• 대한의생명과학회지
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• 제17권4호
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• pp.329-336
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• 2011

The female has previously been shown to be an independent risk factor for mortality and morbidity after coronary artery bypass grafting surgery (CABG). The aim of this retrospective study is to evaluate gender differences of the perioperative outcomes in elderly patients underwent CABG. Data for seventy elderly patients (>70 years) that underwent CABG (between January 2005 and July 2011) were divided into two groups: male patients (n=33, male group) and female patients group (n=37, female group). Heights, body weights, body surface area and coronary artery obstruction rate (right coronary artery territory) in the female group were lower than those of the male group ($P$ <0.05). History of hypertension, hyperlipidemia, congestive heart failure and percutaneous coronary artery intervention in the female group was higher than that of the male group ($P$ <0.05). Total cholesterol and brain natriuretic peptide levels in the female group were higher than those of the male group ($P$ <0.05). Platelet count in the female group was higher than the male group at preoperative (Pre-OP) period ($P$ <0.05). Erythrocyte count, hematocrit and hemoglobin levels in the female group were lower than those of the male group at Pre-OP period ($P$ <0.05). But, erythrocyte count, hematocrit and hemoglobin levels in the female group were higher than those of the Male group at postoperative (Post-OP) period ($P$ <0.05). Left ventricular ejection fraction in the female group was higher than the male group at Post-OP period ($P$ <0.05). Hospital stay length in the female group was higher than the male group ($P$ <0.05). Post-OP bleeding volume and incidence of ventricular premature contraction in the female group were lower than those of the male group ($P$ <0.05). These results suggest that despite female gender have a greater risk factors and require a longer hospitalization than male, there was no significant difference incidence of mortality and complication.

• Journal of Chest Surgery
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• 제44권4호
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• pp.273-278
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• 2011

Despite aggressive treatment, the mortality rate of cardiogenic shock with acute myocardial infarction (AMI) is high. We performed extracorporeal membrane oxygenation (ECMO) prior to coronary reperfusion, and evaluated the early clinical results and risk factors. Materials and Methods: From May 2006 to November 2009, we reviewed the medical records of 20 patients in cardiogenic shock with AMI (mean age $67.7{\pm}11.7$ yrs, M : F 14 : 6). After initially performing ECMO using the CAPIOX emergency bypass system ($EBS^{(R)}$Terumo, Tokyo, Japan), patients underwent coronary reperfusion (coronary artery bypass grafting, 13; percutaneous coronary intervention, 7). Results: All patients were in a cardiogenic shock state, cardiopulmonary resuscitations (CPR) were performed for fourteen patients (mean CPR time $20.8{\pm}26.0$ min). The mean time from vascular access to the initiation of ECMO was $17.2{\pm}9.4$ min and mean support time was $3.8{\pm}4.0$ days. Fourteen patients were able to be weaned from ECMO and ten patients were discharged (mean admission duration $50.1{\pm}31.6$ days). Patients survived on average $476.6{\pm}374.6$ days of follow-up. Longer CPR and support time, increased cardiac enzyme, lower ejection fraction, lower albumin, and major complications were the risk factors of mortality (p<0.05). Conclusion: The early application of ECMO prior to coronary reperfusion and control of risk factors allowed for good clinical results in cardiogenic shock with AMI.

• Journal of Chest Surgery
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• 제39권10호
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• pp.779-781
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• 2006

좌주관상동맥 폐쇄증은 매우 드문 선천성 관상동맥 기형의 하나로 좌주관상동맥의 근위부가 단절되어 있어서 대부분의 경우 실신이나 성장지연, 심근경색 등의 증상을 나타내며 수술적 치료를 요한다. 호흡곤란을 주소로 내원한 생후 14개월 여아에서 좌주관상동맥 폐쇄증이 진단되어 내흉동맥을 이용한 관상동맥 우회술 시행 후 1년 이상의 추적관찰로 좋은 결과를 확인할 수 있었기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제38권7호
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• pp.504-506
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• 2005

심강내관상동맥은 전체 관상동맥우회술 환자 중 약 $0.2\~0.3\%$에서 발견되며, 국내에서는 아직 보고된 바 없는 극히 드문 관상동맥기형의 일종이다. 수술 전 관상동맥조영술을 통하여 진단하기 어렵고, 관상동맥우회술 후에 우심실로부터의 출혈이 발생할 수 있으므로 우심실절개 부위의 견고한 봉합이 필요하다. 기존의 증례 보고에 따르면 외과용거즈(pledget)를 이용한 수평매트리스봉합(horizontal mattress suture)이 추천되기는 하나 주위의 심근을 압박하여 관상동맥가지 및 관통동맥의 협착을 유발할 수 있어, 단순단속봉합(simple interrupted suture)을 이용하고도 수술 후 별다른 합병증 얼이 호전된 예를 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제39권8호
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• pp.598-603
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• 2006

