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Objective To summarize the clinical experience of off-pump coronary artery bypass grafting (OPCABG) for treating high risk coronary artery disease (CAD,SinoSCORE ≥ 6 points),and to evaluate its safety and efficacy.Methods The clinical data of 73 patients with high risk coronary artery disease treated through OPCABG (high risk group)in our center from April 2012 to December 2015 were retrospectively analyzed and compared with those of other low or moderate risk 78 patients treated through OPCABG (SinoSCORE＜ 6 points,low or moderate risk group) at the same period.Results All operations in the high risk group were successfully performed.Compared with the low or moderate risk group,the rate of using left internal mammary artery grafts in the high risk group was reduced significantly (P＜0.05),the operation time,postoperative ventilator support time,postoperative intensive care unit stay time and postoperative hospitalization time were prolonged significantly (P＜0.05),the rate of using intraaortic balloon pump support was increased significantly (P＜0.05),and the occurrence rate of postoperative severe complications was also increased significantly (P＜0.05).Sixty-nine cases were postoperatively followed up for (18.3±8.6) months.During the following-up period,2 cases died.11 branches of internal mammary artery grafts patency (11/11) and 38 branches of great saphenous vein grafts patency (38/43) were confirmed in 18 cases by coronary artery computer tomography angiography or coronary angiography.One cases was performed the PCI therapy due to angina relapse,and other cases had no angina symptoms with good life quality.Conclusion OPCABG is a relatively minimally invasive and safe operative mode.Strengthening perioperative management can reduce the operation risk and achieves good short or middle term efficacy in the patients with high risk CAD.
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Objective To investigate the safety of left atrial appendage occlusion by silk thread ligation during open heart op‐eration in patients with rheumatic atrial fibrillation ,and to evaluate its effectiveness for prevention of cerebral embolism .Methods From April 2012 to March 2014 ,129 patients with rheumatic atrial fibrillation were undergone mitral valve replacement and left at‐rial appendage occlusion by ligation using two silk threads from the outside of the heart (ligation group) .The indexes related to the operation ,postoperative complications incidence ,and cerebral embolism incidence during the follow‐up period of ligation group were compared with the indexes of another 129 patients without ligation of left atrial appendage over the same period (control group) . Results The operation time ,the cardiopulmonary bypass time ,the clamp time ,the intensive care unit stay time ,the postoperative hospitalization time in ligation group were (235 ± 50)min ,(88 ± 24)min ,(57 ± 16)min ,(26 .5 ± 9 .3)h and (12 .4 ± 7 .5)d respective‐ly ,and significant difference was not found compared with control group (P>0 .05) .The thoracotomy for hemostasis(1 cases) ,low cardiac output syndrome(2 cases) ,acute renal failure(2 cases) ,pulmonary infection(3 cases) ,sternal wound dehiscence(2 cases) and other complications in ligation group had no significant difference ,compared with control group(P>0 .05);2 cases died in liga‐tion group ,3 patients died in control group ,the differences had no statistical significance(P>0 .05) .No cerebral embolism occurred in ligation group with 127 patients following‐up (23 .6 ± 11 .3) months ,but 5 patients suffered from cerebral embolism in control group with 126 patients following‐up (22 .9 ± 12 .1) months ,the difference had statistical significance(P<0 .05) .Conclusion Left atrial appendage occlusion by silk thread ligation during open heart operation in patients with rheumatic atrial fibrillation is simple and safe ,can reduce cerebral embolism incidence .
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Objective To explore the safety and clinical efficacy of the purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis.Methods The clinical data of 238 patients with thoracic esophageal carcinoma and 24 patients with carcinoma of the esophagogastric junction received intrathoracic apparatus anastomosis at the Sichuan Provincial People's Hospital from January 2008 to December 2011 were retrospectively analyzed.There were 122 patients received conventional intrathoracic esophagogastric anastomosis (conventional group) and 140 patients received purse string suture stitched in gastric wall of anastomotic stoma before intrathoracic esophagogastric anastomosis (improvement group).The incidences of anastomotic fistula and stenosis of the 2 groups were compared.All data were anlayzed using the t test,chisquare test or Fisher exact probability.Results There were no significant differences in the operation time,intraoperative blood loss,volume of drainage of peritoneal effusion within 24 hours after operation,postoperative hospital stay and postoperative pTNM staging between the 2 groups (t =0.410,0.798,0.634,0.362,x2=0.605,P ＞ 0.05).There were no significant differences in the anastomotic location,stapler type,the weight of stapler esophageal end tissue between the 2 groups (x2 =0.118,0.221,t =0.459,P ＞ 0.05).There were no significant differences in the incidences of pulmonary complication,arrhythmia and mortality between the 2 groups (P ＞ 0.05).The weight of stapler stomach end tissue in the improvement group was significantly greater than that of the conventional group,while the incidences of postoperative anastomotic fistula and stenosis of the improvement group were significantly lower than those of the conventional group (t =13.856,P ＜ 0.05).Conclusion The purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis is simple and safe,and could effectively reduce the rate of anastomotic fistula and stenosis.
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Objective:To investigate the reasons and treatment measures of heparin resisitance in patients undergoing cardiac surgery during cardiopulmonary bypass(CPB).Methods:Retrospective analysis of 1 258 patients undergoing cardiac surgery was made.Results: After 400 U/kg heparin was injected intravenously,the activated clotting time(ACT)could not be extended to 480 seconds or was shortened soon after extended to 480 seconds in nineteen patients(1.51%)including seven patients with cardiac myxoma,three patients with rheumatic heart disease,three patients with infective endocarditis patients,two cases of atrial septal defect patients,two cases of tetralogy of Fallot patients,one cases of ventricular septal defect patient and one cases of double outlet right ventricle patient.A large number of heparin was added to maintain ACT at safe range for anticoagulation.But it was invalid for five patients to add heparin,and then ACT could be extended to 480 seconds after 400～600 ml fresh frezon plasma or blood was transfused.Conclusion:Heparin resistance was commonly encountered in cardiac myxoma,infective endocarditis and cyanotic heart diseases requiring CPB.It was associated with the appearance of similar heparin mucopolysaccharide material in the blood,decrease of antithrombinⅢ(ATⅢ)content and activity,increase of platelet count,preoperative anticoagulant therapy and the use of contraceptives.ACT should be monitored frequently during CPB.
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Objective:To investigate the effect of JAK2/STAT3 pathway on myocardial protection of tetrodotoxin(TTX) cardioplegia in rat hearts.Methods:A total of 24 Wistar rats were randomly divided into Group Control,Group TTX and Group TTX+AG490(n=8).The left ventricular samples in Group Control were collected as pre-ischemia control through thoracotomy.After isolated heart Langendorff and Neely models were established,the rat hearts in Group TTX were continuously perfused with Krebs-Henseleit(K-H) buffer solution for 30 minutes,arrested by TTX cardioplegia(4℃) for 60 minutes,and underwent reperfusion with K-H buffer solution for 60 minutes,then the left ventricular samples were collected for detections.The rat hearts in Group TTX+AG490 were perfused and reperfused with JAK2 inhibitor AG490(5?mol/L) and K-H buffer solution under the same procedure as Group TTX.The protein expression indexes(PEI) of phosphorylated-STAT3(p-STAT3) and B-cell lymphoma-2(Bcl-2) in myocardium were detected by immunohistochemical assay(IHC).The apoptosis index(AI) of cardiomyocyte was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling(TUNEL).The changes of these indexes in three groups were used for comparison.Results:Compared with Group Control,the PEI of p-STAT3 and Bcl-2 in Group TTX and Group TTX+AG490 increased significantly(P