• Journal of Chest Surgery
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• v.37 no.4
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• pp.322-327
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• 2004

Coronary artery bypass grafting on the beating heart is no longer a new methods for any cardiac surgeon. We evaluated the application of the off-pump coronary artery bypass procedure relative to safety and efficiency as measured by postoperative complication and operative mortality. Material and Method: We used our retrospective database to compare the patients having off-pump coronary surgery (n=100) with those having on-pump coronary surgery (n=100) between June, 1999 and August, 2002. Patients whom underwent associated valvular or aortic aneurysmal operation were excluded. Result: Neither groups showed any differences in the patient's risk factors and extent of coronary disease. Off-pump CABG group did not have significantly less mean operation time (295$\pm$73 min vs 323$\pm$83 min, p=ns) and mean hospital day (15.34$\pm$6.02 day vs 13.80$\pm$4.95 day, p=ns). However, off-pump CABG group had significantly shorter mean ventilation time (17.3$\pm$11.27 hour vs 24.98$\pm$16.1 hour, p＜0.05). No patients were converted to on-pump CABG in off-pump CABG. Intraoperative hemodynamic instability in off-pump CABG were 6 cases, of whom 2 cases were in lateral wall approach and 4 cases in right coronary anastomosis. Postoperative mortality was 1 case in off-pump CABG and 2 cases in on-pump CABG. Intra-aortic ballon pump (IABP) was applied in 1 case with off-pump CABG and in 2 cases with on-pump CABG. No patients presented postoperative cerebral infarction ＆ stroke in off-pump CABG but 2 patients in on-pump CABG. Postoperative arrhythmia presented in 4 cases with off-pump CABG and in 6 cases with on-pump CABG. Acute renal failure (ARF) was complicated in 3 cases with off-pump CABG and in 2 cases with on-pump CABG. Conclusion: This study documented the immediate safety and efficiency of the off-pump CABG procedure.

• Journal of Chest Surgery
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• v.46 no.1
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• pp.22-26
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• 2013

Background: Constrictive pericarditis after coronary artery bypass surgery has been known to affect cardiac output by limiting diastolic ventricular filling. We aimed to assess the influence of postoperative constrictive physiology on the early outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCAB). Materials and Methods: Between January 2008 and July 2011, 903 patients underwent an isolated OPCAB and postoperative transthoracic-echocardiography. The patient cohort was classified into two groups: group A, constrictive physiology and group B, control group without constrictive physiology. Early outcomes were analyzed between the two groups. Results: Of the total 903 patients, group A consisted of 153 patients (16.9%). The amount of blood loss in group A during the postoperative 24 hours was greater than that of group B, but this was not statistically significant (p=0.20). No significant differences were found in the mortality rates (group A, 0.6%; group B, 1.4%; p=0.40) and 30-day major adverse cardiac and cerebrovascular events (MACCEs; group A, 3.3%; group B, 6.1%; p=0.42). Conclusion: Postoperative constrictive physiology does not affect 30-day MACCEs or other major complications after OPCAB. The results of this study suggest that patients with early postoperative constrictive physiology do not need medical or surgical treatment, and that conservative care is sufficient.

• Journal of Chest Surgery
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• v.46 no.1
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• pp.84-87
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• 2013

A 60-year-old man visited the outpatient clinic due to one month of recurrent exertional chest pain. Eleven years earlier he had undergone off-pump coronary artery bypass grafting using bilateral internal thoracic artery (ITA) Y-composite grafts based on the left ITA. Preoperative coronary angiography showed patent distal graft anastomoses and visualized the left ITA retrogradely. The arch aortography revealed near-total occlusion of the left subclavian artery at the level of the ostium. The patient underwent left carotid-to-subclavian artery bypass grafting using a 6 mm vascular conduit. Postoperative computed tomographic angiography revealed a patent bypass conduit between the left common carotid artery and left subclavian artery. The patient was discharged on postoperative day 4 with no symptoms or signs of myocardial ischemia.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.773-776
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• 2007

A 47-year-old male with hypertension, diabetes mellitus and heavy smoking, but no anginal symptoms, presented with claudication of the lower extremities. Extremity angiography with coronary angiography revealed peripheral arterial lesions including a left subclavian artery occlusion with coronary artery disease. The patient underwent an initial off-pump coronary artery bypass with an ascending aorto-axillary bypass. The right internal mammary artery was anastomosed to the left anterior descending coronary artery. The greater saphenous vein graft was connected from the ascending aorto-axillary bypass graft to the diagonal branch. At postoperative day 18, femorofemoral and bilateral femoropopliteal bypasses were performed. We report a case of the combined repair of coronary artery disease and a left subclavian artery occlusion.

• Journal of Chest Surgery
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• v.40 no.1 s.270
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• pp.56-59
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• 2007

A 65 year-old male had chest pain which was diagnosed as unstable angina needing urgent coronary artery bypass surgery. Physical examination demonstrated signs of severe anemia and hemoglobin level was 5.7 g/dL. Gastrofiberscopy showed a 4 cm sized fungating mass at the lesser curvature with active bleeding. The mass was adenocarcinoma by pathologic examination. Simultaneous coronary artery bypass surgery and total gastrectomy were planned due to bleeding of the mass. Off-pump coronary bypass grafting was done first, followed by total gastrectomy. The postoperative course was smooth. He was discharged from the hospital after 12 days and was on surveillance for 9 months. We report a rare case of simultaneous surgery for angina and gastric cancer.

