• Tuberculosis and Respiratory Diseases
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• v.74 no.4
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• pp.163-168
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• 2013

Background: In uncontrolled hemoptysis patient, bronchial arteriography and bronchial artery embolization (BAE) is a important procedure in diagnosis and treatment. The aim of this study is to assess the incidence of contrast-induced nephropathy and the risk factors of contrast-induced nephropathy (CIN) after bronchial arteriography and BAE. Methods: We retrospectively reviewed the medical records of the patients who underwent bronchial arteriography and BAE in two university hospitals from January 2003 to December 2011. CIN was defined as rise of serum creatinine more than 25% of baseline value or 0.5 mg/dL at between 48 hours and 96 hours after bronchial arteriography and BAE. We excluded patients who already had severe renal insufficiency (serum creatinine${\geq}4.0$) or had been receiving dialysis. Results: Of the total 100 screened patients, 88 patients met the enrollment criteria. CIN developed in 7 patients (8.0%). The mean duration between the exposure and development of CIN was $2.35{\pm}0.81$ days. By using multivariate analysis, serum albumin level was found to be significantly associated with the development of CIN (p=0.0219). Conclusion: These findings suggest that the incidence of CIN was higher than expected and patients with hypoalbuminemia should be monitored more carefully to prevent the development of CIN after bronchial arteriography and BAE.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.749-753
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• 2006

Background: The purpose of this study is to assess a score system for operative risk evaluation of CABG. Material and Method: From January 2001 to September 2005, retrospective study for various perioperative factors of 2993 cases was done. Result: The early operative mortality was 2.4% and the beta coefficients of 7 core variables related to it (preoperative LV dysfuction, preoperative renal failure, MI within 1 week, reoperation, combined surgery, preoperative atrial fibrillation, preoperative IABP) were adjusted to score system. ROC curve and Hosmer and Lemeshow goodness of fit test was done. Conclusion: This score system was effective in assessing operative risk of CABG. But It is necessary to gather larger volume of case and perform multicenter study.

• Pediatric Infection and Vaccine
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• v.24 no.3
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• pp.141-145
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• 2017

Purpose: Clinical and laboratory features of two Kawasaki disease (KD) groups were evaluated; the patient with pyuria and those without pyuria. Methods: From January 2015 to December 2016, the medical records of 140 (86 males and 54 females) inpatients with KD were retro-spectively analyzed. Results: Forty-eight KD patients (34.3%) presented with pyuria. KD patients with pyuria showed a higher level of C-reactive protein (CRP) and a higher proportion of elevated liver enzymes than those without pyuria. There were no differences in the proportions of unresponsiveness to intravenous immunoglobulin and coronary artery lesions between the two groups. Six KD patients (12.5%) with pyuria underwent a renal imaging study to rule out the possibility of a urinary tract infections. Thirty-two KD patients (66.7%) with pyuria received treatment with antibiotics in addition to the standard treatment for KD. Conclusions: KD patients with pyuria showed a higher level of CRP and elevated levels of liver enzymes than those without pyuria. These findings suggest that KD patients with pyuria have more severe systemic inflammation than those without pyuria.

• Journal of Chest Surgery
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• v.38 no.10 s.255
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• pp.680-684
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• 2005