배경 : 경막외 마취를 이용하여 의식 있는 환자에서 관상동맥우회술을 시행하는 경우 기계 환기 및 전신 마취에 의한 합병증을 피할 수 있는 장점들이 기대된다. 대상 및 방법: 2005년 4월부터 2005년 9월까지 12명의 환자를 대상으로 상흉부 경막외 마취를 이용하여 의식이 있는 상태에서 심폐바이패스를 사용하지 않는 관상동맥우회술을 시행하였다. 1명은 여자였고 11명은 남자였으며 평균 연령은 $66{\pm}6$세였다. 정중 흉골 절개술을 시행한 후 동맥도관만을 이용하여 관상동맥우회술을 시행하였다. 결과: 평균 원위부 문합수는 ${1.8{\pm}0.9\;(1{\sim}3)}$이었으며, 수술사망 예는 없었다. 수술을 시행하는 동안 모두 8 명의 환자에서 기흉이 발생하였으며, 수술 중 기흉 (n =3), 복부내장의 팽창 (n=1), 흉관 삽입 후 발생한 혈흉 (n=1) 등의 원인으로 12 명 중 5 명의 환자에서는 기관 삽관 후 전신마취로 전환이 필요하였다. 모든 환자에서 수술 후 $1.2{\pm}0.6$일째에 관상동맥조명술을 시행하였으며, 모든 우회도관은 개통되어 있었다. 결론: 본원의 초기 경험을 통해 전신 마취를 하지 않고 의식이 있는 상태에서 심폐바이패스를 사용하지 않는 관상동맥우회술을 시행하는 것이 가능함을 확인할 수 있었다 . 이러한 수술 방법의 적응증 및 제한점에 대해서는 향후 경험을 통한 추가적인 연구가 필요할 것으로 생각된다.

• Journal of Chest Surgery
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• 제49권3호
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• pp.177-184
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• 2016

Background: Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Several therapeutic and preventive strategies have been introduced for postoperative AF, but the treatment and prophylaxis of AF remain controversial. We aimed to compare the efficacy of intravenous amiodarone and oral propafenone in the treatment of AF after coronary artery bypass grafting (CABG). Methods: This was a randomized controlled trial performed in two hospitals in Shiraz, Iran from 2009 to 2012. We included all patients who underwent elective CABG and developed AF postoperatively. The patients were randomly assigned to receive propafenone or amiodarone. The duration of AF, the success rate of the treatment, the need for cardioversion, the frequency of repeated AF, and the need for repeating the treatment were compared. Results: The duration of the first (p=0.361), second (p=0.832), and third (p=0.298) episodes of AF, the need for cardioversion (p=0.998), and the need to repeat the first and second doses of drugs (p=0.557, 0.699) were comparable between the study groups. Repeated AF was observed in 17 patients (30.9%) in the propafenone group and 23 patients (34.3%) in the amiodarone group (p=0.704). Conclusion: Oral propafenone and intravenous amiodarone are equally effective in the treatment and conversion of recent-onset AF after CABG.

• Journal of Chest Surgery
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• 제44권5호
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• pp.355-357
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• 2011

Anomalous origin of a coronary aortic artery is a rare cardiac anomaly. Although it can cause angina, syncope, and palpitations, most patients are asymptomatic. This anomaly requires surgical treatment or intervention because it is associated with sudden death. Several surgical techniques, such as coronary reimplantation, coronary artery bypass grafting (CABG), unroofing, and neo-ostium formation, have been proposed as treatments. We report a case surgically treated with neo-ostium formation in anomalous origin of the left coronary artery from the right coronary sinus.

• Journal of Chest Surgery
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• 제35권12호
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• pp.898-901
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• 2002

관상동맥 우회술에서 동맥도관만을 사용하는 방법은 동맥편이 가진 도관개통률의 우수성 때문에 복재정맥을 혼합하여 사용하는 관상동맥 우회술에 비해 좋은 단기 성적은 물론이고, 향상된 장기 성적을 기대할 수 있다. 그러나 때때로 내흉동맥 또는 다른 동맥편들의 사용이 가능하지 않은 경우가 있고, 특히 당뇨환자에서 양측 내흉동맥의 사용은 술 후 종격동염을 비롯한 합병증을 우려하여 사용이 꺼려지기도 한다. 또한 관상동맥 우회술의 재수술의 경우에는 사용가능한 동맥편 수의 제한이 문제가 되는데 이러한 경우 대체동맥편으로서 흉배동맥을 사용할 수 있으며, 저자들은 흉배동맥을 사용하여 시행했던 3례의 관상동맥 우회술을 보고하고자 한다.

• Journal of Chest Surgery
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• 제18권2호
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• pp.193-204
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• 1985

During the period from February to March, 1984, we employed a partial left heart bypass [left atrium to ascending aorta] in 2 patients who could not weaned from cardiopulmonary bypass with inotropic agents and cardiac pacing after coronary bypass surgery. These two patients showed significant improvement in ventricular function 18 to 47 hours after inserting the left heart bypass and were able to wean from the left heart bypass under using inotropic agents. Two patients died of multiple organ failures 11 days and 15 days postoperatively. These results indicate that early institution of left heart bypass in ventricular failure patients after open heart surgery can provide satisfactory long-term result.

• Journal of Chest Surgery
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• 제53권5호
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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.