Clinical analysis of 1018 cases of coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze retrospectively 1018 patients who underwent coronary artery bypass grafting surgery (CABG) in order to summarize surgical techniques and clinical outcome.</p><p><b>METHODS</b>From 1997 through 2004, data of same surgeon for 508 patients who underwent conventional coronary artery bypass surgery on pump (CCABG) and 510 patients who underwent off-pump CABG (OPCAB) were collected and analyzed retrospectively. Eight hundred and fifty-two patients had unstable angina, 582 patients were over 60 years old (57.2%) and 784 patients had concomitant diseases including valve lesion, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect, stroke, chronic obstructive pulmonary diseases, renal failure and cancer. A hundred and fifty-six patients had left main stem (LIMS) stenosis and 671 patients, triple-vessel disease.</p><p><b>RESULTS</b>Total mortality was 0.39% (4-case death) and morbidity, 1.6% (sternal dehiscence, stroke and mediastinitis). The grafts per patient with CCABG and OPCAB were 3.3 +/- 0.6 vs. 2.5 +/- 0.4. Left internal mammary artery use was 93.8% of the patients, 29 patients were implanted intra-aortic balloon pump intraoperatively. Follow-up was 4 months to 7 years.</p><p><b>CONCLUSIONS</b>Scientific surgical strategies, excellent surgical techniques and improvement of cardiac anesthesia and cardiopulmonary bypass make the mortality and morbidity decrease significantly, CABG surgery is safe and effective in patients with coronary artery disease.</p>

Safeguard and management of the heart vales in congenital heart disease procedure / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in performing reoperation of valve dysfunction after congenital heart disease procedure.</p><p><b>METHODS</b>From 1994 to 2001 we reviewed the data of 13 patients with valve dysfunction after congenital heart disease operation, in which 8 patients after ventricular septal defect, 3 after atrioventricular canal and 2 after respectively tetralogy of Fallot and atrial septal defect were corrected. Before the first operation, 6 patients had presented the mild to moderate mitral regurgitation, 1 had aortic regurgitation. Other 6 patients had valves dysfunction occurring after the first operation, among them, 2 suffered from respectively residual shunt of the ventricular septal defect, 2 had anterior chordae rupture of tricuspid valve, one had an operative injured aortic valve and one had surviving of right ventricular outlet obstruction. Thirteen patients were reoperated, including mitral valve replacement in 6, tricuspid valve replacement in 2, aortic valve replacement in one, aortic valve replacement consists with mitral valve repair and tricuspid valve repair in one and tricuspid valve repair in 3. Concomitant procedures were performed.</p><p><b>RESULTS</b>Low cardiac output occurred in 3 cases and there were 2 early deaths, due to cerebral air-embolism, respiratory and circulatory failure respectively. Other 11 cases discharged and were followed up well.</p><p><b>CONCLUSIONS</b>It is important to safeguard and repair the valvular construction and function during the operation in congenital heart disease. Reoperation should be performed timely for obtaining recurrent and a good results.</p>

Left ventricular aneurysmectomy with geometric reconstruction / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience in performing left ventricular aneurysmectomy (LVA) with geometric reconstruction and concomitant coronary artery bypass grafting (CABG) without mortality.</p><p><b>METHODS</b>Forty-two patients underwent LVA with geometric reconstruction and concomitant CABG. Forty-one patients were male, one was female with mean age of (55.5 +/- 2.4) years (40 - 68 years). Preoperative cardiac function was NYHA class III in 32 patients and class IV in 10. Thirty-eight patients had unstable angina pectoris and 10 had the history of severe ventricular arrythmia. Eight patients had ventricular tachycardia. Preoperative left ventricular ejection fraction (LVEF) was 41% (17% - 63%), LVEF was less than 40% in 29 cases. Left ventricular anatomic aneurysms were confirmed by ventriculography. Thirty-three cases underwent Jatene technique; 8 cases, Dor technique, and 1 case, Cooley technique. Mural thrombi were found in 21 patients and were completely removed. CABG was concomitantly performed in all patients. All of the left anterior descending artery was bypassed with left internal mammary artery and the other target vessels with saphenous vein. Mean cardiopulmonary bypass time was (135 +/- 11) minutes and aortic clamping time was (78 +/- 10) minutes.</p><p><b>RESULTS</b>No hospital mortality occurred and all patients were discharged. Postoperative reexploration for bleeding in 1 patient. The diameter and end systolic and diastolic volume of left ventricle were significantly decreased to nearly normal after operation. Operative ejection fraction had a tendency to increase but without significance (P > 0.05).</p><p><b>CONCLUSIONS</b>LVA with geometric reconstruction and concomitant CABG could not only improve heart function but also eliminate ventricular arrythmia. The clinical result was excellent.</p>

Myocardial revascularization combined with concomitant valve operations: report of 45 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To introduce the experience in coronary artery bypass grafting (CABG) combined with concomitant valve operation.</p><p><b>METHODS</b>From 1998 to 2002, forty-five patients (38 men and 7 women) with coronary artery lesion and valve diseases underwent myocardial revascularization combined with concomitant valve operation. The mean age of the patients was 59 years (42 to 75 years). Heart function was Class II (NYHA) in 7 patients, Class III in 30, Class IV in 8. The value of ejection fraction was 0.32 to 0.50. Thirty patients had mitral valve lesion, 7 aortic lesion, and 8 both lesions. Seventeen patients had single-vessel diseases, 20 double-vessel diseases, 8 triple -vessel diseases, and 8 left main artery lesion. After cardiac arrest by cold blood cardioplegia under moderate cardiopulmonary bypass (CPB), distal anastomosis of the saphenous vein (SV) to the target vessels were firstly performed and followed by valve replacement (32 patients) or plasty (2). The left internal mammary artery (LIMA) was grafted to the left anterior descending artery (LAD) before aortic unclamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping time was 112.6 min.</p><p><b>RESULTS</b>No mortality occurred during hospitalization and all patients were discharged 9.2 days after operation. Cardiac function of all patients was improved to Class I-II and no patient died during follow-up.</p><p><b>CONCLUSIONS</b>CABG combined with valve surgery can be safely performed with good results.</p>