Early and Midterm Outcome of Redo Coronary Artery Bypass Grafting: On-Pump versus Off-Pump Bypass

BACKGROUND: Redo coronary artery bypass grafting (CABG) is still associated with increased morbidity and mortality as compared to the first-time operation. Further, the application of the off-pump technique to redo CABG is limited due to technical difficulties. The aim of this retrospective study was to analyze early and midterm results after redo CABG and compare the outcome of redo on-pump and off-pump CABG. METHODS: From June 1996 to October 2011, elective redo CABG was performed in 32 patients. Mean age was 64.8 years (on pump 64.3 years vs. off pump 65.5 years; p=0.658), and 21 patients were male. Among these patients, 14 (43.8%) underwent on-pump CABG, and 18 (56.2%) underwent off-pump CABG. RESULTS: Internal thoracic artery was used in 22 patients (68.8%), and total arterial revascularization was achieved in 17 patients (53.1%). The average number of distal anastomoses was 2.13, and the rate of incomplete revascularization was 43.8%. The rate of total arterial revascularization was higher in the off-pump group (14.3% vs. 83.3%, p<0.001), and the use of saphenous vein graft was more in the on-pump group (78.6% vs. 16.7%, p<0.001). Overall hospital mortality was 3.1% (n=1) and was comparable in both groups (on pump 7.1% vs. off pump 0%; p=0.249). Postoperative complications occurred in 9 patients (64.2%), and the rate of complications was high in the on-pump group without statistical significance (64.2% vs. 33.3%, p=0.082). The mean follow-up duration was 5.4 years, and overall survival at 10 years was 86.0%+/-10.5%. There was no significant difference in the 10-year survival rate between the two groups (79.6% vs. 100%, p=0.225). CONCLUSION: Redo CABG can be safely performed with acceptable mortality. Redo off-pump coronary artery bypass is feasible with low mortality and morbidity, comparable target vessel bypass grafting, and long-term survival. The off-pump technique might be considered a safe option for redo CABG in high-risk patients.

Clinical Outcome of Pterional Approach to the Anterior Communicating Artery Aneurysm Surgery According to Identification of H-Complex

OBJECTIVE: In case of the anterior communicating artery(A-com A) aneurysm surgery with pterional approach, complete identification of A-com A complex(H-complex) has been thought to be important and influence the clinical results. The authors present a retrospetive analysis to determine the significance of identification of H-complex in A-com A surgery. METHODS: We analysed 90 cases among 116 cases that were operated the A-com A aneurysm with pterional approach from June 1993 to May 1998. The cases were classified according to aneurysmal direction, size, and placement of A1-A2 junction by preoperative angiogram and intraoperative findings. RESULTS: Incomplete visualization of H-complex was influenced by the approach side to the anteriorly placed A1-A2 junction, larger than 11mm in aneurysmal size and superior or posterior direction of aneurysm. Postoperative outcome was influenced by Hunt-Hess grade, and seemed to be better when the approach was performed to side of the posteriorly placed A1-A2 junction with or without dominant A1, but aneurysmal direction was not concerned with postoperative outcome. CONCLUSION: The results suggest that in A-com A aneurysm surgery with pterional approach, careful evaluation of preoperative angiogram and approach to the side of the posteriorly placed A1-A2 junction lead to better outcome.

A case of cavernous lymphangioma in mediastinum

Cavernous lymphangioma in mediastinum is a rare congenital malformation of lymphatic system and is caused by lack of adequate drainage from the sequestrated lymphatic vessels to the venous system due to insufficiency or atresia of the efferent lymphatic channels The authors experienced 10 month-old male patient with cavernous lymphangioma in mediastinum documented by chest CT and open biopsy The review of the literature was made briefly.

A Case of Oligodendroglioma of the Cerebellar Vermis

In the posterior fossa rarely develops oligodendroglioma and a review of the literature yields reports of two cases in the 4th ventricle in Korea. The authors present a case of 65-year-old woman patient with only the symptoms of increased intracranial pressure such as headache, dizziness and vomiting in spite of a large, irregular calcified mass occupying the cerebellar vermis on the brain CT scan. The caudal portion of the tumor attached firmly to the floor of the 4th ventricle and the complete removal of the mass, associated with a good long-term prognosis, was not feasible.