Objectives: A decline of systemic blood pressure is one of the most common complications during percutaneous coronary intervention (PCI). Urgent elimination of fundamental cause as well as improvement of hemodynamic crisis should be simultaneously accomplished to prevent important organs from severe ischemic damage. Therefore, in this study, we sought to optimize high-risk patients against potential deterioration of hemodynamic status. Methods: Total of 316 consecutive patients underwent PCI in a single cardiovascular center from January 2010 till May 2011 was finally analyzed. They were divided into two groups due to the use of intravenous norepinephrine for hemodynamic support during PCI, and parameters such as patient backgrounds, lesion characteristics and PCI procedures were compared between the groups. Results: The norepinephrine group showed significantly higher age (73 vs 70 years old, p=0.036), higher value of low density lipoprotein cholesterol [116 (93–135) vs 99 (80–125) mg/dl, p<0.01], higher rate of acute coronary syndrome (44 vs 27%, p<0.01) and right coronary artery intervention (49 vs 31%, p<0.01) rather than the non-norepinephrine group. In terms of angiographic and procedural parameters, significantly larger size of deployed stents (3.4 vs 3.1 mm, p<0.01), higher volume of contrast use (221 vs 193 ml, p<0.01), and higher rate of IABP (8.0 vs 1.0%, p<0.01) and intracoronary nicorandil injection (18 vs 4.0%, p<0.01) were observed in the norepinephrine group. In addition, 79% of norepinephrine cases needed multiple injections to stabilize systemic status. Conclusions: The present study demonstrated several preoperative predictors and procedural features of hemodynamic destabilization during PCI. These results may help staffs in the cath lab to correspond to emergent situations quickly and properly.

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Early ambulation after cardiovascular operations has been recommended, especially for octogenarians. Recently, it is suggested that early weaning from the ventilator enables octogenarians to ambulate earlier. Therefore when we underwent isolated off-pump coronary artery bypass (OPCAB) operations, we tried to extubate immediately after the operations were finished in the operating room. We compared the clinical outcome of “immediate extubation” after OPCAB between octogenarians and younger patients. From January 2006 to December 2010, 107 patients underwent isolated OPCAB. We defined group A as octogenarians (n=28; 82.5±0.4 years old) and group B as younger patients (n=79; 69.3±0.8 years old). “Immediate extubation” was defined as wakening and extubating in operation room as soon as the operation was finished. Contraindications to “immediate extubation” were hemodynamic instability and moderate chest tube drainage of blood at the end of operation. There were significant differences between group A and B in terms of the following preoperative factors; moderate or severe mitral valve regurgitation (MR) (46.4% vs 21.5%; P<0.05), chronic renal failure (CRF) (32.1% vs 11.4%; P<0.05) and poor left ventricular function (37.5% vs 14.8%; P<0.05), whereas no statistical difference was acknowledged in any intraoperative factor such as operative time, the number of grafts, the use of IABP and emergency status. Rate of immediate extubation (53.6% vs. 79.5%; P<0.05), length of ICU stay (7.4±1.7 vs 2.8±0.3 days, P<0.001) and numbers of in-hospital deaths (21.4% vs 0%, P<0.001) were significantly worse in group A. However, octogenarians who were succeeded in immediate extubation could reduce the length of ICU stay and hospital stay. We further need to investigate the relationship between pre- and postoperative factors and early ambulation.

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There are few reports regarding outcomes of total arch replacement (TAR) with concomitant coronary artery bypass grafting (CABG). This study aimed to analyze outcomes after TAR with CABG in our institute. Between January 2005 and December 2011, 82 patients underwent elective TAR with or without CABG. Of these patients, we divided two groups; 31 had concomitant CABG (Group A) and the others had TAR only (Group B). Between the two groups, there were no significant differences in preoperative characteristics. TAR was performed with selective cerebral perfusion (SCP) and the four branched arch graft. The mean number of coronary anastomoses was 1.7±0.8 in Group A. Operation time, cardiopulmonary bypass time, cardiac ischemic time and SCP time were significant longer in Group A. Early graft patency of bypass grafts was 100%. There were no significant differences in the incidence of cardiac events and major postoperative complications between two groups. In conclusion, TAR with CABG can be safely performed with favorable outcomes.

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The aim of this study was to evaluate the outcome of total aortic arch replacement (TAR) combined with coronary artery bypass grafting (CABG). From January 2002 to May 2012, 79 consecutive patients underwent TAR. Of these, 48 patients underwent isolated TAR and 31 patients underwent TAR combined with CABG. The mean number of coronary anastomoses was 1.6±0.8. There were no hospital deaths. Stroke occurred in 6.4% of patients. All of these patients had coronary artery disease. There were no differences in survival or freedom from cardio-aortic events in the isolated TAR versus TAR combined with CABG. The outcomes of TAR combined with CABG were satisfactory. However, special attention should be paid to the possibility of postoperative stroke in these patients.

