• Journal of Chest Surgery
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• 제56권6호
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• pp.394-402
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• 2023

Background: The optimal choice of valve substitute for aortic valve replacement (AVR) in pediatric patients remains a matter of debate. This study investigated the outcomes following AVR using mechanical prostheses in children. Methods: Forty-four patients younger than 15 years who underwent mechanical AVR from March 1990 through March 2023 were included. The outcomes of interest were death or transplantation, hemorrhagic or thromboembolic events, and reoperation after mechanical AVR. Adverse events included any death, transplant, aortic valve reoperation, and major thromboembolic or hemorrhagic event. Results: The median age and weight at AVR were 139 months and 32 kg, respectively. The median follow-up duration was 56 months. The most commonly used valve size was 21 mm (14 [31.8%]). There were 2 in-hospital deaths, 1 in-hospital transplant, and 1 late death. The overall survival rates at 1 and 10 years post-AVR were 92.9% and 90.0%, respectively. Aortic valve reoperation was required in 4 patients at a median of 70 months post-AVR. No major hemorrhagic or thromboembolic events occurred. The 5- and 10-year adverse event-free survival rates were 81.8% and 72.2%, respectively. In univariable analysis, younger age, longer cardiopulmonary bypass time, and smaller valve size were associated with adverse events. The cut-off values for age and prosthetic valve size to minimize the risk of adverse events were 71 months and 20 mm, respectively. Conclusion: Mechanical AVR could be performed safely in children. Younger age, longer cardiopulmonary bypass time and smaller valve size were associated with adverse events. Thromboembolic or hemorrhagic complications might rarely occur.

• Korean Journal of Radiology
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• 제22권3호
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• pp.324-333
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• 2021

Objective: The clinical course of an individual patient with heart failure is unpredictable with left ventricle ejection fraction (LVEF) only. We aimed to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived myocardial fibrosis extent and to determine the cutoff value for event-free survival in patients with non-ischemic cardiomyopathy (NICM) who had severely reduced LVEF. Materials and Methods: Our prospective cohort study included 78 NICM patients with significantly reduced LV systolic function (LVEF < 35%). CMR images were analyzed for the presence and extent of late gadolinium enhancement (LGE). The primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, heart transplantation, implantable cardioverter-defibrillator discharge for major arrhythmia, and hospitalization for congestive heart failure within 5 years after enrollment. Results: A total of 80.8% (n = 63) of enrolled patients had LGE, with the median LVEF of 25.4% (19.8-32.4%). The extent of myocardial scarring was significantly higher in patients who experienced MACE than in those without any cardiac events (22.0 [5.5-46.1] %LV vs. 6.7 [0-17.1] %LV, respectively, p = 0.008). During follow-up, 51.4% of patients with LGE ≥ 12.0 %LV experienced MACE, along with 20.9% of those with LGE ≤ 12.0 %LV (log-rank p = 0.001). According to multivariate analysis, LGE extent more than 12.0 %LV was independently associated with MACE (adjusted hazard ratio, 6.71; 95% confidence interval, 2.54-17.74; p < 0.001). Conclusion: In NICM patients with significantly reduced LV systolic function, the extent of LGE is a strong predictor for long-term adverse cardiac outcomes. Event-free survival was well discriminated with an LGE cutoff value of 12.0 %LV in these patients.

• Korean Journal of Radiology
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• 제24권6호
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• pp.512-521
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• 2023

Objective: There is increasing recognition that left atrial (LA) strain can be a prognostic marker of various cardiac diseases. However, its prognostic value in acute myocarditis remains unclear. Therefore, this study aimed to evaluate whether cardiovascular magnetic resonance (CMR)-derived parameters of LA strain can predict outcomes in patients with acute myocarditis. Materials and Methods: We retrospectively analyzed the data of 47 consecutive patients (44.2 ± 18.3 years; 29 males) with acute myocarditis who underwent CMR in 13.5 ± 9.7 days (range, 0-31 days) of symptom onset. Various parameters, including feature-tracked CMR-derived LA strain, were measured using CMR. The composite endpoints included cardiac death, heart transplantation, implantable cardioverter-defibrillator or pacemaker implantation, rehospitalization following a cardiac event, atrial fibrillation, or embolic stroke. The Cox regression analysis was performed to identify associations between the variables derived from CMR and the composite endpoints. Results: After a median follow-up of 37 months, 20 of the 47 (42.6%) patients experienced the composite events. In the multivariable Cox regression analysis, LA reservoir and conduit strains were independent predictors of the composite endpoints, with an adjusted hazard ratio per 1% increase of 0.90 (95% confidence interval [CI], 0.84-0.96; P = 0.002) and 0.91 (95% CI, 0.84-0.98; P = 0.013), respectively. Conclusion: LA reservoir and conduit strains derived from CMR are independent predictors of adverse clinical outcomes in patients with acute myocarditis.

