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.
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.
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.
Objective To investigate surgical outcomes and prognostic factors for patients with coronary heart disease and low left ventricular ejection fraction （LVEF≤40%） undergoing off-pump coronary artery bypass grafting （OPCAB）. Methods We retrospectively analyzed clinical records of 63 discharged patients with coronary heart disease and low LVEF who underwent OPCAB in Peking University People’s Hospital from 2001 to 2004 year. There were 48 males and 15 females with mean age of 65.1±9.2 years and mean LVEF of 33.8%±5.0%. Regular follow-up evaluation was completed. We investigated risk factors for long-term survival of the patients by Kapalan-Meier survival curve, log-rank test and Cox regression model.?Results?Follow-up time was 3-107 （71.3±24.4） months, and six patients were lost during the follow-up. Nineteen patients （30.2%） died during follow-up including 10 patients （15.9%） who had cardiac-related death. The survival rate at 1, 3, 5 and 8 year was 96.7% （61）, 94.9% （60）, 85.9% （55）, 77.2% （53） respectively. Univariate analysis shows LVEF≤30% and acute myocardial infarction within 30 days are risk factors for long-term survival（P＜0.05）. Cox regression analysis showed that LVEF≤30%（RR=4.662, P＜0.05）and acute myocardial infarction within 30 days（RR=5.544, P＜0.05）were two independent risk factors for cardiac-related death after discharge. Conclusion Patients with coronary heart disease and low LVEF can have satisfactory surgical outcomes after OPCAB. LVEF≤30% and acute myocardial infarction within 30 days are the two independent risk factors for cardiac-related death after discharge.