• Journal of Chest Surgery
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• v.28 no.5
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• pp.453-463
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• 1995

During 42 month period 91 consecutive patient underwent coronary artery bypass surgery. The mean age of these patient was 57 years [range from 28 to 78 years . There were 57 men and 34 women. The preoperative risk factors that include beyond the 50 % of total patients were male sex, obesity, hypo-high-density lipoproteinemia, smoking, hypercholesterolemia, hyper-low-density lipoproteinemia, hypertriglyceridemia and hypertension. Preoperatively 27 patients had stable angina pectoris and 39 patients of unstable angina pectoris. Twenty five patients had previous myocardial infarction history. The patterns of disease were 8 patients of single vessel involvement, 18 patients of double vessel involvement, 54 patients of triple vessel involvement and 11 patients of left main coronary artery disease. Fifty five patients were in Canadian Cardiovascular Society functional class III. Myocardial revascularization was performed under emergency conditions in 5 patients. Nine percent of patients had previous PTCA history. We performed 16 cases of sequential anastomosis, internal mammary artery harvest in 86 percent of total patients and total 284 distal anastomoses[mean 3.1 anastomosis per patient . The mean ACC time was 60.5 minutes and ECC time was mean 110 minutes. The combined surgeries were 16 cases of endarterectomy, 2 cases of LV aneurysmectomy, 1 case of Bentall operation, 1 case of repair of sinus of Valsalva, 1 case of ligation of coronary AV fistula and 1 case of excision of breast mass. The most common complication was wound infection[12 cases, 13 % . There was one hospital death due to postoperative respiratory failure and low output syndrome in patient with postinfarction VSD, LV aneurysm. Postoperative 88 patients were in Functional class I or II. The 99mTc-MIBI myocardial perfusion scan that used as evaluation of postoperative state was well correlated with patient`s symptoms instead of some disadvantages.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.630-637
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• 2000

Backgroud: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. Material and Method: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). Result: There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. Conclusion: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.

• Journal of Chest Surgery
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• v.56 no.2
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• pp.99-107
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• 2023

Background: The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a novel predictive marker of cardiovascular disease. However, its prognostic role in patients under-going coronary artery bypass grafting (CABG) is unclear. This study aimed to determine the association between the preoperative NLR and early mortality in patients undergoing CABG. Methods: Cardiac surgery was performed in 2,504 patients at Seoul St. Mary's Hospital from January 2010 to December 2021. This study retrospectively reviewed 920 patients who underwent isolated CABG, excluding those for whom the preoperative NLR was unavailable. The primary endpoints were the 30- and 90-day mortality after isolated CABG. Risk factor analysis was performed using logistic regression analysis. Based on the optimal cut-off value of preoperative NLR on the receiver operating characteristic curve, high and low NLR groups were compared. Results: The 30- and 90-day mortality rates were 3.8% (n=35) and 7.0% (n=64), respectively. In the multivariable analysis, preoperative NLR was significantly associated with 30-day mortality (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.17-1.39; p<0.001) and 90-day mortality (OR, 1.17; 95% CI, 1.07-1.28; p<0.001). The optimal cut-off value of the preoperative NLR was 3.4. Compared to the low NLR group (<3.4), the high NLR group (≥3.4) showed higher 30- and 90-day mortality rates (1.4% vs. 12.1%, p<0.001; 2.8% vs. 21.3%, p<0.001, respectively). Conclusion: Preoperative NLR was strongly associated with early mortality after isolated CABG, especially in patients with a high preoperative NLR (≥3.4). Further studies with larger cohorts are necessary to validate these results.

• Journal of Chest Surgery
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• v.45 no.5
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• pp.301-307
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• 2012

Background: Perioperative transfusion of red blood cell (RBC) may cause adverse effects. Bloodless-cardiac surgery has been spotlighted to avoid those problems. Off pump coronary artery bypass (OPCAB) surgery can decrease the transfusion. However, the risk factors of transfusions in OPCAB have not been investigated properly. Materials and Methods: One hundred and thirteen patients (male:female=35:78, mean age=$66.7{\pm}9.9$ years) who received isolated OPCAB were retrospectively analyzed from March 2006 to September 2007. The threshold of RBC transfusion was 28.0% of hematocrit. Bilateral internal thoracic arteries graft were used for 99 patients (87.6%). One hundred and three (91.1%) and 35 patients (31.5%) took aspirin and clopidogrel just before surgery. Results: Sixty-five patients (47.5%) received the RBC transfusion (mean $2.2{\pm}3.2$ units). Mortality and major complications were not different between transfusion and no-transfusion group. But, ventilator support time, intensive care unit stay and hospitalization period had been reduced in no-transfusion group (p<0.05). In multivariate analysis, patients risk factors for RBC transfusion were preoperative low hematocrit (<37.5%) and clopidogrel medication. Surgical risk factors were longer graft harvesting time (<75 minutes) and total operation time (<5.5 hours, p <0.05). Conclusion: We performed the transfusion according to transfusion guideline; over 40% cases could conduct the OPCAB without transfusion. There were no differences in major clinical results between transfusion and non-transfusion group. In addition, when used together with accurate understanding of transfusion risk factors, it is expected to increase the proportion of patients that do not undergo transfusions.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.227-230
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• 2002

