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Objective Big endothelin-1(big ET-1) is associated with the prognosis of various cardiovascular diseases. This study is to explore the predictive value of plasma big ET-1 level for long-term outcome after mitral valvuloplasty in patients with moderate to severe chronic ischemic mitral insufficiency .Methods A total of 142 consecutive patients with moderate to severe chronic ischemic mitral regurgitation who underwent coronary artery bypass grafting and mitral valvuloplasty were enrolled at our center from January 2009 to December 2015.The clinical baseline data were collected and recorded.All patients were followed up.The mortalities and major adverse cardiovascular and cerebrovascular events during the follow-up period were re-corded.Results A total of 142 patients were enrolled, with mean age of(59.4 ±8.3) years.During(51.9 ±22.6) months follow-up, 19 cases(13.4％) died and 35 cases(24.6％) had major adverse cardiovascular and cerebrovascular events.Uni-variate and multivariate Cox regression analysis showed that big ET-1 was an independent risk factor for all-cause mortality (HR=3.970, 95％CI:1.535-10.268) and major adverse cardiovascular and cerebrovascular events(HR=2.754, 95％CI:1.238-6.129).In addition, left ventricular ejection fraction, pulmonary hypertension and stroke history were independent risk factors for all-cause mortality , while left ventricular ejection fraction , stroke history were independent risk factors for major adverse cardiovascular and cerebrovascular events.Conclusion Long-term outcomes of simultaneous coronary artery bypass grafting and mitral valvuloplasty for moderate to severe ischemic mitral insufficiency are satisfactory and big ET-1 is an inde-pendent risk factor for long-term outcomes of these patients.
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<p><b>BACKGROUND</b>The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG). We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump CABG.</p><p><b>METHODS</b>From October 2009 to September 2013 at the Fuwai Hospital, 127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction (MI), stroke, requirement for intra-aortic ballon pump (IABP) assistance and prolonged ventilation. Major adverse cardiac events (MACEs: Death, MI or repeat revascularization) and angina recurrence were considered as mid-term endpoints.</p><p><b>RESULTS</b>No significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups versus 59.5 ml in sequential venous grafts groups (P < 0.001). There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, MI, stroke, IABP assistance and prolonged ventilation (11.0% vs. 14.2%, P = 0.45). Individual in-hospital measurement also did not differ significantly between the two groups. At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36) and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48) were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both MACEs and angina recurrence.</p><p><b>CONCLUSIONS</b>Compared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in-hospital or mid-term adverse events in patients undergoing off-pump CABG.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Coronary Artery Bypass, Off-PumpABSTRACT
Objective The purpose of this study was to assess the incidence,treatment and prognosis of silent pulmonary embolism (PE) after off-pump coronary artery bypass graft (CABG).Methods From December 2009 to September 2012,582 consecutive patients underwent off-pump CABG by a same surgeon.Their age ranged from 16 to 86 years with a mean age of (61.4 ± 9.3) years.Left internal mammary artery and saphenous vein were harvested routinely.A dose of 20 mg unfractionated heparin was given intravenously every 6 hours on the operative day after postoperative pleural fluid less than 50 ml per hour.All patients received aspirin 100 mg daily starting on postoperative day 1.The 64-slice coronary MDCT was performed to assess the graft patency on postoperative day 5 ～ 7.Results There were no in-hospital death.PE,which involved the lobar or more proximal arteries,was detected on the CT images of 10 patients (1.7％).In these 10 patients,there were no significant dyspnea or hypoxemia postoperatively ; echocardiography and ECG showed no specific signs of PE ; all bypass grafts were patent in CT images except a LIMA to LAD graft with LAD endarterectomy.PE involved both lungs in 6 patients,and only the right lung in 4 patients.All patients received anticoagulation with warfarin for 3 to 6 months except one.All patients were with good quality of life during 6 to 18 months of follow-up.Three to six months after discharge,8 patients received repeated MDCT,which showed diminish of PE.Conclusion Acute PE after off-pump CABG was an uncommon complication and was difficult to diagnose.MDCT played an important role in examining the patency of graft vessels and helped detect silent PE in CABG patients.The prognosis of acute PE after off-pump CABG was acceptable.PE diminished after 3 months of anticoagulation with warfarin.
