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@#Objective To investigate the perioperative clinical effects and follow-up results of minimally invasive coronary artery bypass grafting (MICS CABG) versus conventional coronary artery bypass grafting (CABG) in thoracotomy. Methods The patients who received off-pump CABG in Beijing Anzhen Hospital from January 2017 to October 2021 were collected. Among them, the patients receiving MICS CABG performed by the same surgeon were divided into a minimally invasive group, and the patients receiving median thoracotomy were into a conventional group. By propensity score matching, preoperative data were balanced. Perioperative and postoperative follow-up data of the two groups were compared. Results A total of 890 patients were collected. There were 211 males and 28 females, aged 60.54±9.40 years in the minimally invasive group, and 487 males and 164 females, aged 62.31±8.64 years in the conventional group. After propensity score matching, there were 239 patients in each group. Compared with the conventional group, patients in the minimally invasive group had longer operation time, shorter drainage duration, less drainage volume on the first postoperative day, shorter postoperative hospital stay, and lower rate of positive inotropenic drugs use, while there was no statistical difference in the mean number of bypass grafts, ICU stay, ventilator-assisted time, blood transfusion rate or perioperative complications (P>0.05). During the median follow-up of 2.25 years, there was no statistical difference in major adverse cardiovascular and cerebrovascular events, including all-cause death, stroke or revascularization between the two groups (P>0.05). Conclusion Reasonable clinical strategies can ensure perioperative and mid-term surgical outcomes of MICS CABG not inferior to conventional CABG. In addition, MICS CABG has the advantages in terms of postoperative hospital stay, postoperative drainage volume, and rate of positive inotropic drugs use.
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@#Objective To compare the mid- and long-term efficacy of minimally invasive coronary artery bypass grafting (MICS) versus conventional coronary artery bypass grafting (CABG). Methods This study analyzed 679 patients with coronary heart disease treated in the Minimally Invasive Heart Center of Beijing Anzhen Hospital from 2015 to 2019, including 532 males and 147 females with an average age of 61.16 years. A total of 281 patients underwent MICS (a MICS group) and 398 patients underwent conventional CABG (a CABG group). The clinical data of the patients in the two groups were analyzed. Results The average operation time was longer (P<0.001), the total hospital stay was shorter (P<0.001), and the amount of drainage 24 h after the operation was less (P=0.029) in the MICS group. There was no statistical difference in the incidence of perioperative complications between the two groups. The median follow-up time was 2.68 years. The follow-up results showed that the total incidence of cumulative main adverse cardiovascular and cerebrovascular events in the CABG group was higher at 2 years (6.2% vs. 3.8%) and 4 years (9.3% vs. 7.6%), but the difference was not statistically significant (P>0.05). There was no statistical difference in 2- or 4-year all-cause death between the two groups (3.5% vs. 2.8%, 5.6% vs. 2.8%, P>0.05). At the same time, there was no statistical difference in the incidence of myocardial infarction, stroke or revascularization between the two groups (P>0.05). Conclusion Compared with conventional CABG, MICS can achieve satisfactory mid- and long-term outcomes.
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Objective:To investigate the influence of the complexity of coronary artery disease based on SYNTAX score(SS) on the effect of minimally invasive or conventional bypass surgery.Methods:From January 2017 to January 2020, the medical group of the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital received a total of 760 patients undergoing off-pump coronary artery bypass grafting(OPCABG) surgery, including 596 males and 164 females. 28-85 years old, with an average of(60.88±9.36) years old. 379 cases underwent minimally invasive coronary artery bypass grafting(MICS CABG)(minimally invasive group) and 381 cases underwent median thoracotomy CABG(conventional group). In this study, according to the SS, patients of both groups were divided into 3 levels, and then the perioperative data of the two sets of high, medium, and low score intervals were compared respectively, and a preliminary analysis of the perioperative data for patients in each SS score section was performed.Results:There was no significant difference in the SS value between the minimally invasive group and the conventional group in the three intervals. There was no statistical difference in preoperative data including age, sex ratio, body mass index, hypertension, diabetes, abnormal head CT history, lung disease, history of tobacco and alcohol. The number of minimally invasive bypasses in the three groups was significantly less than that of the conventional group. The duration of minimally invasive surgery in the SS low score group was similar to that of conventional surgery, and the duration of minimally invasive surgery in the SS medium and high score group was longer than that in the conventional group. The hospital stay in the SS low and middle score group was less than that of the conventional group. There was no statistical difference in the proportion of MACCE and auxiliary equipment implantation in the 30-day perioperative period.Conclusion:In the same grade of SS group, there is no significant difference on the perioperative clinical effect between conventional CABG or MICS CABG group. The complexity of coronary artery disease is not the decisive basis for choosing minimally invasive or conventional bypass.
