• Journal of Chest Surgery
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• v.35 no.3
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• pp.188-198
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• 2002

Background: Reoperations on the aortic root or the ascending aorta are being performed with increasing frequency and remain a challenging problem. This study was performed to analyze the results of reoperations on the ascending aorta and aortic root. Material and Method: Between May 1995 and April 2001, 30 patients had reoperations on the ascending aorta and aortic root and were reviewed retrospectively. The mean interval between the previous repair and the actual reoperation was 56 months(range 3 to 142 months). Seven patients(23.3%) had two or more previous operations. The indications for reoperations were true aneurysm in 7 patients(23.3%), prosthetic valve endocarditis in 6(20%), false aneurysm in 5(16.7%), paravalvular leak associated with Behcet's disease in 4(13.3%), malfunction of prosthetic aortic valve in 4(13.3%), aortic dissection in 3(10%), and annuloaortic ectasia in 1(3.3%). The principal reoperations performed were aortic root replacement in 17 patients(56.7%), replacement of the ascending aorta in 8(26.7%), aortic and mitral valve replacement with reconstruction of fibrous trigone in 2(6.6%), patch aortoplasty in 2(6.6%), and aortic valve replacement after Bentall operation in 1 (3.3%). The cardiopulmonary bypass was started before sternotomy in 7 patients and the hypothermic circulatory arrest was used in 16(53.3%). The mean time of circulatory arrest, total bypass, and aortic crossclamp were 20$\pm$ 12 minutes, 228$\pm$56 minutes, and 143$\pm$62 minutes, respectively Result: There were three early deaths(10%). The postoperative complications were reoperation for bleeding in 7 patients(23.3%), cardiac complications in 5(16.7%), transient acute renal failure in 2(6.6%), transient focal seizure in 2(6.6%), and the others in 5. The mean follow-up was 22.8 $\pm$20.5 months. There were two late deaths(7.4%). The actuarial survival was 92.6$\pm$5.0% at 6 years. One patient required reoperation for complication of reoperation on the ascending aorta and aortic root(3.7%). The 1- and 6-year actuarial freedom from reoperation was 100% and 83.3$\pm$15.2%, respectively. One patient with Behcet's disease are waiting for reoperation due to false aneurysm, which developed after aortic root replacement with homograft. There were no thromboembolisms or anticoagulant related complications. Conclusions: This study suggests that reoperations on the ascending aorta and aortic root can be performed with acceptable early mortality and morbidity, and adequate surgical strategies according to the pathologi conditions are critical to the prevention of the reoperation.

• Clinical and Experimental Pediatrics
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• v.52 no.11
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• pp.1216-1220
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• 2009

Purpose:To analyze and compare various cases in which peritoneal drainage was used as the primary treatment method in preterm infants with intestinal perforation. Methods:Among the preterm infants of less than 28 weeks of gestation who were admitted to the neonatal intensive care unit (NICU) at the Gangnam Severance Hospital from April 2006 to April 2009, 7 who had developed intestinal perforation were studied retrospectively. We investigated the clinical characteristics, secondary operation performances, morbidities, complications, and mortalities. Results:Among the 7 infants, 5 survived. Of the 5 cases, 3 received laparotomy, of which 2 were confirmed as having necrotizing enterocolitis. Of the 2 infants who died, 1 had received laparotomy before 48 h of peritoneal drainage, while the other had not received any subsequent treatment. Of the 7 children, 4 had patent ductus arteriosus (PDA), of which 3 had received indomethacin injection. Five infants had begun enteral feeding before they developed intestinal perforation. Of the 5 infants who survived, 4 were diagnosed with cholestasis. Of the 7 infants, 4 developed periventricular leukomalacia (PVL) and 3 developed rickets. Conclusion:Although the use of peritoneal drainage as the primary management of intestinal perforation in preterm infants is controversial, we suggest that it can be used for treating extreme premature neonates. Further randomized controlled study will be required to determine the feasibility of using this method.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.559-569
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• 2004

