Cirugía coronaria sin circulación extracorpórea

La cirugía de revascularización coronaria (CABG) es el estándar de tratamiento para la revascularización de la enfermedad de la arteria coronaria izquierda y/o de tres vasos. La cirugía coronaria sin bomba (OPCAB) evita el uso de derivación cardiopulmonar y puede mejorar los resultados a largo plazo al reducir las tasas de lesión miocárdica perioperatoria, accidente cerebrovascular (ACV), deterioro neurocognitivo y mortalidad de causa cardiaca. En la actualidad, se han llevado a cabo diversos ensayos clínicos desde la popularización del OPCAB en la década de los 90. Sin embargo, hasta el momento no se ha demostrado ningún beneficio del OPCAB en comparación con la cirugía tradicional a pesar de las reducciones favorables a corto plazo en los requerimientos de transfusión y otras complicaciones postoperatorias. Además, OPCAB se asocia con una revascularización miocárdica menos eficaz y no previene por completo las complicaciones tradicionalmente asociadas con la circulación extracorpórea (CEC). Este artículo revisa la evidencia actual de OPCAB en comparación con CABG tradicional en cuanto a los resultados clínicos a corto y largo plazo. Se analizan los resultados de la cirugía coronaria sin circulación extracorpórea (CEC) , comparándola con la cirugía convencional (con CEC). La revascularización coronaria sin CEC presenta resultados similares a la convencional, siempre que se cumplan determinadas condiciones en la selección de los pacientes. Una de ellas, muy importante, es la mayor experiencia del cirujano con el procedimiento.

The results of coronary artery revascularization performed without extracorporeal circulation (off pump) are compared to those of the traditional ("on pump") procedure. Compliance with selective conditions are required to obtain similar results. The most important being the experience of the surgeon performing the off pump procedure.

Resisting Arrest: Perioperative Confirmation and Management of an Iatrogenic Aortocoronary Arteriovenous Fistula after Coronary Artery Bypass Grafting for Redo Cardiac Surgery

Although rare, iatrogenic aortocoronary arteriovenous fistulae (ACAVF) occur when a coronary graft is mistakenly anastomosed to an epicardial vein rather than its intended arterial target. Patients may be asymptomatic, demonstrate angina, dyspnea, arrhythmias, syncope, or diminished exercise capacity, and may have wide pulse pressures with evidence of coronary steal. A thorough insight into the disordered anatomy is critical to safely manage a patient for redo cardiac surgery, especially when attempting to arrest the heart. We present a case for redo cardiac surgery of an iatrogenic ACAVF confirmed perioperatively with multiple modalities and its intraoperative management.

Improvement and development direction of bariatric metabolic surgery / 中华消化外科杂志

In more than half a century of the development of bariatric metabolic surgery, a variety of classic surgical methods have been formulated. However, the improvement and innovation of bariatric metabolic surgery has never stopped. The replacement of new and old surgical methods in clinical application and development reflects the vitality and progress in the field of bariatric metabolic surgery, and also promotes the development of bariatric metabolic surgery to the best balance between benefits and risks. In the early stages, studies in metabolic surgery are more inclined to confirm the efficacy, safety and mechanism of classical procedures. In recent years, metabolic surgeons around the world have become more inclined to focus on the exploration and innovation of new procedures. In addition, the improvement of biliopancreatic diversion with duodenal switch and the sleeve gastrectomy plus procedures have gradually become hot spots for surgical innovation. However, the new techniques are diverse, scattered and partially overlapping. The authors make a comment on this content, in order to provide assistance to clinical and scientific research.

