Outcomes of coronary artery bypass grafting in old patients with diabetes / 中华胸心血管外科杂志

Objective The risk for coronary artery bypass surgery is reported to be increased with age and associated with diabetes. We examined the outcomes of coronary artery bypass grafting (CABG) in patients with diabetes who were older than 70 years of age and evaluate the effect of diabetes on CABG in those patients. Methods From March 2000 to March 2008, the data of 649 patients older than 70 years of age were collected retrospectively and divided into diabetic group or non-diabetic group based on pre-operative diagnosis. The blood glucose level of patients was maintained between 7.0 mmol/L ( 126mg/dl) and 10.0 mmoL/L ( 180 mg/dl) porioporatively. Stats 7.0 was used for statistical analysis. The t test and χ~2 test were used to determine the differences in the numerical variables and categorical variables respectively. Results No statistical differences were observed between the two groups in the baseline variables, such as age [ ( 74.78±3.67 ) years for diabetic group vs. ( 75.00±3.65 ) years for non-diabetic group, P = 0. 4877 ], female patients ( 34.76% vs. 29.22%, P =0. 1663 ), ejection fraction [ ( 57.02±10. 10 ) % vs. ( 58.49±10. 39 ) %, P = 0. 1004 ) ], myocardial infarction history (26.20% vs. 28.35%, P =0. 5795), though there were more left main diseases in the diabetic group (52.41% vs.26.41%, diabetic vs. non-diabetic, P = 0. 0000 ). The overall in-hospital mortality was 6.32% (8.02% in the diabetic group vs. 5.63% in the non-diabetic group, P = 0. 2571 ). The main causes of death were sudden respiratory and cardiac arrest,low cardiac output syndrome ( LCOS), malignant arrhythmia, respiratory failure, renal failure, central nervous system compli-cations, and multiple organ failure. Major post-operative complications were bleeding, atrial fibrillation, plural effusion and pulmonary infection. Post-operative variables, such as EF (0.59±0. 13 in the diabetic group vs. 0. 61±0.15 in the non-dia-betie group, P =0. 1807), re-revascularization due to bleeding (2. 14% vs. 4.76%, P = 0. 1232), blood transfusion (89.84% vs. 84.63%, P = 0.0820) and the administration of vasoactive agent (21.93% vs. 27.71%, P= 0. 1286),were found no significant difference between the two groups. Conclusion Conclusions The early outcomes of CABG in aged patients are acceptable. The surgical consequences in diabetic patients may be similar to those in non-diabetic patients.

Cardiac hemodynamics on ischemia/reperfusion rat heart model / 医学研究生学报

Objective: To explore the feasibility of observing hemodynamics on ischemia/reperfusion(I/R) rat heart model in vivo by studying the changes of hemodynamics,myocardial zymogram and electrocardiogram. Methods: Twenty SD rats were randomly divided into 2 groups(n=10)(IR group and control group).The left anterior descending coronary artery was ligated or left untouched,a catheter was put into the left ventricle to trace the pressure change index and peak pressure of left ventricle,and to record ST segment changes of ECG.At the end of experiment,the levels of myocardial zymogram were determined.The results of two groups were compared. Results: Compared with control group,IR group showed reduced dp/dt max,declined LVSP,raised ST segment in ECG,and elevated myocardium zymogram. Conclusion: Our I/R rat heart model in vivo is feasible and stable to explore the cardiac hemodynamics.

Treatment of Severe Coronary Artery Disease with CO2 Laser Transmyocardial Revascularization / 中国胸心血管外科临床杂志

Objective　To summarize the treatment of 7 cases of severe coronary artery disease with CO2 laser transmyocardial revascularization(TMLR).　Methods　The mean preoperative angina class (Canadian Cardiovascular Society, CCS), number of diseased coronary arteries were 3.6±0.7 and 2.8±0.6 respectively. All the patients underwent left anterolateral thoracotomy through the fifth intercostal space under general anesthesia, the left ventricule was exposed and then TMLR was performed. The mean channels in TMLR was 32.5. 　Results　The symptoms of angina disappeared during the first postoperative month, with no relapse reported in the first follow-up year. There was significant difference in the angina class (P＜0.05), ejection fraction also increased. The ischemia region of the heart decreased through the single photon emission computed tomographic(SPECT) test.　Conclusion TMLR can relieve angina and improve life quality of patients with severe coronary artery disease. It can accelerate the recovery of dormant myocardium and enhance the contractility.