ObjectiveTo analyze clinical outcomes of coronary artery bypass grafting (CABG) without concomitant surgical ventricular restoration (SVR) for patients with coronary artery disease (CHD) and left ventricular aneurysm (LVA). MethodsA total of 105 patients with CHD and LVA underwent surgical treatment in Wuhan Asia Heart Hospital from January 2008 to December 2012. Among them,74 patients were found to have no clear boundary LVA,poor wall motion or no obvious contradictory wall motion during surgical exploration,and didn't received SVR,including 59 male and 15 female patients with their age of 60.96±9.09 years. Coronary angiography showed 5 patients with single-vessel disease,10 patients with double-vessel disease,45 patients with triple-vessel disease,and 14 patients with left main and triple vessel disease. Intraoperative findings showed no clear boundary LVA in 30 patients,apical thinning without obvious LVA in 29 patients,LVA without obvious contradictory wall motion but thickening of the apex in 15 patients. All the 74 patients received CABG including 62 patients undergoing on-pump CABG and 12 patients undergoing off-pump CABG. Seventy patients received left internal mammary artery to left anterior descending anastomosis,and 2 patients received endarterectomy of the left anterior descending coronary artery. For moderate to severe mitral regurgitation,3 patients received concomitant mitral valvuloplasty,and 2 patients received concomitant mitral valve replacement. One patient received concomitant aortic valve replacement for severe aortic stenosis. ResultsPostoperatively,2 patients (2.7%) died of malignant arrhythmia and hypoxic ischemic encephalopathy respectively. Six patients received intra-aortic balloon pump (IABP) support for low cardiac output syndrome,perioperative myocardial infarction and malignant arrhythmias. Seventy patients were followed up after discharge for 24-60 (43±12) months. During follow-up,left ventricular thrombus was found in 8 patients,disappeared within 1 year after warfarin treatment in 5 patients,and no thromboembolic event happened. Echocardiogram showed that LVA disappeared in 18 patients (25.7%). Ejection fraction (EF) at discharge,6 months and 1 years after discharge were significantly higher than preoperative EF (EF at 6 months after discharge versus preoperative EF:44%±6% vs. 39%±5%). Left ventricular end-diastolic diameter (LVEDD,LVEDD at 6 months after discharge versus preoperative LVEDD:54.37±6.28 mm vs. 59.24±6.24 mm) and left ventricular end-systolic diameter (LVESD) were significantly reduced compared with preoperative values (P<0.01). But as time went by,LVEDD and LVESD gradually became larger than those values at discharge. ConclusionFor patients with CHD and LVA,CABG without SVR,which is decided according to actual surgical exploration,can significantly improve postoperative EF,LVEDD and LVESD,but left ventricular enlargement may happen progressively after discharge.
Objective To explore the factors affecting the operation of coronary artery bypass grafting with heart beating and improve the effect of the operation. MethodsFrom January 2012 to June 2016, 898 patients with coronary heart disease who received cardiovascular surgery in the Second Affiliated Hospital of Jilin University were analyzed retrospectively. All patients only underwent coronary artery bypass grafting with beating heart. Among them, 797 patients underwent the off-pump coronary artery bypass grafting (an OPCABG group, 592 males and 205 females, with an average age of 60.5±8.4 years); another 101 patients received on-pump beating heart coronary artery bypass grafting (an OPBH group, 77 males and 24 females, with an average age of 61.5±8.2 years). ResultsThe average number of grafts in the OPCABG group was 3.36±0.74, and in the OPBH group was 3.71±0.69 (P<0.05). The postoperative ventilation time (10.8±9.5 h vs. 20.6±12.3 h), ICU stay (28.8±15.5 h vs. 37.4±30.8 h), hospital stay (10.9±4.8 d vs. 14.8±8.6 d), mortality (1.1% vs. 3.0%), the utilization rate of intra-aortic balloon pump (2.4% vs. 8.9%) and extracorporeal membrane oxygenation (0.5% vs. 5.0%) were significantly different between the OPCABG group and OPBH group (all P<0.05). Twelve patients died after surgery, and the total bloodless operation ratio was 91.3%. ConclusionThe results show that most patients can achieve good results with the help of apical fixation and myocardial fixator, improved surgical techniques and methods, good anesthesia management as well as flexible and accurate use of vasoactive drugs. But extracorporeal circulation is necessary in the patients with large left ventricle, low ejection fraction and hemodynamic instability after intraoperatively moving the heart.
Objective To investigate the 30-day mortality risk factors in elderly patients (≥70 years) with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024. Simple random sampling in R was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic stepwise regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. ResultsA total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training cohort, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression with stepwise selection, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065–11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269–67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057–46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997–6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000–2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: training set AUC was 0.898 (95%CI 0.831–0.966); validation set AUC 0.912 (95%CI 0.805–1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.
Coronary artery bypass grafting has made great progress in recent years. Off-pump coronary artery bypass grafting （off-pump） can escape from many complications resulting from cardiopulmonary bypass which powered the interest of more and more surgeons, but it is more technically demanding. Conventional coronary artery bypass grafting aided by cardiopulmonary bypass （on-pump） can provide with good condition for anastomosis, and is still applied widely. The comparation of the two surgical techniques were reviewed, including graft patency, mortality, inflammatory response, influence on coagulation and anticoagulation, injury to important organs, hospital length of stay and cost, technical convertion, et al.