Effects of the continuous nursing education on anxiety level of caregivers of patients with all-robot coronary artery bypass surgery / 四川精神卫生

BackgroundMost of the researches on continuous nursing education is from the perspective of patients， and there is a lack of studies on the impact of continuous nursing education on patient caregivers， and the care quality of caregivers is closely related to postoperative rehabilitation status of the patients. ObjectiveTo investigate the effect of continuous nursing education on anxiety relief of caregivers of patients with all-robot coronary artery bypass surgery， and to provide references for improving caregivers' anxiety and promoting patients' recovery. MethodsA total of 120 caregivers of patients with all-robot coronary artery bypass surgery at the First and Sixth Center of 301 Chinese PLA General Hospital were included from January 1， 2021 to December 31， 2022. The caregivers were randomly divided into study group and control group with 60 cases in each group by systematic random sampling method. Before the patient discharge from the hospital， all caregivers received routine nursing education. The study group received continuous nursing education for 4 weeks after patient discharged. Self-rating Anxiety Scale （SAS） was used to evaluate the two groups before and one month after discharge. ResultsOne month after discharge， SAS score in the study group was significantly lower than that in the control group ［（57.77±14.08） vs. （70.19±13.60）， t=-4.913， P<0.01］， and the proportion of SAS score above 60 in the study group was significantly lower than that in the control group （41.67% vs. 75.00%， χ2=-13.714， P<0.01）. ConclusionContinuous nursing education may help reduce the level of anxiety in caregivers of patients with all-robot coronary artery bypass surgery.

Superexpressão Gênica PTEN em Tecidos Miocárdicos de Pacientes de Cirurgia de Revascularização Miocárdica / Overexpression of the PTEN Gene in Myocardial Tissues of Coronary Bypass Surgery Patients

Resumo Fundamento: A doença arterial coronariana é um distúrbio complexo que causa morte em todo o mundo. Um dos genes envolvidos no desenvolvimento dessa doença pode ser o PTEN. Objetivos: Nosso objetivo foi investigar a expressão gênica e proteica do PTEN em amostras de tecido e sangue retiradas de pacientes submetidos à cirurgia de revascularização miocárdica. Métodos: Foram realizados estudos moleculares no Centro de estudos do genoma humano e células-tronco da Universidade Erciyes (GENKOK). Amostras do apêndice atrial direito e de sangue foram coletadas da veia central de 22 pacientes submetidos à cirurgia de revascularização miocárdica antes de iniciar e terminar a circulação extracorpórea. A expressão do PTEN foi determinada usando PCR quantitativo em tempo real e análise de Western Blot. O nível de significância aceito foi de p<0,05. Resultados: Não houve diferença significativa na expressão gênica do PTEN em amostras de sangue coletadas antes e depois da circulação extracorpórea. Entretanto, foi observado um aumento substancial nos níveis de expressão gênica e proteica de P-PTEN e PTEN nas amostras de tecido. A expressão gênica miocárdica PTEN aumentou significativamente ao final da circulação extracorpórea. A expressão gênica do PTEN no período pós-circulação extracorpórea aumentou em comparação com o período pré-circulação extracorpórea, mas não foi um aumento significativo em comparação com sujeitos saudáveis do grupo de controle. Conclusão: Este estudo revelou pela primeira vez o papel do gene PTEN analisando a expressão de mRNA e de proteína em pacientes com revascularização miocárdica, que se manifesta tanto em tecido miocárdico quanto em amostras de sangue. O aumento dos níveis de PTEN pode ser um marcador no tecido miocárdico para pacientes com doença arterial coronariana.

Abstract Background: Coronary artery disease is a complex disorder that causes death worldwide. One of the genes involved in developing this disease may be PTEN. Objectives: This study aimed to investigate the PTEN gene and protein expression in tissue and blood samples taken from coronary bypass surgery patients. Methods: Molecular studies were performed at Erciyes University Genome and Stem Cell Center (GENKOK). Right atrial appendage and blood samples were taken from the central vein of 22 coronary bypass surgery patients before starting and ending cardiopulmonary bypass. PTEN expression was determined using quantitative real-time PCR and western blot analysis. The significance level was accepted as p<0.05. Results: There was no significant difference in the PTEN gene expression in blood samples taken before and after cardiopulmonary bypass. However, a substantial increase in both protein and gene expression levels of P-PTEN and PTEN was observed in the tissue samples. Myocardial expression of the PTEN gene was significantly increased at the end of the cardiopulmonary bypass. PTEN gene expression in the post-cardiopulmonary bypass period was increased when compared to the pre-bypass period, but it was insignificant when compared to healthy controls. Conclusion: This study first revealed the role of the PTEN gene by analyzing both mRNA and protein expression in coronary bypass patients, appearing in both myocardial tissue and blood samples. Increased levels of PTEN may be a marker in myocardial tissue for patients with coronary artery disease.

