-
[show abstract]
[hide abstract]
ABSTRACT: Background: Heart transplantation (HTPL) is the effective treatment option to improve quality of life as well as survival of terminal heart failure patients. Shortage of donors, however, limits HTPL to all indicated cases. The temporal trend and clinical characteristics of HTPL donors in Korea were therefore investigated. Methods and Results: Among 2,001 brain-death donors registered in Korean Network for Organ Sharing from February 2000 to May 2012, a total of 28% of hearts (n=552) were utilized for HTPL. The mean age of Korean heart donors was 10 years younger than that of heart recipients (33.2±12 years vs. 43.2±17 years, respectively). The oldest was 56 years old, and donors aged over 50 accounted for only 6.2% (n=34) of total cases. Female donors were utilized less than male donors (23.6% vs. 29.6%, respectively). To determine characteristics of declined donor heart candidates, subgroup analysis of echocardiographic data was done, and 74.6% had normal ventricular function and structure, although only 42.3% were actually transplanted. The utilization rate of donor hearts with minor echocardiography abnormalities was only 15.2%. Clinical outcomes of marginal heart donors were not different from non-marginal donors. Conclusions: Although shortage of donor organs is an emerging issue, most donor hearts have been under-utilized in the past in Korea. In particular, aged and female donor hearts with minor echocardiographic abnormalities had a low rate of utilization.
Circulation Journal 06/2013; · 3.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Heart transplantation in elderly patients has raised concerns because of co-morbidities and limited life expectancy in the era of donor shortage. We examined the outcomes after heart transplantation in elderly patients.
From March 1994 to December 2011, 81 patients (male:female=64:17, 49.1±14.0 years) underwent heart transplantation. The outcomes after heart transplantation in the younger patients (<60 years; group Y, n=60) were compared with those in the elderly patients (≥60 years; group O, n=21). The follow-up duration was 51.8±62.7 months.
Early mortality (≤30 days) occurred in 5.0% (3/60) and 4.8% (1/21) of groups Y and O, respectively (p>0.999). There were no differences in overall survival between the two groups (p=0.201). Freedom from rejection was higher in group O than in group Y (p=0.026). Multivariable analysis revealed that age ≥60 years was not a significant risk factor for long-term survival; postoperative renal failure was the only significant risk factor for long-term survival (p=0.011).
Early and mid-term results of heart transplantation in elderly patients were similar to those in younger patients.
The Korean journal of thoracic and cardiovascular surgery. 04/2013; 46(2):111-6.
-
[show abstract]
[hide abstract]
ABSTRACT: We present our 12-year experience of pulmonary thromboendarterectomy in patients with chronic thromboembolic pulmonary hypertension.
Between January 1999 and March 2011, 16 patients underwent pulmonary thromboendarterectomy. Eleven patients (69%) were classified as functional class III or IV based on the New York Heart Association (NYHA) classification. Seven patients had a history of inferior vena cava filter insertion, and 5 patients showed coagulation disorders. Pulmonary thromboendarterectomy was performed during total circulatory arrest with deep hypothermia in 14 patients.
In-hospital mortality and late death occurred in 2 patients (12.5%) and 1 patient (6.3%), respectively. Extracorporeal membrane oxygenation support was required in 4 patients who developed severe hypoxemia after surgery. Thirteen of the 14 survivors have been followed up for 54 months (range, 2 to 141 months). The pulmonary arterial systolic pressure and cardiothoracic ratio on chest radiography was significantly decreased after surgery (76±26 mmHg vs. 41±17 mmHg, p=0.001; 55%±8% vs. 48%±3%, p=0.003). Tricuspid regurgitation was reduced from 2.1±1.1 to 0.7±0.6 (p=0.007), and the NYHA functional class was also improved to I or II in 13 patients (81%). These symptomatic and hemodynamic improvements maintained during the late follow-up period.
Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension shows good clinical outcomes with acceptable early and long term mortality.
The Korean journal of thoracic and cardiovascular surgery. 02/2013; 46(1):41-8.
-
[show abstract]
[hide abstract]
ABSTRACT: 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.
The Korean journal of thoracic and cardiovascular surgery. 02/2013; 46(1):84-7.