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Objective:To compare the perioperative outcomes and short-term graft patency between patients who underwent multivessel off-pump coronary artery bypass graft(OPCABG) via left intercoastal space or sternotomy.Methods:Between January 2017 and August 2019, 100 patients who underwent minimal invasive coronary artery bypass graft(MICS CABG) were compared with 235 patients who underwent OPCABG by single surgeon at our institute. Among them, 257 cases were male and 78 were female, aged 34 to 84 years, with mean age(61.35±8.79)years old. Due to important differences in patients’ characteristics, a propensity score-matched analysis based on 12 covariates was performed to match in a 1∶2 fashion. 82 patients(MICS group) were matched with 127 patients(OPCABG group). Surgical and postoperative outcomes were evaluated.Results:There was no statistical difference of perioperative mortality, myocardial infarction, and stroke rate( P>0.05). In MICS group, use of internal thoracic artery was higher and conversion to cardiopulmonary bypass was lower( P<0.05), but reoperation, new onset atrial fibrillation , and the use of mechanical device were similar( P>0.05). In addition, operation duration was longer but transfusion rate, postoperative chest tube drainage within 24 hours and postoperative hospital stays were less in the MICS group( P<0.05). LIMA, vein and overall graft patency were similar in the two groups shown by postoperative one-year CTA( P>0.05). Conclusion:MICS CABG is safe and feasible for patients with multiple coronary lesions. It has similar in-hospital outcomes and short-term graft patency but less transfusion and faster recovery compared to conventional OPCABG via sternotomy.
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Objective:To explore the perioperative effect of radial artery as a sequential graft in coronary artery bypass grafting(CABG).Methods:The clinical data and perioperative complications of 109 patients, who underwent radial artery(RA) or great saphenous vein(SVG) as a sequential graft during CABG from April 2020 to December 2020 in Beijing Anzhen Hospital, were analyzed, there were 86 males and 23 females, aged from 39 to 79 years, with an average of(61.1±8.0)years old. According to the graft materials, they were divided into the RA group(n=47) and SVG group(n=62).Results:There were no significant differences between the two groups in age, gender, comorbidities, echocardiographic results, transplant vascular indexes, coronary angiography results, and operation methods(on-pump or off-pump, use of left internal mammary artery, number and distribution of distal anastomoses)( P>0.05). There were also no significant difference between the two groups in ICU stay, postoperative hospital stay and drainage with 24 hours after CABG( P>0.05). The incidence of postoperative cerebrovascular events, postoperative infection and secondary thoracotomy in the RA group were higher than that in the SVG group. The incidence of myocardial infarction, postoperative ventricular arrhythmia and postoperative IABP assistance in the SVG were higher than that in the RA group, but the difference was not statistically significant( P>0.05). Conclusion:The application of radial artery as a sequential graft during CABG does not increase the risk of perioperative complications, and the patients recover smoothly.
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Objective:The perioperative and early follow-up data of the simultaneous hybrid CAS+ OPCABG and sequential CAS+ OPCABG were compared to evaluate the safety and efficacy of the simultaneous CAS+ OPCABG.Methods:A total of 26 patients with coronary heart disease complicated with carotid artery stenosis received CAS plus OPCABG hybrid surgery in our hospital from January 2020 to July 2021, among which 12 patients received simultaneous CAS+ OPCABG and 14 patients received staged sequential CAS+ OPCABG.The perioperative and postoperative follow-up data of 3 months were compared and analyzed.Results:There were no significant differences in the operation time, drainage on the first day after surgery, ventilator assisted time and ICU time between the two groups.The amount of intraoperative blood loss in the simultaneous group was more than that in the staged group, but no secondary thoracotomy occurred in both groups. The number of days in hospital after operation was significantly less in the simultaneous group. There was 1 case of perioperative cerebral infarction and 1 case of myocardial infarction in the staged group, but there was no statistical difference between the two groups. There was no new cerebral infarction in the two groups, carotid artery ultrasound stent was unobstructed, and there was no statistical difference in cardiac function grading and left ventricular ejection fraction 3 months after operation.Conclusion:Simultaneous CAS+ OPCABG surgery is safe and feasible, it is recommended as the first choice especially for patients with severe myocardial ischemiaor severe left main artery disease caused.How to reduce the risk of bleeding and alleviat carotid sinus reflex are major issues that need to be concerned.
