No abstract available.
Coronary Artery Bypass* ; Coronary Vessels* ; Mortality*

BACKGROUND: Complete arterial off-pump coronary artery bypass grafting (OPCAB) by sequential anastomoses with one or two arterial grafts provides favorable outcomes. However, problems of insufficient graft length, hypoperfusion, kinking of graft, and unfavorable course of graft may be encountered. To solve these problems, we have used different technique with multiple arterial Y composite graft to allow end-to-side rather than sequential anastomoses and evaluated the results of this method. MATERIAL AND METHOD: Between February 2003 and October 2004, 71 patients underwent total arterial OPCAB using multiple arterial Y composite grafts with left internal mammary artery (LIMA), radial artery (RA), and right internal mammary artery (RIMA). We divided RA into multiple segments by number of distal target site after measuring of individual proper length and constructed arterial composite graft. One of segments was sutured end-to-side to LIMA and other segment was sutured end-to-side to the previously constructed radial graft. Postoperative graft patency was evaluated in 61 patients by multi-slice computed tomography. RESULT: An average of 2.5+/-0.6 arteries and 3.7+/-0.7 distal anastomoses per patient were done. There was no perioperative myocardial infarction, clinical hypoperfusion syndromes, and operative mortality. Postoperative mean CK-MB level was 17.4+/-29.7 IU/L. Overall graft patency was 99.1% (214/216)(LIMA: 100%, RA: 98.4%, RIMA: 100%). CONCLUSION: This technique allows total arterial OPCAB without technical problems and provides excellent early clinical results and graft patency. We believe that this technique is more convenient in the obtuse marginal area compared to sequential technique, and helpful in patients who require complex arterial grafting.
Arteries ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Humans ; Mammary Arteries ; Mortality ; Myocardial Infarction ; Radial Artery ; Transplants*

OBJECTIVETo analyze retrospectively 1018 patients who underwent coronary artery bypass grafting surgery (CABG) in order to summarize surgical techniques and clinical outcome.

METHODSFrom 1997 through 2004, data of same surgeon for 508 patients who underwent conventional coronary artery bypass surgery on pump (CCABG) and 510 patients who underwent off-pump CABG (OPCAB) were collected and analyzed retrospectively. Eight hundred and fifty-two patients had unstable angina, 582 patients were over 60 years old (57.2%) and 784 patients had concomitant diseases including valve lesion, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect, stroke, chronic obstructive pulmonary diseases, renal failure and cancer. A hundred and fifty-six patients had left main stem (LIMS) stenosis and 671 patients, triple-vessel disease.

RESULTSTotal mortality was 0.39% (4-case death) and morbidity, 1.6% (sternal dehiscence, stroke and mediastinitis). The grafts per patient with CCABG and OPCAB were 3.3 +/- 0.6 vs. 2.5 +/- 0.4. Left internal mammary artery use was 93.8% of the patients, 29 patients were implanted intra-aortic balloon pump intraoperatively. Follow-up was 4 months to 7 years.

CONCLUSIONSScientific surgical strategies, excellent surgical techniques and improvement of cardiac anesthesia and cardiopulmonary bypass make the mortality and morbidity decrease significantly, CABG surgery is safe and effective in patients with coronary artery disease.

Aged ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; methods ; mortality ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; mortality ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

Background: Off-pump coronary artery bypass grafting (Off-Pump CABG) has been proven to have less morbidity and to facilitate early recovery. High-risk surgical patients may have benefitted by avoiding the adverse effects of the cardiopulmonary bypass. We compared the effectiveness of Off-Pump CABG with that of coronary artery bypass using cardiopulmonary bypass (On-Pump CABG) in high-risk patients. Material and Method: 682 patients (424 Off-Pump CABG and 258 On-Pump CABG) underwent isolated coronary artery bypass grafting between January 200l and June 2003. Patients who were considered high risk were selected High risk is defined as the presence of one or more of nine adverse prognostic factors. Data were collected from 192 patients in Off-Pump CABG and 100 in On-Pump CABG for risk factors, extent of coronary disease, and in-hospital outcomes. Result: Off-Pump CABG group and On-Pump CABG group did not show differences in their preoperative risk factors. We used more arterial grafts in Off-Pump CABG group (p<0.05). Postoperative results showed that operative mortality (0.5% in Off-Pump CABG versus 2.0% in On-Pump CABG), renal failure (2.6% in Off-Pump CABG versus 7.0% in On-Pump CABG), and perioperative myocardial infarction (l.5% in Off-Pump CABG versus l.0% in On-Pump CABG) did not differ significantly. However, Off-Pump CABG had shorter mean operation time (p<0.05), lower mean CK-MB level (p<0.05), lower rate of usage of inotropics (p<0.05), shorter mean ventilation time (p<0.05), lower perioperative stroke (0% versus 2.0%), and shorter length of stay (p<0.05) than On-Pump CABG. On-Pump CABG had more distal grafts (p<0.05) than Off-Pump CABG. Although Off-Pump CABG and On-Pump CABG did not show statistical differences in mortality and morbidity was more frequent in CABG. Conclusion: Off-Pump CABG reduces morbidity and favors hospital outcomes. Therefore, Off-Pump CABG is safe, reasonable and may be a preferable operative strategy for high-risk patients.
Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; Coronary Vessels* ; Humans ; Length of Stay ; Mortality ; Myocardial Infarction ; Renal Insufficiency ; Risk Factors ; Stroke ; Transplants ; Ventilation

