ABSTRACT
@#Objective To investigate the feasibility and safety of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD). Methods A total of 50 patients with MVCAD who underwent HCR technique in our heart center from May 2016 to April 2019 were included in this study (a HCR group), including 38 patients who underwent two-stage HCR and 12 patients one-stop HCR. There were 39 males and 11 females, with an average age of 62.4 (46-82) years. Another 482 patients who underwent conventional median incision under off-pump coronary artery bypass grafting (OPCAB) at the same period were selected as control (an OPCAB group), including 392 males and 90 females, with an average age of 64.2 (48-84) years. The safety and feasibility of HCR were evaluated and compared with conventional OPCAB technique. Results There was no perioperative death in both groups. Compared with the OPCAB, HCR was associated with shorter operation time, less chest tube drainage, lower requirement of blood transfusion, shorter mechanical ventilation time and shorter postoperative intensive care unit (ICU) stay (P<0.05). There was no statistical difference in the incidence of major adverse cardiac or cerebrovascular events during the follow-up of 6 to 36 months between the two groups. Conclusion HCR provides favorable short and mid-term outcomes for selected patients with MVCAD compared with conventional OPCAB.
ABSTRACT
To investigate the effect of preoperative uses of levosimendan in patients with low LVEF(≤0. 40) undergoing off-pump coronary artery bypass grafting(OPCABG). Methods 63 patients with low LVEF coronary artery diseases were prospectively enrolled during June 2015 to May 2018, randomized to levosimendan-treated group(n =32) and control group(n =31)preoperatively. Patients in levosimendan-treated group underwent levosimendan intravenous infusion 24 h before OPCABG. All patients underwent OPCABG at normal temperature. Internal mammary artery and great saphenous vein were used as bypass materials. Hemodynamics and cardiac function were compared between the two groups after OPCABG. Results Compared to control group, the systemic vascular resistance(SVR) and central venous pressure(CVP) of levosimendan- treated group were decreased significantly and the CO and LVEF increased significantly at 12h and 24h after surgery(P < 0. 05). The heart rate and mean artery pressure had no statistical difference between the two groups(P >0. 05). The dosage and administration time of vasoactive agents in levosimendan-treated group were significantly smaller than those in control group (P <0. 05). The time of mechanical ventilation, the ICU stay length, the BNP level in the first two days after operation, and the incidence of new atrial fibrillation were less than those of the control group(P <0. 05). The perioperative intra-aortic balloon pump implantation rate in levosimendan-treated group was significantly lower than that of the control group(P < 0. 05). Conclusion Preoperative use of levosimendan can significantly improve the hemodynamic and cardiac function status of patients with low LVEF after OPCABG, shorten the time of ventilator assisted and ICU hospitalization, and reduce the incidence of adverse events.
ABSTRACT
To identify the predictors of prolonged mechanical ventilation in patients undergoing surgery for stanford type A acute aortic dissection. Methods 202 patients who underwent surgery for acute aortic dissection type A from May 2009 to May 2016 were divided into two groups based on their mechanical ventilation time after surgery, including 70 patients with mechanical ventilation 48 hours or more(group A), 132 patients with mechanical ventilation less than 48 hours (group B). Univariate and multivariate analysis(logistic regression) were used to identify the predictive risk factors. Results The mechanical ventilation time was(146. 8 ±78. 5)h and(21. 7 ±9. 5)h in group A and group B respectively. Overall inhospital mortality was 8. 6％ and 2. 3％. Multivariate logistic analysis showed that BMI(OR = 5. 956, 95％ CI: 2. 585 - 13. 723, P =0. 000), CPB time(OR =1. 108, 95％CI: 1. 052 -1. 166, P =0. 000), DHCA(OR =4. 562, 95％ CI: 1. 250 - 16. 640, P =0. 022), red blood cell transfusion intraoperative and in 24 hours postoperatively(OR =2. 625, 95％ CI: 1. 515 -4. 549, P =0. 001) were the independent predictors for prolonged mechanical ventilation. Conclusion The incidence of prolonged mechanical ventilation is high after surgery for stanford type A acute aortic dissection. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to shorten the mechanical ventilation time.