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Coronary Artery Bypass Grafting (CABG) Surgery is considered the standard treatment for revascularization in Coronary Artery Disease. The Off-Pump Coronary Artery Bypass Graft (OPCAB) which evades the use of Cardiopulmonary Bypass (CPB) became a popular CABG procedure, due to the adverse effect of CPB. Hypothetically, OPCAB may improve the rates of perioperative Myocardial Injury, Neurocognitive Impairment, Stroke and Mortality. However, some studies showed no superior outcomes for OPCAB compared to on-pump CABG. This study aims to evaluate the short-term and long-term outcomes of OPCAB versus On-Pump CABG. The results showed that OPCAB is probably a safe procedure for patients, especially for those with high-risk conditions. OPCAB procedure showed superior short-term outcomes in terms of Myocardial Infarction, Systemic Inflammatory Response, Postoperative Cognitive Dysfunction, Renal Failure, Stroke, Pulmonary Complication, Postoperative Transfusion, Hospital stay length and infection than On-pump CABG. However, regarding long-term outcomes, Off-Pump CABG had a higher rate of incomplete revascularization and repeat revascularization and a higher risk of long-term mortality as well as lower graft patency. Furthermore, the result showed that the higher experience of the surgeons in OPCAB improves the outcome of the Surgery.
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@#Objective To study the relationship between preoperative heart rate variability (HRV) and postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB). Methods A retrospective analysis was performed on the clinical data of 290 patients who were admitted to the Department of Cardiovascular Surgery, General Hospital of Northern Theater Command from May to September 2020 and received OPCAB. There were 217 males and 73 females aged 36-80 years. According to the incidence of POAF, the patients were divided into two groups: a non-atrial fibrillation group (208 patients) and an atrial fibrillation group (82 patients). The time domain and frequency domain factors of mean HRV 7 days before operation were calculated: standard deviation of all normal-to-normal intervals (SDNN), root mean square of successive differences, percentage difference between adjacent normal-to-normal intervals that were greater than 50 ms, low frequency power (LF), high frequency power (HF), LF/HF. Results The HRV value of patients without POAF was significantly lower than that of patients with POAF (P<0.05). The median SDNN of the two groups were 78.90 ms and 91.55 ms, respectively. Age (OR=3.630, 95%CI 2.015-6.542, P<0.001), left atrial diameter (OR=1.074, 95%CI 1.000-1.155, P=0.046), and SDNN (OR=1.017, 95%CI 1.002-1.032, P=0.024) were independently associated with the risk of POPAF after OPCAB. Conclusion SDNN may be an independent predictor of POAF after OPCAB.
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A 70-year-old woman diagnosed with angina pectoris was scheduled to undergo off-pump coronary artery bypass grafting (OPCAB) using the left internal thoracic artery and the saphenous vein (SVG). We performed a proximal anastomosis of the SVG to the ascending aorta using a clampless proximal anastomotic device. When this device was removed from the ascending aorta after completion of the SVG proximal anastomosis, we noticed the extensive appearance of an ascending aortic adventitial hematoma. Transesophageal echocardiography revealed a flap in the ascending aorta, which was diagnosed as an iatrogenic aortic dissection. The decision was made to immediately perform an additional aortic replacement. There was an intimal tear consistent with the device insertion site, which was identified as the site for the development of aortic dissection. After performing an ascending aortic replacement, coronary artery bypass grafting was performed. Her postoperative course was uneventful, and enhanced CT on postoperative day 12 showed aortic dissection up to the level of the abdominal aorta, but the false lumen was completely thrombosed. Iatrogenic aortic dissection caused by proximal anastomotic device during OPCAB is a very rare but serious complication, and early intraoperative diagnosis and prompt additional surgical treatment were considered necessary to save the patient's life.
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Man in his 70s, who had suffered from idiopathic thrombocytopenic purpura (ITP), was admitted to our hospital with chest pain at rest. Coronary angiography revealed obstruction of the right coronary artery and triple vessel disease. Because a bleeding tendency was expected during coronary artery bypass grafting, we performed percutaneous coronary intervention to the culprit lesion first, and then intravenous immunoglobulin and high dose dexamethasone were tried. His platelet count rose from 49,000 to 103,000/mm3, so we performed coronary artery bypass grafting. The patient had no postoperative hemorrhagic complications. We believe that high dose dexamethasone therapy is useful for patients with ITP who need surgery immediately.