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Duration of anticoagulation therapy is one of the major concerns about management of new-onset atrial fibrillation (AF) after myocardial revascularization. We evaluated whether right and left atrial contractility was restored early after electrical sinus conversion in patients who experienced new-onset AF after off-pump coronary artery bypass grafting. METHODS: From January 2009 to December 2010, 62 patients who underwent off-pump coronary artery bypass grafting and experienced new-onset AF were prospectively enrolled. Right and left atrial contractility was evaluated with transthoracic echocardiography performed 23 ± 10 hours after restoration of sinus rhythm. Anticoagulation was initiated when the AF continued for more than 24 hours. RESULTS: New-onset AF occurred at 2.3 ± 1.2 postoperative days, and continued or recurred for 26 ± 31 hours (>24 hours in 22 patients). Right and left atrial contractility was demonstrable after sinus conversion in all patients. Mitral inflow E and A wave velocities and the E/A ratio were 0.71 ± 0.21 m/s, 0.68 ± 0.19 m/s, and 1.15 ± 0.57, respectively. Mitral valve A' velocity was 7.9 ± 1.9 cm/s. Tricuspid inflow E and A wave velocities and E/A ratio were 0.52 ± 0.12 m/s, 0.42 ± 0.13 m/s, and 1.30 ± 0.27, respectively. There were no significant differences in echocardiographic data between patients who had AF lasting longer than 24 hours and those with AF lasting 24 hours or less. Anticoagulation was discontinued after demonstration of atrial contractility. No patients experienced bleeding complications during anticoagulation or thromboembolic events after cessation of anticoagulation. CONCLUSIONS: Short-term anticoagulation may be sufficient for the prevention of thromboembolic events in patients who underwent off-pump coronary artery bypass grafting and experienced new-onset AF because right and left atrial contractility was restored early after sinus conversion.
The Annals of thoracic surgery 11/2012; · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The Saphenous Vein Versus Right Internal Thoracic Artery as a Y-Composite Graft trial was designed to evaluate the saphenous vein compared with the right internal thoracic artery as a Y-composite graft anastomosed to the side of the left internal thoracic artery. In this early analysis, we compared early angiographic patency rates and clinical outcomes.
From September 2008 to October 2011, 224 patients with multivessel coronary artery disease were randomized prospectively to undergo off-pump revascularization using the saphenous vein group (n = 112) or the right internal thoracic artery group (n = 112) as Y-composite grafts. Early postoperative (1.4 ± 1.1 days) angiographic patency and clinical outcomes were compared.
There was 1 operative death in the right internal thoracic artery group. No statistically significant differences in postoperative morbidities, including atrial fibrillation and acute renal failure, were observed between the groups. The number of distal anastomoses using the side-arm Y-composite graft (saphenous vein vs right internal thoracic artery) were 2.3 ± 0.8 and 1.9 ± 0.7 in the saphenous vein and right internal thoracic artery groups, respectively (P < .001). A third conduit was used in 44 patients (saphenous vein group vs right internal thoracic artery group, 4/109 vs 40/110; P < .001) to extend the side-arm Y-composite graft for complete revascularization. Early angiography demonstrated an overall patency rate of 99.4% (771 of 776 distal anastomoses). Patency rates of the side-arm Y-composite graft (saphenous vein vs right internal thoracic artery) were 98.8% (245 of 248) and 99.5% (207 of 208) in the saphenous vein and right internal thoracic artery groups, respectively (P = .629).
A third conduit was needed to extend the right internal thoracic artery composite graft and reach the target vessels in 36.4% (40/110) of the patients. The saphenous vein composite graft was comparable with the right internal thoracic artery composite graft in terms of early angiographic patency and clinical outcomes.
The Journal of thoracic and cardiovascular surgery 08/2012; 144(5):1027-35. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report a redo coronary artery bypass grafting (CABG) in a 55-year-old man. Angina recurred 7 years after the initial surgery. Coronary angiography showed all patent grafts except a faint visualization of the in situ right gastroepiploic artery (RGEA) graft, which was anastomosed to the posterior descending coronary artery, associated with celiac axis stenosis. Redo-CABG was performed at postoperative 10 years because of aggravated angina and decreased perfusion of the inferior wall in the myocardial single photon emission computed tomography. The saphenous vein graft was interposed between the 2 in situ grafts used previously; the right internal thoracic artery and RGEA grafts. Angina was relieved and myocardial perfusion was improved.