Use of Intraoperative Coronary Angiography to Guide Surgical Intervention in Coronary Artery Bypass Graft Surgery

Following coronary artery bypass graft surgery, graft patency is a major factor contributing to patient morbidity and mortality. There are several modalities available for assessing graft patency intra?op used by both the anesthesiologist and surgeon. However, these modalities have their own advantages and disadvantages which will be summarized in this case report. As illustrated by this case, angiography continues to be the gold standard for coronary anatomy assessment and can be performed easily using a portable digital fluoroscopic system.

Perioperative Management of Myasthenia Gravis Patient for off Pump Coronary Artery Bypass Surgery and Thymectomy

Myasthenia gravis (MG) is an autoimmune disorder characterized by antibody?mediated immunologic reaction striking the acetylcholine receptors. The anesthesia concerns for patients with MG include the disease state, drug interactions, and the anesthetic medications particularly the neuromuscular blocking agents (NMBAs). The anesthesia management in these patients is meticulous and requires appropriate execution of knowledge. Besides, such patient for off?pump coronary artery bypass surgery is quite uncommon; hence, we report this case.

Comparison Between Treatment Strategies of Carotid Stenosis in Patients Undergoing Coronary Artery Bypass Grafting

ABSTRACT Introduction: In patients undergoing coronary artery bypass grafting (CABG), stroke is a major complication that increases morbidity and mortality. The presence of carotid stenosis (CS) increases risk of stroke, and the optimal treatment remains uncertain due to the lack of randomized clinical trials. The aim of this study is to compare three management approaches to CS in patients submitted to CABG. Methods: From 2005 to 2015, 79 consecutive patients with significant CS submitted to CABG were retrospectively evaluated. Patients were divided in three groups, according to CS treatment: 17 underwent staged carotid endarterectomy (CEA)-CABG, 26 underwent synchronous CEA-CABG, and 36 underwent isolated CABG without carotid intervention. The primary outcomes were composed by 30-day postoperative acute myocardial infarction (MI), 30-day postoperative stroke, and death due to all causes during the follow-up. Results: Patients were evaluated during an average 2.05 years (95% confidence interval = 1.51-2.60) of follow-up. Major adverse cardiac events, including death, postoperative MI, and postoperative stroke, occurred in 76.5% of the staged group, 34.6% of the synchronous group, and 33.3% of the isolated CABG group (P=0.007). As for MI, the rates were 29.4%, 3.85%, and 11.1% (P=0.045), respectively. There was no statistically significant difference in total mortality rates (35.3%, 30.8%, and 25.0%, respectively; P=0,72) and stroke (29.4%, 7.7%, and 8.3%, respectively; P=0,064) between groups. Conclusion: Staged CEA-CABG is associated with higher major adverse cardiac events and MI rate when compared to the strategy of synchronous and isolated CABG, but without statistically difference in total mortality during the entire follow-up.

Exposed bone cement technique and pectoralis major advancement muscle flap in treatment of chronic sternal osteomyelitis after coronary artery bypass surgery / 中华显微外科杂志

