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Objective:To investigate the value of 256-slice CT coronary angiography(CTA)in evaluating graft patency after coronary artery bypass grafting(CABG)in elderly patients.Methods:A total of 30 elderly patients under follow-up after CABG surgery in our hospital from May 2016 to May 2018 were randomly selected.During the same period, coronary angiography(CAG)and 256-slice CTA were performed to evaluate the patency of grafts.The diagnostic efficacy of CTA in evaluating the patency of bypass grafts was assessed by using CAG results as the gold standard.Results:In all, 82 grafts were observed on CAG, of which 31 were arterial grafts and 51 were saphenous vein grafts(SVG). Arterial grafts involved 27 original left internal mammary arteries(LIMA)→left anterior descending branch(LAD)grafts, 1 original right internal mammary artery(RIMA)→LAD graft, 1 aorta(AO)→LIMA→LAD graft, and 2 AO→radial arteries(RA)→right coronary artery(RCA)grafts.Venous grafts involved 9 AO→SVG→LAD grafts, 20 AO→SVG→left circumflex artery(LCX)grafts, and 22 AO→SVG→RCA grafts.CAG results showed that 28 arterial grafts were unobstructed with a patency rate of 90.3%, while 3 arterial grafts(9.7%)were occluded.Meanwhile, 34 venous grafts were unobstructed with a patency rate of 66.7%, 11 venous grafts(21.6%)had stenosis and 6 grafts(11.8%)were occluded.A total of 87 grafts were observed by using CTA.Based on the results from CAG, the overall sensitivity, specificity and Kappa value of CTA for the assessment of grafts were 95.1%, 97.6% and 0.93, respectively.The sensitivity, specificity and Kappa value of CTA were 96.8%, 95.0% and 0.90 for assessing unobstructed grafts, 81.8%, 97.2% and 0.79 for assessing stenosed grafts, and 100%, 98.6%, and 0.94 for assessing occluded grafts, respectively.Conclusions:256-slice CT coronary angiography can be used to accurately evaluate graft status and possesses advantages such as non-invasiveness, simplicity and low risk.Therefore, it should be recommended as the first choice in the evaluation of graft patency after CABG in elderly patients.
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Objective To investigate the effect of cardiopulmonary bypass (CPB)on platelet inhibition rate(INHAA) and Aspirin resistance (AR) after coronary artery bypass grafting (CABG)surgery.Methods A total of 114 patients undergoing CABG surgery were divided into two groups:on-pump group(n=54)and off-pump group(n=60).Aspirin treatment(100 mg/d)was paused 7 days before surgery and continued 6 hours after surgery.INHAA was detected and calculated by using thrombelastography(TEG)at 6 hours after taking the last dose of aspirin before surgery(T0),12 hours (T1),5 days(T2),10 days (T3) and 15 days (T4) after surgery respectively.The incidence of AR was calculated.Results There was no significant difference in the overall INHAA between the two groups of on vs.off-pump(F =0.336,P =0.563),while the differences of INHAA index at each time point was statistically significant between two groups of on vs.off-pump(F =95.519,P =0.000).There was an interaction effect of timing and grouping(F =15.500,P =0.000).In comparison of INHAA between the two groups of on vs.off-pump at each time point,INHAA was higher in on-pump group than in off-pump group at T1 (P＜0.05),while INHAAbecame lower in on-pump group than in off-pump group at T2 (P＜0.05),and there was no statistical difference in INHAAbetween the two groups at T3 and T4 (P ＞0.05).In the on-pump group,the total difference of INHAA at different time points was significant (P＜0.05),and the INHAA was lower at T2 than at T1,T3,T4 (P＜0.05).In the off-pump group,the total difference of INHAA between different time points was significant(P＜0.05),and the INHAA was lower at T1 than at T2,T3,T4 (P＜0.05).In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point,the incidence of AR was lower in on-pump group than in off-pump group at T1 (P ＜ 0.05),while there were no statistical significance between two groups of on vs.off-pump at T2,T3 and T4 (P＞0.05).In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point,the incidence of AR was lower in on-pump group than in off-pump group at T1 (P ＜0.05),while there were no statistical significance between two groups of on vs.off-pump at T2,T3 and T4 (P ＞ 0.05).Conclusions The increase of platelet inhibition rate and aspirin resistance occurs in early period after CABG surgery.The platelet inhibition rate is higher and aspirin resistance rate is lower in on-pump group than in off-pump group at 12 h after surgery,and the platelet inhibition rate is lower at 5 days after CABG surgery in on-pump group than in off-pump group.CPB has little effect on the platelet inhibition rate and on the incidence of AR after 5 days of CABG surgery.
