Objective To summarize experience in surgery about off-pump coronary artery bypass grafting(OPCAB)for the treatment of left main with three-vessel coronary disease. Methods OPCAB were perfomed in 33 patients of left main with three-vessel coronary disease. The left internal mammary artery(LIMA) was used to be the graft vessel to anastomose with left anterior descending. The saphenous vein was used to be the graft vessel to anastomose with left circumflex coronary artery, right coronary artery/posterior descend artery, diagonal branch, obtuse marginal branch. Results There was no operative death.The average number of grafting was 3.4 per case.There was no perioperative myocardial infarction, respiratory or hepatic or renal failure and other serious complications.Blood transfusion was not needed in 33% of cases.The angina pectoris was free after operation in all cases. Conclusions OPCAB is safe and effective for the treatment of left main with three-vessel coronary disease. The injuries were minimal. Preoperative preparation, using of intra-aortic balloon counterpulsation, operative matching, techniques and to create a skill and swift team for meet an emergency are the key factors to assure surgical outcome.
Objective To investigate the effect of combined carotid endarterectomy (CEA) and offpump coronary artery bypass grafting (OPCAB) on patients with carotid arteriostenosis and coronary heart diseases. Methods A total of 121 consecutive patients with carotid arteriostenosis and coronary artery diseases underwent CEA and OPCAB between January 2003 and December 2009 in Nanjing First Hospital of Nanjing Medical University. There were 81 males and 40 females, with their ages ranged from 62 to 72 years (67.2±4.5 years). All patients had 3vessel coronary artery lesions, and there were 3 cases of left main coronary artery lesion. Unilateral carotid arteriostenosis (≥50%) occurred in 95 patients, and bilateral (≥50%) in 26 patients. The occurrence of stroke, myocardial infarction, angina pectoris and other complications after operation was observed, and followup was carried out. Results All patients underwent unilateral CEA including 50 on the right side and 71 left. The mean block time of carotid artery in CEA was 20.5±7.0 minutes. The average number of distal grafts per patient in OPCAB was 2.9±0.3. None of the patients had stroke or myocardial infarction and no perioperative death occurred. Eightyseven patients felt well in terms of their neuropsycho symptoms; 32 felt no change; and 2 worsened. Follow-up was done for all the patients with a follow-up rate of 100%. The mean time of the follow-up was 67.5±12.5 months. During this period, none of the patients manifested stroke, myocardial infarction or neuropsycho symptoms. Conclusion Concomitant OPCAB and CEA is a safe and effective procedure in patients with carotid arteriostenosis and coronary artery diseases. It can reduce the rate of postoperative stroke significantly. However, longterm outcome of the procedure needs operative experience accumulation, longterm follow-up and observation, and serious research and illumination.
Objective To summarize and analyze the clinical experience and surgical results of re-do coronary artery bypass grafting (Re-CABG) for reconvert coronary artery disease. Methods Eighteen patients who underwent Re-CABG in this hospital between June 2001 and December 2006 were analyzed. There were 15 males and 3 females aged from 65 to 78 years old. Seven patients were in class III angina(CCS) and 11 patients were in class IV. Coronary artery angiography showed stenosis or occlusion of great saphenous vein grafts in 16 patients, occlusion of left internal mammary artery(LIMA) grafts in 2 patients and new significant stenosis of the native coronary artery in 6 patients. All Re-CABG were done through re-sternotomy. Fifteen patients underwent cardiopulmonary bypass (CPB for their Re-CABG and 3 patients underwent off-pump Re-CABG. The concomitant procedures included left ventricular aneurysmectomy in 1 patient, mitral valve repair in 3 patients, combined aortic and mitral valve replacement and carotid endarterectomy in 1 patient. Bilateral IMA were used in 4 patients, LIMA in 12 patients, radial artery in 3 patients, and the rest of the grafts consisted of great and lesser saphenous vein. Results In on-pump Re-CABG, the aortic cross clamp time was 57±26min (range 45 to 112 min), the CPB time was 78±24min (range 66 to 140 min).The mean number of distal anastomosis per patient was 3.11(range 1 to 5). Intraoperative flow study of the grafts by Medi-Stim Butterfly showed a mean flow rate of 27.0±12.5 ml/min with pulsatility index( PI)less than 4.2. Intra-aortic balloon pump (IABP) was used in 1 patient who underwent concomitant aortic and mitral valve replacement and carotid endarterectomy. Post-operatively this patient developed renal failure and expired 6 days later. There was no residual angina and peri-operative myocardial infarction in the remain 17 patients.The post-operatively mechanical ventilation time varied from 5 to 15 hours, chest drainage varied from 290 to 1 040ml. Seventeen patients were discharged uneventfully. Follow-up from 6 months to 4.5years in 17 patients showed no evidence of recurrent angina. Postoperative coronary artery angiography in 4 patients showed patent grafts. Conclusion Re-CABG can be performed as safely and effectively as primary CABG in spite of the fact that it is more demanding. Selecting the proper target vessels, satisfactory blood flow of grafts, complete revascularization and proper peri-operative management are all key factors to a successful Re-CABG.
Objective To investigate the effect of coronary artery bypass grafting (CABG) on patients with coronary heart disease and giant left ventricular dimension but without aneurysm. Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm, including 50 males and 1 female, undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed. The patients were at the age of 54-61 years with an age of 57.5±3.2 years. All patients received CABG, combined with aortic valve replacement in 7, mitral valve replacement in 16, mitral valvoplasty in 17 and tricuspid valvoplasty in 7. After surgery, perioperative complications and mortality were closely observed and followup for a period of 37 months was carried out. Results The number of distal anastomoses per patient was 2.0-4.0(3.8±1.1). Four patients died perioperatively (7.8%), among whom 2 died from malignant ventricular fibrillation, 1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome. All other patients were discharged from hospital with good recovery. After operation, 5 patients had atrial fibrillation and 11 had ventricular fibrillation, but all of those patients survived after proper treatment. The followup period for 47 patients was 37-49 months (43±11months), with a followup rate of 100%. No death occurred during the follow-up. Ultrasound cardiography in the followup period showed that there was a decreased left ventricular enddiastolic dimension (59±2 mm vs. 68±5 mm; t=7.320, Plt;0.05) and an improved left ventricular ejection fraction (45%±17% vs. 34%±15%; t=4.770, Plt;0.05) compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.
ObjectiveTo discuss the effect of Cabrol in treatment of Stanford type A aortic dissection.MethodsThe clinical data of patients whom were diagnosed with type A aortic dissection of Stanford in our hospital from January 2013 to January 2018 were retrospectively analyzed. All of 40 patients underwent Cabrol surgical procedure. There were 31 males and 9 females aged 26–75 (48.8±3.3) years. The surgical treatment effect of the patients was evaluated, mainly including the aortic index, the changes in cardiac function before and after operation, and the postoperative follow-up.ResultsAll the 40 patients completed the operation successfully. The diameter of ascending aorta and aortic sinus in postoperative patients were smaller than those before operation (P<0.05). Postoperative left ventricular ejection fraction and cardiac output increased, central venous pressure and left ventricular end-diastolic dimension decreased, and cardiac function indexes were significantly different from those before the operation (P<0.05). Seven patients suffered complications in postoperative follow-up including one stenting leakage, three neurological diseases and three acute renal failure. Two patients died postoperatively.ConclusionCabrol’s operation is effective in the treatment of Stanford type A aortic dissection, which can significantly improve the cardiac function of patients, simplify the anastomosis of coronary artery ostia and decrease amount of bleeding.