Feasibility and safety of minimally invasive cardiac coronary artery bypass grafting surgery for patients with multivessel coronary artery disease: Early outcome and short-mid-term follow up results / 北京大学学报(医学版)

OBJECTIVE@#To explore the feasibility, safety and mid-term outcome of minimally invasive cardiac surgery coronary artery bypass grafting (MICS CABG) surgery.@*METHODS@#Data of patients who underwent MICS CABG between November 2015 and November 2017 in Peking University Third Hospital were retrospectively analyzed. Results were compared with the patients who underwent off-pump coronary aortic bypass grafting (OPCABG) surgery over the same period. The two groups were matched in propensity score matching method according to age, gender, left ventricular ejection fraction, body mass index, severity of coronary artery disease, smoking, diabetes mellitus, hypertension, hyperlipidemia, renal insufficiency, history of cerebrovascular accident, and history of chronic obstructive pulmonary disease (COPD).@*RESULTS@#There were 85 patients in MICS CABG group, including 68 males (80.0%) and 17 females (20%), with an average age of (63.8±8.7) years; 451 patients were enrolled in OPCABG group, and 85 patients were matched by propensity score as control group (OPCABG group). There was no significant difference in general clinical characteristics (P>0.05). The average grafts of MICS CABG and OPCABG were 2.35±0.83 and 2.48±0.72 respectively (P=0.284). No conversion to thoracotomy in MICS CABG group or cardiopulmonary bypass in neither group occurred. There was no significant difference in the major adverse cardiovascular events (MACCEs, 1.17% vs. 3.52%), reoperation (2.34 vs. 3.52%), new-onset atrial fibrillation rate (4.70% vs. 3.52%) or new-onset renal insufficiency rate (1.17% vs. 0%) between MICS CABG group and OPCABG group (P>0.05). The operation time in MICS CABG group was longer than that in OPCABG group [(282.8±55.8) min vs. (246.8±56.9) min, P < 0.05], while the time of ventilator supporting(16.9 h vs. 29.6 h), hospitalization in ICU [(29.3±20.8) h vs. (51.5±48.3) h] and total hospitalization [(18.3±3.2) d vs. (25.7±4.2) d] in MICS CABG group were shorter than those in OPCABG group (P < 0.05). The total patency rate (A+B levels) of MICS CABG was 96.5% after surgery. There was no significant difference in MACCEs rate between the two groups [1.18%(1/85) vs. 3.61%(3/83), P>0.05] in 1-year follow up.@*CONCLUSION@#The MICS CABG surgery is a safe and feasible procedure with good clinical results in early and mid-term follow-up.

Risks factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes / 北京大学学报(医学版)

OBJECTIVE@#The pathogenesis of myocardial injury upon corona virus disease 2019 (COVID-19) infection remain unknown,evidence of impact on outcome is insufficient, therefore, we aim to investigate the risk factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes in this study.@*METHODS@#This was a single-centered, retrospective, observational study. Patients of Sino-French Eco-City section of Tongji Hospital, Wuhan, China attended by Peking University Supporting Medical Team and admitted from Jan. 29, 2020 to Mar. 20, 2020 were included. The positive nucleic acid of COVID-19 virus and combination with hypertension, coronary heart disease or diabetes were in the standard. We collected the clinical data and laboratory examination results of the eligible patients to evaluate the related factors of death.@*RESULTS@#In the study, 94 COVID-19 patients enrolled were divided into the group of death (13 cases) and the group of survivors (81 cases), the average age was 66.7 years. Compared with the survival group, the death group had faster basal heart rate(103.2 beats/min vs. 88.4 beats /min, P=0.004), shortness of breath(29.0 beats /min vs. 20.0 beats /min, P<0.001), higher neutrophil count(9.2×109/L vs. 3.8×109/L, P<0.001), lower lymphocyte count(0.5×109/L vs. 1.1×109/L, P<0.001), creatine kinase MB(CK-MB, 3.2 μg/L vs. 0.8 μg/L, P<0.001), high sensitivity cardiac troponin Ⅰ(hs-cTnⅠ, 217.2 ng/L vs. 4.9 ng/L, P<0.001), N-terminal pro brain natriuretic peptide(NT-proBNP; 945.0 μg/L vs. 154.0 μg/L, P<0.001), inflammatory factor ferritin(770.2 μg/L vs. 622.8 μg/L , P=0.050), interleukin-2 recepter(IL-2R, 1 586.0 U/mL vs. 694.0 U/mL, P<0.001), interleukin-6(IL-6, 82.3 ng/L vs. 13.0 ng/L, P<0.001), interleukin-10(IL-10, 9.8 ng/L vs. 5.0 ng/L, P<0.001)were higher than those in the survival group. Univariate logistic regression analysis showed that the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, abnormal increase of IL 2R, IL-6, and IL-10. Multivariate regression showed that old age (OR=1.11, 95%CI=1.03-1.19, P=0.026), low non oxygen saturation(OR=0.85, 95%CI=0.72-0.99, P=0.041), and abnormal increase of IL-10(＞9.1 ng/L, OR=101.93, 95%CI=4.74-2190.71, P=0.003)were independent risk factors for COVID-19 patients combined with hypertension, coronary heart disease or diabetes.@*CONCLUSION@#In COVID-19 patients combined with hypertension, coronary heart disease or diabetes, the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, and abnormal increase of IL-2R, IL-6, and IL-10. Old age, low non oxygen saturation and abnormal increase of IL-10 were independent risk factors.