BACKGROUND: This study aimed to evaluate the usefulness of preoperative placement of intraaortic balloon pump(IABP) in reducing operative risk and facilitating posterior vessel OPCAB in high risk patients with left main disease(>75 % stenosis), intractable resting angina, postinfarction angina, or left ventricular dysfunction(ejection fraction<35 %). MATERIAL AND METHOD: One hundred eighty- nine consecutive patients who underwent multi-vessel OPCAB including posterior vessel revascularization were studied. The patients were divided into group I(n=74) that received preoperative or intraoperative IABP and group II(n=115) that did not receive IABP. In group I, there were 39 patients with left main disease, 40 patients with intractable resting angina, 14 patients with left ventricular dysfunction and 7 patients with postinfarction angina. Ten patients received intraoperative IABP support due to hemodynamic instability during OPCAB. RESULT: There was one operative mortality in group I and two mortalities in group II. The average number of distal anastomoses was not different between group I and group II(3.5+/-0.9 vs 3.4+/-0.9, p=ns). There were no significant differences in the number of posterior vessel anastomosis per patient between the two groups. There were no differences in ventilator support time, length of hospital stay, and morbidity between the two groups. There was one case of IABP-related complication in group I. CONCLUSION: IABP facilitates posterior vessel OPCAB in high risk patients, with comparable surgical results to low risk patients.
Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Hemodynamics ; Humans ; Length of Stay ; Mortality ; Transplants* ; Ventilators, Mechanical ; Ventricular Dysfunction, Left

BACKGROUND: In patients with coronary artery disease, dysfunctional hypoperfused myocardium at rest may represent either nonviable or viable hibernating myocardium. Two-dimensional echocardiography can detect regional wall motion abnormalities resulting from myocardial ischemia by dobutamine infusion. The purpose of the present study was to identify the prediction of improvement of regional left ventricular (LV) function after surgical revascularization. MATERIALS AND METHODS: Sixteen patients with chronic regional LV dysfunction underwent dobutamine stress echocardiography (DSE) (dobutamine: baseline, 5, 10, 20microgram/kg/min) before coronary artery bypass grafting (CABG) and underwent echocardiography at least 2 months after CABG. RESULTS: All patients were male with mean age of 58 years ranging from 42 to 73 years. The mean LV ejection fraction was 41.8% with a range from 19% to 55%. During DSE, there were no complications, also, there were no operative morbidities or mortalities. Improvement of wall motion within the dysfunctional myocardium was found in 8 (50%) of 16 patients in DSE. Among them, 6 patients (75%) showed functional recovery after CABG. Another 8 patients did not show improvement of wall motion in DSE. But among them, 3 patients (38%) showed functional recovery after CABG. 84 dysfunctional segments were found in 256 segments of 16 patients. Improvement of wall motion was found in 34 of 84 segments in DSE. Among them, 23 segments (74%) showed functional recovery after CABG. Another 53 segments did not show improvement of wall motion in DSE. But among them, 12 segments (23%) showed functional recovery after CABG. The sensitivity and specificity of DSE for the prediction of postoperative improvement of segmental wall motion were 66% and 84%, respectively. The positive and negative predictive value of DSE were 74% and 77%, respectively. In patients with chronic regional LV dysfunction, think that DSE is a good predictor of the improvement of dysfunctional segments after CABG.
Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Dobutamine* ; Echocardiography ; Echocardiography, Stress* ; Humans ; Male ; Mortality ; Myocardial Ischemia ; Myocardium* ; Sensitivity and Specificity

