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.
Abstract:Objective To investigate the pattern and affecting factors of hematopoietic stem cell mobilization after off-pump coronary artery bypass grafting（OPCAB）. Methods Fifty-five patients of coronary artery disease without acute myocardial infarction （AMI） who underwent selective OPCAB were chosen for this study. Four ml blood sample was taken at 30 min before operation, and 6, 12, 24, 48, 72 and 120 h after operation. The hematopoietic stem cell count was made by flow cytometer with CD34 and CD45 double antibody. The serum myoeardium enzyme and troponin T （cTnT） were measured at the same time. Results The hematopoietic stem cell count was 0. 13%±0. 12% of all nucleated cells in the peripheral blood circulation before operation. It increased significantly witha peak value at 24 halter OPCAB（0.34%±0.20%）. It turned back to pre-operativelevelat 120h after operation. Smoking, hyperlipemia and diabetes mellitus had no effect on hematopoietic stem cell mobilization. But hypertension could reduce its mobilization significantly. The hematopoietic stem cell count was positively correlated with creatine kinase （CK）, creatine kinase-MB isoenzyme （CK-MB）, lactate de hydrogenase （LDH） and cTnT （r=0. 692,P=0. 000; r=0. 558, P=0. 000; r=0. 447, P=0. 000 and r=0. 401, P=0. 004, respectively） 24h after OPCAB. Conclusion Hematopoietic stem cells mobilize rapidly and temporarily after OPCAB. Myocardial injury and CABG risk factors take part in hematopoietic stem cell mobilization.
Risk stratifications are valuable aids for stratifying patients by disease severity, driving informed clinical decisions, because they allow the selection of the most appropriate strategy of treatment based on the patient's individual characteristics. The clinical algorithms help patients and their families to get a better understanding of issues relevant to treatment strategies and subsequent risks as part of the process to obtain informed consent. The current risk stratifications of coronary artery bypass grafting included the Society of Thoracic Surgeons Score, the European System for Cardiac Operative Risk Evaluation, SinoSystem for Coronary Operative Risk Evaluation. This review focuses on the progress of risk stratifications of coronary artery bypass grafting for patients undergoing cardiac surgery.
Objective To develop a new small-caliber vascular xenograft and evaluate the feasibility of xenogenic artery for coronary artery bypass grafting. Methods Canine carotid arteries were decellularized by detergent and enzymatic extraction. All decellularized xenografts were randomly divided into two groups. Heparin-linked group （n=24）： grafts were then covalently linked with heparin. Non-heparin-linked group （n=24）： as control. Xenografts in two groups were implanted in rabbits＇ left and right carotid artery respectively as bypass grafts. Graft patency was checked by ultrasonography after 3 weeks, 3 and 6 months. Grafts were harvested after 3 and 6 months. Microscopic observation and immunohistochemical staining were performed. Results All the cells were removed while the extracellular matrix were well preserved observed. Heparin was successfully linked to the grafts through their whole thickness. There was no obstruction at both sides after implantation of the grafts, while less thrombus was found in the decellularized heparin-linked grafts than in the other side. Smooth muscle cells densely populated the graft wall and endothelial cells covered the lumen at 3 months after implantation. Conclusion Canine common carotid artery treated by detergent and enzymatic extraction and heparin linkage may be a new small-caliber vascular xenograft for coronary artery bypass grafting.
