Risk factors affecting graft stenosis and occlusion after coronary artery bypass graft surgery / 대한내과학회지

BACKGROUND: Coronary artery bypass graft (CABG) surgery has been a main treatment modality of ischemic heart disease since Sabiston reported the first CABG operation using a saphenous vein graft in 1963. However, graft stenosis that happens after CABG surgery is one of the main limitations of the procedure. We investigated risk factors that are related to graft stenosis and occlusion in patients that needed a coronary angiogram after CABG surgery. METHODS: From May 1995 to April 2004, we performed 348 CABG surgeries. Among them, we performed follow up coronary angiogram for 45 patients because of clinical indications, corresponding to 146 graft vessels. According to the angiography findings, patients with 27 graft vessels that showed stenosis or occlusion were defined as group S and patients with 119 graft vessels that showed no stenosis or occlusion were defined as group P. RESULTS: The mean patient age of group S is 59.44 (+/-8.549) years and the mean patient age of group P is 57.99 (+/-8.676) years. Group P patients had more stenotic native coronary arteries than group S patients, which is statistically significant (80.0+/-7.2% vs. 68.0+/-11.9%, p=0.005). Group S patients had a statistically significant lower postoperative HDL level than the level of the group P patients (40.4+/-15.9 mg/dL vs. 50.5+/-4.4 mg/dL, p=0.002). CONCLUSIONS: When performing CABG surgery and postoperative patient management, the severity of native coronary artery stenosis and the postoperative HDL level should be considered for better patient outcome.

Effectiveness of MDCT for the Followup of CABG Patients with LIMA to LAD and Saphenous Veins to Others / 대한흉부외과학회지

BACKGROUND: There are several options for choosing a graft in CABG, we routinely chose LIMA for LAD and great saphenous vein for other target vessels. To evaluate the posoperative graft patency, we have studied the results using a 16 slices multi-detector computed tomography. MATERIAL NAD METHOD: From 1995 to 2003, 80 CABG patients who did not complain any event of MACE have been examined by 16-MDCT, mostly in an out patient clinic. RESULT: There were 61 men and 19 women. MDCT was used as early as 7 days to 9 years postoperatively with a median follow-up period of 6.5 years, and mean follow-up peiod of 31.5+/-25.4 months. Mean age was 58.4+/-12.6 years old in men and 61.5+/-17.2 years old in women. 72/80 patients received LIMA to LAD, and all other patients received vein grafts for bypass. The target vessel of vein grafts were 8 in LAD, 47 in RCA, 60 in diagonals, and 61 in obtuse marginals. Among them 42 sequential anastomoses were performed. The mean graft number was 3.1+/-1.8 grafts. 5 year graft patency rate of each grafts was as followings; 93.1% in LIMA to LAD, 94.9% in vein to diagonals, 92.1% in vein to obtuse marginals, and 79.2% in vein to RCA. Sequential grafting showed better graft patency than the isolated grafting (95.2% vs 78.7~95.0%). CONCLUSION: In this study, CABG with LIMA and saphenous veins showed satisfactory longterm results. 16-MDCT provided good images for follow-up study after CABG. Additionally, as radiologic tools (64-MDCT, MRI) improve more in the future, they can be used for diagnosing preoperative anatomical coronary disease as well as cardiac functions.

Postoperative Echocardiographic Hemodynamic Comparison between Recently Available Bileaflet Mechanical Valves / 대한흉부외과학회지

