Early outcomes of isolated coronary artery bypass grafting in Chinese aged patients with diabetes mellitus

To compare the early outcomes of coronary artery bypass grafting [CABG] in aged diabetic patients, and evaluate the affection of diabetes on the early outcomes of CABG in aged patients. The study took place in the Department of Cardiovascular Surgery, Shanghai Jiao Tong University Affiliated First People's Hospital, Shanghai, China, between January 2000 and July 2008. Five hundred and ninety-three elderly patients [age >/= 70-years-old], undergoing isolated CABG were retrospectively divided into diabetic group and non-diabetic group. We analyzed the pre-operative, intra-operative, and post-operative variables of the 2 groups. The t-test, Chi-square test, and multivariate logistic regression were used to determine the differences between the 2 groups of patients. There was no statistical difference of pre-operative and intraoperative variables between the 2 groups, except that there were more left main coronary artery diseases in the diabetic group. Values in the post-operative period such as morbidity, complications, and blood infusion had no differences between the 2 groups. Diabetes mellitus and age are not the risk factors for in-hospital mortality. Coronary artery bypass grafting in elderly patients is plausible. Furthermore, diabetic patients could get the same surgical results as those non-diabetic patients

Effect of Astragalus on cytokines in patients undergoing heart valve replacement / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the effect of astragalus (As) on cytokines in patients undergoing heart valve replacement (HVR).</p><p><b>METHODS</b>Thirty patients undergoing HVR were randomized into the As group and the control group. Cardiopulmonary bypass (CPB) was set up routinely and to the As group, As injection (40 mL, 10 mL containing 2 g of crude drug) was added into the prime solution just before CPB. Blood samples were collected at different time points during and after CPB for cytokines determination, including tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), IL-8 and IL-10 by ELISA.</p><p><b>RESULTS</b>All the indexes measured were insignificantly different between groups before skin incision, they began to increase by the end of CPB (P < 0.05), reached the peak 3 h after CPB and then decreased gradually, TNF-alpha returned to the baseline level 24 h after operation. Meanwhile, levels of IL-6, IL-8 and IL-10 decreased obviously but still above the baseline. Comparisons between groups at different time points showed that levels of IL-6 were not different significantly (P > 0.05), those of IL-10 were higher at all time points, and TNF-alpha and IL-8 at 3 h, 6 h and 12 h after CPB were significantly lower in the As group (all P < 0.05).</p><p><b>CONCLUSION</b>Astragalus may decrease the inflammation cytokine promoting factors, and increase the level of anti-inflammatory cytokine (IL-10), so it could attenuate the inflammation reaction in patients after HVR.</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>

Off-pump coronary artery bypass grafting in patients over the age of seventy / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the choice of surgical methods and the safety and efficacy of off-pump coronary artery bypass grafting (OPCAB) in elderly patients.</p><p><b>METHODS</b>From Sept. 1997 to Feb. 2003, 63 cases over the age of seventy (including seventy) undertook OPCAB in our department. We compared the clinical data of those patients with that of 94 cases undertook conventional coronary artery bypass grafting (CABG) at the same age group and that of 58 cases younger than seventy received OPCAB.</p><p><b>RESULTS</b>The clinical outcomes of OPCAB is better than that of CABG in elderly patients concerning inotropic drug, postoperative transfusion, re-operation, intubation time, complications incidence and in-hospital mortality. Furthermore, there is no significant difference of complication incidence and in-hospital mortality between the elderly OPCAB group and the younger OPCAB group.</p><p><b>CONCLUSIONS</b>OPCAB is a safe and efficacious method of myocardial revascularization in the elderly.</p>

Significance of changes in transforming growth factor-beta mRNA levels in autogenous vein grafts / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>This study was designed to investigate changes in mRNA levels of transforming growth factor-beta (TGF-beta), collagen I, and collagen III in autogenous vein grafts.</p><p><b>METHODS</b>Twenty-four New Zealand rabbits were randomly divided into 4 groups with 6 rabbits each. The external jugular veins of the New Zealand rabbits were harvested and grafted into the ipsilateral carotid artery. All rabbits were fed with a standard diet. After the operation, the rabbits were sacrificed at 1, 2, 3, or 4 weeks. TGF-beta, collagen I, and collagen III mRNA levels in the venous grafts were measured by semiquantitative methods at every time point. The contralateral external jugular veins were also harvested and analyzed as controls. Glyceraldehyde-3-phosphate dehydrogenase was used as an internal standard to normalize all samples for potential variations in mRNA content. In order to observe the expression of TGF-beta protein, immunohistochemical SABC methods were used.</p><p><b>RESULTS</b>One week postoperation, the mRNA level of TGF-beta was upregulated to 1.73 +/- 0.19 in the vein graft and 1.21 +/- 0.16 in the control vein (P < 0.01). High mRNA levels were maintained until week 4 postoperation. The mRNA levels of collagen I and collagen III were also significantly increased to 2.18 +/- 0.21 versus 1.12 +/- 0.24 and 1.08 +/- 0.13 versus 0.83 +/- 0.12, respectively (P < 0.05). Immunohistochemical staining revealed a higher density of TGF-beta expression in the vein grafts.</p><p><b>CONCLUSIONS</b>An uninterrupted increase in mRNA levels of TGF-beta, collagen I, and collagen III is observed in autogenous vein grafts. This increase may be the major cause of intimal hyperplasia, sclerosis, and even graft failure.</p>