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Objective:To investigate the difference of adverse events in patients with chronic obstructive pulmonary disease (COPD) who underwent on-pump coronary artery bypass grafting (ONCABG) and off-pump coronary artery bypass grafting (OPCABG).Methods:The clinical data of COPD patients undergoing CABG surgery admitted to Beijing Anzhen Hospital affiliated to Capital Medical University from January 2021 to December 2021 were retrospectively analyzed. According to whether they received cardiopulmonary bypass or not, they were divided into ONCABG group (64 cases) and OPCABG group (154 cases). The preoperative and postoperative clinical data were analyzed. The whole group was divided into 4 subgroups (ON1、ON2、OP1、OP2) according to whether receiving cardiopulmonary bypass or not and FEV160% as the cut-off point, to investigate the difference of postoperative adverse events.Results:A total of 218 patients were included, ranging in age from 45 to 76 years old, with a mean age of (63.81±7.72) years, including 149 males (68.35%). There was no significant difference in the incidence of postoperative adverse events between the ONCABG and OPCABG groups ( P>0.05). In subgroup analysis, the incidence of postoperative pulmonary infection (72.73% vs. 45.65%, P<0.05) and postoperative atrial fibrillation (59.09% vs. 32.61%, P<0.05) was higher in ON1 (FEV1≤60% ONCABG, 22 cases) group than in OP1 (FEV1≤60% OPCABG, 46 cases) group. Conclusion:The incidence of postoperative pulmonary infection and atrial fibrillation in COPD patients with FEV1≤60% was higher in ONCABG than in OPCABG.
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@# Objective To analyze the efficacy of off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation. Methods The clinical data of patients aged≥70 years with coronary artery disease complicated with moderate mitral regurgitation, and undergoing OPCABG from January 2009 to January 2020 in Beijing Anzhen Hospital were retrospectively analyzed. The echocardiographic indicators of the patients were compared preoperatively, postoperatively before discharge and during the follow-up. Results Finally 239 patients were enrolled. There were 136 males and 103 females, aged 74.1±3.2 years. Before postoperative discharge, 49 (20.5%) patients had no mitral regurgitation, 144 (60.3%) mild regurgitation, 46 (19.2%) moderate regurgitation, and 0 severe regurgitation. The area of mitral regurgitation was significantly improved (2.5±1.8 cm2 vs. 5.6±1.0 cm2, P<0.001). There were 10 (4.2%) patients of hospital death, 23 (9.6%) of low cardiac output, 3 (1.3%) of myocardial infarction, and 8 (3.3%) of nervous system injury after operation. As a result, 208 (90.8%) patients were followed up and the mean follow-up time was 3.4 years (range 1-9 years). The cumulative survival rates at postoperative 2, 4, 6, and 8 years were 95.8%, 88.0%, 78.4%, and 73.1%, respectively. Postoperative follow-up showed significant improvements compared with those before surgery in the area of mitral regurgitation, left ventricular ejection fraction, left ventricular end-diastolic and left ventricular end-systolic diameters (all P<0.05). Duirng the follow-up, the major adverse cardiac and cerebrovascular events were all cause death in 22 (10.6%) patients, including cardiac death in 17 (8.2%) patients, myocardial infarction in 7 (3.4%) patients, heart failure in 24 (11.5%) patients, cerebrovascular events in 11 (5.3%) patients, re-hospitalization due to heart disease in 23 (11.1%) patients, and none of the patients with myocardial infarction were revascularized. Conclusion The mid- and long-term outcomes of OPCABG in the treatment for elderly patients with coronary artery disease complicated with moderate ischemic mitral regurgitation is good.