Patients with coronary artery disease and depressed ventricular function have better long- term benefits after coronary artery bypass grafting compared with medical therapy. But operative mortality remains high. This study was designed to identify the risk factors for coronary artery bypass grafting according to ventricular function. The records of 103 patients who underwent coronary artery bypass grafting from July 1994 to June 1996 were analysed. The patients were divided into two groups based on preoperative ejection fraction: Low EF group(Ejection fraction < 40%, n=24) and Normal EF group(Ejection fraction >or= 40%, n=79). The indication of operation was significantly different between the two groups (p=0.00003). Postinfarction angina was frequent in Low EF group but unstable angina was frequent in Normal EF group. The frequency of cardiomegaly(p=0.0012), serum creatinine abnormality(p=0.0473) and preoperative use of IABP(Intra Aortic Balloon Pump, p=0.0095) were higher in Low EF group. The left internal thoracic artery was used less frequently in Low EF group(p=0.00416). The operative mortality was 8.3% in Low EF group and 5.1% in Normal EF group, but without statistical difference(p=0.5492). In Normal EF group, age (p=0.041) was identified as a significant risk factor for operative mortality. In Low EF group, age(p=0.018), preopertive use of IABP(p=0.0036), hypercholesterolemia(p=0.0007), and emergency of operation(p=0.0037) were identified as significant risk factors. Postoperative morbidity was 50% in Low EF group and 33% in Normal EF group, but without statistical significance(p=0.1007). These results suggest that in patients with coronary artery disease and depressed ventricular function, more aggresive coronary artery bypass grafting is needed to improve the symptom and long-term benefit. Risk factor
Angina, Unstable ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Creatinine ; Emergencies ; Humans ; Mammary Arteries ; Mortality ; Risk Factors* ; Ventricular Function

Development of intraoperative aortic dissection during coronary artery bypass surgery is extremely rare with catastrophic outcomes resulting in high rates of morbidity and mortality. The prognosis is highly dependant upon prompt diagnosis and emergent treatment. We report our experience on a 72 year old female patient who successfully received ascending aortic graft replacement for acute intraoperative aortic dissection during coronary artery bypass procedure.
Aged ; Coronary Artery Bypass* ; Coronary Vessels* ; Diagnosis ; Female ; Humans ; Mortality ; Prognosis ; Transplants

BACKGROUNDMyocardial bridging (MB) is usually considered a benign condition but may result in myocardial ischemia, myocardial infarction (MI), exercise-induced tachycardia, atrioventricular conduction block or even sudden cardiac death. This retrospective study summarizes our operative methods and outcomes for treatment of 31 cases of MB.

METHODSFrom January 1997 to December 2006, 31 consecutive patients (24 men and 7 women; aged 35 - 67 years; mean 52.3 years) with MB underwent surgical treatment. Thirteen patients had MB only and 18 patients had MB associated with other heart diseases. In preoperative cardiac function grading, 5 patients were in NYHA class I and 18 in NYHA class II and 8 in NYHA class III. Among them, 15 underwent myotomy and 16 underwent coronary artery bypass grafting (CABG).

RESULTSAll patients survived and recovered uneventfully. Neither hospital or late death nor major complications occurred. Postoperative exercise testing in all patients failed to reveal any persistent ischemia. Follow-up time was 3 - 115 months (mean 31 months). Follow-up angiographic studies in 21 patients (68%) demonstrated restoration of coronary blood flow and myocardial perfusion without significant residual compression of the artery. All patients were symptom-free and currently in NYHA class I - II.

CONCLUSIONThe patients who are refractory to medication should actively undergo the surgical procedures such as myotomy and CABG. Myotomy should be advocated as the first choice because of its safety and satisfactory results.

Adult ; Aged ; Coronary Angiography ; Coronary Artery Bypass ; Female ; Humans ; Male ; Middle Aged ; Myocardial Bridging ; mortality ; surgery

The aim of this study is to investigate the clinical outcomes of the elderly patients with Non ST-segment elevation myocardial infarction (NSTEMI) undergoing coronary artery bypass surgery (CABG) compared to non-elderly patients. Patients with NSTEMI and undergoing CABG (n=451) who were registered in the Korea Acute Myocardial Infarction Registry between December 2003 and August 2012 were divided into two groups.; the non-elderly group ( < 75 years, n=327) and the elderly group (≥75 years, n=124). In-hospital mortality was higher in the elderly group (4.9% vs. 11.3%, p=0.015), but cardiac death, myocardial infarction, and major adverse cardiovascular events (MACE) including cardiac death, myocardial infarction, percutaneous revascularization, and redo-CABG after a one-year follow up were not different between the two groups. Predictors of in-hospital mortality in patients with NSTEMI undergoing CABG were left ventricular (LV) dysfunction (ejection fraction ≤40%) [hazard ratio (HR): 2.76, 95% confidence interval (CI): 1.16–6.57, p=0.022] and age (HR: 1.05, 95% CI: 1.01–1.10, p=0.047). So elderly NSTEMI patients should be considered for CABG if appropriate, but careful consideration for surgery is required, especially if the patients have severe LV systolic dysfunction.
Aged ; Coronary Artery Bypass ; Coronary Vessels ; Death ; Follow-Up Studies ; Hospital Mortality ; Humans ; Korea ; Myocardial Infarction