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.

Background: Antithrombin III (AT III) deficiency is a rare disorder and thrombosis can be induced by a minor cause that does not normally lead to thrombosis, such as an external injury and surgery. Therefore, patients with AT III deficiency undergoing cardiac surgery that involves heparinization require careful perioperative management. Objective and Methods: From September 2013 through December 2023, we experienced 8 patients (1.92%) with AT III deficiency who underwent cardiac surgery and were managed with AT III replacement. By administration of AT III concentrate, preoperative AT III activity was maintained at ≥ 120% and postoperative AT III activity at ≥ 80%. Results: All five patients were treated successfully without postoperative complications such as hemorrhage or thrombosis. In a case of aortic valve stenosis in a hemodialysis patient, reoperation was performed 9 months after aortic valve replacement with a bioprosthetic valve. Pathological examination suggested that the deterioration was caused by a large amount of thrombus on the outflow side of the valve leaflet and not by iatrogenic calcification due to dialysis. Conclusions: In patients with AT III deficiency undergoing cardiac surgery, it is important to perform AT III replacement to achieve preoperative AT III activity ≥ 120% and postoperative AT III activity ≥ 80%, while the activated clotting time is maintained at > 400 s during cardiopulmonary bypass. In addition, long-term postoperative anticoagulant therapy is necessary in hereditary AT III deficiency patients with a history of thrombosis.