Objective To analyze the mean flow in left internal m am mary artery ( L IMA) graft and the influencing factors in off- pump coronary artery bypass grafting ( OPCAB) in the Chinese. Methods One hundred and eighty patients with OPCAB were studied.Transit- tim e flowmeter( TTFM) was utilized to measure and record the L IMA’s blood flow wave,pulsatility index( PI) ,value of mean flow,systolic and diastolic peak flow,vascular resistance,insufficiency ratio and mean blood pressure and to analyze the relationship between mean flow of LIMA and other factors. Results Total mean flow calculated from that of all patients was2 8.19± 2 .89ml/ min( 6 - 178 ml/ m in) .Majority m ean value ( 6 4 .4 % ) was in the range of 10 - 30 ml/ min.Statistics showed that mean flow was significantly related to systolic and diastolic peak flow and vascular resistance rather than the other factors( r=0 .75 , 0 .94 ,- 0 .95 ) . Conclusions For the Chinese,over 10 ml/ min mean flow of L IMA graftis acceptable and ov...更多er 2 2 ml/ min is satisfactory.The diastolic peak flow and vascular resistance are two most important factors in influencing mean flow.
Objective To explore the factors affecting the operation of coronary artery bypass grafting with heart beating and improve the effect of the operation. MethodsFrom January 2012 to June 2016, 898 patients with coronary heart disease who received cardiovascular surgery in the Second Affiliated Hospital of Jilin University were analyzed retrospectively. All patients only underwent coronary artery bypass grafting with beating heart. Among them, 797 patients underwent the off-pump coronary artery bypass grafting (an OPCABG group, 592 males and 205 females, with an average age of 60.5±8.4 years); another 101 patients received on-pump beating heart coronary artery bypass grafting (an OPBH group, 77 males and 24 females, with an average age of 61.5±8.2 years). ResultsThe average number of grafts in the OPCABG group was 3.36±0.74, and in the OPBH group was 3.71±0.69 (P<0.05). The postoperative ventilation time (10.8±9.5 h vs. 20.6±12.3 h), ICU stay (28.8±15.5 h vs. 37.4±30.8 h), hospital stay (10.9±4.8 d vs. 14.8±8.6 d), mortality (1.1% vs. 3.0%), the utilization rate of intra-aortic balloon pump (2.4% vs. 8.9%) and extracorporeal membrane oxygenation (0.5% vs. 5.0%) were significantly different between the OPCABG group and OPBH group (all P<0.05). Twelve patients died after surgery, and the total bloodless operation ratio was 91.3%. ConclusionThe results show that most patients can achieve good results with the help of apical fixation and myocardial fixator, improved surgical techniques and methods, good anesthesia management as well as flexible and accurate use of vasoactive drugs. But extracorporeal circulation is necessary in the patients with large left ventricle, low ejection fraction and hemodynamic instability after intraoperatively moving the heart.
摘要:目的: 探讨非体外循环冠状动脉旁路移植术(offpump coronary artery bypass grafting,OPCABG)患者的围术期管理。 方法 : 回顾分析2005 年7 月至2008 年6 月的200 例择期非体外循环下冠状动脉旁路移植术患者200例,诱导用咪唑安定005～01 mg/kg,依托咪酯03 mg/kg,芬太尼5～15 μg／kg,罗库溴铵05～10 mg／kg,麻醉维持采用持续泵注异丙酚1～4 mg/kg·h,,间断辅以05%～20%异氟烷吸入,术中随手术操作时出现的血流动力学变化,用血管活性药物调整。 结果 : 麻醉效果满意,术中血压心率基本满意。本组患者苏醒时间,拔管时间和ICU停留时间为(178±42) min、(105±40)h、(18±63)h。术毕180例患者在12 h内拔管。180例预后良好,无麻醉并发症。 结论 :非体外循环下冠状动脉旁路移植术麻醉管理的关键是合理的应用麻醉药和血管活性药来维持血流动力学平稳。Abstract: Objective: To summarize the technique and evaluate the effect of anesthesia for offpump coronary artery bypass surgery (OPCAB). Methods :From July of 2005 through June of 2008,two hundred consecutive patients undergoing OPCAB were retrospectively studied. Anesthesia was induced with midazolam 00501mg/kg, or etomidate 03mg/kg and fentanyl 515μg/kg. Anesthesia was maintained with isoflurane 05%20% and oxygen, combined with propofol 14mg/(kg·h). Intraoperative hypotension resulting from either surgical procedure or anesthetics should be dealt with inotropes immediately. Results :Intraoperative hemodynamics deviation was tolerated with the support of inotropics. The mean of patients of consciousness recovery time, tracheal extubation time and stay in ICU time were 178±42 min,105±40 hours and 18±63 hours. The patients were discharged in 80±12 days. Racheal intubation were remained 12 hours in 180 patients after operation, 180 patients had good recovery without any anesthesia complications. Conclusion : Rational use of anesthetics and inotropics to stabilize hemodynamics during operation plays a key role in successful OPCAB.
