• Journal of Korean Neurosurgical Society
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• v.64 no.2
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• pp.198-206
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• 2021

Objective : The low-profile Neuroform Atlas stent can be deployed directly without an exchange maneuver by navigating into the Gateway balloon. This retrospective study assessed the safety and efficacy of Neuroform Atlas stenting as a rescue treatment after failure of mechanical thrombetomy (MT) for large artery occlusion. Methods : Between June 2018 and December 2019, a total of 31 patients underwent Neuroform Atlas stenting with prior Gateway balloon angioplasty after failure of conventional MT caused by residual intracranial atherosclerotic stenosis (ICAS). Primary outcomes were successful recanalization and patency of the vessel 24 hours after intervention. Secondary outcomes were vessel patency after 14 days and 3-month modified Rankin Scale. Peri-procedural complications, intracerebral hemorrhage (ICH), and 3-month mortality were reviewed. Results : With a 100% of successful recanalization, median value of stenosis was reduced from 79.0% to 23.5%. Twenty-eight patients (90.3%) showed tolerable vessel patency after 14 days. New infarctions occurred in three patients (9.7%) over a period of 14 days; two patient (6.5%) underwent stent occlusion at 24 hours, and the other patient (3.2%) with delayed stent occlusion had a non-symptomatic dot infarct. There were no peri-procedural complications. Two patients (6.5%) developed an ICH immediately after the procedure with one of them is symptomatic. Conclusion : Neuroform Atlas stenting seems to be an effective and safe rescue treatment modality for failed MT with residual ICAS, by its high successful recanalization rate with tolerable patency, and low peri-procedural complication rate. Further multicenter and randomized controlled trials are needed to confirm our findings.

• Journal of Yeungnam Medical Science
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• v.40 no.3
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• pp.259-267
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• 2023

Background: Malnutrition and impaired immune responses significantly affect the clinical outcomes of patients with atherosclerotic stenosis. The Controlling Nutritional Status (CONUT) score has recently been utilized to evaluate perioperative immunonutritional status. This study aimed to evaluate the relationship between immunonutritional status, indexed by CONUT score, and postoperative complications in patients undergoing carotid endarterectomy (CEA). Methods: We retrospectively evaluated 188 patients who underwent elective CEA between January 2010 and December 2019. The preoperative CONUT score was calculated as the sum of the serum albumin concentration, total cholesterol level, and total lymphocyte count. The primary outcome was postoperative complications within 30 days after CEA, including major adverse cardiovascular events, pulmonary complications, stroke, renal failure, sepsis, wounds, and gastrointestinal complications. Cox proportional hazards regression analysis was used to estimate the factors associated with postoperative complications during the 30-day follow-up period. Results: Twenty-five patients (13.3%) had at least one major complication. The incidence of postoperative complications was identified more frequently in the high CONUT group (12 of 27, 44.4% vs. 13 of 161, 8.1%; p<0.001). Multivariate analyses showed that a high preoperative CONUT score was independently associated with 30-day postoperative complications (hazard ratio, 5.98; 95% confidence interval, 2.56-13.97; p<0.001). Conclusion: Our results showed that the CONUT score, a simple and readily available parameter using only objective laboratory values, is independently associated with early postoperative complications.

• Journal of Chest Surgery
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• v.56 no.5
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• pp.346-352
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• 2023

