Abstract： Objectives To evaluate the early and mid-term follow-up outcomes of “one-stop” hybrid coronary revascularization strategy for patients with multivessel coronary artery disease. Methods From June 2007 to December 2009, 104 consecutive patients underwent “one-stop”hybrid coronary revascularization in Fu Wai Hospital. There were 93 male patients and 11 female patients with mean age of （61.8±10.2）years（ranging from 35 to 81 years）. All the patients had multivessel coronary artery disease including left anterior descending （LAD）coronary artery stenosis, and underwent “one-stop”hybrid coronary revascularization. “One-stop”hybrid procedure was first performed through a lower partial sternotomy at the second left intercostal space. The distal anastomosis of in situ left internal mammary artery （LIMA）to LAD graft was completed. Angiography was performed immediately to confirm patency of the LIMA graft after closure of the thorax. A 300 mg loading dose of clopidogrel was administered through a nasogastric tube after confirmation of LIMA graft patency. Intravenous unfractionated heparin was administered to obtain an activated clotting time of greater than 250 s. Then percutaneous coronary intervention（PCI）was performed on the non-LAD lesions. Results All the patients underwent“one-stop”hybrid coronary revascularization including grafted LIMA to LAD，and one hundred and ninety one drug eluting stents and three bare metal stents were used for other non-LAD lesions. No death event occurred during surgery and in hospital. All the patients were followed up for a mean duration of 1.5 years. There was no myocardial infarction, neurologic event or death occurred during follow-up except one patient with stent stenosis who was treated by PCI. Conclusion “One-stop” hybrid coronary revascularization is a feasible and safe alternative for patients with multivessel coronary artery disease.
Abstract: Objective To investigate the relationship between graft flow and incidence of perioperative myocardial infarction (MI) in coronary artery bypass grafting (CABG). Methods Between January 2010 and June 2010, 58 consecutive patients with coronary artery disease who underwent offpump CABG in the First Hospital of Peking University were enrolled in this study. An anastomosis between left internal mammary arteries (LIMA) and left ant erior descending coronary artery (LAD) were performed. And saphenous vein (SV) graft s were used as bypass grafts. Graft flow was measured intraoperatively using a transi t time flowmeter, and the total graft flow of each patient was calculated as a parameter of myocardial revascularization. The 58 patients were divided into a MI group and a nonMI group retrospectively. There were 11 patients in the MI group, including 7 males and 4 females, with an average age of 67.4±10.3 years.There were 47 patients in the nonMI group, 38 males and 9 females, with a mean age of 633±99 years. The graft flow of the two groups was tested and compared, and the preoperative variables were compared. Results There was no statistically significant difference in operation time (205.4±59.6min versus 1834±32.4 min, t=1.691, P=0.096) between the two groups. Therewere also no statistical differences in the average number of grafts (3.00±1.00 branches versus 2.96±0.78 branches, t=0.154, P=0878) or LIMALAD flow (1540±11.37 ml/min versus 16.50±10.83 ml/min, t=0.301, P=0.764) between the two groups. However, a significant difference was found in the total graft flow between the two groups (41.03±19.50 ml/min versus 64.09±32.44 ml/min, t=2.254, P=0.028), with lower total graft flow in the MI group. Further analysis showed [CM(159mm]that a total graft flow lt;48.5ml/min was a risk factor for MI (odds ratio 4.706, 95% confidence interval 1.099 to 20.147). Conclusion Total graft flow could be used to predict the occurrence of perioperative myocardial ischemia, as there is a high probability of MI for patients with a total graft flow of less than 48.5 ml/min.
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 investigate the effect of bone marrow mesenchymal stem cell (MSCs) transp1antation combined with transmyocardial drilling revascularization (TMDR) and degradable stent on myocardium revascu1arization after acute myocardial infarction(AMI), and to provide the experimental evidence for surgical treatment of myocardial infarction. Methods After established models of AMI, the 24 pigs were divided into four groups with random number table, 6 pigs each group. Control group: only established models of AMI; MSCs group: AMI immediately followed by MSCs implantation; TMDR combined with stent group: AMI followed by TMDR and absorbable basic fibroblast growth factor (bFGF) stent implantation; MSCs combined with TMDR and stent group: AMI followed by TMDR and absorbable bFGF stent implantation, and then MSCs implantation. Three months after operation, the infarcted areas and vessel density in infarcted zone were detected by histopathology method. Results Three months after operation, the histopathological examination showed that infarcted areas in MSCs group, TMDR combined with stent group, and MSCs combined with TMDR and stent group were decreased as compared with control group （27.9%±3.1% vs. 48.9%±2.7%，P=0.000；20.3%±1.7% vs. 48.9%±2.7%，P=0.000；12.5%±1.9% vs. 48.9%±2.7%，P=0.000）; and vessel density was further increased （8.4±1.2/HP vs.4.5±14/HP，P=CM(1583mm] 0.001；11.5±2.6/HP vs.4.5±1.4/HP，P=0.001;15.6±1.4/HP vs.4.5±1.4/HP，P=0.000）. Conclusion [CM)]MSCs transplantation combined with TMDR and absorbable bFGF stents implantation could significantly reduce the infarction areas, increase the vessel density. This method may enhance the efficacy of MSCs transplantation in acute cardiac infarction model, which provide a new ideas for the surgical treatment of myocardial infarction.
Composite grafting techniques is a commonly used strategy in coronary artery bypass grafting,especially suits elderly patients.It is an attractive myocardial revascularization strategy when the grafts are not sufficient to achieve complete myocardial revascularization.Furthermore,composite grafting in the presence of a diseased aortic wall seems a rational approach to reduce the incidene of postoperative neurological deficit or stroke by avoiding the manipulation of atherosclerotic aorta.Also,it gained excellent short and midterm results.This review provides an overview of the various surgical techniques,outcomes,concerns and controversies associated with composite grafting.
