The effect of radial artery on coronary bypass surgery in patients aged 65 years and older / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of autologous radial artery (RA) on coronary artery bypass grafting (CABG) in the elderly aged 65 years and older.</p><p><b>METHODS</b>Three hundreds and twenty-two patients aged 65 years and older underwent CABG with autologous RA from January 2000 to March 2007. Peri-operative complication and mortality were observed and follow-up was performed.</p><p><b>RESULTS</b>Three hundreds and forty-four RA grafts including 300 cases of single and 22 cases of bilateral RA were collected. The total number of distal anastomosis was 974, with the mean of (3.0 +/- 0.4). The mean of RA distal anastomosis was (1.1 +/- 0.4). There were 321 single, 16 Y or T composite and 7 sequential grafts of RA constructed. The distal end of RA was anastomosed to right coronary artery system for 234 times, to obtuse marginal for 95 times, to diagonal or intermediate ramous artery for 22 times. The proximal end of RA was anastomosed to aorta for 328 times, to left internal mammary artery for 9 times and to saphenous vein for 7 times. Only 13 patients manifested transient paresthesia in the area of radial aspect of thumb and no other complication occurred in the forearm. During hospitalization, 7 patients died. No patient died after the follow-up of (46.5 +/- 6.7) months. Seventy-three patients were performed with coronary angiography postoperatively. It was showed by coronary angiography that all RA conduits were patent after the duration of (47.5 +/- 11.2) months after CABG.</p><p><b>CONCLUSION</b>Utilization of RA to CABG in the elderly is safe and effective.</p>

Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Total arterial revascularization (TAR) was widely utilized in coronary artery bypass grafting (CABG) as a result of its better long-term effect compared with vein grafts. Of the arterial conduits, radial artery (RA) gained popularity for its easy availability and reported long-term patency. Thus, the objective of this study was to investigate the effect of RA in TAR in CABG.</p><p><b>METHODS</b>From January 2000 to December 2006, 85 patients (56 male and 29 female) at a mean age of 57.0 +/- 5.2 years, underwent TAR in CABG. RA and left internal mammary artery (LIMA) with composite Y or T and sequential grafting techniques were used. Post-operative complications were recorded and follow-up was performed.</p><p><b>RESULTS</b>Eighty-five LIMA and 149 RA grafts including 21 single and 64 bilateral RA were collected. A total of 87 distal anastomoses were done with the LIMA and another 152 were done with the RA, with the mean number of distal anastomosis per patient of 2.81 +/- 0.47. The proximal RA ends were anastomsed directly to the aorta in 140 grafts with Y or T graft off in situ LIMA in 9, Y or T graft off RA in 9. The distal end was anastomsed to right coronary artery system in 92, to obtuse margina in 46, to diagonal in 19 and to ramous intermedius in 5. Nine sequential anastomoses were performed with RA. Nine composite Y or T grafts were constructed with RA and LIMA while another 9 were constructed with RA and RA. One (1.2%) patient died, 3 patients (3.5%) experienced acute renal failure and 2 (2.4%) developed stroke. All patients were still alive and no patient had evidences of newly occurred myocardial infarction or angina after a mean follow-up of 36.5 +/- 4.1 months (6 - 67 months). Postoperatively at 6 month, mean left ventricular ejective fraction was increased to 0.49 +/- 0.09, compared with that of 0.43 +/- 0.11 preoperatively (P = 0.027). Postoperative mean New York Heart Association class was 2.5 +/- 0.5, compared with that of 3.0 +/- 0.4 preoperatively (P = 0.003).</p><p><b>CONCLUSIONS</b>TAR with arterial conduits of which RA was mainly used was proved in this study to be effective and safe in CABG.</p>

Analysis of the risk factors of acute renal insufficiency following coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To study the risk factors of acute renal insufficiency (ARI) following coronary artery bypass grafting (CABG).</p><p><b>METHODS</b>The clinic data of 2242 patients undertaking CABG between July 1997 and July 2006 were retrospectively analyzed, and ARI following CABG was included.</p><p><b>RESULTS</b>ARI occurred in 219 patients, with an incidence of 9.8%. Univariate analysis revealed that advanced age, diabetes mellitus, preoperative chronic renal dysfunction, left main disease, low left ventricular erection faction, emergency operation, on-pump CABG, ascending aortic atherosclerosis, postoperative respiratory function insufficiency and low cardiac output syndrome were significantly related to ARI following CABG, and logistic multivariate regression analysis showed that presence of advanced age (P = 0.031), preoperatively chronic renal dysfunction (CrCl <or= 60 ml/min, P = 0.023 or Scr >or= 150 micromol/L, P = 0.041), on-pump CABG (P < 0.001), postoperative respiratory function insufficiency (P = 0.013) and low cardiac output syndrome (P = 0.004) were independent risk factors of ARI.</p><p><b>CONCLUSIONS</b>Advanced age, preoperatively chronic renal dysfunction, on-pump CABG, postoperative respiratory function insufficiency and low cardiac output syndrome are the risk factors of ARI following CABG.</p>