Objective To compare milrinone （MIN）, Phenoxybenzamine （PHE），and mixture of nitroglycerin and verapamil(NVC) for the prevention and treatment of human radial artery spasm. Methods Residuary radial arteries from 30 patients undergoing coronary artery bypass grafting （CABG） using autologous radial artery from March to September of 2012 in General Hospital of Shenyang Military District were collected. All the artery specimens were cut into 60 vessel rings of 3 mm in width and hanged in the Organ-Bath. Using a random number table，all the vessel rings were divided into 4 groups：PHE group，NVC group，MIN group and blank group （control group）. Firstly，20 vessel rings were used for spasm relaxation experiment with 5 rings in each group. Phenylephrine was added into the Organ-Bath to reach final concentration of 10-3 mol/L in order to cause vessel rings spasm. PHE of 1 mmol/L，NVC of both 30 μmol/L，MIN of 30 μmol/L and Krebs-Ringer’s solution were added respectively into above groups to compare the relaxant effect of these vasodilators on radial artery spasm. Secondly，the other 40 vessel rings were used for spasm prevention experiment with 10 rings in each group. All the 40 vessel rings were dipped in above 4 groups. After 30 minutes，phenylephrine was added to the Organ-Bath to reach final concentration of 10-3 mol/L. Time-dependent constriction of the vessel rings were compared to examine the prevention effect of these vasodilators on radial artery spasm. Results In the spasm relaxation experiment, vessel ring spasm relaxed most quickly in NVC group （P＜ 0.01）. Vessel rings in MIN group relaxed more slowly but steadily （P＜ 0.05）. Vessel rings in PHE group relaxed most slowly （P＜0.01）. And there was no relaxation in the control group. In the spasm prevention experiment，vessel rings in the control group contracted （spasm） 100% immediately after phenylephrine administration. Vessel rings in MIN group contracted immediately after phenylephrine administration too，but slower than the control group（P＜0.01）. Vessel rings in NVC group did not contract right after phenylephrine administration，but the sedentary tension of these vessel rings gradually increased 120 minutes after phenylephrine administration，and vessel ring contraction reached 46.89% 240 minutes after phenylephrine administration. There was no vessel ring contraction in PHE group. Conclusions All the vasodilators in our experiment are effective for the prevention and treatment of radial artery spasm to different degree，but each medication has its own characteristics，vasodilatation result and time-dependent effect. NVC is most effective to dilate radial artery which has been in spasm state, while radial artery pretreated by PHE is least to become spasm after being stimulated.
Objective To explore perioperative outcomes of coronary artery bypass grafting （CABG） using the radialartery as the second arterial graft. Methods Clinical data of 175 consecutive patients undergoing off-pump coronary artery bypass grafting （OPCAB） in General Hospital of Shenyang Military Command from August 2011 to April 2012 were retrospectively analyzed. All the 175 patients were divided into two groups. There were 75 patients including 49 male and 26 female patients with their age of 56.8±8.2 years in group 1，who received radial artery as a graft vessel. There were 100patients including 66 male and 34 female patients with their age of 57.7±8.1 years in group 2，who received great saphenousvein but not radial artery as the graft vessel. The use of left internal mammary artery as a graft vessel was 100% in both groups. Perioperative cardiovascular events and other clinical results were compared between the two groups. Results All the patients survived OPCAB and there was no 30-day death. There was no statistical difference in operation time，thoracic drainage within the first 24 hours after surgery or postoperative hospital stay between the two groups（P＞0.05）. Length of postoperative ICU stay and mechanical ventilation time of group 1 were shorter than those of group 2，although the differencewas not statistically significant. The percentage of patients receiving prolonged postoperative inotropic therapy of group 2 was higher than that of group 1 ［16% （16/100） vs. 12% （9/75）］，although the difference was not statistically significant. Postoperatively，there was no patient in group 1 who had new-onset myocardial ischemia or received intra-aortic balloon pump （IABP） support for hemodynamic instability. In group 2，3 patients had new-onset myocardial ischemia and 2 patientsreceived IABP support after OPCAB. Conclusion Radial artery can partly replace great saphenous vein as a graft vesselfor OPCAB，which does not increase the risk of perioperative cardiovascular events but is beneficial for postoperativerecovery to some degree. Radial artery can be more extensively used in CABG.
