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Objective:To evaluate the prognosis of off-pump coronary artery bypass grafting combined(OPCABG) with coronary endarterectomy(CE) treating the diffuse coronary artery disease.Methods:From January 2012 to December 2014, the clinical data of 2 496 OPCABG patients in our department were retrospectively analyzed, and they were divided into OPCABG group and OPCABG+ CE group. After 1∶1 matching via the propensity score matching method, the perioperative prognosis, long-term survival and adverse cardiovascular and cerebrovascular events(MACCE) were compared between the two groups.Results:A total of 238 pairs of patients were included after propensity score matching. The incidence of postoperative AMI in the OPCABG+ CE group was significantly higher than that in the OPCABG group(5.04% vs. 1.68%, P=0.042). With an average follow-up of 7.3 years, there was no significant difference in the cumulative survival rate(92.44% vs. 88.65%, P=0.159) and long-term MACCE(10.92% vs. 15.13%, P=0.173) between the two groups. Compared with the OPCABG group, the recurrence of angina pectoris(CCS grade Ⅲ-Ⅳ) in the OPCABG+ CE group increased significantly(20.16% vs. 12.60%, P=0.026). Conclusion:The risk of early AMI and long-term angina recurrence after OPCABG+ CE is significantly increased, but the long-term survival and MACCE of OPCABG+ CE and OPCABG are comparable.
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Objective:To compare the efficacy of Milrinone and Papaverine in relieving the spasm of internal mammary artery (LIMA) during off-pump coronary artery bypass grafting (OPCABG).Methods:Between April 2018 to December 2018, 200 patients who suffered obvious angina pectoris and three-vessel disease documented by coronary angiography, undergoing OPCABG at Beijing Anzhen Hospital, Capital Medical University were recruited in this study, including 103 males and 97 females, aged 46-74 years, with an average of (59.12±0.49) years old. For all patients, the LIMA was anastomosed to left anterior descending artery(LAD). According to different methods relieving LIMA spasm, all patients randomly divided into 4 groups (n=50): Papaverine surface infiltration group (group Ⅰ), Papaverine injection group (group Ⅱ), Milrinone surface infiltration group (group Ⅲ) and Milrinone injection group (group Ⅳ). The blood flow (ml/min) of the free LIMA, the blood flow of the LIMA-LAD after bypass, anastomotic time of obtuse marginal artery, the use of vasoactive drugs, the outcomes of perioperative period and 1 year after operation were compared in the four groups.Results:There was no significant difference between group Ⅲ and group Ⅰ in the blood flow of free LIMA and LIMA-LAD[(45.50±1.43)ml/min vs. (47.42±1.61)ml/min、(28.60±0.89)ml/min vs. (28.40±0.96)ml/min, all P>0.05]. The blood flow of free LIMA and the LIMA-LAD in group Ⅱ were significantly higher than those in group Ⅰ[(60.36±1.28)ml/min vs. (47.42±1.61)ml/min, (42.40±1.25)ml/min vs. (28.40±0.96)ml/min, all P<0.05]. The blood flow of free LIMA and LIMA-LAD in group Ⅳ were significantly higher than those in group Ⅲ[(70.86±2.00) ml/min vs. (45.50±1.43) ml/min, (59.46±1.25) ml/min vs. (28.60±0.89) ml/min, all P<0.05]. The blood flow of free LIMA and LIMA-LAD in group Ⅳ were significantly higher than those in group Ⅱ[(70.86±2.00) ml/min vs. (60.36±1.28) ml/min, (59.46±1.25) ml/min vs. (42.40±1.25)ml/min, all P<0.05]. The anastomotic time of obtuse marginal artery[(7.14±0.72)min vs. (8.30±0.93)min, (8.10±0.89)min, (8.14±0.90)min, P<0.05], the dopamine dose[(3.76±0.40)μg·kg -1·min -1 vs. (5.02±0.52)μg·kg -1·min -1, (4.84±0.48)μg·kg -1·min -1, (4.90±0.49)μg·kg -1·min -1,P<0.05] and the esmolol usage (32% vs. 60%, 58%, 58%, P<0.05) during the operation in group Ⅳ were significantly reduced compared with the other three groups. The V3 ST depression on the postoperative first day[(0.34±0.18)mv vs. (0.71±0.22)mv, (0.68±0.20)mv, (0.69±0.22) mv, P<0.05], and the TNI on the postoperative third day[(0.24±0.08)ng/ml vs. (0.56±0.15)ng/ml, (0.54±0.11)ng/ml, (0.53±0.12) ng/ml, P<0.05] were significantly lower in group Ⅳ than those in the other three groups. However, there was no significant difference about the first-year patency of LIMA-LAD among four groups. Conclusion:For relieving spasm of LIMA, the Milrinone injection was better than that of Papaverine, which could shorten the anastomotic time of obtuse marginal artery, maintain intraoperative hemodynamics stability, reduce myocardial damage during OPCABG.