The vasodilatory shock after cardiopulmonary bypass is defined as the condition involving severe and persistent form of hypotension, tachycardia, normal or increased cardiac output and decreased systemic vascular resistance. Because of the unsuccessful response to infusion of fluids or catecholamine vasopressors, a sustained systemic shock state occurs and results in a high morbidity and mortality. We successfully treated this syndrome of 3 patients after open heart surgery with low dose of arginine vasopressin(AVP). Therefore, we report these cases with a review of related articles.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.541-546
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• 1988

A 34-year-old female was seen with Budd-Chiari syndrome caused by an obstruction of the inferior vena cava above the hepatic veins. Transatrial dilation or membranotomy was not available due to severe hourglass constriction of the inferior vena cava. Retrohepatic cavoatrial bypass with a low porosity woven Dacron graft[24mm in the diameter] was performed. For increasing the patency of venous graft, we used anticoagulation with warfarin. Postoperative course was uneventful except pleural effusion of the right luring.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.393-398
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• 1987

Unstable angina pectoris is often premonitory to an acute myocardial infarction. Surgical revascularization in this syndrome is of great potential benefit and relatively low mortality. A patient with unstable angina pectoris is reported. A 65-year-old man complained of dyspnea and pain in the left anterior chest. The pain was brought on by mild exercise, occurred at rest and sleeping time. The pain worsened over a month period and more aggravated in intensity and duration. Physical examination showed no abnormalities except hypertension and laboratory data were within normal limits. His anginal pain was not relived by nitroglycerin ingestion. Preoperative coronary angiograms revealed significant obstruction [>90%] of left anterior descending coronary artery. Aorto-left anterior descending coronary bypass with autogenous saphenous vein used as conduit was performed. The postoperative course was uneventful and he was discharged on 16th postoperative day in a healthy condition.

• JSTS:Journal of Semiconductor Technology and Science
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• v.14 no.3
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• pp.331-338
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• 2014

A charge-pump circuit using a current-bypass technique, which suppresses charge sharing and reduces the sub-threshold currents, helps to decrease phase-locked loop (PLL) jitter without resorting to a feedback amplifier. The PLL shows no stability issues and no power-up problems, which may occur when a feedback amplifier is used. The PLL is implemented in 0.11-${\mu}m$ CMOS technology to achieve 0.856-ps RMS and 8.75-ps peak-to-peak jitter, which is almost independent of ambient temperature while consuming 4 mW from a 1.2-V supply.

• Journal of Chest Surgery
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• v.37 no.11
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• pp.922-924
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• 2004

A 55 year old male was admitted for dyspnea. The patient was diagnosed as acute myocardiac infarction, and coronary artery bypass grafting was performed with cardiopulmonary bypass. At postoperative day ＃1, Systemic Inflammatory Response Syndrome was developed with fever, leukocytosis, tachycardia, tachypnea and low systemic vascular resistance. The patient was recovered after being treated with high dose of (36 $\mug/min)$ norepinephrine, and was discharged.

• Journal of Chest Surgery
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• v.24 no.7
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• pp.725-731
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• 1991

Four patients with traumatic rupture of aorta underwent operative repair at Seoul national university hospital. All cases were confirmed by preoperative aortography. Rupture site was aortic isthmus or just distal to it. Operations were somewhat delayed due to the low degree of suspicion and difficulties in diagnosis: ranging from 5 hours to 8 days. Operation was performed as same manners in all cases: resection of the ruptured portion and tubular woven dacron graft interposition in conjunction with shunt or bypass procedures, TDMAC-Heparin shunt between ascending and descending aorta was used in 3 cases, and LA-femoral centrifugal pump was used in one case. There were no intraoperative or postoperative mortality. Hoarseness was developed in all patients but paraplegia or other significant complications were not found in any of patients. We concluded that 1] high degree of suspicion is essential in the early diagnosis and treatment of traumatic aortic rupture and 2] any kind of shunt or bypass procedure is necessary in operative repair of traumatic aortic rupture and use of centrifugal pump without systemic heparinization is easier and safer procedure than others for the maintenance of adequate distal flow.