Objective To evaluate the clinical efficacy of coronary artery bypass grafting in the treatment of coronary artery disease patients aged over 70 years. Methods A total of 160 patients with coronary atherosclerotic heart disease underwent off-pump coronary artery bypass grafting from January 2013 to December 2017. There were 94 males and 66 females at age of 70–85 (76.67±2.33) years. Operations were performed by using sternal median incision with the assistance of local myocardial surface fixator and shunt plug, and the saphenous vein and internal mammary arterywere used as grafted vessels. Results All the patients were received successful off-pump coronary artery bypass grafting without death, and the cardiac function improved significantly. There were 62 patients with the internal mammary artery bridge and 98 patients with the whole vein bridge. All the patients were followed-up for 1 to 4 years. All the patients had obvious relief of angina pectoris. Conclusion Off-pump coronary artery bypass grafting for the treatment of elderly patients with coronary heart disease is an effective and safe operation, especially for patients with renal insufficiency, cerebrovascular disease, respiratory disease and severe left ventricular dysfunction.
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 surgical therapy for chronic total occlusion (CTO) of coronary artery with offpump coronary artery bypass grafting (OPCAB). Methods From Aug. 1999 to Oct. 2007, 696 patients with 853 totally occluded coronary arteries (127 coronary arteries lack of opacification while the other 726 arteries with reverse flow showed by coronary angiography) underwent OPCAB. A total of 2 231 grafts were constructed including 136 placed to coronary endarterectomy (CE) targets and 28 arterialized middle cardiac veins. Blood flow was detected during operation in 26 coronary arteries with no opacification in preoperative angiography, while no blood flow was detected in 63 coronary arteries with opacification in preoperative angiography. Cardiopulmonary bypass was applied in 15 cases because of a poor hemodynamics and 6 of which were assisted with intraaortic balloon pump(IABP). Results All patients survived the operation. 6 died in hospital because of low cardiac output (2 cases), renal failure (2 cases), perioperative cardiac infarction (1 case) or cerebrovascular accident (1 case). Stress ulceration occurred in one case, mediastinal infection occurred in another case after operation. Both were treated medically and recovered. 692 patients were followed up and the rate of flup was 99.42%(685/686)， with 4 withdrawal. Freedom from cardiac angina was 99.85%(685/686) and cardiac functional grading (NYHA) was Ⅰ-Ⅱ. Conclusion OPCAB can be well performed in patients with chronic total occlusion of coronary arteries. The ralue of coronary angiography for evaluating totally occluded coronary artery is limited, and endoscope or intravascular ultrasound techniques may be helpful.
Abstract: Objective To explore the inhospital mortalityrelated risk factors in the patients undergoing offpump coronary artery bypass grafting (OPCAB). Methods We retrospectively analyzed the clinical data of 215 patients undergoing OPCAB in our hospital from November 2007 to November 2008. There were 171 males and 44 females aged between 40 and 85 years old. Among them, there were 47 patients older than 70 years old. All of them were coronary artery disease (CAD) patients with triple vessel disease. We adopted univarialble analysis and logistic multivariable regression analysis to screen the risk factors for the mortality of OPCAB. Results Six patients died in hospital after OPCAB with a mortality rate of 2.79% (6/215). No renal dysfunction or respiratory failure occurred. The rate of reoperation for bleeding was 4.65% (10/215) and all the 10 patients having undergone reoperation were alive. A total of 209 patients were all alive after 1year follow-up. The results of logistic multivariable regression analysis showed that New York Heart Association (NYHA) Ⅲ and Ⅳ heart function (OR=42.116，95% CI 3.319 to 534.465，P=0.004) and mechanical ventilation duration (OR=1.007，95%CI 1.001 to 1.013，P=0.028) were independent risk factors for inhospital mortality of OPCAB. Conclusion OPCAB is an effective and safe treatment for CAD with triple vessel disease. NYHA Ⅲ and Ⅳ heart function and mechanical ventilation time after OPCAB are the risk factors for OPCAB inhospital mortality, yet, needs further study with large sample.
