• Journal of Chest Surgery
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• v.52 no.1
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• pp.16-24
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• 2019

Background: Optimal graft selection for coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction remains debatable. We report an analysis of our experiences of isolated CABG in patients with severe LV dysfunction and the impact of graft strategy on long-term outcomes. Methods: We analyzed 209 patients with severe LV dysfunction (ejection fraction [EF] <30%) who underwent primary isolated CABG. Of these, 169 were revascularized with a bilateral internal thoracic arterial (ITA) graft (BITA group) and 40 were revascularized with a single ITA graft (SITA group). The mean follow-up duration was $22{\pm}32$ months. Results: There were 18 early deaths (8.6%). Overall survival at 5 years was 66.7%. The rate of freedom from cardiac-related death at 5 years was 74.1%, and was significantly higher in patients who underwent off-pump CABG (p=0.005) and in the BITA group (p=0.023). Multivariate analysis demonstrated that old age (hazard ratio [HR], 2.548; 95% confidence interval [CI], 1.134-5.762; p=0.024), off-pump CABG (HR, 0.245; 95% CI, 0.090-0.661; p=0.006), and BITA grafts (HR, 0.333; 95% CI, 0.146-0.757; p=0.009) were correlated with cardiac mortality. Conclusion: CABG in patients with severe LV dysfunction (EF <30%) showed reasonable long-term outcomes. The rate of freedom from cardiac-related death was significantly higher in patients who underwent off-pump CABG and in the BITA group. Off-pump BITA grafting strategies can be accepted as a viable primary option in patients with severe LV dysfunction if performed by an experienced surgeon.

• Journal of Chest Surgery
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• v.40 no.9
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• pp.633-636
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• 2007

Coronary artery spasm immediately after the coronary artery bypass graft (CABG) surgery is rare but it can cause sudden and severe hypotension or a ventricular arrhythmia. We report a case of low cardiac output syndrome caused by a right coronary artery spasm following CABG that did not show any significant stenotic lesions on preoperative coronary angiography.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.553-555
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• 2002

Transabdominal approach in redo coronary artery bypass grafting(CABG) may avoid the risk related to repeat sternotomy. Redo CABG using this approach can be performed safely in selected cases. We report a case of redo off-pump CABG through a transabdominal approach in a 59-year-old woman with recurrent unstable angina after a previous CABG. Through a curvilinear epigastric incision, right gastroepiploic artery(RGEA) was harvested as a graft, and the RGEA-to-right coronary artery anastomosis was performed on the beating heart. A 1-day postoperative angiographic study showed the patent RGEA graft, and she was discharged on postoperative 4th day without any complication.

• Journal of Chest Surgery
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• v.53 no.5
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• pp.263-269
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• 2020

Background: The benefits of epicardial ultrasound scanning (EUS) in coronary artery bypass grafting (CABG) have not yet been established. The aim of this study was to evaluate the usefulness of EUS in CABG, including in the assessment of the quality of distal anastomoses, the identification of epicardial target vessels, and the evaluation of any graft issues other than the distal anastomoses. Methods: Fifty-three patients undergoing CABG were enrolled between March 2018 and February 2019. Intraoperative EUS was performed along with transit-time flow measurement (TTFM). Graft evaluations were performed early (shortly after surgery) and 1 year after surgery for 53 (100%) and 47 (88.7%) patients, respectively. Results: EUS was applied to assess the quality of all distal anastomoses, 32 target vessels, and 2 conduit trunks. Insufficient TTFM findings were obtained for 18 grafts. However, graft revision was performed for only 3 distal anastomoses; based on the EUS findings, the remaining 15 sites were not revised. The early and 1-year overall graft patency rates were 100% (141 anastomoses) and 96.1% (122 of 127 anastomoses), respectively. All 15 of the distal anastomoses that were not revised despite insufficient TTFM results were patent at the 1-year mark. Conclusion: The routine application of EUS in CABG could be beneficial by confirming the quality of surgery and reducing unnecessary procedures.