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<p><b>BACKGROUND</b>Coronary artery bypass graft (CABG) has been developed over many years. Recently, an increasing number of patients need a second surgery for relapse of symptoms. In consideration of the high surgical risk, accurate preoperative evaluation is needed. The aim of the study was to assess the predictive value of three different risk scoring system for early postoperative mortality rate in patients with redo-CABG.</p><p><b>METHODS</b>Seventy-seven patients who underwent redo-CABG in Fu Wai Hospital from January 1997 to June 2013 were enrolled. All patients were retrospectively scored for early postoperative mortality rate using EuroSCORE, STS score and SinoSCORE. Overall expected mortality rates were compared with observed mortality rates. Discrimination was evaluated using receiver operating characteristic (ROC) curves and area under a ROC curve (AUC).</p><p><b>RESULTS</b>Four patients died after a redo-CABG 5%. The mortality rates predicted by EuroSCORE, STS score and SinoSCORE were 5.0%, 2.2% and 1.4%, respectively. The AUC of the three kinds of score were 0.465, 0.543 and 0.528, respectively, indicating a poor correlation between the observed and predicted mortality rates.</p><p><b>CONCLUSION</b>The predictive value of EuroSCORE, STS score and SinoSCORE is poor for early postoperative mortality rate in patients with redo-CABG.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Coronary Artery Bypass , Mortality , Postoperative Period , Predictive Value of Tests , ROC Curve , Reoperation , Mortality , Retrospective StudiesABSTRACT
ObjectiveTo evaluate the efficacy and safety of simultaneous hybrid carotid artery stenting and off-pump coronary artery bypass in the treatment of coronary artery disease associated with serious carotid artery stenosis.Methods From January 2008 to December 2010,30 consecutive patients of CAD associated with serious carotid artery stenosis underwent off-pump coronary artery bypass.Fifteen patients received the hybrid revascularization by carotid artery stenting,immediately followed by off-pump coronary artery bypass and 15 consecutive patients underwent staged carotid artery stenting and off-pump coronary artery bypass.ResultsRevascularization was successful in all 30 patients ( 100％ ).There were no procedure-related complications and no in-hospital death for both procedures.Although the postoperative courses were uneventful with the exception of 2 patients who suffered from strokes,no vital organ dysfunction occurred.In the staged group,atrial fibrillation,acute renal inefficiency and reoperation for bleeding occurred each in 1 patient,respectively.There was no significant difference in the ventilation time [(31.7 ± 27.8 ) h vs ( 17.9 ± 7.06 ) h,P =0.073],intensive care unit stay [( 87.7 ± 61.6 ) vs (52.3 ± 80.8) h,P=0.189],and the volume of chest drainage [(945 ±260) ml vs (764 ±334) ml,P =0.109] between the hybrid revascularization and staged procedure groups.There was a shorter hospital stay after CAS of patients undergoing hybrid CAS-OPCAB compared with staged CAS-OPCAB [(9.7 ± 3.3 ) vs ( 17.1 ± 6.9 ) days,P =0.001].Conclusion For patients with both carotid artery stenosis and coronary artery disease,simultaneous hybrid or staged revascularization by carotid artery stenting,followed with off-pump coronary artery bypass,are feasible,safe,and less invasive therapeutic strategies.Both procedures do not influence the liver and renal function.Besides,no significant difference exists in the volume of chest drainage,ICU stay,respirator time,and between the staged and hybrid procedures.Compared with staged CAS-OPCAB the patients undergoing hybrid CAS-OPCAB strategy needs a shorter postoperative hospital stay time and decreases the total hospitalization cost at hospital.Further investigation are warranted to study its long-term efficacy.
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ObjectiveTo assess the prognostic efficiency of three different risk socres in patients underwent redo-coronary artery bypass grafting (redo-CABG).MethodsFrom January 1997 to July 2011,57 patients underwent redo-CABG in Fu Wai Hospital.All patients were prospectively scored for operative mortality using EuroScore,STS Score and Sinoscore.The overall expected mortality were compared with the observed mortality.Discrimination was evaluated by receiver operating characteristic (ROC) cures and area under a ROC curve (AUC).ResultsFour patients died in the whole group,the observed mortality was 7％.The overall predicted mortality of EuroScore,STS Score and SinoScore were 5.6％,2.2％ and 1.5％,all lower than the observed mortality.The AUC of the three kinds of score were respectively 0.495,0.557 and 0.535,which indicated that the discrimination of the three kinds of score are poor.ConclusionThe predictive value of EuroScore,STS Score and SinoScore for early postoperative mortality in patients undergoing redo-CABG is poor.Surgical technology is an important predictor for early postoperative mortality.