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Objective:To investigate the best neutralization ratio of protamine and heparin during off-pump coronary artery bypass grafting(OPCABG) by analyzing the advantages and disadvantages of heparin residue after OPCABG.Methods:From July 2018 to January 2019, 112 patients undergoing elective OPCABG were included in this study. The patients’ whole blood was drawn at 2 time points, including before entering operating room and entering intensive care unit, to receive thrombelastography(TEG) and heparinase-modified thromboelastography(hmTEG) . Conventional coagulation indexes such as activated coagulation time(ACT) were also detected. All the patients were divided into 3 groups, the non-heparin residue group(30 cases), heparin residue group 1(42 cases) and heparin residue group 2(40 cases) according to the laboratory results of TEG, hmTEG and ACT. We observed the dosage of each group of protamine and heparin, as well as the ratio of heparin and protamine. The changes of R time in TEG and ACT between 3 groups were analyzed and compared. Postoperative chest tube drainage at postoperative 12 h and 48 h, cTnI peak value, incidence of perioperative myocardial infarction(MI), incidence of reoperation and poor wound healing, amount of blood loss and transfusion, and acute renal injury were compared between the 3 groups.Results:No significant trio-group differences existed in basic clinical characteristics(all P>0.05). Postoperative R(CKH)time was similar in the 3 groups( P>0.05). Comparing with heparin residue group 1 and heparin residue group 2, the ACT after protamine neutralizing heparin and postoperative R time were decreased, the dosage of protamine, ratio of heparin and protamine, cTnI peak value were increased in the non-heparin residue group( P<0.05). Comparing with heparin residue group 2, the dosage of heparin, postoperative chest tube drainage at postoperative 12h and 48h, amount of blood transfusion and transfusion probability were significantly decreased in non-heparin residue group( P<0.05), but compared with group 1 of heparin residue, there was no significant difference in the above indexes( P>0.05). The perioperative myocardial infarction, incidence of reoperation and poor wound healing, postoperative acute renal injury and time of in ICU stay showed no significant differences between the 3 groups( P>0.05). Conclusion:Moderate heparin residue after OPCAB suggests that it has myocardial protective effect, and does not significantly increase the risk of bleeding. A large number of heparin residues can affect the coagulation function and lead to bleeding tendency, increase the amount of blood loss and transfusion. It is reasonable to make ACT after protamine neutralize heparin higher than the level of ACT before operation, and not higher than 20% of the level before operation.
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Objective To investigate the aberrant expression of long non-coding RNA(lncRNA) in chronic thromboembolic pulmonary hypertension,and explore the lncRNA role in pathogenesis of CTEPH.Methods A total of 5 pulmonary artery endarterium tissue of CTEPH patients and 5 pulmonary artery endarterium tissue of healthy controls were collected.Using high-throughput gene microarray technology to detect two groups of lncRNA and mRNA expression spectrum,build lncRNA-mRNA express network,Pathway and GO analysis to explore the gene function.Results Differential expression of 185 lncRNA was observed in the CTEPH tissues compared with healthy control tissues.Further analysis identified 464 regulated enhancerlike lncRNA and overlapping,antisense or nearby mRNA pairs.Coexpression networks were subsequently constructed and investigated.The expression levels of the lncRNA,NR_036693,NR_027783,NR_033766 and NR_001284,were significantly altered.Gene ontology and pathway analysis demonstrated the potential role of lncRNA in the regulation of central process,including inflammatory response,response to endogenous stimulus and antigen processing and presentation.Conclusion Differentially expressed lncRNA may exert a partial role in CTEPH,the results of this study will help in the future about diagnosis and treatment of CTEPH.
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Objective To compare clinical effects and complications of patients with diabetes in off-pump coronary artery bypass grafting(OPCAB) between endoscopic saphenous vein harvesting(EVH) and conventional saphenous vein harvesting(CVH).Methods Sequence comparison analysis the clinical data of 339 patients with DM who underwent OPCAB in our department from Nov 2011 to Nov 2014.269 cases by EVH,70 cases by CVH.Observing two groups of patients with deprecated rate of SVG,intraoperative SVG blood flow and the value of PI,lower limb wound complications such as incision infection,poor healing,lower limb local hematoma and pain.SVG patency rate of part patients was follow-up by CT coronary angiography.Results To compare the two groups of patients by EVH and CVH,the perioperative death was 8 cases in EVH group (2.4％),2 cases in C VH group (2.9％).The deprecated SVG of patients was 3.9％ vs 2.9％.The blood flow was (17.36 ±11.24) ml/min vs(17.11 ± 8.37) ml/min,PI was 2.78 ± 2.37 vs 2.22 ± 2.17.The incision infection was 0 vs 4.4％,poor healing was 0.9％ vs 8.8％.The lower limb local hematoma was 5.7％ vs 1.5％.The visual pain analogue scale(VAS) was 0.53 ± 1.71 vs 1.26 ± 2.13 3 days after operation.The numbness of lower limb was 9.7％ vs 22.1％.The Edema of the legs was 8.5％ vs 19.1％ 7 days after operation.60 cases were follow-up by CT coronary angiography,the SVG patency rate was91.4％ vs 94.6％ 1 year after operation,83.3％ vs 86.1％ 2 years after operation,72.2％ vs 73.7％ 3 years after operation respectively.Conclusion EVH technology for SVG in the patients combined DM has good clinical result,the recent patency rate of SVG is perfect,postoperative limb complications is decreased by EVH.