Objective:To analyse the effect of the exposed bone cement technique combined with pectoralis major muscle flap in the treatment of chronic sternal osteomyelitis after coronary artery bypass surgery(CABS), and to summarise the clinical experience of staged surgery and comprehensive treatment.Methods:A retrospective analysis were carried out on 5 patients who had chronic sternal osteomyelitis and treated with exposed bone cement after the CABS from October 2017 to October 2020. Five patients(4 males and 1 female) met the inclusion criteria with a mean age of 65(range from 54 to 72) years old. Duration of all the chronic sternal osteomyelitis was 3 weeks to 3 months at admission. During the perioperative period, the general condition of the patients was controlled and systemic nutritional support was given. At the first stage, all patients underwent complete debridement. Then all the wounds were treated with exposed bone cement and covered by vacuum sealing drainage(VSD) to control the infection. At the second stage, bone cement was removed, and the dead cavity was packed with pectoralis major advancement muscle flap. Close attention was paid to the tension of wound, the patency of drainage catheter and the drainage after surgery. The wound healing, scar hyperplasia and complications were observed during the follow-up.Results:The suture tension was moderate, the drainage catheter was unobstructed, and a little liquid was drawn without turbid. All patients were clinically cured and entered follow-up for 6 to 15 months. During the follow-up, there was neigher recurrence of osteomyelitis nor sinus tract formation. No significant complication occurred at the last follow-up. The quality of life of the patients was significantly improved and all the patients were satisfactory to the treatment.Conclusion:Exposed bone cement technique combined with pectoralis major muscle flap is an effective method in the treatment of chronic sternal osteomyelitis after CABS. It has a good short-term treatment efficacy and is worthy for further clinical trials.

Effect of del nido cardioplegia use on kidney injury after coronary bypass operations

SUMMARY OBJECTIVE: After cardiac surgery, acute kidney injury is observed at a rate of 5-30%, and the second most common cause of acute kidney injury in intensive care units is cardiac surgery. In this study, we aimed to investigate the effect of del Nido cardioplegia solution use on postoperative acute kidney injury development in patients who underwent coronary artery bypass grafting operation with cardiopulmonary bypass. METHODS: Consecutive patients who underwent an elective coronary artery bypass grafting operation with cardiopulmonary bypass in our clinic between March 15, 2019, and March 15, 2020, were included in the study retrospectively. The patients were divided into two groups as those who received del Nido cardioplegia solution (Group 1) and blood cardioplegia (Group 2), and factors affecting the development of renal failure were examined. RESULTS: A total of 350 consecutive patients were included in the study. There were 156 patients in the del Nido cardioplegia group and 194 patients in the blood cardioplegia group. Among the patient group, 74 (21.1%) patients developed acute kidney injury. The total acute kidney injury development rate was significantly higher in Group 2 (p=0.018). In multivariate logistic regression analysis, advanced age (OR 1.128; 95%CI 1.044-1.217; p=0.042), increased blood product use (OR 1.318; 95%CI 1.154-1.998; p=0.019), preoperative creatinine elevation (OR 2.434; 95%CI 1.655-4.639; p=0.005), and increased cardioplegia volume (OR 1.254; 95%CI 1.109-2.980; p=0.009) were independent predictors of acute kidney injury. CONCLUSION: With this study, we showed that the use of del Nido cardioplegia solution can reduce the incidence of acute kidney injury.

Clinical efficacy of gastrojejunal bypass surgery combined with radical gastrectomy following conversion therapy for gastric cancer with outlet obstruction / 中华消化外科杂志