The Korean journal of thoracic and cardiovascular surgery. 08/2012; 45(4):251-3.
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the effect of isolated off-pump coronary artery bypass grafting on functional ischemic mitral regurgitation (IMR) associated with acute coronary syndrome.
Of 1,419 acute coronary syndrome patients who underwent coronary revascularization between 2000 and 2010 (1,324 off-pump and 95 on-pump), 59 OPCAB patients had greater than mild degree functional IMR preoperatively (31 mild to moderate, 23 moderate, 5 severe). Clinical outcomes and results from echocardiography, angiography, and myocardial single-photon emission computed tomography performed early and 1 year postoperatively were analyzed.
Operative mortality was 5.1% (3 of 59). All survivors underwent early postoperative echocardiograms, which showed 0 patients with worsened IMR; 41 with less than or equal to mild degree residual IMR (NMR group); and 15 with greater than mild degree IMR (RMR group). Myocardial single-photon emission computed tomography revealed that RMR patients had more reversible ischemic myocardial segments preoperatively than NMR patients (p = 0.009). Successful right coronary revascularization with proven graft patency was a predictor of early improvement of IMR (p = 0.024). There were no differences in postoperative morbidities between the 2 groups. One-year follow-up echocardiograms demonstrated further improvement in 10 of 13 RMR patients. No patients experienced mitral valve-related events during follow-up. Overall survival and major adverse cardiac event-free survival rates at 5 years were 84.6% and 78.1%, respectively, with no intergroup differences.
Most functional IMR associated with acute coronary syndrome, including severe degree IMR, improved during the first postoperative year after off-pump coronary artery bypass grafting.
The Annals of thoracic surgery 07/2012; 94(4):1157-65. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: The role of electrocardiogram (ECG) is unclear for the longitudinal follow-up of patients who undergo corrective surgery for isolated severe tricuspid regurgitation (TR). HYPOTHESIS: This study sought to investigate the usefulness of changes in QRS duration of ECG after TR surgery in predicting right ventricular (RV) reverse remodeling as determined by cardiac magnetic resonance imaging (CMR). METHODS: We enrolled 30 consecutive TR patients (27 women, aged 57.8 ± 9.6 years) who had undergone prior left-sided valve surgery. A computer-assisted analysis was performed for objective calculation of QRS duration before and after surgery. RESULTS: At a median CMR follow-up of 27.5 months postsurgery, QRS duration was cut by 14.6%, from 110.4 ± 14.6 msec to 96.9 ± 11.9 msec (P < 0.001), while CMR showed a decrease in RV end-diastolic volume index (RV-EDVI) from 179.5 ± 59.7 to 119.1 ± 30.4 mL/m(2) (P < 0.001). QRS duration correlated significantly with RV-EDVI and RV end-systolic volume index (r = 0.65, P < 0.001 and r = 0.53, P < 0.001, respectively), and a percent change in QRS duration was significantly correlated with a percent change in RV-EDVI (r = 0.40, P = 0.03). When significant RV reverse remodeling was defined as a reduction in RV-EDVI ≥20% following TR surgery, the sensitivity and specificity for significant RV reverse remodeling were 75% and 78%, respectively, with a 9% reduction in QRS duration (P = 0.01, area underneath the receiver operator curve [AUC] = 0.81). CONCLUSIONS: The extent of changes in postoperative QRS duration can be used as a useful, inexpensive, and simple index reflecting the occurrence of significant RV reverse remodeling in patients undergoing corrective TR surgery. Clin. Cardiol. 2012 doi: 10.1002/clc.22030 First two authors equally contributed to this work. This study was supported in part by grants from the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea (A090064) and Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (MEST) (0640-20100001). The authors have no funding, financial relationships, or conflicts of interest to disclose.
Clinical Cardiology 06/2012; · 2.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Median sternotomy can weaken the upper abdominal wall and result in subxiphoid incisional hernia. We evaluated risk factors associated with the development of subxiphoid incisional hernias after coronary artery bypass grafting (CABG).
