[Special Series on Distinguished Doctors]
① Pioneer of heart surgery: Professor Kim Ki-bong of Myongji Hospital
'Treat your patients as your family, and never stop study'
Cardiothoracic surgery has become one of the departments to avoid among medical students due mainly to difficult surgeries and long hours.
“In the late 1970s, when I was a medical student, we seemed to make less calculating approaches,” said Professor Kim Ki-bong of Myongji Hospital in a recent interview with Korea Biomedical Review. “I chose to become a cardiothoracic surgeon after witnessing the miracles that only heart surgery can bring.”
Kim recollected that he saw many children suffering from cyanotic congenital heart disease whose faces were blue and couldn't move well due to the disease. "After surgery, however, their symptoms immediately improved, and their faces quickly turned red," he said. "Watching such a dramatic effect, I decided to choose cardiothoracic surgery as my specialty."
Professor Kim Ki-bong, director of the Cardiovascular Center at Myongji Hospital in Goyang, north of Seoul, speaks about his long experiences as one of the nation’s most renowned cardiothoracic surgeons during a recent interview with Korea Biomedical Review at his office in the hospital.
Since then, Professor Kim has made major strides in advancing Korea's heart surgery and heart transplantation field at Seoul National University Hospital over the past three decades.
Kim has accomplished numerous landmark surgeries throughout his career. In 1994, he conducted Korea's second heart transplantation which was the first successful long-distance heart transplantation. And he also performed the longest-distance heart transplantation in 1995. However, Kim's most notable accomplishment was his dedication to advancing Off-Pump Coronary Artery Bypass grafting (OPCAB) surgery in Korea.
OPCAB surgery is a form of Coronary Artery Bypass Grafting (CABG) surgery performed on the beating heart without cardiopulmonary bypass (heart-lung machine) to treat coronary heart diseases.
Kim's fame is not confined to Korea, as he holds the biggest database in the world on coronary angiography for patients that have undergone OPCAB surgery.
"When I first conducted the OPCAB surgery in 1998, I was worried about the possibility of the surgery going wrong as I had to conduct anastomosis in a moving heart," he said. "Therefore, the day after the OPCAB surgery, I decided to perform a coronary angiography to confirm if the anastomosis of the blood vessels had been done correctly."
While there was a method of confirming the anastomosis of blood vessels with an ultrasound during the operation, it could not accurately determine the blood vessels' anastomosis.
"Therefore, we had to transport the patient from the intensive care unit to the angiography room," he said. "This was a very difficult procedure as the patient was still recovering from the surgery, and they had many medical devices attached to their bodies."
However, Kim decided to conduct at least 100 cases of coronary angiography to learn more about the surgery outcome and improve his technique.
"The funny thing is that while I had initially decided to conduct only 100 cases, I ended up collecting data from nearly 3,500 cases during the past 20 years," he said. "No one in this world has this kind of data."
Kim noted that such data is unique as although there are many data on surgery results worldwide, no one has this much data on coronary angiography after OPCAB.
"Seoul National University Hospital conducts about 150 cases of CABG-related surgeries a year," Kim said. "This is far smaller than those done by hospitals in the U.S. where conduct over 1,000 CABG-related surgeries a year. Some Chinese hospitals even carry out 6,000 such surgeries a year.
Asked why Korea has such a fewer number of CABG-related surgeries, Kim explained that Korea has fewer patients due to a smaller population, a diet that does not involve too many greasy foods, and very aggressive cardiologists performing percutaneous interventions.
"Because of the vast database for postoperative coronary angiography I have, foreign institutions still ask me to give lectures," he said.
Pioneer in the field of OPCAB
Traditionally, hospitals conducted a CABG surgery that would stop the patient's heart with a cardiopulmonary device during bypass surgeries. In such cases, however, there was a possibility that the surgical result may worsen due to complications. Therefore, Professor Kim noted the need for a new operating procedure that could reduce such complications by preventing side effects of artificial cardiopulmonary devices and stopping the heart during surgery.
"CABG is a procedure in which surgeons use an anastomosis technique to connect new bloods into blocked cardiac small-sized vessels to allow blood to pass through," Kim said. "However, despite the use of various surgical techniques, the mortality rate or complication rate did not drop anymore when conducting CABG surgery, and I felt like there were certain limitations for the surgery method."
Kim then turned to OPCAB as an alternative and safer way of conducting bypass surgeries, as the method did not stop the heart during surgeries, leading to almost no reduction in the patients' blood flow and heart function due to surgery.
"OPCAB surgery had been conducted worldwide since the early 1990s, but it was not used much due to the disadvantage of operating on a moving heart," Kim said. "Because the cardiac blood vessels are about 2mm in diameter, and it was not easy to anastomosis the vessel while the heart was moving."
