Publications by authors named "Pyongsoo Yoon"
Objective: To analyze the factors associated with the need for tracheostomy after surgical repair of acute type A aortic dissection (ATAAD) and its implications for longitudinal outcomes.
Methods: This retrospective analysis of patients who underwent ATAAD repair from 2010 to 2020 focused on a comparison of patients who required a tracheostomy versus those who did not. Adjusted regression analysis and a classification and regression tree (CART) model were used to assess factors influencing the need for tracheostomy and its association with longitudinal survival.
Objective: Surgery for acute type A aortic dissection carries a high risk of morbidity and mortality compared with routine cardiac surgical procedures. The German Registry for Acute Aortic Dissection Type A score has been recommended for use as a mortality risk-stratification tool in recent guidelines. We sought to externally validate this score in our local population.
View Article and Find Full Text PDFIntraoperative Features Improve Model Risk Predictions After Coronary Artery Bypass Grafting.
Ann Thorac Surg Short Rep
September 2024
Background: Intraoperative physiologic parameters could offer predictive utility in evaluating risk of adverse postoperative events yet are not included in current standard risk models. This study examined whether the inclusion of continuous intraoperative data improved machine learning model predictions for multiple outcomes after coronary artery bypass grafting, including 30-day mortality, renal failure, reoperation, prolonged ventilation, and combined morbidity and mortality (MM).
Methods: The Society of Thoracic Surgeons (STS) database features and risk scores were combined with retrospectively gathered continuous intraoperative data from patients.
Reintervention after aortic root replacement with allograft, xenograft, and stented bioprosthetic valves.
Cardiovasc Revasc Med
December 2024
Background: There has been a significant increase in the utilization of non-mechanical valves in the aortic position over time. However, details in reinterventions after aortic root replacement (ARR) with non-mechanical prosthesis were limited in the literature, despite the potential importance of reinterventions in the lifetime management of aortic valve disease.
Methods: This is a single-center retrospective study, identifying all patients who underwent ARR with allograft, xenografts, and stented bioprosthetic valved conduit from 2010 to 2020.
Objective: Elderly patients are less likely to undergo surgery for an acute type A aortic dissection (ATAAD). This study aims to understand the risks of surgical treatment in patients 75 and older.
Methods: This was a retrospective study using an institutional database of patients who underwent ATAAD repair from 2007 to 2021.
Background: We sought to assess the effect of postoperative renal failure (RF) on outcomes of acute type A aortic dissection (ATAAD) and identify predictors of chronic kidney disease (CKD) following ATAAD.
Methods: This retrospective single-center analysis included all adults with ATAAD from 2011 to 2023. Patients were stratified into RF and no RF groups.
Hospital Teaching Status and Outcomes in Type B Aortic Dissection: Analysis of More Than 40,000 Patients.
J Cardiothorac Vasc Anesth
January 2025
Article Synopsis
- The study aimed to evaluate the impact of hospital teaching status on outcomes for patients with type B aortic dissection (TBAD) using data from the National Readmissions Database over four years.
- A total of 44,981 TBAD patients were analyzed, revealing no significant differences in in-hospital mortality or 30-day readmission rates between those treated at teaching hospitals versus non-teaching hospitals.
- At teaching hospitals, the use of thoracic endovascular aortic repair (TEVAR) showed higher risks of in-hospital mortality, while higher hospital patient volumes were linked to increased chances of 30-day readmissions.
Article Synopsis
- The study aimed to assess how intraoperative neuromonitoring (IONM) affects the risk of stroke and mortality during coronary and valvular heart operations over a period of 11 years.
- Out of 19,299 patients, 589 (3.1%) received IONM, and those patients had higher pre-existing cerebrovascular diseases, resulting in increased rates of operative mortality (5.3% vs 2.5%) and stroke (4.9% vs 1.9%).
- However, after adjusting for patient characteristics, there was no significant difference in stroke or mortality rates between IONM users and non-users, suggesting that IONM may indicate risks rather than directly influence outcomes.
Impact of epiaortic ultrasound utilization in patients undergoing coronary artery bypass grafting.
J Thorac Cardiovasc Surg
October 2024
Article Synopsis
- The study aimed to determine if using epiaortic ultrasound to assess aortic calcification would lower the rate of postoperative strokes in patients undergoing coronary artery bypass grafting (CABG).
