Objective To introduce the technique of surgical patch angioplasty for the treatment of patients with isolated left main coronary artery stenosis. Methods Retrospective investigation of results of surgical patch angioplasty in patients with isolated left main coronary artery disease. Results All 8 patients who underwent left main coronary artery patch angioplasty survived with no major perioperative complications. One patient had recurrent angina and required coronary artery bypass grafting 6 months after patch angioplasty. All other patients were symptom free and had normal activity, at a mean follow-up of 5. 3 years. Conclusions Patch angioplasty can be used as an alternative surgical technique in cases of isolated left main coronary artery stenosis with no distal coronary artery disease. However, it may not be suitable for patients with significant left main coronary artery calcification.
Objective To identify the relationship between preoperative left ventricular dysfunction and perioperative risk factors in coronary artery bypass grafting (CABG). Methods The clinical data of 192 patients who underwent CABG from November 2015 to October 2016 were analyzed retrospectively. The patients were divided into three groups by preoperative left ventricular ejection fraction (LVEF) in echocardiography: a serious left ventricular dysfunction group (LVEF≤35%, 23 patients, 15 males and 8 females at age of 63.91±5.36 years), a moderate left ventricular dysfunction group (35%<LVEF<50%, 24 patients, 20 males and 4 females at age of 66.29±6.03 years) and a normal left ventricular function group (LVEF≥50%, 145 patients, 86 males and 59 females at age of 66.60±6.41 years). Results The overall mortality was 4.16% (8/192), 17.39% (4/23) in patients with LVEF≤35% and 2.76% (4/145) in those with LVEF≥50%. Preoperative LVEF≤35%, hypoxia, assisted circulation, acute kidney injury (AKI) and postoperative continuous renal replacement therapy (CRRT) were risk factors of perioperative mortality in coronary artery surgery. LVEF≤35% and CRRT were independent preditors of mortality. There were significant differences in mortality and postoperative complications between the serious left ventricular dysfunction group and other two groups. Conclusion Postoperative mortality and complications are obviously serious in the patients with LVEF≤35%. We should pay more attention to preoperative risk factors. Postoperative individual manipulation, intra-aortic balloon pump and CRRT can enhance survival of those patients.
ObjectiveTo investigate the role and potential mechanisms of neuropilin-1 (NRP1) in the pathogenesis of vein graft failure.MethodsThe rat vascular smooth muscle cells (VSMCs) were transfected with NRP1-shRNA adenovirus and negative control adenovirus respectively. Cell counting kit-8, flow cytometry, Transwell and Western blot were used to investigate the effects of inhibition of NRP1 on VSMCs proliferation viability, apoptosis, migration capacity and its downstream signaling pathway protein expression.ResultsThe proliferation and migration of rat VSMCs could be inhibited after down-regulation of NRP1, and the increase of apoptosis was also observed. Moreover, inhibition of NRP1 significantly reduced Akt and NF-κB phosphorylation in rat VSMCs, but had little effect on activation of ERK1/2.ConclusionNRP1 may promote vein graft hyperplastic remodeling by regulating the proliferation and migration of VSMCs through PI3K/Akt and NF-κB pathways, but further animal study is required.
Minimally invasive cardiac surgeries are the trend in the future. Among them, robotic cardiac surgery is the latest iteration with several key-hole incision, 3-dimentional visualization, and articulated instrumentation of 7 degree of ergonomic freedom for those complex procedures in the heart. In particular, robotic mitral valve surgery, as well as coronary artery bypass grafting, has evolved over the last decade and become the preferred method at certain specialized centers worldwide because of excellent results. Other cardiac procedures are in various stages of evolution. Stepwise innovation of robotic technology will continue to make robotic operations simpler, more efficient, and less invasive, which will encourage more surgeons to take up this technology and extend the benefits of robotic surgery to a larger patient population.