Abstract： Objective To evaluate the effect of a surgical method for treating mild- to moderate-ischemic mitral regurgitation（IMR） using a self-designed device during off-pump coronary artery bypass grafting（OPCAB）. Methods From September 2009 to August 2011, six patients（4 males, 2 females； age was 52-73 years） with mild- to moderate-IMR underwent OPCAB and concomitant mitral valvuloplasty using a self-designed device in Beijing An Zhen Hospital. Their degree of IMR, anteroposterior diameter of mitral annulus, left ventricular long-axis diameter, left ventricular short-axis diameter and left ventricular spherical index（left ventricular short-axis diameter/left ventricular long -axis diameter）were measured using transesophageal Doppler echocardiography before and after mitral valvuloplasty. Their mean aorta pressure, mean pulmonary artery pressure and central venous pressure were also measured via Swan-Ganz catheter before and after mitral valvuloplasty. Perioperative cardiac function indexes were compared. Results There was no in-hospital death. IMR of all patients disappeared postoperatively. After mitral valvuloplasty their anteroposterior diameter of mitral annulus（3.43±0.08 cm vs.3.68±0.08 cm；t=5.430, P=0.001）, left ventricular short-axis diameter（4.80±0.21 cm vs.5.53±0.11 cm；t=7.530, P=0.001）and left ventricular spherical index（0.64±0.02 vs.0.74±0.01；t=11.110, P=0.002）significantly decreased than those before mitral valvuloplasty . But their left ventricular long-axis diameter and hemodynamic indexes did not change significantly after mitral valvuloplasty. All the six patients were followed up at the out-patient department 3 months postoperatively without autonomous symptoms. Their heart function improved to I class（New York Heart Association）. Echocardiography showed 4 patients without IMR and 2 patients with trace of minimalIMR. Conclusion Off-pump surgical therapy for mild- to moderate- IMR during OPCAB can help the patients reverseremodeling of the left ventricle, avoid the risks of cardiopulmonary bypass and improve cardiac function with good short-term effects. This method may be a good choice for treating patients with IMR.
We reported a 59-year-old male with exertional angina pectoris, and the coronary angiography showed multiple vessel lesions. The initial strategy was coronary artery bypass grafting (CABG). The measurement of quantitative flow ration (QFR) before operation indicated that the posterior descending branch (PD) did not need to be treated. The left circumflex branch (LCX) was small, and the QFR of the left anterior descending branch (LAD) and the first diagonal branch (D1) was<0.8. Therefore, the LAD and D1 were re-vascularized. The operation strategy was changed to on-pump CABG through a small incision, and the final strategy was LIMA-D1-LAD (sequential), fractional flow reserve (FFR) of distal LAD and D1 after CABG were>0.8 by computed tomography FFR. SYNTAX scores after CABG were 20 and the functional SYNTAX scores after CABG were 3, indicating a good prognosis.
ObjectiveTo introduce the method and preliminary experience of robot-assisted bilateral internal mammary arteries (BIMA) harvesting for off-pump coronary artery bypass grafting (OPCAB) with 5 grafts via left anterolateral minithoracotomy.MethodsBIMA were harvested using the da Vinci robotic surgical system, and the right internal mammary artery (RIMA) was pulled out of the thoracic cavity through right second intercostal space. Intercepting the distal part of the RIMA for the BIMA composite Lima-Rima Y graft and anastomosing the great saphenous vein with remaining RIMA end to end. The Y graft anastomosed with left anterior descending (LAD) branch and diagonal branches (DIAG), artery-vein graft sequentially anastomosed with blunt round branch, left ventricular posterior branch and posterior descending branch.ResultsThe operation succeeded without hemodynamic instability and intra aortic balloon pump (IABP) implantation or cardiopulmonary bypass. The blood flow of Y graft was 24 mL/min, and the blood flow of artery-vein graft was 30 mL/min. Ventilator assistance time was 35 hours, ICU staying time was 62 hours, and postoperative myocardial enzymes increased temporarily. Postoperative coronary CTA showed that all the grafts were patency, and cardiac ultrasound indicated that the heart function was normal. The patient cured and discharged from hospital 7 days after operation.ConclusionRobot-assisted bilateral internal mammary artery harvesting for OPCAB with 5 grafts via left anterolateral minithoracotomy is feasible, which can achieve complete revascularization.