Objective To summarize the experiences of off-pump coronary artery bypass grafting (off-pump CABG) and on-pump coronary artery bypass grafting (onpump CABG) for patients with coronary artery diseases and to improve the surgical techniques and clinical results. Methods Coronary artery bypass grafting(CABG) were performed from January 2000 to March 2009 on 698 consecutive cases, including 551 male and 147 female with a mean age of 67.2 years(range, 28.0-79.0). There were 552 cases with angina pectoris and 131 with old myocardial infarction. Preoperative cardiac function showed 301 cases in New York Heart Association classⅡ, 339 in class Ⅲ,and 58 in class Ⅳ. Coronary angiography revealed single vessel disease in 21 cases, 2vessel disease in 87, 3vessel disease in 590, and 201 cases had concomitant left main lesions.There were 687 elective CABG and 11 emergency / urgent ones. Offpump CABG were performed on 346 cases and the others received onpump CABG . Results A total number of 2 025 grafts ( range,1-6 grafts, mean, 2.9 grafts /case ) were constructed with 693 left internal mammary arteries,115 free right mammary arteries,229 left radial arteries, and 81 right radial arteries. Total arterial bypass grafting was feasible on 126 cases. Postoperative ventilation duration varied from 0-127 hours (mean, 11.5 hours). Fasttrack procedure was offered to 38 cases with good results.Introaortic balloon pump support were provided to 1 patient preoperatively and 27 postoperatively. There were 25 deaths with a mortality of 3.64% for the elective cases with the cause of acute myocardial infarction ( 5 cases ), low cardiac output syndrome (3 cases),protamine reaction (2 cases),respiratory failure (3 cases), renal failure (2 cases),and multiorgan failure (10 cases).Four deaths occurred to urgent cases with a mortality of 36.36% from low cardiac output syndrome ( 3 cases) and acute myocardial infarction (1 case). One hundred and fiftyone cases（21.63%）developed atrial fibrilation among which 147（97.35%）returned to sinus rhythem with administration of electrolytes and Amiodarone. Resternotomy were performed for bleeding in 12 cases. Upon discharge from the hospital, 511 patients were free from angina while 20 other patients still had coexisting relieved angina. Postoperative followup was carried out on 415 cases（62.03%）for a period of 1month to 8.2 years with 3 deaths for lung cancer (1 case), car accident(1case), and unknown reasons (1 case). Number of patients who were free from angina was 317 and 21 for those who had recurrent angina. The cardiac function improved with 269 cases（65.29%）in New York Heart Association class Ⅱ, 142（34.46%）class Ⅲ, and 1（0.24%） class Ⅳ. Conclusion Good surgical results could be achieved with careful analysis of native Chinese patients’ coronary vessels, individualized operative plan, control of operative risk factors, and proper selection of bypass conduits. Aggressive use of IABP can provide essential support for patients with poor left ventricular function and other high risk factors.