- A total of 10,049 patients were analyzed, with 1,572 receiving epiaortic ultrasound. The results showed no significant difference in stroke rates between the groups, with 0.8% in the ultrasound group and 1.4% in the non-ultrasound group.
- Overall, the study concluded that epiaortic ultrasound did not significantly reduce the odds of postoperative stroke or hazards of mortality in CABG patients.
Article Synopsis
- The study compares outcomes of bioprosthetic versus mechanical valves in older patients who had surgical aortic valve replacement (SAVR), using data from 1,847 patients over a follow-up period of 6.2 years.
- It found no significant differences in early survival between valve types across age groups, but younger patients (<65 years) with bioprosthetic valves faced higher reintervention rates compared to those with mechanical valves.
- The study indicates that bioprosthetic valves are associated with a significantly higher risk of needing repeat aortic valve surgery in younger patients, highlighting the need for better validation of valve type recommendations for different age groups.
Article Synopsis
- Tricuspid valve replacement (TVR) using mechanical valves shows better long-term survival rates and lower reoperation risks compared to tissue valves, based on a review of 21 studies involving 7,166 patients.
- Patients with mechanical valves had a lower risk of death (HR 0.77) and gained an average of 2.2 more years of life (12.4 vs 10.2 years).
- While there was no significant difference in reoperation risk within the first 7 years, mechanical valves showed a substantially lower reoperation risk after 7 years (HR 0.24).
External validation of the ARCH score in patients undergoing aortic arch reconstruction under circulatory arrest.
J Thorac Cardiovasc Surg
April 2025
Article Synopsis
- Aortic arch surgeries with hypothermic circulatory arrest (HCA) are riskier than standard cardiac surgeries, prompting a need to validate the ARCH score for mortality risk.
- The study analyzed 760 patients from 2014 to 2023, finding that while in-hospital mortality was 8.4%, the ARCH score had low effectiveness in predicting this outcome (C-statistic of 0.62).
- Despite its low predictive ability, the ARCH score demonstrated excellent calibration, indicating it can effectively estimate mortality risk when applied properly.
Can we safely expand the donation after circulatory death donor heart pool by extending the donor age limit?
J Thorac Cardiovasc Surg
February 2025
Objective: This study evaluates the impact of donor age on outcomes following donation after circulatory death heart transplantation.
Methods: The United Network for Organ Sharing registry was queried to analyze adult recipients who underwent isolated donation after circulatory heart transplantation from January 1, 2019, to September 30, 2023. The cohort was stratified into 2 groups according to donor age, where advanced donor age was defined as 40 years or more.
Background: This study evaluated the outcomes of patients with cardiogenic shock (CS) supported with Impella 5.0 or 5.5 and identified risk factors for in-hospital mortality.
View Article and Find Full Text PDFOutcomes of Aortomitral Continuity Reconstruction During Concomitant Aortic and Mitral Valve Replacement.
J Cardiothorac Vasc Anesth
April 2024
Article Synopsis
- The study analyzed outcomes of the aortomitral continuity reconstruction (AMC) during simultaneous aortic and mitral valve replacement surgeries, known as the "Commando" procedure, over a 12-year period.
- Among 331 patients who had double-valve replacements, 21 (6.3%) underwent the Commando procedure, which was associated with higher rates of previous surgeries, emergency procedures, and increased short-term complications, including higher operative mortality.
- Despite the short-term challenges seen in the Commando group, the long-term survival rates were similar to those of patients who had standard aortic and mitral valve replacements, suggesting the AMC reconstruction may be just as durable over time.
The Clinical Significance of Unplanned Coronary Artery Bypass Grafting in Aortic Root Replacement.
J Cardiothorac Vasc Anesth
April 2024
Article Synopsis
- This study investigates the occurrence and effects of unplanned coronary artery bypass grafting (CABG) during aortic root replacement (ARR) at a university hospital from 2011 to 2022.
- Among 795 patients, 4.3% required unplanned CABG, most commonly due to ventricular dysfunction, and the study found no link between unplanned CABG and increased mortality rates.
- Notably, a smaller body surface area (below 1.7) was identified as a significant risk factor for needing unplanned CABG.