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@#Objective To compare and analyze the postoperative quality of life in patients after minimally invasive coronary artery bypass grafting (MICABG) and conventional median thoracotomy off-pump coronary artery bypass grafting surgery (OPCABG). Methods From November 2015 to January 2018, 94 patients who underwent MICABG in the Peking University Third Hospital were included in the MICABG group. During the same period 441 patients who received OPCABG were included in the OPCABG group. The patients were matched by using propensity score matching method with a ratio of 1∶1. The quality of life was compared between two groups at 1 month, 6 months and 12 months after the surgery using SF-36 scale. Results A total of 82 patients were matched for each group. In the MICABG group, there were 66 males and 16 females with a mean age of 62.6±8.2 years. In the OPCABG group, there were 67 males and 15 females with a mean age of 63.2±13.2 years. One month after the operation, the physical health assessment (PCS) and mental health assessment (MCS) of the MICABG group were higher than those of the OPCABG group (50.3±10.6 points vs. 46.1±10.3 points, P=0.011; 59.5±9.3 points vs. 54.2±11.0 points, P=0.002). Scores of these following five dimensions: general health, physical functioning (PF), role-physical, social functioning (SF), role-emotion in the MICABG group were higher than those in the OPCABG group, while the score of body pain was inferior to that in the OPCABG group, and the differences were statistically significant (P<0.05). Six months after the surgery, the PCS and MCS of the two groups were not statistically different (80.0±13.1 points vs. 77.8±12.4 points, P=0.271; 81.6±13.5 points vs. 80.4±11.2 points, P=0.537). However, the scores of PF and SF in the MICABG group were still higher than those in the OPCABG group (P<0.05). Twelve months after the surgery, there was no statistical difference in the score of each dimension between the two groups (P>0.05). Conclusion The improvement of quality of life within 6 months after MICABG is better than that of OPCABG, and it is similar between the two groups at 12 months after the surgery, indicating that MICABG has a certain effect of improving the short-term quality of life after the surgery, and the long-term quality of life is comparable to conventional surgery.
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@#Objective To analyze the risk factors for acute kidney injury (AKI) after off-pump coronary artery bypass grafting (OPCABG). Methods The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang data, CBM, VIP, CNKI were searched by computer for researches on risk factors associated with the development of AKI after OPCABG from the inception to March 2022. The meta-analysis was performed using RevMan 5.4 software. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies. Results A total of 18 researches were included, involving 9 risk factors. The NOS score of all included studies was≥6 points. Meta-analysis results showed that age [OR=1.03, 95%CI (1.01, 1.06), P=0.020], body mass index (BMI) [OR=1.10, 95%CI (1.05, 1.15), P<0.001], history of hypertension [OR=1.45, 95%CI (1.27, 1.66), P<0.001], history of diabetes [OR=1.50, 95%CI (1.33, 1.70), P<0.001], preoperative serum creatinine level [OR=2.05, 95%CI (1.27, 3.32), P=0.003], low left ventricular ejection fraction [OR=4.51, 95%CI (1.39, 14.65), P=0.010], preoperative coronary angiography within a short period of time [OR=2.10, 95%CI (1.52, 2.91), P<0.001], perioperative implantation of intra-aortic balloon pump [OR=3.42, 95%CI (2.26, 5.16), P<0.001], perioperative blood transfusion [OR=2.00, 95%CI (1.51, 2.65), P<0.001] were risk factors for AKI after OPCABG. Conclusion Age, BMI, history of hypertension, history of diabetes, preoperative serum creatinine level, low left ventricular ejection fraction, preoperative coronary angiography within a short period of time, perioperative implantation of intra-aortic balloon pump, perioperative blood transfusion are risk factors for AKI after OPCABG. Medical staff should focus on monitoring the above risk factors and early identifying, in order to prevent or delay the onset of postoperative AKI and promote early recovery of patients.
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Concomitant occurrence of coronary arterial disease (CAD) with abdominal aortic aneurysm (AAA) is not rare. Combined performance of open surgery (OS) of AAA repair and coronary arterial bypass grafting (CABG) has been reported to be effective as the way to avoid the risk of rupture of the aneurysm and acute coronary syndrome (ACS), while it's highly invasive. We successfully performed a combination performance of endovascular aneurysm repair (EVAR) and off-pump CABG (OPCAB) with the support of an intra-aortic balloon pump (IABP) in 2 cases with AAA and unstable angina pectoris (UAP). It was suggested that this strategy is a reasonable clinical option for the patient with UAP complicated with large AAA.
