Purpose: The aim of the present study was to validate the efficacy of partial clamp during off-pump coronary bypass grafting. Methods: A retrospective review of 1680 patients who underwent coronary bypass grafting from 1998 to 2013 was conducted. Four hundred sixty-nine patients (group P) underwent OPCAB with partial-clamp, while 188 patients (group N) underwent aorta no-touch OPCAB. Partial-clamp was conducted if patients had normal or mild atherosclerosis on the ascending aorta confirmed by epiaortic echography. Results: There was no difference of the postoperative stroke rate in both groups (group P: 1%, group N: 0.5%). The average number of grafting was significantly higher in group P (group P: 3.4, group N: 2.8, p<0.05). The early graft patency was the same between groups. However, the late graft patency at 5 and 10 years was significantly better in group P (RA patency at 10 years: group P 91%, group N 58%, p<0.05; SVG patency at 10 years: group P 81%, group N 50%, p<0.05). The composite graft was used more frequently in group N (group P: 12%, group N: 48%, p<0.05). Conclusions: In patients with mild atherosclerosis on the ascending aorta, the use of partial clamp during OPCAB does not increase the risk of perioperative stroke. Moreover, the strategy of proximal anastomosis to the aorta under partial clamp could increase the total number of grafting and improve the long-term graft patency of radial artery and SVG rather than composite grafts in aorta no-touch OPCAB.

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Aim: We sought to clarify the clinical features and prognostic factors of acute decompensated heart failure (ADHF) based on its etiology. Method and Results: From July 2006 to June 2010, consecutive 757 ADHF patients were examined and divided into ischemic heart disease group (IHD), valvular heart disease group (VHD) and non-ischemic non-valvular heart disease group (NINVHD). In hospital mortality, IHD, VHD and NIV were 3.4%, 4.5%, and 5.8% respectively. There were higher in gender, age, prevalence of hypertension, hyperlipidemia and, diabetes in IHD than non-IHD (VHD and NINVHD). But the prevalence of arterial fibrillation lower in IHD than non-IHD. Long term mortality did not differ among the groups. Multivariate analyses revealed significant determinants of long term mortality were diabetes and smoking in IHD, hypertension and serum Na level in VHD, hypertension, serum creatinine and plasma BNP levels in NIV. Conclusion: Long-term mortality of patients with ADHF was comparable in terms of its etiology; however, the prognostic factors vary according to the underlying diseases.

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Our aims were to investigate the short and midterm clinical outcomes of surgery in patients with aortic stenosis aged 80 years or older undergoing AVR with concomitant coronary artery bypass grafting (CABG). Between January 2006 and January 2013, 44 patients aged 80 years and older underwent AVR with concomitant CABG. The mean age was 83.5±3.0 years, 20 patients (45%) were in New York Heart Association (NYHA) class III–IV. The mean logistic EuroSCORE was 17.5±13.4. The mean valve area was 0.75±0.41 cm², and the mean peak gradient was 78.7±36.5 mmHg. All patients were treated with bioprostheses. The mean number of grafts were 1.8±1.0. No hospital mortality occurred. Postoperative complications were respiratory failure, gastrointestinal bleeding, AV block, and refractory pleural effusion. Median hospital stays were 22 days. The NYHA class at 30 days improved from 2.4±1.0 to 1.3±0.6 (p<0.01). Survival rates at 1 and 3 years were 100% and 74.4±12.3%. AVR with concomitant CABG in elderly patients can be performed at low risk and its risk should not be overestimated in the era of transcatheter aortic valve implantation.

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Background: Reducing ischemia is an important therapeutic goal in patients with coronary artery disease. We investigated the relationships between stress myocardial perfusion imaging (MPI) before and after percutaneous coronary intervention (PCI) and the cardiac events and revascularization. Methods and Results: We retrospectively analyzed 111 patients who underwent PCI (PCI group) from 2008 to 2012 and who underwent stress MPI before treatment and for 3–30 months (mean, 313 days; median, 239 days) after treatment. The extent of ischemia observed on stress MPI before treatment was improved after PCI. The major cardiac events were observed in 11 patients (9.9%) and the rate of revascularization was 28.8% during follow-up period. Major adverse cardiac events were influenced by ischemia on second MPI and revascularization was influenced by ischemia on second MPI and HDL-cholesterol levels. 59.3% of cases underwent revascularization were not related to restenosis of primary lesions. Conclusions: Stress MPI after PCI may be useful for assessing myocardial ischemia by detecting restenosis, the progression of residual stenosis, and new lesions within the coronary artery in patients after PCI.

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For the redo off-pump coronary artery bypass grafting (OPCABG) for multivessel disease including the left main trunk, an atypical procedure was selected in which a proximal anastomosis of a saphenous vein graft (SVG) was made to a previous SVG through a left thoracotomy approach. The patient was on hemodialysis and had undergone repeated percutaneous coronary interventions for angina. OPCABG had been performed for three-vessel disease in another hospital; however, only bypasses were performed for the LCX #14 and RCA #4 with a SVG because of severe calcification of the LAD. For the repeat surgery, based on the patient’s background and baring in mind that only a short time had elapsed since the initial surgery, a thoracotomy approach, graft and the method of proximal anastomosis was considered. As a result, the bypasses for LAD and #12 was performed by above described procedures. Postoperative coronary CT angiography showed that the patency of the graft was good.

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A 68-year-old female had chest pain on exertion and went to hospital. Coronary angiogram showed triple vessel disease with 50% stenosis of the left main trunk (LMT). Coronary artery bypass grafting (CABG) for complete revascularization was scheduled. Saphenous vein graft (SVG) was planned to use for the circumflex artery, because the stenosis of LMT was not severe. Minimally invasive cardiac surgery CABG (MICS CABG) was performed via a small left thoracotomy on the 4th intercostal space. After two SVGs were anastomosed to the ascending aorta with a side clamp via the incision, the left internal thoracic artery (LITA) was grafted to the left anterior descending artery (LAD). Each SVG was anastomosed to the posterior descending artery (PDA) and the high-lateral artery (HL) with a heart positioner and an epicardial stabilizer. All anastomoses were made under direct vision without the use of cardiopulmonary bypass (CPB) or blood transfusion. All the graft patency was postoperatively confirmed by a computed tomography coronary angiography. MICS CABG avoiding median sternotomy without the use of CPB can be a good alternative procedure to standard CABG.

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