Objective To explore ability of deformation ,small deformation, orientation and in vivo half-life of erythrocytes following intraoperative autotransfusion by ZITI-3000 cell saving system (Jingjing medical facility corporation, Beijing). Methods Twenty consecutive patients undergoing scheduled off-pump coronary artery bypass grafting (CABG) were divided into two groups according to intraoperative autotransfusion, experimental group(n=10): intraoperative autotransfusion was performed; control group (n=10): intraoperative autotransfusion wasn’t used. Laser diffractometer was used to measure deformation index(DI), small deformation index[(DI)d.max], and orientation index [(DI)or.max],and chromium51 istope labeling technique was used to measure half-life of erythrocytes (51C1/2) of processed and unprocessed in vivo. Results There were no significant difference in DI, (DI)d.max, (DI)or.max and 51C1/2 in vivo between experimental group and control group. Conclusion Intraoperative autotransfusion has no significant effect on erythrocytes’s ability of DI, (DI)d.max, (DI)or.max and 51C1/2 in vivo in off-pump CABG.
ObjectiveTo investigate the influence of different discontinuation time of clopidogrel and aspirin before off-pump coronary artery bypass grafting on postoperative volume of drainage and blood products imported.MethodsA total of 454 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from January 2017 through December 2019 were included. According to the preoperative discontinuation of clopidogrel and aspirin, all the 454 patients were divided into three groups including a guide group, a non-stop group and a stop group. There were 86 patients in the guide group including 59 males and 27 females with an average age of 64.12±6.15 years. They continued to take aspirin 100 mg/d before operation, but stopped clopidogrel for more than 5 days. In the non-stop group, there were 234 patients including 141 males and 93 females with an average age of 63.71±7.01 years. They continued to take aspirin 100 mg/d before operation, and stopped clopidogrel <5 days. In the stop group, there were 134 patients including 76 males and 58 females with an average age of 62.90±7.78 years. They stopped aspirin and clopidogrel for more than 5 days before operation. The clinical effectiveness was compared among the three groups.ResultsNo perioperative death occurred in all patients. There was no statistical difference in platelet count, coagulation function, liver function, renal function, or myocardial markers among the groups (P>0.05). The hemoglobin [97 (15) g/ L vs. 98 (21) g/L vs. 100 (20) g/ L, F=4.894, P=0.008] in the non-stop group was lower than that in the guide group and the non-stop group at 30 minutes postoperatively. The flow volume (399.87±127.19 mL vs. 367.05±125.89 mL vs. 349.63±130.68 mL, F=7.770, P=0.000) in the non-stop group at 3 hours postoperatively, the flow volume [600 (300) mL vs. 580 (245) mL vs. 550 (350) mL, Z=8.218, P=0.016] in the non-stop group at 6 hours postoperatively, the flow volume [750 (370) mL vs. 730 (350) mL vs. 730 (350) mL, Z=8.329, P=0.016] in the non-stop group at 12 hours postoperatively, the flow volume [890 (365) mL vs. 850 (340) mL vs. 850 (350) mL vs. Z=6.585, P=0.037] in the non-stop group at 24 hours postoperatively and the flow volume [950 (375) mL vs. 940 (360) mL vs. 940 (380) mL, Z=8.680, P=0.013] in the non-stop group at 48 hours postoperatively were more than those of the guide group and the stop group. The retention time of drainage tube was longer in the non-stop group [3 (1) d vs. 3 (1) d vs. 3 (1) d, Z=6.579, P=0.037] than in the guide group and the non-stop group. The amount of suspended erythrocytes input [0 (2) U vs. 0 (2) U vs. 0 (0) U, Z=6.150, P=0.046], and the amount of plasma input [200 (200) mL vs. 0 (200) mL vs. 0 (200) mL, F=4.144, P=0.016], the number of cases of plasma input (119 patients vs. 34 patients vs. 47 patients, Z=10.116, P=0.006) were more than those of the guide group and the stop group.ConclusionAspirin maintenance is recommended for patients before off-pump coronary artery bypass grafting. If not necessary, clopidogrel is discontinued for at least 5 days.
Coronary artery bypass grafting has made great progress in recent years. Off-pump coronary artery bypass grafting （off-pump） can escape from many complications resulting from cardiopulmonary bypass which powered the interest of more and more surgeons, but it is more technically demanding. Conventional coronary artery bypass grafting aided by cardiopulmonary bypass （on-pump） can provide with good condition for anastomosis, and is still applied widely. The comparation of the two surgical techniques were reviewed, including graft patency, mortality, inflammatory response, influence on coagulation and anticoagulation, injury to important organs, hospital length of stay and cost, technical convertion, et al.