Background: A significant proportion of cardiac surgery intensive care unit (CSICU) patients require long-term ventilation, necessitating tracheostomy placement. The goal of this study was to evaluate the long-term postoperative outcomes and complications associated with percutaneous dilatational tracheostomy (PDT) in CSICU patients. Methods: All patients undergoing PDT after cardiac, thoracic, or vascular operations in the CSICU between January 1, 2013 and January 1, 2021 were identified. They were evaluated for mortality, decannulation time, and complications including bleeding, infection, and need for surgical intervention. Multivariable regression models were used to identify predictors of early decannulation and the complication rate. Results: Ninety-three patients were identified for this study (70 [75.3%] male and 23 [24.7%] female). Furthermore, 18.3% of patients had chronic obstructive pulmonary disease (COPD), 21.5% had history of stroke, 7.5% had end-stage renal disease, 33.3% had diabetes, and 59.1% were current smokers. The mean time from PDT to decannulation was 39 days. Roughly one-fifth (20.4%) of patients were on dual antiplatelet therapy and 81.7% had anticoagulation restarted 8 hours post-tracheostomy. Eight complications were noted, including 5 instances of bleeding requiring packing and 1 case of mediastinitis. There were no significant predictors of decannulation prior to discharge. Only COPD was identified as a negative predictor of decannulation at any point in time (hazard ratio, 0.28; 95% confidence interval, 0.08-0.95; p=0.04). Conclusion: Percutaneous tracheostomy is a safe and viable alternative to surgical tracheostomy in cardiac surgery ICU patients. Patients who undergo PDT have a relatively short duration of tracheostomy and do not have major post-procedural complications.

• Journal of Chest Surgery
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• v.56 no.2
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• pp.90-98
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• 2023

Background: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. Totally thoracoscopic ablation (TTA) is a surgical treatment showing a high success rate as a hybrid procedure with radiofrequency catheter ablation to control AF. This study compared the early complications of warfarin and non-vitamin K antagonist oral anticoagulants (NOACs) in patients who underwent TTA. Methods: This single-center retrospective cohort study enrolled patients who underwent planned TTA for AF from February 2012 to October 2020. All patients received postoperative anticoagulation, either with warfarin or a NOAC (apixaban, rivaroxaban, dabigatran, or edoxaban). Propensity score matching was performed for both groups. Early complications were assessed at 12 weeks after TTA and were divided into efficacy and safety outcomes. Both efficacy and safety outcomes were compared in the propensity score-matched groups. Results: Early complications involving efficacy outcomes, such as stroke and transient ischemic attack, were seen in 5 patients in the warfarin group and none in the NOAC group. Although the 2 groups differed in the incidence of efficacy outcomes, it was not statistically significant. In safety outcomes, 11 patients in the warfarin group and 24 patients in the NOAC group had complications, but likewise, the between-group difference was not statistically significant. Conclusion: Among patients who underwent TTA, those who received NOACs had a lower incidence of thromboembolic complications than those who received warfarin; however, both groups showed a similar bleeding complication rate. Using a NOAC after TTA does not reduce efficacy and safety when compared to warfarin.

• Journal of Chest Surgery
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• v.32 no.9
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• pp.790-798
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• 1999

Background: As the early outcome after coronary artery bypass grafting(CABG) has been stabilized, neurologic complication has now become one of the most important morbidity. The aim of this study was to find out the risk factors associated with the neurologic complications after CABG. Material and Method: In 351 patients who underwent CABG, the incidence and features of neurologic complications, with associated perioperative risk factors, were retrospectively reviewed. Neurologic complication was defined as a new cerebral infarction confirmed by postoperative neurologic examination and radiologic studies, or delayed recovery of consciousness and orientation for more than 24 hours after the operation. Result: Neurologic complications occurred in 18 patients(5.1%), of these nine(2.6%) were diagnosed as having new cerebral infarctions(stroke). Stroke was manifested as motor paralysis in four patients, mental retardation or orientation abnormality in four, and brain death in one. Statistical analysis revealed the following variables as significant risk factors for neurologic complications by both univariate and multivariate analyses: cardiopulmonary bypass longer than 180 minutes, atheroma of the ascending aorta, carotid artery stenosis detected by Duplex sonography, and past history of cerebrovascular accident or transient ischemic attack. Age over 65 years, aortic calcification detected by simple X-ray, and intraoperative myocardial infarction were significant risk factors by univariate analysis only. Neither the severity of carotid artery stenosis nor technical modifications such as cannulation of the aortic arch or single clamp technique, which were expected to affect the inciden e of neurologic complications, had significant relationship with the incidence. Conclusion: This study confirmed the strong association between neurologic complications after CABG and atherosclerosis of the arterial system. Therefore, to minimize the incidence of neurologic complications, systematic evaluation focused on atherosclerotic lesions of the arterial system followed by adequate alteration of operative strategy is needed.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.123-131
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• 2005

