Surgical treatment in patients with severe left main artery stenosis with severe three-vessel-disease / 中国医师杂志

Objective To explore the appropriately operative chance , method, and perioperative management of coronary arterybypass grafting (CABG) in the patients with severe left main artery (LMA) stenosis with three-vessel-disease.Methods A total of296 patients with severe LMA stenosis with three-vessel-disease who underwent CABG surgery was analyzed retrospectively from 2003through 2013.Of them, 276 patients underwent conventional coronary artery bypass surgery on pump ( CCABG)and 20 patients underwentoff-pump CABG( OPCAB); 172 Patients was over 60 years old (58.1%)and 246 patients (83.10%) had concomitant diseasesincluding valve lesion, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect , stroke, renal failure,and cancer.Left internal mammary artery use was in 281 patients (95.1%); and 32 patients were implanted intra-aortic ballonpump(IABP) perioperatively.Results There were 7 cases(2.36 %) death of postoperative low cardiac output , ventricular fibrillation,cerebral infarction, renal failure, and multiple organ failure, respectively.Postoperative complications were low cardiac output ,respiratory failure , ventricular fibrillation, cereboembolism, cardiac tampomade, renal failure, stroke, and multiple organ failure.Afterfollow-up 2 to 84 months, there was 3 death in which 2 death of cardiac factors.Conclusions CCABG was a safe and effectivemethod in patients with severe LMA stenosis with severe three -vessel-disease.Preoperative insertion of IABP can certainly avoid the po -tential operative risk factor and significantly decrease the mortality and morbidity .

46 cases of off-pump CABG and plication of left ventricular aneurysm / 中华胸心血管外科杂志

Objective To review the experience of OPCAB and plication of left ventricular aneurysm. Methods Without cardiopulmonary bypass, heparin was given at 1.0～1.5 mg/kg.The 2-0 Surgipro 843 sutures were placed across the base of aneurysm using a strip of teflon felt on either side. The suture line was oriented to reconstruct a relatively normal left ventricular contour. Concurrent CABG was performed. Results 46 cases were reviewed. Left internal mammary artery (LIMA) grafts to the LAD were performed in 39 cases, off-pump with cardiopulmonary bypass in 3, IABP were used in 2. One patient died of left ventricular dysfunction. The other patients had no new myocardial infarctions and were discharged 10 to 14 postoperative days. Conclusion OPCAB and plication of left ventricular aneurysm could obviously decrease the risk of cardiac rupture and avoid the complications of cardiopulmonary bypass.