Analysis of the risk factors of acute renal insufficiency following coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To study the risk factors of acute renal insufficiency (ARI) following coronary artery bypass grafting (CABG).</p><p><b>METHODS</b>The clinic data of 2242 patients undertaking CABG between July 1997 and July 2006 were retrospectively analyzed, and ARI following CABG was included.</p><p><b>RESULTS</b>ARI occurred in 219 patients, with an incidence of 9.8%. Univariate analysis revealed that advanced age, diabetes mellitus, preoperative chronic renal dysfunction, left main disease, low left ventricular erection faction, emergency operation, on-pump CABG, ascending aortic atherosclerosis, postoperative respiratory function insufficiency and low cardiac output syndrome were significantly related to ARI following CABG, and logistic multivariate regression analysis showed that presence of advanced age (P = 0.031), preoperatively chronic renal dysfunction (CrCl <or= 60 ml/min, P = 0.023 or Scr >or= 150 micromol/L, P = 0.041), on-pump CABG (P < 0.001), postoperative respiratory function insufficiency (P = 0.013) and low cardiac output syndrome (P = 0.004) were independent risk factors of ARI.</p><p><b>CONCLUSIONS</b>Advanced age, preoperatively chronic renal dysfunction, on-pump CABG, postoperative respiratory function insufficiency and low cardiac output syndrome are the risk factors of ARI following CABG.</p>

Coronary artery bypass graft for patients with ascending aorta atherosclerosis / 中华外科杂志

<p><b>OBJECTIVE</b>The increasing number of aged patients with severe ascending aorta atherosclerosis who are undergoing coronary artery bypass graft (CABG) present high risk for ascending aortic cannulation, cross-clamping or partial occluding and proximal anastomosis. We reviewed the surgical experience in 22 patients of CABG with ascending aorta atherosclerosis and tried to find the way to minimize the complications.</p><p><b>METHODS</b>Twenty-two patients with severe atherosclerotic and calcified ascending aorta underwent CABG in our hospital. Thirteen of them received CABG on beating heart. Nine patients had their CABG with extracorporeal circulation. With deep hypothermia, we reduced the flow rate and intermittently arrested the circulation for the proximal anastomosis on ascending aorta in 5 patients with neither cross-clamping nor partial occluding. The sequential grafts and "Y" type anastomosis between reversed saphenous venous grafts were employed.</p><p><b>RESULTS</b>Twenty of the patients survived after surgery. One died of inhalation pneumonia in two weeks after surgery. Another died of right hemothorax in ten days after surgery. The complications include: pneumonia 4 patients (18%), angina 2 patients (9%), ventricular fibrillation 1 patients (5%), post-CABG myocardium infarction 1 case (5%) and hemothorax 1 case (5%). There is no neurologic complications or aortic dissection after CABG.</p><p><b>CONCLUSION</b>CABG on beating heart with pedicel arterial grafts is the best approach to performing the surgery without touching the diseased ascending aorta. Ventricular fibrillation under mild hypothermia cardiopulmonary bypass and left ventricular suction were employed for quiet and bloodless field while distal anastomosis had no cross-clamping the ascending aorta. Also deep hypothermia and intermittently circulatory arrest offer quiet and bloodless field for the proximal anastomosis on ascending aorta without cross-clamping or partial-occluding. Distal sequential anastomosis and proximal "Y" type anastomosis are the effective approach to minimizing the proximal anastomosis on the ascending aorta.</p>

Appropriate timing of coronary artery bypass grafting surgery after acute myocardial infarction / 中华胸心血管外科杂志

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.