Background: The number of elderly patients undergoing coronary artery bypass grafting (CABG) is increasing. Elderly patients are at increased risk for a variety of perioperative complications and mortality. We identified determinants of operative complications and mortality in elderly patients undergoing CABG. Material and Method: Between January 1995 and July 2003, 91 patients older than 75 years underwent isolated CABG at Asan Medical Center. There were 67 men and 24 women with mean age of $77.0\pm2.4$ years. Thirty clinical or hemodynamic variables hypothesized as predictors of operative mortality were evaluated. Result: CABG was performed under emergency conditions in 5 patients. The internal thoracic artery was used in 85 patients and 10 patients received both internal thoracic arteries. The mean number of distal anastomosis was 3.7 per patient. Operative mortality was $3.3\%$. Twenty-two patients had at least one major postoperative complication. Low cardiac output syndrome was the most common complication, followed by reoperation for bleeding, pulmonary dysfunction, perioperative myocardial infarction, stroke, acute renal failure, ventricular arrhythmia, upper gastrointestinal bleeding, infection, and delayed sternal closure. None were the predictors of mortality. Renal failure, peripheral vascular disease, emergency operation, recent myocardial infarction, congestive heart failure, New York Heart Association (HYHA) class III or IV, Canadian Cardiovascular Society (CCS) angina scale III or IV, and low left ventricle ejection fraction below $40\%$ were univariate predictors of overall complications. Actuarial probability of survival was $94.9\%,\;89.8\%,\;and\;83.5\%$ at postoperative 1, 3 and 5 years respectively. During the follow-up period $93.3\%$ of patients were in NYHA class I, or II and $91.1\%$ were free from angina. Conclusion: Although operative complication is increased, CABG can be performed with an acceptable operative mortality and excellent late results in patients older than 75 years.

• Journal of Chest Surgery
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• v.33 no.12
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• pp.941-947
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• 2000

Background: Central nervous system complication after coronary artery bypass grafting(CABG) is one of the major prognostic determinants and the use of the cardiopulmonary bypass(CPB) may increase the incidence of this devastating complication. In this study, the outcomes after off-pump CABG were studied and compared with those following the conventional CABG using CPB. Material and Method: Among the consecutive isolated CABG's performed in SNUH during Feb. 1995 and Jun. 1999, 338 coronary artery bypass grafting were divided into two groups. 223 patients underwent CABG using the CPB(Group I), and 115 patients underwent CABG without CPB(OPCAB)(Group II). All patients enrolled in this study received extensive preoperative examinations including thorough neurologic examination before and after surgery, transcranial doppler study, carotid duplex ultrasonography, and magnetic resonance angiography if necessary. Central nervous system(CNS) complications were defined as stroke, seizure, metabolic or hypoxic encephalopathy and transient delirium after surgery. Result: There were 61 cases(27.3%) who developed postoperative CNS complication in Group I, whereas 8 cases(7.0%) of CNS complications developed postoperatively in group II(p<0.05). Statistically significant predictors of postoperative CNS complications in group I were age and the use of cardiac assist devices perioperatively. Conclusion: This study suggested that omitting the use of CPB in CABG resulted in significant decrease of the postoperative CNS complications. OPCAB should be more widely applied especially to the elderly who have preexisting cerebrovascular disease.