The CarboMedics mechanical valve has been reported to show acceptable valve-related complication rates. The aim of this study is to evaluate our clinical experience with the CarboMedics valve. Material and Method: Between August 1988 and September 1999, we implanted 1,144 CarboMedics valves in 850 patients (aortic 179; mitral 385; double-valve 234; tricuspid 52). The mean age was 44.5 $\pm$ 12.5 years. Follow-up was completed in 95.2% and median follow-up period was 7.9 years (6753 patient-years). Result: The overall hospital mortality rate was 3.4% and the mortality rate for each group was 1.7% for aortic group, 2.6% for mitral group, 4.7% for double-valve group, and 9.6% for tricuspid group, Tricuspid group showed significantly higher mortality rate than aortic and mitral group (p〈0.05). The actuarial survival at 10 years was 87.1 $\pm$ 2.6%, 88.9 $\pm$ 1.7%, 82.4 $\pm$ 2.9%, and 77.5 $\pm$ 7.0% for aortic, mitral, double, and tricuspid valve group, respectively. Age and tricuspid valve replacement were significant risk factors for long-term survival in multivariate analysis (p 〈 0.05). Freedom from valve thrombosis at 10 years was 99.4 $\pm$ 0.6%, 98.2 $\pm$ 0.8%, 99.2 $\pm$ 0.8%, and 87.6 $\pm$ 0.5% for aortic, mitral, double and tricuspid valve group. Tricuspid valve group showed significantly higher rate of valve thrombosis (p 〈 0.05). Conclusion: Long-term results of our experience demonstrated that CarboMedics valve showed acceptable incidence of valve-related complications. However, tricuspid valve replacement showed higher rate of early mortality and valve thrombosis than other valve replacement groups.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.598-604
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• 2008

Background: The improvements in endoscopic equipment and surgical robots has encouraged the performance of minimally invasive cardiac operations. Yet only a few Korean studies have compared this procedure with the sternotomy approach. Material and Method: Between December 2005 and July 2007, 48 patients (group A) underwent minimally invasive cardiac surgery with AESOP through a small right thoracotomy. During the same period, 50 patients (group B) underwent conventional surgery. We compared the operative time, the operative results, the post-operative pain and the recovery of both groups. Result: There was no hospital mortality and there were no significant differences in the incidence of operative complications between the two groups. The operative $(292.7{\pm}61.7\;and\;264.0{\pm}47.9min$, respectively; p=0.01) and CPB times ($128.4{\pm}37.6\;and\;101.7{\pm}32.5min$, respectively; <0.01) were longer for group A, whereas there was no difference between the aortic cross clamp times ($82.1{\pm}35.0\;and\;87.8{\pm}113.5min$, respectively; p=0.74) and ventilator times ($18.0{\pm}18.4\;and\;19.7{\pm}9.7$ hr, respectively; p=0.57) between the groups. The stay on the ICU $(53.2{\pm}40.2\;and\;72.8{\pm}42.1hr$, respectively; p=0.02) and the hospitalization time ($9.7{\pm}7.2\;and\;14.8{\pm}11.9days$, respectively; p=0.01) were shorter for group A. The Patients in group B had more transfusions, but the difference was not significant. For the overall operative intervals, which ranged from one to four weeks, the pair score was significantly lower for the patients of group A than for the patients of group B. In terms of the postoperative activities, which were measured by the Duke Activity Scale questionnaire, the functional status score was clearly higher for group A compared to group B. The analysis showed no difference in the severity of either post-repair of mitral ($0.7{\pm}1.0\;and\;0.9{\pm}0.9$, respectively; p=0.60) and tricuspid regurgitation ($1.0{\pm}0.9\;and\;1.1{\pm}1.0$, respectively; p=0.89). In both groups, there were no valve related complications, except for one patient with paravalvular leakage in each group. Conclusion: These results show that compared with the median sternotomy patients, the patients who underwent minimally invasive surgery enjoyed significant postoperative advantages such as less pain, a more rapid return to full activity, improved cosmetics and a reduced hospital stay. The minimally invasive surgery can be done with similar clinical safety compared to the conventional surgery that's done through a median sternotomy.

