ABSTRACT
Objective To investigate the effects of coronary artery bypass grafting in different bypass grafts on survival rate,angina recurrence rate and cardiac function in patients with diffuse right coronary artery disease.Methods Sixty-four patients with diffuse right coronary artery stenosis admitted to the hospital were enrolled.All patients underwent coronary artery bypass grafting and were divided into large saphenous vein group(40 cases) and internal mammary artery group(24 cases) according to the difference of graft vessels.The follow-up survival rate,bypass graft vascular/cardiac venous patency rate,angina recurrence rate,NYHA classification before and after surgery,left ventricular ejection fraction(LVEF),and left ventricular diastolic end diameter(LVEDD) level of both groups were compared.Results Comparison in the same group,NYHA cardiac function grading,LVEF and LVEDD levels were better than those before surgery(P ＜ 0.05).Compared with the great saphenous vein group,the difference of the venous patency/intracardiac venous patency rate and angina pectoris was better in the internal mammary artery group (P ＜ 0.05).At 1 year after operation,there was no significant difference in NYHA cardiac function grading,LVEF,LVEDD level and follow-up survival rate(P ＞0.05).Conclusion There is no significant difference in follow-up survival rate and long-term improvement of cardiac function between patients with diffuse right coronary artery stenosis undergoing coronary venous artery bypass grafting with saphenous vein and internal mammary artery bypass graft.However,the internal mammary artery is more helpful to improve the patency of the bypass graft vessel/cardiac vein and avoid the recurrence of angina pectoris.
ABSTRACT
To analyze the success rates and prognosis of heart valvuloplasty and valve replacement for elderly patients, and to provide clinical evidence. A total of 1240 patients who received heart valve surgeries in our hospital from June 2004 to October 2014 were selected and retrospectively analyzed. They were divided into two groups based on age [60], and those older than 60 [Group B] suffered from rheumatic valvular heart disease and nonrheumatic valvular heart disease including degenerative valve disease. Mitral valve replacement [MVR], tricuspid valve replacement [TVR], aortic valve replacement [AYR], double valve replacement [DVR], mitral valvuloplasty [MVP] and tricuspid valvuloplasty [TVP] were performed by using bioprosthetic and mechanical valves. Before surgery, coronary angiography, coronary artery bypass grafting [CABG], left atrial thrombectomy, left atrial wall folding and radiofrequency ablation were conducted. For the patients younger than 60 [Group A] who had congenital heart disease, rheumatic valvular heart disease and valvular heart disease, MVR, AYR, DVR, MVP, TVP and closed cuspid commissurotomy were performed with bioprosthetic and mechanical valves. The two groups were then monitored. The mortality rates of Group A and Group B were 2.7% [16 cases] and 3.1% [20 cases] respectively. They died mainly of malignant ventricular arrhythmias, multiple organ failure, left ventricular rupture, low cardiac output syndrome, acute renal failure, respiratory failure, upper gastrointestinal bleeding, mechanical valve failure and cerebrovascular accident. The two groups had significantly different application rates of bioprosthetic valve, times of auxiliary ventilation and hospitalization stay lengths [P<0.05], but left ventricular ejection fractions, left ventricular end-diastolic diameters [LVEDDs], mortality rates as well as times of aortic cross-clamping and cardiopulmonary bypass were similar [P>0.05]. LVEDD, complicated coronary artery disease, CABG and grade of the New York Heart Association Functional Classification were independent risk factors for postoperative death. When heart valvuloplasty and valve replacement were performed for elderly patients, the success rate and prognosis could only be improved by optimizing preoperative preparation, shortening the times of cardiopulmonary bypass and aortic cross-clamping, and paying particular attention to myocardial protection and postoperative treatment