Objective To compare the accuracy of different renal function measurements for predicting postoperativeadverse events after off-pump coronary artery bypass grafting （OPCAB） for Chinese patients. Methods Clinical data of 283 Chinese patients undergoing isolated OPCAB from January 2010 to December 2011 in the First Hospital of Peking University were retrospectively analyzed. There were 194 male and 89 female patients with their age of 65.0±9.7 years. Estimated glomerular filtration rate （eGFR） was calculated using Cockcroft-Gault equation，Modification of Diet in Renal Disease （MDRD） study equation and Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation respectively.Logistic multivariate regression analysis was performed to compare the accuracy of these 3 different renal function measure-ments for predicting postoperative adverse events. Results Logistic multivariate regression analysis showed that preoper-ative renal dysfunction was an independent risk factor for higher postoperative morbidity，more blood transfusion，prolongedhospitalization，mechanical ventilation time and length of ICU stay. Among the different postoperative complications，preop-erative renal dysfunction was an independent risk factor for postoperative acute renal injury，gastrointestinal bleeding，new onset atrial fibrillation and low cardiac output syndrome. Among Cockcroft-Gault equation，MDRD study equationand CKD-EPI equation to calculate eGFR，CKD-EPI equation was most accurate to predict postoperative morbidity （OR=1.227），acute renal injury （OR=1.534），new onset atrial fibrillation （OR=1.184），prolonged hospitalization（OR=1.160），mechanical ventilation time （OR=1.165） and ICU stay （OR=1.151）. Conclusion Preoperative renal dysfunction is an independent risk factor for postoperative adverse events after OPCAB. CKD-EPI equation is more suitable for predicting postoperative adverse events after OPCAB for Chinese patients.
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.
Objective To investigate the risk factors of acute kidney injury（AKI）after onpump coronary artery bypass grafting(on-pump CABG) and off-pump coronary artery bypass grafting (off-pump CABG) in order to provide superior renal protective measure after operation. Methods The clinical data of 849 consecutive patients undergone coronary artery bypass grafting（CABG） in a single institution between January 1990 and August 2006 were retrospectively analyzed. A simplex module and a multivariate logistic regression model were constructed to identify risk factors for the development of AKI. Results AKI were occurred in 61 patients （11.8%，61/518） undergone off-pump CABG and 63 patients （19.0%，63/331） undergone onpump CABG. Peak of serum creatinine (Scr) after operation arrived at the 12th hour and 24th hour in patients undergone off-pump CABG and patients undergone on-pump CABG respectively. The rapidly recovering period of Scr in patients undergone off-pump CABG and on-pump CABG were from the 24th hour to the 48th hour and from the 48th hour to the 72th hour respectively.The results of the multivariate forward stepwise logistic regression analysis found that risk factors for the development of postoperative AKI following isolated CABG were associated with heavy body mass index（OR=1.190，1.179）, emergent procedure（OR=2.737，3.678）, diabetes（OR=1.705，2.042）, peripheral vascular disease（OR=2.002，2.559）,ejection fraction≤30%（OR=2.267，4.606）, and New York Heart Association(NYHA) class Ⅲ and Ⅳ（OR=1.861，1.957） were risk factors for the development of postoperative AKI following offpump and on-pump CABG; pulse pressure≥60mmHg and triplevessel disease were risk factors for the development of postoperative AKI following off-pump CABG. But perioperative and postoperative intra aortic balloon pumping (IABP) could make protective effect on kidney for on-pump CABG （OR=0.146）which could lessen development of AKI. Conclusions It is critical period for AKI that renal protection strategies should be performed from general anesthesia until postoperative 48 hours (off-pump CABG) and 72 hours (on-pump CABG). AKI might be the most important stage in which a positive test should increase the physician’s awareness of the presence of risk for renal injury and then preventive or therapeutic intervention could be performed when the situation still is reversible.
