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@#Objective To study the relationship between preoperative heart rate variability (HRV) and postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB). Methods A retrospective analysis was performed on the clinical data of 290 patients who were admitted to the Department of Cardiovascular Surgery, General Hospital of Northern Theater Command from May to September 2020 and received OPCAB. There were 217 males and 73 females aged 36-80 years. According to the incidence of POAF, the patients were divided into two groups: a non-atrial fibrillation group (208 patients) and an atrial fibrillation group (82 patients). The time domain and frequency domain factors of mean HRV 7 days before operation were calculated: standard deviation of all normal-to-normal intervals (SDNN), root mean square of successive differences, percentage difference between adjacent normal-to-normal intervals that were greater than 50 ms, low frequency power (LF), high frequency power (HF), LF/HF. Results The HRV value of patients without POAF was significantly lower than that of patients with POAF (P<0.05). The median SDNN of the two groups were 78.90 ms and 91.55 ms, respectively. Age (OR=3.630, 95%CI 2.015-6.542, P<0.001), left atrial diameter (OR=1.074, 95%CI 1.000-1.155, P=0.046), and SDNN (OR=1.017, 95%CI 1.002-1.032, P=0.024) were independently associated with the risk of POPAF after OPCAB. Conclusion SDNN may be an independent predictor of POAF after OPCAB.
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Objective To evaluate the short-term-outcome of MVP in the treatment of moderate IMR patients with CABG.Methods Data from 129 patients with moderate IMR who underwent surgical treatment in our department from June 2007 to September 2011,57 patients(44.2％) underwent CABG combined with MVP,and 72 patients(55.8％) underwent CABG.Postoperative follow-up of patients with heart function NYHA grade to evaluate the clinical status of patients,with LVESD,LVEF,LVEDD to evaluate the reverse of left ventricular remodeling;The postoperative residual mitral regurgitation and major cardiac cerebral vascular events were recorded.Results There was no significant difference between two groups in the preoperative data(P ＞ 0.05).The mortality rate was 3.9％ (5 cases),2 cases (2.8 ％) died in CABG group,3 cases (5.3 ％) died in the combined surgery group.The average follow-up was 24 months,9 cases of late death (5 in CABG group,4 in CABG + MVP group),the cumulative survival rate(P =0.645) and the major cardiovascular events(P =0.761) of the two groups were not statistically different.The degree of mitral regurgitation(P ＜ 0.01) was significantly decreased in the combined surgery group.Compared with the preoperative state,the two groups of left ventricular remodeling indicators such as LVESD,LVEF,LVEDD were significantly improved(P ＜0.05),but the difference between two groups was not significant(P ＞0.05).NYHA heart function classification was significantly improved (P ＜ 0.001).Conclusion MVP can effectively improve the reverse flow of patients with moderate IMR,but CABG combined with MVP can not bring more benefits in the reversal of left ventricular remodeling,short-term survival and cardiac function.
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Objective To evaluate the different cardioprotective function of transplantation of marrow mesenchymal stem cells(BMSCs) from coronary heart disease(CHD) patients with diabetes mellitus (DM) or not to myocardial infarction rats.Methods 45 adult male rats with acute myocardial infarction experimentally were randomized into three groups,15 rats in each group.BMSCs from CHD patients with DM or not were injected into the infarcted myocardium.In control group,culture medium was used.Echocardiography,Western-blot analysis,TUNEL were performed 4 weeks after transplantation.Results Proliferation of BMSCs in DM group was significantly lower than that in non-DM group.Transplantation of BMSCs in the infarcted border zone improved cardiac function,Bcl-2 protein level in DM and non-DM group compared with control group,moreover,BAX protein level and TUNEL positive cells were decreased.Furthermore,compared with non-DM group,cardiac function and Bcl-2 protein level were decreased,however,BAX protein and TUNEL positive cells were improved.Conclusion BMSCs from CHD patients have proliferative properties.Transplantation of BMSCs can improve cardiac function by inhibiting apoptosis.But DM may decrease apoptosis resistance,which might impair the cardioprotective function of cells transplantation.
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Objective To investigate the localization and expression of endothelial nitric oxide synthase (eNOS) within the wall of the human internal mammary arteries (LMA), radial arteries (RA) and the great saphenous veins (SV) using immunohistochemistry method. Methods Specimens were harvested from 20 patients undergoing coronary artery bypass grafting and submitted to light microscope analysis using immunohistochemistry method. Results The expression of eNOS was evident in the intima of LIMA, RA and SV and in the media of muscular LIMA and RA. No eNOS expression was found in the media of great saphenous veins. Semiquantitative and the imaging analysis indicated by gray level values revealed a higher eNOS expression in the wall of internal mammary artery, particularly at the level of the media. Conclusion Different expression of eNOS in the intima and media of LIMA, RA and SV may provide a histological explanation for the better results of the LIMA when used for coronary artery bypass grafting.
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Objective To review the experience of treatment of atrial fibrillation (AF) after coronary artery bypass grafting (CABG), and to analyze its risk factors. Methods 110 patients were subjected to CABG. AF occurred in 26 of them after surgery. All these patients were treated with drugs or direct current. AF group and non-AF group were studied retrospectively, with an analysis of risk factors of AF. Results The incidence of AF after CABG was 23.6%. 19 patients were treated with Amiodarone, and 17 of them had sinus rhythm restored to normal (84.2%). In 3 of 4 patients, who were treated with Esmolol, sinus rhythm restored to normal (75%). All 3 patients who were treated with direct current had their sinus rhythm restored. The occurrence of AF was related to age, volume of left atrium, pathological change in proximal-median segment of right coronary artery, and the administration of ?-receptor blockade before surgery. It was indicated by logistic regression multiple factors analysis that both advanced age and abstinence of administration of ?-receptor blockade before surgery were individual risk factors for AF. Conclusion Ventricular rhythm should be controlled positively when AF occurred after CABG. Amiodarone, Esmolol and direct current were safe and effective treatment modalities. Patients with advanced age, large left atrium and pathological change in proximal-median segment of right coronary artery, should be treated with ?-receptor blockade to prevent AF.