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Objective To observe the feasibility, safety and efficacy of percutaneous coronary intervention (PCI) for treatment of chronic total occlusions (CTO)by only the guidewire versus by the guidewire dependent on balloon. Methods The 108 patients with CTO confirmed by coronary angiography and treated with PCI from March 2009 to March 2011 were enrolled in this study, including 59 cases with old myocardial infarction, 22 unstable angina cases and 27 stable angina cases. The clinical data, outcomes of PCI, perioperative complications and incidence of major adverse cardiac events (MACEs) during follow-up were retrospectively analyzed between group A (only by the guide wire) and group B (by guide wire dependent on balloon). Results The 88 of 108 patients (81.5%) got successful operations. The success rate of CTO was a little higher in group B than in group A [80.0%(52/65) vs. 83.7%(36/43), P＞0.05]. The rate of total complications was more in group A than in group B [10.8%(7/65) vs. 2.3%(1/43), P＜0.05]. No death occurred during operation, no MACE occurred after operation in hospital and no patients underwent emergency coronary artery bypass graft (CABG) in the two groups. Conclusions The PCI for treatment of CTO used by the guidewire dependent on balloon shows a safety and effecary.
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Objective Based on the Helical Ventricular Myocardial Band (HVMB) theory proposed by Torrent-Guasp,the ventricular myocardial hand extends from the root of the pulmonary artery to the root of the aorta with two helical coils.This new theory is considered as a revolutionary concept for further understanding the global, three-dimensional and functional architecture of the ven- tricular myocardium. No repot had described techniques for disecting HVMB while keepin～ the integrity of the coronmy artery sys- tern. We explored techniques for dissecting HVMB in swine.Methads 33 fresh swine hearts were randomly divided intoll groups, 3 bearts in each. 160% barium sulfate (type I)suspmmion was injected into the coronary artery system. The coronary arteries were li- gated. The strial tissue was removed following puuing the hearts in boiling water then cooling for several hours. The superficial coro- nary vessels and fat tissue around the atrio-ventricular taxi inter-ventricular sulcus we～'e preserved. Some branches of the left anterior descending artery, distal segment, of posterior descending branch, and middle and distal segment of obtuse marginal branches were mu- tilated appropriately. HVMB dissection was completed with fingers in accordnce with Torrent Guasp' s technique. Results A contin- ued bundle of muscle, originated at the root of pulmonary artery and ended at the root of aorta, was unwrapped along the major dire- tion of the cardiac muscle fiber in all of the 33 hearts with spating of the coronary artery. The swine hearts' ventricular myocandium was cumosed of two loops, with basal loop firm the root of the pulmonart artery to the anterior papillary muscle and apical from the beginning of the anterior papillary muscle to the root tithe aorta. Each loop consisted of two segments: the right segment-coincid- ing with the right ventricular free wall and the left segment-coinciding with the basal d the left ventricular free wall. Posterior papillary muscle, which belongs to the descendant segment, denmrcated the border between the descendent and the ascendant of the HVMB's apical loop. Conclusion Although controversies about the theory of the HVMB remain, we have dissected the HVMB in the swine hearts' ventricular myocardium successfully with sparing of the coronary artery systems. This dissection procedure provides technical information for the studies of associated diseases based on the theory of HVMB.
