Objective To investigate the impact of edaravone on serum reactive oxygen species during the perioperative period of off-pump coronary artery bypass grafting （OPCAB）. Methods A total of 40 patients who underwent selective OPCAB in the First Hospital of Hebei Medical University between June 2011 and November 2012 were prospectively enrolled in this study. All the patients were randomly divided into a trial group and a control group by a random digitaltable method with 20 patients in each group. There were 13 males and 7 females in the trial group with their age of 40-67（51.8±11.5） years， and 9 males and 11 females in the control group with their age of 42-70 （53.5±13.1） years. Afteranesthesia induction， patients in the trial group received continuous intravenous infusion of edaravone 60 mg （diluted in 100 ml saline）， while patients in the control group received continuous intravenous infusion of saline 100 ml， both of whichwere finished within 30 minutes. Venous blood samples were taken 24 hours preoperatively （T1）， 1 hour after skin incision（T2）， at the end of the surgery （T3） and 24 hours postoperatively （T4） to examine the concentration of superoxide dismutase（SOD） and malondialdehyde （MDA）. The data of the two groups were compared. Results All the patients successfully underwent their surgery and were included in the analysis. At the T2， T3 and T4 time point， SOD concentration was 80.3±21.3 U/ml， 78.5±17.4 U/ml and 81.4±17.5 U/ml， and MDA concentration was 10.2±1.8 nmol/ml， 11.3±1.9 nmol/ml，14.8±2.1 nmol/ml respectively in the control group；SOD concentration was 92.8±18.4 U/ml，90.0±18.1 U/ml，and 88.7±18.7 U/ml，and MDA concentration was 7.2±1.7 nmol/ml，8.2±1.2 nmol/ml，10.2±1.3 nmol/ml respectively in the trial group. At each above time point， SOD activity was significantly higher in the trial group than the control group （F=2.90，P=0.003；F=2.80，P=0.003；F=2.80，P=0.001）， and MDA concentration was significantly lower in the trial group than the control group （F=2.79，P=0.001；F=2.80，P=0.001；F=2.90，P=0.000）. Conclusion Edaravone can decrease serum reactive oxygen species caused by OPCAB and reduce myocardial injury.
Abstract: Objective To compare the midterm patency rates of individual and sequential saphenous vein grafts (SVG) as coronary bypass conduits of offpump coronary artery bypass grafting (OPCAB) and evaluate the impact of the grafting techniques (individual or sequential grafts) on the graft patencyafter OPCAB. Methods The clinical data of 398 patients in General Hospital of the People’s Liberation Army receiving OPCAB with individual and sequential grafts from June 2005 to March 2009 were retrospectively analyzed. There were 301 males and 97 females with their age ranged from 53 to 82 years (63.6±10.3 years). A total of 714 distal coronary anastomoses on 448 SVG were assessed by using 64multislice computed tomography (64MSCTA) at an average of 19.8±23.6 months (3 months to 5 years) after OPCAB procedure. The blood flow of grafts in the proximal segment of individual and sequential SVG and the patency rates of grafts and anastomoses were compared, and the effect of different locations on the patency rate of the anastomoses was analyzed. Results The mean blood flow in double SVG (37.11±16.70 ml/min vs. 25.15±14.24 ml/min, P0.042) and in triple SVG (37.56±19.58 ml/min vs. 25.15±14.24 ml/min, P=0.048) were both significantly higher than the flow in single SVG. The anastomoses on the sequential conduits had better patency (95.1％ vs. 90.1％, P=0.013). The patency of sideto side anastomoses was better than that of endtoside anastomoses (97.0% vs. 93.1%, P=0.002) and that of the individual endtoside anastomoses (97.0% vs. 90.1%, P=0.041). There was no significant difference between distal anastomoses in sequential and those in single grafts (P=0.253). No significant difference was observed between the two methods in regard to the three major coronary systems (including the anterior descending branch, the right coronary artery, and the circumflex branch). However, anastomoses on sequential grafts had superior patency to those on individual grafts in the right coronary system (P=0.008). Conclusion The midterm patency of a sequential SVG conduit after OPCAB is excellent and generally superior to that of an individual one. The best runoff coronary artery should be placed at the distal end and the poor coronary vessels should be arranged in the middle of the grafts.
