ObjectiveTo evaluate the safety and efficacy of total arterial off-pump coronary artery bypass grafting (OPCABG) using a left internal thoracic artery (LITA) combined with bilateral radial arteries (RAs). MethodsWe retrospectively analyzed the clinical data of patients with severe multi-vessel coronary artery disease who underwent total arterial OPCABG with a LITA and bilateral RAs at Sichuan Provincial People’s Hospital from November 2020 to April 2023. Results A total of 24 patients were included, comprising 23 males and 1 female, with a mean age of (53.63±4.33) years. The New York Heart Association (NYHA) functional class was Ⅱ to Ⅲ. The mean number of distal anastomoses was 3.17±0.38. A Y-graft was constructed in 12 patients and sequential grafting was performed in 4 patients. Concomitant procedures included coronary endarterectomy in 1 patient, intra-aortic balloon pump (IABP) implantation in 10 patients, and thymoma resection in 1 patient. The mean operative time was (308.13±30.39) min, mechanical ventilation time was (15.42±7.42) h, ICU stay was (46.08±27.32) h, and postoperative hospital stay was (11.71±1.90) d. There were no in-hospital deaths. Postoperative complications included one patient of acute renal failure and one patient of cerebral infarction. Pre-discharge color Doppler echocardiography revealed that the left ventricular end-diastolic diameter was significantly smaller than before surgery (P<0.05), while the left ventricular ejection fraction and fractional shortening were significantly higher (P<0.05). Coronary computed tomography angiography (CTA) showed that all arterial grafts were patent. During a mean follow-up of (14.58±8.75) months, no patients experienced angina recurrence or mortality. Repeat coronary CTA or angiography in 16 patients one year postoperatively confirmed that all arterial grafts remained patent. Conclusion Total arterial OPCABG using a LITA and bilateral RAs is a safe and effective treatment for patients with severe multi-vessel coronary artery disease. For high-risk patients, intraoperative IABP support is recommended.
Objective To analyze the timing and mid-term prognosis of bypass surgery for children with Kawasaki disease complicated with coronary artery aneurysms. Methods A retrospective analysis was conducted on the clinical data of children with Kawasaki disease complicated with coronary artery aneurysms who underwent coronary artery bypass grafting at Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine from March 2018 to December 2023. Results Finally, 20 pediatric patients were enrolled, including 16 males and 4 females, with a median age of 118 (74, 140) months. All patients who failed drug treatment and had progressive coronary artery dilation with thrombosis underwent bypass surgery, including 14 patients with cardiac arrest and 6 patients without cardiac arrest. One patient died of severe left heart failure. The median follow-up of 19 surviving children was 34 (16, 61) months, and 84.2% of them had electrocardiogram recovery. The coronary artery diameter decreased from (16.2±9.2) mm to (8.2±2.7) mm, and the left ventricular ejection fraction increased from (58.2±8.6)% to (63.8±7.0)%. The 89.4% (17/19) of the patients’ vessels were unobstructed, and 94.7% of the heart function recovered to grade Ⅰ/Ⅱ. Conclusion Coronary artery bypass grafting is safe and effective for treating Kawasaki disease coronary artery aneurysms in children, with a good mid-term prognosis.