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@#Objective To investigate the safety and effectiveness of the multi-artery graf tstrategy for coronary bypass (MICS-CABG) with small incision in the left chest, and to provide experience for the promotion of this technique. Methods The clinical data of 64 patients with MICS-CABG in Department of Cardiac Surgery of Peking University Third Hospital from December 2015 to November 2019 were retrospectively analyzed. There were 54 males and 10 females, aged 36-77 (61.1±8.7) years. The left lateral thoracic incision (5-8 cm) was made through the 5th intercostal incision, and the operation was performed under off-pump CABG. With the help of the chest wall suspension device and the heart fixator, the proximal anastomosis of the ascending aorta, anastomosis of the target vessels of the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) systems were completed. The number of grafts was 2-4 (2.3±0.5) including 2 grafts in 45 patients, 3 grafts in 17 patients and 4 grafts in 2 patients. Three patients were treated with percutaneous intervention (PCI) hybridization and 62 patients were treated with total artery bypass graft. Coronary angiography was performed within 7 days after the operation to evaluate the graft patency rate. The incidence of major adverse cardiac and cerebrovascular events (MACCE) was recorded in the follow-up. The MACCE rate was calculated by Kaplan-Meier method. Results None of the patients was transferred to thoracotomy and no intra-aortic balloon counterpulsation (IABP) or extracorporeal membrane oxygenation (ECMO) was used during the operation. Incision infection was in 1 patient and reoperation in 2 patients (all were postoperative hemorrhage). Within 30 days after surgery, MACCE occurred in 1 patient, including 1 patient of non-fatal myocardial infarction. The overall patency rate of angiography bypass was 96.2%, and the patency rate of anterior descending branch bypass was 98.2%. Follow-up was performed from 12 to 60 months (median follow-up time was 28 months). The loss rate was 7.8% (5/64). The incidence of MACCE was 84.9% (95%CI 79.5%-90.3%). Conclusion The MICS-CABG can achieve completed re-vascularization and totally artery-CABG and the short-term and medium-term clinical results of the operation are good.
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Objective:To assess the feasibility and safety of 2-staged hybrid technique for treating coronary artery disease (CAD) patients with multi-vessel lesions. Methods: Our research included 2 groups:Hybrid group, CAD patients with left anterior descending artery (LAD) lesion or with other major epicardial vessel stenosis>70%who received 2-staged hybrid treatment in our hospital from 2012-03 to 2015-03 and Control group, CAD patients received elective conventional off-pump coronary artery bypass (OPCAB) by the same surgeon at meanwhile. n=91 in each group. The peri-operative conditions and complications were compared between two groups. Results: Compared with Control group, Hybrid group had the shorter post-operative mechanical ventilation time (7.9 ± 4.8) h vs (21.6 ± 35.9) h, shorter ICU-stay time (29.6 ± 20.8) h vs (47.5 ± 38.3) h, all P0.05. Conclusion:2-staged hybrid technique is a safe, feasible and minimally invasive technique for treating CAD patients with LAD and multi-vessel lesions.
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Objective:To investigate the predicting value of European system for cardiac operative risk evaluation ( EuroSCORE ) and sino system for coronary operative risk evaluation ( SinoSCORE ) in early quality of life of patients after coronary artery bypass surgery (CABG).Methods:A total of 218 consecu-tive patients who underwent CABG from March 2010 to January 2013 were evaluated with both systems before operation .Health related quality of life ( QoL) was estimated by using 36-item short form health survey ( SF-36) preoperatively and postoperatively in order to evaluate the predicting value of the two sys -tems in early post-operative QoL.Calibration was evaluated by Hosmer-l,emeshow goodness-of-fit test. Discrimination was tested by determining the area under the receiver operating characteristic ( ROC ) curve .Results:There was no significant difference between the accumulation of the EuroSCORE and SinoSCORE in the all patients (t=-0.904, P=0.368), When using Wilcoxon test on life quality in the preoperative and postoperative patients respectively ,the data showed that the quality of life improved significantly in various dimensions of the postoperative patients (Z=-2.886, P1 , P<0 .05 ) .Furthermore , the EuroSCORE predicted the outcome with a higher OR.For SinoSCORE the Hosmer-Lemeshow test was significant (P=0.628) and the area under ROC curve was 0.754.For the EuroSCORE the Hosmer-Lemeshow test was significant (P=0.538) and the area under ROC curve was 0.854.Conclusion:Both EuroSCORE and SinoSCORE could be viewed as a predictor for several aspects of postoperative QoL , while EuroSCORE might have a greater predicting value.
