were the left anterior descending artery in 97 cases, the obtuse marginal branch in 63, the diagonal branch in 53, the right coronary artery in 30, the intermediate branch in 11, the posterior descending artery in 9 and the posterior lateral branch in 3. The conversion to cardiopulmonary bypass occurred in 4 cases. Graft patency was checked before discharge by coronary angiography or multi-slice coronary CT angiography in 72 cases, with a patency rate of 92.9% (184/198). There was one case of mortality due to sepsis. Postoperative arrhythmias or myocardial in-farctions were not observed. Postoperative complications were a cerebral stroke in 1 case and wound infection in 1. The mean time of respirator care was $20{\pm}35$ hours and the mean duration of stay in the intensive care unit was $68{\pm}47$ hours. The mean amounts of blood transfusion were $4.0{\pm}2.6$ packs/patient. Conclusion: We found good clinical outcomes after OPCAB, and suggest that OPCAB could be used to expand the use of coronary artery bypass grafting.

• Korean Journal of Adult Nursing
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• v.13 no.2
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• pp.209-222
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• 2001

The environment in the ICU leads to negative changes in a patient's usual sleep pattern and so contributes negatively to the patient's health condition as compared to patients in general wards. Therefore, it is thought that an important nursing intervention would be to identify the relation between noise and sleep patterns which play an important role in illness recovery. The purpose of the present study was to explore the relationship between noise in the ICU and the sleep pattern of patients admitted to the ICU. A descriptive correlation design was used to examine the relationship. Thirty-four subjects were recruited from a Medical ICU (MICU), Surgical ICU (SICU) and Coronary Care Unit (CCU) at a large university hospital in Suwon. Data were collected from September 28 to October 31 in 1999. In the present study, noise was categorized into noise level and patients' perception of noise. The objective noise level was measured using the A-Weighted Sound Level Meter. The patients' preception of noise was measured using a self-reported questionnaire developed by the researcher. Sleep patterns in this study includes both quantity and quality of sleep. These were measured using open ended questionnaires and the 'Korean Sleep Scale A' developed by Oh, Song, Kim(1998). The data was analyzed using the SPSS-WIN to test the research question, Pearson product moment correlation coefficient was run. Ancillary analysis were conducted with demographic variables to determine their relation to the main study variables. For the ancillary analysis, t-test and one-way ANOVAs were performed. The results of the present study are summerized as follows : 1. The total mean of objective noise level (10pm-6am) was 56.2dB. The means for night time noise level in individual ICUs for the SICU, MICU and CCU, were 58.7dB, 58.6dB and 48.3dB, respectively. The total mean for patients' noise perception was 42.8 out of a maximum possible score of 76. For item means of noise perception, the one ranked highest was "conversations between doctors and nurses" (3.2). The one ranked lowest was "noise from the radio" (1.2). Regarding the degree of perception for each type of noise source, the one ranked highest was "equipment noise" (2.6), the second was "conversation between medical staff" (2.4), the third was "conversation between patients, caregivers and visitors" (2.3), and the one ranked lowest was "environment noise" (1.8). 2. Looking at quantity of sleep of ICU patients, the mean nocturnal sleep time was found to be 4.9 hours. The total mean of sleep quality for ICU patients was 21.0 out of a maximum possible score of 40. 3. The relationship between perception of noise and quantity of sleep was statistically significant(r= - .41, p<.05). The relationship between perception of noise and quality of sleep was also statistically significant(r= - .47, p<.01). The results of the study indicate that personal perception of noise is related to sleep patterns. Therefore, it is suggested that nursing interventions be developed to reduce the degree of personal perception of noise and, thus, decrease sleep pattern disturbances in patients in the ICU.