Objective To investigate the 30-day mortality risk factors in elderly patients (≥70 years) with heart failure with reduced ejection fraction (HFrEF) after isolated coronary artery bypass grafting (CABG) and to construct a nomogram for predicting mortality risk. Methods A retrospective analysis of elderly HFrEF patients undergoing isolated CABG at Tianjin Chest Hospital from 2010 to 2024. Simple random sampling in R was used to divide the dataset into training and validation sets in a 7 : 3 ratio. The training set was further divided into survivors and non-survivors. Univariate logistic regression was performed to identify differences between groups, followed by multivariate logistic stepwise regression to select independent risk factors for death and to establish a death-risk nomogram, which underwent internal validation. The predictive value of the nomogram was assessed by plotting receiver operating characteristic (ROC) curves, calibration curves, and decision-curve analyses for both the training and validation sets. ResultsA total of 656 patients were included. The training set consisted of 458 patients (survivors 418, deaths 40); the validation set consisted of 198 patients (survivors 180, deaths 18). In the training cohort, univariate analysis showed significant differences between survivors and deaths for creatinine (Cr) level, brain natriuretic peptide (BNP), maximum Cr, intra-aortic balloon pump (IABP) use, assisted ventilation, reintubation, hyperlactatemia, low cardiac output syndrome, and renal failure (P<0.05). After multivariable logistic regression with stepwise selection, five independent risk factors were identified: IABP use (OR=3.391, 95%CI 1.065–11.044, P=0.038), reintubation (OR=15.991, 95%CI 4.269–67.394, P<0.001), hyperlactatemia (OR=8.171, 95%CI 2.057–46.089, P=0.007), Cr (OR=4.330, 95%CI 0.997–6.022, P=0.024), and BNP (OR=1.603, 95%CI 1.000–2.000, P=0.010). Accordingly, a nomogram predicting mortality risk was constructed. The ROC and calibration analyses indicated good predictive value: training set AUC was 0.898 (95%CI 0.831–0.966); validation set AUC 0.912 (95%CI 0.805–1.000). Calibration and decision-curve analyses showed good agreement and clinical utility. Conclusion The nomogram incorporating IABP use, reintubation, hyperlactatemia, creatinine, and BNP provides good predictive value for 30-day mortality after CABG in elderly patients with HFrEF and demonstrates potential clinical utility.
Objective To review the clinical experience of coronary artery bypass grafting without the assistance of extracorporeal circulation (Off pump CABG, OPCAB). Methods\ Between August 1999 and June 2000, 73 consecutive OPCAB were performed at our institution. The exposure and immobilization of the coronary artery target site during anastomosis were achieved with the help of Octopus mechanical stabilization and intraluminal shunt devices. Results\ There was no mortality, no perioperative myocardial infarct...
Objective\ To test whether off pump coronary artery bypass grafting(OPCAB) has advantages over conventional coronary artery bypass grafting(CCABG).\ Methods\ Between January 1999 and February 2000, 170 patients with multivessel coronary disease underwent only coronary artery bypass grafting by one surgeon. They were divided into two groups, OPCAB group:88 cases underwent CABG with off pump and beating heart via sternotomy; CCABG group: 82 cases underwent conventional CABG with extracorporeal circulation....
Abstract: Objective To investigate the relationship between graft flow and incidence of perioperative myocardial infarction (MI) in coronary artery bypass grafting (CABG). Methods Between January 2010 and June 2010, 58 consecutive patients with coronary artery disease who underwent offpump CABG in the First Hospital of Peking University were enrolled in this study. An anastomosis between left internal mammary arteries (LIMA) and left ant erior descending coronary artery (LAD) were performed. And saphenous vein (SV) graft s were used as bypass grafts. Graft flow was measured intraoperatively using a transi t time flowmeter, and the total graft flow of each patient was calculated as a parameter of myocardial revascularization. The 58 patients were divided into a MI group and a nonMI group retrospectively. There were 11 patients in the MI group, including 7 males and 4 females, with an average age of 67.4±10.3 years.There were 47 patients in the nonMI group, 38 males and 9 females, with a mean age of 633±99 years. The graft flow of the two groups was tested and compared, and the preoperative variables were compared. Results There was no statistically significant difference in operation time (205.4±59.6min versus 1834±32.4 min, t=1.691, P=0.096) between the two groups. Therewere also no statistical differences in the average number of grafts (3.00±1.00 branches versus 2.96±0.78 branches, t=0.154, P=0878) or LIMALAD flow (1540±11.37 ml/min versus 16.50±10.83 ml/min, t=0.301, P=0.764) between the two groups. However, a significant difference was found in the total graft flow between the two groups (41.03±19.50 ml/min versus 64.09±32.44 ml/min, t=2.254, P=0.028), with lower total graft flow in the MI group. Further analysis showed [CM(159mm]that a total graft flow lt;48.5ml/min was a risk factor for MI (odds ratio 4.706, 95% confidence interval 1.099 to 20.147). Conclusion Total graft flow could be used to predict the occurrence of perioperative myocardial ischemia, as there is a high probability of MI for patients with a total graft flow of less than 48.5 ml/min.
