• Journal of Chest Surgery
• /
• 제36권2호
• /
• pp.98-100
• /
• 2003

최근 심폐기를 가동하지 않는 최소 절개를 이용한 최소침습적 관상동맥우회술(MIDCAB)이 급속도로 발전하고 있다. 저자들은 좌전소절개술을 통해 최소침습적 관상동맥우회술을 시도하려 하였으나, 심한 늑막유착으로 인해 상부 부분흉골절개술로 연장하여 심폐기를 가동하지 않는 관상동맥우회술을 시행하여 만족스러운 결과를 얻었기에 문헌고찰과 더불어 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제25권1호
• /
• pp.42-48
• /
• 1992

Clinical improvement after coronary artery bypass surgery depends on the complete revascularization and patency of graft vessels. Patency rate and the factors influencing the patency were studied by examining 134 grafts in 55 patients at a mean follow-up of 22.8$\pm$4.2 months, range 15 days and 108 months. Serial studies were performed on 7 patients with 18 grafts. The over-all patency rate was 80.6%, and the rate more than 5 years after surgery was 50.0% with mean interval of 81 months. Patency rate of patients who had taken both aspirin and dipyridamole was higher than of patients who had been treated with aspirin only[80.5% vs 56.5%]. The average serum triglyceride level of patients who had graft stenosis or occlusion in at least one site was significantly higher than that of patients in whom all grafts were patent[262.1mg% vs 174.8mg%]. Patency rate of grafts in patient who had angina was 73.2% and in patients without angina 79.2%. 6 patients underwent successful percutaneous transluminal angioplasty for narrowed or occluded grafts.

• Journal of Chest Surgery
• /
• 제24권9호
• /
• pp.881-889
• /
• 1991

The ideal goal of the coronary artery bypass surgery is complete revascularization. To estimate the numerical degree of completeness of revascularization, the following formula was used in 50 patients having aorta-coronary bypass grafting for the treatment of unstable angina. myocardial perfusion score of revascularized area Degree of Completeness = ----------------------------------------------------------------------------- x100[%] preoperative myocardial perfusion score Randomized patients who underwent revascularization procedures in 19Hb were compared with the patients who received similar elective operation each year from 1988 through 1991. To obtain these data, the patients aged 38 ~ 75[mean 54$\pm$9.1years], composed of 31 males and 19 females were randomly sampled. The number of grafts per patient increased from 2.30 in 1986, to 3.07 in 1988 - 89, to 3.21 in 1990, and to 3.50 in 1991. [0.05 The degree of completeness improved from 75.4% to 81.4%, 91.6% and 88.6% respectively. It improved significantly in the last two years, [P<0.05, Mann-Whitney U test] At a follow-up of three months, 90 percent[45/50] of patients remained angina, free, 6 percent[3/50] had residual angina, and 4 percent[2/50] died. The last two patients degree of completeness corresponded to 43% and 30% respectively As a conclusion, the degree of completeness seems to improve year by year, and to have close relationship with the clinical results.

• Journal of Chest Surgery
• /
• 제50권1호
• /
• pp.14-21
• /
• 2017

Background: Off-pump coronary artery bypass (OPCAB) is performed worldwide, but significant risks are associated with conversion to on-pump surgery. Therefore, we evaluated the composite outcomes between an OPCAB group and a conversion group. Methods: From January 2008 to December 2012, 100 consecutive patients underwent OPCAB at Hallym University Sacred Heart Hospital, of whom 84 underwent OPCAB without adverse events (OPCAB group), and 16 were converted to on-pump surgery (conversion group). Early morbidity, early and long-term mortality, and major adverse cardiac and cerebrovascular events (MACCEs) were the primary and long-term composite endpoints. Results: The mean follow-up period was $55{\pm}26months$, with 93% of the patients completing follow-up. The composite outcomes in the OPCAB and conversion groups were as follows: early morbidity, 2.3% versus 12.5%; early mortality, 4.7% versus 0%; long-term mortality, 14.3% versus 25.0%; and MACCEs, 14.3% versus 18.8%, respectively. No composite endpoints showed statistically significant differences. Preoperative acute myocardial infarction (AMI) was identified as an independent risk factor for conversion (p=0.025). Conclusion: The conversion group showed no statistically significant differences in early mortality and morbidity, MACCEs, or long-term mortality compared with the OPCAB group. The preoperative diagnosis of AMI was associated with an increased number of conversions to on-pump surgery.

• Journal of Chest Surgery
• /
• 제52권2호
• /
• pp.70-77
• /
• 2019

Background: Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock. Methods: We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%). Results: The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%). Conclusion: CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.

• Journal of Chest Surgery
• /
• 제47권4호
• /
• pp.434-436
• /
• 2014

Left ventricular thrombus is a common complication related to acute myocardial infarction. Removing this with an incision of the free wall of the left ventricle may cause fatal cardiac dysfunction or arrhythmias. Furthermore, performing incision and suture on the fragile myocardium of an acute myocardial infarction patient may cause serious bleeding complications. If there is a patient with left ventricular thrombus who needs thoracotomy for another reason, the case is attempted with the thought that if effective intraventricular visualization and manipulation can be done, fatalities caused by incision and suture may be reduced. For patients undergoing cardiopulmonary bypass, if intracardiac manipulation is required, an endoscope can be used, and given the potential complications after the incision and suturing of the infarcted tissue, the benefits are deemed sufficient.

