• Journal of Chest Surgery
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• v.33 no.7
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• pp.552-559
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• 2000

Background; The aim of this study is to evaluate our clinical experience with the Carbomedics heart valve prosthesis. Material and Method; Between Aug. 1988 and Dec. 1998, 294 Carbomidics valves were implanted in 235 patients(mitral; 143, mitral and aortic; 59, aortic; 33) The mean age at operation is 40.0$\pm$12.3 years(range 7 to 68 years); 63.8% (150patients) were woman. Follow up was 97.4% complete and mean follow up time was 5.7years with a total of 1209.2 patient-years. Result; The hospital mortality was 8.9%(mitral; was 95.2$\pm$1.6%(mitral ; 94.9$\pm$2.1%, mitral and aortic 95.0$\pm$3.7%, aortic 96.2$\pm$3.8%). Actual freedom rates from complications(linearized rates in parentheses) were fllowings; thromboembolism 96.2$\pm$1.5%(0.59%pt-yr), valve thrombosis 96.7$\pm$1.4%(0.5%/pt/yr), anticoagulant related hemorrhage 98.3$\pm$1.0%(0.25%/pt-yr), perivalvular leak 99.0$\pm$1.4%(0.5%/pt-yr), endocarditis 98.7$\pm$1.0%(0.25%/pt-yr), perivalvular leak 99.0$\pm$0.7%(0.17%pt-yr), endocarditis 98.7$\pm$1.0%(0.17%$\pm$pt-yr) and overall valve-related complications 88.9$\pm$2.5%(1.68%/pt-yr). Conclusion; The clinical performance of the Carbomedics valve was quite satisfactory with a low incidence of valve related mortality and morbidity.

• 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.

• Journal of Chest Surgery
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• v.51 no.6
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• pp.367-375
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• 2018

Background: It is unclear whether mitral valve (MV) repair for degenerative mitral regurgitation (MR) provides the same advantages in the elderly that it does in the general population. Methods: From 1994 to 2016, 188 elderly patients (mean age, $68.3{\pm}5.50years$) underwent MV repair (n=153) or MV replacement (n=35) for primary degenerative MR. Early and long-term outcomes were compared before and after propensity score matching (PSM). Results: Before PSM, there was a significant difference in operative mortality (p=0.011). Overall survival and freedom from cardiac-related death (CRD) at 5, 10, and 15 years were significantly higher in patients who underwent MV repair (p=0.039 and p=0.007, respectively). In the multivariable analysis, MV replacement was an independent risk factor of CRD. After PSM, operative mortality was not significantly lower in patients who underwent MV repair (p=0.125). Overall survival and freedom from CRD at 5, 10, and 15 years showed no significant difference between the 2 groups in the PSM cohort (p=0.207, p=0.47, respectively). There was no significant difference in freedom from reoperation before or after PSM (p=0.963 and p=0.575, respectively). Conclusion: MV repair for primary degenerative MR might be a valid option in the elderly population if successful repair is possible.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.891-898
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• 1997

Between May 1984 and January 1996, 130 patients were replaced cardiac valve using 150 St. Jude Medical prosthetic valves(42 aortic, 68 mitral, 20 aortic and mitral valve replycements). Follow-up was 97.6% complete. The early mortality rate was 5.4%, and late mortality rate was 4.9%. The valve-related late mortality rate was 3.3%. Of late complications, there were 6 anticoagulant related hemorrhages, 4 thromboembolisms and 1 paravalvular leakage. Linearized rates of late complication and valve-related late mortality were as follows: total late complications, .1.68o per patient-year: anticoagulant related hemorrhages, 0.92% per patient-year: thromboembolism, 0.61% per patient-year: paravalvular leakage, 0.15% per patient-year: reoperation, 0.15% per patient-year: and valve-related late mortalities, 0.61% per patient-year. Actuar al event free rate at 10 years was 87.4 $\pm$ 3.2%. The overall actuarial survival rate was 90.4$\pm$2.7% at 5 years, 87.5$\pm$3.3% at 10 years. Ninety eight percent of the survivors were in the New York Heart Association functional class I or II at the end of follow-up. There was significant improvement of cardiothoracic ratio. In conclusion, this study suggests the excellent durability of the St. Jude Medical Heart valve and remarkable functional benefit for the majority of the patients. However, prosthesisrelated complications are still common. Outcome is strongly related to the patient's preoperative cardiac condition and to the adequacy of anticoagulation control.

• Journal of Chest Surgery
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• v.27 no.1
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• pp.1-8
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• 1994

Allograft cardiac valves have been used for over 30 years to replace diseased cardiac valves, reconstruct right or left ventricular outflow tract. With increasing its requirement, the establishment of a viable bank capable of maintaining the viability of graft over a prolonged period would be desirable. The method for determining the viability of allograft by metabolic assay technique using radiolabeled aminoacids has been used recently. An experimental study was done for evaluation of viability of cardiac allograft which was preserved for 14 days at 4oC in nutrient medium[fresh preservation] by metabolism assay technique using 3H-glycine. Also, the effectiveness of low concentration antibiotic solution[CLPV] for sterilization was evaluated. The effectiveness of CLPV solution for sterilization of allograft was perfect. Pre-treatment cultured organisms were not cultured after treatment at all in every cases. The viability of allograft after sterilization was reduced to 66.4%[aortic wall], 74.7%[pulmonary wall], 76.3%[aortic valve], 67.9%[aortic wall]. And after the fresh preservation for 14 days, the viability was reduced to 14.7%, 18.5%, 17.7%, 19.0%, respectively.In conclusion, viability of allograft was reduce to 71.3[66.4-76.3]% after sterilization and 17.5[14.7-19.0]% after fresh preservation. And sterilization effect of CLPV solution was satisfactory.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.1
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• pp.584-592
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• 2020

