Abstract： Objective To analyze clinical outcomes of intra-aortic balloon pump （IABP） application for high-risk patients before undergoing off-pump coronary artery bypass grafting （OPCAB）， and summarize our experience and weaning indications of IABP. Methods We retrospectively analyzed clinical data of 102 high-risk patients with coronary artery disease who underwent IABP implantation before OPCAB from January 2008 to July 2011 in Zhongshan Hospital of Fudan University. There were 71 male patients and 31 female patients with their average age of 63.0±8.2 years in this IABP group. We also chose another 100 patients without IABP implantation before undergoing OPCAB as the control group， including 55 male patients and 45 female patients with their average age of 64.1±9.5 years. Postoperative systolic arterial blood pressure （SABP）， mean arterial blood pressure （MABP）， mechanical ventilation time， length of intensive care unit（ICU） stay， morbidity， duration of IABP treatment and in-hospital mortality of two groups were compared. Left ventricular ejection fraction （LVEF） was evaluated with echocardiography 3 months after surgery. Results Postoperative SABP （95.3±12.2 mm Hg vs. 80.1±11.7 mm Hg；t=8.440， P=0.000） and MABP （78.9±13.5 mm Hg vs. 52.3±15.1 mm Hg； t=12.410， P=0.000） of the IABP group were significantly higher than those of the control group. Mechanical ventilation time， length of ICU stay and duration of inotropic support of the IABP group were significantly shorter than those of the control group. The incidence of ventricular arrhythmia， low cardiac output syndrome， perioperative myocardial infarction and dialysis-requiring acute kidney failure of the IABP group were significantly lower than those of the control group. In-hospital mortality of the IABP group was significantly lower than that of the control group ［5.9% （6/102） vs. 17.0% （17/100）， χ 2 =6.180， P=0.020］. Ninety-six patients in the IABP group and 83 patients in the control group were followed up for 3 months. Three months after surgery， echocardiography showed that LVEF of the IABP group was significantly higher than that of the control group（45.3%±12.0% vs. 39.1%±8.2%， t=3.950， P=0.000）. Conclusion Preoperative prophylactic IABP implantation and optimal timing of weaning from IABP support can not only significantly reduce surgical risk and improve surgical outcomes and postoperative recovery of high-risk patients undergoing OPCAB， but also considerably ameliorate patient heart function and reduce perioperative morbidity and mortality.
Objective To identify clinical significance of high level cardiac troponin I （cTnI） in the early postoperative period of off-pump coronary artery bypass grafting （OPCAB） and its predictive value for early clinical outcomes. Methods A total of 240 patients undergoing isolated OPCAB in the Department of Cardiac Surgery of People’s Hospitalof Peking University during 2011 were recruited in the study. There were 164 males and 76 females with their age of 36-83（62.07±8.24） years. Serum cTnI levels in 4-6 hours and 12-18 hours after OPCAB were monitored. Influential factors and its predictive value for early clinical outcomes of OPCAB were analyzed. Binary logistic regression analysis，correlation analysis and receiver operating characteristic （ROC） curve were performed for statistic analysis. Results Serum cTnI level in 4-6 hours after OPCAB （TNI0） was 1.28±0.40 ng/ml，and serum cTnI level in 12-18 hours after OPCAB （TNI1） was 3.60±0.74 ng/ml. Binary logistic regression analysis revealed that graft number was significant influential factors of TNI0 （P=0.000） and TNI1 （P=0.010）. Serum cTnI level in 12-18 hours after OPCAB was significantly correlated with early clinicaloutcomes of OPCAB （P＜0.05），but the correlational relationship was not b （correlation coefficient＜0.5）. ROC curveanalysis showed that serum cTnI level in 12-18 h after OPCAB had higher predictive value for patient prognosis （P＜0.05）. Serum cTnI level higher than 1.49 ng/ml in 12-18 h after OPCAB had good predictive value for postoperative ECG changes，use of intra-aortic balloon pump （IABP） and in-hospital mortality. Conclusions Serum cTnI level increases in varying degrees in the early postoperative period of OPCAB. Together with ECG changes，serum cTnI level can be used for early diagnosis of perioperative myocardial infarction with significant predictive value for early clinical outcomes of OPCAB.
