Background: Coronary malperfusion associated with aortic dissection is a lethal complication. To salvage such moribund patients, aggressive coronary revascularization concomitant with aortic repair is essential. We review the surgical results and mechanism of coronary malperfusion associated with acute type A aortic dissection (AAAD). Methods: Between January 2007 and December 2015, 12 patients (5.3%) from a total of 228 consecutive patients with AAAD undergoing surgery suffered coronary malperfusion associated with the dissection. There were 7 male and 5 female (mean age, 65.7years). Seven patients had acute myocardial infarction before surgery, and three patients suffered coronary malperfusion after aortic declamping. The right coronary was involved in eight patients, the left in three patients and both coronary arteries in one patient. Percutaneous coronary intervention (PCI) was performed before surgery in two patients. Coronary artery bypass grafting was performed concomitant with aortic repair in 11cases. We performed PCI in one patient after surgery. Results: Hospital mortality was 25% (3 patients) Causes of death were septic shock, cerebral bleeding and intestinal ischemia. In all three patients, the right coronary artery was involved and Coronary ostial lesions of them were circumferential detachment with an inner cylinder intussusception. Two patients had cerebral infarction and one patient had acute renal failure postoperatively. Other patients recovered with any major complication. Conclusions: AAAD with coronary involvement is associated with high mortality rate, aggressive coronary revascularization and early aortic repair with simple techniques are necessary to salvage these critically ill patients.

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Objectives: We reviewed our operative outcome of redo cardiac surgery after previous CABG. Methods: Between January 1, 1994, and June 30, 2014, 127 patients (mean age 70.9 ± 8.8 years, male rate 65.4%) underwent redo cardiac surgery after previous CABG. Results: The mean duration from first time CABG was 7.5 ± 5.5 years. Redo CABG was performed in 62 patients (48.8%), redo AVR was performed in 33 patients (26.0%), redo MVP or MVR was performed in 18 patients (14.2%) and proximal thoracic aortic redo surgery was performed in 14 patients (11.0%). The operative mortality was 4.7% (6 cases). In-hospital mortality was 11.0% (17 cases). Emergency operation was significant factor associated with in-hospital mortality (p=0.017). Overall survival rates at 1 and 5 years was 77.4% and 61.5%. Redo CABG was 84.2% and 72.5%. Redo AVR was 79.3%, 55.9, Redo MVP/MVR was 65.5%, 48.5%. Redo Aortic surgery was 60.1%, 45.1%. The survival rate of redo CABG was better than other redo operations (p=0.013). Conclusions: Redo CABG was a most case in redo cardiac surgery after CABG. Emergency operation is associated with in-hospital mortality. The long term survival in patients performed redo CABG after previous CABG was better than other redo surgery.

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Objecives: The aim of this study was to assess the strategy of coronary artery bypass grafting (CABG) for diffusely diseased left anterior descending coronary artery (LAD). Methods: We retrospectively reviewed 59 patients undergoing CABG in the diffusely diseased LAD between September 1995 and March 2014. Of these, 47 patients underwent multiple grafting (group M) and 12 patients underwent onlay patch grafting (group O). We compared and analyzed two groups. Results: The mean number of distal anastomosis was 4.8 and 4.3 in the groups M and O, respectively. The operation time was longer and the prevalence of reoperation for bleeding and postoperative stroke was significantly higher in the group O. The early operative mortality rate was zero in both groups. The probability of freedom from cardiac death, cardiac events, long-term graft patency rate was similar and excellent in both groups. Conclusions: The revascularization of LAD extensively using multiple grafting or onlay patch grafting showed excellent early and long-term outcomes.

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We investigated the difference in radiation dose between the two imaging technique by dividing the patients undergoing cardiac angiography a (857 cases) and coronary intervention (142 cases) into the biplane group and the single-plane group to Fluoroscopy time, fluoroscopy dose, number of cineangiography runs, cineangiography dose, total dose and amount of contrast media were compared and examined in the both groups. In the cardiac angiography, 487 cases in the biplane group were significantly higher in fluoroscopy time, fluoroscopy dose, number of cineangiography, fluoroscopy dose, cineangiography dose and total dose than 370 cases in the single-plane group while the contrast load used was significantly lower. Also in coronary intervention, 37 cases in the biplane group showed significantly higher fluoroscopy time, fluoroscopy dose, number of cineangiography runs, cineangiography dose and total dose than 105 cases in the single-plane group, however there was no difference in amount of contrast media. Since biplane imaging leads to increase the radiation dose, we should select imaging technique according to the procedure and patient condition.

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