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Objective To evaluate the feasibility,validity and safety of pulmonary endarterectomy for patients with chronic thromboembolic pulmonary hypertension.Methods 50 patients undertook pulmonary endarterectomy operations were enrolled in this study.Of them,38 were males (76％),the average age was (43.35 ± 12.51) years,23 patients had deep venous thrombosis.Obvious pulmonary hypertension and hypoxemia were observed in all patients.Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest.Preoperative systolic pulmonary artery pressure was(104.16 ± 16.95) mmHg,pulmonary vascular resistance was(129.68 ± 50.88) kPa · s · L-1,central venous pressure was (14.91 ± 4.88) mmHg,and cardiac output was (3.28 ± 1.04) L/min.Results The average time of cardiopulmonary bypass was(294.37 ± 94.01) min,aortic cross clamp time was(127.93 ± 35.57) min,circulatory arrest time was(34.30 ±21.74) min.Post-operative mechanical ventilation time was (97.24 ±70.53) hours,and the ICU stay was (9.52 ± 12.96) days.There were 4 patients that died after PEA surgery for postoperative residual pulmonary hypertension of reperfusion pulmonary edema.Post-operation,all patients had significant decrease in systolic pulmonary artery pressure (54.11 ± 16.86) mmHg and pulmonary vascular resistance(20.55 ± 15.17) kPa · s · L-1,and central venous pressure (9.00 ± 3.09) mmHg,and great improvement in cardiac output (5.75 ± 1.48) L/min.6-months follow-up showed that the cardiac function of 44 (95.7 ％) cases returned to NYHA class Ⅰ or Ⅱ,with great improvement in computed tomography pulmonary angiography.All patients go back to normal work and physical exercise at 1-year follow-up.Conclusion Conclusions According the successful experience of surgery for CTEPH patients,pulmonary endarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement,with favorable outcomes of heart and lung function in short and middle time follow-up.
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Objective To investigate the common sites and risk factom of reoperation for bleeding after coronary artery bypass grafts(CABG).Methods During Jan 2000 to July 2011,2765 CABG procedures hed been done in our hospital,including 874 cases with CABG by cardiopulmonary bypass,1891 cases with off-pump coronary artery bypass grafts (OPCAB),105 cases combined with other procedures (cardiac valve operation,resection of ventricular aneurysm,et al),216 cases applied intra-aortic balloon pump (LABP)).67 patients needed reoperation for bleeding,the morbidity is 2.4％.Factors that might affect the result of reoperation were analyzed by single-factor analysis.Results The following factors were related to high rates of reoperation (P ＜ 0.05 ):the internal mammary artery (IMA) used,anfithrombotic medication discontinued less 5 days before elective surgery,concurrent hypertension,combined with other surgery procedures and ages ＞70 years.It was not signifieantly related to CABG or OPCAB,ff use of IABP,ff concurrent diabetes,number of grafts inserted.Major sources of bleeding found in 48 patients were the IMA and its vessels bed,vein grafts,sternum,aortic faucet,midriff,thymus glrard bed vessels.Conclusion Prepared satisfactorily before operation,avoid risk factors can reduce reoperation for bleeding,but the most important is the operation carefully during operation of hemostasis.
