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Objective:To investigate the predictive value of preoperative left atrial diameter in postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) and its influencing factors.Methods:This study was a prospective observational study. A total of 113 patients with CABG surgery were enrolled in Beijing Anzhen Hospital affiliated to Capital Medical University from January 2020 to December 2020. Preoperative coronary angiography, echocardiography and blood test were finished. The number of graft vessel was counted during the operation. The occurrence of POAF was confirmed by electrocardiogram or electrocardiograph monitoring after surgery. The preoperative baseline data, blood test, perioperative complications and other indicators of patients with or without POAF were compared.Results:According to the inclusion criteria and exclusion criteria, 90 patients undergoing CABG were enrolled in the study[71 males and 19 females, aged from 42 to 75, mean age (62±8)years old]. The incidence of POAF was 27.8%(25 cases). The left atrial diameter[40(36-43)mm vs. 35(33-37)mm, P=0.00]and troponin I[4.76(0.87-13.60)ng/ml vs. 1.48(0.56-4.52)ng/ml, P=0.04] in patients with POAF were significantly higher than that in patients without POAF. Compared to patients without POAF, POAF significantly increased the incidence of stroke[4(16%) vs. 0(0), P=0.01], ICU stay[67(24-96) days vs. 22(19-41) days, P=0.00] and hospital stay[21(19-24) days vs. 16(14-24) days, P=0.05]. Binary logistic regression showed that left atrial diameter was significantly correlated with the occurrence of POAF ( OR=1.9, 95% CI: 1.39-2.79, P<0.001). ROC curve analysis showed that 40 mm of left atrial diameter was a predictor of POAF( AUC=0.82, sensitivity 52%, specificity 100%, P<0.001). Linear regression analysis showed that left atrial diameter was significantly positively correlated with hypersensitive C-reactive protein ( Beta=0.24, 95% CI: 0.00-0.26, P=0.043). Conclusion:POAF significantly increased the incidence of stroke after CABG. Preoperative left atrial diameter is an independent predictor for POAF, which is closely related to the systemic inflammatory response.
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Objective:To evaluate the validity of adventitial collagen cross-linking by glutaraldehyde(GA) to reduce intimal hyperplasia of vein graft in a rabbit carotid artery bypass graft model.Methods:Harvesting 36 segments of the external jugular vein and 6 segments of the internal carotid artery with 3 cm length from the New Zealand white rabbits. The veins were randomly divided into 6 groups and underwent adventitial collagen cross-linking by 0.3% glutaraldehyde for 0 min, 1 min, 2 min, 3 min, 4 min, and 5 min, respectively. All vessel segments were subjected to biomechanical tests and pathological tests. Carotid artery bypass graft models were established in 24 New Zealand white rabbits including crosslinked group(n=12) and non-crosslinked group(n=12). The vein grafts were obtained for pathological examination 4 weeks after models feeding, and the intimal hyperplasia of vein graft was evaluated.Results:Adventitial cross-linking increased fiber density of adventitia significantly, and increased the stiffness of the veins as the time of cross-linking increased. And in the high strain region(strain ratio 1.4-1.8), the mechanical curve of veins receiving 3min cross-linking was similar to that of the carotid artery. The patent rate of the vein grafts of rabbit models was 100% after 4 weeks. Comparing with non-crosslinked group, the intimal and medial thickness of vein grafts in crosslinked group were reduced remarkably[(78.83±9.02)μm vs.(140.19±19.90)μm, (43.75±5.05)μm vs.(58.35 ± 8.61) μm, P<0.01). Conclusion:Adventitial collagen cross-linking by GA can enhance the mechanical strength of the jugular vein, and reduce the intimal hyperplasia of the jugular vein grafts in rabbit models.