Of 1,656 isolated CABGs performed between January 2001 and July 2010, 1,599 patients who were completely followed up were analyzed. The mean follow-up duration was 49.5±34.3 months. Subxiphoid incisional hernia requiring surgical repair developed in 13 patients (0.8%). The hernia was diagnosed 16.3±10.3 months postoperatively, and hernia repair was performed 25.0±26.1 months after the initial operation. Risk factors associated with the development of subxiphoid incisional hernia were analyzed with the Cox proportional hazard model.
Five-year freedom from the hernia was 99.0%. Univariate analysis revealed that female sex (p=0.019), height (p=0.019), body surface area (p=0.046), redo operation (p=0.012), off-pump CABG (p=0.049), a postoperative wound problem (p=0.041), postoperative bleeding (p=0.046), and low cardiac output syndrome (p<0.001) were risk factors for the development of the hernia. Multivariable analysis showed that female sex (p=0.01) and low cardiac output syndrome (p<0.001) were associated with subxiphoid hernia formation.
Female sex and postoperative low cardiac output syndrome were risk factors of subxiphoid hernia. Therefore, special attention is needed for patients with high-risk factors.
The Korean journal of thoracic and cardiovascular surgery. 06/2012; 45(3):161-5.
-
[show abstract]
[hide abstract]
ABSTRACT: PurposeWe evaluated the short-term and mid-term differences in perfusion and function after off-pump and on-pump coronary artery
bypass grafting (CABG) using gated myocardial single photon emission computed tomography.
Materials and MethodsA total of 70 patients with coronary artery disease who underwent CABG were included based on the propensity score matching
results from 165 patients. Thirty-five patients underwent off-pump and 35 patients on-pump CABG. Rest 201Tl/dipyridamole stress 99mTc-methoxyisobutylisonitrile gated single photon emission computed tomographies were performed preoperatively and postoperatively
at short-term (103 ± 23days after surgery) and mid-term follow-up (502 ± 111days after surgery). Changes in left ventricular
ejection fraction, end systolic volume, stress and rest segmental perfusion, and segmental wall thickening were compared between
the two groups. The segments with preoperative rest 201Tl uptake under 60% of maximum uptake were included in the segmental analysis.
ResultsLeft ventricular ejection fraction (P = 0.001) and end systolic volume (P = 0.008) showed significant improvement in both groups. There were no significant short-term and mid-term differences between
the two groups in terms of left ventricular ejection fraction (P = 0.309) and end systolic volume (P = 0.938). Likewise, segmental rest (P = 0.178) and stress perfusion (P = 0.071), and systolic wall thickening (P = 0.241) showed significant improvement in both groups with similar time courses.
ConclusionOff-pump CABG resulted in significant improvements in left ventricular ejection fraction, end systolic volume, and regional
myocardial perfusion and function that are comparable to on-pump CABG at short-term and mid-term. Gated myocardial SPECT successfully
revealed that off-pump CABG is as good as on-pump CABG from the viewpoint of myocardial perfusion and function.
KeywordsGated myocardial single photon emission computed tomography-Off-pump coronary artery bypass grafting-Cardiopulmonary bypass-Coronary artery disease
04/2012; 44(2):110-115.
-
Seung-Pyo Lee,
Yong-Jin Kim,
Joo Myung Lee,
Ho-Young Hwang,
Hyung-Kwan Kim,
Kyung-Hwan Kim, Ki-Bong Kim,
Dae-Won Sohn,
Hyuk Ahn,
Byung-Hee Oh,
Young-Bae Park
[show abstract]
[hide abstract]
ABSTRACT: Although atrial fibrillation (AF) and decreased exercise capacity are common in chronic mitral regurgitation patients, the relationship between rhythm status and exercise capacity after corrective surgery is largely unknown.
Seventy-one patients undergoing repair or replacement of mitral valve for chronic severe mitral regurgitation were examined with preoperative and 6 months' postoperative cardiopulmonary exercise test and two-dimensional echocardiography. Patients were divided into three groups according to preoperative versus postoperative rhythm (sinus/sinus, SS [n=42]; AF/sinus, AS [n=17]; AF/AF, AA group [n=12]).