• Journal of Chest Surgery
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• v.46 no.6
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• pp.426-432
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• 2013

Background: Heart transplantation has become a widely accepted surgical option for end-stage heart failure in Korea since its first success in 1992. We reviewed early postoperative complications and mortality in 239 patients who underwent heart transplantation using bicaval technique in Asan Medical Center. Methods: Between January 1999 and December 2011, a total of 247 patients aged over 17 received heart transplantation using bicaval technique in Asan Medical Center. After excluding four patients with concomitant kidney transplantation and four with heart-lung transplantation, 239 patients were enrolled in this study. We evaluated their early postoperative complications and mortality. Postoperative complications included primary graft failure, cerebrovascular accident, mediastinal bleeding, renal failure, low cardiac output syndrome requiring intra-aortic balloon pump or extracorporeal membrane oxygenation insertion, pericardial effusion, and inguinal lymphocele. Follow-up was 100% complete with a mean follow-up duration of $58.4{\pm}43.6$ months. Results: Early death occurred in three patients (1.3%). The most common complications were pericardial effusion (61.5%) followed by arrhythmia (41.8%) and mediastinal bleeding (8.4%). Among the patients complicated with pericardial effusion, only 13 (5.4%) required window operation. The incidence of other significant complications was less than 5%: stroke (1.3%), low cardiac output syndrome (2.5%), renal failure requiring renal replacement (3.8%), sternal wound infection (2.0%), and inguinal lymphocele (4.6%). Most of complications did not result in the extended length of hospital stay except mediastinal bleeding (p=0.034). Conclusion: Heart transplantation is a widely accepted option of surgical treatment for end-stage heart failure with good early outcomes and relatively low catastrophic complications.

• Journal of Chest Surgery
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• v.42 no.6
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• pp.704-709
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• 2009

Background: We assessed the efficacy of intraoperative intra-aortic balloon pump therapy for achieving hemodynamic instability during off-pump coronary artery bypass surgery. Material and Method: We studied seven hundred ninety-six patients who underwent off-pump coronary artery bypass between January 2000 and December 2006. The patient were divided into group I (n=39), which received intraoperative intra-aortic balloon pump therapy, and group II (n=757), which did not receive intraoperative intra-aortic balloon pump therapy. Result: There were no differences in the operative mortalities (2.6%, 1/39 vs 0.8%, 6/757; p=0.195) and morbidities such as atrial fibrillation (p=0.691), stroke (p=0.908) and mediastinitis (p=0.781) between the 2 groups, although the ventilator support time, the length of the intensive care unit stay and the length of the hospital stay were longer in group I than in group II (p<0.05). Multivariate analysis failed to prove that group I was a high risk group for operative mortality (p=0.549). There were 3 intraoperative intra-aortic balloon pump-related complications in group I (7.9%). However, no longer complications occurred after 2003, when the surgeons began using a smaller sized 8 F catheter that was inserted using a sheathless technique. Conclusion: Intraoperative intra-aortic balloon pump therapy for achieving hemodynamic instability during off-pump coronary artery bypass surgery can be performed safely and it showed comparable clinical results to that of not using intraoperative intra-aortic balloon pump therapy.

• Journal of Biomedical Engineering Research
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• v.24 no.6 s.81
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• pp.515-522
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• 2003

Pharynx is a system transporting foods by peristaltic motion(contraction and expansion movement! into the esophagus and functioning as airway passages. In this study, structural changes of pharyngeal dysfunction are analyzed by biomechanical model using CT and FEM(finite clement method). Loading condition was assumed that equal pressure was loaded sequentially to inside of pharyngeal tissue. In order to analyze the pharyngeal muscular dysfunction by biomechanical model. the pharyngeal dysfunctions was classified into 3 cases. Taking into account the clinical complication by neuromuscular symptoms such as pharyngeal dysfunction after stroke. we assumed that a change of material property is caused by muscular tissue stiffness. A deformation of cross sectional area of the pharynx is analyzed increasing the stiffness $25\%,\;50\%,\;75\%$ in each case on the basis of stress-strain relationship. Based on three-dimensional reconstruction of pharyngeal structure using limited factor - techniques and the optimization procedure by means of inverse dynamic approach. the biomechanical model of the human pharynx is implemented. The results may be used as clinical index illustrating the degree of pharyngeal muscular dysfunction. This study may be used as useful diagnostic model in discovering early deglutitory impediment caused by physiological or pathological pharyngeal dysfunction.