• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.749-753
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• 2006

Background: The purpose of this study is to assess a score system for operative risk evaluation of CABG. Material and Method: From January 2001 to September 2005, retrospective study for various perioperative factors of 2993 cases was done. Result: The early operative mortality was 2.4% and the beta coefficients of 7 core variables related to it (preoperative LV dysfuction, preoperative renal failure, MI within 1 week, reoperation, combined surgery, preoperative atrial fibrillation, preoperative IABP) were adjusted to score system. ROC curve and Hosmer and Lemeshow goodness of fit test was done. Conclusion: This score system was effective in assessing operative risk of CABG. But It is necessary to gather larger volume of case and perform multicenter study.

• Journal of Chest Surgery
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• v.31 no.12
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• pp.1172-1182
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• 1998

Background: Primary goal of anticoagulation treatment in patients with mechanical heart valve is the effective prevention of thromboembolism and safe avoidance of bleeding as well. Material and Method: Two-hundred and nine patients with the St. Jude Medical prosthesis operated on between 1984 and 1995, for mitral(MVR 122), aortic(AVR 39) and double mitral and aortic valve replacement(DVR 48) respectively, were studied on the practically achieved levels of anticoagulation and the clinical outcomes. Patients were on Coumadin and followed up by monthly visit to outpatient clinic for examination and prothrombin time measurement to adjust the International Normalized Ratios(INRs) within the low-intensity target range between 1.5 and 2.5. Result: A total anticoagulation follow-up period was 1082.0 patient- years(mean 62.1 months) and INRs of 10,205 measurements were available for evaluation. The accomplished INRs among the replacement groups were not significantly different and only 65% of INRs were within the target range. And, in individual patients, only 37% of patients had INRs included within the target range in more than 70% of tests during follow-up period. The levels of INRs in patients with atrial fibrillation, which was found in 57% of patients, were definitely higher than the ones measured in patients with regular rhythm(p<0.001). Thromboembolisms were experienced by 15 patients with the incidence of 1.265%/patient- year(MVR 1.412%, AVR 0.462% and DVR 1.531%/patient-year) and major bleeding by 4 patients with the incidence of 0.337%/patient-year(MVR 0.424%, AVR none and DVR 0.383%/patient-year). Frequent as well as prolonged missing of prothrombin time tests was the main risk factor strongly associated with the thromboembolic complications(odds ratio 1.99). The proportion of INRs within target range of less than 60% in individual patient was the highly significant risk factor of both thromboembolic and overall embolic and bleeding complications(p<0.004 and p<0.002 respectively). Conclusion: In conclusion, the low-intensity therapeutic target range of INRs was adequate in patients with AVR and in sinus rhythm. However, the patients with replacement of the mitral valve were more likely to require higher target range of INRs, especially in the presence of atrial fibrillation, to achieve the practical levels of anticoagulation enough to prevent thromboembolic complications effectively. For the higher therapeutic target range of INRs between 2.0∼3.0, further accumulation of clinical evidences are required. It is highly desirable to improve the patients' compliance under continuous instructions in visiting outpatient clinic and in taking daily Coumadin without omission and to keep INRs consistently within optimal range with tight control for minimization of chances and of periods of exposure to the risk of complications. And, particularly, patients with high risk of complications and with wide fluctuation of INRs should be better managed with frequent monitoring anticoagulation levels.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.249-254
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• 1999

Background: Recovery of the left atrial contractile function after the Cox-Maze procedure is related to the size of the left atrium. We have postulated that if too wide area of the atrium were isolated electrically, then the atrial contractile function would be impaired postoperatively. We have modified the Cox-Maze procedure to dissect each pair of the pulmonary veins separately instead of the conventional pulmonary vein encircling incision, and compared the atrial contractile function after each procedure. Material and Method: From February 1995 to October 1997, 55 cases of the Cox-Maze procedure were performed in mitral valvular heart disease. We excluded the cases that did not covert to sinus rhythm. The patient groups were divided according to the interpulmonary vein distance(IPVD) and the procedure performed. Group I was IPVD under 6.5 cm(n=30), group II was IPVD over 6.5cm and the conventional Cox-Maze III procedure was performed(n=16), and group III was IPVD over 6.5cm and the modified Cox-Maze procedure was performed(n=9). Result: Atrial contractile function was evaluated by the echocardiography follow-up between 6 months to 12 months. The right atrial contractile function recovered gradually, the recovery rate after long-term follow-up was 90% in group I, 81% in group II, and 100% in group III(p>0/05). In the left atrium the recovery rate was 63% in group I, 31% in group II(p=0.03), and 66% in group III(p>0.05). Conclusion: The modified Cox-Maze procedure may have beneficial effects on the recovery of the left atrial contractile function, however, there are no statistically significant values. Therefore, further evaluation of this procedure is necessary.

• Korean Journal of Clinical Pharmacy
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• v.24 no.1
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• pp.15-25
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• 2014

