Prediction of functional coronary stenosis by computed tomography-derived fractional flow reserve in surgical revascularization.

Objectives: The aims of this study were (1) to compare computed tomography-derived fractional flow reserve (CT-FFR) values with graft patency and (2) to establish the cut-off value of CT-FFR for predicting competitive graft flow after coronary artery bypass grafting (CABG).

Methods: Of the 77 patients who underwent isolated CABG with an in situ internal thoracic artery (ITA)-based composite graft and who were also evaluated by preoperative cardiac CT, CT-FFR values were obtained in 74 patients. Early postoperative angiograms were performed in all 74 patients.

Effect of patent complete revascularization on the akinetic myocardial segments.

Objectives: The aims of the study were (i) to examine the changes in echocardiographic parameters and (ii) to compare the fate of myocardial segments with akinesia and without akinesia on preoperative echocardiography after coronary artery bypass grafting.

Methods: One hundred one patients who underwent complete revascularization, who were assessed by preoperative, before discharge, postoperative 3- and 12-month echocardiographic examinations, and who showed all patent grafts at postoperative 1-year angiograms were included. Echocardiographic left ventricular ejection fraction was assessed, and a 16-segment model was adopted for regional analysis of the left ventricle.

Consensus statement-graft treatment in cardiovascular bypass graft surgery.

Coronary artery bypass grafting (CABG) is and continues to be the preferred revascularization strategy in patients with multivessel disease. Graft selection has been shown to influence the outcomes following CABG. During the last almost 60 years saphenous vein grafts (SVG) together with the internal mammary artery have become the standard of care for patients undergoing CABG surgery.

Strategies to Minimize Sternal and Leg Wound Complications after Coronary Artery Bypass Grafting Using No-Touch Saphenous Vein Grafts.

Purpose: The aims of the present study were to examine sternal and saphenous vein (SV) harvest site wound complication rates, and to assess the strategies to minimize the sternal and leg wound complications after coronary artery bypass grafting using a no-touch (NT) SV.

Methods: Patients who underwent coronary artery bypass grafting (CABG) using internal thoracic artery (ITA) and/or NT SV grafts from March 2021 to June 2023 (N = 166) at a newly opened cardiac surgical program were included. We obeyed the current guidelines for the prevention of sternal wound infection.

Expert systematic review on the choice of conduits for coronary artery bypass grafting: endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS).

The finalized document was endorsed by the EACTS Council and STS Executive Committee before being simultaneously published in the European Journal of Cardio-thoracic Surgery (EJCTS) and The Annals of Thoracic Surgery (The Annals) and the Journal of Thoracic and Cardiovascular Surgery (JTCVS).

Skin Closure After No-Touch Saphenous Vein Harvest: Strategies to Minimize Wound Complications.

The no-touch saphenous vein with surrounding pedicle tissue harvesting technique preserved endothelium and vessel wall integrity and demonstrated improved long-term saphenous vein conduit patency that was comparable to internal thoracic artery conduit patency. Despite improved saphenous vein conduit patency rates, there is a possibility that no-touch saphenous vein harvest may increase wound complication rates by increased tissue disruption, including venous and lymphatic channels. Comprehensive strategies to minimize leg wound complications after no-touch saphenous vein harvest are discussed.

Techniques and Outcomes of the No-Touch Vein Conduit as a Y-Composite Graft.

Although the saphenous vein is a widely used conduit for coronary artery bypass grafting, revascularization using the saphenous vein as an aortocoronary bypass graft has shown disadvantages of lower long-term graft patency rates and subsequently worse clinical outcomes, compared with revascularization using the internal thoracic artery. Of the various efforts to overcome the limitations of vein conduit that are resulting from structural and functional differences from arterial conduit, recent technical improvement in no-touch vein composite graft construction and outcomes of revascularization using no-touch vein composite grafts based on the left internal thoracic artery will be discussed in this topic.

Competitive Flow in Vein Composite Grafts Based on the Left Internal Thoracic Artery: Early and 1-Year Angiographic Analyses.

We assessed the incidence of competitive flow with early postoperative angiograms in patients who received a "no-touch" saphenous vein (NT SV) composite graft and reexamined the status of competitive flow at 1-year. Early postoperative angiograms were performed in 806 patients who underwent myocardial revascularization using a NT SV Y-composite graft based on the in situ left internal thoracic artery (LITA). Competitive conduit flow was observed in 102 distal anastomoses (102 of 3039 [3.

Reopening of the occluded saphenous vein composite grafts after coronary artery bypass grafting.

Background: We have observed reopening of the occluded "no-touch" saphenous vein (NT SV) composite grafts on follow-up angiograms in patients who underwent coronary artery bypass graftings (CABGs).

Methods: Between 2008 and 2018, 1283 patients received NT SV conduits without or with surrounding pedicle tissue as composite grafts based on the in situ left internal thoracic artery (ITA) for CABG and underwent early postoperative angiographies. Among the 1283 patients, 53 patients showed 55 occluded SV conduit anastomoses, and 46 patients who had 48 occluded SV anastomoses were re-evaluated by 1-year postoperative angiographies.

