Redo coronary artery bypass grafting: on-pump and off-pump coronary artery bypass grafting revascularization techniques / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the short-term outcomes of redo coronary artery bypass grafting (CABG) using on-pump and off-pump CABG techniques.</p><p><b>METHODS</b>From January 2003 to August 2013, non-randomized 80 patients were treated with redo CABG in the Department of Cardiac Surgery, Peking University Third Hospital. Among these patients, 40 underwent on-pump CABG technique (redo-ONCAB group) and 40 underwent off-pump CABG technique (redo-OPCAB group). Furthermore, transmyocardial laser revascularization was performed in high-risk patients who were not suitable to conventional grafting. Clinical data of the two groups were recorded and analyzed including operation time, coronary grafts, incomplete revascularization, postoperative ventilation, perioperative stroke, and low output syndrome, etc.</p><p><b>RESULTS</b>There were no significantly differences in age, gender distribution, incidences of hypertension, stroke, and other clinical characteristics between redo-OPCAB group and redo-ONCAB group (all P>0.05), except for incidences of renal dysfunction and pulmonary disease (all P<0.05). The number of grafting vessels in the redo-ONCAB and redo-OPCAB groups was 2.1 ± 0.74 and 1.4 ±0.52 respectively. There was significant difference between the two groups (P=0.0243). Compared with the redo-ONCAB group, there was shorter operation time (P=0.0045), postoperative ventilation (P=0.0211) and intensive care unit stay (P=0.0400), as well as fewer use of platelet (P=0.0338) and blood transfusion (P=0.0034) in the redo-OPCAB group. The incidence of incomplete revascularization (P=0.0253) and the use of transmyocardial laser revascularization (P=0.0052) were higher in the redo-OPCAB group than those in the redo-ONCAB group (all P<0.05). However, no significant differences were showed for the incidence of the use of intra aortic balloon pump and continuous renal replacement therapy, perioperative stroke, low output syndrome, and in-hospital mortality between the two groups (all P>0.05).</p><p><b>CONCLUSION</b>Redo CABG is the safety and efficacy surgical procedure, and redo-OPCAB technique with better outcomes is commended especially in high-risk patients.</p>

Sternal reconstruction of deep sternal wound infections following median sternotomy by single-stage muscle flaps transposition / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To assess clinical effectiveness of using bilateral pectoralis major or plus rectus abdominis muscle flaps in treating deep sternal wound infection (DSWI) following median sternotomy.</p><p><b>METHODS</b>Between January 2009 and December 2013, 19 patients with DSWI after median sternotomy for cardiac surgery were admitted to our hospital, including 14 males (73.7%) and 5 females (26.3%), aged 55±13 (18-78) years. According to the Pairolero classification of infected median sternotomies, 3 (15.8%) patients were type II, and the other 16 (84.2%) were type III. Surgical procedure consisted of adequate debridement of infected sternum, costal cartilage, granulation, steel wires, suture residues and other foreign substances. Sternal reconstruction used the bilateral pectoralis major or plus rectus abdominis muscle flaps to obliterate dead space. The drainage tubes were placed and connected to a negative pressure generator for adequate drainage.</p><p><b>RESULTS</b>There were no intraoperative deaths. In 15 patients (78.9%), bilateral pectoral muscle flaps were mobilized sufficiently to cover and stabilize the defect created by wound debridement. 4 patients (21.0%) needed bilateral pectoral muscle flaps plus rectus abdominis muscle flaps because their pectoralis major muscle flaps could not reach the lowest portion of the wound. 2 patients (10.5%) presented with subcutaneous infection, and 3 patients (15.8%) had hematoma. They recovered following local debridement and medication. 17 patients (89.5%) were examined at follow-up 12 months later, all healed and having stable sternum. No patients showed infection recurrence during the follow-up period over 12 months.</p><p><b>CONCLUSION</b>DSWI following median sternotomy may be effectively managed with adequate debridement of infected tissues and reconstruction with bilateral pectoralis major muscle or plus rectus abdominis muscle flap transposition.</p>

The role of European system for cardiac operative risk evaluation in the prediction of quality of life in patients after coronary artery bypass graft surgery / 中华心血管病杂志

<p><b>OBJECTIVE</b>To assess the value of European system for cardiac operative risk evaluation (EuroSCORE) in predicting quality of life in patients post coronary artery bypass graft surgery (CABG).</p><p><b>METHODS</b>A total of 387 patients underwent CABG in our institute from December of 2002 to December of 2007 were assessed by EuroSCORE before operation. Health-related quality of life (QoL) was estimated postoperatively with Seattle angina questionnaire (SAQ), Nottingham healthy profile (NHP) and Duke activity status index (DASI) in order to evaluate the value of EuroSCORE for predicting quality of life in patients post CABG.</p><p><b>RESULTS</b>There were statistically significant but weak correlations between postoperative QoL score and preoperative EuroSCORE score (r: 0.010 - 0.276). Emotional and psychological experience subgroup analysis showed better predictive value of EuroSCORE score on postoperative QoL score in improved physical functioning subgroups (r > 0.2). Linear regression analysis showed that EuroSCORE score was significant but weakly (r(2) < 0.1) correlated with postoperative QoL score (P < 0.05).</p><p><b>CONCLUSION</b>Preoperative EuroSCORE score is weakly correlated with postoperative QoL score in patients post CABG.</p>

Association between nuclear factor of activated T cells 1 gene mutation and simple congenital heart disease in children / 中华心血管病杂志