• Journal of Chest Surgery
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• v.54 no.2
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• pp.117-126
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• 2021

Background: Several factors, such as the degree of target vessel stenosis, are known to be associated with radial artery (RA) graft patency in coronary artery bypass grafting (CABG). There is a lack of data regarding the effect of the RA proximal configuration (aortic anastomosis versus T-anastomosis). This study evaluated the effects of the RA proximal configuration on the patency rate and clinical outcomes after CABG. Methods: We conducted a retrospective study, analyzing 328 patients who had undergone CABG with an RA graft. We divided the patients into 2 groups. The primary endpoint was RA patency and the secondary endpoints were overall mortality and major adverse cardiac and cerebrovascular events (MACCE). We performed a propensity score-matched comparison. Results: Aorta-RA anastomosis was performed in 275 patients, whereas the rest of the 53 patients received T-RA anastomosis. The mean age was 67.3±8.7 years in the T-RA anastomosis group and 63.8±9.5 years in the aorta-RA anastomosis group (p=0.02). The mean follow-up duration was 5.13±3.07 years. Target vessel stenosis ≥70% (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.91; p=0.03) and T-RA anastomosis configuration (HR, 2.34; 95% CI, 1.01-5.19; p=0.04) were significantly associated with RA occlusion in the multivariable analysis. However, T-RA anastomosis was not associated with higher risks of overall mortality and MACCE following CABG (p=0.30 and p=0.07 in the matched group, respectively). Conclusion: Aorta-RA anastomosis showed a superior patency rate compared to T-RA anastomosis. However, the RA proximal anastomosis configuration was not associated with mortality or MACCE.

• Journal of Korean Critical Care Nursing
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• v.1 no.1
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• pp.33-45
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• 2008

Purpose: Patients who underwent a coronary artery bypass graft surgery(CABG) experienced the unpleasant emotions and discomfort when their chest tube was removed. The purpose of this study was to evaluate the effects of cold therapy on pain related to chest tube removal(CTR) in CABG patients. Methods: Fifty adult patients undergoing CABG were recruited in a prospective, double blinded study. Subjects were divided into the experimental group and the control group considering their sex and age. The pretest data were obtained 20 minutes before CTR. Patients in the experimental group, received cold therapy for 10 minutes before CTR. Pain sense and intensity were determined immediately after CTR and at 10 minutes after CTR. Results: The total score of pain sense immediately after CTR of the experimental group was significantly lower than that of the control group(t=-3.703, p=.003). And scores of pain intensity immediately after CTR in the experimental group were significantly lower than that of the control group(t=-3.073, p=.001). But, there was no significant difference in the score of pain intensity 10 minutes after CTR between the experimental and the control group(t=1.759, p=.085). Conclusion: The cold therapy would be recommended as an effective and nonpharmacologic nursing intervention for relieving pain in patients undergoing CTR.

• Journal of Korean Academy of Nursing
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• v.37 no.7
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• pp.1159-1165
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• 2007

Purpose: The purpose of this study was to investigate the stages of change in smoking cessation after a Coronary Artery Bypass Graft(CABG) and to identify the related factors. Methods: The subjects (n=157) were patients who underwent a CABG in a university hospital from March 1998 to October 2005 and were smokers before the CABG. Data was collected viachart review and a telephone interview, and analyzed with descriptive statistics, $X^2$ test, one-way ANOVA, and Kruskal-Wallis procedure by the SPSS/PC win 12.0 program. Results: The subjects smoked for an average of 34 years (21 cigarettes per day) before surgery. Eleven percent of the subjects were in pre-contemplation, 6.4% in contemplation, 13.5% in preparation, 4.5% in action, and 64.5% in the maintenance stage. Nicotine dependence and self-efficacy were different among the groups with different stages of change in smoking cessation. Nicotine dependence was the lowest (p=0.00) and self-efficacy was the highest (p=0.00) in the maintenance stage. The number of subjects in pre-contemplation and contemplation significantly increased 6 years after surgery(p=0.05). Conclusions: To implement effective smoking cessation interventions for CABG patients, the intervention should be developed to accommodate individual readiness for smoking cessation, especially so for those who had a CABG more than 6 years previously.