Background: With the increasing age of the population, coronary artery bypass grafting in the elderly patients is becoming common. Off-pump coronary artery bypass grafting (OPCAB) has been proven to be less morbidity and to facilitate early recovery. The elderly patients may have benefits by avoiding the adverse effects of the cardiopulmonary bypass. The purpose of this study is to evaluate our results of OPCAB in elderly patients. Material and Method: A retrospective chart review was carried out for 12 patients aged over 80 years who underwent isolated OPCAB from January 2001 and March 2004. Data were collected risk factors for disease, extent of coronary disease, and in-hospital outcomes. Postoperative graft patiency was evaluated in 9 patients by multi-slice computed tomography. Result: Eleven patients had triple vessel disease or left main disease. Four patients were suffered from preoperative CVA, and 4 patients had chronic obstructive pulmonary disease. Two patients had myocardial infarction (MI), among them 1 patient was suffered from pulmonary edema after preoperative MI. There was no perioperative death, perioperative MI, and no ventricular arrhythmia. Also there was no perioperative stroke and renal failure. But there was one deep sternal infection who recovered by treating of muscle flap. Atrial fibrillation was newly developed in 1 patient, but was well controlled by medication. Mean intubation time was $15.9\pm4.4(8\~20hrs)$ hrs and mean ICU stay was $2.9\pm0.8(2\~4 days)$ days. Mean hospital day was $21.6\pm14.3(13\~56 days)$ days. Postoperative mean CK-MS was $11.3\pm14.1\;ng/mL$. Early postoperative graft patency rate was $100\%(24/24)$. Follow-up was completed in all patients. In this time, there was no patients with angina or death. Conclusion: The results of this study suggest that OPCAB reduces morbidity and favors hospital outcomes. Therefore, OPCAB is safe, reasonable and might be preferable operative strategy in elderly patients.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1049-1055
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• 1998

Background: Coronary artery bypass surgery is an important treatment for ischemic heart disease. Recently operative mortality and morbidity has decreased, however further improvement is necessary. Materials and methods: This study was designed to evaluate the risk of operative mortality and morbidity by retrospective method. From 1992 to 1997, eighty six patients underwent coronary artery bypass surgery. There were 61 males and 25 females aged 36~74 years(mean, 58.6). Fourteen patients(16%) had previous PTCA or stent insertion, 41 patients(48%) had unstable angina, and 45 patients(52%) had three vessel disease. Patients with low LV ejection fraction(<35%) were 7 cases and urgent or emergent operation were 10 cases. There were 6 cases of combined surgery which were mitral valve replacement(2 cases), aortic valve replacement(2 cases), ASD repair(1 case), and VSD repair(1 case). Average number of distal anastomosis was 3.5 per patient and average aortic cross clamp time was 115±38.3min. Preoperative risk factors were defined as follows: female, old age(>70 years), low body surface area(<1.5M2), PTCA or stent insertion history, hypercholesterolemia, smoking, hypertension, DM, COPD, urgent or emergent operation, left main disease, low LV ejection fraction(<35%), and combined surgery. Results: Operative mortality was 7cases(8%). As a postoperative morbidity, perioperative myocardial infarction was 6 cases, cerebrovascular accident 6 cases, reoperation for bleeding 5 cases, acute renal failure 4 cases, gastrointestinal complication 3 cases, and mediastinitis 3 cases. In the evaluation of operative risk factors, low body surface area, DM and low LV ejection fraction were found to be predictive risk factors of postoperative morbidity(p<0.05), and low ejection fraction was especially a risk factor of hospital mortality(p<0.05). Conclusions: In this study, low body surface area, DM and low LV ejection fraction were risk factors of postoperative morbidity and low ejection fraction was a risk factor of hospital mortality.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.715-721
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• 1999

Background:The number of old patients receiving coronary artery bypass grafting(CABG) is increasing. With the more recent advances in operative techniques, the age at which CABG is indicated has also increased. This study evaluated the risk factors associated with the hospital mortality and the morbidity following CABG in elderly patients. Material and Method: Between March 1991 and June 1998, we retrospectively reviewed 45 consecutive patients aged 65 years or older who underwent CABG. We compared the data with the results of 179 patients under the age 65 years operated during the same period. Result: Mean age was 68${\pm}$1.41 years(range 65 to 74 years). Emergency surgery was required in 4, and elective surgery in 41 patients. The mean number of distal anastomosis per patient was 3.62 ${\pm}$0.81 and mean aortic cross-cramp time was 69.84${\pm}$18.5 minutes. Thirty patients had Canadian class III or IV preoperatively, but 43 patients had class I or II postoperatively. The left ventricular ejection fraction increased significantly from 54.23${\pm}$10.62% preoperatively to 58.14${\pm}$9.88% postoperatively(p<0.05). Postoperative complication was pneumonia in 2 patients, acute renal failure in 2 patients, sternal wound infection in 1 patient, and postoperative myocardial infarction in 1 patient. There were two postoperative deaths. The causes of deaths were low output syndrome in one patient, and sepsis due to pneumonia in the other patient. The hospital mortality was higher in the elderly group(4.4 versus 2.86%) but was not statistically significant(p>0.05). Incremental risk factors for hospital deaths in the elderly were emergent operation, preoperative PTCA, postoperative use of IABP and postoperative ARF(p<0.05). The duration of hospital stay after operation was significantly longer for the elderly group than the younger group(19.27${\pm}$12.51 vs 15.55${\pm}$6.99 days; p＜ 0.05). Follow-up was complete for 34 of the hospital survivors and ranged from 1 to 73 months(mean: 23.58${\pm}$19.56 months). There was no late mortality of cardiac origin. Conclusion: Age is an important factor in selecting optimal management for elderly patients with coronary compromise, but age alone should not dictate the choice of therapy. Coronary artery bypass surgery in the elderly is associated with acceptable early mortality and excellent long-term results.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.322-327
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• 2004