• Journal of Chest Surgery
• /
• 제24권3호
• /
• pp.296-302
• /
• 1991

Coronary artery involvement and myocardial ischemic symptom in Takayasu`s arteritis is uncommon Its presentation as coronary artery narrowing is a potentially lethal but correctable problem. In this case report, a 17-year-old woman of Takayasu`s arteritis with unstable anginal and moderate heart failure is presented. Her coronary angiogram showed that the main trunk of the left coronary artery was moderately narrowed and the proximal portion of the circumflex branch was severely obstructed and the right coronary artery was also narrowed diffusely. Simultaneously the patient had the moderate degree of mitral regurgitation. In order to save her life, the coronary bypass surgery using the saphenous veins and the modified Wooler`s mitral annuloplasty were done urgently, Immediate recovery was uneventful and the postoperative exercise capacity was markedly improved. But the long-term prognosis seems to be uncertain because of 3 reasons: 1] natural progress and complication of Takayasu`s arthritis; 2] fate of the saphenous vein grafts in a relatively young patient with aortitis; 3] residual mitral regurgitation. So long-term follow-up should be needed.

• Journal of Chest Surgery
• /
• 제32권10호
• /
• pp.883-890
• /
• 1999

Long term patency of arterial graft has been better than venous graft and redo coronary artery bypass grafting has been increasing, therefore, there has been an increasing need for alternative arterial grafts except internal thoracic artery(ITA). Material and Method: Right gastroepiploic arteries(RGEA) were harvested from 100 patients who had received gastrectomy for gastric cancer or ulcer. ITAs were obtained from 10 patients undergoing coronary artery bypass grafting. The length of RGEA was measured from the pyloric ring. Items of the morphometric and histologic study at the pyloric ring and sites of the 10cm and 20cm RGEA from the pyloric ring were luminal diameter, intimal thickness, medial thickness, wall thickness, degree of intimal hyperplasia, intimal thickness, medial thickness, wall thickness, degree of intimal hyperplasia, intimal thickness index, medial thickness index, and the number of discontinuities of the internal elastic lamina. Similar items were applied to the proximal site of ITAs. Result: The length of RGEA was 23${\pm}$2.7cm(range 17∼31cm). Comparing the 20cm RGEA with ITA, intimal thickness, medial thickness, wall thickness, and degree of intimal hyperplasia did not show any difference(p>0.05). However, 20cm RGEA was greater than ITA at the luminal diameter, intimal thickness index, and the number thickness and wall thickness in each site of the RGEA(pyloric ring, 10cm, 20cm) decreased from the pyloric ring to the distal sites(p<0.05). The degree of intimal hyperplasia and the number of discontinuities of the internal elastic lamina did not show any difference between the pyloric ring and 10cm, however, those of 20cm were smaller than these sites(p<0.05). RGEA had more number of discontinuities of the internal elastic lamina and rich smooth muscle cells in the media than ITA. Conclusion: The length and diameter of RGEA is good enough to reach most of the coronary arteries. Moreover, long term patency of RGEA may be improved, if anastomosed in the distal site.

• Journal of Chest Surgery
• /
• 제30권9호
• /
• pp.885-890
• /
• 1997

.저자들은 1994년 7월부터 1996년 6월까지 관상동맥우회 술을 시행한 환자 103명을 심실구축력 40%를 기준 으로 심실기능저하군 24명과 심실기능정상군 79명으로 분류하여 환자의 술전,수술변수 18개를 분석하였다. 분석결과 환자의 특성과 수술사망에 영향을 미치는 위험인자에 대해 다음과 같은 결과를 얻었다. 1. 술전 변수중 심비대(p=0.0012), 혈청 크레아티닌 이상(p=0.0166), IABP 실시(p=0.0096)는 기능저하군이 기능 정상군보다 유의하게 높은 빈도를 보였다 2. 수술변수중 기능저하군은 수술적응증에 있어서 심근경색후 협심증의 빈도가 많았고(p=0.00003), 내흉동맥 의 사용은 유의하게 적었다(p=0.00416). 3. 조기사망률은 기능저하군이 기능정상군보다 약간 높았으나 통계적으로 유의한 차이는 없었다(기능저하군 8.3%, 기능정상군 5.1%, p=0.5492). 4. 합병증발생률은 기능저하군 50%(12/24), 기능정상군 33%(79/25)로 두군간에 유의한 차이는 없었다(p=0.1007). 5. 심실기능정상군에서는 연령(고령)(p=0.041)이 수술후 조기사망에 유의한 위험인자로, 심실기능저하군에서 는 연령(p=0.018)외에도 술전 IAaP 실시(p=0.0036), 고콜레스테롤혈증(p=0.00 7), 응급수술(p=0.0036)이 유의 한 위험인자로 작용하였다. 이상의 결과를 통해 심실기능이 저하된 관상동맥질환 환자는 심실기능이 정상인 환자에 비해 많은 술후 조기사망의 위험인자를 갖고있으나.술후 조기사망률과 합병증 발생률은 두 군간에 유의한 차이를 보이지 않 음으로써 심실기능이 저하된 환자에 있어서도 증상의 개선과 장기생존률의 향상을 얻기 위하여 좀더 적극적인 관상동맥우회 술의 실시가 필요할 것으로 생각된다.

• Advances in biomechanics and applications
• /
• 제1권4호
• /
• pp.279-292
• /
• 2014

This paper presents some simulations of fluxes and pressures in the coronary network, in the case of very severe coronary disease (several stenoses on the left branches and total occlusion of the right coronary artery). In that case, coronary artery bypass graft surgery is the commonly performed procedure. However, the success of the intervention depends on many factors. Modeling of the coronary circulation is thus important since it can help to understand the influence of all these factors on the coronary haemodynamics. We previously developed an analog electrical model that includes the eventual presence of collateral flows, and can describe the different revascularization strategies (two grafts, three grafts, ...). The aim of the present work is to introduce in our simulations the time-dependence of the coronary microvascular resistances, in order to better represent the effect of the systolic ventricular contraction (which induces an elevation of the resistances because the vessels are squeezed).