BACKGROUND: There was no difference between the bileaflet mechanical valves on the midterm and longterm clinical outcome. We reviewed the hemodynamic comparison between recently available mechanical valves by Doppler Echocardiography. MATERIAL AND METHOD: We retrospectively reviewed 396 postoperative hemodynamic datas (EOA, MDPG, and MSPG) by doppler echocardiography in 345 patients. Mechanical valves from 5 venders (Sorin Bicarbon, SJM, ATS, On-X, and Edward MIRA) were compared. There were 232 valves in mitral position, 162 in aortic, and 2 in tricuspid. RESULT: There were 178 men (mean age; 50.6+/-13.9 years old) and 167 women (52.6+/-14.6). MDPG/EOA of 27 mm in mitral position was Sorin; 4.2+/-1.5 mmHg/3.0+/-0.9 cm2, SJM; 2.3+/-1.2/3.5+/-0.6. In 29 mm, Sorin, SJM, ATS, On-X, MIRA revealed 3.4+/-1.2/3.1+/-0.6, 3.3+/-1.1/2.7+/-0.4, 3.8+/-0.8/3.2+/-0.6, 4.0+/-3.0/3.1+/-0.9, 2.9+/-0.9/3.0+/-0.8. In 31 mm, Sorin, SJM, ATS, MIRA revealed 3.9+/-1.9/2.9+/-0.6, 3.5+/-1.2/3.0+/-0.6, 3.4+/-0.8/2.8+/-0.2, 3.7+/-1.5/2.7+/-0.7. In 33 mm, Sorin, SJM, MIRA revealed 4.4+/-0.9/2.5+/-0.4, 3.4+/-1.5/3.3+/-0.5, 4.7+/-2.4/3.0+/-0.3. MSPG/EOA of 19 mm aortic position was Sorin, SJM, ATS, On-X, MIRA 18.0 mmHg/1.2 cm2, 25.6+/-8.7/1.1+/-0.3, 25.9+/-12.6/1.2+/-0.3, 23.0/1.3, 27.9+/-7.1/1.2+/-0.1 in that order. In 21 mm, SJM, ATS, On-X, MIRA revealed 18.3+/-6.7/1.5+/-0.5, 13.7+/-2.1/1.7+/-0.3, 17.0/1.4, 17.1+/-5.5/1.8+/-0.5. In 23 mm Sorin, SJM, ATS, On-X, MIRA revealed 14.0+/-4.6/1.7+/-0.6, 12.8+/-3.2/2.0+/-0.2, 16.8+/-12.2/2.1+/-0.9, 14.0/1.5, 15.0+/-5.5/1.8+/-0.5. In 25 mm, SJM and MIRA revealed 14.0+/-5.1/1.8+/-1.0, 11.0/2.3. There was no statistically significant difference in these values between the venders given the same position and size. 2 redo valve replacements were performed, 1 due to severe hemolysis in ATS and 1 due to leaflet immobilization in SJM. CONCLUSION: Postoperative hemodynamic comparison by doppler echocardiography shows no statistically significant difference between recently available mechanical valves in this country.

Surgical Management of Traumatic Cardiac Injury / 대한흉부외과학회지

BACKGROUND: Traumatic cardiac injury is very rare but mortality is very high when the diagnosis and management are delayed. We reviewed our case retrospectively. MATERIAL AND METHOD: From March 1995 to July 2003, 17 patients were diagnosed as having traumatic cardiac rupture. Five patients were stabbed, seven patients were motor vehicle accidents, four patients had fallen down, and the cause was unknown in one patient. Emergency operations were done and six patients were operated under CPB. RESULT: Four patients died during or after operation. The mean ICU stay period was 3.86+/-3.35 days and the mean hospital stay was 18.27+/-14.99 days. No mortality was observed in those whose vital signs were stable in the operating room. CONCLUSION: Preoperative vital status was very important and thoracic traumatic patient should be suspected as having cardiac injury.

Surgical Management of Primary Cardiac Tumor: Early and Late Results / 대한흉부외과학회지

BACKGROUND: Primary cardiac tumors are rare disease and they present nonspecific symptom. They are divided in benign and malignant tumors and require surgical therapy and/or additional therapy. MATERIAL AND METHOD: From March 1995 to March 2003, twenty one patients were diagnosed as having primary cardiac tumors. We analysed them retrospectively in terms of various perioperative factors and early and late results. RESULT: 6 men and 15 women and their average age was 45.44+/-18.76. Pathology revealed eighteen benign (fourteen myxoma, two fibroelastoma, one hemangioma and one paraganglioma) disease and three malignant (one angiosarcoma, one mesothelioma and one myxofibrosarcoma) disease. There was one (myxoma) operative mortality and three late death (hemangioma, angiosarcoma and mesothelioma) during additional therapy and follow up. CONCLUSION: Surgical treatment of primary cardiac tumor is important and sometimes additional therapy is required but the prognosis of malignant cardiac tumor is still very poor.