Objective To study the characteristics of endothelin(ET) and hemodynamics parameters in patients with coronary artery disease (CAD) in perioperative period and aim to find out some rules and useful suggestions for clinical trial. Methods Fortyseven patients were divided into 5 groups: patients undergoing coronary artery bypass grafting (CABG) and resection of left ventricular aneurysm(CABG+LVAN group),patients undergoing classical CABG(CABG group), patients undergoing offpump coronary artery bypass grafting (OPCAB group), patients undergoing transmyocardial laser revascularization (TMLR group), and group control, patients undergoing mitral valve replacement because of rheumatic heart disease(RHD). The ET was measured in the following time: before operation, before aortic clamping(or before revascularization or before TMLR), aortic declamping(or just after revascularization or just TMLR), 3 h, 6 h, 24 h after reperfusion. CI was measured before operation, 3 h, 6 h and 24 h after reperfusion, respectively. Results ET Compared in each group: in CABG+LVAN group, it significantly increased when aortic declamping (69.93±7.20 pg/ml),at 3 h (89.99±5.76 pg/ml),6 h (60.94±8.69 pg/ml) and, 24 h (6899±10.30 pg/ml) after reperfusion than that beforeoperation (40.17±13.37 pg/ml，Plt;0.05); in CABG group, ET significantly increased when reperfusion(66.59±4.86 pg/ml), at 3 h (95.97±10.72 pg/ml), 6 h (61.51±765 pg/ml) and, 24 h (57.85±6.34 pg/ml) after reperfusion than that beforeoperation(43.22±9.13 pg/ml，Plt;0.05); in OPCAB group, ET increased significantly when reperfusion(66.47±5.90 pg/ml) than that beforeoperation(44.80±6.51 pg/ml，Plt;0.05), and then returned to normal level; in TMLR group,there is no difference before and after operation; in control group, ET increased significantly after operation. ET compared between different groups: ET level was higher in CABG group than that in OPCAB group at 3 h after reperfusion(95.97±10.72 pg/ml vs.59.72±4.81 pg/ml,Plt;0.05). Although CI significantly increased after myocardial reperfusion in all groups, the CI was significantly higher in OPCAB group than that in CABG group at 3 h after reperfusion(3.25±0.05 pg/ml vs. 2.17±0.46 L/min·m2,Plt;0.05). Conclusions In patients with CAD, the ET increases after operation, but the increasing levels are different among the different groups. In patients with OPCAB, the changes of ET and hemodynamics are mild, and heart function recovers quickly, so OPCAB is a very good choice for CAD surgical therapy if the indications are suitable; In patients with classical CABG, the changes of ET are obvious, and the heart function recovers a little bit slowly, but they all can return to normal level at 24 h after operation; TMLR is a good supplement for CAD therapy.
Objective To summarize the essential of perioperative therapy and improve the prognosis of coronary artery bypass grafting （CABG） and transmyocardial laser revascularization （TMLR） through analyzing 1405 patients with coronary atherosclerotic heart disease. Methods From May 1997 to January 2006, 1 405 patients were treated in our hospital. On-pump CABG were performed in 825 patients, single CABG were performed in 666 patients, CABG with cardiac valvular operation in 98 patients, CABG with cardiac ventricular aneurysm resection in 55 patients, CABG with ventricular septal defect repairment in 2 patients; CABG with left atrium gelatinous tumor resection in 2 patients, CABG with ascending aorta repairment in 1 patient, and mediastinal septum tumor resection in 1 patient. Off-pump coronary artery bypass grafting （OPCAB） were performed in 500 patients; single TMLR were performed in 30 patients, CABG＋TMLR were performed in 50 patients. Results The number of bridge vessel was 2.9±1.0. Forty-two patients（3.0%） died of bleeding, myocardial infarction, low cardiac output syndrome, renal failure, multiple organ failure（MOF） and so on. Various complications were occurred in 70 patients（5.0%）, including bleeding, low cardiac output syndrome, myocardial infarction, renal failure and so on. All of them were recovered after treatment. There were 1 177 patients of angina in grade Ⅲ-Ⅳ （CCS） before operation, 1 154 of them （98.0%） changed in grade 0-Ⅰ （CCS） postoperatively. There were 857 patients （62.9%） in follow-up for 8.3±2.9 months postoperatively. There was no angina in 788 patients（91.9%） 6 months after surgery. The ultrasonic graphic showed that left ventricular ejection fraction was 0.66±0.10 and raised 7.9% than that before operation. The quality of life was better than before. Conclusion CABG has become the most potent routine operation in the therapy of coronary artery disease. It can extend the applications of CABG and improve the operative prognosis, if the indications are correctly mastered and the perioperative management are enhanced.