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@#Objective To study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time. Methods From March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery. Results There was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single- vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention. Conclusion The learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.
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@#Objective To investigate the safety and effectiveness of minimally invasive coronary artery bypass grafting (MICABG) through comparing the perioperative clinical effects of conventional surgery and MICABG. Methods A total of 543 patients in the single medical group of Beijing Anzhen Hospital who underwent beating coronary artery bypass grafting from January 2017 to September 2020 were collected, including 161 patients receiving MICABG (a minimally invasive group, 143 males and 18 females, aged 60.08±9.21 years), 382 patients receiving median thoracotomy (a conventional group, 284 males and 98 females, aged 61.68±8.81 years). The propensity score was used to match 143 patients in each of the two groups, and the perioperative data of the two groups were summarized and analyzed. Results There was no death, perioperative myocardial infarction or stroke in the minimally invasive group. Compared with the conventional group, the minimally invasive group had longer operation time (296.36±89.4 min vs. 217.80±50.63 min, P=0.000), less number of bypass grafts (2.86±1.03 vs. 3.17±0.78, P=0.005), shorter postoperative hospital stay (6.29±1.46 d vs. 6.78±2.61 d, P=0.031), less drainage on postoperative day 1 (339.57±180.63 mL vs. 441.92±262.63 mL, P=0.001) and lower usage rate of inotropic drugs (9.09% vs. 26.57%, P=0.001). There was no statistical difference between the two groups in postoperative ICU stay ventilator assistance time, blood transfusion rate, secondary thoracotomy rate, or use of mechanical equipment. Conclusion Reasonable clinical strategies can ensure the satisfactory overall safety of MICABG. In addition, it has the advantages of shorter postoperative hospital stay, less bleeding and smaller dosage of inotropic drugs.
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Objective To compare the perioperative outcomes between patients who underwent multivessel off-pump coronary artery bypass graft(OPCABG) via single left intercoastal space and sternotomy,and to explore the perioperative outcomes and technigues about minimally coronary artery bypass grafting with multi-vessel lesion.Methods From January 2017 to July 2018,100 patients were recruited using both left internal mammary artery and vein graft.They were divided into minimal invasive coronary artery bypass grafting(MICS) group and control group.Perioperative outcomes were analyzed and surgical techniques were summarized.Results There was no statistical difference in preoperative profiles,mean grafts and postoperative complications(P ＞0.05).Compared with control group,MICS group had statistical benefits in length of operation incision [(8.2 ± 1.2) cm vs.(25.3 ± 3.5) cm,P =0.000],i ntraoperative washed blood loss [(301 ± 188) ml vs.(444 ± 331) ml,P =0.01],postoperative ventilation duration [(16.18 ± 5.90) h vs.(19.60 ± 3.92) h,P =0.001] and length of ICU stay [(19.19±6.85)hvs.(23.44±4.64)h,P=0.001].Conclusion There is a learning process for surgeons to perform minimal invasive OPCABG via single left intercoastal space.Surgery is feasible for patients with multiple coronary lesions.Mid and long term following up need to be studied.
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Objective This study reviews the 198 consecutive mitral valve operations for elderly patients(＞ 65 y) with ischemic mitral insufficiency performed at Anzhen Hospital between January 2000 and june 2016.The results for mitral valve reconstruction are compared with those for biological mitral valve replacement.Methods From January 2000 to June 2016,198 elderly patients with ischemic mitral insufficiency underwent mitral valve reconstruction (n =150) or biological mitral valve replacement(n =48).All of them coronary artery bypass gafting was performed at the same time.Preoperative clinical characteristics,procedural characteristics,major and minor complications after surgery,preoperative and postoperative left ventricular ejection fraction (LVEF) by echocardiography,and outcome (survivor or death,mitral regurgitation,NYHA degree) were assessed.Results There was no significant difference between the two groups in the rate of mortality during hospitalization and early postoperative cardiac function.The proportion of severe MR in 1,3,and 5 years after MVP were 5.1％ 、6.3％、7.7％ respectively.There was no MVR due to the recurrent moderate-to-severe reflux.There were 2 SBE but no reflux appeared after MVR.There was no significant difference in cardiac function and mortality between the two groups within 5 years.Conclusion There is no significant difference between CABG + MVP and CABG + MVR(BV) in cardiac function and mortality in the treatment of elderly patients with IMR.,There was a possibility of MR recurrence after CABG + MVP.There was no MR after CABG + MVR(BV),but the risk of SBE is higher than MVP.We can select operation mode personalized according to the type of mitral valve disease and cardiac function.