ObjectiveTo explore surgical methods and risk factors of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). MethodsClinical data of 28 ALCAPA patients who underwent surgical repair from October 1993 to September 2013 in Beijing Anzhen Hospital were retrospectively reviewed. There were 8 male and 20 female patients with their age of 0.6-l6.8 (4.3±0.7)years including 10 patients less than 1 years old. Surgical procedures included simple ligation of left coronary artery, intrapulmonary tunnel procedure (Takeuchi)and direct coronary reimplantation of the anomalous artery. Postoperative death, complication and cardiac function were observed. ResultsAmong the 28 patients, 1 patient received simple ligation of left coronary artery, and 7 patients received intrapulmonary tunnel procedure (Takeuchi), among whom 2 patients died postoperatively. Twenty patients received direct implantation of the anomalous artery into the ascending aorta, and 3 patients died postoperatively. Five patients who died postoperatively were 10.20±3.27 months old, including 3 patients with moderate mitral regurgitation (MR)and 2 patients with mild MR preoperatively. Preoperative heart function of the patients who died postoperatively was significantly reduced. Preoperative left ventricular ejection fraction of the patients who died postoperatively was significantly lower than that of the patients who survived (36.6%±8.5% vs. 60.9%±10.7%, P=0.000). Low cardiac output syndrome was the reason for all postoperative death. All survival patients were followed up from 1 month to 18 years. One patient who underwent intra-pulmonary tunnel procedure (Takeuchi)received pulmonary artery balloon dilatation for pulmonary supravalvular stenosis 15 years after discharge. None of the other patients received a secondary operation. During follow-up, left ventricular function was improved. Growth and development of all the patients was normal. MR did not significantly aggravate in all the patients. ConclusionPatients with younger age and worse left ventricular function have greater surgical risks of ALCAPA.
Patients undergoing coronary artery bypass grafting (CABG) belong to the very high-risk group of atherosclerotic cardiovascular disease. Although CABG gets advantages in relieving symptoms and improving long-term outcomes, a significant risk of cardiovascular adverse events after surgery still exists and standardized secondary prevention is needed. Lipid management plays a critical role as a secondary preventive strategy in CABG. However, lipid management of CABG patients in real clinical setting is inadequate, including lack of standardized lipid-lowering strategy, low goal attainment rate, as well as poor long-term medication adherence. In recent years, a series of clinical trials have provided a lot of groundbreaking new evidence for lipid management in patients with cardiovascular diseases which offers new strategies together with objectives of lipid-lowering and comprehensive management for patients undergoing CABG. This article reviews the strategy and research progress of lipid management after CABG, aiming to provide objective reference for clinical treatment.
ObjectiveTo analyze the risk factors of new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG).MethodsFrom September 2011 to October 2013, 1 614 consecutive patients underwent elective coronary artery bypass grafting in Fuwai Hospital. There were 1 281 males and 333 females at average age of 60.3±8.4 years. Holter data recorded for 5 days after operation were collected and analyzed. The risk factors associated with POAF were assessed according to the baseline and intraoperative data, and the positive variables were stratified.ResultsA total of 314 patients (19.5%) developed new-onset POAF. The rate of POAF was elevating with the increase of age (P<0.001).ConclusionAge was an independent risk factor for POAF in patients undergoing elective CABG alone.
Objective To investigate the use of intraoperative transit time flow measurement （TTFM） to accuratelyevaluate graft patency during sequential coronary artery bypass grafting （CABG）. Methods Clinical data of 131 patientsundergoing sequential off-pump coronary artery bypass grafting （OPCAB） with the great saphenous vein （with or without internal mammary artery） as graft vessels in Beijing Anzhen Hospital from April 2012 to January 2013 were retrospectivelyanalyzed. There were 92 male and 39 female patients with their age of 61.35±8.24 years. During the operation，2 methods were used to measure mean blood flow volume，pulsatility index （PI） and diastolic filling （DF） of the graft vessels. For thenon-blocking method，blood flow in graft vessels was maintained，and TTFM was applied 2 cm proximal to the anastomoticsite in graft vessels to record above parameters. For the blocking method，blood flow in graft vessels was temporally blockedby clipping distal graft vessels with an atraumatic bulldog clamp，and TTFM was applied 2 cm proximal to the anastomotic site in graft vessels to record above parameters. Results Blood flow volumes of the diagonal branch （27.43±15.22 ml/minvs. 59.28±30.13 ml/min），obtuse marginal branch （26.14±19.74 ml/min vs. 47.19±24.27 ml/min） and posterior left ventr-icular branch （19.16±8.92 ml/min vs. 38.83±20.11 ml/min） measured by the blocking method were significantly smallerthan those measured by the non-blocking method （P＜0.05） . PI values of the diagonal branch （2.93±1.30 vs. 2.31±0.91），obtuse marginal branch （2.62±1.17 vs. 2.01±0.87） and posterior left ventricular branch （2.33±0.92 vs. 1.80±0.73） meas-ured by the blocking method were significantly higher than those measured by the non-blocking method （P＜0.05）. There was no statistical difference in DF values measured by 2 methods at respective anastomotic sites，and all DF values were higher than 50%. Non-blocking method identified 1 anastomotic site and blocking method identified 3 anastomotic sites that were not patent，and these anastomotic sites became patent after graft reconstruction. Conclusion Blood flow velocity of sequential grafts is higher than that of single grafts，indicating that sequential grafts have the advantages of high blood flow volume and low risk of thrombosis. Blocking method can more accurately evaluate graft patency at the anastomotic sites and sensitively identify graft vessels that are not patent，which is helpful for anastomotic site reconstruction in time and enhancement of successful rate of CABG.