• Journal of Yeungnam Medical Science
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• v.28 no.2
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• pp.124-132
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• 2011

Background: Antiplatelet agent administration is critical in managing coronary-artery disease, but there is a concern regarding operation-related bleeding and an increase in blood transfusion in such, especially when delivering combined antiplatelet agents. This study was conducted to evaluate the effect of the administration of antiplatelet agents on off-pump coronary-artery bypass surgery (OPCAB). Methods: From March 2003 to December 2009, 49 patients who had undergone OPCAB were collected retrospectively. The patients were divided into three groups according to the administration of antiplatelet agents before the OPCAB operation: 21 patients were given an aspirin agent (group 1), 19 patients were given combined agents (aspirin+clopidogrel) (group 2), and nine patients were not given any antiplatelet agent (group 3). The three groups' perioperative hematologic and coagulation profiles, including their platelet counts, hemoglobin levels, hematocrit, prothrombin times, and aPTTs (activated partial thromboplastin times), and their postoperative bleeding, related complications, transfusion requirements, and operation times, were compared. Results: The operation time in group 2 was 4.3 hours, longer than those in the two other groups, and urgent operation was significantly most frequent in group 2 (63%). The amount of blood loss and the number of patients who received blood transfusion were not different in the three groups. The perioperative hemoglobin level, hematocrit, platelet count, prothrombin time, and aPTT were also not significantly different among the three groups. Conclusion: The continuous administration of antiplatelet agents to the patients in this study did not increase their postoperative bleeding or operation-related complications. Therefore, OPCAB may well be considered even if combined antiplatelet agents are being administered.

• Journal of Chest Surgery
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• v.53 no.6
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• pp.403-407
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• 2020

To validate the technique of the single Heartstring aortotomy for multiple off-pump venous bypass grafts (described in 2015), the results of a 38-month follow-up study of 18 patients, including high-risk patients, are presented. No early deaths or cardiac or cerebral complications occurred. During the follow-up period, 2 patients died of non-cardiac causes, and 3 developed coronary ischemia. Ischemia occurred due to late graft occlusion in 2 patients, both of whom had normal postoperative courses and correct graft flow. The presence of acute symptoms 24 months after surgery in these patients indicated that technical graft failure was unlikely. This safe technique combines the advantages of simple and reproducible revascularization, the off-pump approach, and minimal aortic manipulation.

• Journal of Chest Surgery
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• v.52 no.1
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• pp.16-24
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• 2019

Background: Optimal graft selection for coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) dysfunction remains debatable. We report an analysis of our experiences of isolated CABG in patients with severe LV dysfunction and the impact of graft strategy on long-term outcomes. Methods: We analyzed 209 patients with severe LV dysfunction (ejection fraction [EF] <30%) who underwent primary isolated CABG. Of these, 169 were revascularized with a bilateral internal thoracic arterial (ITA) graft (BITA group) and 40 were revascularized with a single ITA graft (SITA group). The mean follow-up duration was $22{\pm}32$ months. Results: There were 18 early deaths (8.6%). Overall survival at 5 years was 66.7%. The rate of freedom from cardiac-related death at 5 years was 74.1%, and was significantly higher in patients who underwent off-pump CABG (p=0.005) and in the BITA group (p=0.023). Multivariate analysis demonstrated that old age (hazard ratio [HR], 2.548; 95% confidence interval [CI], 1.134-5.762; p=0.024), off-pump CABG (HR, 0.245; 95% CI, 0.090-0.661; p=0.006), and BITA grafts (HR, 0.333; 95% CI, 0.146-0.757; p=0.009) were correlated with cardiac mortality. Conclusion: CABG in patients with severe LV dysfunction (EF <30%) showed reasonable long-term outcomes. The rate of freedom from cardiac-related death was significantly higher in patients who underwent off-pump CABG and in the BITA group. Off-pump BITA grafting strategies can be accepted as a viable primary option in patients with severe LV dysfunction if performed by an experienced surgeon.

• Journal of Chest Surgery
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• v.46 no.4
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• pp.265-273
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• 2013

Background: The safety and efficacy of arterial composite grafts for total arterial revascularization have been demonstrated. The saphenous vein (SV) is a widely used graft because of its accessibility, sufficient length, and ease of manipulation. Our aim was to compare mid-term outcomes of saphenous vein Y-grafts with radial artery Y-grafts joined by anastomosis to the left internal thoracic artery. Materials and Methods: Records of off-pump coronary artery bypass grafting with composite Y-grafts based on the left internal thoracic artery technique in 552 patients were analyzed retrospectively. After propensity score matching, 79 radial arterial (RA) composite grafts (RA group) and 79 saphenous vein composite grafts (SV group) were compared. The duration of mean follow-up was $24.6{\pm}14.6$ months (range, 1 to 55 months). Results: There were no differences in surgical mortality, all-cause mortality, or morbidity among the groups. Rates of 4-year survival were 91.7% and 96.3% in the RA and SV groups, respectively (p=0.519). The coronary reintervention-free survival rate and freedom from major adverse cardiovascular or cerebrovascular events were similar in the two groups (p=0.685, p=0.564). Conclusion: Construction of composite Y-grafts using the radial artery or saphenous vein showed similar mid-term results. Long-term follow-up and randomized trials will be needed to confirm our present conclusions.

• Journal of Chest Surgery
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• v.33 no.2
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• pp.186-189
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• 2000

In an attermpt to aviod the deleterious effects of cardiopulmonary by pass such as pulmonary complication neurologic complication and renal failure off-pump CABG has been rediscovered and developed. We experienced off-pump CABG in 2 cases with unstable angina complicated with COPD and report herein the cases with review of literature.