Clinical research of minimal extracorporeal circulation in perioperative blood conservation of coronary artery bypass graft / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the clinical effect of minimal extracorporeal circulation (MECC) in blood conservation perioperatively coronary artery bypass graft (CABG).</p><p><b>METHODS</b>The data of 120 cases received simple CABG since August 2006 to October 2009 was analyzed retrospectively. All the patients were divided to three groups according to the mode of circulation support in-operation: MECC, conventional extracorporeal circulation (cECC) or off-pump, 40 cases in each group. Jostra MECC system with normal temperature was used in MECC group, and common membrane oxygenator with moderate hypo-temperature was used in cECC group. Collect the data of coagulation and the blood cytological examination perioperatively, the draining volume during the first 24 h after operation, and consumption of blood products perioperatively.</p><p><b>RESULTS</b>Standard and logistic EuroSCORE were higher in MECC group than the others (P < 0.01). The operative time and the number of distal anastomosis of off-pump group were less than MECC and cECC groups (P < 0.05), while no difference between MECC group and cECC group. Intrinsic coagulation (activated partial thromboplastin time) were much more prolonged early postoperatively in cECC group, and higher than in MECC group and off-pump group at 2 h, 6 h and 12 h postoperatively (P < 0.05), but no difference in extrinsic coagulation (prothrombin time) among three group. Adjusted by hematocrit of the same sample, free hemoglobin level rose up during the ECC procedure and reached the maximum at the end of ECC in cECC group and MECC group, but the levels were more higher in cECC group than in MECC group (P < 0.05). The draining volume during the first 24 h after operation of cECC group was larger than MECC group and off-pump group (P < 0.05). Although the decreased platelet count perioperatively and more consumed of the blood products in cECC group, but no difference among the three groups.</p><p><b>CONCLUSION</b>MECC could reduce the ruin to blood cell and interfere to coagulation function during the conventional ECC procedure, decrease the postoperative draining volume and requirement of blood products.</p>

Relative factors of recent discovered atrial fibrillation following isolated coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To identify the relative factors of recent discovered atrial fibrillation (AF) following isolated coronary artery bypass grafting (CABG).</p><p><b>METHODS</b>Classified the 649 cases undergoing isolated CABG from January 2005 to December 2006 to two groups according to whether AF appeared after operation. Collected the peri-operative data and operative strategy, then analyzed with single-factor analysis and Logistic regression.</p><p><b>RESULTS</b>The incidence of AF was 8.0% (52 cases), and 84.6% (44 cases) recovered sinus-rhythm leaving hospital. Age, standard European system for cardiac operative risk evaluation (EuroSCORE), ratio of high-operative-risk, left atrium diameter and ratio of left coronary artery dominance were higher in AF group than in non-AF group. Age, eject fraction, left atrium diameter, operative risk evaluation, left coronary artery dominance and anastomosis on right coronary artery were the relative factors of recent discovered AF following isolated CABG. But off-pump operation, prescription of adrenergic beta-antagonists pre-operatively and degree of coronary artery stenosis had no influence to AF.</p><p><b>CONCLUSIONS</b>AF following CABG is a result of common influence by many factors. EuroSCORE might forecast partially the incidence of AF following CABG. Improve the myocardial protection and reduce the surgical damage during operative progress maybe the mostly approach to decrease the incidence of AF following CABG.</p>

Analysis in primary clinic outcomes of minimal extracorporeal circulation in the coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To analysis comparatively the primary clinic outcomes between minimal extracorporeal circulation (MECC) and conventional extracorporeal circulation (cECC).</p><p><b>METHODS</b>Forty cases accepted coronary artery bypass grafting from August to October at 2006 were divided into MECC group and cECC group at random, 20 cases for each group. Record and analysis of the general information, clinic data perioperatively, and complications postoperatively for each group were performed.</p><p><b>RESULTS</b>There were no deference between groups in gender, anamnesis and preoperative cardiac function, while age (P < 0.05), standard EuroSCORE and logistic EuroSCORE were much more higher in MECC group than in cECC group (P < 0.01). Similarly, there were no deference in operative time, bypass time, ischemic time and graft number between two groups. Contrasted with cECC group, the values of cTNI were lower in MECC group at 2 h, 6 h and 12 h post-ECC (P < 0.01), oxygen index were higher post-operatively and there was a statistic deference at 12 h post-ECC (P < 0.05). The valves of ALT and TBIL in cECC group were higher abnormally at early post-ECC, and significant higher than in MECC group at 2 h, 6 h post-ECC of ALT (P < 0.05), and at termination, 2 h post-ECC of TBIL (P < 0.05). The values of activated partial thromboplastin time were almost at physiological status in MECC group, but were significantly prolonged in cECC group at early post-ECC, and were statistically longer than in MECC group at 2 h, 6 h, 12 h post-ECC (P < 0.05). The concentration of free hemoglobin in cECC group were higher than in MECC group peri-operative, and there was a statistic deference at 2 h post-ECC (P < 0.05). There were no deference between the two group in Cr, PLT and WBC.</p><p><b>CONCLUSIONS</b>Compared with cECC, MECC carries more biocompatibility, more safe and credible. MECC system can alleviate the organ injury postoperatively and decrease the incidence of complications, especially in high-risk patients.</p>

Clinical application of intro-aortic balloon pump and centrifugal pump in low cardiac output syndrome after coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical application of Intra-aortic balloon pump (IABP) and centrifugal pump in low cardiac output syndrome (LCOS) after coronary artery bypass grafting (CABG).</p><p><b>METHODS</b>From April 2000 to January 2004, 5 patients suffered serious LCOS after CABG in our department. Because maximum vasoactive agent had no significant effect, we supported these 5 patients with IABP and centrifugal pumps. The centrifugal pumps were connected with cannulas of right superior pulmonary vein and ascending aorta. The flow rate of the centrifugal pumps were increased to 3-4 L/min gradually. The dosage of vasoactive agent and flow rate of the centrifugal pumps were decreased gradually after hemodynamics stabilized.</p><p><b>RESULTS</b>All 5 patients' hemodynamics were improved significantly after the left ventricular assist by IABP and centrifugal pumps. Five patients were weaned from the centrifugal pumps after 4 to 7 days successfully. But some degree damage to blood cells and renal function were detected. Renal function of 3 patients were recovered gradually after centrifugal pumps removed and discharged successfully, One patient died of acute renal failure, 1 patient died of multiple organ failure, 5 patients need transfusion of whole blood or concentrated erythrocytes and 4 patients need transfusion of platelets.</p><p><b>CONCLUSIONS</b>There were significant improvements in hemodynamics after support with IABP and centrifugal pumps in the patients who suffered serious LCOS with less effect of maximum vasoactive agent after CABG. Some complications on blood cells and renal function should be paid more attention.</p>