Preoperative maximal oxygen consumption was lower and ventilatory efficiency was higher in the AS and AA groups compared with the SS group. However, maximal oxygen consumption improved only in the AS group at 6 months' postoperative cardiopulmonary exercise test (24.0±6.9 versus 24.6±6.1 mL·kg(-1)·min(-1) in the SS group, 19.3±5.9 versus 23.2±6.4 mL·kg(-1)·min(-1) in the AS group, 19.8±5.4 versus 18.8±5.1 mL·kg(-1)·min(-1) in the AA group; p=0.016 for maximal oxygen consumption by analysis of covariance) as well as ventilatory efficiency. Echocardiography verified more significant reduction of left atrial volume in the SS and AS groups than in the AA group (172.2±68.0 versus 96.7±31.0 mL in the SS group, 247.5±77.8 versus 129.2±25.7 mL in the AS group, 316.7±210.0 versus 192.0±95.0 mL in the AA group; p=0.001 for left atrial volume by analysis of covariance) as well as pulmonary artery systolic pressure. When analyzed for significant predictors of postoperative maximal oxygen consumption, being in the AS group but not the SS group was a significant positive predictor when compared with the AA group (β=5.475; p=0.006).
Successful sinus conversion of AF, preferably by maze operation, in patients undergoing surgical correction of chronic severe mitral regurgitation confers improved exercise capacity. Reduction of left atrial volume and pulmonary artery pressure may contribute to this improvement.
The Annals of thoracic surgery 04/2012; 93(6):1888-95. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated long-term results of tricuspid valve replacement (TVR) with mechanical valves and bioprostheses in patients less than 65 years old who needed anticoagulation therapy irrespective of TVR.
Among 156 patients who underwent TVR from January 1996 to April 2010, 119 patients younger than 65 years who needed anticoagulation therapy independent of the TVR were studied. Anticoagulation therapy was needed owing to left-sided mechanical valves (n = 11), atrial fibrillation (n = 13), or both (n = 95). Seventy patients underwent mechanical TVR, and 49 underwent bioprosthetic TVR. The follow-up duration was 68 ± 38 months. Propensity score-adjusted analyses were performed.
Early postoperative outcomes were similar between groups, with an operative morality rate of 6.7% (8 of 119). Overall survival rates at 5 and 10 years were 86.4% and 80.3%, respectively. There were no differences in propensity score-adjusted overall survival rates between the two groups (p = 0.291). Freedom from the composite endpoint of thrombosis, embolism, and bleeding was lower in the mechanical TVR group than in the bioprosthetic TVR group (76.3% and 70.0% at 5 and 10 years, respectively, versus 97.6% and 97.6%, p = 0.020). Five- and 10-year valve-related event-free survivals were also lower in the mechanical TVR group than in the bioprosthetic TVR group, although not statistically significant (75.0% and 61.7% versus 89.2% and 80.3%, p = 0.129).
Even in younger patients who need anticoagulation therapy irrespective of TVR, mechanical TVR is not superior because of increased occurrence of valve-related events, especially the composite of thrombosis, embolism, and bleeding.
The Annals of thoracic surgery 02/2012; 93(4):1154-60. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Myocardial injury is associated with an adverse outcome after off-pump coronary artery bypass graft surgery (OPCAB). The authors conducted a randomized controlled trial to evaluate whether remote ischemic preconditioning (RIPC) with remote ischemic postconditioning (RIPostC) reduces myocardial injury in patients undergoing OPCAB. Methods and Results: Seventy patients scheduled for OPCAB were randomly assigned to an RIPC+RIPostC group (n=35) or a control group (n=35). In the RIPC+RIPostC group, 4 cycles of 5-min ischemia and 5-min reperfusion were done on a lower limb before anastomoses (RIPC) and after anastomoses (RIPostC). RIPC+RIPostC significantly reduced postoperative serum troponin I levels (P=0.001). The area under the curve for postoperative troponin I was 48.7% lower in the RIPC+RIPostC group (median [interquartile range], 21.3 h·ng⁻¹·ml⁻¹, 16.5-53.1 h·ng⁻¹·ml⁻¹ vs. 41.5 h·ng⁻¹·ml⁻¹, 24.6-90.2 h·ng⁻¹·ml⁻¹, P=0.020). There was no significant difference in creatinine levels and PaO₂/F(i)O₂ ratios between the 2 groups. CONCLUSIONS: RIPC+RIPostC by lower limb ischemia decreased postoperative myocardial enzyme elevation by almost half postoperatively in patients undergoing OPCAB.
