Objective To summarize the experiences of off-pump coronary artery bypass grafting (off-pump CABG) and on-pump coronary artery bypass grafting (onpump CABG) for patients with coronary artery diseases and to improve the surgical techniques and clinical results. Methods Coronary artery bypass grafting(CABG) were performed from January 2000 to March 2009 on 698 consecutive cases, including 551 male and 147 female with a mean age of 67.2 years(range, 28.0-79.0). There were 552 cases with angina pectoris and 131 with old myocardial infarction. Preoperative cardiac function showed 301 cases in New York Heart Association classⅡ, 339 in class Ⅲ,and 58 in class Ⅳ. Coronary angiography revealed single vessel disease in 21 cases, 2vessel disease in 87, 3vessel disease in 590, and 201 cases had concomitant left main lesions.There were 687 elective CABG and 11 emergency / urgent ones. Offpump CABG were performed on 346 cases and the others received onpump CABG . Results A total number of 2 025 grafts ( range,1-6 grafts, mean, 2.9 grafts /case ) were constructed with 693 left internal mammary arteries,115 free right mammary arteries,229 left radial arteries, and 81 right radial arteries. Total arterial bypass grafting was feasible on 126 cases. Postoperative ventilation duration varied from 0-127 hours (mean, 11.5 hours). Fasttrack procedure was offered to 38 cases with good results.Introaortic balloon pump support were provided to 1 patient preoperatively and 27 postoperatively. There were 25 deaths with a mortality of 3.64% for the elective cases with the cause of acute myocardial infarction ( 5 cases ), low cardiac output syndrome (3 cases),protamine reaction (2 cases),respiratory failure (3 cases), renal failure (2 cases),and multiorgan failure (10 cases).Four deaths occurred to urgent cases with a mortality of 36.36% from low cardiac output syndrome ( 3 cases) and acute myocardial infarction (1 case). One hundred and fiftyone cases（21.63%）developed atrial fibrilation among which 147（97.35%）returned to sinus rhythem with administration of electrolytes and Amiodarone. Resternotomy were performed for bleeding in 12 cases. Upon discharge from the hospital, 511 patients were free from angina while 20 other patients still had coexisting relieved angina. Postoperative followup was carried out on 415 cases（62.03%）for a period of 1month to 8.2 years with 3 deaths for lung cancer (1 case), car accident(1case), and unknown reasons (1 case). Number of patients who were free from angina was 317 and 21 for those who had recurrent angina. The cardiac function improved with 269 cases（65.29%）in New York Heart Association class Ⅱ, 142（34.46%）class Ⅲ, and 1（0.24%） class Ⅳ. Conclusion Good surgical results could be achieved with careful analysis of native Chinese patients’ coronary vessels, individualized operative plan, control of operative risk factors, and proper selection of bypass conduits. Aggressive use of IABP can provide essential support for patients with poor left ventricular function and other high risk factors.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis with surgical taboos or high risk. With the update of the guidelines, the indication of TAVR has been extended to the intermediate-risk aortic stenosis population, and even has a tendency to further expand to the low-risk population. This review highlights the research progress and new evidence of TAVR in respects of patient selection, valve and approach selection, ethnic differences, and surgical complications such as perivalvular leakage, cardiac conduction block, vascular complications, stroke, acute kidney injury, and coronary artery occlusion.
Objective To analyze the characteristics of sternal Mycobacterium tuberculosis (Mtb) infection after cardiac surgery. Methods An electronic search was conducted for publicly available cases of sternal Mtb infection after cardiac surgery in PubMed, Web of Science, Wanfang database, and CNKI since their inception up to 18 July 2023, and 2 researchers analyzed the characteristics of the included cases and extracted relevant data. Results A total of 26 patients were included in 15 studies, 16 males and 10 females, aged 5-80 (61.9±15.6) years. Previous surgical history included coronary artery bypass grafting in 14 cases (53.8%), valve surgery in 8 cases (30.8%), congenital heart surgery in 3 cases (11.5%), and aortic surgery in 2 cases (7.7%). The main symptoms and signs were incisional abscesses, poor healing, mostly with pain, with or without erythema, and usually without systemic symptoms such as low-grade fever, night sweats, and weight loss. 13 cases reported a postoperative time to discovery of infection with a mean of 11.8 (0.5-60) months, and 9 cases reported an interval between discovery of infection and diagnosis with a mean of 12.1 (1.5-62) months. Confirmation of the diagnosis was mainly by Mtb culture of cleared bone tissue or pus, pathology and antacid staining. One case died of cardiac arrest before diagnosis. After the diagnosis of 25 cases, 13 cases received only anti-tuberculosis treatment, of which 11 cases received surgical treatment before diagnosis; 12 cases received anti-tuberculosis and surgical treatment, and all 25 cases were successfully cured. The duration of anti-tuberculosis treatment ranged from 6 to 12 months. Conclusion Sternal Mtb infection after cardiac surgery has a long incubation period, early diagnosis is difficult, the rate of missed diagnosis and misdiagnosis is extremely high, and timely diagnosis and treatment can significantly improve the prognosis.