• 한국임상약학회지
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• 제22권2호
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• pp.113-122
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• 2012

ACC/AHA/SCAI Guideline recommends for administration dual antiplatelet therapy after drug-eluting stent (DES) to prevent restenosis and stent thrombosis in patients with percutaneous coronary intervention (PCI). Recently triple antiplatelet therapy including cilostazol is known to reduce restenosis and stent thrombosis significantly after DES implantation. However, there is lack of data providing the efficacy of triple antiplatelet therapy. The purpose of this study is to evaluate the clinical effects of the triple therapy after DES implantation compared with the dual therapy. This retrospective study collected data from medical charts of 251 patients who received DES implantation between Jul 2006 and Jun 2008. They received either dual antiplatelet therapy (N = 154 clopidogrel and aspirin; Dual group) or triple antiplatelet therapy (N = 97 cliostazol, clopidogrel and aspirin; Triple group). Major adverse cardiac event rates (MACE, included total death, myocardial infarction, target lesion revascularization) at 12 months, 24 months, stent thrombosis, rates of bleeding complications and adverse drug reactions were compared between these two groups. Compared with the dual group, the triple group had a similar incidence of the MACE rates at 24months (12.3% vs. 12.4%, p = 0.99). There is no difference in overall stent thrombosis between two groups (Dual group 2.6% vs. Triple group 4.1%, p = 0.5). Subgroup analysis showed that diabetic patients got more benefit in reducing MACE rates but, there is no statistical difference. Bleeding complications and adverse drug effects were not different significantly. As compared with dual antiplatelet therapy, triple antiplatelet therapy did not reduce the 12-months, 24-months MACE rates and stent thrombosis. Bleeding complications and adverse drug effects were not different.

• Journal of Chest Surgery
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• 제43권3호
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• pp.246-253
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• 2010

배경: 술전 경도 및 중등도의 허혈성 승모판막 폐쇄부전증이 동반된 환자들의 무심폐순환 관상동맥 우회로 조성술을 시행한 후의 장기 예후를 추적 조사하였다. 대상 및 방법: 1996년 9월부터 2004년 3월까지 1,000명의 연속된 무심폐순환 관상동맥 우회로 조성술을 시행 받은 환자들의 데이터를 전향적으로 조사하였으며, 97%의 환자에서 추적 조사가 가능하였다. 육십칠명(6.7%)의 환자들이 수술 당시 경도 및 중등도의 허혈성 승모판막 폐쇄부전증이 동반되었다. 허혈성 승모판막 폐쇄부전증이 끼치는 영향에 대하여 수술사망율, 실제생존율 및 주요 심장 부작용이 없는 생존율 등을 비교하였다. 결과: 평균 추적 조사 기간은 $66{\pm}22$개월이었다. 허혈성 승모판막 폐쇄부전증이 동반된 환자들의 연령이 더 높았으며(p<0.001), 더 낮은 심박출량을 보였고(p<0.001) 더 많은 위험 인자들을 갖고 있었다. 여성에게 의미있게 더 많았으며(p=0.002), 수술사망율이나 술전후 심근 경색의 빈도에는 의미있는 차이는 없었다(p=0.25). 팔 년 생존율은 허혈성 승모판막 폐쇄부전증이 동반된 환자들이 더 낮았다($39.6{\pm}11.8%$ vs $76.7{\pm}2.2$, p<0.001). 하지만 동반된 위험 인자들을 교정했을 때 술전 경도 및 중등도의 허혈성 승모판막 폐쇄부전증 자체가 장기 사망률의 의미있는 위험 인자는 아니었다(p=0.42). 8년 간의 주요 심장 부작용이 없는 생존율은 허혈성 승모판막 폐쇄부전증이 동반된 환자들에서 의미있게 낮았다($53.12{\pm}12%$ vs $77{\pm}2%$, p<0.001). 위험 인자들을 교정했을 때 허혈성 승모판막 폐쇄부전증은 주요 심장 부작용이 없는 생존율(HR: 2.31), 울혈성 심기능 저하와 재발성 심근 경색에 의미있는 위험 요소이었다. 결론: 무심폐순환 관상동맥 우회로 조성술을 시행 받은 환자들 중 술전 경도 및 중등도의 허혈성 승모판막 폐쇄부전증이 동반된 경우 더 많은 술전 위험요소들을 갖고 있었다. 술전후의 사망률이나 유병율은 비슷하였으나, 장기적으로 심장 합병증의 유발율은 더 높았다

• Journal of Preventive Medicine and Public Health
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• 제55권4호
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• pp.351-359
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• 2022

