• Journal of Chest Surgery
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• v.29 no.6
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• pp.599-605
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• 1996

A total of 249 patients undergoing isolated coronary revascularization were studied for the occurrence of postoperative atrial fibrillation(AF). Possible associations of this arrhythmia with various preoperative, intraoperative and postoperative factors were studied by univariate and multivariate analysis. The overall incidence of postoperative AF was 15%, with the median time occurence of 48 hours(mean time : 59.1 $\pm$ 56.9 hours) after arrival to the intensive care unit. Cardiac index decreased significantly after occurence of AF(p=0.001). There were no in-hospital complications in those patients with AF. Univariate studies indicated preoperative ejection fract on(EF), triglyceride level, postoperative peak CKMB isoenzpme and atrial pacing to be the dominant factor promoting postoperative AF, with an increasing prevalence in lower EF(p=0.025), triglyceride(p=0.006) and peak CKMB isoenzyme(p=0.002), and in patients with atrial pacing(p=0.001). Hospital stay(p=0.001) and late mortality(p=0.003) were significantly increased in patients with postoperative AF Multivariate analysis showed that body weight and postoperative atrial pacing to be the dominant factor promoting postoperative AF, with an increasing prevalence in over- weight patients(p=0.011) and patients with atrial pacing(p=0.001). Both univariate and multivariate analy- sis showed that the age was not a significant factor but tended to promote postoperative AF respectively (p=0.053, 0.064). After 30.1 $\pm$ 11.4 months gfollow-up, those patients with AF had sinus rhythm. We think that we must try to prevent postoperative AF after ccoronary artery bypass grafting because of its deleterio s hemodynamic effect, prolonged hospital stay, and increased late mortality.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.828-833
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• 2003

Background: It has been reported that the recently developed intermittent antegrade warm blood cardioplegia (IAWBC) has better myocardial protective effects during coronary artery bypass surgery than cold blood cardioplegia or continuos retrograde cold blood cardioplegia. The aim of this study is to evaluate the safety and usefulness of IAWBC by comparing it retrospectively with intermittent retrograde cold blood cardioplegia (lRCBC). Material and Method: From April 2001 to Feb. 2003, fifty seven patients who underwent isolated coronary surgery were divided into two groups (IAWBC vs. IRCBC). The two group had similar demographic and angiographic characteristics. There were no statistical differences in age, sex, Canadian Cardiovascular Society Functional Classification for angina, ejection fraction, and number of grafts. Result: Aortic cross clamping time and total pump time in IAWBC (99$\pm$23 and vs. 126$\pm$32 min) were shorter than those of IRCBC (118$\pm$32 min. and 185$\pm$48 min.)(p<0.05). The reperfusion time (13$\pm$7 min) in IAWBC was shorter than that of IRCBC (62$\pm$109 min.)(p<0.05). CKMB at 12 hours and 24 hours (16$\pm$15 and 9$\pm$13) in IAWBC was lower than that of IRCBC (33$\pm$47 and 17$\pm$26)(p<0.05). The awakening time in IAWBC (2$\pm$1 hour) was shorter than that of IRCBC (4$\pm$3)(p<0.05). The number of spontaneous heart beat recovery in IAWBC (85%) was more than that of IRCBC (35%)(p<0.05). The cardiac index after discontinuing cardio-pulmonary bypass was significantly elevated in the IAWBC group. The prevalence of perioperative myocardial infarction in IAWBC (4%) was lower than that of IRCBC group (20%)(p<0.05). Conclusion: Intermittent antegrade warm blood cardioplegia is a safe, reliable, and effective technique for myocardial protection. It can also provide simpler and economic way than the retrograde cold cardioplegia by shortening of cardiopulmonary bypass time and avoiding retrograde cannulation for coronary sinus.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.249-254
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• 1999

Background: Recovery of the left atrial contractile function after the Cox-Maze procedure is related to the size of the left atrium. We have postulated that if too wide area of the atrium were isolated electrically, then the atrial contractile function would be impaired postoperatively. We have modified the Cox-Maze procedure to dissect each pair of the pulmonary veins separately instead of the conventional pulmonary vein encircling incision, and compared the atrial contractile function after each procedure. Material and Method: From February 1995 to October 1997, 55 cases of the Cox-Maze procedure were performed in mitral valvular heart disease. We excluded the cases that did not covert to sinus rhythm. The patient groups were divided according to the interpulmonary vein distance(IPVD) and the procedure performed. Group I was IPVD under 6.5 cm(n=30), group II was IPVD over 6.5cm and the conventional Cox-Maze III procedure was performed(n=16), and group III was IPVD over 6.5cm and the modified Cox-Maze procedure was performed(n=9). Result: Atrial contractile function was evaluated by the echocardiography follow-up between 6 months to 12 months. The right atrial contractile function recovered gradually, the recovery rate after long-term follow-up was 90% in group I, 81% in group II, and 100% in group III(p>0/05). In the left atrium the recovery rate was 63% in group I, 31% in group II(p=0.03), and 66% in group III(p>0.05). Conclusion: The modified Cox-Maze procedure may have beneficial effects on the recovery of the left atrial contractile function, however, there are no statistically significant values. Therefore, further evaluation of this procedure is necessary.