• Journal of Hospice and Palliative Care
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• v.21 no.1
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• pp.23-32
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• 2018

Purpose: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in U.S. hospitals. We examine hospital cost trends and the impact of palliative care utilization on the use of life-sustaining procedures in this population. Methods: Retrospective nationwide cohort analysis was performed using National Inpatient Sample (NIS) data from 2005 and 2014. We examined the receipt of both palliative care and intensive medical procedures, defined as systemic procedures, pulmonary procedures, or surgeries using the International Classification of Diseases, 9th revision (ICD-9-CM). Results: We used compound annual growth rates (CAGR) to determine temporal trends and multilevel multivariate regressions to identify factors associated with hospital cost. Among 77,394,755 hospitalizations, 79,314 patients were examined. The CAGR of hospital cost was 5.83% (P<0.001). The CAGRs of systemic procedures and palliative care were 5.98% and 19.89% respectively (each P<0.001). Systemic procedures, pulmonary procedures, and surgeries were associated with increased hospital cost by 59.04%, 72.00%, 55.26%, respectively (each P<0.001). Palliative care was associated with decreased hospital cost by 28.71% (P<0.001). Conclusion: The volume of systemic procedures is the biggest driver of cost increase although there is a cost-saving effect from greater palliative care utilization.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.844-849
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• 2006

Background: The diffuse infiltrative lung disease requires surgical lung biopsy for its final diagnosis. We evaluated the effect of surgical lung biopsy for final diagnosis of duffuse interstitial lung disease and compared video assisted thoracoscopic lung biopsy(TLB) with open lung biopsy(OLB). Material and Method: We evaluated the patients who underwent surgical lung biopsy from March 2000 from December 2005, retrospectively, We divide to two groups(OLB and TLB group) and compared them. Result: There were 36 patients and cough was the most common pre- operative symptom. Surgery time, anesthetic time, hospital stay, duration of chest tube indwelling, specimen volume and the rate of post-operative complication were not significantly different between two groups. Histologic diagnosis was confirmed in all cases. There was one post-operative death who had suffered from respiratory failure since pre-operative period. Conclusion: Surgical lung biopsy is effective method in final diagnosis for diffuse infiltrative lung disease. Video assisted thoracoscopic lung biopsy is lesser invasive method than open lung biopsy and provide similar results, so it is basic diagnostic method of surgical lung biopsy.

• Journal of Chest Surgery
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• v.36 no.9
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• pp.646-650
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• 2003

Many surgical techniques for ischemic mitral regurgitation (IMR) have been used with their excellent results and advantages. Here, we report our simple posterior annuloplasty techniques using vascular graft strip with their early results. Material and Method: Twenty two patients (13 male) underwent the operations for IMR (excluding the papillary muscle rupture) from December 2001 to January 2003. Preoperative risk factors were low ejection fraction (<35％, n=9), hypertension (n=13), diabetes (n=9), and renal failure (Cr>2.5, n=4). The wide dissection beneath the both vena cavae and interatrial groove after bicaval cannulation enabled the easy exposure of mitral valve even in the small left atrium. After eight or nine interrupted sutures in posterior annulus for anchoring the 6 mm width vascular graft strip, symmetric (n=8) or asymmetric (n=14) annuloplasty were done. Combined surgeries were CABG (n=21), Dor procedures (n=3), tricuspid valve annuloplasty (n=1), Maze operation (n=1), and aorto-right subclavian artery bypass (n=1). Result: Except for one surgical mortality, all the patients were doing well and the mean grade of regurgitation was decreased from 2.95 to 0.88, however the ejection fraction had not changed significantly just before discharge. Post-operative valve function evaluated before discharge revealed no residual regurgitation in 8 (including 1 patient with mild stenosis due to over reduction), minimal in 11, mild in 2, and mild to moderate regurgitation in 1. One patient who had ischemic cardiomyopathy and renal failure died of the arrhythmia during the hemodialysis. Conclusion: These observations suggest that the annuloplasty with vascular graft strip could be a safe and cost effective techniques for ischemic mitral regurgitation. However, the long term evaluation for the mitral valve function should be defined for the final conclusion.

• Journal of Chest Surgery
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• v.41 no.5
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• pp.573-579
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• 2008

Background: Composite valve graft replacement is currently the treatment of choice for a wide variety of the lesions of aortic root disease. The purpose of this study was to explore the results of aortic root replacement after using the Cabrol technique over a 13-year period at our institution, and we analyzed the results to help surgeons make better decisions when repairing aortic root disease. Material and Method: Between January 1994 and December 2006, twenty-five patients underwent a Cabrol technique operation at our institution. The mean patient age was $43.7{\pm}14.1$ years old (range: $6{\sim}65$ years) and the male and female ratio was 21:4 (84% : 16%). The patients' follow-up was 100% complete, and the mean follow-up period was $60.7{\pm}50.4$ (range:$1{\sim}162$) months. Annuloaortic ectasia (n=18) was the most frequent cause of aortic disease in this series, followed by aortic dissection (n=7). The mean cardiopulmonary bypass time was $177.2{\pm}44.9$ minutes and the mean aortic cross clamping time was $123.4{\pm}34.1$ minutes. Nine patients were checked with MDCT (Multidetector computed tomography) for evaluating a well functioning secondary graft and the coronary anastomosis site. Result: The early mortality rate was 4% (1 of 25 patients). A significant stenosis, kinking or occlusion of the secondary graft was detected by MDCT in 4 patients. The overall survival rate was 88%. Conclusion: The Cabrol technique demonstrated a significant incidence of long-term complications such as secondary graft stenosis or obstruction. It could be used when the modified Bentall technique is not feasible.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.200-208
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• 2007

