Comparison of Mid-Term Graft Patency between On-Pump and Off-Pump Coronary Artery Bypass Grafting.

BACKGROUND: Multiple studies have compared on-pump coronary artery bypass (ONCAB) grafting with off-pump coronary artery bypass (OPCAB) grafting, but the optimal surgical strategy has yet to be established. Furthermore, there is limited evidence regarding mid-term graft patency rates. METHODS: Between April 2001 and March 2014, 365 consecutive patients underwent isolated coronary artery bypass grafting (CABG; male: 75%; mean age: 69 ± 10 years). After propensity-score-matched analysis, we assessed the results of 67 patients in each group (ONCAB: group A, OPCAB: group B). The mean follow-up period of graft patency and survival rate was 35 ± 37 months and 54 ± 47 months, respectively. RESULTS: There were no significant differences in baseline characteristics between the two groups. There was a trend for an increased number of distal anastomoses in group B as compared to group A (group A vs. group B: 3.8 ± 1.1 vs. 4.1 ± 1.6, P = 0.17). The total graft patency rate was tend to be lower in group A, but not statistically significant (group A: 156 months, 45.2%; group B: 96 months, 72.6%; P = 0.21). There was no difference for survival and major-adverse-cardiac-and-cerebrovascular-events (MACCE) free rate (P = 0.42 and 0.76, respectively). CONCLUSION: Propensity-score-matched analysis revealed no difference in mid-term survival rate, MACCE free rate, graft patency rates, and number of distal anastomoses between ONCAB and OPCAB groups.

Hemodynamic deterioration after aortic valve replacement in a patient with mixed systemic amyloidosis.

We report a case of hemodynamic deterioration after aortic valve replacement in a patient with mixed systemic amyloidosis. A 77-year-old male with severe aortic valve stenosis and 19 years hemodialysis underwent aortic valve replacement. Postoperatively, the patient died of hemodynamic deterioration. Autopsy findings showed massive, whole-body edema and mixed systemic amyloidosis (dialysis-related and AA amyloidosis). Clinical and autopsy findings implied that hemodynamic deterioration was caused by increased vascular permeability. The amyloid deposit to the vessel causes inflammatory changes and increases vascular permeability. Mixed systemic amyloidosis occurs very rarely and could increases vascular permeability even more than each single type of amyloidosis. Systemic amyloidosis may be a risk factor for hemodynamic deterioration after cardiac surgery. Patients with longtime hemodialysis and a history associated with dialysis-related amyloidosis would have at least single systemic amyloidosis, which should be considered a contraindication to cardiac surgery with cardiopulmonary bypass.

Visualization of collateral channels with coronary computed tomography angiography for the retrograde approach in percutaneous coronary intervention for chronic total occlusion.

BACKGROUND: There have been no reports about the diagnostic ability of coronary computed tomography angiography (CTA) in evaluating collateral channels used for retrograde chronic total occlusion (CTO) percutaneous coronary intervention (PCI). OBJECTIVE: We investigated the ability and diagnostic accuracy of coronary CTA compared with invasive coronary angiography to detect collaterals used in retrograde CTO PCI and to compared the success rates for wire crossing between collaterals that are detectable and not detectable in coronary CTA. METHODS: We retrospectively reviewed data from 43 patients (55 collaterals) who underwent coronary CTA and PCI for CTO with the retrograde approach. We compared the ability of coronary CTA to visualize collaterals to invasive coronary angiography and evaluated the rates of successful wire crossing between CTA-visible and invisible collaterals. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of coronary CTA for detecting collaterals which were used for the retrograde approach was 100.0%, 50.0%, 65.9%, 100.0%, and 74.5%, respectively. Guidewire collateral crossing was more successful in CT-visible collaterals than those not detectable in CT (74.1% vs. 46.4%, p = 0.034). There were fewer collateral vessel injuries in CTA-visible collaterals (11.1% vs. 32.1%, p = 0.041). CONCLUSION: Coronary CTA provides good visualization of collaterals used in retrograde CTO PCI. For retrograde guidewire crossing, a higher success rate with fewer complications was observed in CTA-visible collaterals than in those not detectable in coronary CTA.

[Efficacy of Multi-vessel Coronary Artery Bypass Grafting for Patient with Low Left Ventricular Ejection Fraction].

The efficacy of multi-vessel coronary artery bypass grafting (CABG) for low left ventricular ejection fraction (LVEF) is controversial. We assessed 31 consecutive low LVEF patients who underwent CABG in our hospital from April 2007 to September 2014. Seventeen patients underwent CABG with distal anastomosis 5 or less (group A), and 14 patients underwent CABG with distal anastomosis 6 or more (group B). Twenty-eight (90%)patients underwent off-pump CABG, and 3 (10%) patients underwent on-pump beating CABG. There was no operative mortality. Postoperative LVEF was improved in group B more than that in group A [9.3±7.0% vs 4.6±9.0% (p=0.023)]. The percentage of patients with improvement of LVEF more than 5% was higher in group B [group A vs group B=29.4% vs 78.6%(p=0.006)]. Early patency rate was 100% (137/137 anastomoses), and cumulative patency rate was not different between 2 groups [group A (1 year:100%, 3 year:100%, 5 year:100%), group B (1 year:100%, 3 year:94.8%, 5 year:94.8%).p=0.177]. The multi-vessel CABG (6 or more distal anastomoses) could be performed safely and would improve LVEF more than less number vessel CABG( 5 or less distal anastomoses) in low LVEF patients.

Temporary ventricular overdrive pacing for electrical storm after coronary artery bypass grafting.

A 57-year-old man who had been receiving chemotherapy for multiple myeloma complained of chest pain and was diagnosed with coronary artery disease. Coronary artery bypass grafting without cardiopulmonary bypass was performed smoothly, and extubation was done in the operating room. The next evening, cluster of ventricular tachycardia and fibrillation triggered by ventricular premature contractions occurred and required multiple electrical defibrillations. Despite intravenous administration of lidocaine, amiodarone, magnesium, and ß-blocker, the storm sustained and was suppressed only by temporary ventricular overdrive pacing. He was discharged on foot.