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Objective:To investigate the relationship between preoperative high-sensitivity C-reactive protein (Hs-CRP) levels and clinical outcomes of patients undergoing off-pump coronary artery bypass graft (OPCABG) surgery.Methods:We prospectively selected 123 patients who received OPCABG at Beijing Anzhen Hospital from January 2019 to October 2019, and collected relevant preoperative and postoperative data. Patients were divided into a normal Hs-CRP group(78 cases) and an elevated Hs-CRP group(45 cases)according to the cutoff value (2 mg/L) of Hs-CRP level. The data of the two groups were compared, and regression analysis was performed on the postoperative data with differences to define independent factors.Results:The leukocyte count in the Hs-CRP group was significantly higher than that in the normal Hs-CRP group[(6.5±1.6)×10 9/ml vs. (7.4±2.1) ×10 9/ml, t=-2.839, P=0.005]. In the elevated Hs-CRP group, proportion of patients with atrial post-CABG atrial fibrillation (38% vs. 19%, χ2=5.100, P=0.024), duration of hospitalization[(21.2±7.1)days vs.(16.0±4.6)days, t=-4.469, P=0.000], hospital costs[(143.1±30.7)×10 3 yuan vs. (123.7±21.8)×10 3 yuan, t=-4.090, P=0.000]were significantly higher than those in the normal Hs-CRP level group. Smoking ( OR=1.660, 95% CI: 1.186-1.993, P=0.031) and Hs-CRP ( OR=1.170, 95% CI: 1.050-1.294, P=0.007) were independent risk factors for post-CABG atrial fibrillation. Hs-CRP ( B=0.436, 95% CI: 0.197-0.675, P=0.000) and left ventricular ejection fraction (LVEF, B=-0.180, 95% CI: -0.289--0.071, P=0.001) were independent influencing factors of duration of hospitalization. Hypertension ( B=-11.256, 95% CI: -20.670--1.842, P=0.020), Hs-CRP( B=1.235, 95% CI: 0.217-2.254, P=0.018) and LVEF ( B=-1.168, 95% CI: -1.634--0.702, P=0.000) were independent influencing factors of hospital costs. Conclusion:The preoperative Hs-CRP level of OPCABG is an independent influencing factor of post-CABG atrial fibrillation, duration of hospitalization and hospital costs. This finding lays the foundation for Hs-CRP combined with other indicators to accurately predict the prognosis of OPCABG and screen high-risk patients.
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Objective:To investigate the effect and mechanism of obstructive sleep apnea hypopnea syndrome(OSAHS) on nocturnal angina in patients who undergo coronary artery bypass grafting(CABG).Methods:According to the inclusion criteria and exclusion criteria, this prospective observational study included 76 patients who underwent CABG at Beijing Anzhen Hospital affiliated to Capital Medical University from January 2018 to December 2018. Patients included 60 males and 16 females, mean aged(61.4±7.3) years, BMI(25.7±2.3) kg/m 2. Portable sleep respiration monitoring and bedside ECG monitoring were performed before surgery. According to the apnea index(AHI), patients were divided into mild or no OSAHS group(AHI<15, 35 patients) and moderate to severe OSAHS group(AHI≥15, 41 patients). Baseline data, hematologic examination, degree of coronary stenosis, sleep breathing examination, night time heart rate and incidence of atrial fibrillation, and nocturnal angina were compared between the two group. Results:Combined with mild or no OSAHS group, moderate to severe OSAHS group had a significantly higher syntax-score(47.3±10.6 vs 35.1±6.8), a significantly higher proportion of coronary diffuse lesions(53.7% vs 31.4%), a significantly faster heart rate[(94.3±21.5)times/min vs(74.8±10.0) times/min], a significantly higher proportion of nocturnal angina(29.2% vs 2.9%). The differences were statistically significant( P<0.05). Binary logistic regression analysis showed that the fastest heart rate at night significantly affected the occurrence of nocturnal angina in CABG patients( OR=1.320, 95% CI: 1.084-1.607, P=0.006), the syntax-score, the fastest heart rate at night significantly affected the degree of OSAHS in CABG patients( OR=1.269, 95% CI: 1.094-1.473, P=0.002; OR=1.066, 95% CI: 1.004-1.131, P=0.036). Two linear regression showed a significant linear correlation between AHI with the fastest heart rate and syntax-score at night( R2=0.576, P<0.001; R2=0.658, P<0.001). Conclusion:OSAHS can significantly aggravate the degree of coronary artery stenosis in CABG patients, and further increase the incidence of nocturnal angina by significantly increasing nighttime heart rate.