Article Synopsis
- The study aimed to compare the clinical outcomes between radial artery (RA) and right internal mammary artery (RIMA) grafts used in coronary artery bypass grafting (CABG) over the years 2010-2022.
- A total of 1,674 patients who had multiarterial CABG were analyzed, with 323 patients in each graft group after matching for baseline characteristics.
- The findings indicated no significant differences in immediate postoperative outcomes or long-term survival; however, the RA group showed a higher trend for major adverse cardiac and cerebrovascular events (MACCE) and repeat revascularization after five years compared to the RIMA group.
Midterm Outcomes After Aortic Valve Neocuspidization (Ozaki Procedure) in Adults.
Ann Thorac Surg
April 2024
Background: Trileaflet aortic valve neocuspidization (AVN) using autologous pericardium (Ozaki procedure) is an emerging surgical treatment option for aortic valve diseases. Although excellent results have been reported from Japan, data pertaining to its use in the United States are sparse.
Methods: All adult patients who underwent AVN (AVN group) or surgical aortic valve replacement (SAVR) with a bioprosthetic valve (SAVR group) between 2015 and 2022 were identified.
Article Synopsis
- Multiarterial grafting has advantages, but saphenous vein (SV) grafts are still more commonly used in coronary artery bypass grafting (CABG) despite unclear benefits of radial artery (RA) grafts.
- A study analyzed outcomes from 8,774 CABG patients between 2010 and 2022, comparing those with RA grafts to those with SV grafts, using propensity score matching to balance the cohorts.
- The findings showed no significant difference in immediate complications or long-term survival between the graft types, but patients with SV had a higher rate of freedom from major adverse cardiac and cerebrovascular events (MACCE).
Long-Term Outcomes of Valve-in-Valve Transcatheter Aortic Valve Implantation Versus Redo Surgical Aortic Valve Replacement: Meta-Analysis of Kaplan-Meier-Derived Data.
Am J Cardiol
February 2024
Article Synopsis
- - ViV-TAVI (valve-in-valve transcatheter aortic valve implantation) has emerged as a less invasive alternative to redo surgical aortic valve replacement (SAVR) for patients with failed bioprostheses, and a meta-analysis of 16 studies (4,373 patients) was conducted to compare all-cause mortality between the two procedures.
- - The analysis found that ViV-TAVI had a significantly lower risk of mortality in the first 6 months post-procedure (HR 0.58), but this advantage reversed after 6 months, with redo-SAVR showing better survival (HR 1.92).
- - Key factors influencing outcomes included age and existing heart conditions, and while
Objective: To quantitate the impact of heart donation after circulatory death (DCD) donor utilization on both waitlist and post-transplant outcomes in the United States.
Methods: The United Network for Organ Sharing database was queried to identify all adult waitlisted and transplanted candidates between October 18, 2018, and December 31, 2022. Waitlisted candidates were stratified according to whether they had been approved for donation after brain death (DBD) offers only or also approved for DCD offers.
Valve-in-valve transcatheter aortic valve replacement versus isolated redo surgical aortic valve replacement.
J Thorac Cardiovasc Surg
October 2024
Objective: To compare outcomes of patients undergoing valve-in-valve transcatheter aortic valve replacement (ViV TAVR) versus redo surgical aortic valve replacement (SAVR).
Methods: This was a retrospective study using institutional databases of transcatheter (2013-2022) and surgical (2011-2022) aortic valve replacements. Patients who underwent ViV TAVR were compared with patients who underwent redo isolated SAVR.
Background: Stentless aortic root replacement (ARR) and aortic root enlargement (ARE) are established strategies to avoid prosthesis-patient mismatch in patients with aortic stenosis (AS) and small annuli. We sought to compare outcomes of these 2 procedures.
Methods: This was an observational study using an institutional database of aortic valve replacements from 2010 to 2021.
Outcomes of bovine versus porcine surgical aortic valve replacement.
J Card Surg
December 2022
Introduction: There are no guidelines regarding the use of bovine pericardial or porcine valves for aortic valve replacement, and prior studies have yielded conflicting results. The current study sought to compare short- and long-term outcomes in propensity-matched cohorts of patients undergoing isolated aortic valve replacement (AVR) with bovine versus porcine valves.
Methods: This was a retrospective study utilizing an institutional database of all isolated bioprosthetic surgical aortic valve replacements performed at our center from 2010 to 2020.