• Journal of Chest Surgery
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• v.48 no.3
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• pp.174-179
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• 2015

Background: The endoscopic vein harvesting (EVH) method has been used in coronary artery bypass surgery in many countries. We started using the EVH method recently, and investigated the results during the early learning period. Methods: Between March 2012 and June 2014, 75 patients (31 patients in the EVH method group, and 44 patients in the open method group) who underwent isolated first-time coronary artery bypass grafting using vein grafts were retrospectively analyzed with respect to the early outcomes including graft patency and risk factors for leg wound complications. For assessing the patency of vein graft, we performed coronary computed tomography angiography during the immediate postoperative period and 6 months later. Results: Mean harvesting time of endoscopic method was about 15 minutes. Patency rate during the immediate operative period and the 6-month patency rate were similar between the two groups (postoperative period: EVH 100% vs. open method 94.4%, p=0.493; at 6 months: EVH 93.3% vs. open method 90.9%, p=0.791). Leg wound complications occurred more frequently in the open method group (EVH 3.2% vs. open method 13.6%, p=0.127). According to the analysis, age was an independent risk factor for leg wound complications. Conclusion: EVH is a feasible method even for beginners and can be performed satisfactorily during their learning period.

• Journal of Chest Surgery
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• v.53 no.6
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• pp.403-407
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• 2020

To validate the technique of the single Heartstring aortotomy for multiple off-pump venous bypass grafts (described in 2015), the results of a 38-month follow-up study of 18 patients, including high-risk patients, are presented. No early deaths or cardiac or cerebral complications occurred. During the follow-up period, 2 patients died of non-cardiac causes, and 3 developed coronary ischemia. Ischemia occurred due to late graft occlusion in 2 patients, both of whom had normal postoperative courses and correct graft flow. The presence of acute symptoms 24 months after surgery in these patients indicated that technical graft failure was unlikely. This safe technique combines the advantages of simple and reproducible revascularization, the off-pump approach, and minimal aortic manipulation.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.275-281
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• 1997

The radial artery as a graft for myocardial revascularization was introduced by Carpentier in the early 1970s. Mid-term results were unfortunately discoura ing, and the clinical experience with this graft was interrupted. At the end of the 1980s, these authors reproposed the same arterial conduit with more satisfying results, because of improved technique and pharmacological management of the graft. Between October 1994 and July 1995, 36 patients underwent myocardial revascularization with a radial artery graft in Seiong General Hospital. Left internal mammary artery was concomitantly used as a pedicled Vift in 34 patients. Fifteen patients (42%) had a complete arterial waft revascularization. A total of 12) distal anastomoses were performed (average 3.4 per patient), including 36 left internal mammary artery wafts (two sequential in 2 patients), and 23 saphenous vein grafts. The remaining 64 distal anastomoses were perFormed with radial artery grafts (mean 1.8 per patient). The radial arteries were anastomosed to the circumflex (n=38), diagonal (n= 18), right coronary(n=G), and left anterior descending coronary artery(n=2). The percent ge of radial artery graft anastomoses (64) to the total anastomoses(123) was 52%. The radial artery was used as a single graft in 10 patients, as a sequential graft in 25 patients, and two grafts in 1 patient. Twenty patients underwent associated procedures coronary endarterectomy (14), coronary artery patch angioplasty (4), mitral valve repair (1), and repair of ventricular septal rupture (1). One patient died of low cardiac output syndrome and the others had no perioperative myocardial infarction. There are no ischemic and functional complications in the arm or hand aftcr removal of the radial artery. Only 1 patient required reexploration of the am, for the hematoma evacuation, and 2 patients complained transient thumb dysesthesia of the side of the havested arm. This dysesthesia improved within one month. Postoperative angiovaphic controls were obtained in 11 patients(31%) postoperative 79 to 210 days (mean 126 days). The patency rate were as follows : left internal mammary artery (100%), saphcnous vein (100%), and radial artery(95%). We concluded that the radial artery is useful alternative graft, but long term clinical and angiographic studies are required to derterminc whether wider application is warranted.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.252-255
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• 2009

We performed a hybrid procedure for a 58-year-old man with coronary artery disease and a left subclavian artery stenosis. He underwent left subclavian artery stenting and off-pump coronary artery bypass surgery, including grafting the in situ left internal mammary artery to the left anterior descending coronary artery. The post-operative coronary angiogram and computed tomography showed good patency of the graft and stent. He discharged at postoperative 8 days and he has been followed up for six month with an excellent clinical condition.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.313-321
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• 2023