ObjectiveTo analyze the risk factors for acute kidney injury (AKI) after off-pump coronary artery bypass grafting (OPCABG). Methods The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang data, CBM, VIP, CNKI were searched by computer for researches on risk factors associated with the development of AKI after OPCABG from the inception to March 2022. The meta-analysis was performed using RevMan 5.4 software. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies.ResultsA total of 18 researches were included, involving 9 risk factors. The NOS score of all included studies was≥6 points. Meta-analysis results showed that age [OR=1.03, 95%CI (1.01, 1.06), P=0.020], body mass index (BMI) [OR=1.10, 95%CI (1.05, 1.15), P<0.001], history of hypertension [OR=1.45, 95%CI (1.27, 1.66), P<0.001], history of diabetes [OR=1.50, 95%CI (1.33, 1.70), P<0.001], preoperative serum creatinine level [OR=2.05, 95%CI (1.27, 3.32), P=0.003], low left ventricular ejection fraction [OR=4.51, 95%CI (1.39, 14.65), P=0.010], preoperative coronary angiography within a short period of time [OR=2.10, 95%CI (1.52, 2.91), P<0.001], perioperative implantation of intra-aortic balloon pump [OR=3.42, 95%CI (2.26, 5.16), P<0.001], perioperative blood transfusion [OR=2.00, 95%CI (1.51, 2.65), P<0.001] were risk factors for AKI after OPCABG. ConclusionAge, BMI, history of hypertension, history of diabetes, preoperative serum creatinine level, low left ventricular ejection fraction, preoperative coronary angiography within a short period of time, perioperative implantation of intra-aortic balloon pump, perioperative blood transfusion are risk factors for AKI after OPCABG. Medical staff should focus on monitoring the above risk factors and early identifying, in order to prevent or delay the onset of postoperative AKI and promote early recovery of patients.
ObjectiveTo evaluate the clinical efficacy of preoperative intra-aortic balloon pump (IABP) insertion in patients with off-pump coronary artery bypass grafting (OPCABG) surgery.MethodsThe clinical data of 130 patients who underwent OPCABG with IABP from 2015 to 2019 in our hospital were retrospectively analyzed. The patients were divided into two groups, including a group A (preoperative IABP insertion, n=72) and a group B (emergent IABP insertion, n=58). There were 42 males and 30 females in the group A with an average age of 60-72 (65.0±5.2) years. There were 32 males and 26 females in the group B with an average age of 56-73 (62.3±7.6) years. The in-hospital mortality rate and prognosis were compared between the two groups.ResultsThe in-hospital mortality rate in the group A (4.2%) was significantly lower than that in the group B (12.1%, P=0.002). The IABP time (40.8±10.3 min vs. 65.3±15.6 min), mechanical ventilation time (18.7±6.1 min vs. 48.7±10.5 min) and ICU stay time (48.1±7.8 min vs. 90.2±21.3 min) of the group A were shorter than those of the group B (P<0.05). The number of bypass grafts was not significantly different between the two groups (3.6±1.2 vs. 3.8±1.0, P=0.387). Multivariable logistic regression analysis indicated that independent risk factors for in-hospital mortality included age [OR=1.04, 95%CI (1.01, 1.10), P=0.030], female [OR=2.56, 95%CI (1.53, 6.12), P=0.000] and left ventricular end-diastolic diameter [OR=1.05, 95%CI (1.01, 1.13), P=0.030]. Preoperative IABP support was the protective factor [OR=0.17, 95%CI (0.01, 0.78), P=0.005].ConclusionPatients undergoing OPCABG with preoperative IABP insertion may reduce in-hospital mortality rate and improve outcomes.