Abstract: Objective To compare the effects of nitroglycerine (NTG)， Verapamil(VP), papaverine(PA) and the mixed solution of Verapamil and nitroglycerine (VG) on relaxing function of human radial arteries. Methods The radial arteries of thirty patients were used during the operation of coronary artery bypass grafting (CABG). A short segment (1.0-1.5cm) of radial arteris were taken from the distal end of radial arteries of each patient and were cut into vascular rings, which were mounted in the organ bath chamber and then subject to a series of tests for vascular smooth muscle viability and endothelial integrity. The effects of five storage solutions on the relaxing function were evaluated by “OrganBath” technique. The five solutions included: (1) Ringer’ s solution (control group); (2) VP solution (VP group); (3) NTG solution (NTG group); (4) PA solution (PA group); (5) VG solution (VG group). First, challenged with phenylephrine (10-5mol/L), vasorelaxant effect of these drugs (effect onset and efficacy) was observed at different time point and resting tension was recorded. Second, after 30min preincubation with either verapamil, papaverine, phenoxybenzamine or VG mixture, potassium chloride (final concentration of 60mmol/L) was added in the organ bath chamber and then vasoconstriction was observed subsequently. Finally, after 30min pretreatment of different antispasmodic agent in the same way as described above, the vascular rings were mounted in organ bath chamber and challenged with phenylephrine(10-5mol/L). Vascular spasticity and vosospasm duration were observed at different time point which might provide guidance for optimal timing of clinical application. Results The radial arteries in VG, VP, NTG and PA solutions were relaxed in 11 min after vasospasm and there was no difference between them (Pgt;0.05). But during the initial three minutes，the relaxation effect of VG and NTG was significantly better than other two groups. Relaxation curve showed that the ability of vasodilatation of VG, NTG, VP and PA decreased in order. In the experiment about antivasospasm pretreatment of radial arteries, there was no difference between VG and VP group (Pgt;0.05 ), whose effects were better than NTG and PA group(Plt;0.05 ). After cold storage for 24h, VG and VP still could prevent vasospasm. But NTG and PA hardly had any function and there was no difference compared with the control group (Pgt;0.05 ). Conclusion Although in the final all these drugs could prevent and relieve vasospasm of radial arteries in the different level, it appeared that a combination of verapamil and nitroglycenn is more fit for treating radial artery during CABG operation than other drugs.
Abstract: Though the use of the radial artery (RA) as a coronary artery bypass graft has been accepted world widely in myocardial revascularization, there has been no uniformity regarding harvest techniques, assessment of the adequacy of hand collateral circulation, antispasm rotocols, selection of target vessels, and the site of proximal anastomosis. It is widely believed and practiced that the RA should be harvested as a pedicle graft and preferably be used to bypass critically stenosed (gt;70% stenosis) coronary arteries. It is used either as a free graft with proximal anastomosis to the ascending aorta or as a composite arterial graft along with the left or right internal thoracic artery. The patency of RA grafts depends on the severity of the target coronary artery stenosis and target artery location rather than its use as an aortocoronary conduit or composite graft. Though lacking of evidences, most surgeons use antispasm therapy for RA conduits. There are advantages in using RA as an alternative for right internal mammary artery in total artery coronary revascularization.
Objective\ To search for suitable and multiple arterial grafts for myocardial revascularization, in order to avoid the long term problems of vein graft atherosclerosis. Methods\ Between October 1994 and April 2000, 456 consecutive patients underwent myocardial revascularization using radial artery and internal mammary artery. In coronary artery bypass grafting, minimally traumatic harvesting radial artery techniques and new pharmacologic antispasmodic agents was used. Results\ 448 internal mammary artery ...
ObjectiveTo explore the mid-term outcomes achieved by using the left internal mammary artery to saphenous vein composite grafts in off-pump coronary artery bypass surgery (OPCAB) for elderly patients. MethodsA total of 59 elderly patients (≥70 years old) underwent OPCAB by using left internal mammary artery (LIMA) to radial artery (RA) or saphenous vein (SV) composite grafts in Xinhua Hospital between March 2006 and October 2012. There was 37 males and 22 females at age of 72.71±1.95 years. Twenty one patients used LIMA-SV composite grafts (LIMA-SV group), and 38 patients used LIMA-RA composite grafts (LIMA-RA group). ResultsAll patients successfully underwent OPCAB with LIMA-SV or LIMA-RA composite grafts. There was one early death in the LIMA-RA group. No statistical differences in early postoperative outcomes were found between the two groups (P > 0.05). During a follow-up of 12 to 91 months, no patient occurred revascularization. There were no statistical differences in overall survival or graft patency rate, and 1 year, 3 years or 5 years survival rates between the two groups (P > 0.05). The patency rate of LIMA in each group was 100% respectively. There was also no statistical difference in overall patency rate of SV and RA between the two groups at the end of 1 year, 3 years or 5 years (P > 0.05). ConclusionAlthough artery grafts are the best choice for OPCAB, LIMA-SV composite grafts can be used as an alternative graft for elderly patients whose RA or right internal mammary artery is not possible or advisable.