The Performance of the Current Risk Prediction Scoring Systems in Patients Undergoing Anaortic Off-pump Coronary Artery Bypass Grafting.

Background: This study aimed to evaluate the performance of the Society of Thoracic Surgeons (STS) risk model and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II for patients undergoing anaortic off-pump coronary artery bypass grafting (OPCAB).

Methods: From January 2010 to June 2017, 1,048 patients (isolated anaortic OPCAB: 1,043, on-pump conversion:5) undergoing isolated anaortic OPCAB were enrolled. The STS risk score and EuroSCORE II were calculated with dedicated online software.

Incidence and Risk Factors of Pannus after Mechanical Aortic Valve Replacement.

Background: This study was conducted to evaluate the occurrence rate and risk factors of subaortic pannus (SAP) after bileaflet mechanical aortic valve (AV) replacement.

Methods: Between 1990 and 2014, 862 patients underwent primary AV replacement with bileaflet mechanical prosthesis. SAP was defined as (1) gradual increase in mean pressure gradient through mechanical AV without any evidence of motion limitation of the leaflets on echocardiography and (2) AV mean pressure gradient >40 mm Hg or AV peak velocity >4 m/s on echocardiography, and (3) any visible subaortic tissue ingrowth beneath the mechanical AV on echocardiography or computed tomography.

Mid-Term Outcomes and Angiographic Patency of Redo Coronary Artery Bypass Grafting: A Comparison between Off-Pump and On-Pump Surgery.

Background: We evaluated the mid-term outcomes and angiographic patency of redo coronary artery bypass grafting (CABG).

Methods: Of 2,851 patients who underwent isolated CABG at Seoul National University Hospital from 2000 to 2017, 88 underwent redo CABG. Patients' mean age at redo CABG was 66.

Comparative analysis of structural valve deterioration after bioprosthetic tricuspid valve replacement: Bovine pericardial versus porcine valves.

This study was conducted to compare the occurrence and the risk factors of structural valve deterioration (SVD) after bioprosthetic tricuspid valve replacement (TVR) between bovine pericardial valves and porcine valves. One-hundred and thirty-four TVR patients were enrolled; 108 patients underwent TVR with bovine pericardial bioprostheses (BTVR group) and 26 underwent TVR with porcine bioprostheses (PTVR group). The early results and long-term clinical outcomes were compared.

Relation between functional coronary artery stenosis and graft occlusion after coronary artery bypass grafting.

Objectives: This study was conducted to evaluate graft patency rates during the 5 years after coronary artery bypass grafting according to the functional significance of the coronary artery stenosis, as determined by myocardial single-photon-emission computed tomography.

Methods: Two hundred ninety-five patients who underwent coronary artery bypass grafting using Y-composite grafts based on the in situ left internal thoracic artery, and in whom preoperative stress/rest myocardial single-photon-emission computed tomography and 1-year angiographies were available were enrolled. Seven hundred sixty-nine and 262 distal anastomoses were constructed to ischemic and nonischemic areas, respectively.

Hemodynamic Performance of Pericardial Bioprostheses in the Aortic Position.

Background: This study was conducted to evaluate the hemodynamic performance and the incidence of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) using bovine pericardial valves (Carpentier-Edwards Perimount Magana and Magna Ease).

Methods: In total, 216 patients (mean age, 70.0±10.

Serial ultrastructural evaluation of myocardial ischemic injury after infusion of del Nido cardioplegia in the human heart.

Objectives: The safe ischemic time after a single-dose del Nido cardioplegia (DNC) infusion has not yet been established. This study evaluated the progression of myocardial ischemic injury to establish the safe ischemic time after a single-dose DNC infusion in the human heart using a transmission electron microscope.

Methods: Seven hearts extracted from heart transplant recipients after infusion of 1000 mL single-dose DNC were evaluated.

Right gastroepiploic artery versus right internal thoracic artery composite grafts: 10-year patency and long-term outcomes.

Objectives: We compared the 10-year graft occlusion rates and long-term clinical outcomes of right gastroepiploic artery (RGEA) composite grafts with those of right internal thoracic artery (RITA) composite grafts.

Methods: From 2000 to 2008, 548 patients had undergone total arterial revascularization for multivessel coronary artery disease using the RGEA (RGEA group; n = 389) or RITA (RITA group; n = 159) as a second-limb Y-composite graft based on the in situ left ITA. A propensity score-matched analysis was used to match the RGEA group (n = 152) with the RITA group (n = 152).

Early Surgery versus Watchful Waiting in Patients with Moderate Aortic Stenosis and Left Ventricular Systolic Dysfunction.

Background And Objectives: Severe aortic stenosis (AS) with left ventricular systolic dysfunction (LVSD) is a class I indication for aortic valve replacement (AVR) but this recommendation is not well established in those at the stage of moderate AS. We investigate the clinical impact of AVR among patients with moderate AS and LVSD.

Methods: From 2001 to 2017, we consecutively identified patients with moderate AS and LVSD, defined as aortic valve area 1.