<p><b>OBJECTIVE</b>To elucidate association between the mutation of nuclear factor of activated T cells 1 (NFATC1) gene in IPT-NFAT region and simple congenital heart disease (CHD) in children.</p><p><b>METHOD</b>We used polymerase chain reaction (PCR) and the sequencing reaction to detect the mutations on the patients and their parents and (or) siblings.</p><p><b>RESULTS</b>PCR amplification of the exon 7 region showed that 2 bands are obtained in 58% of patients with CHD and in 74% of their healthy parents and (or) siblings. Sequencing of the 2 bands revealed that both are amplicons of the exon 7 region, and that the additional band harbors an additional 44 nucleotides segment in the intronic region. The homozygous form of this allele was only present in patients with ventricular septal defect (2/24), atrial septal defect (3/18) and bicuspid aortic valve (1/4) in which G to A transition at nucleotide 17 of the third 44 bps was found. Neither the unrelated non-CHD individuals nor the ones with other CHD showed positive presence for the homozygous form of this allele.</p><p><b>CONCLUSIONS</b>There is a differential amplification of a tandem repeat region in intron 7 of NFATC1 and homozygous form of this allele in patients with ventricular septal defect, atrial septal defect and bicuspid aortic valve. NFATC1 gene may be an a susceptibility marker for ventricular septal defect, atrial septal defect and bicuspid aortic valve.</p>

Quality of life five years after coronary artery bypass grafting / 中华心血管病杂志

<p><b>OBJECTIVE</b>The quality of life (QOL) 5 years after coronary artery bypass grafting (CABG) was evaluated by NHP, SAQ and DASI questionnaires.</p><p><b>METHODS</b>NHP, SAQ and DASI questionnaires were mailed to 287 patients who received CABG in our department between Jan 2001 and Jan 2002. The reliability and construct validity of the questionnaires and the influence factor of QOL were analyzed.</p><p><b>RESULTS</b>Two hundred and seventy-three patients (95%) responded to the questionnaires. The reliability of three questionnaires about QOL was 0.81, 0.75 and 0.78, respectively. QOL at 5 years post CABG was significantly better in CCS I/II patients than CCS III/IV patients' according to SAQ. Exertional scale and disease perception scale according to SAQ, social isolation and physical abilities to NHP also significantly related to QOL 5 years post CABG.</p><p><b>CONCLUSIONS</b>All 3 questionnaires had high reliability and statistical validity for evaluating QOL. CCS angina degree affect the quality of life in patients 5 years post CABG.</p>

A study on viral gastroenteritis attributed to noroviruses in hospitals / 中华流行病学杂志

<p><b>OBJECTIVE</b>To better understand the clinical feature of viral gastroenteritis attributed to noroviruses and to summarize the experience on an outbreak of acute gastroenteritis through rapidly colleting and confirmation of related information regarding to noroviruses in hospitals.</p><p><b>METHODS</b>Information on an outbreaks involving 18 patients with acute gastroenteritis in one hospital regarding its epidemiological and clinical features and to perform bacteria culture for stool specimens on every patient. On 7 patients, rotavirus antigen were RNA tested together with norovirus nucleic acid were examined by ELISA and PAGE and RT-PCR.</p><p><b>RESULTS</b>(1) Most of the patients were elderly with several chronic diseases. (2) Watery diarrhea (12/18, 66.67%) and few with mucous (3/18, 16.67%) were seen. Most stool examination was normal (10/18, 55.56%) but few stool specimen could be found with some leucocytes (3/18, 16.67%) and little occult blood (4/18, 22.22%). (3) All bacteria culture in stools showed negative. There was no rotavirus RNA identified but 3 specimen showed norovirus nucleic acid positive as 42.86% (3/7).</p><p><b>CONCLUSION</b>Norovirus was one of the important pathogens causing acute gastroenteritis outbreaks in hospitals attacking elderly with several chronic diseases in particular. Surveillance program targeting elderly inpatient with diarrhea should be enhanced, especially in autumn and winter.</p>

Chronic effects of transmyocardial laser revascularization combined with off-pump coronary artery by pass (OPCAB) compared with OPCAB alone in patients with ischemic heart disease: a prospective multicenter follow-up study / 中华心血管病杂志

<p><b>OBJECTIVE</b>To approach the long term safety and efficacy of transmyocardial laser revascularization (TMLR, holmium: YAG) combined with off-pump coronary artery bypass (OPCAB) compared with OPCAB alone in patients with ischemic cardiac disease.</p><p><b>METHODS</b>Between 1999 and 2005, 80 patients with diffusely diseased target vessels from two centers in Beijing were enrolled to the study and randomized to receive either TMLR/OPCAB (n = 40) or OPCAB (n = 40) operation. Baseline demographics and operative characteristics were similar between groups. Follow-up (mean 3.4 +/- 1.7 years) included CCS angina class and NYHA classification assessments, 6 minutes walking test (6MWT) and echocardiography.</p><p><b>RESULTS</b>Perioperative mortality was 5% in both groups. No death occurred during follow up. At the end of follow-up, patients at both groups experienced significant improvement on angina score compared with baseline, and angina score was also significantly lower (1.21 +/- 0.42 vs. 1.57 +/- 0.87, P = 0.03) and 6MWT-distance significantly increased (518.0 +/- 65.5 m vs. 473.8 +/- 65.8m, P = 0.006) in OPCAB/TMLR group than that in the OPCAB group. Fewer patients developed recurrent severe angina and received re-CABG/PCI in OPCAB/TMLR group than that in the OPCAB (1 vs. 6 cases, P = 0.113). NYHA and LVEF were similar between the groups at the end of follow up.</p><p><b>CONCLUSION</b>Our study showed that the addition of TMLR to OPCAB is superior in improving angina and exercise tolerance, but there is no further improvement in cardiac function compared to OPCAB alone.</p>