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Objective To analysis of preoperative preparation,operation,character,advantage and deficiency of two non-robotic TIMAH approach in MIDCAB,and to observe the short-term follow up result.Methods 7 male CAD patients with classic unstable angina pectoris,the age ranged from 52 to 75 years,average (63.8 ± 8.5) years,underwent TIMAH and MIDCAB,in which 6 single LAD disease patients and one patient for reoperation with saphenous vein graft (SVG) graft failure to LAD and progressive obtuse marginal(OM) coronary artery disease.These patients were intubated with a double-lumen endotracheal tube,and one-lung ventilation were used to facilitate the procedure.In the approach of two incisions TIMAH for 4 patients,the thoracoscope was placed at the third intercostals space(ICS) on the anterior axillary line,and LIMA was dissected with endo-instruments placed from the two angles of mini-thoracotomy at fifth ICS on the midclavicular line.In the approach of three incisions TIMAH for 3 patients,LIMA was dissected with endo-instruments placed from two ports at the fourth ICS on the anterior axillary line and at the fifth ICS on the midclavicular line,and the thoracoscope was placed at the second or third intercostals space (ICS) on the anterior axillary line.Anastomosis of LIMA and LAD followed through mini-thoracotomy at fifth ICS with the heart stabilizer after TIMAH.SVG graft was used from LIMA to OM in the reoperation patient.Results All patients underwent TIMAH and MIDCAB safely without transferece to stenotomy,only one LIMA was extended with 2 cm SVG for injure at the distal.In 6 single vessel disease patients the length of mini-thoracotomy incision was (6.0 ± 0.9) cm,TIMAH time was (112 ±18) min,operation time was (293 ± 75) min,bleeding volume was (233 ± 52) ml,endotracheal tube time was (14.2 ± 10.7) h,ICU time was (1.8 ±0.4) d and hospital stay time was (10.1 ±6.7) d.All patients were uneventful discharged and with no recurrence of cardiac symptoms in short-term follow up.Conclusion TIMAH can perform safely in both approaches for LIMA prepare to MIDCAB as described before.The minimally invasive procedure need not enlarge incision for LIMA harvesting with good short term results.
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0.05). However, we found that the proportions of low Qm (5) in the patients over 60 years were significantly higher than those in the patients younger than 60. [For low Qm, IMA: 13% (10/75) vs 2% (1/46), and GSV: 13% (33/259) vs 6% (7/123), ?2=4.296 and 4.422, P
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0.05]. Moreover, the Qm and PI of the grafted anterior descending, circumflex, and right coronary arteries were similar between the two groups.Conclusions No significant difference exists in the graft blood flow between OPCABG and CCABG groups.
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Objective To evaluate the appropriate timing of coronary artery bypass grafting(CABG) with acute myocardial in- farction(AMI) and to discuss the influence of postoperative mortality on 30 days.Methods 233 patients after CABG were divided into 2 groups,AM/group and unstable angina (UA) group.There were 176 males (75.4%) and 57 females (24.5%).The mean age was (65.6?9.2) years(range 34～86 years).The mean grafts were 3.46?0.89.The complex risk elements between the 2 groups were analyzed to evaluate the independent risk element of death.Results Internal mammary arteries were used in 137 patients (58.8%).The postoperative mortality rate was 4.3 % (10/233).The operative mortality rates(OMR) were closely related to the in- creasing time intervals between AMI and CABG,for less than 3 days was 14.6% (6/41 cases),for 4 to 10 days was 2.7 % (1/37) and for 11 to 30 days was 0.The OMR of AMI less than 3 days has significant difference (P=0.033) comparing with that of unstable an- gina pectoris [2.3% (3/130) ].Conclusion Proper timing of CABG should be done in 3 days after AMI.