• Journal of Chest Surgery
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• v.42 no.5
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• pp.604-609
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• 2009

Background: Recently, percutaneous cardiopulmonary support (PCPS) has been widely used to rescue patients in cardiogenic shock or cardiac arrest. However, patients with cardiopulmonary bypass (CPB) weaning failure during open heart surgery still have very poor outcomes after PCPS. We investigated clinical results and prognostic factors for patients who underwent PCPS during open heart surgery. Material and Method: From January 2005 to December 2008, 10 patients with CPB weaning failure during open heart surgery underwent PCPS using the CAPIOX emergency bypass system ($EBS^{(R)}$, Terumo Inc, Tokyo, Japan). We retrospectively reviewed the medical records of those 10 patients. Result: The average age of the patients was $60.2{\pm}16.5$ years (range, $19{\sim}77$ years). The mean supporting time was $48.7{\pm}64.7$ hours (range, $4{\sim}210$ hours). Of the 10 patients, 6(60%) were successfully weaned from the PCPS While 5 (50%) were able to be discharged from the hospital. Complications were noted in 5 patients (50%). In univariate analysis, long aortic cross clamp time during surgery, mediastinal bleeding during PCPS and high level of Troponin-I before PCPS were significant risk factors. All of the discharged patients are still surviving $34{\pm}8.6$ months (range, $23{\sim}48$ months) post-operatively. Conclusion: The use of PCPS for CPB weaning failure during open heart surgery can improve the prognosis. More experience and additional clinical studies are necessary to improve survival and decrease complications.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.645-649
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• 1992

Jehovah`s Witnesses who require cardiac operations represent a challenge to surgeon because of the patients` refusal to accept blood transfusion, We report a 6 year period, ending May, 1991 with a consecutive series of 25 Jehovah`s witnesses. Patients ranged in age from 11 months to 61 years. All operations were performed during cardiopulmonary bypass with bloodless priming, No patient received any blood or blood products during hospitalization. Perioperative mortality was 2 paients[8%]. We conclude that if we performed the cardiac surgery with careful operative technique and various blood conserving procedures, we can do the bloodless open heart surgery with relatively safety.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.577-583
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• 1990

Subglottic stenosis is a disorder characterized by narrowing of the airway below the glottis. In children, the stenosis is usually due to scar formation secondary to prolonged airway intubation, rather than to external trauma. The location and extent of the stenosis are highly variable, consequently, corrective measures need to be selected to suit the individual problem. Conservative treatment is adequate for lesser degrees of stenosis but those with more severe scarring require external laryngeal surgery. We managed 2 children with subglottic stenosis due to prolonged intubation after open heart surgery who needed a resectional surgery of the stenotic upper airway. The preoperative evaluation and surgical technique for subglottic stenosis were reviewed.

• Journal of Chest Surgery
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• v.16 no.1
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• pp.115-120
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• 1983

We implanted pacemakers using screw-in sutureless myocardial electrode in 40 patients between February, 1980 and November, 1982 at Seoul Nation University Hospital. Mean age of total patient who received the pacemaker implantation was 39.9 years, but excluding the patient who received the open heart surgery, mean age was 49.3 years. Cause of pacemaker implantation was complete A-V block in 13 patients, symptomatic sick sinus syndrome in 12 patients, complete A-V block after open heart surgery in 12 patients, second degree A-V block with dizziness in one patient, and atrial fibrillation with slow ventricular response in two patients. In thirty nine cases, electrodes were implanted by subxiphoid approach, on the diaphragmatic surface of right ventricle. I n one case, electrode was implanted through the left anterior thoracotomy. Acute stimulation threshold, measured in 35 patients, varied from 0.1 to 2.5 mA [mean 0.85 mA.], and R-wave amplitude [sensitivity], measured in 19 patients, varied from 2.9 mV to 11.5 mV [mean 7.6 mV]. There was no hospital death. The postoperative complications included wound seroma in two patients [5%], wound hematoma in three patients [7.5%], and pacing failure in one patient [2.5%]. The subxiphoid implantation of the pacemaker using sutureless myocardial lead was valuable in obtaining safe, reliable and long-term impulse generation.