ObjectiveTo analyze the clinical efficacy of right minithoracotomy approach in the treatment of patients with regurgitation after left-sided valve surgery (LSVS).MethodsThe clinical data of 77 patients who suffered tricuspid regurgitation (TR) after LSVS and received surgical treatment in the Heart Center of Henan Provincial People's Hospital from 2012 to 2019 were selected. According to the operation method, the patients were divided into a right minithoracotomy group (n=32), including 13 (40.6%) males, aged 57.3±5.3 years and a median sternotomy group (n=45), including 17 (37.8%) males, aged 55.7±6.6 years. Preoperative and postoperative clinical data of the two groups were compared and analyzed.ResultsThere was no significant difference in preoperative data between the two groups. There were 24 patients of tricuspid valvuloplasty (TVP) and 8 patients of tricuspid valve replacement (TVR) in the right minithoracotomy group. There were 29 patients of TVP and 16 patients of TVR in the median sternotomy group. The operation time, postoperative hospitalization time, intubation time and ICU stay time of the right minithoracotomy group were shorter than those of the median sternotomy group (P<0.001). The operative bleeding, postoperative drainage in 24 hours, postoperative blood transfusion rate and incision poor healing of the right minithoracotomy group were significantly decreased compared with those of the median sternotomy group (P<0.05). The extracorporeal circulation time between the two groups was not significantly different (P=0.382). The postoperative complications and mortality of the righ minithoracotomy group were significantly lower than those of the median sternotomy group (P<0.05).ConclusionThe procedure of right minithoracotomy access can reduce perioperative morbidity and mortality compared with the median sternotomy, and results in satisfied clinical efficacy.
Objective To compare the early outcomes of domestic third-generation magnetically levitated left ventricular assist device (LVAD) with or without concomitant mitral valvuloplasty (MVP). Methods The clinical data of 17 end-stage heart failure patients who underwent LVAD implantation combined with preoperative moderate to severe mitral regurgitation in Fuwai Central China Cardiovascular Hospital from May 2018 to March 2023 were retrospectively analyzed. The patients were divided into a LVAD group and a LVAD+MVP group based on whether MVP was performed simultaneously, and early outcomes were compared between the two groups. Results There were 4 patients in the LVAD group, all males, aged (43.5±5.9) years, and 13 patients in the LVAD+MVP group, including 10 males and 3 females, aged (46.8±16.7) years. Compared with the LVAD group, the LVAD+MVP group had a lower pulmonary artery systolic pressure and pulmonary artery mean pressure 72 h after operation, but the difference was not statistically different (P>0.05). Pulmonary artery systolic pressure was significantly lower 1 week after operation, as well as pulmonary artery systolic blood pressure and pulmonary artery mean pressure at 1 month after operation (P<0.01). There was no statistically significant difference in blood loss, operation time, cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time, and ICU stay time between the two groups (P>0.05). The differences in 1-month postoperative mortality, acute kidney injury, reoperation, gastrointestinal bleeding, and thrombosis and other complications between the two groups were not statistically significant (P>0.05). Conclusion Concomitant MVP with implantation of domestic third-generation magnetically levitated LVAD is safe and feasible, and concomitant MVP may improve postoperative hemodynamics without significantly increasing perioperative mortality and complication rates.