Background: The effect of patient-prosthesis mismatch (PPM) on the clinical outcome following aortic valve replacement (AVR) remains controversial. This study compared the surgical outcomes of AVR between patients with a patient-prosthesis mismatch and those having undergone an aortic annular enlargement. Material and Method: Six hundred and twenty seven adult patients, who underwent AVR with stented bioprosthetic or mechanical valves, between January 1996 and February 2006, were evaluated. PPM was defined as an indexed effective orifice area (iEOA) ${\leq}0.85cm^2/m^2$, and Severe if the iEOA${\leq}0.65cm^2/m^2$ PPM was present in 103 (16.4%, PPM group) patients, and severe in 11 (1.8%, SPPM group). During the period of the study, 21 patients underwent an AVR with annular enlargement (AE group). Result: The mean iEOA of the AE group was larger than that of the PPM group ($0.95\;vs.\;0.76cm^2/m^2,\;p=0.00$). The AE group had longer CPB, ACC and operation times than the PPM group, and showed a tendency toward higher operative mortality (14.3% vs. 2.9%, p=0.06). The SPPM group had higher AV pressure gradients (peak/mean) than the AE group (72/45 mmHg vs. 38/25 mmHg, p=0.02/0.06) and suffered more AV related events (AV reoperation or severe aortic stenosis)(45.5% vs. 9.5%, p=0.03). LV masses were not regressed in the patients who experienced an AV related event. Conclusion: During AVR in patients with a small aortic annulus, annular enlargement should be carefully applied taking into account the high risk of operative mortality due to annular enlargement and co-morbidities of patients. Aortic annular enlargement; however, should be considered as an alternative method in patients expected to have a severe PPM after an AVR.

• Pediatric Infection and Vaccine
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• v.12 no.2
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• pp.157-165
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• 2005

Purpose : Children occupy a large proportion of burn victims. So we want to aid to pediatric burn care through the understanding of the bacterial distribution in burn wounds and antibiotic susceptibility against isolated microorganisms from burn wounds. Methods : We analysed the medical records of 213 pediatric burn patients(0~15 years), 406 samples that grew bacteria in burn wound sites. Results : Of the total 213 patients, male were 59.6% and female were 40.4%. Scalding burn was the most common(78.4%), flame burn was the second(16.4%). Pathogens were isolated in 406 samples. The most common was Pseudomonas aeruginosa(58.1%). Next were Enterococcus species, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus species, Acinetobacter species. P. aeruginosa was resistant to trimethoprim-sulfamethoxazole in 100%, cephalothin in 98.1%, ampicillin-sulbactam in 96.2%, ampicillin in 95.3%, ceftriaxone in 95.2%, tobramycin in 93.7%, cefoperazone in 68.9%, ceftazidime in 67.7%. Enterococcus species were resistant to tetracycline in 63.9%, streptomycin in 45.5%, gentamicin in 36.1%, penicillin G in 13.7%. S. aureus was resistant to gentamicin in 89.7%, tetracycline in 86.2%, ciprofloxacin in 86.2%, penicillin G in 84.3%, oxacillin in 78.4%, erythromycin in 76.5%. Acinetobacter species were resistant to ampicillin-sulbactam in 100%, gentamicin in 85.7%, ampicillin in 83.3%, piperacillin in 61.5%. Conclusion : P. aeruginosa was highly resistant to drugs like cefoperazone in 68.9%, ceftazidime 67.7%. S. aureus was highly resistant to penicillin G in 84.3%, oxacillin in 25.9 %, but none to vancomycin in 0%, teicoplanin in 2.2%. According to the study, Acinetobacter species turned out to be multi-resistant strains, so careful attention must be paid to the choice of antibiotics.