Feasibility study of SYNTAX Ⅱ score in guiding the strategy of two-staged hybrid coronary artery revascularization / 中国介入心脏病学杂志

Objective To evaluate the feasibility of selecting the hybrid operation strategy according to the preoperative SYNTAX Ⅱ score by analyzing the characteristics of the SYNTAX score and the changes of the SYNTAX Ⅱ score in the different stages of the hybrid coronary artery bypass surgery. Methods Patients admitted in our hospital from Jan 1, 2016 to December 31, 2017 who received staged hybrid coronary revascularization (first stage CABG, followed by second stage PCI) were reviewed. The total SYNTAX Ⅱ scores before and after minimally invasive direct coronary artery bypass grafting (MIDCAB) were compared. Results A total of 50 patients were analyzed and scored by coronary angiography with lumen stenosis exceeding 50％. The SYNTAX Ⅰ score before MIDCAB was 36.00 points (13.00, 70.50) and the ratio of SYNTAX Ⅰ score>33 points was 58％ (29/50). After MIDCAB operation, the residual SYNTAX Ⅰ score was 11.50 points (7.00, 18.50), which decreased by 25.50 points (19.00, 33.75). According to the SYNTAX Ⅱ score before MIDCAB, a proportion of 10％ (5/50) patients who received PCI procedure showed a lower 4-year mortality than the CABG operation. The forecasted proportion SYNTAX Ⅱ score after MIDCAB increased to 38％ (19/50) while the actual proportion after MIDCAB was 42％ (21/50). The consistency between the forecasted value and the actual value was 90％ (45/50, P=0.125, McNemar test). Conclusions Using SYNTAX Ⅱ score to predict PCI or CABG treatment after MIDCAB is feasiable. The changes in SYNTAX Ⅱ score before and after MIDCAB was mainly resulted from the improvement in creatinine level after operation.

Efficacy and safety of "2-staged" Hybrid Coronary Revascularization Using Bilateral Internal Thoracic Artery Y Graft for Patients With Multivessel Coronary Artery Disease / 中国循环杂志

Objectives: To explore the feasibility and safety of "2-staged" hybrid coronary revascularization using bilateral internal thoracic artery (BITA) for the treatment of multivessel coronary artery disease. Methods: Data of 65 patients who underwent "2-staged" hybrid technique (HCR) using BITA (BITA-HCR group) in our heart center because of multivessel coronary artery lesions during 2014.05-2017.05 were retrospectively analyzed. Results were compared with 96 patients who underwent "2-staged" HCR with single ITA (SITA-HCR group) by the same surgeon over the same time period. Results: There was no significant difference of preoperative characteristics between two groups. Operation time was significantly longer [(204.6±28.7) min vs (147.9±31.6) min, P<0.05], number of distal anastomoses was significantly higher [(2.2±0.5) vs (1.0±0.0), P<0.05], number of stents was significantly lower [(1.90±0.67) vs (2.40±0.49), P<0.05] in BITA-HCR group than in SITA-HCR group. Bleeding volume [(520.1±120.3) ml vs (532.2±350.3)ml, P>0.05], mechanical ventilation time [(7.7±3.2) h vs (6.9±2.3) h, P>0.05] and blood transfusion required [5(7.7%)vs 8(8.3%), P>0.05] were similar between the two groups. Conclusions: The "2-staged" hybrid procedure using BITA is safe and feasible for the revascularization of multiple coronary artery lesions.

Comparative Study of Minimally Invasive Directly Bypass Grafting With Bilateral Internal Mammary Artery and Conventional Off-pump Bypass Grafting for Treating Multi-vessel Lesion Coronary Artery Disease / 中国循环杂志

Objective: To assess the early experience and clinical value of left anteriolateral minor thoracotomy minimally invasive directly coronary artery bypass (MIDCAB) for treating multi-vessel lesion coronary artery disease (CAD) with bilateral internal mammary artery (BITA). Methods: Our research included in 2 groups: MIDCABG group, n=38 consecutive patients received left anteriolateral minor thoracotomy MIDCAB with BITA in our hospital from 2015-05 to 2017-01 and Control group, n=236 patients received conventional off-pump coronary artery bypass (OPCAB) by the same surgeon at same period. Peri-operative condition and relevant complications were compared between 2 groups. Results: In MIDCAB group, the success rate for harvesting BIMA was 94.7% (36/38), the mean time for harvesting right internal mammary artery (RIMA) and LIMA were (42.3±10.5) min and (35.2±8.3) min respectively; a total of 78 grafts were made in 38 patients with the mean of (2.05±0.31) graft/patient, no patient was switching to conventional CABG during the operation. Compared with Control group, MIDCAB group had reduced post-operative mechanical ventilation time (8.9±3.8) h vs (23.6±15.9) h, ICU stay time (29.3±20.8) h vs (56.5±38.3) h and hospital stay time (11.3±3.2) d vs (15.7±4.2) d, all P<0.05; while the incidence of peri-operative MACCE including death, myocardial infarction (MI), revascularization, cerebrovascular accident and poor incision healing were similar between 2 groups, P>0.05. No occlusion of anastomotic stoma was found by post-operative coronary angiography in neither group. The patients were followed-up for the average of 3 months, no death, angina or MI occurred. Conclusion: Through left anterolateral small incision, we can successfully get bilateral internal mammary artery and complete beating heart multi branch CABG.