ObjectiveTo explore the outcomes achieved by using left internal mammary artery (LIMA) to radial artery (RA) or saphenous vein (SV) Y-composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease. MethodsFrom January 2009 through May 2015, 56 patients (36 males and 20 females) with multiple vessel disease underwent MIDCAB with LIMA-RA or LIMA-SV Y-composite grafts without cardiopulmonary bypass in our hospital. MIDCAB was performed through a left anterior minithoracotomy. Thirty four patients used LIMA-RA grafts, and twenty two patients used LIMA-SV grafts. ResultsAll patients success-fully underwent MIDCAB with LIMA-SV or LIMA-RA Y-composite grafts. No patient required to convert to sternotomy during the surgery. Revascularization was performed for 2 target vessels in 12 patients, 3 target vessels in 41 patients and 4 target vessels in 3 patients. Mean postoperative ventilation time was 27.14±31.35 h. Mean ICU time was 3.16±2.53 d, and mean postoperative inhosptial time was 11.89±3.91 d. Thirty-day mortality was 1.79% (1/56). At a follow-up of 1 to 77 months, no patients received revascularization. The overall survival at 2 years postoperatively was 94.4%±5.4% in the LIMA-RA group and 86.8%±9.2% in the LIMA-SV group (P=0.299). The patency rate of LIMA was 100.0%. The overall patency rate of RA or SV grafts at 2 years postoperatively was 90.3%±5.3% or 86.7%±6.3% with no statistical difference (P=0.265). ConclusionMIDCAB with LIMA-RA or LIMA-SV Y-composite grafts is a safe and an effective procedure with favorable early and mid-term outcomes for patients with multiple vessel disease. LIMA-SV composite graft can be used as an alternative graft for patient whose RA is not possible or advisable.
ObjectiveTo systematically review the efficacy and safety of endoscopic radial artery harvesting for coronary artery bypass grafting (CABG). MethodsDatabases including The Cochrane Library (Issue2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to August 2015 to collect randomized controlled trials (RCTs) and cohort studies about endoscopic radial artery harvesting technique versus traditional incision technique for CABG. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.2 software. ResultsA total of 12 studies involving 1359 patients were included. The results of meta-analysis showed that no significant differences were found between the two groups in perioperative mortality (OR=0.66, 95%CI 0.17 to 2.57, P=0.55), the incidence of postoperative myocardial infarction (OR=0.78, 95%CI 0.30 to 2.06, P=0.62), vascular graft patency rate (OR=1.40, 95%CI 0.80 to 2.45, P=0.24) and the incidence of wound infection (OR=0.59, 95%CI 0.33 to 1.07, P=0.08). The endoscopic group showed significantly lower incidence of hematoma formation (OR=0.39, 95%CI 0.20 to 0.74, P=0.004) and paresthesia (OR=0.44, 95%CI 0.22 to 0.88, P=0.02) than that of the incision group. ConclusionCurrent evidence shows that, compared with the incision technique, the endoscopic radial artery harvesting could significantly reduce the incidence of hematoma formation and paresthesia in patients underwent CABG. Due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by carrying out more high-quality studies.
The radial artery pulse wave contains a wealth of physiological and pathological information about the human body, and non-invasive studies of the radial artery pulse wave can assess arterial vascular elasticity in different age groups.The piezoelectric pulse wave transducers were used to non-invasively acquire radial artery pulse waves at different contact pressures in young and middle-aged and elderly populations. The radial artery waveforms were decomposed using a triangular blood flow model fitting method to obtain forward and reflected waves and calculate reflection parameters. Finally a correlation analysis and regression analysis of the contact pressure Psensor with the reflection parameters was carried out. The results showed that the reflection parameters RM, RI and Rd had a strong negative correlation with Psensor in both types of subjects, and the correlation coefficients and slopes of the regression curves were significantly different between the two types of subjects (P<0.05). Based on the results of this study, excessive contact pressure on the transducer should be avoided when detecting radial artery reflection waves in clinical practice. The results also show that the magnitude of the slope of the regression curve between the reflection parameters and the transducer contact pressure may be a potentially useful indicator for quantifying the elastic properties of the vessel.