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Objective:To evaluate the validity of adventitial collagen cross-linking by glutaraldehyde(GA) to reduce intimal hyperplasia of vein graft in a rabbit carotid artery bypass graft model.Methods:Harvesting 36 segments of the external jugular vein and 6 segments of the internal carotid artery with 3 cm length from the New Zealand white rabbits. The veins were randomly divided into 6 groups and underwent adventitial collagen cross-linking by 0.3% glutaraldehyde for 0 min, 1 min, 2 min, 3 min, 4 min, and 5 min, respectively. All vessel segments were subjected to biomechanical tests and pathological tests. Carotid artery bypass graft models were established in 24 New Zealand white rabbits including crosslinked group(n=12) and non-crosslinked group(n=12). The vein grafts were obtained for pathological examination 4 weeks after models feeding, and the intimal hyperplasia of vein graft was evaluated.Results:Adventitial cross-linking increased fiber density of adventitia significantly, and increased the stiffness of the veins as the time of cross-linking increased. And in the high strain region(strain ratio 1.4-1.8), the mechanical curve of veins receiving 3min cross-linking was similar to that of the carotid artery. The patent rate of the vein grafts of rabbit models was 100% after 4 weeks. Comparing with non-crosslinked group, the intimal and medial thickness of vein grafts in crosslinked group were reduced remarkably[(78.83±9.02)μm vs.(140.19±19.90)μm, (43.75±5.05)μm vs.(58.35 ± 8.61) μm, P<0.01). Conclusion:Adventitial collagen cross-linking by GA can enhance the mechanical strength of the jugular vein, and reduce the intimal hyperplasia of the jugular vein grafts in rabbit models.
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Objective:To describe a distal anastomosis support (DAS) technique, and retrospectively investigate the effect of DAS on the mid-term graft patency of patient with small posterior descending artery.Methods:Between January and December 2016, 100 patients with triple-vessel disease and small PDA who continuously underwent off-pump coronary artery bypass grafting (OPCABG) (OPCABG group, n=50) and OPCABG with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCABG+ DAS group, n=50) were evaluated retrospectively. The dynamic changes of electrocardiogram and TnI level were observed within 48h after the surgery. All patients came back to follow-up visit 6th, 12th, 24th and 36th postoperative month. The primary endpoint was the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA.Results:There was no death during the operation. There was no acute inferior wall myocardial infarction confirmed by electrocardiogram. Peak TnI within 48h of surgery was 0.74(0.98)ng/ml vs. 0.92(1.29)ng/ml, P>0.05, and the number of patients with peak TnI≥70×ULN was 3(6%, 3/50) vs.5(10%, 5/50), P>0.05. There was no postoperative death, and all the patients were discharged 5-15 days postoperatively. We found significantly improved cumulative graft patency in OPCABG+ DAS group at 36 months after operation [85.7%(42/49) vs. 68.0%(34/50), P<0.05). In multivariate logistic regression analysis, PDA with atherosclerotic lesions ( OR=6.513, 95% CI: 1.279-33.180, P=0.024), and peak TnI≥70×ULN within 48 h of surgery ( OR=5.948, 95% CI: 1.128-31.368, P=0.036) were independent predictors of graft failure, whereas concomitant DAS ( OR=0.222, 95% CI: 0.069-0.713, P=0.011) was significant protective factor. Conclusion:Concomitant DAS conferred superior mid-term patency of SVG-PDA in patients with small PDA. Adding the DAS procedure to OPCABG may be a promising surgical option for small PDA with atherosclerotic lesions.
