ObjectiveTo investigate predictive value of intraoperative graft flow measurements during off-pump coronary artery bypass grafting (OPCAB) for early clinical prognosis. MethodsWe retrospectively analyzed the clinical data of 133 patients with three-vessel disease who underwent OPCAB in the Department of Cardiac Surgery of People's Hospital of Peking University in 2013 year. There were 103 males and 30 females with mean age of 62.84±7.13 years. Pulsatility index (PI) and mean flow were measured using a flow metre before the end of surgery. Then the total graft flow and the average graft flow were calculated. Univariate, bivariate correlation and logistic regression analysis were performed for statistical analysis. ResultsThe blood flow and PI of LIMA-to-LAD graft was respectively 28.69±16.90 ml/min and 2.70±1.39, and the total graft flow and the average graft flow was respectively 79.94±37.20 ml/min and 35.55±16.75 ml/min. The PI of LIMA-to-LAD graft was significantly correlated with serum cardiac troponin I(cTnI)level in 12 hours, with the highest serum cTnI level within 48 hours, with ICU stay and with ventilator time (P<0.01), but the correlation was not strong(coefficient correlation <0.4). Compared with the patients without perioperative myocardial infarction (PMI), the blood flow of LIMA-to-LAD graft, the total graft flow and the average graft flow were lower in the patients with PMI (P<0.01). Logistic regression analysis revealed that the total graft flow was an independent predictor of PMI (P=0.004, RR=0.950, 95%CI 0.918-0.984). ConclusionIntraoperative graft flow measurements during OPCAB can predict shortterm prognosis. The lower total graft flow is a risk factor for PMI.
ObjectiveTo evaluate the safety and myocardial protective results of single high-dose Atorvastatin loading before off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 140 patients undergoing selective OPCAB in Jiangsu Province Hospital between February 2010 and August 2011 were recruited in this study. All the patients were randomly divided into a control group and an Atorvastatin loading group (single oral atorvastatin 80 mg)with 70 patients in each group. Biomarkers of cardiac injury including Troponin T (TnT), creatine kinase-MB (CK-MB)and myoglobin (Mb)were measured on admission, 6, 12, 24, 48, 72, 96 and 120 hours after OPCAB. Liver function (alanine aminotransferase (ALT), aspartate aminotransferase (AST)and total bilirubin (TBIL)), serum lipids (total cholesterol (TC), trigl-yceride (TG)and low-density lipoprotein cholesterol (LDL-C))and high-sensitivity C-reactive protein (hsCRP)were measured 2 days before OPCAB, 1, 4 and 7 days after OPCAB as well as before discharge. ResultsAll the patients successfully received OPCAB and were discharged. There was no statistical difference in preoperative clinical characteristics or above indexes between the 2 groups (P > 0.05). There was no statistical difference in ALT or AST between the 2 groups. Incidences of ALT (4.29% vs. 5.71%, P=1.000)and AST (4.29% vs. 0%, P=0.245)greater than 3 times above the upper normal limit were not statistically different between the 2 groups. Peak levels of postoperative TnT (0.23±0.27 ng/ml vs. 0.16±0.24 ng/ml, P=0.011), CK-MB (29.57±30.04 U/L vs. 17.73±14.07 U/L, P=0.001)and hsCRP (31.85±22.89 mg/L vs. 20.81±10.96 mg/L, P=0.001)of the control group were significantly higher than those of Atorvastatin loading group. Incidences of TnT greater than the upper normal limit (47.1% vs. 65.7%, P=0.041)and TnT greater than 5 times above the upper normal limit (8.6% vs. 22.9%, P=0.037)of Atorvastatin loading group were significantly lower than those of the control group. Incidence of CK-MB greater than the upper normal limit of Atorvastatin loading group was significantly lower than that of the control group (20.0% vs. 54.3%, P=0.000). ConclusionSingle high-dose Atorvastatin loading before OPCAB is safe and can alleviate postoperative myocardial injury.