Abstract： Objective?To summarize our experience of redo coronary artery bypass grafting（CABG） and explore appropriate redo CABG strategy for Chinese patients. Methods We retrospectively analyzed clinical data of 27 patients who underwent redo CABG in People’s Hospital of Peking University from January 2000 to January 2010. There were 15 male patients and 12 female patients with their age of 41-84 （63±8） years. The mean time between the first CABG and the redo CABG was 45 （4-168） months. Preoperatively all the patients had unstable angina pectoris. Twenty-one patients were in New York Heart Association （NYHA） functional classⅠ-Ⅱ， and 6 patients were in NYHA functional classⅢ-Ⅳ. Preoperatively， their left ventricular end-diastolic dimension （LVEDD） was 41-69 （51.0±0.7） mm， and their left ventricular ejection fraction （LVEF） was 32%-78% （58%±12%）. At the time of redo CABG for the 27 patients， there were 6 new coronary artery lesions， 7 left internal mammary artery （LIMA） lesions， 3 radial artery lesions （including 1 proximal anastomosis lesion alone） and 49 saphenous vein graft （SVG） lesions （including 3 proximal lesions alone and 3 distal lesions alone）.?Results?The surgical approach of redo CABG included median sternotomy in 18 patients， left lateral thoracotomy in 8 patients， upper midline abdomen and subxiphoid incision in 1 patient. Off-pump coronary artery bypass grafting （OPCAB） surgery was performed in 25 patients， but intra-operatively 2 patients underwent conversion to CABG under cardiopulmonary bypass. A total of 65 distal anastomoses and 41 proximal anastomoses were performed during redo CABG. A total of 10 LIMA， 3 right internal mammary artery (RIMA)， 16 left radial artery， 2 right radial artery and 17 SVG were used in redo CABG . There were 1-4 （2.4±0.8） distal anastomoses for each patients. The operation time was 170-530 （304±86）min. Postoperative transfusion was 0-10 （4.3±3.5） U packed red blood cells and 0-1 600 (685±549) ml fresh frozen plasma for each patient. Postoperative mechanical ventilation time was 6-156 （24±32） h and postoperative hospital stay was 7-35 （14±6） d . There was no in-hospital death. All the patients were discharged without any angina symptoms. A total of 26 patients were followed up and 1 patient was lost with the mean follow-up time of 80 （13-133） months. During follow-up， 16 patients were alive without angina symptoms， 4 patients died， and 6 patients had recurrent angina symptoms or heart failure. Conclusions OPCAB is an effective surgical strategy of redo CABG， but cardiopulmonary bypass should also be prepared. Arterial graft should be use as long as possible in redo CABG and the surgical strategy should be individualized.
Abstract: Objective To invest igate the effect of p ro staglandin E1 (PGE1 ) during off-pump co ronary artery bypass graft ing (O PCAB ). Methods F rom O ct. 2005 to Dec. 2005, 40 consecut ive pat ients w ho underw ent O PCAB w ere random ly divided into two group s. The cont ro l group received convent ional t reatment w h ile the PGE1 group received cont inuous int ra2vena PGE1 infusion ( 5220 ngouml;k g?m in) fo r 24248 hours. The perioperat ivehemodynam ic indexes, including cardiac index (C I) , system ic vascular resistance ( SVR ) , pulmonary vascular resistance (PVR ) , and hematocrit (HCT ) , coagulation index (C I) , partial pressure of oxygen in artery (PaO 2 ) ,serum creat inine (Cr) and blood urea nitrogen (BUN ) were measured and compared. Results Postoperative SVR and PVR decreased and C I increased significantly in the PGE1 group (P lt; 0. 05). Postoperative HCT decreased in the both group patients. Coagulation index decreased significantly on the operation day, but then increased in both groups on the next day after operation, with the increase in the PGE1 group significantly less than control group (P lt;0. 05). Postoperative serum Cr and BUN increased significantly in the both groups, especially in the control group (P lt; 0105). Conclus ion PGE1 has potential beneficial effect on patients undergoing OPCAB.