Objective To report a reliable left heart failure model in sheep using selected ligation of the diagonal branch. Methods Four male sheep were used. After a left anterior thoracotomy in sheep, the diagonal branch of coronary artery was ligated at a point approximately 40% of the distance from the apex to the base of the heart. Hemodynamic and echocardiography measurements were done preligation, 30 minutes and 7 days after the coronary artery of diagonal branch ligation. The electrocardiograms were obtained as needed, and cardiac function was also evaluated. The sheep were killed for postmortem examination of their hearts. Results Four sheep survived the experimental procedures. Comparing with before surgery, systemic arterial blood pressure and cardiac output were decreased, pulmonaryartery systolic pressure, pulmonary capillary wedge pressure and central venous pressure were increased at 30 min and 7 days after selected ligation of the coronary artery of diagonal branch; left ventricular end-diastolic dimension and left ventricular end-systolic dimension were increased; left ventricular ejection fraction and left ventricular fractional shortening were also decreased (Plt;0.05). Conclusion A reliable ovine model of left ventricular failure using selected ligation of the diagonal branch of the coronary artery can be achieved. This animal model is comparable to the clinical correlation.
Objective To study the method to inhibit perioperative internal mammary artery (IMA) spasm from the perspective of muscarinic receptor, and research the function of muscarinic cholinergic receptor subtypes of IMA. Methods IMA segments in vitro with intact endothelium were obtained from 30 patients who underwent coronary artery bypass grafting (CABG). According to muscarinic receptor antagonists of different concentrations， They were divided into control group (not using receptor antagonist), atropine group (nonselective M receptor antagonist), pirenzepine group (M1 receptor antagonist) and Methoctramine group(M2 receptor antagonist) by random number table. The effects of antagonists on vasodilatation were analyzed, Scott ratio was used to calculate affinity index (pD2) and Schild plot was used to count rivalry index (pA2). Results Acetylcholine (Ach)induced concentrationdependentrelaxation response of IMA segments with intact endothelium precontracted with potassium chloride (KCl). The pD2 was 6.92±0.05. The effects of atropine, pirenzepine and methoctramine on doseresponse curve induced by Ach with intact endothelium were all concentrationdependent. With the increase of the concentration of antagonists, the Achinduced doseresponse curves had a significant shift to right(Plt;0.05). Atropine, pirenzepine and Methoctramine competitively antagonized the reaction of vessel to Ach. The pA2 were 9.62±0.15,7.70±0.08 and 630±0.08, respectively. Conclusion The Achinduced relaxation response of IMA with intact endothelium is concentrationdependent. According to the affinity of different antagonist, IMA in Vitro Achinduced relaxation response is implemented by acting on nonneuronal muscarinic cholinergic M1 receptor subtype.
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: Though the use of the radial artery (RA) as a coronary artery bypass graft has been accepted world widely in myocardial revascularization, there has been no uniformity regarding harvest techniques, assessment of the adequacy of hand collateral circulation, antispasm rotocols, selection of target vessels, and the site of proximal anastomosis. It is widely believed and practiced that the RA should be harvested as a pedicle graft and preferably be used to bypass critically stenosed (gt;70% stenosis) coronary arteries. It is used either as a free graft with proximal anastomosis to the ascending aorta or as a composite arterial graft along with the left or right internal thoracic artery. The patency of RA grafts depends on the severity of the target coronary artery stenosis and target artery location rather than its use as an aortocoronary conduit or composite graft. Though lacking of evidences, most surgeons use antispasm therapy for RA conduits. There are advantages in using RA as an alternative for right internal mammary artery in total artery coronary revascularization.