ObjectiveTo investigate the safety and effectiveness of the multi-artery graf tstrategy for coronary bypass (MICS-CABG) with small incision in the left chest, and to provide experience for the promotion of this technique.MethodsThe clinical data of 64 patients with MICS-CABG in Department of Cardiac Surgery of Peking University Third Hospital from December 2015 to November 2019 were retrospectively analyzed. There were 54 males and 10 females, aged 36-77 (61.1±8.7) years. The left lateral thoracic incision (5-8 cm) was made through the 5th intercostal incision, and the operation was performed under off-pump CABG. With the help of the chest wall suspension device and the heart fixator, the proximal anastomosis of the ascending aorta, anastomosis of the target vessels of the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) systems were completed. The number of grafts was 2-4 (2.3±0.5) including 2 grafts in 45 patients, 3 grafts in 17 patients and 4 grafts in 2 patients. Three patients were treated with percutaneous intervention (PCI) hybridization and 62 patients were treated with total artery bypass graft. Coronary angiography was performed within 7 days after the operation to evaluate the graft patency rate. The incidence of major adverse cardiac and cerebrovascular events (MACCE) was recorded in the follow-up. The MACCE rate was calculated by Kaplan-Meier method.ResultsNone of the patients was transferred to thoracotomy and no intra-aortic balloon counterpulsation (IABP) or extracorporeal membrane oxygenation (ECMO) was used during the operation. Incision infection was in 1 patient and reoperation in 2 patients (all were postoperative hemorrhage). Within 30 days after surgery, MACCE occurred in 1 patient, including 1 patient of non-fatal myocardial infarction. The overall patency rate of angiography bypass was 96.2%, and the patency rate of anterior descending branch bypass was 98.2%. Follow-up was performed from 12 to 60 months (median follow-up time was 28 months). The loss rate was 7.8% (5/64). The incidence of MACCE was 84.9% (95%CI 79.5%-90.3%).ConclusionThe MICS-CABG can achieve completed re-vascularization and totally artery-CABG and the short-term and medium-term clinical results of the operation are good.
ObjectiveTo analyze the feasibility of using triangular-sail technique that allows intermittent two-lung ventilation during minimally invasive coronary artery bypass grafting (MICS CABG).MethodsThe clinical data of 207 patients with MICS CABG in our cardiac center from January 2019 to November 2020 were retrospectively analyzed. These patients were divided into two groups. A group OLV included 111 patients who underwent one-lung ventilation during surgery, while a group TLV included 96 patients who underwent intermittent two-lung ventilation. The triangular-sail technique was used in the group TLV. This simple technique isolated the operative field from lung lobes with the traction of pericardial adipose tissue. The preoperative data and perioperative clinical data of the two groups were compared and analyzed.ResultsThere was no statistical difference in basic preoperative data between the two groups. The operation time in the OLV group was shorter than that in the TLV group (296.7±57.3 min vs. 334.1±87.0 min, P=0.000), and the duration of postoperative mechanical ventilation and ICU stay were not statistically different between the two groups. There was also no statistical difference in the incidence of pneumothorax or atelectasis between the two groups.ConclusionThe triangular-sail technique is simple and easy to implement. The technique allows intermittent two-lung ventilation during MICS CABG procedure.
Abstract: Objective To investigate the effect of liposomal prostaglandin E1 (LipoPGE1) on inflammatory reaction during cardiopulmonary bypass (CPB) coronary artery bypass grafting (CABG). Methods Between July 2006 and December 2008, a total of 32 patients undergoing CABG were randomly divided into two groups of 16 patients each using a random digits table. The experimental group had 9 male and 7female patients with a mean age of 54.4±18.1 years; each patient received 15.0ng/(kg·min) of LipoPGE1 by venous pump through the central vein throughouttheCPB procedure. The control group had 9 male and 7 female patients with a mean age of 54.8±20.4 years, who were treated identically to the experimental group except did not receive LipoPGE1. Arterial blood samples were taken before CPBand at the 1st, 2nd, 6th, and 24th hour after open aorta ascendens. The levels of interleukin6(IL6), tumor necrosis factorα (TNFα), and soluble intercellular adhesion molecule1 (sICAM1) were tested and compared. Results In both groups, levels of IL6, TNFα, and sICAM1 were all gradually increased after the ascending aorta was opened, and they reached their highest levels at the 6th hour after open aorta ascendens. In the experimental group, at every time point afterthe ascending aorta was open, levels of IL6 (24th hour after open aorta ascendens: 16.1±2.2 μg/L vs. 19.2±4.5 μg/L,Plt;0.05), TNFα (24th hour after open aorta ascendens: 1.8±04 μg/L vs. 2.2±0.5 μg/L,Plt;0.05), and sICAM1 (24th hour after open aorta ascendens: 233.6±36.6 μg/L vs. 294.2±55.7 μg/L,Plt;0.05) were significantly lower than those of the control group. 〖WTHZ〗Conclusion LipoPGE1 effectively reduces the aggregation of polymorphonuclear neutrophilic leukocytes, inhibits activation of vascular endothelialcells, and decreases systemic inflammatorome during CPB.