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Objective To investigate the role of titanium plate fixation for sternum closure after off-pump coronary artery bypass grafting (OPCABG) in elderly patients.Methods A total of 120 elderly patients who accepted OPCABG were randomly divided into two groups.The control group (n =60) received wire to fix the sternum,and the experimental group (n=60) received titanium plate combined with wire to fix the sternum.The chest closure time,the rate of postoperative incision pain,the rate of sternal dehiscence and sternal re-fixation between two groups were observed and recorded.Results The rates of postoperative incision pain,sternal dehiscence,sternal re-fixation was lower in experimental group than in control group [11.7％(7/60) vs.38.3％(23/60),3.3％(7/60) vs.13.3％(8/60),1.7％(1/60) vs.11.7％(7/60),x2 =11.378,3.927,4.821 respectively all P＜0.05].The chest closure time was longer in experimental group than in control group [(39±5)min vs.(30±2) min,x2 =13.386,P＜0.05].Conclusions Titanium fixation plate combined with wire for sternum closure can increase the stability of sternum fixation,reduce the postoperative pain and sternal dehiscence,and then decrease the risk of sternal re-fixation,but delay sternal closure of OPCABG in the elderly.
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Objective To comparison of extracorporeal circulation coronary artery bypass grafting (CABG) with off‐pump coronary artery bypass grafting (OPCABG ) the degree of myocardial injury by multi index evaluation .Methods From January 2010 to January 2014 underwent coronary artery bypass graft operation in our hospital were randomly selected for CABG and OP ‐CABG patients ,a total of 60 cases .According to the operation mode for CABG would be recorded as the control group ,OPCABG recorded as observation group ,30 patients in each group ,compared the two groups of anesthesia induced by 5 min after operation (T0 ) ,1 d after operation (T1 ) and 2 d (T2 ) of myocardial troponin I (cTnI) concentration ,creatine kinase isoenzyme (CK‐MB) ac‐tivity ,the concentration of NT‐proBNP and interleukin‐6 (IL‐6) level .And the calculation of myocardial mitochondrial injury ,sta‐tistical comparison of systolic blood pressure (SBP) ,diastolic blood pressure (DBP) and mean arterial pressure (MAP) after 24 h . Results Two groups of patients with cTnI ,CK‐MB ,NT‐proBNP on T0 moment ,any time the level of IL‐6 had no difference(P>0 .05) .In T1 ,T2 moments ,cTnI ,CK‐MB ,NT‐proBNP and IL‐6 were lower than that of the control group (P< 0 .05) .In addition , the observation group in postoperative myocardial mitochondria injury score (1 .90 ± 0 .27) ,significantly lower than the control group (2 .80 ± 0 .31) points ;The observation group ,SBP ,DBP and MAP blood pressure index were higher than the control group , the differences were all statistically significant (P< 0 .05) .Conclusion OPCABG on myocardial injury degree is less than CABG , and the OPCABG postoperative patients recover faster and with higher clinical value .
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Objective To study the variation characteristics of plasma von Willebrand factor antigen (vWF Ag) after the off-pump coronary artery bypass graft (OPCAB) and its predictive value on the assessment of cardiovascular ischemia events in the postoperative patients.Methods A total of 338 patients with non-ST-segment elevation myocardial infarction were selected from 2010 to 2012 in this retrospective cohort study,with 249 males and 89 females and a mean age of (69.2 ± 4.5) years.The level of vWF Ag was assayed by the IL ACL-TOP 700 blood coagulation instrument.Receiver-operator curve (ROC) analysis of vWF Ag levels in the prediction of risk of ischemic events was performed.x2 test and Logistic regression were conducted to analyze the relevance between vWF Ag and clinical pathological factors.Cox regression analysis model were used to evaluate the effect on prognosis.Results There was significant difference in vWF Ag level at different time point between the poor recovery group and the stable disease group (x2 =129.53 and 101.48 respectively,both P＜0.01).And the vWF Ag level was higher in the poor recovery group on the 14th,30th,60th,90th day after OPCAB than in the stable disease group at the same time points respectively (all P＜0.05).The optimum cut-off point of vWF Ag (the 30th day after OPCAB) for prediction of ischemic events was 251 ％ within the 31-90th day after OPCAB,the area under ROC curve was 0.839 (95％ confidence interval:0.776-0.902).The Logistic regression analysis showed that the vWF Ag level on 30th day after OPCAB was affected by age,left ventricular ejection fraction,left main artery disease,serum creatinine level,vascular number of bypass grafts,history of myocardial infarction and hypertension (all P＜0.01).The Cox analysis showed that the cut-off value of vWF Ag (on the 30th day after OPCAB) was the independent prognostic assessment parameter for ischemic events in patients with cardiovascular diseases within one year.Conclusions The variation of serum vWF Ag level can reflect the integrated influence of multiple pathological factors on vascular endothelial function after the OPCAB,it can become the effective predictor for disease progression within 90 days and the long-term prognosis after OPCAB.