ObjectiveTo investigate the perioperative hemodynamic changes of off-pump coronary artery bypass grafting (OPCABG) patients monitored by pulse recorded analysis method (MostCare/PRAM devices) and its relationship with the prognosis.MethodsA total of 89 patients who underwent OPCABG from October 2016 to January 2017 in Beiijng Anzhen Hospital were included, including 53 males and 36 females aged 60.50±8.40 years. The hemodynamic changes were recorded. The patients were divided into two groups (a major adverse cardiovascular events group and a stable group) according to whether major adverse cardiovascular events occurred or not. The difference of hemodynamic changes between the two groups was analysed.ResultsThe mean percentage increases of stroke volume (SV) in the passive leg raising (PLR) test before opening chest and after chest closure were 23.00%±3.20% and 29.40%±3.70%, respectively. Hemodynamic data were analysed seven times, namely, anaesthesia, opening chest, heparin administration, coronary artery bypass grafting, protamine administration, thoracic closure and after operation. SV was significantly decreased during above periods, while systemic vascular resistance index (SVRI) was significantlyincreased. Cardiac circle efficiency (CCE) and maximum pressure gradient (dP/dT) were decreased after anaesthesia, and decreased to the lowest value during the procedure of bypass grafting, and then they began to increase gradually after the manipulation of bypass grafting was finished. Stroke volume variation (SVV) and pulse pressure variation (PPV) were slightly decreased during anaesthesia, then increased significantly through the whole surgery. Major adverse cardiovascular events occurred in 9 patients and 4 of them died. The basic mean values of SVRI, SVV and PPV of patients in the major adverse cardiovascular events group before opening chest were significantly higher than those of patients in the stable group. There was no significant difference in the mean values of CCE, dP/dT or SV between the two groups. There was no significant correlation between the prognosis and the mean values of SVRI, SVV, PPV, CCE, dP/dT or SV.ConclusionThe hemodynamic indexes are not stable, thus, it is necessary to monitor the perioperative hemodynamic changes of OPCABG patients timely by MostCare/PRAM device and adjust treatment measures accordingly.
ObjectiveTo evaluate immediate outcomes of 8-0 Prolene sutures for distal anastomosis during off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 101 patients who underwent OPCAB in Department of Cardiac Surgery of Beijing Anzhen Hospital in 2010 and 2012 respectively were enrolled in this study. There were 87 male and 14 female patients with their age of 46-82 (61.35±8.24)years. All the 36 patients in 2010 received 7-0 Prolene sutures for distal anastomosis, and the 65 patients in 2012 received 8-0 Prolene sutures for distal anastomosis. After anastomosis, transit time flow measurement was used to measure blood flow indexes of graft vessels[left internal mammary artery (LIMA)and saphenous vein (SV)] including blood flow volume (BFV), pulsatility index (PI)and diastolic filling fraction (DF), which were compared between patients receiving 7-0 and 8-0 Prolene sutures. ResultsBFV of LIMA grafts with 8-0 Prolene sutures (n=44)was significantly larger than that with 7-0 Prolene sutures (n=30)[ (33.70±21.13)ml/min vs. (27.50±17.34)ml/min, P=0.032], while PI of LIMA grafts with 8-0 Prolene sutures was significantly smaller than that with 7-0 Prolene sutures (2.15±0.69 vs. 2.58±1.01, P=0.047). BFV and PI of SV grafts with 8-0 Prolene sutures (n=21) were not statistically different from those with 7-0 Prolene sutures (n=6)[ (34.19±16.00)ml/min vs. (29.00±15.48)ml/min, P > 0.05;2.07±0.53 vs. 1.95±0.55, P > 0.05]. DF of all the grafts was greater than 50%, and there was no statistical difference in DF between the 2 groups (P > 0.05). Conclusion8-0 Prolene sutures for LIMA-to-left anterior descending artery can improve BFV and decrease PI of LIMA grafts, which reflects better immediate graft patency of the distal anastomosis and helps improve surgical success rate and long-term prognosis.