Circulation Journal 02/2012; 76(4):884-90. · 3.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the efficacy of minimally manipulative surgical strategies to harvest the saphenous vein for use in a Y-composite graft based on the left internal thoracic artery in terms of preservation of endothelial structure and function.
Twenty patients who underwent off-pump coronary revascularization using the saphenous vein in a Y-composite graft based on the left internal thoracic artery were studied. The saphenous vein was harvested from each patient with minimal manipulation. An excess saphenous vein segment was removed before dilatation (control group), and a second segment was removed after dilation performed using a pressure-sensing syringe (conventional group). A third segment was obtained from a Y-composite vein graft dilated by flow and pressure from the left internal thoracic artery (composite group). Hematoxylin-eosin staining and immunohistochemistry using antibodies against CD31, CD34, von Willebrand factor, and endothelial nitric oxide synthase were performed. A generalized estimating equation was adopted for statistical analysis.
Histologic and immunohistochemical studies revealed better endothelial preservation in the composite and control groups than in the conventional group (P < .01 in each). The composite group saphenous vein showed a lower grade of endothelial integrity than the control group saphenous vein based on hematoxylin-eosin staining, CD34 immunohistochemistry, and nitric oxide synthase staining (P < .001 in each).
Harvesting of the saphenous vein using minimal manipulation for use in a Y-composite graft based on the left internal thoracic artery preserved endothelial structure and function when compared with manually dilated saphenous vein harvesting.
The Journal of thoracic and cardiovascular surgery 02/2012; 144(3):690-6. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The long-term results of homografts used in systemic circulation are controversial. We assessed the long-term results of using a cryopreserved homograft for an aortic root or aorta and its branch replacement.
From June 1995 to January 2010, 23 patients (male:female=15:8, 45.4±15.6 years) underwent a homograft replacement in the aortic position. The surgical techniques used were aortic root replacement in 15 patients and aortic graft interposition in 8 patients. Indications for the use of a homograft were systemic vasculitis (n=15) and complicated infection (n=8). The duration of clinical follow-up was 65±58 months.
Early mortality occurred in 2 patients (8.7%). Perioperative complications included atrial arrhythmia (n=3), acute renal failure (n=3), and low cardiac output syndrome (n=2). Late mortality occurred in 6 patients (26.1%). The overall survival rates at 5 and 10 years were 66.3% and 59.6%, respectively. Six patients (28.6%) suffered from homograft-related complications.
Early results of homograft replacement in aortic position were favorable. However, close long-term follow-up is required due to the high rate of homograft-related events.
The Korean journal of thoracic and cardiovascular surgery. 02/2012; 45(1):30-4.
-
[show abstract]
[hide abstract]
ABSTRACT: We report on two women who underwent myocardial revascularization associated with antiphospholipid syndrome (APS) with different pathogenic patterns. The first woman presented with acute myocardial infarction, and preoperative angiograms demonstrated rapidly progressing coronary lesions, presumptive unstable plaque, and dissection. Operative findings, however, showed fresh thrombi in the coronary arteries, and she was diagnosed postoperatively as having APS. Her one-year angiogram demonstrated improved coronary lesions and a competitive flow pattern in the grafts. The second woman presented with unstable angina and had been treated for systemic lupus erythematosus and secondary APS for more than 14 years. She underwent myocardial revascularization due to accelerated coronary atherosclerosis. Her one-year angiogram demonstrated patent grafts.
The Korean journal of thoracic and cardiovascular surgery. 12/2011; 44(6):423-6.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the ability of pulse-pressure variation to predict fluid responsiveness during heart displacement for off-pump coronary artery bypass surgery using receiver operating characteristic analysis.
A prospective study.
A clinical study in a single cardiac anesthesia institution.
Thirty-five patients undergoing elective off-pump coronary artery bypass surgery.