Background: This study evaluated the early, 1-year, and 3-year graft patency rates and mid-term clinical outcomes after no-touch saphenous veins (NT-SVs) were used as aortocoronary grafts in coronary artery bypass grafting (CABG). Methods: In total, 101 patients who underwent CABG using NT-SVs as aortocoronary grafts were included. The 2 most common indications for performing aortocoronary grafting with NT-SVs were unavailability of the left internal thoracic artery (n=36) and moderate lesions where flow competition was expected (n=27). Early (median, 1 day; interquartile range [IQR], 1-2 days), 1-year (median, 13 months; IQR, 11-16 months), and 3-year (median, 34 months; IQR, 27-41 months) graft angiography was performed in 98 (97.0%), 84 (83.2%), and 40 patients (39.6%), respectively. The median follow-up duration was 43 months (IQR, 13-76 months). Overall survival rates and the cumulative incidence of major adverse cardiac events were evaluated. Results: The operative mortality rate was 2% (2 of 101 patients). Early postoperative patency rates for overall and aortocoronary NT-SV grafts were 98.2% (223 of 227 distal anastomoses) and 98.2% (164 of 167), respectively. The 1- and 3-year patency rates for aortocoronary SV grafts were 94.9% (131 of 138) and 90.6% (58 of 64), respectively. The overall survival rates at 5 and 10 years were 81.7% and 59%, respectively. The cumulative incidence of major adverse cardiac events at 5 and 10 postoperative years was 20.7% and 39%, respectively. Conclusion: The feasibility of using NT-SVs as aortocoronary grafts in CABG was shown in this study, based on the graft patency rates up to 3 years and the mid-term clinical outcomes.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.760-769
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• 1997

This study aimed to determine factors that influence blood flow through coronary bypass grafts and to analyze relationship between the graft flow and postoperative outcome. Blood flow through 146 bypass grafts(GBF) was measured with transit-time ultrasound flowmeter during coronary artery bypass grafting operations in 50 patients. Single and multiple regression analyses were done for relationships between the GBF and four variables: internal diameter of recipient coronary artery, myocardial value of bypassed branch(es), type of graft, and finding of preoperative myocardial perfusion scan. The relationship between GBF and postoperative scan finding was also analyzed. 1. The mean GBF was significantly higher in sequential grafts than in single vein grafts or in internal thoracic artery grafts(61.5 vs. 46.9 and 42.5 ml/min). 2. Myocardial value and recipient artery diameter were found to be the factors determining GBF. There was no correlation between GHF and presence of perfusion defect in the preoperative scan. 3. Myocardial value was found to be more important than recipient artery diameter in determinintg GBF. 4. Reversible perfusion defects were more frequently found in the areas upplied by grafts with low GBP. But this fact had only mild statistical significance. These results suggest that blood flow through a bypass graft is more determined by the size of its supplyinf: myocardium than by the size of recipient artery. So, we can expect effective improvement in myocardial flow reserve after grafting of small(1~1.5mm) coronary arteries, if they supply substantial area of myocardium.

• Journal of Chest Surgery
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• v.35 no.1
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• pp.20-26
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• 2002

Background: Due to the concern of flow competition or retrograde steal, it has been generally suggested that the right gastroepiploic artery(RGEA) pedicled graft should be used in critical coronary stenosis lesion. The study was designed to evaluate the potential of retrograde flow competition in the RGEA pedicled graft by measuring the native pressure differences(PD) between the normal coronary artery and celiac arterial pressure, which would be compared with trans-stenosis pressure gradients(TSPG) in coronary artery occlusive disease. Material and Method: Between July, 1998 and February, 1999, pressures of the right coronary artery and the right gastroepiploic artery(or the celiac artery) were measured in patients with the patent right coronary artery(n=12). The PD between the arteries was compared with the TSPG in the occlusive coronary arteries(n=32). Result: The pressures of the normal right coronary artery and celiac artery were 143$\pm$23 vs. 134$\pm$17mmHg in systole(p<0.005), 74$\pm$13 vs. 73$\pm$14mmHg in diastole(p=NS), and 100$\pm$16 vs. 97$\pm$15mmHg in mean (p<0.05). The PD between the arteries were -8~25mmHg in systole, -4~7mmHg in diastole, and -1~10mmHg in mean. The TSPG measured in the occlusive coronary arteries were -4~19(7$\pm$5.8)mmHg in the lesion less than 75% stenosis vs. 7~74(27$\pm$18.3)mmHg in the 75% or over stenosis lesion(p<0.005). The normally existing pressure difference between the coronary arteries and RGEA(15~20mmHg) was significantlyless than the TSPG in .the occlusive coronary artery with 75% or over stenosis(p<0.001). Conclusion: If the pressure gradient between the RGEA and the coronary artery distal to the stenosis is the main determinant of development of retrograde flow competiton in the RGEA pedicled graft, the above data suggests that there will be little chance of competition when It is used in the coronary lesion with 75% or over stenosis.