ObjectiveTo explore the incidence of total occlusion of right coronary artery (RCA)and its treatment strategy during off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 1 153 patients with total RCA occlusion were chosen from 6 206 patients who underwent OPCAB in Beijing Anzhen Hospital from January 1, 2005 to December 31, 2012. There were 889 male (77.1%)and 264 female (22.9%)patients with their age of 45-78 years. The incidence of total RCA occlusion was calculated, and its treatment strategies were discussed. ResultsAmong 6 206 OPCAB patients, 1 153 patients (18.6%)had total RCA occlusion. All the 1 153 patients successfully received OPCAB, but 13 patients (1.1%)died postoperatively. Thirty-four patients (2.9%)had postoperative complications including cerebral infarction, mild to moderate pleural effusion and poor wound healing, all of whom were cured or improved, and all the other patients were discharged uneventfully. A total of 1 110 patients (97.4%)were followed up for 1 month to 7 years, and 30 patients were lost during follow-up. Angina symptoms disappeared in 758 patients and were relieved in 352 patients. During follow-up, 64-row helical CT of 586 patients with preoperative total RCA occlusion showed good graft patency, and echocardiography and nuclear myocardial scan showed improved left ventricular systolic function and myocardial blood flow. ConclusionThe incidence of total RCA occlusion is 18.6% in our study. Appropriate surgical strategies are needed according to individualized patient conditions to get satisfactory clinical outcomes.
ObjectiveTo evaluate the changes of the flow parameters before and after the anastomotic port exploration and dredging during coronary artery bypass grafting by using the transit time flow measurement (TTFM).MethodsA total of 167 patients who underwent continuous coronary artery bypass grafting and anastomotic port exploration and dredging surgery in Beijing Anzhen Hospital from 2018 to 2019 were enrolled in this study. There were 136 male and 31 female patients aged 41-82 (58.35±17.26) years. If the probe entered and exited the anastomotic port smoothly, it was recorded as a non-resistance group; if the resistance existed but the probe could pass and exit, it was recorded as a resistance group; if the probe could not pass the anastomotic port for obvious resistance, it was recorded as the stenosis group. In the stenosis group, the grafts were re-anastomosed and the flow parameters were re-measured by TTFM.ResultsA total of 202 anastomotic ports were carried out by exploration and dredging. Among them, 87 anastomosis (43.1%) were in the non-resistance group, and there was no significant change in the blood flow volume (BFV) and pulsatility index (PI) before and after exploration and dredging (6.16±3.41 mL/min vs. 6.18±3.44 mL/min, P=0.90; 7.06±2.84 vs. 6.96±2.49, P=0.50). Sixty-four anastomosis (31.7%) were in the resistance group, the BFV was higher after exploration and dredging than that before exploration and dredging (17.11±7.52 mL/min vs. 4.96±3.32 mL/min, P<0.01), while the PI was significantly smaller (3.78±2.20 vs. 8.58±2.97, P<0.01). Fifty-one anastomosis (25.2%) were in the stenosis group, and there was no significant change in the BFV and PI before and after exploration and dredging (3.44±1.95 mL/min vs. 3.48±2.11 mL/min, P=0.84; 10.74±4.12 vs. 10.54±4.11, P=0.36). After re-anastomosis, the BFV was higher (16.48±7.67 mL/min, P<0.01) and the PI deceased (3.43±1.39, P<0.01) than that before exploration and dredging.ConclusionThe application of anastomotic exploration and dredging can reduce the occurrence of re-anastomosis, and promptly find and solve the stenosis of the distal coronary artery, improve the poor perfusion of distal coronary, and thus improves the prognosis of patients.
Objective To explore the factors affecting the operation of coronary artery bypass grafting with heart beating and improve the effect of the operation. MethodsFrom January 2012 to June 2016, 898 patients with coronary heart disease who received cardiovascular surgery in the Second Affiliated Hospital of Jilin University were analyzed retrospectively. All patients only underwent coronary artery bypass grafting with beating heart. Among them, 797 patients underwent the off-pump coronary artery bypass grafting (an OPCABG group, 592 males and 205 females, with an average age of 60.5±8.4 years); another 101 patients received on-pump beating heart coronary artery bypass grafting (an OPBH group, 77 males and 24 females, with an average age of 61.5±8.2 years). ResultsThe average number of grafts in the OPCABG group was 3.36±0.74, and in the OPBH group was 3.71±0.69 (P<0.05). The postoperative ventilation time (10.8±9.5 h vs. 20.6±12.3 h), ICU stay (28.8±15.5 h vs. 37.4±30.8 h), hospital stay (10.9±4.8 d vs. 14.8±8.6 d), mortality (1.1% vs. 3.0%), the utilization rate of intra-aortic balloon pump (2.4% vs. 8.9%) and extracorporeal membrane oxygenation (0.5% vs. 5.0%) were significantly different between the OPCABG group and OPBH group (all P<0.05). Twelve patients died after surgery, and the total bloodless operation ratio was 91.3%. ConclusionThe results show that most patients can achieve good results with the help of apical fixation and myocardial fixator, improved surgical techniques and methods, good anesthesia management as well as flexible and accurate use of vasoactive drugs. But extracorporeal circulation is necessary in the patients with large left ventricle, low ejection fraction and hemodynamic instability after intraoperatively moving the heart.