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Objective To review the outcome of coronary artery bypass grafting (CABG) using left internal thoracic artery (LITA) grafts in these patients aged more than 70 years old.Methods 1471 patients aged more than 70 years old[mean (73.3 ± 3.9) years] from July 2010 through August 2012,who underwent CABG in Anzhen hospital,form the cohort of this study.Among them,1395 cases underwent off-pump CABG,while 76 cases underwent on-pump CABG which includes onpump beating heart CABG in 12 cases.The average number of the grafts is 3.12 ±0.68.All of the patients were divided into two groups on base of the graft:Group A:only saphenous vein graft was used in 564 cases; Group B:The left internal thoracic artery to the left anterior descending artery was used in 907 cases,which also include total arterial grafting,facilitated by the use of the radial artery,right gastroepiploic artery was operated in 42 cases,beside these artery grafts,saphenous vein graft was used to anastomosis with other vessels.Results Operative mortality was 2.12％ in group A and 2.09％ in group B.There was no significance between the 2 groups.The volume of blood drainage was larger in group B than that in group A.At the same time,there was no significance in the incidence rate of second thoractomy,malignant arrhythmia,stroke,poor wound healing,and usage of IABP between the 2 groups.Conclusion It did not increase the mortality and morbidity of serious complications using the left internal thoracic artery to the left anterior descending artery in those elderly patients aged more than 70 years old during the CABG operation.With consideration of the obvious advantages in the long term patency,LITA was proposed to be used in CABG even in those age ＞ 70 patients.
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Objective To evaluate the combination of dual-energy CT angiography (DE-CTA) and dual-energy CT peffusion (DE-CTP) in the diagnosis of coronary artery disease. Methods Thirty-one patients with angina pectoris were examined using dual-source dual energy CT and conventional coronary angiography. For DE-CTA, we used a contrast-enhanced ECG-gated coronary scan protocol with energy levels of two tube detector arrays at 140 and 100 kVp. Two kinds of acquired images were fused for the CT angiogram and further calculated to construct a perfusion map (Siemens DE Heart PBV). The compared the following results: DE-CTA vs. CA, DE-CTP vs. CA to assess the sensitivity and specificity, and further compared DE-CTA plus DE-CTP with CA. Results DECT obtained diagnostic image quality in 28 patients.DE-CTA detected 41/112 arterial stenosis. Using CA as a reference, the sensitivity of DE-CTA was 81%(38/47), specificity was 95% (62/65), positive predictive value was 92% (38/41), negative predictive value was 87% (62/71), and accuracy was 89% (100/112). DE-CTP detected 46 perfusion defects in artery territories. Using CA as a reference, the sensitivity of DE-CTP was 76% ( 36/47), specificity was 85% (55/65), positive predictive value was 78% (36/46), negative predictive value was 83% (55/66),and accuracy was 81% (91/112). DE-CTA plus DE-CTP diagnosed 52 arteries stenosis. Using CA as a reference, combination of DE-CTA and DE-CTP gave sensitivity of 95% ( 45/47 ), specificity of 89%(58/65) , NPV of 97% (58/60), and accuracy of 92% (103/112). Conclusions DECT can provide perfusion blood volume information as well as vessel pathology in one scan. DECT can provide comprehensive diagnosis and improve diagnosis of CAD.
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patients aged from 60 to 78 years underwent heart valve replacement, and all of the valves were replaced with mechanical valve except 2 with bioprothesis. Among them there were 4 groups: mitral valve replacement in 14, aortic valve replacement in 10, double valves replacement in 13, and modified Bentall′s procedure in 3. Coronary angiography was performed routinely before operation, and coronary artery bypass grafting were performed in 7.The overall mortality rate was 5.0%. 1 case was complicated by Ⅲ? atrial ventricular block 18 days after operation, and a permanent pacemaker was implanted. No other serious postoperative complication occurred. 33 cases were followed up from 4 months to 7 years.It was found that cardiac function got better significantly in all the patients,and no one died within that period. The results suggested that:①Good result was obtained in cardiac valve replacement in the elderly; single geriatric factor did not seem to be a contraindication for cardiac valve replacement. ②Coronary angiography should be performed as a routine; all the patients with significant stenosis of the coronary artery should undergo coronary artery bypass grafting. ③All the parameters of physiological demand should be more strictly observed in undertaking the operation. ④The reservation of the organ function declines in the elderly,thus multiorgan insufficiency was prone to occur after the operation, therefore prevention and treatment of the complications is the key to have a successfully rehabilitation.