Central venous pressure, pulmonary arterial occlusion pressure, pulse-pressure variation, and cardiac index were measured 5 minutes after revascularization of the left anterior descending coronary artery and before heart displacement. Immediately after heart displacement for revascularization of the left circumflex artery, and 10 minutes after fluid loading with hydroxyethyl starch 6% (10 mL/kg) during heart displacement, the measurements were repeated. Patients whose cardiac indices increased by ≥15% from fluid loading were defined as responders. After heart displacement, only pulse-pressure variation showed significant difference between the responders and nonresponders (13.48 ± 6.42 v 7.33 ± 3.81, respectively; p < 0.01). Moreover, receiver operating characteristic analysis showed that pulse-pressure variation successfully predicted fluid responsiveness (area under the curve = 0.839, p = 0.0001). Pulse-pressure variation >7.69% identified the responders, with a sensitivity of 86% and a specificity of 83%.
Pulse-pressure variation successfully predicted fluid responsiveness and would be useful in guiding fluid management during heart displacement for off-pump coronary artery bypass surgery.
Journal of cardiothoracic and vascular anesthesia 09/2011; 25(6):1056-62. · 1.06 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We compared 5-year graft patency rates and long-term clinical outcomes after off-pump coronary artery bypass grafting (OPCAB) using bilateral internal thoracic arteries (ITAs) as in situ grafts with those using bilateral ITAs as a Y-composite graft.
Of 398 patients who underwent OPCAB, bilateral ITAs were used as in situ grafts in 164 patients and as a Y-composite graft in 234 patients. A propensity score-matched analysis was used to match patients using bilateral ITA in situ grafts (group I, n=110) with patients using bilateral ITA Y-composite grafts (group Y, n=110). Postoperative early, 1-year, and 5-year angiographic patency rates and long-term clinical outcomes during follow-up of 104 (1 to 149) months were compared.
There were no differences in operative mortalities (2 of 110 vs 1 of 110; p>0.999) and postoperative complications between groups I and Y. Early, 1-year, and 5-year postoperative angiographies showed no significant differences in bilateral ITA graft patency rates between groups I and Y (early, 98.2% vs 99.3%, p=0.450; 1-year, 92.5% vs 95.7%, p=0.138; 5-year, 92.5% vs 92.4%, p=0.978). No differences in overall survival (p=0.347) and freedom from cardiac death (p=0.780) rates were observed between the groups; 10-year freedom from cardiac death rates were 95.1% and 94.2% in groups I and Y, respectively. Reintervention-free survival (p=0.379) and major adverse cardiac event-free survival (p=0.338) rates were also similar between the groups.
The OPCAB using both bilateral ITA configurations demonstrated that there were no differences in terms of 5-year patency rates and long-term clinical outcomes between the groups.
The Annals of thoracic surgery 08/2011; 92(2):579-85; discussion 585-6. · 3.74 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We performed a prospective cohort trial on 220 patients undergoing elective off-pump coronary artery bypass surgery and taking aspirin to evaluate the effect of aspirin resistance on myocardial injury. The patients were divided into aspirin responders and aspirin non-responders by the value of the aspirin reaction units obtained preoperatively using the VerifyNow™ Aspirin Assay. The serum levels of troponin I were measured before surgery and 1, 6, 24, 48 and 72 hr after surgery. In-hospital major adverse cardiac and cerebrovascular events, graft occlusion, the postoperative blood loss and reexploration for bleeding were recorded. Of the 220 patients, 181 aspirin responders (82.3%) and 39 aspirin non-responders (17.7%) were defined. There were no significant differences in troponin I levels (ng/mL) between aspirin responders and aspirin non-responders: preoperative (0.04 ± 0.08 vs 0.03 ± 0.06; P = 0.56), postoperative 1 hr (0.72 ± 0.87 vs 0.86 ± 1.10; P = 0.54), 6 hr (2.92 ± 8.76 vs 1.50 ± 2.40; P = 0.94), 24 hr (4.16 ± 13.44 vs 1.25 ± 1.95; P = 0.52), 48 hr (2.15 ± 7.06 vs 0.65 ± 0.95; P = 0.64) and 72 hr (1.20 ± 4.63 vs 0.38 ± 0.56; P = 0.47). Moreover, no significant differences were observed with regard to in-hospital outcomes. In conclusion, preoperative aspirin resistance does not increase myocardial injury in patients undergoing off-pump coronary artery bypass surgery. Postoperative dual antiplatelet therapy might have protected aspirin resistant patients.
Journal of Korean medical science 08/2011; 26(8):1041-6. · 0.84 Impact Factor