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Objective:To compare the perioperative outcomes and short-term graft patency between patients who underwent multivessel off-pump coronary artery bypass graft(OPCABG) via left intercoastal space or sternotomy.Methods:Between January 2017 and August 2019, 100 patients who underwent minimal invasive coronary artery bypass graft(MICS CABG) were compared with 235 patients who underwent OPCABG by single surgeon at our institute. Among them, 257 cases were male and 78 were female, aged 34 to 84 years, with mean age(61.35±8.79)years old. Due to important differences in patients’ characteristics, a propensity score-matched analysis based on 12 covariates was performed to match in a 1∶2 fashion. 82 patients(MICS group) were matched with 127 patients(OPCABG group). Surgical and postoperative outcomes were evaluated.Results:There was no statistical difference of perioperative mortality, myocardial infarction, and stroke rate( P>0.05). In MICS group, use of internal thoracic artery was higher and conversion to cardiopulmonary bypass was lower( P<0.05), but reoperation, new onset atrial fibrillation , and the use of mechanical device were similar( P>0.05). In addition, operation duration was longer but transfusion rate, postoperative chest tube drainage within 24 hours and postoperative hospital stays were less in the MICS group( P<0.05). LIMA, vein and overall graft patency were similar in the two groups shown by postoperative one-year CTA( P>0.05). Conclusion:MICS CABG is safe and feasible for patients with multiple coronary lesions. It has similar in-hospital outcomes and short-term graft patency but less transfusion and faster recovery compared to conventional OPCABG via sternotomy.
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Objective:To investigate the influence of the complexity of coronary artery disease based on SYNTAX score(SS) on the effect of minimally invasive or conventional bypass surgery.Methods:From January 2017 to January 2020, the medical group of the Minimally Invasive Cardiac Surgery Center of Beijing Anzhen Hospital received a total of 760 patients undergoing off-pump coronary artery bypass grafting(OPCABG) surgery, including 596 males and 164 females. 28-85 years old, with an average of(60.88±9.36) years old. 379 cases underwent minimally invasive coronary artery bypass grafting(MICS CABG)(minimally invasive group) and 381 cases underwent median thoracotomy CABG(conventional group). In this study, according to the SS, patients of both groups were divided into 3 levels, and then the perioperative data of the two sets of high, medium, and low score intervals were compared respectively, and a preliminary analysis of the perioperative data for patients in each SS score section was performed.Results:There was no significant difference in the SS value between the minimally invasive group and the conventional group in the three intervals. There was no statistical difference in preoperative data including age, sex ratio, body mass index, hypertension, diabetes, abnormal head CT history, lung disease, history of tobacco and alcohol. The number of minimally invasive bypasses in the three groups was significantly less than that of the conventional group. The duration of minimally invasive surgery in the SS low score group was similar to that of conventional surgery, and the duration of minimally invasive surgery in the SS medium and high score group was longer than that in the conventional group. The hospital stay in the SS low and middle score group was less than that of the conventional group. There was no statistical difference in the proportion of MACCE and auxiliary equipment implantation in the 30-day perioperative period.Conclusion:In the same grade of SS group, there is no significant difference on the perioperative clinical effect between conventional CABG or MICS CABG group. The complexity of coronary artery disease is not the decisive basis for choosing minimally invasive or conventional bypass.