ObjectiveTo analyze the efficacy of one-stop carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OPCABG) for patients with coronary artery disease (CAD) combined with carotid artery stenosis. MethodsThe clinical data of patients with CAD and severe carotid artery stenosis who underwent one-stop CEA and OPCABG in our department from March 2018 to June 2021 were retrospectively analyzed. Before the surgery, all patients routinely underwent coronary and carotid angiography to diagnose CAD and carotid artery stenosis. All patients underwent CEA first and then OPCABG in the simultaneous procedure. ResultsA total of 12 patients were enrolled, including 9 males and 3 females, aged 58-69 (63.7±3.4) years. All patients had unilateral severe carotid artery stenosis, and the degree of stenosis was 70%-90%. The lesions of carotid artery stenosis were located in the bifurcation of carotid artery or the beginning of internal carotid artery. All patients successfully underwent one-stop CEA combined with OPCABG. The number of bridging vessels was 2-4 (2.8±0.6). The operation time of CEA was 16-35 (25.7±5.6) min. There was no death during the perioperative or follow-up periods. No serious complications such as stroke and myocardial infarction occurred during the perioperative period. During the follow-up of 6-40 months, the patency rate of arterial bridge was 100.0% (12/12), and that of venous bridge was 95.5% (21/22). Cervical vascular ultrasound showed that the blood flow of carotid artery was satisfactory. ConclusionOne-stop CEA and OPCABG can be safely and effectively used to treat CAD and carotid artery stenosis. The early and middle-term curative effect is satisfactory.
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.
ObjectiveTo study the learning curve of minimal invasive coronary artery bypass grafting (MICS CABG) and the influence on the perioperative clinical effects by analyzing operation time.MethodsFrom March 2012 to November 2020, 212 patients underwent MICS CABG by the same surgeon. Among them, 59 patients (52 males and average age of 62.89±8.27 years) with single vessel bypass grafting were as a single-vessel group and 153 patients (138 males, average age of 59.80±9.22 years) with multi-vessel bypass grafting were as a multi-vessel group. Two sets of operation time-operation sequence scatter plots were made and learning curve was analyzed by cumulative summation (CUSUM) and regression method of operation time. The surgical data of each group before and after the inflection point of the learning curve were compared with the main clinical outcome events within 30 days after surgery.ResultsThere was no death, perioperative myocardial infarction and stroke in 212 MICS CABG patients and no transfer to cardiopulmonary bypass or redo thoracotomy. The learning curve conformed to the cubic fitting formula. In the single-vessel group, CUSUM (x operation number)=–1.93+93.45×x–2.33×x2+0.01×x3, P=0.000, R2=0.986, the tipping point was 27 patients. In the multi-vessel group, CUSUM (x)=y=2.87+1.15×x–1.29× x2+3.463×x3, P=0.000, R2=0.993, and the tipping point was 59 patients. The two sets of case data were compared before and after the learning curve and there was no statistical difference in main clinical outcomes within 30 days (mortality, acute myocardial infarction, stroke, perioperative blood transfusion rate), ventilator tube, and intensive care unit retention.ConclusionThe learning curve of MICS CABG conforms to the cubic formula, and the process transitions from single to multiple vessels bypass. To enter the mature stage of the learning phase, a certain number of patients need to be done. Reasonable surgical procedures and quality control measures can ensure the safety during the learning phase.
ObjectiveTo evaluate the changes of the flow parameters before and after the anastomotic port exploration and dredging during coronary artery bypass grafting by using the transit time flow measurement (TTFM).MethodsA total of 167 patients who underwent continuous coronary artery bypass grafting and anastomotic port exploration and dredging surgery in Beijing Anzhen Hospital from 2018 to 2019 were enrolled in this study. There were 136 male and 31 female patients aged 41-82 (58.35±17.26) years. If the probe entered and exited the anastomotic port smoothly, it was recorded as a non-resistance group; if the resistance existed but the probe could pass and exit, it was recorded as a resistance group; if the probe could not pass the anastomotic port for obvious resistance, it was recorded as the stenosis group. In the stenosis group, the grafts were re-anastomosed and the flow parameters were re-measured by TTFM.ResultsA total of 202 anastomotic ports were carried out by exploration and dredging. Among them, 87 anastomosis (43.1%) were in the non-resistance group, and there was no significant change in the blood flow volume (BFV) and pulsatility index (PI) before and after exploration and dredging (6.16±3.41 mL/min vs. 6.18±3.44 mL/min, P=0.90; 7.06±2.84 vs. 6.96±2.49, P=0.50). Sixty-four anastomosis (31.7%) were in the resistance group, the BFV was higher after exploration and dredging than that before exploration and dredging (17.11±7.52 mL/min vs. 4.96±3.32 mL/min, P<0.01), while the PI was significantly smaller (3.78±2.20 vs. 8.58±2.97, P<0.01). Fifty-one anastomosis (25.2%) were in the stenosis group, and there was no significant change in the BFV and PI before and after exploration and dredging (3.44±1.95 mL/min vs. 3.48±2.11 mL/min, P=0.84; 10.74±4.12 vs. 10.54±4.11, P=0.36). After re-anastomosis, the BFV was higher (16.48±7.67 mL/min, P<0.01) and the PI deceased (3.43±1.39, P<0.01) than that before exploration and dredging.ConclusionThe application of anastomotic exploration and dredging can reduce the occurrence of re-anastomosis, and promptly find and solve the stenosis of the distal coronary artery, improve the poor perfusion of distal coronary, and thus improves the prognosis of patients.