Coronary artery bypass grafting on the beating heart is no longer a new methods for any cardiac surgeon. We evaluated the application of the off-pump coronary artery bypass procedure relative to safety and efficiency as measured by postoperative complication and operative mortality. Material and Method: We used our retrospective database to compare the patients having off-pump coronary surgery (n=100) with those having on-pump coronary surgery (n=100) between June, 1999 and August, 2002. Patients whom underwent associated valvular or aortic aneurysmal operation were excluded. Result: Neither groups showed any differences in the patient's risk factors and extent of coronary disease. Off-pump CABG group did not have significantly less mean operation time (295$\pm$73 min vs 323$\pm$83 min, p=ns) and mean hospital day (15.34$\pm$6.02 day vs 13.80$\pm$4.95 day, p=ns). However, off-pump CABG group had significantly shorter mean ventilation time (17.3$\pm$11.27 hour vs 24.98$\pm$16.1 hour, p＜0.05). No patients were converted to on-pump CABG in off-pump CABG. Intraoperative hemodynamic instability in off-pump CABG were 6 cases, of whom 2 cases were in lateral wall approach and 4 cases in right coronary anastomosis. Postoperative mortality was 1 case in off-pump CABG and 2 cases in on-pump CABG. Intra-aortic ballon pump (IABP) was applied in 1 case with off-pump CABG and in 2 cases with on-pump CABG. No patients presented postoperative cerebral infarction ＆ stroke in off-pump CABG but 2 patients in on-pump CABG. Postoperative arrhythmia presented in 4 cases with off-pump CABG and in 6 cases with on-pump CABG. Acute renal failure (ARF) was complicated in 3 cases with off-pump CABG and in 2 cases with on-pump CABG. Conclusion: This study documented the immediate safety and efficiency of the off-pump CABG procedure.

• Journal of Chest Surgery
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• v.39 no.6 s.263
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• pp.449-455
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• 2006

Background: Female sex was known to be a risk factor for mortality after coronary bypass grafting (CABG), and women showed higher in-hospital mortality than men. Material and Method: Between 1992 and 1996, 147 consecutive patients (98 men and 49 women) undergoing CABG were included in the study. Most patients had undergone CABG with left internal thoracic artery and saphenous vein under cardiopulmonary bypass. We examined the influence of gender on survival after CABG and looked for risk factors for survival. Result: There was no in-hospital mortality in women, but 3 death (3.0%) in men. During the mean follow-up period of $138.5{\pm}23.0$ months, mortality was lower in women than in men (20.4% vs 44.9%, p=0.004), and the most common cause of death in women was chronic renal failure (40%). Survival in women at 1, 5, 10, and f4 years was 100%, $98.0{\pm}2.0%,\;81.2{\pm}5.6%,\;and\;78.4{\pm}6.1%$, respectively, which was better than in men (p=0.004). Although preoperative left ventricular ejection fraction was higher in women than in men, this did not affect early and long-term survival difference between two sexes (p=0.15). Risk factor for long-term survival in women was diabetes (p=0.033) and in men number of diseased coronary artery (p=0.006). Conclusion: Long-term survival after CABG was better in women than men. Risk factor for long-term survival in women was morbid disease rather than cardiac disease.