Objective:To investigate the clinical efficacy of gastrojejunal bypass surgery combined with radical gastrectomy following conversion therapy for gastric cancer with outlet obstruction.Methods:The retrospective and descriptive study was conducted. The clinicopatho-logical data of 10 initially unresectable gastric cancer patients with outlet obstruction who were admitted to Ruijin Hospital of Shanghai Jiao Tong University School of Medicine from October 2019 to July 2020 were collected. There were 8 males and 2 females, aged from 41 to 59 years, with a median age of 53 years. Patients underwent 'sandwich therapy' of gastrojejunal bypass surgery combined with gastrectomy following conversion therapy. Observation indicators: (1) gastrojejunal bypass surgery and postoperative situations; (2) conversion therapy and complications; (3) radical gastrectomy and postoperative situations; (4) follow-up. Follow-up using outpatient examinations or telephone interview was conducted to detect postoperative complications, progress-free survival, tumor recurrence and metastasis up to March 2019. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Gastrojejunal bypass surgery and postoperative situations: 10 patients received modified gastrojejunal bypass surgery combined with No.4sb lymph node dissection, without intraoperative serious complications, conversion to laparotomy or death. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to liquid diet intake were 73 minutes(range, 60-87 minutes), 33 mL(range,20-110 mL), 3 days(range, 2-6 days), 4 days(range, 4-9 days). One patient had post-operative Clavien-Dindo grade Ⅱ complication of anastomotic bleeding, and was improved after transfusion of blood products. (2) Conversion therapy and complications: of 10 patients, 9 cases received 4 cycles of FLOT regimen. One of the 9 cases was suspended chemotherapy due to Clavien-Dindo grade Ⅱ anastomotic edema after 2 cycles of FLOT regimen. Of 10 patients, there were 6 cases with partial response and 4 cases with stable disease. Of 6 patients with partial response, 4 cases with preoperative cT4b stage were down stage to T4a stage, showing the relationship of tumor with transverse mesentery and pancreatic capsule clearer than the first exploration, 2 cases with preoperative lymph nodes fusion had shrank obviously. Of 4 patients with stable disease, 3 cases were negative for lymph nodes shranking, and the rest 1 case with tumor peritoneal metastasis diagnosed by initial laparoscopy can not be evaluated by imaging examination after chemotherapy. Two of 10 patients had Clavien-Dindo grade I complication of elevated blood glucose during the chemotherapy, which were improved after insulin therapy. (3) Radical gastrectomy and post-operative situations: 10 patients underwent radical resection after conversion therapy. Of 4 cases with stable disease, 3 cases with preoperative lymph nodes fusion showed obvious space between lymph nodes and surrounding tissues at resurgical exploration and received radical resection, 1 case with peritoneal metastasis showed abdominal wall nodelus and omental tuberosity as fibrous scars at resurgical exploration and received radical resection. The operation time, volume of intra-operative blood loss, time to postoperative first flatus, time to initial liquid diet intake, duration of total hospital stay, duration of postoperative hospital stay of 10 patients were 148 minutes(range, 95-195 minutes), 108 mL(range, 100-180 mL), 3 days(range, 2-7 days), 4 days(range, 3-9 days), 11 days(range, 10-21 days), 8 days(range, 7-16 days). Two of 10 patients had perioperative complications. Results of pathological examination of 10 patients showed the number of dissected lymph nodes as 25±6. There were 1 case of stage T1, 5 cases of stage T3, 4 cases of stage T4a. There were 1 case of stage N0, 2 cases of stage N1, 3 cases of stage N2, 4 cases of stage N3. There were 3 cases of tumor regression grade 1a, 1 case of grade 1b, 4 cases of grade 2, 2 cases of grade 3. (4) Follow-up: 10 patients were followed up for 3.9-13.0 months, with a median follow-up time of 6.0 months. The median progression-free survival time of 10 patients was 6.0 months. During the follow-up, 1 case underwent postoperative Clavien-Dindo grade Ⅱ complication of delayed gastric emptying and was improved after symptomatic treatment.Conclusion:The gastrojejunal bypass surgery combined with gastrectomy following conversion therapy for gastric cancer with outlet obstruction is safe and effective.

Effectiveness of in vitro fenestration versus bypass surgery for type B aortic dissection involving the left subclavian artery / 中国胸心血管外科临床杂志

@#Objective    To analyze the effectiveness of in vitro fenestration versus bypass surgery techniques in the treatment of type B aortic dissection involving the left subclavian artery by thoracic endovascular aortic repair (TEVAR). Methods    Among the 53 patients with type B aortic dissection involving the left subclavian artery admitted to our center from January 2017 to October 2020, 23 underwent in vitro fenestration + TEVAR (a fenestration group with 18 males and 5 females aged 53.6±5.3 years), and 30 patients underwent left common carotid artery-left subclavian artery bypass + TEVAR (a bypass group with 24 males and 6 females aged 51.8±3.8 years). The effectiveness and safety between the two groups were compared. Results    The surgical success rate was 100.0% in both groups. And there was no death within postoperative 30 days and during the follow-up. There was no endoleak immediately postoperatively and during 1-year follow-up in the two groups. The operation time and hospitalization expenses in the fenestration group was less or shorter than those in the bypass group (P<0.05). The reduction in blood pressure of the left upper limb in the fenestration group was greater than that in the bypass group (P<0.05). There was no symptom of left upper limb ischemia, dizziness or hoarseness in both groups. Conclusion    The two methods of reconstruction of the left subclavian artery are safe and effective. In vitro fenestration can reduce surgical trauma and costs, and bypass surgery can provide better forward blood flow for the left subclavian artery.