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Attributed to the growing popularity of western diets, the age of coronary artery disease (CAD) is on a lowering trend in recent years. Therefore the number of young patients undergoing CABG is steadily growing. The purpose of this study is to evaluate the prevalence of risk factors of CAD and the early outcome of surgical revascularization in patients aged 50 or younger undergoing CABG. The retrospective study involved 558 patients, who underwent off-pump CABG in our institution between May 2007 and December 2011. The study group included 22 patients aged 50 years or younger, mean age was 42.5±6.1 years. Hyperlipidemia was found in 16 patients (72.7%), hypertension in 11 (50.0%), smoking in 9 (40.9%), diabetes mellitus in 7 (31.8%), obesity in 5 (22.7%) and 2 (9.1%) had family history of CAD. Left internal thoracic artery (ITA) was used in 21 (95.5%), right ITA in 15 (68.2%), right gastroepiploic artery in 12 (54.5%), radial artery in 7 (31.8%) and vein graft in 3 patients (13.6%). 19 patients (86.4%) received only arterial grafts. No patient was switched to on-pump surgery. The mean number of bypass grafts was 3.3±1.4. All patients experienced complete revascularization. Patients were discharged in 19.3±5.8 days. Patients aged 50 or younger undergoing CABG had a high incidence of hyperlipidemia, hypertension and active smoking. We have aimed for long term patency with arterial grafts particularly for young patients.

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Between January 2001 and December 2011, 971 consecutive patients underwent isolated coronary artery bypass grafting (CABG) in our institution. These patients included 123 patients with impaired renal function (serum creatinine ≥1.5 mg/dl). These patients were divided into 2 groups, hemodialysis (HD) group and impaired renal function without hemodialysis (non HD) group. The average age at operations was significantly younger in HD group (65.5±9.1 vs 68.8±8.3: p=0.03 ). The ratio of off pump CABG was lower in HD group (83.1% vs 95.3%: p=0.03). The operative mortality and the in-hospital mortality rates (HD vs non HD) were 1.7% vs 1.6%, and 3.4% vs 6.3% respectively (p=n.s). Overall survival and freedom from cardiac events were not statistically significantly different between the two groups. Although freedom form cardiac death was significantly lower in non HD group (1 year; 92.3% vs 98.4%, 3 years; 82.8% vs 98.4%, 5 years; 61.4% vs 98.4% p<0.05), overall survival was not significantly different in both group (1 year: 85.1% vs 88.5%, 3 years 68.7% vs 69.3%, 5 years 45.4% vs 64.0%). Careful observation after operation not only for cardiovascular disease but also other diseases is considered to be important in patients with impaired renal function.

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Purpose: We retrospectively evaluated the initial assessment of cardiac rehabilitation (CR) in patients who did not received rehabilitation following coronary artery bypass grafting (CABG). Methods: Sixty-four consecutive patients (mean age 71.3, 17 female: 47 male) who underwent isolated CABG in our institute were enrolled in this study. None of the patients received CR after surgery. Acute coronary syndrome was recognized in 17 patients, left main trunk disease in 33, and 3-vessel coronary artery diseases in 40. Emergent or urgent CABG was performed in 19 patients. Fifteen patients underwent mechanical circulatory support with intra-aortic balloon pumping prior to or during surgery. Beating CABG with or without cardiopulmonary bypass was performed in 57 patients, with a 3.0 of mean number of bypasses. Results: Although 62 patients were discharged, 8 patients were unable to leave their beds at that time. We observed new-onset atrial fibrillation in 20 patients and pleural effusion in 29 patients following CABG. Overall 54 patients who could leave bed at a mean of 6.2 postoperative days had resumed activities of daily living (ADLs), but 8 patients could not resume ADLs at discharge, especially in elderly patients. Conclusions: Introduction of CR and early mobilization following CABG may improve early clinical outcomes and help in resuming ADLs.

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Background: Since the procedure for coronary artery bypass grafting (CABG) has been well established, surgical mortality is decreasing. But surgery for patients with low left ventricular ejection fraction (LVEF) is still high risk. Stitch trial demonstrated that CABG had lower rates of death from cardiovascular causes than medical therapy alone in patients with coronary artery disease and left ventricular (LV) dysfunction. We report our experience comparing impaired LV function patients with preserved patients and show our surgical strategy for patients with coronary artery disease and LV dysfunction. Methods: We had 191 patients performed CABG between 2011 and 2013. We studied 26 patients with an EF of 35% or less (Group A: 67.7 years old, average LVEF 28.3%) and 165 patient of over 35% (Group B: 67.5 years old, average LVEF 61.1%). Results: There were statistically significant differences between Group A and B in the percentage of off-pump CABG (77% vs 98%, p<0.001), percentage of extubation at operating room (54% vs 73%, p=0.04). We had 3 hospital deaths, which were performed emergency operation. There was no hospital death in patients performed elective operation. There was no neurological complication. Conclusions: To accomplish no mortality and no strokes, off-pump CABG is the first choice in our institution. It needs some artifices in perioperative management to complete off-pump CABG in low LVEF patients. CABG for patients with LV dysfunction is safe procedure and the results were acceptable with well-considered management.

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It is very difficult for the emergency medical service (EMS) personnel to understand perfectly about the condition of the emergency patient’s because of the lack of the time. Moreover the emergency cases without typical symptoms or subjective symptoms often seen in elderly make more complicated to diagnose on-site. In this study, we analyzed the emergency patients with complains of a chest pain when they were taken in the ambulance. As a result, the hospitalization rate of patients with cardiovascular diseases（Myocardial infarction）who complained of a chest pain was higher than those without it (chest pain 84.1% versus without chest pain 76.7%), whereas the proportion of patients with severe cardiovascular diseases（Myocardial infarction）who did not complained of a chest pain was higher than those without it (chest pain 2.8% versus without chest pain 12.7%). To obtain emergency cardiovascular patient’s complains by the EMS interview and to combine various complains with other data would be of help to transport patients to appropriate hospitals.

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