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Objective To summarize the clinical features of patients with diffuse coronary artey diseases,and evaluate the clinical efficacy of off-pump coronary artery bypass grafting(OPCABG) combined with selective coronary venous bypass grafting (SCVBG).Methods Retrospectively analyzed the clinical data of 61 patients with diffuse right coronary stenosis undergoing operation of OPCABG + SCVBG from January 2007 to December 2013,and couducted the comparative study of the patients who underwent OPCABG during the same period based on propensity score.Patients were divided into SCVBG group(61 cases,underwent OPCABG + SCVBG) and control group(60 cases,matched by propensity score and underwent OPCABG without SCVBG).Results Compared with control group,the rate of myocardial infarction in SCVBG group was higher (67.2％ vs.46.7c％,P ＜0.05),the heart rate was faster[(69.92 ± 15.82) bpm vs.(64.48 ± 13.72) bpm,P ＜ 0.05],the low density lipoprotcin and triglyceride were higher[(2.67 ± 0.78) mmol/L vs.(2.37 ± 0.78) mmol/L (1.84 ± 0.79) mmol/L vs.(1.36 ± 0.60) mmol/L,both P ＜ 0.05] and the troponin I was higher in the first postoperative day [0.85 (0.29,3.15)μg/L vs.5.09 (2.02,13.03)μg/L,P ＜ 0.05].The perioperative(postoperative) mortality(1.6％ vs.0) and the long-term survival curve difference had no statistically significance(P ＞0.05).Conclusion Patients with coronary artery disease should pay more attention to the control of heart rate and blood lipids,poorly controlled heart rate and high blood lipids are the important factors for the development of coronary heart disease.The exact efficacv of selective coronary vein arterialization for diffuse coronary artery disease is confirmed through the small sample comparative study.
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Objective To evaluate the efficacy and clinical significance of medical chemical glue as an external stent in improving the fluency rate of venous bypass graft after coronary artery bypass grafting .Methods Randomly selected 200 pa-tients from April 2010 to December 2016 included who were underwent coronary artery bypass grafting in Beijing Anzhen Hospi-tal.All patients had different degrees of angina , and coronary angiography showed multi-branches artery lesion.They were ran-domly divided into two groups, 100 in each group.Spray gel group: coronary artery bypass grafting simultaneously spraying medical chemical glue on the surface of the bridge vessel.Unsprayed gel group:simple coronary artery bypass grafting.All 200 patients were followed up in June 2018.The follow-up content mainly included: recent recurrence of angina pectoris, recent echocardiography and electrocardiogram report, coronary CTA or coronary angiography results, and current living conditions. The data obtained were collectively summarized and compared .Results The follow-up rate was 96％ in the sprayed group, and 92％ in the unsprayed group.Compared with the unsprayed group , the incidence of chest pain and angina pectoris was significantly lower in the sprayed group(23.96％ vs.40.22％, P<0.05), the venous occlusion rate of the vein bypass graft in the sprayed group was significantly lower(29.17％ vs.55.43％, P<0.01), the probability of death due to cardiac causes in the sprayed group was significant decrease(1.04％ vs.6.52％, P<0.05), the number of patients with the main adverse cardiac and cerebral events(MACCE) in the sprayed group was significantly lower(9.38％ vs.21.74％, P<0.01), all with statistically significant differences .The number of patients with heart failure and recurrent myocardial infarction was lower in the sprayed group, but there were no statistically significant differences .Conclusion Medical chemical glue as an external stent does play a role in improving the venous patency rate after coronary artery bypass grafting , and it is reliable for the preven-tion and treatment of vein bypass vascular stenosis after coronary artery bypass grafting .
