Objective\ In order to assess and evaluate the clinical results of cold blood cardioplegia and intermittent cross clamping as myocardial preservation in coronary artery bypass grafting(CABG).\ Methods\ According to the management methods, 2 013 cases for elective, isolated CABG were divided into two groups at St.George’s Hospital, London.Cold blood cardioplegia group: 596 patients treated with cold blood cardioplegia, and hypothermic ventricular fibrillation group: 1 417 patients treated with intermitt...
Objective To review the clinical experience of coronary artery bypass grafting without the assistance of extracorporeal circulation (Off pump CABG, OPCAB). Methods\ Between August 1999 and June 2000, 73 consecutive OPCAB were performed at our institution. The exposure and immobilization of the coronary artery target site during anastomosis were achieved with the help of Octopus mechanical stabilization and intraluminal shunt devices. Results\ There was no mortality, no perioperative myocardial infarct...
Objective To investigate the treatment and prognosis of moderate ischemic mitral regurgitation (IMR) in coronary artery disease(CAD). Methods From January 1998 to May 2006, 28 patients of CAD with moderate IMR underwent coronary artery bypass grafting (CABG) and mitral valve plasty(MVP, 24) or mitral valve replacement (MVR,4). The Reed method were used in 9 cases, the annuloplasty ring were used in 15 cases. Mechanical valve were implanted in 1 case and biological valve in 3 cases. Results There was no operative or hospital death. Twentysix patients were followed up to a mean period of 41 months. There were two late death(one was MVP, the other was MVR). In MVP cases, nineteen patients were in New York Heart Association (NYHA) functional class Ⅰ and Ⅱ, 3 in class Ⅲ, which was better than that of preoperative one. Ultrasonic cardiography (UCG) examination showed no mitral regurgitation in 5 cases, mild in 7, light in 6, moderate in 3, severe in 1. Left atrial volume (LAV) and left ventricular enddiastolic volume (LVEDV) were 54.1±12.7ml and 60.9±14.8 ml, decreased more significantly than that preoperatively (Plt;0.05). In MVR cases, 2 cases were survival and followed. One patient was in NYHA functional class Ⅰ, 1 in class Ⅱ, which was better than that of preoperative one. Conclusion Moderate IMR with CAD should be treated carefully. MVP with annuloplasty ring have better early results. For patients with bad heart function and abnormal left ventricular wall motion, the late results need more studies.
ObjectiveTo compare early postoperative outcomes of Chinese patients undergoing off-pump coronary artery bypass grafting (OPCAB) with or without preoperative discontinuation of aspirin. MethodsClinical data of 354 patients who underwent elective OPCAB in Department of Cardiac Surgery, People's Hospital of Peking University from 2011 to 2012 were retrospectively analyzed. There were 132 patients during year 2011 who discontinued aspirin more than 5 days before OPCAB and were defined as a discontinuation group, including 93 males and 39 females with their age of 36-83 (61.70±8.74) years. There were 222 patients during year 2012 who continued aspirin treatment before OPCAB and were defined as an aspirin group, including 162 males and 60 females with their age of 37-82 (63.26±8.94) years. Postoperative chest drainage, incidence of reexploration for bleeding, in-hospital morbidity and mortality were compared between the 2 groups. Serum cardiac troponin I (cTnI) levels during 4-6 hours, 12-18 hours and 24-48 hours after OPCAB were also compared. ResultsPreoperative clinical characters were not statistically different between the 2 groups (P>0.05). Average number of grafts in the discontinuation group was significantly smaller than that in the aspirin group (3.00±0.89 vs. 3.43±0.93, P=0.001). There was no significant difference in postoperative chest drainage (1 063.75±511.50 ml vs. 1 131.35±460.13 ml, P=0.201), incidence of reexploration for bleeding(0 case vs. 1 case, P=1.000), perioperative myocardial infarction(2 cases vs. 1 case, P=0.647), postoperative acute renal failure(4 cases vs. 7 cases, P=1.000), stroke(1 case vs. 4 cases, P=0.726), mechanical ventilation time(41.46±85.50 hours vs. 52.07±143.59 hours, P=0.441), length of ICU stay(81.46±116.90 hours vs. 79.07±136.43 hours, P=0.867), or in-hospital mortality(0.8% vs. 0.9%, P=1.000)between the 2 groups. Serum cTnI levels during 4-6 hours after OPCAB were not statistically different between the 2 groups (P=0.506). Serum cTnI levels during 12-18 hours and 24-48 hours after OPCAB were statistically different between the 2 groups (P=0.002 and P=0.000). The percentages of patients with cTnI level higher than 4.0 ng/ml during 12-18 hours and 24-48 hours after OPCAB in the aspirin group were significantly lower than those in the discontinuation group (5.4% vs. 16.7%, P=0.001;5.9% vs. 17.4%, P=0.000). ConclusionOPCAB without preoperative discontinuation of aspirin does not increase the risk of postoperative bleeding, in-hospital morbidity or mortality, but can decrease postoperative myocardial injury of Chinese patients undergoing OPCAB.
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.