Objective To analyse the characteristic of hemodynamic changes during off-pump coronary artery bypass grafting （OPCAB）. Methods One hundred consecutive patients received OPCAB and the hemodynamic changes were monitored during the grafts was anastomosed. They were anastomosis of the left internal mammary artery （LIMA） to left anterior descending （LAD） in 97 patients, the anastomosis of saphenous vein （SV） or radial artery（RA） to right coronary artery （RCA） including posterior descending artery （PDA） and posterior left branch （PLB） in 84 patients, to left circumflex coronary artery （LCX） in 50 patients, to optuse marginal artery（OM） in 27 patients, to diagonal artery （DG） in 25 patients. The grafts number in each patient was 3. 1±0. 7. Results Hemodynamics changed when LAD and DG were anastomosed with significantly increase of heart rate （HR）, significantly decrease of mean arterial pressure （MAP） and left ventricular stroke work index （LVSWI, P〈0.05）. Hemodynamics changed when LCX,PDA,PLB,OM were anastomosed with significantly increase of HR and center veinous pressure （CVP, P 〈 0. 05）, significantly decrease of MAP, cardiac index （CI）, stroke index （SI）, right ventricular ejection fraction （RVEF）, right ventricular end-diastolic volume （RVEDV）, LVSWI and right ventricular stroke work index （RVSWI,P〈0.05）. Hemodynamics tended to be stable and CI improved at the end of operation. Conclusion There are no or little hemodynamic changes during the LAD and DG were anastomosed in OPCAB, while hemodynamics changed significantly during LCX, PDA, PLB and OM were anastomosed. Hemodynamics become stable and CI improves after operation.
Objective To evaluate the efficacy of preoperative low-dose oral amiodarone for the prevention of atrial fibrillation （AF） after off-pump coronary artery bypass grafting （OPCAB） in patients older than 70 years. Methods A total of 156 patients older than 70 years who underwent OPCAB in Qingdao Fuwai Cardiovascular Disease Hospital from January 2011 to June 2012 were included in this prospective，double-blind and placebo controlled study. Preoperatively，all the 156 patients were randomly divided into amiodarone group and control group. In the amiodarone group，there were 80 patients including 38 male and 42 female patients who were given oral amiodarone （trade name： Cordarone） 200 mg，three times a day，3-5 days before surgery，and amiodarone was stopped on the OPCAB day and postoperatively. Preoperative duration of amiodarone intake was 4.0±1.2 days，and total amiodarone dosage was 2.6±0.5 g. In the control group，there were 76 patients including 35 male and 41 female patients who were given oral placebo as the same medication schedule，and preoperative duration of placebo intake was 4.0±1.4 days. Operation time，graft number，postoperative AF incidence，AF duration，hospital stay and readmission rate for cardiovascular events within 6 postoperative months were compared between the two groups. Results There was no in-hospital death in either group. There was no statistical difference in graft number，operation time，AF duration of patients who had postoperative AF，or postoperative hospital stay between the two groups. Postoperative AF incidence of the amiodarone group was significantly lower than that of the control group ［18.7% （15/80） vs. 34.2% （26/76），P=0.028］. Seventy-three patients in the amiodarone group （91.3%） and 66 patients in the control group （86.8%） were followed up for 8-24 months. During follow-up，2 patients in the amiodarone group died of acute myocardial infarction and cerebral hemorrhage respectively. There was no statistical difference in readmission rate for cardiovascular events within 6 postoperative months between the 2 groups ［6.8% （5/73） vs. 6.1% （4/66），P=0.860］ .Conclusion Preoperative low-dose oral amiodarone can significantly reduce the incidence of postoperative AF in patients older than 70 years undergoing OPCAB.