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Objective@#To evaluate the feasibility and validity of combined directly epicardial and transapical endocardial substrate ablation guided by Carto mapping for ventricular tachycardia(VT) with left ventricular aneurysm(LVA) intra-operation in a swine model.@*Methods@#Twenty-four swine models with sustained VT and LVA were randomly divided into study group(radiofrequency ablation, RFCA, from epicardium via direct-view and endocardium via transapical access, 12 cases) and control group(endocardial RFCA via retrograde transaortic access, 12 cases). Substrate mapping for captured abnormal potentials via endocardium and epicardium was used to precisely locate the low-voltage areas. After ablation in two groups, VT was induced again to compare the effectiveness of different RFCA strategies.@*Results@#Three dimensional electro-anatomic mapping was implemented successfully in two groups under open chest. And VT substrates were largely located in the border zone of LVA. All objects in the study group underwent endocardial ablation via transapical access smoothly without operative failure. When VT inducing again, 2 cases of study group was with inducible VT, however, VT recurrence in control group was 5 cases, P=0.04.@*Conclusion@#Combined direct epicardial and transapical endocardial substrate mapping and ablation appeared to be feasible and effective for treating VT with LVA under thoracotomy.
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Objective To evaluate the guiding role of CYP2C19 gene assay in dual antiplatelet therapy(DAPT) after off-pump coronary artery bypass grafting ( OPCABG ) .Methods The patients who received scheduled OPCABG between May 2017 and May 2018 were recruited in this study.According to the results of CYP2C19 gene assay, the patients who carried CYP2C19 gene *2/*2,*2/*3 and*3/*3 mainly causing slow metabolism of clopidogrel were randomly divided into two groups: the clopidogrel group(patients receiving 100mg/qd aspirin plus 75mg/qd clopidogrel after surgery ), the ticagrelor group(patients receiving 100mg/qd aspirin plus 90mg/bid ticagrelor after surgery).Patients in the two groups underwent plate-let aggregation rate test first day before surgery and the 1, 4, 7 days antiplatelet therapy after surgery.And the major adverse cardiac events(MACE) was investigated 30 days after surgery in the two groups.Results A total of 244 patients were recrui-ted in the study with the clopidogrel group(n=122) and the ticagrelor group(n=122).The platelet aggregation rate after one day of postoperative DAPT in the ticagrelor group was lower than that in the clopidogrel group[(28.5 ±9.7)％ VS(51.8 ± 16.8)％, P<0.05].After 4 days of postoperative DAPT, platelet aggregation rate in the ticagrelor group maintained a stable and desired level.The MACE 30 days after surgery in the clopidogrel group and the ticagrelor group were 3.3％ and 1.6％ re-spectively, and ticagrelor plus aspirin reduced MACE in patients undergone coronary endarterectomy , P=0.043.Conclusion According to the results of CYP2C19 gene assay, ticagrelor replacing clopidogrel could shorten the duration of desired platelet aggregation rate in patients with DAPT after OPCABG , and may be reduce the risk of MACE after OPCABG and coronary end-arterectomy.
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Objective Saphenous vein graft(SVG) re-stenosis has an severe adverse effect on the long-term prognosis of coronary artery bypass grafting.Intimal hyperplasia(IH) is the prima~ cause and basic pathology of SVG re-stenosis.Comparing to arterial graft IH,different factors promotc IH of SVG.In this review,we summarized the special factors promoting IH of SVG.