ObjectiveTo evaluate the relationship between four classic inflammatory biomarkers, including C-reactive protein (CRP), white blood cell (WBC), IL (interleukin family), tumor necrosis factor-α (TNF-α), and postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) and valve replacement (VR) surgeries.MethodsWe searched PubMed, EMBase, the Cochrane Library, Ovid, Chinese Journal Full-text Database, Chinese Biomedical Literature Database, VIP database and WanFang database from the inception to April 2020. Studies on the relationship between POAF and the above four inflammatory biomarkers were analyzed. Two researchers independently reviewed the literature, extracted data and evaluated the quality of the literature. RevMan 5.3 software was used for meta-analysis.ResultsA total of 47 articles were included, covering 10 711 patients. The levels of preoperative CRP (SMD=0.38, 95%CI 0.14-0.62, Z=3.12, P=0.002) and postoperative CRP (SMD=0.40, 95%CI 0.06-0.74, Z=2.33, P=0.02), IL-6 (SMD=1.34, 95%CI 0.98-1.70, Z=7.26, P<0.001) and TNF-α (SMD=?0.33, 95%CI ?0.65-?0.01, Z=2.02, P=0.040) were related to POAF, while preoperative IL-8 (SMD=?0.05, 95%CI ?0.28-0.18, Z=0.42, P=0.68) and TNF-α (SMD=?0.43, 95%CI ?1.22-0.36, Z=1.07, P=0.28), postoperative WBC (WMD=1.16, 95%CI ?0.09-2.42, Z=1.82, P=0.07) and IL-10 (SMD=0.21, 95%CI ?0.35-0.77, Z=0.73, P=0.46) were not related to POAF. The relationships between preoperative WBC and IL-10, postoperative IL-8 and POAF were inclusive, which needed further verification. Furthermore, the relationship between postoperative CRP and POAF were not consistent, as they were not significantly correlated in sub-group analysis.ConclusionThe inflammatory substrate before the surgery and inflammatory reaction induced by the operation is related to the occurrence and maintenance of POAF. Compared with preoperative inflammatory status, postoperative inflammatory factors may have a greater predictive value for POAF. Preoperative CRP, postoperative IL-6 and TNF-α levels are reliable biomarkers of POAF.
摘要:目的:評價64層螺旋CT對冠心病的診斷價值。方法:對25例典型病例的CT圖片進行分析、總結,觀察64層螺旋CT對冠狀動脈的管腔狹窄程度及冠脈內斑塊性質的顯示能力,并對橋血管和支架通暢性進行觀察。結果:近端冠脈中度以上狹窄的敏感度、準確度、陽性預測值分別為93.5%,90.3%,88.5%,對左主干及前降支病變診斷價值較高;對冠狀動脈內軟斑塊顯示較佳;對橋血管及支架通暢和有無再狹窄顯示良好。結論:MSCT冠狀動脈成像在冠心病篩查及冠狀動脈支架術后和搭橋術后的隨訪發揮重要作用。Abstract: Objective: To study the diagnose value of 64slice spiral CT for coronary heart disease. Methods:The CT pictures of 25 typical cases of coronary heart disease were analyzed so as to survey the displaying ability coronal arterial stenosis, its degree and the character plaques, the patency of bypass graft and stents by 64slice spiral CT. Results:The sensitivity, accuracy, positive predictive value for RCA1 narrow above moderate was 93.5%, 90.3%, 88.5% respectively. For LM and LAD, its diagnose value was high. The coronary soft or fibrous plaque, stent and bypass graft were displayed well. Conclusion:MSCT plays an important role in filtering coronary heart disease and reexamination after stents and bypass.