Abstract: Objective To compare the midterm patency rates of individual and sequential saphenous vein grafts (SVG) as coronary bypass conduits of offpump coronary artery bypass grafting (OPCAB) and evaluate the impact of the grafting techniques (individual or sequential grafts) on the graft patencyafter OPCAB. Methods The clinical data of 398 patients in General Hospital of the People’s Liberation Army receiving OPCAB with individual and sequential grafts from June 2005 to March 2009 were retrospectively analyzed. There were 301 males and 97 females with their age ranged from 53 to 82 years (63.6±10.3 years). A total of 714 distal coronary anastomoses on 448 SVG were assessed by using 64multislice computed tomography (64MSCTA) at an average of 19.8±23.6 months (3 months to 5 years) after OPCAB procedure. The blood flow of grafts in the proximal segment of individual and sequential SVG and the patency rates of grafts and anastomoses were compared, and the effect of different locations on the patency rate of the anastomoses was analyzed. Results The mean blood flow in double SVG (37.11±16.70 ml/min vs. 25.15±14.24 ml/min, P0.042) and in triple SVG (37.56±19.58 ml/min vs. 25.15±14.24 ml/min, P=0.048) were both significantly higher than the flow in single SVG. The anastomoses on the sequential conduits had better patency (95.1％ vs. 90.1％, P=0.013). The patency of sideto side anastomoses was better than that of endtoside anastomoses (97.0% vs. 93.1%, P=0.002) and that of the individual endtoside anastomoses (97.0% vs. 90.1%, P=0.041). There was no significant difference between distal anastomoses in sequential and those in single grafts (P=0.253). No significant difference was observed between the two methods in regard to the three major coronary systems (including the anterior descending branch, the right coronary artery, and the circumflex branch). However, anastomoses on sequential grafts had superior patency to those on individual grafts in the right coronary system (P=0.008). Conclusion The midterm patency of a sequential SVG conduit after OPCAB is excellent and generally superior to that of an individual one. The best runoff coronary artery should be placed at the distal end and the poor coronary vessels should be arranged in the middle of the grafts.
Abstract: Though the use of the radial artery (RA) as a coronary artery bypass graft has been accepted world widely in myocardial revascularization, there has been no uniformity regarding harvest techniques, assessment of the adequacy of hand collateral circulation, antispasm rotocols, selection of target vessels, and the site of proximal anastomosis. It is widely believed and practiced that the RA should be harvested as a pedicle graft and preferably be used to bypass critically stenosed (gt;70% stenosis) coronary arteries. It is used either as a free graft with proximal anastomosis to the ascending aorta or as a composite arterial graft along with the left or right internal thoracic artery. The patency of RA grafts depends on the severity of the target coronary artery stenosis and target artery location rather than its use as an aortocoronary conduit or composite graft. Though lacking of evidences, most surgeons use antispasm therapy for RA conduits. There are advantages in using RA as an alternative for right internal mammary artery in total artery coronary revascularization.
Objective To investigate the efficacy and safety of tranexamic acid in patients with the age>70 years during off-pump coronary artery bypass grafting (OPCABG). Methods From June 2014 to August 2016, 340 patients undergoing elective OPCABG were included in this study. All the patients were more than 70 years old, among whom 282 were males and 58 were females. According to the random number generation method, the patients were randomly assigned to receive either tranexamic acid (30 mg/kg, infusion time was longer than 30 min after anesthesia induction; n=170) or a placebo (infusion equivalent volume of saline solution; n=170). The primary end point was chest tube drainage 6 h and 24 h postoperatively. The secondary end points were blood transfusion volumes, incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay. Results Compared with patients in the placebo group, the patients receiving tranexamic acid had a significant reduction in chest tube drainage at postoperative 6 h (275.6±105.1 ml vs. 459.6±110.2 ml, P<0.001) and 24 h (685.3±202.5 ml vs. 915.9±223.6 ml, P<0.001). There was also a significant reduction in allogeneic red blood cell transfusion (0.80±0.66 U vs. 1.60±1.30 U, P<0.001) and fresh frozen plasma transfusion (166±25 ml vs. 257±30 ml, P<0.001). There were no significant differences in incidence of various thrombotic events, duration of mechanical ventilation, length of ICU and hospital stay between the two groups. Conclusion Tranexamic acid can significantly reduce blood loss and transfusion in elderly patients 6 h and 24 h after OPCABG and the incidence of thrombotic events will not increase.
Abstract: Coronary artery bypass grafting (CABG) has become more and more popular, but how to decrease the thrombotic stenosis of saphenous vein grafts remains a tough problem clinically. Some researchers raised that aspirin resistance (AR) may be one of the most principal causes of graft thrombus and many correlative studies have been reported in recent years．In this article, we reviewed and analyzed the concept and evaluation criterion, incidence rate, mechanisms, clinic significance, and preventing strategy of AR, expecting to deepen the understanding of AR and help to optimize the antiplatelet therapy for postCABG patients with AR.