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Objective To evaluate the performance of the Sino System for Coronary Operative Risk Evaluation ( SinoSCORE) on in-hospital mortality and postoperative complications in patients undergoing coronary artery bypass grafting (CABG) in a single heart center. Methods From January 2007 to December 2008, clinical information of 201 consecutive patients undergoing isolated CABG in our hospital was collected. The SinoSCORE was used to predict hospital mortality and major complications[sternal wound infection, postoperative renal failure, multiple organ dysfunction syndrome, perioperative intra-aortic balloon pumps ( IABP), etc.]after CABG among our study participants, which was initially designed as CBAG operative risk scoring system and included 11 risk factors. We estimated the predictable capability of SinoORE model by the means of analysing the calibration and discrimination characters of this risk scoring system. Calibration was evaluated with the method of Hosmer-Lemeshow goodness-of-fit test. Discrimination was tested by determining the area under the receiver operating characteristic (ROC) curve. The optimal cut-off point for SinoSCORE predicting major complications was obtained by the Youden index. Results Of all our study patients, the observed in-hospital mortality was 1.99% (4/201). The overall mean baseline age was ( 63.3 ± 9.2 ) years and 24.4% ( 49/201 ) were female. The predicted mortality cakulated by the SinoSCORE was 2.88% which was slightly higher than the actual mortality. SinoSCORE model slwed very high discriminatory ability and the good calibration power in predicting in-hospital mortality: Hosmer-Lemeshow calibration test:x2 =4. 304, P =0.744 and area under ROC was 0. 81 (95% CI: 0.687 -0.932). As for the major postoperative complications after CABG,SinoSCORE model still achieved a satisfactory performance with the good predictive value for the main complications risk evaluation such as postoperative renal failure, multiple organ dysfunction syndrome and IABP. Hosmer-Lemeshow: P =0.75, P =0. 75, P = 1.00; Areas under ROC respectively at was 0. 768 ( 95 % CI: 0.613 - 0. 924 ). 0. 832 ( 95 % CI: 0. 732 - 0. 932 )and 0. 737 (95% CI: 0. 607 -0. 867 ). The optimal cut-off points for SinoSCORE model predicting each of the above three major postoperative complications was ultimately determined to be 4.5. Conclusion In our patient database, the SinoSCORE model proved a good preoperative risk model in predicting both in-hospital mortality and major complications after CABG, which provides a realistic estimation of hospital death and post-operative complications risk for patients undergoing CABG. Sinoscore model is a suitable operative risk estimation system for Chinese CABG patients.
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Objective Hypothyroidism may have adverse effects on the post-operative outcomes. We evaluated the outcomes of coronary artery bypass grafting (CABG) in patients who had both coronary artery disease (CAD) and hypothyroidism.Methods Among 1347 patients undergoing CABG between September 2002 and June 2009, hypothyroidism was diagnosed in 21 patients (Group A, with 6 men and 15 women) and treated with thyroxin replacement therapy. The average age of patients in group A was(60.4 ± 10.2). Hypothyroidism was identified with tests for thyroid functions. CABG in 4 patients was performed with extracorporeal circulation, three of them received on-pump beating heart CABG, and in 17 patients was performed with off pump CABG( OPCAB). CABG was performed following the improvement of FT3, FT4 and TSH with the use of levothyroxine for all patients in group A Twenty patients with CAD in the absence of hypothyroidism ( group B) served as control, 4 of these patients underwent CABG with extracorporeal circulation. Data of thyroid function and hemodynamics pre-, post- and during operation were analyzed. Results Serum thyroid hormones, such as FT3, were measured with sensitive and specific radioimmunoassays peri-operatively. In the patients receiving CABG without extraorporeal circulation, the mean serum FT3 concentrations were ( 1. 39 ± 0. 36 ) pg/ml pre-operatively and ( 1.29 ± 0. 32 ) pg/ml post-operatively ( P = 0.18 ) for 17 cases in group A, and were (2.28 ±0.36)pg/ml and (2.19 ±0.34) pg/ml respectively (P =0.24)for 16 cases in Group B. In the patients receiving CABG with extracorporeal circulation, the mean serum FT3 concentrations were( 1.53 ±0.51 )pg/ml pre-operatively and (0.85 ± 0.40) pg/ml post-operatively ( P = 0. 04 ) for 4 cases in group A, and were ( 2.08 ± 0.24) pg/ml vs. ( 1.96 ±0. 26) pg/ml ( P = 0. 26 ) for 4 cases in group B. The CIs of patients in group A and group B were ( 2.7 ± 1.4)L · min-1 · m-2 vs. (2.8 ±1.5) L · min-1 · m-2, P=0.53). One patients with severe hypothyroidism and underwent CABG with extracorporeal circulation in Group A died of refractory bradycardia after failure in heart resuscitation. Twenty survivors in group A underwent coronary artery bypass on-beating heart. All survivors had improvement in cardiac function during 2to 30 months of follow-up, their preoperative ejection fraction (EF) was 0.48 ± 0.17 and follow-up EF was 0.55 ± 0. 21. All 20 patients in group B were alive. There was no significant difference between group A and B in hemodynamics, prognosis, duration of hospitalization [( 12.2 ±4.7 ) day vs. ( 10. 1 ± 3.9 ) day, P = 0.17], time to extubation [( 17.6 ± 9. 1 ) h vs.(15.1 ± 13.7) h, P =0.12]. Conclusion CABG in patients with both CAD and hypothyroidism is relatively safe. Proper peri-operative nanagement, combined with on-beating heart techniques of CABG, may decrease the operation risks. Off pump CABG had little effect on serum concentrations of FT3. Peri-operative thyroid replacement therapy was critical for patients with hypothyroidism. Patients with severe hypothyroidism who underwent CABG with extracorporeal circulation were at high risk.