Abstract： Objective To evaluate clinical outcomes of plication of left ventricular aneurysm during off-pump coronary artery bypass grafting （OPCAB）. Methods A total of 114 patients who underwent coronary artery bypass grafting （CABG） and concomitant surgical treatment for left ventricular aneurysm from January 2007 to January 2011 in Beijing Anzhen Hospital were included in this study. All the patients were divided into 2 groups according to the different surgical procedures they received. In groupⅠ， there were 76 patients including 57 males and 19 females with their average age of （63.4±7.8） years who underwent CABG and left ventricular aneurysmectomy under cardiopulmonary bypass on the non-beating heart. In groupⅡ， there were 38 patients including 32 males and 6 females with their average age of （60.6±8.9） years who underwent OPCAB and plication of the left ventricular aneurysm on the beating heart. Preoperative data were not statistically different between the 2 groups except that the percentage of the left ventricular aneurysm to the left ventricle of groupⅠwas significantly larger than that of groupⅡ（42.2%±13.6% vs. 26.5%±12.3％， t=5.499， P=0.000）. Postoperative clinical outcomes and morbidities were compared between the 2 groups， and all the patients were followed up for 6 months. Results There was 2 in-hospital death in groupⅠ， one for postoperative refractory ventricular arrhythmia， and the other for severe pneumonia. There was 1 in-hospital death in groupⅡ because of perioperative myocardial infarction. Postoperative thoracic drainage， incidence of reexploration for bleeding， mechanical ventilation time and incidence of intra-aortic balloon pump （IABP） implantation were not statistically different between the 2 groups （P＞0.05）. To compare their echocardiography outcomes at early postoperative stage and 6 months after discharge with preoperative values， left ventricular end-diastolic dimensions （LVEDD） at early postoperative stage and 6 months after discharge were both signific antly decreased than preoperative value in both groups ［groupⅠ： （54.0±7.8） mm amp; （56.0±8.1） mm vs. （59.6±6.6） mm， groupⅡ： （52.0±7.2） mm amp; （53.6±5.3） mm vs. （57.9±5.4） mm］， and left ventricular ejection fraction （LVEF） at early postoperative stage and 6 months after discharge were both significantly higher than preoperative value in both groups （groupⅠ：43.5%±3.2％ amp; 55.7%±3.7% vs. 38.0%±7.4%， groupⅡ：44.7%±2.8％ amp; 57.0%±3.5% vs. 41.0%±6.6%）， but there was no statistical difference in LVEDD and LVEF between the 2 groups（P＞0.05）. Conclusion Plication of left ventricular aneurysm during OPCAB is a safe and effective surgical procedure， and possibly more appropriate for patients with a smaller left ventricular aneurysm.
Abstract： Objective To explore the application of lower sternal incision with on-pump， beating heart intracardiac procedures in mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 42 patients （minimal incision group） with valvular heart diseases who underwent MVR via lower sternal incision under the beating heart condition in Xinqiao Hospital of the Third Military Medical University from January 2011 to December 2011. There were 16 male and 26 female patients with their average age of 42.3±12.7 years in the minimal incision group. We also randomly selected 42 patients with valvular heart diseases who underwent MVR via routine midline sternotomy during the same period in our department as the control group. There were 18 male and 24 female patients with their average age of 43.8±13.1 years in the control group. Operation time， cardiopulmonary bypass time， major complications， chest drainage in postoperative 24 hours， skin incision length and average postoperative hospital stay were observed and compared between the two groups. Results There was no major perioperative complication such as in-hospital death. There was no reexploration for postoperative bleeding， complete atrioventricular block， embolism or perivalvular leakage in the minimal incision group. There was no statistical difference in cardiopulmonary bypass time， operation time， or the incidence of reexploration for postoperative bleeding， wound infection and perivalvular leakage between the two groups（P＞0.05）. The skin incision length in the minimal incision group was shortened by 5.2 cm compared to that in the control group （7.9±1.4 cm vs. 13.1±3.3 cm， P=0.000）. Chest drainage in postoperative 24 hours in the minimal incision group was significantly less than that of the control group （183.6±40.2 ml vs. 273.4±59.9 ml， P=0.000）. Postoperative hospital stay in the minimal incision group was significantly shorter than that of the control group （8.1±1.3 d vs. 10.6±2.1 d， P=0.000）. Forty patients in the minimal incision group were followed up for 3-15 months and 2 patients were lost during follow-up. Four patients had postoperative wound pain， and the majority of patients didn’t have significant wound scar formation but a satisfactory quality of life. Thirty-eight patients in the control group were followed up for 3-15 months， 4 patients were lost during follow-up， and 17 patients had postoperative wound pain. Conclusion Lower sternal incision with beating heart can reduce the surgical injury， simplify the operation procedure and improve the therapeutic efficacy. It is a safe， effective and esthetic surgical approach for MVR.