We reviewed 223 cases of isolated coronary artery bypass grafting (CABG) during the past 6 years, and used the EuroSCORE to assess the differences in clinical outcomes between off-pump CABG (OPCAB) and on-pump CABG (conventional CABG: CCABG). After March 2000, our first choice has been OPCAB, with CCABG selected only for cases with unstable hemodynamics. The total of 223 isolated CABG cases consisted of 129 OPCAB and 94 CCABG, but after March 2000, 94 OPCAB and 42 CCABG were performed. Mean EusoSCORE was 5.8 for OPCAB and 4.1 for CCABG, and corresponding expected survival rates were 7.20% and 5.04%. The 3 cases of hospital death (mortality, 1.3%) all belonged to the earlier CCABG groups and were not related to cardiac death. After March 2000, no hospital deaths occurred in either group. Midterm results showed 5 deaths, but these were not related to cardiac death, either. There were no significant differences between the 2 groups in terms of hospital complications other than long mechanical ventilation time, which was markedly longer only for the OPCAB groups (p<0.01). Mean number of grafts was significantly high for patients in the CCABG groups (OPCAB 2.1 vs. CCABG 2.8; p<0.05). We have therefore been using OPCAB for high-risk cases, and midterm results of our CABG patients were satisfactory.

Endoventricular circular patch plasty (the Dor procedure) has been demonstrated to improve outcome in patients with ischemic cardiomyopathy. However, in some of them congestive heart failure (CHF) occurred during follow-up. This study examined the effects of the Dor procedure on the long-term survival and predictors of CHF after this procedure. Hemodynamic and clinical results were analyzed and predictors of CHF were examined. Postoperative ESVI in the CHF group was larger than that in the non-CHF group. The delayed MR rate was greater following the CHF group (82.4%) compared to the non-CHF group (19.2%). Despite mitral valve repair (N=8), 3 patients had delayed MR. All of them were greater than MR³. Hemodynamic and clinical results were improved by the Dor procedure. However, cardiac events were usually occurred during the follow-up. The predictor of CHF was delayed MR. Therefore, patients with preoperative MR should be treated. If preoperative MR is greater than 3, there will be MR recurrence cases after MVP only. Therefore, patients with preoperative MR (3 or 4) should be treated by alternative surgical procedures.

To improve the long-term clinical results of coronary artery bypass grafting, we evaluated our graft selections and the designs that were used, in relation to the quality of the anastomoses and patient backgrounds. We retrospectively reviewed the records of 505 patients who underwent isolated coronary artery bypass grafting involving more than 3 vessel reconstructions between May 1999 and March 2007. Neither the selection of a saphenous vein graft nor that of an internal thoracic artery graft was a statistically significant cardiac event factor. The cardiac event-free rates (at 1 and 5 years) according to anastomotic site were as follows : a) 92.9% and 76.6% for a radial artery graft and 93.2% and 83.9% for a saphenous vein graft at the right coronary artery ; b) 93.0% and 70.3% for a radial artery graft and 95.1% and 80.4% for a saphenous vein graft at the distal right coronary artery ; c) 94.5% and 77.8% for a left internal thoracic artery graft and 93.0% and available for a right internal thoracic artery graft at the left anterior descending artery ; d) 96.5% and 79.8% for a radial artery graft, 93.0% and 78.0% for a saphenous vein graft, and 91.3% and 75.6% for an internal thoracic artery graft at the left circumflex artery. Significant cardiac event factors were dialysis (risk ratio, 5.28 ; p<0.001), the use of a right gastroepiploic artery graft as the inflow blood vessel of a radial artery graft (risk ratio, 5.75 ; p=0.02), and off-pump coronary artery bypass grafting (risk ratio, 1.62 ; p=0.03). As a tendency toward more frequent early-stage cardiac events among patients with radial artery grafts was confirmed, careful follow-up is important for this group of patients. Right gastroepiploic artery grafts should be chosen carefully with full consideration of the anastomotic site quality and the flow demand, as the blood supply capability of such grafts is limited. For dialysis patients, although the mid-term clinical results are still being evaluated, a saphenous vein grafts have bwer early-stage of cardiac events. In younger patients, off-pump bypass is not the only treatment method available, and revascularization with extracorporeal circulation can reliably achieve good long-term results. To improve the long-term clinical results for coronary artery bypass grafts, graft selection and design should be carefully considered on a case-by-case basis. The quality of the anastomotic site and the patient background are important factors, especially with regard to the selection of a saphenous vein graft or a right gastroepiploic artery graft. A radial artery graft should be selected for use in relatively young patients because of its superior patency. Off-pump bypass may not necessarily be the treatment of choice in some cases because revascularization using extracorporeal circulation can reliably achieve better long-term results.

Four patients, 13 to 53 years old, with congenital venous malformation including Klippel-Trenaunay syndrome underwent surgical treatment followed by sclerotherapy. They developed marked dilatation of varicose veins with spots, and complained of pain, dullness, and bleeding. Two patients also had hypertrophy of the diseased leg. Phlebography and color Doppler ultrasonography were performed in all patients to precisely determine the abnormal vein and incompetent communicating veins which were then resected and/or ligated with minimal skin incision. In two patients, additional ligation of incompetent communicating veins was necessary. One to two weeks after surgical therapy, sclerotherapy was performed with 1-2% polidocanol. Symptoms improved after treatment, even in a patient with claudication before operation. Surgical therapy for congenital venous malformation was feasible and satisfactory, with the aid of meticulous identification of abnormal veins and communicating veins by not only phlebography but color Doppler ultrasonography.