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Objective To explore the clinical significance of protection "Choke vessel area" in the application of perforator flap to repair large defect of trunk after tumor resection.Methods A total of 62 patients (38 males and 24 females,aged from 19 to 79 years) from the Department of Plastic Surgery,Second Affiliated Hospital of Suzhou University underwent reconstructive surgery for large area defects of the trunk from March 2012 to January 2016.The perforator flap was designed according to the perforator location detected by Doppler before surgery.The flaps were harvested on the pedicle of perforators and dissected on the deep layer of deep fascia (including part of the myolemma).The areas of flap ranged from 5.0 cm × 10.0 cm to 19.0 cm × 22.0 cm.The donor site was sutured directly or local flap was transferred to repair.Results Flaps survived well in 59 of the 62 cases.The tip of flap was necrotic and healed after dressing change in 1 diabetic patient.The distal part of flap was necrotic on cuticular layer and healed after dressing change in another patient with scrotal defect.One patient had flap necrosis 10 days after operation and was repaired twice.The results were satisfied after following-up from 3 months to 2 years for 17 cases and from 6 months to 2 years for 25 cases.Fibrosarcoma protuberant and squamous cell carcinoma recurred in 1 case each,but the function and appearance were satisfactory after primary repair.Conclusions The procedure of preserving Choke vessel area can improve the blood supply of perforator flap and obtain larger survival area and survival quality.It is worthy of clinical application.
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Objective@#To introduce the application of free-style perforator flap based on aesthetic units to repair facial defect after tumor resection.@*Methods@#By following the concept of free-style perforator flap and the principle of facial aesthetic unit, the design of a free-style perforator flap allowed over any nearby cutaneous vessel chosen purely on the characteristics of its Doppler signal. Conventional knowledge of anatomical landmarks and possible vascular variations were less relevant. A greater freedom in flap selection was gained to recover defect in different forms such as rotation flap, advanced flap and propeller flap, which were all based on free-style perforators. The flap size ranged from 1.5 cm×1.0 cm to 12.0 cm×6.0 cm with the perforator diameter of 0.3-3.0 mm in pedicle, and some of the pedicles are "perforator clusters" .@*Results@#A total of 72 cases underwent surgery, and 68 cases survived completely with satisfactory appearance. 1 case healed two weeks later through dressing due to undesired healing, which result ed from high tension secondary postoperative blooding. 3 cases healed in a delay due to congestion and gained acupuncture treat.@*Conclusions@#The free-style perforator flap, which depended on Doppler-discerned perforator and facial aesthetic unit, represents safe, reliable and versatile for repairing facial defect after extended resection, and it not only offers a greater freedom in flap selection but also provides good aesthetic result.
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Objective To study the value of free-style perforator flap in repairing nasal defects after tumor resection.Methods On the basis of the guidance of free-style perforator flap design concept and the foundation of vascular localization by Doppler based on the ultrasonic echo intensity,combined with nasal beauty subunits,we designed free-style perforator flap in different forms such as V-Y advancing flap,rotating flap,and propeller flap,which had with free-style perforator in pedicle all.We transplanted the flaps to repair nasal defects after tumor resection.The area of the flaps was between 2 cm x 1.0 cm and 8.0 cm x 5.0 cm,and the diameter of the perforate vessel in the pedicle of flap was between 0.3 mm-3 mm,and some of the pedicles were composed of perforate vessel tube bundle.In order to reduce recurrence rate,the radiotherapy was performed according to the pathology in 1 month after surgery.Results In 31 cases of this group,29 cases were performed and the postoperative shape was good.1 case appeared postoperative hemorrhage,and the epidermis of flap formed blister because of greater tension,and the patient healed 10 days later after extraction the bubble fluid and changing medicine.The flap of 1 case was silted because the venous was blocked,and the acupuncture was treated,and then the flap got delayed union.23 cases received adjuvant radio therapy after surgery and fellowed up from 6 months to 5 years,showing that local profile and color were satisfacfory without tumor recurrence.Conclusions It is worthy of clinical promotion to designing freetype perforator flap and to repair defect after extensive nasal tumor resection on the basis of beauty subunits in nasal and vascular anatomy,which can not only reduce the recurrence rate by postoperative radiotherapy in time,but also realize better cosmetic requirements.