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 evaluate the validity of European System for Cardiac Operative Risk Evaluation (EuroSCORE) Ⅱ for predicting in-hospital mortality and prolonged ICU stay after Sun's procedure (total aortic arch replacement with stented elephant trunk implantation) for Stanford type A aortic dissection (STAAD). MethodsClinical data of 384 STAAD patients undergoing Sun's procedure in Beijing Anzhen Hospital between February 2009 and February 2012 were retrospectively analyzed, including 228 (59.38%) patients with acute STAAD. Accoding to EuroSCORE Ⅱ to predict postoperative mortality, all the patients were divided into a low-risk group, a medium-risk group, a high-risk group and an extremely-high-risk group. There were 296 patients including 52 females in the low-risk group with their age of 45.39±10.75 years, 70 patients including 19 females in the medium-risk group with their age of 47.67±11.26 years, 13 patients including 5 females in the high-risk group with their age of 53.08±4.94 years, and 5 patients including 1 female patient in the extremely-high-risk group with their age of 41.60±11.08 years. All the patients received Sun's procedure under deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. EuroSCORE Ⅱ was used to predict postoperative mortality and prolonged ICU stay. ResultsIn-hospital mortality was 8.07% (31/384). Mean length of ICU stay was 3.06 days. Length of ICU stay of 42 patients was longer than 7 days. For low-risk group, the predicted mortality was lower than the actual mortality. For medium-risk, high-risk and extremely-high-risk groups, the predicted mortality was higher than the actual mortality. EuroSCORE Ⅱ showed unsatisfactory discriminatory ability to predict postoperative mortality and prolonged ICU stay. The area under ROC curve were 0.49 and 0.52 respectively. The calibration was also poor for predicting postoperative mortality and prolonged ICU stay (P<0.001). ConclusionsEuroSCORE Ⅱ is not satisfactory for predicting mortality and prolonged ICU stay after Sun's procedure for the treatment of STAAD. A new risk evaluating system specific for STAAD is needed.