Current perspectives and future directions of the treatment for non acute intracranial artery occlusion / 中国综合临床

Non-acute intracranial artery total occlusion can lead to severe neurological defect and high recurrence rate of stroke.At present, there is no effective treatment recommended by the guidelines.Traditional treatment methods include medical therapy, extracranial-intracranial bypass surgery and minimally invasive endovascular recanalization therapy.In recent years, with the development of microsurgical vascular anastomosis technique and neurosurgical intervention, and the development of interventional materials, the treatment of non-acute intracranial artery total occlusion has become a hot spots.In this paper, the concept of non on-acute intracranial artery total occlusion, medical therapy, extracranial-intracranial bypass surgery and endovascular interventional therapy are reviewed.

Supervivencia de la cirugía coronaria de múltiples vasos en el seguimiento hasta 20 años / Long-term survival of multi-vessel coronary surgery bypass grafting up to 20 years of follow-up

RESUMEN Introducción: Los resultados del seguimiento a largo plazo constituyen uno de los mejores parámetros para evaluar la calidad de una intervención médica. Objetivos: Analizar la supervivencia global y la supervivencia libre de eventos cardiovasculares a 20 años de la cirugía coronaria en un hospital de comunidad con historia clínica electrónica de larga data. Métodos: Se estudiaron en forma retrospectiva los resultados alejados de las cirugías coronarias aisladas efectuadas en pacientes con enfermedad de múltiples vasos o tronco de coronaria izquierda entre 1999 y 2003 en un hospital de comunidad. El seguimiento hasta 20 años se realizó a través de la historia clínica electrónica. Resultados: Se logró un tiempo de seguimiento medio de 125 meses (rango: 6-268) en 254 pacientes de los 272 operados en ese período (93,4%). El número promedio de puentes fue 3,3 (desvío estándar: 0,97); en 97,6% se usó al menos una arteria mamaria y 59,4% recibieron un puente con arteria radial. Se obtuvo un seguimiento de 2646 pacientes-años, con un riesgo anual de muerte por toda causa de 2,5%. La supervivencia global al seguimiento medio fue de 0,806 (error estándar, EE: 0,03), y la supervivencia libre de eventos cardiovasculares fue de 0,826 (EE: 0,03). Conclusiones: El registro electrónico completo de los afiliados a un hospital de comunidad operados hace más de 15 años permitió analizar la supervivencia global y libre de eventos a largo plazo. Estos resultados servirán como estándar al momento de elegir entre la cirugía y la angioplastia de múltiples vasos.

ABSTRACT Background: The outcomes of long-term follow-up constitute one of the best parameters to assess the quality of a medical intervention. Objectives: To analyze the overall and the free-of-cardiovascular events 20-year survival after coronary surgery in a community hospital with a long-standing electronic medical records. Methods: The results of coronary surgeries in patients with multi-vessel or trunk disease operated between 1999 and 2003 in a community hospital were retrospectively studied. The follow-up up to 20 years was carried out through the electronic medical record. Results: Of 272 patients operated, a mean follow-up of 125 months (range 6-268) was achieved in 254 (93.4%). The average number of bypasses was 3.3 (standard deviation 0.97); in 97.6%, at least one internal mammary artery was used and 59.4% received a radial artery graft. A follow-up of 2646 patient-years was obtained with an annual risk of death from all causes of 2.5%. The overall survival at the mean follow-up time was 0.806 (standard error (SE) 0.03), and the cardiovascular event-free survival 0.826 (SE 0.03). Conclusions: The complete electronic registration of affiliates to a community hospital operated more than 15 years ago allowed us to analyze the overall survival and the freedom of long-term events. These results will serve as a standard when choosing between surgery and multi-vessel angioplasty.