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OBJECTIVE To investigate the eff ects of hypoalbuminemia and human albumin supplementation on patients with acute kidney injury （AKI）after off-pump coronary artery bypass grafting （OPCABG）. METHODS From December 2018 to January 2020，clinical information of 484 patients with coronary atherosclerotic heart disease who underwent selective OPCABG in Tianjin Chest Hospital were analyzed retrospectively. The basic data ，American Society of Anesthesiologists （ASA）grading，the number of coronary artery bypass grafting ，amount of intraoperative bleeding ，use of artificial colloid ，minimum value of hemoglobin within 7 days after operation ，hypoalbuminemia occurred after operation ，monitoring time in postoperative intensive care unit ，drainage volume of thoracic catheterization ，perioperative blood transfusion ，amount of human albumin after operation were summarized. All patients were divided into non-AKI group （414 cases）and AKI group （70 cases）according to the occurrence of AKI. The differences of the above indexes between the two groups were compared. Multiple Logistic regression analysis was performed to analyze the risk factor of AKI when selecting the indexes with P＜0.1. According to whether hypoalbuminemia occurred after operation ，all patients were divided into normal protein group （347 cases）and hypoalbuminemia group （137 cases）. Hierarchical analysis was carried out to explore the correlation between human albumin supplementation and AKI. RESULTS The results of multiple Logistic regression analysis showed that there was no significant effect on AKI in postoperative hypoalbuminemia （P＞0.05），but there were significant effect in body mass index and the dosage of postoperative human serum albumin （P＜0.05）. The risk of AKI would increase by 12.7％ every time the body mass index increases by 1 unit；the risk of AKI increased by 17.3％ for every 10 g increase in the dosage of human albumin. Stratified analysis showed that the risk of AKI would increased by 26.9％ for every 10 g increase in postoperative human albumin supplementation in normal protein group and 14.0％ for every 10 g increase in postoperative human albumin supplementation in hypoalbuminemia group. CONCLUSIONS Hypoalbuminemia is not a risk factor fo r the development of AKI after OPCABG ，but human albumin supplementation is a risk factor for AKI after OPCABG.
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@#Objective To evaluate the clinical efficacy of preoperative intra-aortic balloon pump (IABP) insertion in patients with off-pump coronary artery bypass grafting (OPCABG) surgery. Methods The clinical data of 130 patients who underwent OPCABG with IABP from 2015 to 2019 in our hospital were retrospectively analyzed. The patients were divided into two groups, including a group A (preoperative IABP insertion, n=72) and a group B (emergent IABP insertion, n=58). There were 42 males and 30 females in the group A with an average age of 60-72 (65.0±5.2) years. There were 32 males and 26 females in the group B with an average age of 56-73 (62.3±7.6) years. The in-hospital mortality rate and prognosis were compared between the two groups. Results The in-hospital mortality rate in the group A (4.2%) was significantly lower than that in the group B (12.1%, P=0.002). The IABP time (40.8±10.3 min vs. 65.3±15.6 min), mechanical ventilation time (18.7±6.1 min vs. 48.7±10.5 min) and ICU stay time (48.1±7.8 min vs. 90.2±21.3 min) of the group A were shorter than those of the group B (P<0.05). The number of bypass grafts was not significantly different between the two groups (3.6±1.2 vs. 3.8±1.0, P=0.387). Multivariable logistic regression analysis indicated that independent risk factors for in-hospital mortality included age [OR=1.04, 95%CI (1.01, 1.10), P=0.030], female [OR=2.56, 95%CI (1.53, 6.12), P=0.000] and left ventricular end-diastolic diameter [OR=1.05, 95%CI (1.01, 1.13), P=0.030]. Preoperative IABP support was the protective factor [OR=0.17, 95%CI (0.01, 0.78), P=0.005]. Conclusion Patients undergoing OPCABG with preoperative IABP insertion may reduce in-hospital mortality rate and improve outcomes.
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@#Objective To study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time. Methods From March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery. Results There was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single- vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention. Conclusion The learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.
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@#Objective To explore the difference of myocardial injury between off-pump coronary artery bypass grafting (OPCAB) and modified perfusion on-pump coronary artery bypass grafting (ONCAB). Methods A total of 558 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from 2017 to 2019 were included. According to whether or not they received modified perfusion cardiopulmonary bypass, all the 558 patients were divided into two groups including an OPCAB group (OP group) and an ONCAB group (ON group). There were 465 patients in the OP group including 282 males and 183 females with an average age of 63.58±7.87 years. In the ON group, there were 93 patients including 64 males and 29 females with an average age of 63.91±7.51 years. Creatine kinase MB (CK-MB) and cardiac specific troponin I (cTnI) were measured 24 hours before operation, 30 minutes after operation, 12 hours after operation, 36 hours after operation and 48 hours after operation. Results No perioperative death occurred in all patients. CK-MB (5.00 ng/mL vs. 8.60 ng/mL, Z=–2.189, P=0.029) and cTnI (3.00 ng/mL vs. 7.80 ng/mL, Z=–5.307, P=0.000) in postoperative 12 hours in the ON group were less than those in the OP group. CK-MB (5.00 ng/mL vs. 5.60 ng/mL, Z=–2.280, P=0.023) and cTnI (0.10 ng/mL vs. 1.02 ng/mL, Z=–6.418, P=0.000) in postoperative 36 hours in the ON group were less than those in the OP group. cTnI (0.07 ng/mL vs. 0.81 ng/mL, Z=–1.946, P=0.032) in postoperative 48 hours in the ON group was less than that in the OP group. Conclusion Compared with OPCAB, modified perfusion ONCAB has less myocardial damage.