Objective To assess the use of arterial revascularization and to compare the early outcomes with traditional coronary artery bypass grafting (CABG). Methods From January 1999 to January 2005, 123 patients (114 male, 9 females; age 52.2±10.1 years) underwent coronary artery surgery alone with disease of more than one coronary artery were considered for complete arterial revascularization (artery revascularization group). Internal mammary artery and radial artery was considered for artery grafts. At same period 115 patients (102 males, 13 females; age 60.3±9.1 years) underwent traditional revascularization using left internal mammary artery and veins (traditional group). The purpose was to compare the operative results between two groups. Results The patients in artery revascularization group were younger than that in traditional group, but there were more patients with three vessels disease in traditional group(54.5% vs. 86.1%, P=0.001). Off-pump CABG was choosed for more patients in artery revascularization group (26.0% vs. 57.4%, P=0.001). Patients in this group need more operative time if on-pump technique was used. The number of grafts were less in this group (2.6±0.7 vs. 3.4±0.9, P=0.001).There was no significant difference in hospital mortality and morbidity between two groups. Conclusion Proper patients using artery grafts appear to be safe in terms of in hospital mortality and morbidity.
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.
Objective To compare the effectiveness, complications, and follow-up results between endovascular recanalization (EVR) and open surgical revascularization (OSR) in the treatment of peripheral pseudoaneurysm, so as to provide a reference for choosing a appropriate surgical procedure. Methods Clinical data of 62 cases of peripheral pseudoaneurysm between January 2001 and January 2012 were analyzed retrospectively. EVR was performed in 28 patients (EVR group) and OSR in 34 patients (OSR group). There was no significant difference in gender, age, cause of injury, tumor location, and diameter of tumor between 2 groups (P gt; 0.05). Results The operation time, blood loss, ICU monitoring time, and hospitalization time in EVR group were significantly shorter than those in OSR group (P lt; 0.05). In OSR group, 12 cases (35.29%) had early postoperative complications, including 2 deaths due to acute respiratory distress syndrome, 5 cases of pulmonary infection, 3 cases of wound infection, and 2 cases of deep vein thrombosis; in EVR group, 2 cases (7.14%) had early postoperative complications, including 1 case of hematoma at puncture site and 1 case of thrombosis in stent. There was significant difference in early postoperative complication incidence between 2 groups (χ2=6.691, P=0.008). The patients were followed up 12-39 months (mean, 26 months). In OSR and EVR groups after operation, the patency rates of the reconstructed vessels were 96.88% (31/32) and 92.86% (26/28) respectively at 12 months, showing no significant difference (χ2=0.014, P=0.905); the patency rates were 89.29% (25/28) and 84.00% (21/25) respectively at 24 months, showing no significant difference (χ2=0.322, P=0.570). Conclusion Compared with OSR, EVR is a minimally invasive, safe, and effective therapy for peripheral pseudoaneurysm with the advantages of less bleeding, shorter hospitalization time, and less complications. Long-term effectiveness still needs further observation, and patients have to take antiplatelet drugs for long time after EVR.
Objective To discuss the safety and feasibil ity of treating complex renal aneurysm with ex vivo aneurysmectomy and renal revascularization and renal autotransplantation after hand-assisted retroperitoneoscopic nephrectomy. Methods In October 2006, one male patient with complex renal aneurysm was treated. The preoperative color Doppler ultrasonograph, CT and DSA showed that there was an aneurysm (3.4 cm × 4.3 cm × 4.5 cm) located in the main renalartery bifurcation and its five branches of the left kidney. The patient had a history of hypertension with no response to treatment. After successful hand-assisted retroperitoneoscopic nephrectomy, the kidney off-body was perfused by the renal irrigating solution immediately to protect the kidney. Then ex vivo aneurysmectomy and renal artery revascularization were performed, the renal artery was reconstructed with an autologous right internal il iac artery. The reconstructed left kidney was re-implanted into the right il iac fossa. Results The operation was successful and the patient recovered without perioperative complications. The postoperative renal function was normal and the color Doppler ultrasonograph showed that the blood circulation in the transferred renal artery of the right il iac fossa and its branches was smooth, the blood circulation of the renal venous was smooth and no stenosis in the ureter 2 weeks after operation. Thirteen months follow-up showed the blood pressure was recovered to normal and the renal function was normal. Conclusion The method of ex vivo aneurysmectomy and autotransplantation is safe, feasible and minimally invasive for treating complex hilar renal artery aneurysms.
ObjectiveTo summarize the experience of 4 patients with a great saphenous venous graft patency after 15 years of postoperitive great saphenous venous sequential aortic coronary artery bypass grafting. MethodWe retrospectively analyzed the clinical data of 4 patients accepted great saphenous vein aortic coronary artery bypass graft under moderate hypothermia cardiopulmonary bypass from November 1989 to December 1992 year. There were 3 males and 1 female with a mean age of 48.3 years ranging from 40-58 years. We harvested great saphenous vein under groin 45-50 cm. The proximal and distal anastomoses were performed with parachute technique under two clamps technique. Coronary artery bypass graft was performed by two sequential grafts routinely. Aspirin was given through nasal tube 6 hours after operation. The risk factors of arteriosclerosis were controlled by patients themselves after discharge. ResultFour patients received coronary angiography in 15, 16, 18, and 21 years after surgery and the grafts and both proximal and distal anastomoses were patent. The patients lived about 20 years without angina. Conclusioncarefully dealing with the vein graft, taking sequential bypass grafting to guarantee parabolic curve and meticulous anastomosis are preconditional and necessary for long-term patency.