Abstract: Objective To explore the inhospital mortalityrelated risk factors in the patients undergoing offpump coronary artery bypass grafting (OPCAB). Methods We retrospectively analyzed the clinical data of 215 patients undergoing OPCAB in our hospital from November 2007 to November 2008. There were 171 males and 44 females aged between 40 and 85 years old. Among them, there were 47 patients older than 70 years old. All of them were coronary artery disease (CAD) patients with triple vessel disease. We adopted univarialble analysis and logistic multivariable regression analysis to screen the risk factors for the mortality of OPCAB. Results Six patients died in hospital after OPCAB with a mortality rate of 2.79% (6/215). No renal dysfunction or respiratory failure occurred. The rate of reoperation for bleeding was 4.65% (10/215) and all the 10 patients having undergone reoperation were alive. A total of 209 patients were all alive after 1year follow-up. The results of logistic multivariable regression analysis showed that New York Heart Association (NYHA) Ⅲ and Ⅳ heart function (OR=42.116，95% CI 3.319 to 534.465，P=0.004) and mechanical ventilation duration (OR=1.007，95%CI 1.001 to 1.013，P=0.028) were independent risk factors for inhospital mortality of OPCAB. Conclusion OPCAB is an effective and safe treatment for CAD with triple vessel disease. NYHA Ⅲ and Ⅳ heart function and mechanical ventilation time after OPCAB are the risk factors for OPCAB inhospital mortality, yet, needs further study with large sample.
ObjectiveTo investigate the safety and effectiveness of minimally invasive coronary artery bypass grafting (MICABG) through comparing the perioperative clinical effects of conventional surgery and MICABG.MethodsA total of 543 patients in the single medical group of Beijing Anzhen Hospital who underwent beating coronary artery bypass grafting from January 2017 to September 2020 were collected, including 161 patients receiving MICABG (a minimally invasive group, 143 males and 18 females, aged 60.08±9.21 years), 382 patients receiving median thoracotomy (a conventional group, 284 males and 98 females, aged 61.68±8.81 years). The propensity score was used to match 143 patients in each of the two groups, and the perioperative data of the two groups were summarized and analyzed.ResultsThere was no death, perioperative myocardial infarction or stroke in the minimally invasive group. Compared with the conventional group, the minimally invasive group had longer operation time (296.36±89.4 min vs. 217.80±50.63 min, P=0.000), less number of bypass grafts (2.86±1.03 vs. 3.17±0.78, P=0.005), shorter postoperative hospital stay (6.29±1.46 d vs. 6.78±2.61 d, P=0.031), less drainage on postoperative day 1 (339.57±180.63 mL vs. 441.92±262.63 mL, P=0.001) and lower usage rate of inotropic drugs (9.09% vs. 26.57%, P=0.001). There was no statistical difference between the two groups in postoperative ICU stay ventilator assistance time, blood transfusion rate, secondary thoracotomy rate, or use of mechanical equipment.ConclusionReasonable clinical strategies can ensure the satisfactory overall safety of MICABG. In addition, it has the advantages of shorter postoperative hospital stay, less bleeding and smaller dosage of inotropic drugs.
ObjectiveTo investigate predictive value of intraoperative graft flow measurements during off-pump coronary artery bypass grafting (OPCAB) for early clinical prognosis. MethodsWe retrospectively analyzed the clinical data of 133 patients with three-vessel disease who underwent OPCAB in the Department of Cardiac Surgery of People's Hospital of Peking University in 2013 year. There were 103 males and 30 females with mean age of 62.84±7.13 years. Pulsatility index (PI) and mean flow were measured using a flow metre before the end of surgery. Then the total graft flow and the average graft flow were calculated. Univariate, bivariate correlation and logistic regression analysis were performed for statistical analysis. ResultsThe blood flow and PI of LIMA-to-LAD graft was respectively 28.69±16.90 ml/min and 2.70±1.39, and the total graft flow and the average graft flow was respectively 79.94±37.20 ml/min and 35.55±16.75 ml/min. The PI of LIMA-to-LAD graft was significantly correlated with serum cardiac troponin I(cTnI)level in 12 hours, with the highest serum cTnI level within 48 hours, with ICU stay and with ventilator time (P<0.01), but the correlation was not strong(coefficient correlation <0.4). Compared with the patients without perioperative myocardial infarction (PMI), the blood flow of LIMA-to-LAD graft, the total graft flow and the average graft flow were lower in the patients with PMI (P<0.01). Logistic regression analysis revealed that the total graft flow was an independent predictor of PMI (P=0.004, RR=0.950, 95%CI 0.918-0.984). ConclusionIntraoperative graft flow measurements during OPCAB can predict shortterm prognosis. The lower total graft flow is a risk factor for PMI.