Objectives: The Regional CardioCerebroVascular Center (RCCVC) project was initiated to improve clinical outcomes for patients with acute myocardial infarction or stroke in non-capital areas of Korea. The purpose of this study was to evaluate the outcomes and issues identified by the Busan RCCVC project in the treatment of ST-segment elevation myocardial infarction (STEMI). Methods: Among the patients who were registered in the Korean Registry of Acute Myocardial Infarction for the RCCVC project between 2007 and 2019, those who underwent percutaneous coronary intervention (PCI) for STEMI at the Busan RCCVC were selected, and their medical data were compared with a historical cohort. Results: In total, 1161 patients were selected for the analysis. Ten years after the implementation of the Busan RCCVC project, the median door-to-balloon time was reduced from 86 (interquartile range [IQR], 64-116) to 54 (IQR, 44-61) minutes, and the median symptom-to-balloon time was reduced from 256 (IQR, 180-407) to 189 (IQR, 118-305) minutes (p<0.001). Inversely, the false-positive PCI team activation rate increased from 0.6% to 21.4% (p<0.001). However, the 1-year cardiovascular death and major adverse cardiac event rates did not change. Even after 10 years, approximately 75% of the patients had a symptom-to-balloon time over 120 minutes, and approximately 50% of the patients underwent inter-hospital transfer for primary PCI. Conclusions: A decade after the implementation of the Busan RCCVC project, although time parameters for early reperfusion therapy for STEMI improved, at the cost of an increased false-positive PCI team activation rate, survival outcomes were unchanged.

• Journal of Chest Surgery
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• 제39권7호
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• pp.534-543
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• 2006

배경: 급성심근경색증 환자에서 수술 시기는 아직도 논란이 많으며, off pump coronary artery bypass grafting (OPCAB)은 심폐체외순환의 부작용을 피할 수 있다는 장점이 있지만 급성심근경색증에 있어서 OPCAB의 효용성은 아직 입증되지 않았다. 저자들은 급성심근경색증 환자들에서 시행한 OPCAB의 수술시기와 경색의 정도에 따른 단기 및 중기 성적을 비교 분석하여 급성심근경색에 있어서 OPCAB의 적절한 수술시기와 효용성을 알아보고자 하였다. 대상 및 방법: 2002년 1월부터 2005년 7까지 OPCAB을 시행 받은 환자 중 수술 전 급성심근경색으로 진단되었던 126명을 대상으로 하였다. 환자들의 평균 연령은 61.2세였고, 남성이 92명(73.0%), 여성이 34명(27.2%)이었다 대상 환자 중 109명(86.5%)에서 3개 혈관 병변 혹은 좌주관상동맥 병변을 보였고, 긴급 또는 응급 수술을 요하는 환자는 25명(19.8%)이었다. 비전층 심근경색환자(제1군)는 72명(57.1%), 전층 심근경색한자(제2군)는 54명(42.9%)이었으며, 수술 전 심장성 쇼크와 대동맥 내 풍선펌프 삽입의 빈도는 제2군에서 더 높았으나 그 외의 수술 위험인자의 유병률은 차이가 없었다. 급성 심근경색이 발생한 후 수술까지의 시간을 각각 24시간 내, 1-3일, 4-7일, 8일 이후로 나누어 사망률 및 합병증을 비교하였다. 수술까지의 평균 대기 기간은 $5.3{\pm}7.1$일이었으며, 제1군은 $4.2{\pm}5.9$일, 제2군은 $6.6{\pm}8.3$일이었다. 결과: 환자당 평균 3.21개의 문합을 시행하였으며, 수술 후 3명에서 대동맥풍선펌프를 사용하였다. 제1군에서 1명 (0.79%)의 저심박출증에 의한 수술 사망이 있었으나, 심근경색이 새로 발생한 예는 없었다. 두 군간의 주 합병증의 발생률의 차이가 없었으며, 수술 대기시간에 따른 합병증의 발생률 차이도 없었다. 평균 추적관찰 기간은 21.3개월(2-42개월)이었으며, 추적 조사 결과, 42개월 전제 생존율은 $94.9{\pm}2.4%$로 제1군은 $91.4{\pm}4.7%$, 제2군은 $98.0{\pm}2.0%$로 두 군간의 통계적 유의성은 없었다(p=0.26). 심장관련 사망에 대한 42개월 전체 생존율은 $97.6{\pm}1.4%$로 제1군은 $97.0{\pm}2.0%$, 제2군은 $98.0{\pm}2.0%$로 두 군간의 통계적 유의성은 없었다(p=0.74). 심장 관련 합병증의 42개월 전체 자유도는 $95.4{\pm}2.0%$로 제1군은 $94.8{\pm}2.9%$, 제2군은 $95.9{\pm}2.9%$로 두 군간의 통계적 유의성은 없었다(p=0.119). 결론: 급성심근경색환자에서 대기 시간 없이 심폐체외순환기를 사용하지 않는 관상동맥우회술을 시행하여 좋은 중 단기 성적을 확인하였으며, 심근경색의 정도는 수술 성적에 영향을 미치지 않았다. 저자들은 급성심근경색의 치료로써 관상동맥우회술이 필요한 경우 대기시간 없이 OPCAB을 시행하여도 안전할 것이라고 생각한다. 그러나 이를 확인하기 위해서는 좀 더 많은 대상군과 전향적인 연구가 필요할 것이다.