Abstract： Objective To evaluate graft patency at one year after coronary artery bypass grafting （CABG） and analyze the risk factors of graft occlusion. Methods We prospectively included 71 consecutive patients with coronary heart disease who underwent CABG in First Affiliated Hospital of Harbin Medical University from June to December 2010. There were 37 males and 34 females with their average age of 59.8±7.7 years. All the patients underwent CABG performed by the same surgeon， and received standard drug therapy after surgery. At 1 year after CABG， 256-slice multislice computed tomography （MSCT） angiography was performed to evaluate graft patency. All the patients were divided into two groups according to their graft patency during follow-up， including 16 patients in the occluded graft group and 55 patients in patent graft group. Preoperative， intra-operative and postoperative variables were collected. Univiariate analysis and logistic regress analysis were performed to analyze risk factors of graft occlusion. Results The graft patency was 91.0% （172/189） at 1 year after CABG. Univiariate analysis showed that pre-operative cholesterol （t=-2.389，P=0.017）， diffused coronary artery disease （χ2=4.449，P=0.042）， diameter of target vessels （t=5.064，P=0.000）， non-adherence to prescribed antiplatelet medications （χ2=10.175，P=0.008） were potential risk factors of graft occlusion after CABG. Logistic regress analysis showed that diameter of target vessels ［RR=0.014，95% CI （0.001，0.229），P=0.003］ and non-adherence to prescribed antiplatelet medications ［RR=13.375，95% CI （1.075，175.536），P=0.044］ were significant risk factors for graft occlusion. Conclusion The graft patency is satisfactory at 1 year after CABG. Graft patency after CABG is closely related to the stenosis degree of target vessels and adherence to prescribed antiplatelet medications after surgery.
Objective To evaluate the effects of emergency coronary artery bypass grafting (ECABG) in the treatment of emergent patients, and to summarize our experience. Methods We retrospectively analyzed the clinical data of 160 patients who underwent coronary artery bypass grafting (CABG) in Nanjing General Hospital of Nanjing Command from January 2010 through December 2013. The patients were divided into an ECABG group (operation underwent on the day diagnosed, n=27, 22 males and 5 females, at age of 70.2±10.2 years) and a conventional group (CABG operation underwent on 5 days after diagnosed, n=133, 104 males and 29 females, at age of 66.3±8.9 years). Results Statistical differences were found between the ECABG group and the conventional group in EuroSCORE (5.8±3.2 versus 3.4±2.1, P=0.001), acute myocardial infarction (33.3% vs. 11.3%, P=0.007), rate of application of IABP (29.6% versus 12.0%, P=0.034), pericardium and mediastinal tube drainage (533.4±132.8 ml versus 414.8±124.3 ml, P=0.018). There was no statistical difference in continuous renal replacement therapy (P=0.677), postoperative sternal wound complication (P=1.000), the length of hospital stay (P=0.589), or 30-day-mortality (P=0.198) between the two groups. We followed up 24 patients(88.89%) for 3-36 months in the ECABG group. One patient occurred angina symptoms at the end of 1 year follow-up. The symptoms disappeared after treatment. The other patients had no symptoms of angina pectoris and myocardial ischemia. Conclusion ECABG as a lifesaving therapy is an effective procedure in the treatment of severe and acute patients. Sufficient preoperative assessment, good myocardial protection, full revascularization, and comprehensive treatment plays an important role in the success of ECABG.
Objective To investigate the incidence of perioperative stroke in elderly patients (≥65 years) undergoing offpump coronary artery bypass grafting (OPCAB) versus onpump coronary artery bypass grafting (CABG). Methods WTBZ]We electronically searched PubMed (from 1966 to 2010), Cochrane Library (Issue 12, 2010), EMbase (from 1974 to 2010), CNKI (Chinese, from 1997 to 2010), CBM (Chinese, from 1989 to 2010), and manually searched some journals to collect published or grey literatures of clinical researches on comparison between OPCAB and CABG for elderly patients in the incidence of perioperative strokes. We assessed the methodology quality of included researches and extracted data to conduct metaanalysis by RevMan 5.0 software. Four subgroups (aged 65 to 70 years, 70 to 75 years, 75 to 80 years, and older than 80 years) according to the age of the patients, and subgroups according to the study design were analyzed respectively. Sensitivity analysis was conducted by deleting the studies of low quality. Results We finally identified 17 studies including 5 historical cohort studies and 12 case control studies. No randomized controlled trial was searched. A total of 7 275 patients including 2 521 (34.65%) in the OPCAB group and 4 754 (65.35%) in the CABG group were identified. The metaanalyses of historical cohort study subgroup and case control study subgroup showed statistical difference in stroke incidence between the OPCABG and CABG groups with OR 0.25 and 95%CI 0.10 to 0.62,and with OR 0.25 and 95%CI 0.15 to 0.41,respectively. Statistical difference was tested in three age subgroups (70 to 75 years, 75 to 80 years, and elder than 80 years) and the OR (95%CI) value was 0.35 (0.21, 0.59), 0.14 (0.04, 0.54), and 0.09 (0.02, 0.38),respectively. The difference of stroke incidence between OPCAB and CABG patients in all the three subgroups was significant, while there was no statistical difference in the subgroup aged 65 to 70 years with OR 0.10 and 95%CI 0.01 to 1.68. The sensitvity analysis showed that metaanalysis was stable in case control study subgroup, was not stable in historical cohort study subgroup. Conclusions OPCAB may reduce incidence of perioperative stroke in elderly patients. However, it still needs to be confirmed by more multicenter, largesample, and randomized doubleblind controlled trials in the future.
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.
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.