• Journal of Chest Surgery
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• v.13 no.1
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• pp.1-12
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• 1980

In 1979 during the period of about 10 months 320 cases of open heart surgery were done in Seoul National University Hospital. There were 220 Congenital anomaly cases consisting of 113 acyanotic and 107 cyanotic varieties, and 1 O0 acquired cardiac lesions. Out of 100 acquired lesions 96 were valvular cues. Among 97 valve replacement cases 3 were Ebstein anomaly treated with plication and tricuspid valve replacement. Operative mortality rate for congenital anomaly was 10.6%, with 2.7% for acyanotic and 22.4% for cyanotic group. For acquired lesions over all operative mortality was 7%. Tetralogy of Fallot, ventricular septal defect, and atrial septal defect were the 3 main congenital anomalies, with 88 cues, 69 cases, and 27 cues respectively. In 61 simple ventricular septal defect without other anomalies operative mortality rate was 1.6%, in 27 atrial septal defect no death and, in tetralogy of Fallot 12.2%. Among 69 ventricular septal defect cases 19[27.5%] type I VSDs, after Kirklin-Becu classification, were found, rather high relative incidence of type I compared with Caucasian patients. Among 97 valve replacement cases 20 double valves were replaced-11 mitral with aortic and 9 mitral with tricuspid valves. Over all operative mortality rate for valve replacement was 8.2% with 3.3% in 61 mitral valve replace-merit. The over all operative mortality rate for 320 open heart surgery cases was 10.6%. Bubble type oxygenator and xenograft bioprosthetic valves were utilized In almost all cases.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.518-524
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• 1999

Background: This study has proven the effect of modified ultrafiltration(MUF) performed after the cessation of cardiopulmonary bypass in pediatric patients who underwent open heart surgery. Material and Method: From Jan. to Dec. 1997, modified ultrafiltration was performed after cardiopulmonary bypass in 50 infants with cyanotic heart disease and the results were compared to the control group of 50 patients with cyanotic heart disease in whom modified ultrafiltration was not used. Changes of hematocrit, central venous pressure, systolic and diastolic pressure, heart rate and body weight were compared. Result: Age and body weight were not different(p=0.38, p=0.46). Disease categories were similar. Average filtering volume was 60.0$\pm$29.2cc/kg for 7.0$\pm$2.4minutes of filtration. Mean hematocrit after filtration(MUF=36.1%, control=26.4%, p=0.001) was higher in the MUF group. Systolic (p=0.0001) and diastolic blood pressure(p=0.0001) were observed to increase more and the central venous pressure(p=0.02) and the heart rate(p=0.02) were lower after filtration in the MUF group. Conclusion: This study demonstrated that modified ultrafiltration after cardiopulmonary bypass was a technically feasible option to improve the post-surgical course through the effective hemoconcentration, hemodynamic improvements, and body water control.

• Journal of Chest Surgery
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• v.17 no.3
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• pp.402-408
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• 1984

During the period of August 1983 to February 1984 study has been done on the value of serum lactate at regular intervals before, during and after operation on 30 patients who went through open heart surgery with extracorporeal circulation for congenital or acquired heart diseases at the Department of Thoracic and Cardiovascular Surgery, School of Medicine, Hanyang University- The results were as follows: 1.The mean value of serum lactate before the operation was observed to be 28.5 \ulcorner.41 mg/dl. 2.At 10 minutes after the beginning of extracorporeal circulation the mean value of serum lactate showed a rapid increase to 73.24\ulcorner3.61 mg/dl, an increase of 44.74 mg/dl [156.9%] from the pre-operation value. 3.At 40 minutes after the beginning of extracorporeal circulation the mean value of serum lactate was observed to be 78.98\ulcorner1.67 mg/dl which was the highest level. It was an increase of 50.48 mg/dl [177.12%] from the preoperation value. 4.At 70 minutes after the beginning of extracorporeal circulation the mean value of serum lactate was observed to be 64.39\ulcorner9.29 mg/dl, an increase of 35.89 mg/dl [125.9%] from the preoperation value, and at over 100 minutes it was observed to be 68.00\ulcorner5.79 mg/dl, an increase of 39.5 mg/dl [138.5%] from the preoperation value. 5.The mean value of serum lactate immediately after the operation was 61.36\ulcorner6.94 mg/dl, an increase of 32.86 mg/dl [115.2%] from the preoperation value. 7.On the 7th post-operative day the value of serum lactate returned the preoperation value.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.718-731
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• 1985