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Objective The sirolimus-eluting stent (SES) has dramatically reduced the rate ofrestenosis in comparison to that with the bare-metal stent (BMS).This study aimed to evaluate the short-term efficacy and safety of Firebird stent implantation for patients with coronary heart disease (CHD). Methods From Apri12006 through July 2007, 155 patients (mean age 58.93～10.27 years) with CHD were implanted with Firebird stent or Cypher select stent at Daxing Hospital. Patients were followed up for one year. All-cause mortality, major adverse cardiac events (MACE, including cardiac death, myocardial infarction, recurrence of angina pectoris, heart failure, revascularization, and adverse arrhythmia) and stent thrombosis were compared between the 2 groups. Results Of the 155 consecutive patients, 147 patients were revascularized completely. Of these patients, 48 (with 59 lesions) were treated with Firebird stent, 59 patients (with 75 lesions) with Cypher select stent. The demographic characteristics were similar in the 2 groups. All the angiographic and procedural results were not significantly different between the 2 groups. All-cause mortality, myocardial infarction, recurrence of angina pectoris, MACE and stent thrombosis were almost identical between the 2 groups before discharge, at 6 months and at one year .Conclusion The short-term efficacy and safety of Firebird stent are similar to that of the cypher select stent for the treatment of patients with CHD.
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Objective In this angiographic trial,we compared the efficacy and safety of Pro-UK with urokinase in Chinese patients with acute myocardial infarction.Methods We recruited patients with acute ST-elevation myocardial infarction presented within 6 hours in Beijing Tongren Hospital offiliated to Capital Vnirersity of Medical Sciences from Feb.2003 to Mar.2004.After giving informed consent,patients were assigned a bolus and infusion of Pro-UK or a infusion of urokinase.The primary efficacy end points and safety end points were observed.Results Overall 26 patients were enrolled in the trial,of whom 16 patients were assigned to receive Pro-UK(6 patients to 40mg,6 patients to 50 mg,4 patients to 60 mg),and 10 patients to urokinase.The rates of TIMI grade 3 flow were 56.25%(9/16)with Pro-UK and 70%(7/10) with urokinase(P=0.683),of whom 66.7%(4/6) with 50 mg Pro-UK,75%(3/4)with 60 mg Pro-UK. The rates of TIMI grade 2 or 3 were similar for patients treated with Pro-UK versus urokinase(56.25% and 80%,respectively,P=0.399). All safety end points were similar between the two groups. The level of fibrinogen in blood plasma was significantly higher in Pro-UK group than that in urokinase group,indicating that Pro-UK had higher fibrin-specificity.Conclusion The bolus and 30 minutes infusion of Pro-UK 50 mg and 60 mg was clinically safe and effective thrombolytic regimen,but need further study.
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OBJECTIVE Deep sternal wound infection (DSWI) is one of the most serious complications after the open heart cardiac surgery. To explore the risk factors and appropriate treatment methods,we performed this study retrospectively. METHODS Between Jan 2001 and Jan 2006,1123 patients underwent various cardiac surgical procedures via a median sternotomy in the Cardiovascular Center of Beijing Tongren Hospital. These patients were divided into two groups by whether suffered from DSWI. Univariate analyses were performed for possible risk factors,and Logistic regression was used in multivariate analysis. RESULTS Eight among 1123 (0.71%) patients suffered from DSWI. No one died from wound infection. Results from both single variate analysis and multivariate analysis showed that only age significantly associated with DSWI. No other independent risk factors significantly associated with DSWI. Blood culture in acute DSWI group tended to be positive,while in chronic group it tended to be negative. All patients with DSWI were effectively cured. CONCLUSIONS Age is an independent risk factor for DSWI. Early debridement with closed chest catheter irrigation and antibiotics using are strongly recommended as an easy and effective way to treat DWSI. Large-scale multicenter studies are still needed to determine reliable risk factors for DSWI.