• The Korean Journal of Health Service Management
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• v.8 no.4
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• pp.47-55
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• 2014

The purpose of this study was to analyze the differences in the outcome for CABG according to whether hospitals provided heart related surgeries. The 2011 National Inpatient Sample (NIS) and inpatient quality indicator principles from the Healthcare Research and Quality (AHRQ) were used for analysis. Hospitals were divided into three groups according to the surgeries they provided. The length of stay and in-hospital deaths were adjusted for the differences in risks. ANOVA was performed to examine the differences for the risk-adjusted in-hospital mortality rate and risk-adjusted length of stay among the three groups. The analysis results showed that hospitals providing CABG, PTCA, and PHS had lower risk-adjusted in-hospital mortality rates or similar risk-adjusted lengths of stay compared to those of hospitals providing only CABG. However, the three groups did not have statistically significant differences in outcome indicators. Another study will be needed with a larger sample.

• Journal of Chest Surgery
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• v.49 no.5
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• pp.387-391
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• 2016

The dehiscence of saphenous vein grafts (SVGs) is a rare, often fatal, complication of coronary artery bypass grafting (CABG). We present the case of a 57-year-old man who underwent hemiarch graft interposition and CABG for a Stanford type A aortic dissection. Five months after discharge, the patient developed streptococcal sepsis caused by a hemodialysis catheter. Complete rupture of the proximal anastomoses of the saphenous veins and containment by the obliterated pericardial cavity was observed 25 months after the initial operation. The patient was successfully treated surgically. This report describes a patient who developed potentially fatal dehiscence of SVGs secondary to infection and outlines preventive and management strategies for this complication.

• Journal of Chest Surgery
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• v.47 no.3
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• pp.225-232
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• 2014

Background: Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality as compared to the first-time operation. Further, the application of the off-pump technique to redo CABG is limited due to technical difficulties. The aim of this retrospective study was to analyze early and midterm results after redo CABG and compare the outcome of redo on-pump and off-pump CABG. Methods: From June 1996 to October 2011, elective redo CABG was performed in 32 patients. Mean age was 64.8 years (on pump 64.3 years vs. off pump 65.5 years; p=0.658), and 21 patients were male. Among these patients, 14 (43.8%) underwent on-pump CABG, and 18 (56.2%) underwent off-pump CABG. Results: Internal thoracic artery was used in 22 patients (68.8%), and total arterial revascularization was achieved in 17 patients (53.1%). The average number of distal anastomoses was 2.13, and the rate of incomplete revascularization was 43.8%. The rate of total arterial revascularization was higher in the off-pump group (14.3% vs. 83.3%, p<0.001), and the use of saphenous vein graft was more in the on-pump group (78.6% vs. 16.7%, p<0.001). Overall hospital mortality was 3.1% (n=1) and was comparable in both groups (on pump 7.1% vs. off pump 0%; p=0.249). Postoperative complications occurred in 9 patients (64.2%), and the rate of complications was high in the on-pump group without statistical significance (64.2% vs. 33.3%, p=0.082). The mean follow-up duration was 5.4 years, and overall survival at 10 years was $86.0%{\pm}10.5%$. There was no significant difference in the 10-year survival rate between the two groups (79.6% vs. 100%, p=0.225). Conclusion: Redo CABG can be safely performed with acceptable mortality. Redo off-pump coronary artery bypass is feasible with low mortality and morbidity, comparable target vessel bypass grafting, and long-term survival. The off-pump technique might be considered a safe option for redo CABG in high-risk patients.