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 systematically evaluate the risk factors for new-onset atrial fibrillation (NOAF) after off-pump coronary bypass grafting (OPCABG). MethodsPubMed, EMbase, Web of Science, The Cochrane Library, Wanfang data, CBM, VIP, and CNKI databases were systematically searched by computer to collect studies related to the risk factors for NOAF after OPCABG from the establishment of the database to July 2023. Literature screening and quality evaluation were conducted independently by two researchers. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the literature. RevMan 5.3 and Stata15.0 were used for meta-analysis. ResultsFinally, 19 case-control studies related to the risk factors for NOAF after OPCABG were included, all of which were high-quality literature with NOS score≥6 points, with a total of 7019 subjects. The results of meta-analysis showed that the following factors were associated with NOAF after OPCABG: (1) the patient’s own factors: age (MD=3.51, 95%CI 2.39 to 4.63, P<0.01); (2) preoperative factors: history of hypertension (OR=1.17, 95%CI 1.04 to 1.32, P=0.01), history of myocardial infarction (OR=1.21, 95%CI 1.06 to 1.38, P<0.01), history of percutaneous coronary intervention (OR=2.22, 95%CI 1.03 to 4.77, P=0.04), EuroSCOREⅡ score (MD=0.59, 95%CI 0.25 to 0.94, P<0.01), low-density lipoprotein (MD=0.11, 95%CI 0.02 to 0.20, P=0.02), left atrial diameter (MD=1.64, 95%CI 0.24 to 3.04, P=0.02); (3) postoperative and treatment factors: left ventricular end-diastolic diameter (MD=1.16, 95%CI 0.33 to 1.99, P<0.01), left ventricular ejection fraction (MD=0.90, 95%CI 0.07 to 1.73, P=0.03), mechanical ventilation time (MD=2.78, 95%CI 1.65 to 3.90, P<0.01), B-type natriuretic peptide (MD=219.67, 95%CI 27.46 to 411.88, P=0.03), ICU retention time (MD=7.07, 95%CI 5.64 to 8.50, P<0.01). ConclusionThe existing evidence shows that age, history of hypertension, history of myocardial infarction, history of percutaneous coronary intervention, preoperative EuroSCOREⅡscore, preoperative low-density lipoprotein, preoperative left atrial diameter, postoperative left ventricular end-diastolic diameter, postoperative left ventricular ejection fraction, postoperative mechanical ventilation time, postoperative B-type natriuretic peptide, and postoperative ICU retention time are risk factors for NOAF after OPCABG. Clinical attention should be paid to the above factors to achieve early identification, thereby reducing the incidence of NOAF after OPCABG and improving the clinical prognosis of patients.
The choice of the graft conduit for coronary artery bypass grafting (CABG) has significant implications both in the short-and long-term. The patency of a coronary conduit is closely associated with an uneventful postoperative course, better long-term patient survival and superior freedom from re-intervention. The internal mammary artery is regarded as the primary conduit for CABG patients, given its association with long-term patency and survival. However, long saphenous vein (LSV) continues to be utilized universally as patients presenting for CABG often have multiple coronary territories requiring revascularization. Traditionally, the LSV has been harvested by creating incisions from the ankle up to the groin termed open vein harvesting (OVH). However, such harvesting methods are associated with incisional pain and leg wound infections. In addition, patients find such large incisions to be cosmetically unappealing. These concerns regarding wound morbidity and patient satisfaction led to the emergence of endoscopic vein harvesting (EVH). Published experience comparing OVH with EVH suggests decreased wound related complications, improved patient satisfaction, shorter hospital stay, and reduced postoperative pain at the harvest site following EVH. Despite these reported advantages concerns regarding risk of injury at the time of harvest with its potential detrimental effect on vein graft patency and clinical outcomes have prevented universal adoption of EVH. This review article provides a detailed insight into the technical aspects, outcomes, concerns, and controversies associated with EVH.
ObjectiveTo evaluate the early and mid-term results of robot-assisted coronary artery bypass grafting (RACAB) in the treatment of multi-vessel coronary artery disease (MV-CAD). Methods Patients with MV-CAD who underwent RACAB from April 2018 to December 2021 in our hospital were included. Patients who underwent hybrid coronary revascularization (HCR) which combined RACAB with percutaneous coronary intervention were allocated to a HCR-RACAB group, and patients who underwent multi-vessel RACAB were allocated to a MV-RACAB group. Perioperative and follow-up data were collected and compared between the two groups. Results A total of 102 patients were included, including 81 males and 21 females with a mean age of 61.7±10.8 years. Two (2.0%) patients were transferred to conventional CABG due to sudden ventricular fibrillation and pleura adhesion. In the remaining 100 patients who underwent RACAB, 100 left internal mammary arteries (LIMA) and 46 right internal mammary arteries (RIMA) were harvested with a 100.0% success rate. Besides, all patients undergoing RACAB achieved LIMA/RIMA-left anterior descending branch reconstruction, with an average number of 2.5±0.6 target vessels revascularized by stent or graft. One patient had perioperative myocardial infarction with an outcome of death. The incidence of major perioperative adverse events was 1.0%. There was no perioperative stroke or re-sternotomy for hemostasis. The mean follow-up time was 28.2 months, with a follow-up rate of 99.0% and an overall major adverse cardiac and cerebrovascular event (MACCE) rate of 7.0%, including 3 all-cause deaths (3.0%), 2 strokes (2.0%) and 3 re-revascularizations (3.0%). The HCR-RACAB group had fewer red blood cell transfusion (P=0.030) and intraoperative blood loss (P=0.037) compared with the MV-RACAB group, and there was no statistical difference in the incidence of major perioperative adverse events or MACCE between the two groups during the follow-up period (P>0.05). ConclusionRACAB can be safely applied in the treatment of MV-CAD with good early and mid-term outcomes. High-quality harvesting of LIMA/RIMA and aortic no-touch technique are crucial to achieve these results.
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.