Objective To summarize the experiences of off-pump coronary artery bypass grafting (off-pump CABG) and on-pump coronary artery bypass grafting (onpump CABG) for patients with coronary artery diseases and to improve the surgical techniques and clinical results. Methods Coronary artery bypass grafting(CABG) were performed from January 2000 to March 2009 on 698 consecutive cases, including 551 male and 147 female with a mean age of 67.2 years(range, 28.0-79.0). There were 552 cases with angina pectoris and 131 with old myocardial infarction. Preoperative cardiac function showed 301 cases in New York Heart Association classⅡ, 339 in class Ⅲ,and 58 in class Ⅳ. Coronary angiography revealed single vessel disease in 21 cases, 2vessel disease in 87, 3vessel disease in 590, and 201 cases had concomitant left main lesions.There were 687 elective CABG and 11 emergency / urgent ones. Offpump CABG were performed on 346 cases and the others received onpump CABG . Results A total number of 2 025 grafts ( range,1-6 grafts, mean, 2.9 grafts /case ) were constructed with 693 left internal mammary arteries,115 free right mammary arteries,229 left radial arteries, and 81 right radial arteries. Total arterial bypass grafting was feasible on 126 cases. Postoperative ventilation duration varied from 0-127 hours (mean, 11.5 hours). Fasttrack procedure was offered to 38 cases with good results.Introaortic balloon pump support were provided to 1 patient preoperatively and 27 postoperatively. There were 25 deaths with a mortality of 3.64% for the elective cases with the cause of acute myocardial infarction ( 5 cases ), low cardiac output syndrome (3 cases),protamine reaction (2 cases),respiratory failure (3 cases), renal failure (2 cases),and multiorgan failure (10 cases).Four deaths occurred to urgent cases with a mortality of 36.36% from low cardiac output syndrome ( 3 cases) and acute myocardial infarction (1 case). One hundred and fiftyone cases（21.63%）developed atrial fibrilation among which 147（97.35%）returned to sinus rhythem with administration of electrolytes and Amiodarone. Resternotomy were performed for bleeding in 12 cases. Upon discharge from the hospital, 511 patients were free from angina while 20 other patients still had coexisting relieved angina. Postoperative followup was carried out on 415 cases（62.03%）for a period of 1month to 8.2 years with 3 deaths for lung cancer (1 case), car accident(1case), and unknown reasons (1 case). Number of patients who were free from angina was 317 and 21 for those who had recurrent angina. The cardiac function improved with 269 cases（65.29%）in New York Heart Association class Ⅱ, 142（34.46%）class Ⅲ, and 1（0.24%） class Ⅳ. Conclusion Good surgical results could be achieved with careful analysis of native Chinese patients’ coronary vessels, individualized operative plan, control of operative risk factors, and proper selection of bypass conduits. Aggressive use of IABP can provide essential support for patients with poor left ventricular function and other high risk factors.
Objective To investigate the risk factors of perioperative red blood cells transfusion for coronary artery bypass grafting (CABG) surgery. Method We retrospectively analyzed the clinical data of 534 patients underwent CABG in our hospital from January to March 2014 year. Those patients were divided into two groups:an on-pump coronary artery bypass grafting group (on-pump group) and an off-pump coronary artery bypass grafting group (off-pump group). There were 185 males and 54 females with a mean age of 59.1±9.4 years in the on-pump group. There were 233 males and 62 females with a mean age of 60.3±8.5 years in the off-pump group. Preoperative data, the relative parameters of extracorporeal circulation, the quantity of red blood cells transfusion of those two groups were compared. risk factors associated with red blood cells transfusion were evaluated by multivariate logistic regression analysis. Results The risk factors of perioperative red blood cells transfusion were age (OR=1.04, 95% CI 1.02-1.07, P=0.001) , weight (OR=0.95, 95% CI 0.93-0.97, P<0.001) , smoking (OR=0.61, 95% CI 0.39-0.94, P=0.027) , preoperative level of HCT (OR=0.90, 95% CI 0.85-0.96, P=0.001) and cardiopulmonary bypass (CPB) (OR=4.90, 95% CI 3.11-7.71, P<0.001) . During CPB, the nadir hemoglobin (nHb) (OR=0.63, 95% CI 0.47-0.84, P=0.002) was the only independent risk factor of red blood cell transfusion. Conclusions Age, weight, non-smoking, preoperative level of HCT, CPB are the risk factors for patients underwent CABG perioperatively and the lowest level of Hb in CPB is an independent risk factor of perioperative red blood cells transfusion.
Abstract: Coronary artery bypass grafting (CABG) has become more and more popular, but how to decrease the thrombotic stenosis of saphenous vein grafts remains a tough problem clinically. Some researchers raised that aspirin resistance (AR) may be one of the most principal causes of graft thrombus and many correlative studies have been reported in recent years．In this article, we reviewed and analyzed the concept and evaluation criterion, incidence rate, mechanisms, clinic significance, and preventing strategy of AR, expecting to deepen the understanding of AR and help to optimize the antiplatelet therapy for postCABG patients with AR.