The purpose of this study is to explore the relationship between warfarin-related knowledge, self-efficacy, and medication adherence among patients who underwent heart valve replacement surgery. The patients who underwent heart valve surgery and warfarin therapy were included in this study. The data was collected by administering questionnaires, and the data was then analyzed using the SPSS WIN 22.0 program. There was a positive relationship between warfarin-related knowledge and the adherence to medication (r=.285, p=004). Medication adherence was also positively correlated with warfarin-related knowledge (r=.250, p=.046) and self-efficacy (r=.292, p=.019) for elderly patients under 70 years of age. Further, medication adherence of elderly patients over 70 years of age was correlated with only warfarin-related knowledge (r=.358, p=.032). The results of this study show that in order to improve medication adherence, elderly people should be provided with warfarin-related knowledge through individually tailored education and nursing interventions that strengthen self-efficacy, as well as the knowledge that is needed in the elderly group under 70 years old.

• Proceedings of the KOSOMBE Conference
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• v.1991 no.05
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• pp.101-103
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• 1991

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1090-1094
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• 1996

From February 1980 to September 1995, 31 children between 2 months and 15 years of age with mitral valve disease have undergone mitral valve replacement(MVR) at Yonsei Cardiovascular Center and com- plete follow-up has been obtained on 28 patients. There were 10 males and 18 females whose weight ranged from 4.9kg to 56kg. Two patients died early postopeiatively and the overall hospital mortality rate was 7.1%. These two were infants but there were no statistically significant difference in overall mortality among the age groups(p=0.13). The valve related complication rate was 57.1% in children younger than 5 years of age, which showed higher complication rate compared to older patients(p< 0.05). The bioprosthetic valve have been applied in 7 patients, and its 5-year valve failure-free survival rate was 50% . No mechanical valve failu e had occurred in 21 patients. In considering high re-replacement rate of bioprosthetic valve, mechanical valve is recommended despite its possibility of bleeding and thromboembolic complications. However, the consequences of increasing body size and long-term interposition of a rigid prosthesis in a growing heart will require second valve replacement. En conclusion, mitral valve replacement can be performed tilth satisfactory long-term survival in children, although younger mean age of the children has an important influence on early mortality and com- plication rate. And therefore mitral valve replacement in children younger than 5 years of age needs special consideration.

• Journal of Cardiovascular Imaging
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• v.31 no.2
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• pp.108-115
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• 2023

BACKGROUND: Minimizing contrast dose and radiation exposure while maintaining image quality during computed tomography angiography (CTA) for transcatheter aortic valve replacement (TAVR) is desirable, but not well established. This systematic review compares image quality for low contrast and low kV CTA versus conventional CTA in patients with aortic stenosis undergoing TAVR planning. METHODS: We performed a systematic literature review to identify clinical studies comparing imaging strategies for patients with aortic stenosis undergoing TAVR planning. The primary outcomes of image quality as assessed by the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were reported as random effects mean difference with 95% confidence interval (CI). RESULTS: We included 6 studies reporting on 353 patients. There was no difference in cardiac SNR (mean difference, -1.42; 95% CI, -5.71 to 2.88; p = 0.52), cardiac CNR (mean difference, -3.83; 95% CI, -9.98 to 2.32; p = 0.22), aortic SNR (mean difference, -0.23; 95% CI, -7.83 to 7.37; p = 0.95), aortic CNR (mean difference, -3.95; 95% CI, -12.03 to 4.13; p = 0.34), and ileofemoral SNR (mean difference, -6.09; 95% CI, -13.80 to 1.62; p = 0.12) between the low dose and conventional protocols. There was a difference in ileofemoral CNR between the low dose and conventional protocols with a mean difference of -9.26 (95% CI, -15.06 to -3.46; p = 0.002). Overall, subjective image quality was similar between the 2 protocols. CONCLUSIONS: This systematic review suggests that low contrast and low kV CTA for TAVR planning provides similar image quality to conventional CTA.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.971-976
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• 1996

From March 1988 to October 1992, 201 CarboMedics cardiac valve prostheses (150 mitral, 50 aortic and 1 tricuspid) were implanted in 166 consecutive patients (mean age 38 years, male/female 66/100) by one surgical team operating on adult cardiac patients at Kyungpook University Hospital. Total follow up represen:toed 6646 patient-months (mean 40mon1hs) and follow up rate was 96%. One hundred and twenty-four patients (74.7 %) were in NYHA functional class 111 or tV preoperatively and 164 patients (98.7 %) were in class I or ll postoperatively. Hospital mortality was 4.2 % and late death was 4.2%. The actuarial survival at 78 months was 89.4%. The linearized incidence of valve related death, prosthetic valve thrombosis, anticoagulant related hemorrhage, non-structural dysfunction and reoperation was 0.72%/pt-yr, 0.18%/pt-yr, 0.18%trapt-yr, 0.18 %/pt-yr and 0. 36%/pt-yr respective y. The 78 month rates of freedom from valve related death, prosthetic valve thrombosis, anticoagulant related hemorrhage, non-structural dysfunction and reoperation were 94.9%, 99.4%, 99.4%, 98.6 % and 97.9 % respectivly. The 78 month rate of freedom from all valve related complications and deaths including hospital mortality was 90.9%. These fact suggest that the CarboMedics cardiac valve has execellent result, low incidence of valve-ie-lated complications and no structural deterioration, and long term follow up study is necessary.