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@#Objective To investigate the perioperative hemodynamic changes of off-pump coronary artery bypass grafting (OPCABG) patients monitored by pulse recorded analysis method (MostCare/PRAM devices) and its relationship with the prognosis. Methods A total of 89 patients who underwent OPCABG from October 2016 to January 2017 in Beiijng Anzhen Hospital were included, including 53 males and 36 females aged 60.50±8.40 years. The hemodynamic changes were recorded. The patients were divided into two groups (a major adverse cardiovascular events group and a stable group) according to whether major adverse cardiovascular events occurred or not. The difference of hemodynamic changes between the two groups was analysed. Results The mean percentage increases of stroke volume (SV) in the passive leg raising (PLR) test before opening chest and after chest closure were 23.00%±3.20% and 29.40%±3.70%, respectively. Hemodynamic data were analysed seven times, namely, anaesthesia, opening chest, heparin administration, coronary artery bypass grafting, protamine administration, thoracic closure and after operation. SV was significantly decreased during above periods, while systemic vascular resistance index (SVRI) was significantly increased. Cardiac circle efficiency (CCE) and maximum pressure gradient (dP/dT) were decreased after anaesthesia, and decreased to the lowest value during the procedure of bypass grafting, and then they began to increase gradually after the manipulation of bypass grafting was finished. Stroke volume variation (SVV) and pulse pressure variation (PPV) were slightly decreased during anaesthesia, then increased significantly through the whole surgery. Major adverse cardiovascular events occurred in 9 patients and 4 of them died. The basic mean values of SVRI, SVV and PPV of patients in the major adverse cardiovascular events group before opening chest were significantly higher than those of patients in the stable group. There was no significant difference in the mean values of CCE, dP/dT or SV between the two groups. There was no significant correlation between the prognosis and the mean values of SVRI, SVV, PPV, CCE, dP/dT or SV. Conclusion The hemodynamic indexes are not stable, thus, it is necessary to monitor the perioperative hemodynamic changes of OPCABG patients timely by MostCare/PRAM device and adjust treatment measures accordingly.
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@#Objective To evaluate the changes of the flow parameters before and after the anastomotic port exploration and dredging during coronary artery bypass grafting by using the transit time flow measurement (TTFM). Methods A total of 167 patients who underwent continuous coronary artery bypass grafting and anastomotic port exploration and dredging surgery in Beijing Anzhen Hospital from 2018 to 2019 were enrolled in this study. There were 136 male and 31 female patients aged 41-82 (58.35±17.26) years. If the probe entered and exited the anastomotic port smoothly, it was recorded as a non-resistance group; if the resistance existed but the probe could pass and exit, it was recorded as a resistance group; if the probe could not pass the anastomotic port for obvious resistance, it was recorded as the stenosis group. In the stenosis group, the grafts were re-anastomosed and the flow parameters were re-measured by TTFM. Results A total of 202 anastomotic ports were carried out by exploration and dredging. Among them, 87 anastomosis (43.1%) were in the non-resistance group, and there was no significant change in the blood flow volume (BFV) and pulsatility index (PI) before and after exploration and dredging (6.16±3.41 mL/min vs. 6.18±3.44 mL/min, P=0.90; 7.06±2.84 vs. 6.96±2.49, P=0.50). Sixty-four anastomosis (31.7%) were in the resistance group, the BFV was higher after exploration and dredging than that before exploration and dredging (17.11±7.52 mL/min vs. 4.96±3.32 mL/min, P<0.01), while the PI was significantly smaller (3.78±2.20 vs. 8.58±2.97, P<0.01). Fifty-one anastomosis (25.2%) were in the stenosis group, and there was no significant change in the BFV and PI before and after exploration and dredging (3.44± 1.95 mL/min vs. 3.48±2.11 mL/min, P=0.84; 10.74±4.12 vs. 10.54±4.11, P=0.36). After re-anastomosis, the BFV was higher (16.48±7.67 mL/min, P<0.01) and the PI deceased (3.43±1.39, P<0.01) than that before exploration and dredging. Conclusion The application of anastomotic exploration and dredging can reduce the occurrence of re-anastomosis, and promptly find and solve the stenosis of the distal coronary artery, improve the poor perfusion of distal coronary, and thus improves the prognosis of patients.