Objective To investigate the risk factors of perioperative red blood cells transfusion for coronary artery bypass grafting (CABG) surgery. Method We retrospectively analyzed the clinical data of 534 patients underwent CABG in our hospital from January to March 2014 year. Those patients were divided into two groups:an on-pump coronary artery bypass grafting group (on-pump group) and an off-pump coronary artery bypass grafting group (off-pump group). There were 185 males and 54 females with a mean age of 59.1±9.4 years in the on-pump group. There were 233 males and 62 females with a mean age of 60.3±8.5 years in the off-pump group. Preoperative data, the relative parameters of extracorporeal circulation, the quantity of red blood cells transfusion of those two groups were compared. risk factors associated with red blood cells transfusion were evaluated by multivariate logistic regression analysis. Results The risk factors of perioperative red blood cells transfusion were age (OR=1.04, 95% CI 1.02-1.07, P=0.001) , weight (OR=0.95, 95% CI 0.93-0.97, P<0.001) , smoking (OR=0.61, 95% CI 0.39-0.94, P=0.027) , preoperative level of HCT (OR=0.90, 95% CI 0.85-0.96, P=0.001) and cardiopulmonary bypass (CPB) (OR=4.90, 95% CI 3.11-7.71, P<0.001) . During CPB, the nadir hemoglobin (nHb) (OR=0.63, 95% CI 0.47-0.84, P=0.002) was the only independent risk factor of red blood cell transfusion. Conclusions Age, weight, non-smoking, preoperative level of HCT, CPB are the risk factors for patients underwent CABG perioperatively and the lowest level of Hb in CPB is an independent risk factor of perioperative red blood cells transfusion.
Objective To analyse the characteristic of hemodynamic changes during off-pump coronary artery bypass grafting （OPCAB）. Methods One hundred consecutive patients received OPCAB and the hemodynamic changes were monitored during the grafts was anastomosed. They were anastomosis of the left internal mammary artery （LIMA） to left anterior descending （LAD） in 97 patients, the anastomosis of saphenous vein （SV） or radial artery（RA） to right coronary artery （RCA） including posterior descending artery （PDA） and posterior left branch （PLB） in 84 patients, to left circumflex coronary artery （LCX） in 50 patients, to optuse marginal artery（OM） in 27 patients, to diagonal artery （DG） in 25 patients. The grafts number in each patient was 3. 1±0. 7. Results Hemodynamics changed when LAD and DG were anastomosed with significantly increase of heart rate （HR）, significantly decrease of mean arterial pressure （MAP） and left ventricular stroke work index （LVSWI, P〈0.05）. Hemodynamics changed when LCX,PDA,PLB,OM were anastomosed with significantly increase of HR and center veinous pressure （CVP, P 〈 0. 05）, significantly decrease of MAP, cardiac index （CI）, stroke index （SI）, right ventricular ejection fraction （RVEF）, right ventricular end-diastolic volume （RVEDV）, LVSWI and right ventricular stroke work index （RVSWI,P〈0.05）. Hemodynamics tended to be stable and CI improved at the end of operation. Conclusion There are no or little hemodynamic changes during the LAD and DG were anastomosed in OPCAB, while hemodynamics changed significantly during LCX, PDA, PLB and OM were anastomosed. Hemodynamics become stable and CI improves after operation.
Objective To summarize the experiences of surgical treatment for post infarction ventricular aneurysm and mi tral regurgitation， thus to improve surgical curative effect and survival rates . Clinical data of 37 patients with myocardial infarction complicated with ven tricular aneurysm and severer than moderate mitral regurgitation were retrospectively an alyzed between December 2000 and June 2007, all 37 patients underwent coron ary artery bypass grafting and reconstruction of left ventricular after aneurysm resection, mitral valve repair or replacement. Results Three patients died during hospital stay after surgery,mortality rate was 81%, of th em two died in renal failure, one died in brain complications.Thirty patients we re followed up, followup rate was 88.2%(30/34), with 4 patients missed. Follow up time ranged from 1 month to 6 years after surgery, 2 patients died in foll o wup period, of them one died in anticoagulant treatment failure complicated w ith the large cerebral infarction, one died of lung infection and heart failure. The inner diameter of le ft atrium and enddiastolic left ventricle reduced obviously than those before operation （30.1±3.5mm vs.39.3±3.7mm, P=0.004;48.4±4.3mm vs.61.2±5.1mm, P=0.003）by color doppler echocardiography examination at 6th month a fter su rgery.There was no obvious change in size of untouched ventricular aneurysm(diam eterlt;5cm). No regurgitation or slight regurgitation were observed in 12 patient s, mild regurgitation was observed in 2 patients and moderate in 1 patients. Conclusion According to different types of post infarctio n ventricular aneurysm and mitral regurgitation, constitution o f different surgical treatment programs, can result in favorable early and long-term curative effect. There’s marked improvement in most patients’cardiac f unction and survival rate.
Objective To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P＞0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P＞0.05). ConclusionReasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.