The surgery method regained popularity in the late 1990s after medical device makers started developing and commercializing devices that fixed blood vessels to the moving heart, he added.
However, such devices were not available in Korea, which meant it was difficult for Kim to perform the surgery.
An unexpected solution came when Doctor Kwon Ki-hong, alumni of SNUH who had been practicing cardiac surgery in the U.S. and had participated in developing devices that locally fixed blood vessels to the moving heart, visited Korea in 1997.
"Doctor Kwon brought with him a few devices that he had helped commercialize and taught me a new operation method using the device and explained the merits of this surgical technique," Kim said.
"When he returned to the U.S., he gave me the tools that he had brought with him."
Using this device and method, Kim became the first cardiac surgeon to conduct OPCAB surgery in Korea in 1998 successfully.
"The OPCAB surgery method only accounted for 50 percent of all CABG surgeries during the initial period, but it now represents about 99.9 percent of my CABG surgeries," Kim said. "The worse the patient's condition, the greater the advantage of OPCAB surgery grows."
Regarding the positive attributes of OPCAB surgery, Kim stressed that OPCAB could overcome many possible side effects under CABG surgery using an artificial cardiopulmonary system.
"Using an artificial cardiopulmonary system has the advantage of making it easier to operate as it empties the heart. Since the artificial cardiopulmonary system itself circulates the blood, however, it can also increase the risk of blood breakage, infection, and stroke," he said. "Also, when the heart stops, the heart function can deteriorate."
OPCAB surgery can reduce such side effects, Kim added.
Kim explained that although OPCAB also has some drawbacks as physicians have to perform anastomosis in a blood vessel with a width of 1.5-2 mm in a moving heart, such shortcomings can be overcome by experience and using ultrasound to see if the anastomosis was correct during the operation.
Professor Kim’s success was a major breakthrough in Korea's cardiac surgery, but he continued to sharpen his craft to near perfection. By the time he retired from SNUH in 2021, Kim had conducted more than 3,500 OPCAB surgeries and published about 80 academic peer-reviewed journals related to the OPCAB surgery method.
A new start at Myongji Hospital
After retiring from SNUH earlier this year, Kim started working as the director of the Cardiovascular Center at Myongji Hospital in Gyoang, north of Seoul, in March.
Kim said that his move to Myongji Hospital was an easy choice as he wants to make Myongji Hospital a “mecca” of heart surgery outside of Seoul.
"Seoul is expanding to the outskirts, and the population of the northwestern region of Gyeonggi Province, where Myongji Hospital is located, has grown almost close a million," Kim said. "While there are several hospitals in this area of the same size as Myongji Hospital, to my knowledge, none of them actively perform heart surgery."
Therefore, many patients go to the capital city to receive treatment, he added.
However, Kim believes that if a hospital can derive reliable surgical results in Gyeonggi Province, it can greatly increase convenience for patients living in the area.
"I believe Myongji Hospital will be able to play a significant role in achieving such goals," he said.
Kim is devising a one-stop program that starts with diagnosing the patient, finding a suitable treatment option for each patient, and providing rehabilitation programs for patients after surgery.
Kim advised young doctors working at university hospitals to study ceaselessly and present their results in academic journals.
"University hospital doctors are academic surgeons, and they should never keep on repeating the same treatment over and over again," he said. "To keep pace with rapidly changing medicine, surgeries and treatments must also develop."
Even if the mortality rate of surgery is only 1 percent, doctors should not forget that if 5,000 operations are performed, the lives of 50 people are in danger, he added.
Therefore, Kim recommended young physicians write a journal based on their surgical outcomes or treatment results.
"Writing academic journals provides doctors with lots of opportunities for them to grow technically as a surgeon," he said. "I, too, was able to change and improve my surgical method after reading a single line from a different journal while writing my thesis."
Kim noted that he believes that a surgeon working in a university hospital who does not write any academic journals should not be entitled to research at a university hospital.
He also advised young doctors to put patients ahead of diseases.
"When treating patients, doctors can sometimes lose sight of the patient and only focus on the disease itself. However, this is not good for both the patient and the doctor," Kim said. "Therefore, I sometimes scold my resident doctors and ask them if they would have conducted the same practice if the patient was their family member."
If doctors think of the patient like family, the treatment results will always be better, he added.
Asked about his most memorable patients, Kim said that he mainly remembers those who died or had complications despite having undergone difficult surgery rather than those who made a full recovery.
"I have spent the last 30 years thinking about surgeries to reduce the number of such patients," Kim said.
When asked about what makes a physician such an attractive job, Professor Kim pointed out that there are not so many professions where people hear words of appreciation for just doing their jobs.
"I think that's the biggest attraction of the profession as a doctor is that you receive a warm 'thank you' from the patients you helped cure."
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