Background: Elderly patients with gastrointestinal (GI) and cardiovascular (CV) risk factors may be more easily exposed to NSAID-related side effects (SEs). Based on the ACG guideline of year 2009, the aim of the study is to evaluate proper use of NSAIDs and gastroprotective drugs according to the degree of GI and CV risk strengths in the patients. Methods: Retrospectively surveyed 410 elderly patients with NSAIDs for more than 30 days at a general hospital in Korea. GI risk factor includes age, ulcer history, high-dose NSIADs, concurrent aspirin use, steroids or anticoagulants. CV risk factor includes angina, myocardial infarction, cerebral infarction, atrial fibrillation or coronary intervention requiring low-dose aspirin. These factors were classified as high/low cardiovascular groups and high/moderate/low GI groups. Results: There were 14 patients in high CV risk group and high GI risk group. The group was recommended not to use NSAIDs as it is not adequate. There were 101 patients in high CV risk group and moderate GI risk group. This group was recommended to use naproxen and PPI/misoprostol. But all patients except one were not adequate. There were 9 patients in low CV risk group and high GI risk group. This group was recommended to use selective COX-2 inhibitor and PPI/misoprostol. 5 cases were proper while 4 cases did not. There were 285 patients in low CV risk and moderate GI risk group who were recommended to use non selective NSAIDs and PPI/misoprostol or selective COX-2 inhibitor only. 103 patients were proper while 182 patients not adequate. Overall, the SEs were higher in those cases for inadequate use of drugs comparing to the adequate. CV SEs were statistically significant. However, SEs for each risk groups were different. For the case of low CV risk group and high/moderate GI risk group, the inadequate use of drugs makes the SE high and the other groups are not. Also, it was not statistically significant. Conclusions: In elderly patients, the inappropriate use of NSAIDs can increase the risk of the disease. Therefore, GI and CV risk must be considered simultaneously, and the proper use of NSAIDs and gastroprotective drugs for each risk groups should be reconsidered.

• Journal of Chest Surgery
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• v.45 no.5
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• pp.295-300
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• 2012

Background: With growing attention to the aortopathy associated with aortic valve diseases, the number of candidates for accompanying ascending aorta and/or root replacement is increasing among the patients who require aortic valve replacement (AVR). However, such procedures have been considered more risky than AVR alone. This study aimed to compare the surgical outcome of isolated AVR and AVR combined with aortic procedures. Materials and Methods: A total of 86 patients who underwent elective AVR between 2004 and June 2010 were divided into two groups: complex AVR (n=50, AVR with ascending aorta replacement in 24 and the Bentall procedure in 26) and simple AVR (n=36). Preoperative characteristics, surgical data, intra- and postoperative allogenic blood transfusion requirement, the postoperative clinical course, and major complications were retrospectively reviewed and compared. Results: The preoperative mean logistic European System for Cardiac Operative Risk Evaluation (%) did not differ between the groups: $11.0{\pm}7.8%$ in the complex AVR group and $12.3{\pm}8.0%$ in the simple AVR group. Although complex AVR required longer cardiopulmonary bypass ($152.4{\pm}52.6$ minutes vs. $109.7{\pm}22.7$ minutes, p=0.001), the quantity of allogenic blood products did not differ ($13.4{\pm}14.7$ units vs. $13.9{\pm}11.2$ units). There was no mortality, mechanical circulatory support, stroke, or renal failure requiring hemodialysis/filtration. No difference was found in the incidence of bleeding (40% vs. 33.3%) which was defined as red blood cell transfusion ${\geq}5$ units, reoperation, or intentional delayed closure. The incidence of mediastinitis (2.0% vs. 0%), ventilator ${\geq}24$ hours (4.0% vs. 2.8%), atrial fibrillation (18.0% vs. 25.0%), mean intensive care unit stay (34.5 hours vs. 38.8 hours), and median hospital stay (8 days vs. 7 days) did not differ, either. Conclusion: AVR combined with additional aortic or root replacement showed an excellent outcome and recovery course equivalent to that after isolated AVR.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.193-200
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• 2009

Background: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. Material and Method: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: $47.4{\pm}15.1$): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (AVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. Result: The follow-up period was 835.3 patient-years (mean: $5.9{\pm}3.5$) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs $(2.16{\pm}0.23)$ of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those $(2.03{\pm}0.27)$ measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). Conclusion: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients’ compliance should be done for achieving more effective anticoagulation therapy.

• Tuberculosis and Respiratory Diseases
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• v.54 no.3
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• pp.311-319
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• 2003

Background : Previous studies have suggested that a B-type natriuretic peptide(BNP) test can provide important information on diagnosis, as well as predicting the severity and prognosis of heart failure. Myocardial dysfunction is often observed in critically ill noncardiac patients admitted to the Intensive Care Unit, and the prognosis of the myocardial dysfunction needs to be determined. This study evaluated the predictability of BNP on the prognosis of critically ill noncardiac patients. Methods : 32 ICU patients, who were hospitalized from June to October 2002 and in whom the BNP test was evaluated, were enrolled in this study. The exclusion criteria included the conditions that could increase the BNP levels irrespective of the severity, such as congestive heart failure, atrial fibrillation, ischemic heart disease, and renal insufficiencies. A triage B-Type Natriuretic Peptide test with a RIA-kit was used for the fluorescence immunoassay of BNP test. In addition, the acute physiology and the chronic health evaluation (APACHE) II score and mortality were recorded. Results : There were 16 males and 16 females enrolled in this study. The mean age was 59 years old. The mean BNP levels between the ICU patients and control were significantly different ($186.7{\pm}274.1$ pg/mL vs. $19.9{\pm}21.3$ pg/mL, p=0.033). Among the ICU patients, there were 14(44----) patients with BNP levels above 100 pg/mL. The APACHE II score was $16.5{\pm}7.6$. In addition, there were 11 mortalities reported. The correlation between the BNP and APACHE II score, between the BNP and mortality were significant (r=0.443, p=0.011 & r=0.530, p=0.002). The mean BNP levels between the dead and alive groups were significantly different ($384.1{\pm}401.7$ pg/mL vs. $83.2{\pm}55.8$ pg/mL p=0.033). However, the $PaO_2/FiO_2$ did not significantly correlate with the BNP level. Conclusion : This study evaluated the BNP level was elevated in critically ill, noncardiac patients. The BNP level could be a useful, noninvasive tool for predicting the prognosis of the critically ill, noncardiac patients.