ObjectiveTo explore the difference of myocardial injury between off-pump coronary artery bypass grafting (OPCAB) and modified perfusion on-pump coronary artery bypass grafting (ONCAB).MethodsA total of 558 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from 2017 to 2019 were included. According to whether or not they received modified perfusion cardiopulmonary bypass, all the 558 patients were divided into two groups including an OPCAB group (OP group) and an ONCAB group (ON group). There were 465 patients in the OP group including 282 males and 183 females with an average age of 63.58±7.87 years. In the ON group, there were 93 patients including 64 males and 29 females with an average age of 63.91±7.51 years. Creatine kinase MB (CK-MB) and cardiac specific troponin I (cTnI) were measured 24 hours before operation, 30 minutes after operation, 12 hours after operation, 36 hours after operation and 48 hours after operation.ResultsNo perioperative death occurred in all patients. CK-MB (5.00 ng/mL vs. 8.60 ng/mL, Z=–2.189, P=0.029) and cTnI (3.00 ng/mL vs. 7.80 ng/mL, Z=–5.307, P=0.000) in postoperative 12 hours in the ON group were less than those in the OP group. CK-MB (5.00 ng/mL vs. 5.60 ng/mL, Z=–2.280, P=0.023) and cTnI (0.10 ng/mL vs. 1.02 ng/mL, Z=–6.418, P=0.000) in postoperative 36 hours in the ON group were less than those in the OP group. cTnI (0.07 ng/mL vs. 0.81 ng/mL, Z=–1.946, P=0.032) in postoperative 48 hours in the ON group was less than that in the OP group.ConclusionCompared with OPCAB, modified perfusion ONCAB has less myocardial damage.
ObjectiveTo investigate the perioperative hemodynamic changes of off-pump coronary artery bypass grafting (OPCABG) patients monitored by pulse recorded analysis method (MostCare/PRAM devices) and its relationship with the prognosis.MethodsA total of 89 patients who underwent OPCABG from October 2016 to January 2017 in Beiijng Anzhen Hospital were included, including 53 males and 36 females aged 60.50±8.40 years. The hemodynamic changes were recorded. The patients were divided into two groups (a major adverse cardiovascular events group and a stable group) according to whether major adverse cardiovascular events occurred or not. The difference of hemodynamic changes between the two groups was analysed.ResultsThe mean percentage increases of stroke volume (SV) in the passive leg raising (PLR) test before opening chest and after chest closure were 23.00%±3.20% and 29.40%±3.70%, respectively. Hemodynamic data were analysed seven times, namely, anaesthesia, opening chest, heparin administration, coronary artery bypass grafting, protamine administration, thoracic closure and after operation. SV was significantly decreased during above periods, while systemic vascular resistance index (SVRI) was significantlyincreased. Cardiac circle efficiency (CCE) and maximum pressure gradient (dP/dT) were decreased after anaesthesia, and decreased to the lowest value during the procedure of bypass grafting, and then they began to increase gradually after the manipulation of bypass grafting was finished. Stroke volume variation (SVV) and pulse pressure variation (PPV) were slightly decreased during anaesthesia, then increased significantly through the whole surgery. Major adverse cardiovascular events occurred in 9 patients and 4 of them died. The basic mean values of SVRI, SVV and PPV of patients in the major adverse cardiovascular events group before opening chest were significantly higher than those of patients in the stable group. There was no significant difference in the mean values of CCE, dP/dT or SV between the two groups. There was no significant correlation between the prognosis and the mean values of SVRI, SVV, PPV, CCE, dP/dT or SV.ConclusionThe hemodynamic indexes are not stable, thus, it is necessary to monitor the perioperative hemodynamic changes of OPCABG patients timely by MostCare/PRAM device and adjust treatment measures accordingly.