Objective To compare perioperative outcomes of minimally invasive aortic valve surgery by a right anterior minithoracotomy (RAMT) and conventional sternotomy. Methods A retrospective analysis of patients who underwent isolated aortic valve surgeries in our hospital between May 2021 and August 2023 with a minimal incision via the right anterior minithoracotomy approach (a RAMT group) or conventional incision via the full sternotomy approach (a conventional group). A propensity score-matching analysis was performed to balance preoperative data and compare perioperative data of the two groups. ResultsThere were 58 patients in the RAMT group, including 46 males and 12 females with an average age of 52.0±14.1 years; 128 patients were enrolled in the conventional group, including 87 males and 41 females with an average age of 60.0±12.4 years. After propensity-score matching, there were 51 patients in each group. The RAMT patients had a longer mean operation time, cross-clamping time and cardiopulmonary bypass time compared to the conventional group (all P<0.05). However, ICU length of stay, ventilator-assisted time and postoperative hospital stay were significantly shorter in the RAMT group (all P<0.05). Patients in the RAMT group had lower 24 hour chest drain output (P<0.05). RAMT was associated with a trend towards a lower blood transfusion rate in comparison to the sternotomy group, although this was not statistically significant (P>0.05). The occurrence of all-cause death, stroke and perioperative complications was also similar in both groups (P>0.05). Conclusion Right anterior mini-thoracotomy is associated with less trauma, faster recovery, less postoperative drainage, and shorter hospital stay than conventional approach. Right anterior mini-thoracotomy in patients undergoing isolated aortic valve surgery is a safe approach and can be performed by a wide range of surgeons.
ObjectiveTo investigate the early clinical efficacy of minimally invasive coronary artery bypass grafting (MICS CABG) for multivessel coronary artery disease. MethodsThe patients who received off-pump coronary artery bypass grafting in the Central China Fuwai Hospital of Zhengzhou University from June 2021 to June 2023 were enrolled. Patients were divided into two groups according to the operative technique used, including a traditional midline sternotomy group where the full median sternotomy was performed, and a left chest small incision group where left anterior mini-thoracotomy was performed. The clinical data of the two groups were compared. ResultsA total of 143 patients were enrolled, including 70 patients in the traditional midline sternotomy group and 73 patients in the left chest small incision group. The age of the patients in the left chest small incision group and the traditional midline sternotomy group was 63.8±8.0 years and 63.0±7.8 years, respectively; the proportions of males were 69.9% and 74.3%, respectively. The differences were not statistically significant (all P>0.05). All patients in the two groups successfully completed the operation, and no patients in the left chest small incision group were converted to thoracotomy. The patients in the left chest small incision group showed less postoperative drainage within postoperative 24 hours (239.4±177.7 mL vs. 338.0±151.9 mL, P<0.001), lower perioperative blood transfusion rate [32.9% (24/73) vs. 51.4% (36/70), P=0.028], higher postoperative myoglobin level within postoperative 24 hours [366.1 (247.9, 513.0) ng/mL vs. 220.8 (147.2, 314.9) ng/mL, P<0.001], shorter intensive care unit stay [45.5 (31.5, 67.5) h vs. 68.0 (46.0, 78.5) h, P=0.001] and postoperative hospital stay (10.8±4.0 d vs. 13.1±5.3 d, P=0.028] compared to the traditional midline sternotomy group. There was no significant difference in the incidence of major adverse cardiac and cerebrovascular event between the two groups [2.7% (2/73) vs. 2.9% (2/70), P=1.000]. ConclusionCompared to the full median sternotomy, MICS CABG leads to a good clinical result with smaller trauma, faster overall recovery, and less perioperative blood transfusion.
Objective To compare and analyze the early- to mid-term outcomes of transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) combined with coronary artery bypass grafting (CABG) for the treatment of significant aortic stenosis (AS) and coronary artery disease (CAD). Methods The data of patients with significant AS and CAD who underwent surgical treatment at Central China Fuwai Hospital of Zhengzhou University from January 2018 to July 2023 were collected. These patients were divided into a TAVR+PCI group and a SAVR+CABG group according to the operation method. Propensity score matching (PSM) was used to select patients with close clinical baseline characteristics, and the early- to mid-term outcomes of the two groups were compared. Results A total of 272 patients were enrolled, including 208 males and 64 females, with a mean age of 64.16±8.24 years. There were 47 patients in the TAVR+PCI group and 225 patients in the SAVR+CABG group. After 1∶1 PSM, 32 pairs were selected. There was no statistical difference in baseline data between the two groups (P>0.05). Compared with the SAVR+CABG group, the TAVR+PCI group had significantly shorter operative time, mechanical ventilation time, ICU stay, postoperative hospital stay, and less intraoperative bleeding, and significantly lower postoperative transfusion and complete revascularization rates (P<0.05). The differences in the rates of postoperative in-hospital death, myocardial infarction, stroke, and other complications between the two groups were not statistically significant (P>0.05), and the differences in the rates of severe perivalvular leakage, death, or readmission in the mid-term follow-up were not statistically significant (P>0.05). Conclusion In patients with significant AS and CAD, the early- and mid-term rates of death and complications were similar between those treated with TAVR+PCI and SAVR+CABG, and TAVR+PCI is a safe alternative to SAVR+CABG.