• Journal of Chest Surgery
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• v.38 no.11 s.256
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• pp.733-738
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• 2005

Background: The possibility of incomplete revascularization and development of flow competition after revascularization of the borderline lesion made the hybrid strategy as an option for complete revascularization. Material and Method: From January f998 to July 2004, 25 $(3.2\%)$ patients underwent hybrid revascularization among 782 total OPCAB procedures. Clinical results and angiographic patencies were evalulated. Percutaneous coronary intervention (PCI) was peformed before CABG in 8 patients and after CABG in 47 patients. Result: The causes of PCIs before CABG were to achieve complete revascularization with minimally invasive surgery (n=7) and emergent PCI for culprit lesion (n=1). The indications of PCIs after CABG were high possibility of flow competition in the borderline lesion of right coronary artery territory (n=8), diffuse atheromatous lesion preventing anastomosis of graft (n=5), severe calcified ascending aorta with no more arterial grafi available (n=3), and intramyocardial coronary lesion (n=1). Mean number of distal anastomoses was $2.3\pm1.0$. Mean number of lesions treated by PCI was $1.2\pm0.4$. There was no operative or procedure-related mortality. PCI-related complication was periprocedural myocardial infarction in one patient, and complications related to CABG were transient atrial fibrillation (n=5), perioperative myocardial infarction (n=1), and transient renal dysfunction (n=1). Early postoperative coronary angiography $(1.8{pm}1.6days)$ revealed $100\%$ patency rate of grafts (57/57). The stenosis occurred in one patient performed PCI before CABG, which was successfully treated with re-ballooning. During midterm follow-up (mean; $25{\pm}26$ months), 1 patient died of congestive heart failure. All survivors (n=24) accomplished follow-up coronary angiographics, which showed .all grafts (56/57) were patent except one string sign. In-stent restenosis was developed in 2 patients who received bare metal stents. Conclusion: In selected patients, complete revascularization was achieved with low risk by taking the hybrid strategy.

• Journal of Chest Surgery
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• v.38 no.5 s.250
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• pp.349-356
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• 2005

Background: Arterial conduits using in coronary artery bypass grafting (CABG) have been known a great long term patency rates, and improved short and long term clinical outcomes. It has been reported that Off pump CABG has better clinical results than CABG using cardiopulmonary bypass. To evaluate the advantage of arterial conduits over venous conduits and to avoid the adverse effects of cardiopulmonary bypass, we performed total arterial Off pump CABG. Material and Method: From January 2001 to October 2004, Off pump CABG using only arterial conduits was performed on 325 patients with a mean age of $59.3\pm11.9$ years ($36\~83$). Mean ejection fraction was $55.4\pm14.0\%\;(15\~86).$ Angiography showed left main disease or triple-vessel disease in $81.9\%$ of the patients. Indications of using arterial conduits was stenosis $\ge50\%$ of left anterior descending artery, stenosis $\ge80\%$ of branches of left circumflex artery, and stenosis $\ge90\%$ of right coronary artery and its branches. Multi-slice computed tomography was performed on 194 patients to evaluate the short term patency rates. Result: A total of 928 distal anastomoses were performed and the average anastomoses per a patient were $2.86\pm0.78$. There was 1 operative mortality. Postoperative complications were mediastinitis in 6 patients ($1.8\%$), renal failure in 4 patients ($1.2\%$), perioperative myocardial infarction in 3 patients ($0.9\%$), reoperation for bleeding in 3 patients ($0.9\%$). There was no postoperative stroke. Patency rate of arterial conduits was $99.3\%$ (581/585). There were 4 stenoses or competitive flows in 2 radial arteries and 2 right internal mammary arteries. Conclusion: Total arterial Off pump CABG appears to be safe, showing a low surgical mortality and morbidity and excellent short term patency rates of arterial conduits.