Objective To evaluate the efficacy of preoperative low-dose oral amiodarone for the prevention of atrial fibrillation （AF） after off-pump coronary artery bypass grafting （OPCAB） in patients older than 70 years. Methods A total of 156 patients older than 70 years who underwent OPCAB in Qingdao Fuwai Cardiovascular Disease Hospital from January 2011 to June 2012 were included in this prospective，double-blind and placebo controlled study. Preoperatively，all the 156 patients were randomly divided into amiodarone group and control group. In the amiodarone group，there were 80 patients including 38 male and 42 female patients who were given oral amiodarone （trade name： Cordarone） 200 mg，three times a day，3-5 days before surgery，and amiodarone was stopped on the OPCAB day and postoperatively. Preoperative duration of amiodarone intake was 4.0±1.2 days，and total amiodarone dosage was 2.6±0.5 g. In the control group，there were 76 patients including 35 male and 41 female patients who were given oral placebo as the same medication schedule，and preoperative duration of placebo intake was 4.0±1.4 days. Operation time，graft number，postoperative AF incidence，AF duration，hospital stay and readmission rate for cardiovascular events within 6 postoperative months were compared between the two groups. Results There was no in-hospital death in either group. There was no statistical difference in graft number，operation time，AF duration of patients who had postoperative AF，or postoperative hospital stay between the two groups. Postoperative AF incidence of the amiodarone group was significantly lower than that of the control group ［18.7% （15/80） vs. 34.2% （26/76），P=0.028］. Seventy-three patients in the amiodarone group （91.3%） and 66 patients in the control group （86.8%） were followed up for 8-24 months. During follow-up，2 patients in the amiodarone group died of acute myocardial infarction and cerebral hemorrhage respectively. There was no statistical difference in readmission rate for cardiovascular events within 6 postoperative months between the 2 groups ［6.8% （5/73） vs. 6.1% （4/66），P=0.860］ .Conclusion Preoperative low-dose oral amiodarone can significantly reduce the incidence of postoperative AF in patients older than 70 years undergoing OPCAB.
ObjectiveTo explore the incidence of total occlusion of right coronary artery (RCA)and its treatment strategy during off-pump coronary artery bypass grafting (OPCAB). MethodsA total of 1 153 patients with total RCA occlusion were chosen from 6 206 patients who underwent OPCAB in Beijing Anzhen Hospital from January 1, 2005 to December 31, 2012. There were 889 male (77.1%)and 264 female (22.9%)patients with their age of 45-78 years. The incidence of total RCA occlusion was calculated, and its treatment strategies were discussed. ResultsAmong 6 206 OPCAB patients, 1 153 patients (18.6%)had total RCA occlusion. All the 1 153 patients successfully received OPCAB, but 13 patients (1.1%)died postoperatively. Thirty-four patients (2.9%)had postoperative complications including cerebral infarction, mild to moderate pleural effusion and poor wound healing, all of whom were cured or improved, and all the other patients were discharged uneventfully. A total of 1 110 patients (97.4%)were followed up for 1 month to 7 years, and 30 patients were lost during follow-up. Angina symptoms disappeared in 758 patients and were relieved in 352 patients. During follow-up, 64-row helical CT of 586 patients with preoperative total RCA occlusion showed good graft patency, and echocardiography and nuclear myocardial scan showed improved left ventricular systolic function and myocardial blood flow. ConclusionThe incidence of total RCA occlusion is 18.6% in our study. Appropriate surgical strategies are needed according to individualized patient conditions to get satisfactory clinical outcomes.
ObjectiveTo evaluate surgical outcomes of combined off-pump coronary artery bypass grafting (OPCAB)and bipolar radiofrequency ablation (RFA)for atrial fibrillation (AF). MethodsFrom January 2008 to October 2013, 49 patients with coronary artery disease and AF underwent OPCAB and concomitant Atricure bipolar RFA for AF in Beijing Anzhen Hospital. According to their AF duration, all the 49 patients were divided into 2 groups. In group A, there were 14 patients with permanent AF including 9 males and 5 females with their age of 56.7±7.5 years. In group B, there were 35 patients with paroxysmal AF including 27 males and 8 females with their age of 60.2±10.5 years. AF duration was 9.4±6.0 months. Coronary artery stenosis was 85%-100%. Ambulatory electrocardiogram and echocardiography were performed to observe AF recurrence during follow-up. ResultsNone of the patients received intraoperative conversion operation under cardiopulmonary bypass, and there was no in-hospital death. Postoperatively, 81.6% (40/49)patients had conversion to sinus rhythm (SR)or junctional rhythm, 18.4% (9/49)patients remained AF, but none of the patients had second or third-degree atrioventricular block. A total of 139 distal anastomoses were performed with a mean of 2.8 distal anastomoses per patient. Length of hospital stay was 10-15 (12±3)days. SR was observed in 34 patients (69%)before discharge including 9 patients (64%)in group A and 25 patients (71%)in group B. All the patients (100%)were followed up for 5-12 months. 39 patients (80%)maintained SR over 6 months, including 10 patients (71%)in group A and 29 patients (83%)in group B. 44 patients (90%)maintained SR over 12 months, including 11 patients (79%)in group A and 33 patients (94%)in group B. There was no statistical difference in SR maintenance rate between the 2 groups (P > 0.05). ConclusionOPCAB and concomitant bipolar RFA for AF is safe, efficacious and feasible.