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Objective To evaluate the clinical efficacy of early coronary artery bypass grafting(CABG) to treat ST-segment elevation myocardial infarction(STEMI).Methods We retrospectively analyzed the clinical data of 196 patients within 2 weeks of STEMI attack undergoing CABG in our department from September 2010 to December 2014.According to the time-interval between onset of STEMI and the beginning of CABG,all subjects were divided into group Ⅰ (≤6 h,n =46),group Ⅱ (7-72 h,n =37),group Ⅲ (4-7 d,n =52) and groupⅣV (8-14 d,n =61).After CABG,patients' perioperative complications and survival status were analyzed under different surgical time-interval windows to assess the clinical efficacy of early surgical intervention in patients with STEMI.Results Overall in-hospital mortality was 9.18％ (18/196),from group Ⅰ to group ⅣV,the mortality was 10.87％ (5/46),21.62％ (8/37),5.77％ (3/52) and 3.28％ (2/61) respectively.In all groups,comparing with survivals,nonsurvivals were often women (61.11％ vs.24.16 ％,P =0.002),were more often companied by cardiac shock(83.33％ vs.24.16％,P ＜ 0.001),and had higher preoperative cardiac troponin Ⅰ(cTnⅠ) levels [(14.1 ± 8.4) ng/ml vs.(4.7 ± 3.8) ng/ml,P ＜ 0.001].Multi-variable logistic regrassion analysis revealed that age,female,cardiac shock,renal insufficiency and serum levels of cTnⅠ were independent risk factors affecting postoperative death.Conclusion Under optimal preoperative management strategies,CABG is relatively feasible and effective with the time-interval window as delay as possible after 3 days of STEMI attack.
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Objective:To evaluate the promoting surgery incision healing effect of recombinant human acidic fibroblast growth fac-tor ( rh-aFGF) in the treatment of children with open fractures. Methods:A multicenter, randomized and controlled clinical trial was conducted to study the efficacy of rh-aFGF. Totally 120 cases of injured children (age<14y) were randomly divided into two groups, the treatment group (n=60) was given rh-aFGF washing during the operation and spraying after the operation, and the control group ( n=60) was treated with normal saline. Both groups were given traction, screw or Kirschner wire fixation. The healing time, healing status and delayed healing were observed and compared in the two groups. Results:Stage I healing rate, the complete healing time and delayed healing rate in the treatment group was 86. 6%, (20. 3 ± 5. 6)d and 3. 3%, respectively, while that in the control group was 56.7%, (23.4 ±6.2)d and 15.0%, respectively. The differences between the two groups were significant (P<0.05 or 0.01). Conclusion:Rh-aFGF can effectively promote wound healing and shorten the healing time. For all these positive aspects,rh-aFGF de-serves wider clinical application in postoperative rehabilitation after open fractures.
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Aim: To investigate the pathological changes in NTBC[2-(2-nitro-4-trifluoro-methyl-benzoyl) -1,3 cy-clohexanedione]-induced hepatic injury in mice and in the repopulation of adult hepatocytes in Fah~(-/-) mouse. Methods: Autogenous hepatic injuries in Fah~(-/-) mice were induced by the treatment of NTBC. Injection of hepatocytes obtained from wild-type mice to spleen were transplanted into the Fah~(-/-) mice. Then, changes to body weight and the likelihood of the transplanted Fah~(-/-) mice, and hepatic immunohistochemistry were ob-served. In addition, pathological changes to liver damage induced by NTBC treatment were analyzed under HE-staining microscopy and electron microscopy. Results: The surviving Fah~(-/-) mice subjected to hepatocyte trans-plantation were found to be healthy and in stable body weight. liver repopulation reached to 90% in the 8th week. Repopulating hepatocytes caused no alteration to histological structure of the recipient liver, and subacute hepatic injury occurred in the Fah~(-/-) mice after NTBC treatment. Electronic microscopy observations indicated that necrosis in the hepatocytes occurred at early stage and that apoptosis gradually appeared. It was also shown both necrosis and apoptosis co-existed in the same samples of interest at the following stages of the induced liver injury. Conclusion: Transplanted hepatocytes proliferated in Fah~(-/-) mice allow 90% of the hepatocytic repopula- tion. Repopulation renders normal hepatic function and structure in the recipient Fah~(-/-) mice, as a model of liver repopulation, could be applicable in study of stem cell derived hepatic cells in transplantation assay.