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Background: Acute kidney injury (AKI) following off pump coronary artery bypass grafting (OPCABG) within short interval from coronary angiography (CAG) has been well documented. This prospective study is aimed to delineate perioperative effects and effects of elective 7 days interval between CAG and off pump CABG, to observe its outcome on renal functions.Methods: The present study was conducted in a total of 1102 consecutive patients who underwent coronary angiography following coronary artery bypass surgery in Fortis hospital, Mohali. Patients were divided into 2 groups - group A (patients undergoing CABG within 7 days of CAG) and group B (patients undergoing CABG beyond 7 days of CAG). Comparison was made between the two groups, in relation to the timing between CAG and CABG, with its impact on perioperative renal functions.Results: Statistically it was found highly significant higher values of 1st and 3rd day serum creatinine and high incidence of postoperative AKI in patients of group A in comparison to patients of group B.Conclusions: Thus, our study confirms that patients with a shorter interval between CAG and subsequent OPCAB are more likely to present higher peak creatinine level as well as lower minimum eGFR. A gap of 7 days for elective cases is more likely to present less postoperative AKI.
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@#Objective To describe our experiences of application of off-pump coronary artery bypass grafting surgery (OPCABG) in coronary artery disease (CAD) patients with dilated left ventricle. Methods A retrospective analysis of 303 patients with dilated left ventricle [left ventricular end-diastolic diameter (LVEDD)> 60 mm] who underwent OPCABG from January 2008 to December 2018 at a single center was conducted. There were 205 males and 98 females at age of 45-87 (66.9±9.3) years. Results The mean pulmonary artery pressure in 90 patients was more than 25 mm Hg. Sixteen patients underwent OPCABG with emergent transition of extracorporeal circulation (CPB). Twenty-one patients underwent OPCABG with CPB at the beginning of CABG. Thirty-five patients underwent intra-aortic balloon counterpulsation (IABP). Four patients died during in-hospital time with the experience of emergent transition of CPB. Six months after operation, LVEDD and left ventricular ejection fraction (LVEF) were improved. Conclusion OPCABG is a safe and effective alternative for CAD patients with dilated left ventricle. However, for patients with higher pulmonary pressure and a spherical left ventricle after cardiac reshaping, there is a high risk of emergent transition of CPB during OPCABG; for this kind of patients, it is necessary to start CPB at the beginning of OPCABG.
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Data on isolated coronary artery bypass grafting (CABG) performed in 2017 and 2018, and registered in the Japan Cardiovascular Surgery Database were reviewed for preoperative characteristics, postoperative outcomes, and choice of graft material for the left anterior descending artery (LAD). Isolated CABG was performed off-pump in 54.6% (n＝14,684) of all CABG cases (n＝26,913), and graft material for the LAD was left internal thoracic artery in 76.4% and right internal thoracic artery in 19.0%. Operative mortality was 1.5% in elective cases (On-pump CABG : ONCAB 1.9%, off-pump CABG : OPCAB 1.2%, p＜0.001), 7.4% in emergency cases (ONCAB 10.2%, OPCAB 4.3%, p＜0.001), and 2.5% overall. Postoperative morbidity was low in almost all aspects in OPCAB, and average JapanSCORE II is elevating every year. Overall short-term operative results for isolated CABG is stable, and operative candidates are shifting to higher-risk patients.