Off-pump coronary artery bypass grafting with only bilateral internal mammary artery composite Lima-Rima Y graft / 中华外科杂志

<p><b>OBJECTIVE</b>To improve the early and late benefits (the patency and total myocardium revascularization) of coronary artery bypass grafting, stimulate us using only bilateral internal mammary artery (BIMA) composite Lima (left internal mammary artery)-Rima (right internal mammary artery) Y graft with off-pump, here is the early evaluation.</p><p><b>METHODS</b>From October 2002 to December 2005, 125 patients underwent off-pump coronary artery bypass grafting with the only composite grafts. The bilateral semi-skeletonization internal mammary artery pedicles composed the Y graft, the free Rima was anastomosed to the in situ Lima. The operation was performed off-pump and sequential anastomosis.</p><p><b>RESULTS</b>Four hundred and thirteen grafts for 125 patients, average number of grafts per patient was 3.3. Graft flow was measured with Transit time flowmeter during operation time. All grafts were patent during operation. There was no death perioperative period.</p><p><b>CONCLUSION</b>Off-pump coronary artery bypass grafting with only bilateral internal mammary artery composite Lima-Rima Y graft is secure and feasible. The technique could achieve total arterial myocardium revascularization and avoiding any procedure on the ascending aorta.</p>

Repair of left ventricular aneurysm during off-pump coronary artery bypass surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute myocardial infarction can result in left ventricular aneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia and thromboembolic events. This study evaluates results achieved with a modified linear closure of left ventricular aneurysms during off-pump coronary artery bypass surgery.</p><p><b>METHODS</b>From January 2001 to May 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysm during off-pump coronary artery bypass surgery. Repair was completed on the beating heart to minimize ischaemia and allow assessment of wall function and viability to guide closure. All patients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia. The majority (75%) of the patients were in NYHA functional class III or IV. Preoperative ejection fraction was 26% +/- 9%. The mean left ventricular, end diastolic diameter was (57.5 +/- 7.1) mm. The ventricular preoperative and postoperative performances were compared. chi2 test and Student's t test were used to analyse the outcomes. A P value less than 0.05 was considered significant.</p><p><b>RESULTS</b>Hospital mortality was 1.3% (1/75). Coronary artery bypass was performed with an average of (3.3 +/- 1.2) grafts per patient. At the time of followup, all the patients had no symptoms. The mean NYHA class and ejection fraction increased significantly (P < 0.001). The mean left ventricular, end diastolic diameter decreased significantly (P < 0.001).</p><p><b>CONCLUSIONS</b>Surgical closure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. The operation is associated with a low inhospital mortality and morbidity. A postoperative improvement in the early term cardiac functions and symptoms and quality of life was documented, increasing our expectations of an increased long-term survival.</p>