ObjectiveTo investigate predictive value of intraoperative graft flow measurements during off-pump coronary artery bypass grafting (OPCAB) for early clinical prognosis. MethodsWe retrospectively analyzed the clinical data of 133 patients with three-vessel disease who underwent OPCAB in the Department of Cardiac Surgery of People's Hospital of Peking University in 2013 year. There were 103 males and 30 females with mean age of 62.84±7.13 years. Pulsatility index (PI) and mean flow were measured using a flow metre before the end of surgery. Then the total graft flow and the average graft flow were calculated. Univariate, bivariate correlation and logistic regression analysis were performed for statistical analysis. ResultsThe blood flow and PI of LIMA-to-LAD graft was respectively 28.69±16.90 ml/min and 2.70±1.39, and the total graft flow and the average graft flow was respectively 79.94±37.20 ml/min and 35.55±16.75 ml/min. The PI of LIMA-to-LAD graft was significantly correlated with serum cardiac troponin I(cTnI)level in 12 hours, with the highest serum cTnI level within 48 hours, with ICU stay and with ventilator time (P<0.01), but the correlation was not strong(coefficient correlation <0.4). Compared with the patients without perioperative myocardial infarction (PMI), the blood flow of LIMA-to-LAD graft, the total graft flow and the average graft flow were lower in the patients with PMI (P<0.01). Logistic regression analysis revealed that the total graft flow was an independent predictor of PMI (P=0.004, RR=0.950, 95%CI 0.918-0.984). ConclusionIntraoperative graft flow measurements during OPCAB can predict shortterm prognosis. The lower total graft flow is a risk factor for PMI.
Objective To compare the clinical early results of on-pump and off-pump coronary artery bypass grafting re-operations (re-CABG)and introduce our experience. Methods From April 2000 to June 2006, 21 cases with coronary artery diease of re-CABG were performed in this hospital. 10 patients received off-pump CABG (off-pump group), and 11 underwent CABG re-operations with cardiopulmonary bypass CABG(on-pump group). There were no significant difference regarding gender, age, weight, diabetes, hypertension, left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) between two groups before operation. On-pump CABG procedures were performed on hypothermia cardiopulmonary bypass. Standard methods were used to finish off-pump CABG. Flow meters were utilized to measure the flow of grafts in both groups. Results No one in off-pump group needed to conver to on-pump CABG. There was no operative or late mortality. The operation time, respiratory support time, the volume of chest tube drainage, blood transfusion and postoperative hospital stay were less in off-pump group than those in on-pump group after operation. Early death occurred in 1 patient in on-pump group. The number of distal anastomosis were more in on-pump group than that in off-pump group. Conclusions Both off-pump CABG and on-pump CABG can be applied to CABG re-operations and achieved similar completeness of revascularization, similar early surgical results.
Abstract: Objective To invest igate the effect of p ro staglandin E1 (PGE1 ) during off-pump co ronary artery bypass graft ing (O PCAB ). Methods F rom O ct. 2005 to Dec. 2005, 40 consecut ive pat ients w ho underw ent O PCAB w ere random ly divided into two group s. The cont ro l group received convent ional t reatment w h ile the PGE1 group received cont inuous int ra2vena PGE1 infusion ( 5220 ngouml;k g?m in) fo r 24248 hours. The perioperat ivehemodynam ic indexes, including cardiac index (C I) , system ic vascular resistance ( SVR ) , pulmonary vascular resistance (PVR ) , and hematocrit (HCT ) , coagulation index (C I) , partial pressure of oxygen in artery (PaO 2 ) ,serum creat inine (Cr) and blood urea nitrogen (BUN ) were measured and compared. Results Postoperative SVR and PVR decreased and C I increased significantly in the PGE1 group (P lt; 0. 05). Postoperative HCT decreased in the both group patients. Coagulation index decreased significantly on the operation day, but then increased in both groups on the next day after operation, with the increase in the PGE1 group significantly less than control group (P lt;0. 05). Postoperative serum Cr and BUN increased significantly in the both groups, especially in the control group (P lt; 0105). Conclus ion PGE1 has potential beneficial effect on patients undergoing OPCAB.