Objective To investigate the use of intraoperative transit time flow measurement （TTFM） to accuratelyevaluate graft patency during sequential coronary artery bypass grafting （CABG）. Methods Clinical data of 131 patientsundergoing sequential off-pump coronary artery bypass grafting （OPCAB） with the great saphenous vein （with or without internal mammary artery） as graft vessels in Beijing Anzhen Hospital from April 2012 to January 2013 were retrospectivelyanalyzed. There were 92 male and 39 female patients with their age of 61.35±8.24 years. During the operation，2 methods were used to measure mean blood flow volume，pulsatility index （PI） and diastolic filling （DF） of the graft vessels. For thenon-blocking method，blood flow in graft vessels was maintained，and TTFM was applied 2 cm proximal to the anastomoticsite in graft vessels to record above parameters. For the blocking method，blood flow in graft vessels was temporally blockedby clipping distal graft vessels with an atraumatic bulldog clamp，and TTFM was applied 2 cm proximal to the anastomotic site in graft vessels to record above parameters. Results Blood flow volumes of the diagonal branch （27.43±15.22 ml/minvs. 59.28±30.13 ml/min），obtuse marginal branch （26.14±19.74 ml/min vs. 47.19±24.27 ml/min） and posterior left ventr-icular branch （19.16±8.92 ml/min vs. 38.83±20.11 ml/min） measured by the blocking method were significantly smallerthan those measured by the non-blocking method （P＜0.05） . PI values of the diagonal branch （2.93±1.30 vs. 2.31±0.91），obtuse marginal branch （2.62±1.17 vs. 2.01±0.87） and posterior left ventricular branch （2.33±0.92 vs. 1.80±0.73） meas-ured by the blocking method were significantly higher than those measured by the non-blocking method （P＜0.05）. There was no statistical difference in DF values measured by 2 methods at respective anastomotic sites，and all DF values were higher than 50%. Non-blocking method identified 1 anastomotic site and blocking method identified 3 anastomotic sites that were not patent，and these anastomotic sites became patent after graft reconstruction. Conclusion Blood flow velocity of sequential grafts is higher than that of single grafts，indicating that sequential grafts have the advantages of high blood flow volume and low risk of thrombosis. Blocking method can more accurately evaluate graft patency at the anastomotic sites and sensitively identify graft vessels that are not patent，which is helpful for anastomotic site reconstruction in time and enhancement of successful rate of CABG.
Objective To evaluate the clinical efficacy of coronary artery bypass grafting in the treatment of coronary artery disease patients aged over 70 years. Methods A total of 160 patients with coronary atherosclerotic heart disease underwent off-pump coronary artery bypass grafting from January 2013 to December 2017. There were 94 males and 66 females at age of 70–85 (76.67±2.33) years. Operations were performed by using sternal median incision with the assistance of local myocardial surface fixator and shunt plug, and the saphenous vein and internal mammary arterywere used as grafted vessels. Results All the patients were received successful off-pump coronary artery bypass grafting without death, and the cardiac function improved significantly. There were 62 patients with the internal mammary artery bridge and 98 patients with the whole vein bridge. All the patients were followed-up for 1 to 4 years. All the patients had obvious relief of angina pectoris. Conclusion Off-pump coronary artery bypass grafting for the treatment of elderly patients with coronary heart disease is an effective and safe operation, especially for patients with renal insufficiency, cerebrovascular disease, respiratory disease and severe left ventricular dysfunction.
Patients undergoing coronary artery bypass grafting (CABG) belong to the very high-risk group of atherosclerotic cardiovascular disease. Although CABG gets advantages in relieving symptoms and improving long-term outcomes, a significant risk of cardiovascular adverse events after surgery still exists and standardized secondary prevention is needed. Lipid management plays a critical role as a secondary preventive strategy in CABG. However, lipid management of CABG patients in real clinical setting is inadequate, including lack of standardized lipid-lowering strategy, low goal attainment rate, as well as poor long-term medication adherence. In recent years, a series of clinical trials have provided a lot of groundbreaking new evidence for lipid management in patients with cardiovascular diseases which offers new strategies together with objectives of lipid-lowering and comprehensive management for patients undergoing CABG. This article reviews the strategy and research progress of lipid management after CABG, aiming to provide objective reference for clinical treatment.
ObjectiveTo summarize the clinical feature and treatment experience of patients with acute type A aortic dissection involving coronary arteries.MethodsThe clinical data of 107 patients with acute type A aortic dissection involving coronary arteries, who received operation between June 5, 2012 and December 31, 2019 in our hospital, were analyzed retrospectively. There were 80 males and 27 females at age of 24-83 (49.8±11.2) years.ResultsThe right coronary artery was involved in 65 patients, the left in 17 patients, and both coronary arteries in 25 patients. There were 48 (44.9%) patients undergoing coronary artery bypass grafting, 49 (45.8%) patients undergoing coronary artery plasty. Fifteen patients died 30 d after the operation, with a mortality rate of 14.0%. Patients with preoperative cardiogenic shock and postoperative acute renal failure had increased risk of death (P<0.05). Eighty-two (88.2%) patients were followed up for 2 to 71 months, and 1 patient had sudden cardiac death during the follow-up period.ConclusionAcute type A aortic dissection with coronary involvement is associated with high misdiagnosis rate and mortality rate. Taking proper strategies for surgical treatment of involved coronary arteries based on precise diagnosis may improve the prognosis of patients.