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ObjectiveTo evaluate the functional changes of stunned myocardium before and after coronary artery bypass graft(CABG) treatment,and clear the meaning of revascularization which CABG has brought to patients with diffused vascular changes.MethodsA total of 36 patients with 99％ diffused coronary artery stenosis in left anterior descending branch underwent non-pump CABG treatment in the Department of Cardiothoracic Surgery the First affiliated hospital of Harbin Medical University.Real-time three-dimensional echocardiography (RT3DE) was repeatedly performed 1 week before operation and 10 days,1 month,and 3 months after CABG.Regional diastolic volumes,systolic volumes,ejection fractions,regional stroke volume to global diastolic volume and the values of abnormal segments before and after CABG were studied.ResultsOne week before operation and 10 days,1 month and 3 months after CABG,the differences of volumes between groups in the last phases of diastole and systolic were statistically significant in anterior wall basement segment,anterior septal basement segment,anterior wall intercalary segment,anterior septal intercalary segment,anterior wall of apex cordis and septation of apex cordis(F =3.51,3.55,4.08,4.05,2.98,3.01,all P ＜ 0.05; F =4.51,4.55,4.08,3.00,2.96,2.99,all P ＜ 0.05).The values of the six segments mentioned above,3 months after operation[(6.74 ± 1.23),(6.64 ± 1.21),(6.02 ± 1.10),(5.95 ± 1.09),(5.82 ± 1.06),(5.10 ± 0.93)ml; (2.74 ± 0.50),(2.69 ± 0.49),(2.51 ± 0.46),(2.32 ± 0.42),(2.36 ± 0.43),(2.03 ± 0.37)ml] were compared with those of 1 week before operation[(8.33 ± 1.52),(8.20 ± 1.50),(7.43 ± 1.36),(7.36 ± 1.34),(7.19 ± 1.31),(6.29 ± 1.15)ml; (4.94 ± 0.90),(4.85 ± 0.88),(4.53 ± 0.83),(4.18 ± 0.76),(4.25 ± 0.78 ),(3.65 ± 0.67)ml],the differences were statistically significant (all P ＜ 0.05); the differences between groups in regional ejection fractions,regional-global ejection fractions were statistically significant(F =4.56,4.88,4.28,3.15,2.93,2.88,P ＜ 0.01 or ＜ 0.05; F =5.56,5.28,4.98,5.15,3.03,2.78,P ＜ 0.01 or ＜ 0.05).Compared with 1 week before the operation, 1 month after the operation in regional ejection fractions,10 days,1 month in regionalglobal ejection fractions after the operation,4 segments of them were significantly improved(all P ＜ 0.05) and 3 months after operation,all the 6 segments had been improved significantly(all P ＜ 0.05).The maximum volume of the sum of group difference of the 6 segments and the 4 segments in the last phase of diastole was statistically significant(F =2.58,5.81,P ＜ 0.05 or ＜ 0.01 ),and the summation began to decrease 10 days after the operation.The values of 3 months after operation[ (36.27 ± 1.10),(25.35 ± 1.16)ml] were compared with that of 1 week before operation[ (44.80 ± 1.36),(31.32 ± 1.43)ml ] the difference was statistically significant (all P＜ 0.05).The maximum volume summafion comparisons of 6 segments and 4 segments in the last phase of systolic had statistical significance(F =5.77,5.57,all P ＜ 0.01 ),and 10 days after the operation,the summation began to decrease.The values of 1 month[(16.4 0 ± 0.48),(11.58 ±0.51 )ml],and 3 months after operation[ (14.65 ± 0.45),(10.26 ± 0.46)ml],were compared with those of 1 week before operation[ (26.40 ± 0.80),(18.50 ± 0.84)ml],the differences were statistically significant (all P ＜ 0.05).ConclusionsStunned myocardium can be improved through CABG in myocardium systolic,diastole function and ejection fractions of the relevant segments and all of this have proved that patients undergoing CABG revascularization can improve the heart function of the ischemic area.
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ObjectiveThe present study was designed evaluate the aspirin effectiveness in the inhibition of platelet aggregation in patients after OPCAB.Methods290 patients were recruited.145 patients underwent first time OPCAB (surgery group).Arachidonic acid induced platelet aggregation and urine 11-dehydro thromboxane B2 (11-dehydroTxB2) were measured before operation and on aspirin re-administered days 1,4, 10, and 6 months after surgery.The same tests were also detected in 145 patients from the cardiology department (non-surgery group) received medicine therapy as controls.Results Ninety-nine patients were defined as aspirin sensitive after OPCAB (AS Group).Postoperative aspirin resistance was identified in 46 (32％) patients at the first day after aspirin treatment started (AR Group).19 (13％) and 5 (3％) patients remained as AR at day 4 and 10 after aspirin re-administration, respectively.Patients in the AR group had higher 11-dehydroTxB2 levels than those in the AS group (P = 0.049).Six months follow-up showed ARA-induced platelet aggregation was (11.5 ± 3.4) ％.Urine level of 11-dehydroTxB2 was (50.3 ± 15.4) ng/L.No resistance was found.All cardiologic patients were identified as aspirin sensitive, the change of platelet aggregation and 11-dehydroTxB2 were similar as those in the AS group.Weight ＞75 kg and postoperative drainage ＞500 ml were risk factors of aspirin resistance after OPCAB.ConclusionAnti-platelet effect of aspirin was reduced during the early postoperative period in certain patients undergoing OPCAB.In case of resistance,antiplatelet treatment strategy should be intensified or modified.