Numerical study on the mechanical coupling of external vascular stent and vein graft in coronary artery bypass surgery / 生物医学工程学杂志

External support stent is a potential means for restricting the deformation and reducing wall stress of the vein graft, thereby improving the long-term patency of the graft in coronary artery bypass surgery. However, there still lacks a theoretical reference for choosing the size of stent based on the diameter of graft. Taking the VEST (venous external support) stent currently used in the clinical practice as the object of study, we constructed three models of VEST stents with different diameters and coupled them respectively to a model of the great saphenous vein graft, and numerically simulated the expansion-contraction process of the vein graft under the constraint of the stents to quantitatively evaluate the influence of stent size on the radial deformation and wall stress of the vein graft. The results showed that while the stent with a small diameter had a high restrictive effect in comparison with larger stents, it led to more severe concentration of wall stress and sharper changes in radial deformation along the axis of the graft, which may have adverse influence on the graft. In order to solve the aforementioned problems, we ameliorated the design of the stent by means of changing the cross-sectional shape of the thick and thin alloy wires from circle into rectangle and square, respectively, while keeping the cross-sectional areas of alloy wires and stent topology unchanged. Further numerical simulations demonstrated that the ameliorated stent evidently reduced the degrees of wall stress concentration and abrupt changes in radial deformation, which may help improve the biomechanical environment of the graft while maintaining the restrictive role of the stent.

Adrenal insufficiency after cardiovascular surgery with cardiopulmonary bypass / 中国胸心血管外科临床杂志

@#Relative/absolute adrenal insufficiency is not uncommmon in the patients undergoing cardiovascular surgery with cardiopulmonary bypass. However, this complication was rarely reported due to its unspecific clinical presentations and the unawareness of ICU physicians and cardiac surgeons. However, this puts them on a higher risk of hemodynamic instability and cardiovascular adverse events during hospitalization. Systematic reviews concentrated on it are rarely reported currently. We aim to review the etiology, risk factors, potential pathogenesis and related research progress for this complication.

Chronic sternal wound fistula after coronary artery bypass surgery: A case series

Chronic extensive infection of the sternal wound may be a serious problem in patients undergoing sternotomy, especially those who have been operated for coronary artery bypass grafts. We report and evaluate the outcomes of five cases involved in chronic sternal osteomyelitis who were treated with two different strategies as follows: (1) debridement and secondary healing (conventional treatment), and (2) debridement and omental flap transfer for primary wound closure. All of the patients had acceptable results after treatment, but those who were managed by omental flap and primary wound closure had better cosmetic results and a shorter hospital stay.

The predictive effects of clinical hematological changes on saphenous graft patency after coronary artery surgery

Abstract Objectives: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. Methods: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. Results: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). Conclusion: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.

An easy and reliable way to prevent electrocardiographic deteriorations of patients undergoing off-pump coronary artery bypass surgery: preoperative anxiolytic treatment

Abstract Objective: To investigate the effects of preoperative anxiety relieving on electrophysiological changes in patients undergoing off-pump coronary artery bypass surgery. Methods: A total of 61 patients at ASA III risk group in the age range of 18-65 years were enrolled in the present study. Patients were randomly divided into two groups. Group S (Sedation group) was administered 0.04 mg/kg lorazepam per os (PO) twice before the operation. Group C (control group) was not administered with any anxiolytic premedication. State Trait Anxiety Inventory (STAI-I) and Beck Anxiety Inventory (BAI) were used to evaluate the level of anxiety. Electrocardiography (ECG), pulse oximeter and standard monitoring were performed for each patient. QT and P dispersions in each derivation of all ECGs were calculated. Results: Preoperative STAI-I scores were significantly lower in sedation group compared to the controls. Mean values of QT dispersion measured before induction, at the 1st minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.024; P=0.027; P=0.001; P=0.033, respectively). The mean values of P dispersion measured before induction, at the 3rd minute of induction, 30th second of intubation and 4th minute of intubation in sedation group were significantly reduced compared to controls (P=0.001; P=0.020; P=0.023; P=0.005, respectively). Conclusion: Elevated anxiety levels in patients undergoing coronary bypass surgery have a negative effect through prolonged QT and P-wave dispersion times. Anxiolytic treatment before surgery may be useful to prevent ventricular and atrial arrhythmias and associated complications through decreasing the QT and P-wave dispersion duration.