• Journal of Korean Clinical Nursing Research
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• v.14 no.1
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• pp.25-32
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• 2008

Purpose: The purpose of this study was to examine quality of life with patients in 12 months after coronary artery bypass graft surgery, compared with general population. Method: A cross-sectional comparative study was designed. Study participants were 90 adults who had undergone CABG surgery (n=45) in experimental group and general population (n=45) in control group. The subjects were asked the questionnaire (SF-36, Short Form-36) regarding the quality of life. The data were analyzed by the SPSS 13.0 program including frequency, percentage, $x^2$ test, t-test and One-Way ANOVA. Results: There were no significant differences in the quality of life between two groups including physical functioning (t=-.938, p=.351), role-physical limitation (t=-.322, p=.748), bodily pain (t=-.938, p=.351), general health (t=-.1418, p=.888), vitality (t=-.816, p=.417), social functioning (t=.720, p=.474), role-emotional limitation (t=-.710, p=.479), mental health (t=-.431, p=.667). Conclusion: Even though patients in experimental group had operation experience, the quality of life examined on the time of 1 year after bypass surgery is similar in that of general population. We suggest the study change the design as examination of quality of life before and after coronary artery bypass graft surgery.

• Journal of Chest Surgery
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• v.32 no.8
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• pp.693-701
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• 1999

Recently non-invasive diagnostic imaging replaced the invasive catheter angiography in the diagnosis of vascular disease. Catheter methods are now almost confined to the purpose of intervention. Coronary artery or coronary artery bypass graft still needs catheter technique because of small diameter and the cardiac motion. The last challenge for radiologists in this domain is to obtain a non-invasive imaging. Electron beam tomography(EBT) for high temporal resolution is able to obtain a coronary arteriogram or coronary artery bypass graft (CABG), of which CABG imaging is quite useful for the evaluation of patency. In our experience as well as others, the accuracy of EBT angiogram in evaluating CABG patency revealed that the accuracy of patency of saphenous vein grafts(SVG) is high due to relatively wide lumen, short and straight course and less influence from cardiac motion. The sensitivity and specificity of patency of SVGs were 92%, 97% respectively in the prospective evaluat on and 100% each in the retrospective evaluation. A false positive and a false negative case are rudimentary errors in the initial learing period. In contrast the analysis of left internal mammary artery(LIMA) graft was difficult due to the inherent small size and the adjacent surgical clips provoking beam-hardening artifact; therefore, the method of combining 3 dimensional reconstruction and flow mode study was important in improving the accuracy of LIMA patency. The sensitivity and specificity of LIMA patency were 100% and 80% in both prospective and retrospective evaluation. Therefore, EBT angiography is an accurate non-invasive diagnostic modality for evaluating the patency of CABG, particularly in SVGs. The accuracy can be improved with the improvement of the EBT and the development of the image reconstruction software.

• Journal of Chest Surgery
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• v.47 no.5
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• pp.468-472
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• 2014

Diffuse refractory vascular spasms associated with coronary bypass artery grafting (CABG) are rare but devastating. A 42-year-old male patient with a past history of stent insertion was referred for the surgical treatment of a recurrent left main coronary artery disease. A hemodynamic derangement developed during graft harvesting, necessitating a hurried initiation of cardiopulmonary bypass (CPB). Although CABG was carried out as planned, the patient could not be weaned from the bypass. An emergency coronary angiography demonstrated a diffuse spasm of both native coronary arteries and grafts. CPB was switched to the femorofemoral extracorporeal membrane oxygenator (ECMO). Although he managed to recover from heart failure, his discharge was delayed due to the ischemic injury of the lower limb secondary to cannulation for ECMO. We reviewed the case and literature, placing emphasis on the predisposing factors and appropriate management.