Renal dysfunction is a common complication of open-heart surgery: a form of controlled hemorrhagic shock, and successful perioperative management of renal dysfunction depends on recognition of the risk factors and optimal management of factors influencing renal function, including cardiopulmonary bypass, and early detection of renal failure. Changes in renal functional parameters including Ccr, Cosm, CH2O, FENa, and RFI were observed prospectively in forty five patients operated on at Dept. of Thoracic and Cardiovascular Surgery, S.N.U.H., from April to June, 1985. They were 23 males and 22 females with 35 acquired and 10 congenital heart diseases and the mean age and body surface area of them were 38.010.3 years [22-63] and 1.5518 M2[1.151.92] respectively. Followings are the conclusion. 1. The Ccr, representative of renal function, is significantly improved from 90.231.3 ml/min/M2 preoperatively to 101.536.4 ml/min/M2 postoperative and day [P<0.05], and all patients were classified as postoperative renal functional class I of Abel, which representing adequate renal protection during our cardiopulmonary bypass. 2. The Cosm is significantly elevated at immediate postperfusion time and remained high at postoperative one day representing osmotic diuresis at that time, but CH2O shows no significant changes at immediate postperfusion period and is decreased significantly at postoperative one day, representing recovery of renal concentrating ability at that time with decreasing urine flow. 3. The absolute value and changing tendency in FENa and RFI during perioperative period shows no diagnostic reliability on these parameters, but those of CH2O appear to reveal future renal function more accurately than Ccr 4. The depth of hypothermia may be protective upon renal function against the ill effects of prolonged nonpulsatile cardiopulmonary bypass. 5. The depth of the hypothermia, pump time of more than 150 minutes, poor cardiac function, and intraoperative events such as embolism appear to be related with immediate postperfusion renal function. 6. Hemoglobinuria and hemolysis, poor preoperative renal function, history of cardiac surgery, and massive transfusion associated with bleeding appear not to be related with renal dysfunction.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1017-1022
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• 1999

Background: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. Material and Method: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. Result: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. Conclusion: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.

• Clinics in Shoulder and Elbow
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• v.22 no.1
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• pp.29-36
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• 2019

Background: The execution of fibular allograft augmentation in unstable proximal humerus fractures (PHFs) was technically demanding. In this study, the authors evaluated the clinical and radiographic outcomes after tricortical iliac allograft (TIA) augmentation in PHFs. Methods: We retrospectively assessed 38 PHF patients treated with locking-plate fixation and TIA augmentation. Insertion of a TIA was indicated when an unstable PHF showed a large cavitary defect and poor medial column support after open reduction, regardless of the presence of medial cortical comminution in preoperative images. Radiographic imaging parameters (humeral head height, HHH; humeral neck-shaft angle, HNSA; head mediolateral offset, HMLO; and status of the union), Constant score, and range of motion were evaluated. Patients were grouped according to whether the medial column support after open reduction was poor or not (groups A and B, respectively); clinical outcomes were compared for all parameters. Results: All fractures healed radiologically (average duration to complete union, 5.8 months). At final evaluation, the average Constant score was 73 points and the mean active forward flexion was $148^{\circ}$. Based on the Paavolainen assessment method, 33 patients had good results and 5 patients showed fair results. The mean loss of reduction was 1.32 mm in HHH and 5.02% in HMLO. None of the parameters evaluated showed a statistically significant difference between the two groups (poor and not poor medial column support). Conclusions: In unstable PHFs, TIA augmentation can provide good clinical and radiological results when there are poor medial column support and a large cavitary defect after open reduction.