目的总结分析经左胸微创冠状动脉旁路移植术（MIDCAB）与经皮冠状动脉介入治疗（PCI）联合应用治疗冠状动脉多支血管病变的初步临床经验。 方法回顾性分析郑州市第七人民医院2013年1月至2014年11月共16例多支冠状动脉病变冠心病患者的临床资料，其中男10例、女6例，年龄46～73（58.4±9.7）岁，采用“分站式”复合技术（Hybrid）进行心肌再血管化。 结果16例患者手术均顺利完成，无围手术期死亡，PCI时行冠状动脉造影提示冠状动脉吻合口通畅，随访3～22（14.0±8.6）个月，临床症状缓解，恢复正常工作及生活。 结论“分站式”复合技术治疗冠状动脉多支血管病变近期效果满意，长期效果有待进一步随访。
ObjectiveTo compare clinical outcomes between coronary artery bypass grafting (CABG)and off-pump coronary artery bypass grafting (OPCAB)for high-risk coronary artery disease (CAD)patients with high European System for Cardiac Operative Risk Evaluation (EuroSCORE). MethodsA total of 211 CAD patients undergoing surgical treatment in the Department of Cardiovascular Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University from June 2007 to July 2013 were enrolled into this study, including 52 patients receiving CABG and 159 patients receiving OPCAB. Predicted risk of operative mortality (PROM)of each patient was calculated by EuroSCORE. Patients with PROM≥6 were stratified into high-risk subgroups. Clinical outcomes were compared between CABG and OPCAB patients, as well as incidence of cardiovascular events, angina and stroke within 30 postoperative days in high-risk subgroup patients. ResultsOPCAB and CABG group patients had similar left main disease. There was no statistical difference in the number of distal anastomosis between OPCAB (2.75±0.82)and CABG group patients (2.83±0.58) (P > 0.05). Operation time[ (3.92±0.79)hour vs. (6.83±1.53)hour], thoracic drainage[ (983.14±802.39)ml vs. (1 620.40±879.32)ml], blood transfusion[ (1 289.30±668.08)ml vs. (2 325.30±491.98)ml], length of ICU stay[ (3.90±1.33)days vs. (5.08±1.78)days], and mechanical ventilation time[ (9.63±3.32)h vs. (13.76±3.79)h] of OPCAB group patients were significantly shorter or lower than those of CABG group patients (P < 0.05). There was no statistical difference in 30-day mortality between OPCAB and CABG group patients (1.26% vs. 3.85%, P > 0.05). Among high-risk subgroup patients, the odds ratio of stroke within 30 postoperative days in CABG was 5.7 (95%CI 1.28-25.09, P < 0.05)compared with OPCAB group patients, and the incidence of cardiovascular events and angina within 30 postoperative days were similar between the 2 subgroups. ConclusionsPostoperative mortality and number of distal anastomosis are not significantly different between CABG and OPCAB patients, but OPCAB can significantly reduce operation time, thoracic drainage, blood transfusion, length of ICU stay and mechanical ventilation time compared with CABG. For high-risk patients with high EuroSCORE, OPCAB can better reduce the incidence of postoperative stroke compared with CABG.
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.
Minimally invasive cardiac surgeries are the trend in the future. Among them, robotic cardiac surgery is the latest iteration with several key-hole incision, 3-dimentional visualization, and articulated instrumentation of 7 degree of ergonomic freedom for those complex procedures in the heart. In particular, robotic mitral valve surgery, as well as coronary artery bypass grafting, has evolved over the last decade and become the preferred method at certain specialized centers worldwide because of excellent results. Other cardiac procedures are in various stages of evolution. Stepwise innovation of robotic technology will continue to make robotic operations simpler, more efficient, and less invasive, which will encourage more surgeons to take up this technology and extend the benefits of robotic surgery to a larger patient population.
Objective To investigate the relationship between miR-3187-5p in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and postoperative atrial fibrillation (POAF). Methods Patients who underwent CABG in the Heart Center of Beijing Chao-Yang Hospital from March to May 2022 were enrolled. Peripheral blood and pericardial drainage were collected at 0 h after surgery (immediate time for patients to return to ICU from operating room) to detect miR-3187-5p, and perioperative confounding factors were also collected. The miR-3187-5p was measured by quantitative real-time PCR and its regulated target genes were analyzed by bioinformatics. Results A total of 15 patients were enrolled, including 9 males and 6 females with an average age of 65.6±8.2 years. The incidence rate of POAF was 40.0%. miR-3187-5p in pericardial drainage at 0 h after surgery was an independent predictor for POAF. A total of 1 642 target genes of miR-3187-5p were predicted. GO function enrichment analysis and KEGG signal pathway enrichment analysis showed that target genes of miR-3187-5p were enriched in TGF-β, MAPK, Wnt and other classical collagen metabolic signal pathways, which might activate collagen metabolism by negatively regulating SMAD6 and other inhibitors of the pathways. Conclusion This study is the first to find that miR-3187-5p in pericardial drainage at 0 h after surgery is a potential, novel, and predictive factor for POAF, which may be related to the regulation of myocardial fibrosis signal pathways like TGF-β, MAPK and Wnt pathways, promoting the early collagen metabolism imbalance after CABG, increasing the collagen deposition in the atrium, and then promoting the early structural reconstruction after CABG and leading to the occurrence of POAF. The result provides a research basis for the accurate prediction and prevention of clinical POAF.