Abstract:Objective To investigate the pattern and affecting factors of hematopoietic stem cell mobilization after off-pump coronary artery bypass grafting（OPCAB）. Methods Fifty-five patients of coronary artery disease without acute myocardial infarction （AMI） who underwent selective OPCAB were chosen for this study. Four ml blood sample was taken at 30 min before operation, and 6, 12, 24, 48, 72 and 120 h after operation. The hematopoietic stem cell count was made by flow cytometer with CD34 and CD45 double antibody. The serum myoeardium enzyme and troponin T （cTnT） were measured at the same time. Results The hematopoietic stem cell count was 0. 13%±0. 12% of all nucleated cells in the peripheral blood circulation before operation. It increased significantly witha peak value at 24 halter OPCAB（0.34%±0.20%）. It turned back to pre-operativelevelat 120h after operation. Smoking, hyperlipemia and diabetes mellitus had no effect on hematopoietic stem cell mobilization. But hypertension could reduce its mobilization significantly. The hematopoietic stem cell count was positively correlated with creatine kinase （CK）, creatine kinase-MB isoenzyme （CK-MB）, lactate de hydrogenase （LDH） and cTnT （r=0. 692,P=0. 000; r=0. 558, P=0. 000; r=0. 447, P=0. 000 and r=0. 401, P=0. 004, respectively） 24h after OPCAB. Conclusion Hematopoietic stem cells mobilize rapidly and temporarily after OPCAB. Myocardial injury and CABG risk factors take part in hematopoietic stem cell mobilization.
Objective To compare the accuracy of different renal function measurements for predicting postoperativeadverse events after off-pump coronary artery bypass grafting （OPCAB） for Chinese patients. Methods Clinical data of 283 Chinese patients undergoing isolated OPCAB from January 2010 to December 2011 in the First Hospital of Peking University were retrospectively analyzed. There were 194 male and 89 female patients with their age of 65.0±9.7 years. Estimated glomerular filtration rate （eGFR） was calculated using Cockcroft-Gault equation，Modification of Diet in Renal Disease （MDRD） study equation and Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation respectively.Logistic multivariate regression analysis was performed to compare the accuracy of these 3 different renal function measure-ments for predicting postoperative adverse events. Results Logistic multivariate regression analysis showed that preoper-ative renal dysfunction was an independent risk factor for higher postoperative morbidity，more blood transfusion，prolongedhospitalization，mechanical ventilation time and length of ICU stay. Among the different postoperative complications，preop-erative renal dysfunction was an independent risk factor for postoperative acute renal injury，gastrointestinal bleeding，new onset atrial fibrillation and low cardiac output syndrome. Among Cockcroft-Gault equation，MDRD study equationand CKD-EPI equation to calculate eGFR，CKD-EPI equation was most accurate to predict postoperative morbidity （OR=1.227），acute renal injury （OR=1.534），new onset atrial fibrillation （OR=1.184），prolonged hospitalization（OR=1.160），mechanical ventilation time （OR=1.165） and ICU stay （OR=1.151）. Conclusion Preoperative renal dysfunction is an independent risk factor for postoperative adverse events after OPCAB. CKD-EPI equation is more suitable for predicting postoperative adverse events after OPCAB for Chinese patients.
Objective To summarize the experience of emergency coronary artery bypass grafting(CABG) on serious myocardium ischemia in early post CABG. Methods Between 1998 and 2002, emergency redo CABG was performed in 13 patients with serious early post operative myocardium ischemia. The causes included vein graft embolize(4 cases),uncompleted revascularize(3 cases), graft spasm(1 case) and anastomose stenosis or occlusion (5 cases). The grafts was 1 3(1.8±0.9) during redo CABG. Results There were 6 deaths, the mortality was 46%. The mean follow up was 31 months. There was no recurrence of angina. NYHA function was Ⅰ Ⅱ. Conclusion Emergency CABG is an important method in saving the patients with severe myocardium ischemia in early post CABG. The perioperative prevention and early treatment should be emphasized.
Objective To summarize the essential of perioperative therapy and improve the prognosis of coronary artery bypass grafting （CABG） and transmyocardial laser revascularization （TMLR） through analyzing 1405 patients with coronary atherosclerotic heart disease. Methods From May 1997 to January 2006, 1 405 patients were treated in our hospital. On-pump CABG were performed in 825 patients, single CABG were performed in 666 patients, CABG with cardiac valvular operation in 98 patients, CABG with cardiac ventricular aneurysm resection in 55 patients, CABG with ventricular septal defect repairment in 2 patients; CABG with left atrium gelatinous tumor resection in 2 patients, CABG with ascending aorta repairment in 1 patient, and mediastinal septum tumor resection in 1 patient. Off-pump coronary artery bypass grafting （OPCAB） were performed in 500 patients; single TMLR were performed in 30 patients, CABG＋TMLR were performed in 50 patients. Results The number of bridge vessel was 2.9±1.0. Forty-two patients（3.0%） died of bleeding, myocardial infarction, low cardiac output syndrome, renal failure, multiple organ failure（MOF） and so on. Various complications were occurred in 70 patients（5.0%）, including bleeding, low cardiac output syndrome, myocardial infarction, renal failure and so on. All of them were recovered after treatment. There were 1 177 patients of angina in grade Ⅲ-Ⅳ （CCS） before operation, 1 154 of them （98.0%） changed in grade 0-Ⅰ （CCS） postoperatively. There were 857 patients （62.9%） in follow-up for 8.3±2.9 months postoperatively. There was no angina in 788 patients（91.9%） 6 months after surgery. The ultrasonic graphic showed that left ventricular ejection fraction was 0.66±0.10 and raised 7.9% than that before operation. The quality of life was better than before. Conclusion CABG has become the most potent routine operation in the therapy of coronary artery disease. It can extend the applications of CABG and improve the operative prognosis, if the indications are correctly mastered and the perioperative management are enhanced.
ObjectiveTo summarize the experience of 4 patients with a great saphenous venous graft patency after 15 years of postoperitive great saphenous venous sequential aortic coronary artery bypass grafting. MethodWe retrospectively analyzed the clinical data of 4 patients accepted great saphenous vein aortic coronary artery bypass graft under moderate hypothermia cardiopulmonary bypass from November 1989 to December 1992 year. There were 3 males and 1 female with a mean age of 48.3 years ranging from 40-58 years. We harvested great saphenous vein under groin 45-50 cm. The proximal and distal anastomoses were performed with parachute technique under two clamps technique. Coronary artery bypass graft was performed by two sequential grafts routinely. Aspirin was given through nasal tube 6 hours after operation. The risk factors of arteriosclerosis were controlled by patients themselves after discharge. ResultFour patients received coronary angiography in 15, 16, 18, and 21 years after surgery and the grafts and both proximal and distal anastomoses were patent. The patients lived about 20 years without angina. Conclusioncarefully dealing with the vein graft, taking sequential bypass grafting to guarantee parabolic curve and meticulous anastomosis are preconditional and necessary for long-term patency.
ObjectiveTo investigate the predictive value of a new nutritional index, triglycerides-total cholesterol-body mass index (TCBI), for prolonged postoperative hospital stay in patients undergoing coronary artery bypass grafting surgery (CABG). MethodsA retrospective analysis was conducted on the clinical data of CABG patients admitted to Wuhan Asian Heart Hospital, Wuhan University of Science and Technology from January 2022 to March 2024. Based on the postoperative hospital stay duration of CABG patients, they were divided into two groups: normal hospital stay group (≤14 days) and prolonged hospital stay group (>14 days). Univariate and multivariate logistic regression analyses were used to identify independent factors associated with prolonged postoperative hospital stay in CABG patients. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of TCBI for prolonged postoperative hospital stay. ResultsA total of 460 patients were included, with 289 males (62.8%) and 171 females (37.2%), with an average age of 67 years (range 35-83 years). The TCBI level in the prolonged hospital stay group was significantly lower than that in the normal hospital stay group [1161.71 (825.36, 1511.78) vs. 1777.60 (1354.53, 2448.60), P<0.001]. Multivariate logistic regression analysis revealed that drinking history (OR=2.222, P=0.022), low absolute lymphocyte count (OR=0.169, P<0.001), low serum albumin (OR=0.624, P<0.001), and low TCBI (OR=0.816, P<0.001) were independent risk factors for prolonged postoperative hospital stay in CABG patients. ROC curve results showed that the area under the curve for TCBI to predict prolonged hospital stay was 0.808, with a sensitivity of 72.8% and specificity of 70.9% at a cutoff value of 1446.11. ConclusionTCBI is an effective predictive indicator for prolonged postoperative hospital stay in CABG patients, and the risk of prolonged postoperative hospital stay is higher in CABG patients with TCBI ≤1446.11.