Objective To summarize the experience of emergency coronary artery bypass grafting （CABG） after failed percutaneous coronary intervention. Methods From January 1998 to December 2002, 9 patients underwent emergency CABG after failed percutaneous coronary intervention. The indications of emergency CABG were coronary artery dissection （5 cases）or perforation （2 cases） and acute arterial occlusion （2 cases）. The time averaged 2 hours from onset of ischernia to revascularization. The CABG was performed under off-pump bypass in 3 cases and under CPB in 6 cases. The mean graft number was 3. Results There were no hospital death. The mean follow-up was 17 months. No death and angina occurred. The function of New York Heart Association class Ⅰ-Ⅱ were in 8 patients, class Ⅲ in 1 patient. Conclusion Emergency CABG is an effective management for failed percutaneous coronary intervention if the indication is right.
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.
ObjectiveTo observe expre with ssions of insulin receptor substrate 1(IRS-1) and ubiquitin-protein in skeletal muscle of non-obese rats with type 2 diabetes mellitus following gastric bypass operation (GBP), and to investigate possible mechanism of GBP in improving insulin resistance. MethodsMale GK rats were randomly divided into diabetic operation group (DO group), diabetic sham operation group (DSO group), and diabetic control group (DC group), 8 rats in each group; besides 8 male Wistar rats were served as normal control group (NC group). Fasting body weight (FBW), fasting plasma glucose (FPG), and fasting insulin (FINS) were measured respectively before operation and on week 1, 2, 4 and 8 after operation. Homeostasis model-insulin resistant (HOMA-IR) index was calculated respectively before operation and on week 8 after operation. The expressions of IRS-1 protein and ubiquitin-protein in skeletal muscle were detected by using Western blot method on week 8 after operation. Results① Compared with the preoperative levels, the FBWs on week 1, 2, and 4 after operation markedly decreased (P < 0.05), but it recovered to the preoperative level on week 8 after operation (P > 0.05) in the DO group; which in the DSO group decreased on week 1 after operation (P < 0.05) and then increased on week 4 after operation (P < 0.05); which in the DC group or the NC group increased continuously and had a significant difference on week 8 after operation (P < 0.05).② The FPGs in the DO, DSO and DC groups were significantly higher than those of the NC group before operation (P < 0.05), which in the DO group decreased from (9.10±0.98) mmoL/L before operation to (5.70±0.91) mmol/L on week 8 after operation (P < 0.05) and were significantly lower than those of the DSO group or the DC group on week 2, 4, and 8 after operation (P < 0.05); which in the DC group, DSO group and NC group had no obviously changes between before and after operations (P > 0.05). ③ The FINS had no significant differences among these four groups before operation (P > 0.05), which in the DO group obviously increased[(9.64±1.59) mU/L] on week 2 after operation (P < 0.05) and then obviously decreased[(6.58±1.05) mU/L] on week 8 after operation (P < 0.05) and significantly lower than those of the DSO group or the DC group on week 8 after operation (P < 0.05), while which had no significant difference between before and after operations in the DSO group, the DC group, or the NC group (P > 0.05). ④ The HOMA-IR index in the DO, DSO or DC group was significantly higher than that of the NC group before operation (P < 0.05), which in the DO group markedly decreased from 3.18±0.50 before operation to 1.96±0.63 on week 8 after operation (P < 0.05) and significantly lower than that of the DSO group or the DC group on week 8 after operation (P < 0.05), while which had no significant difference between before and after operations in the DSO group, the DC group, or the NC group (P > 0.05). ⑤ The expression of IRS-1 protein in the DO group was significantly higher than that in the DSO group (P < 0.05) or the DC group (P < 0.05) on week 8 after operation. While there was no significant difference between the DSO and the DC group after operation (P > 0.05). ⑥ Compared with the NC group, the expression of ubiquitin-protein was significantly increased in the DO group, the DSO group, or the DC group (P < 0.05). Compared with the DSO group or the DC group, the expression of ubiquitin-protein was significantly decreased in the DO group on week 8 after operation (P < 0.05), especially it was most obvious near the molecular weight of 180×103. While there was no significant difference between the DSO group and the DC group after operation (P > 0.05). ConclusionsExpression of IRS-1 protein in skeletal muscle insulin signaling pathway in type 2 diabetes mellitus rats following GBP is increased, it might be associated with decreasing ubiquitin-protein level in skeletal muscle, thus reduces the IRS-1 ubiquitin-degradation, increase insulin sensitivity, and improve insulin resistance of skeletal muscle.
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 evaluate the effect of cardiopulmonary bypass （CPB） on pulmonary function in infants with variable pulmonary arterial pressure resulting from congenital ventricular septal defect （VSD）. Methods Twenty infants with VSD underwent corrective surgery were divided into pulmonary hypertension group （n= 10） and non-pulmonary hypertension group （n= 10） according to with pulmonary hypertension or not. Pulmonary function was measured before CPB , 3h,6h,9h,12h,15h,18h,21h, and 24h after CPB and duration for mechanical ventilation and cardiac intensive care unit stay were recorded. Results Pulmonary function parameters before CPB in nonpulmonary hypertension group were superior to those in pulmonary hypertension group （P〈0.01）, and pulmonary function parameters after CPB deteriorated than those before CPB （P〈0.05）, especially 9h,12h and 15h after CPB （P〈0.01）. Compared to pulmonary function parameters before CPB, pulmonary function parameters of pulmonary hypertension group at 3h after CPB were improved （P〉0.05）, but they deteriorated at 9h,12h and 15h after CPB （P〈0. 05）. Pulmonary function parameters at 21h and 24h after CPB was recoverd to those before CPB in two groups. Conclusions Although exposure to CPB affects pulmonary function after VSD repair in infants, the benefits of the surgical correction to patients with pulmonary hypertension outweigh the negative effects of CPB on pulmonary function. Improvement of cardiac function can avoid the nadir of pulmonary function decreasing. The infants with pulmonary hypertension will be weaned off from mechanical ventilator as soon as possible, if hemodynamics is stable, without the responsive pulmonary hypertension or pulmonary hypertension crisis after operation.
【Abstract】 Objective To reduce restenosis in vein grafts after coronary artery bypass grafting, to investigate theeffect of human tissue factor pathway inhibitor(TFPI) gene del ivery on neointima formation. Methods The eukaryotic expressed plasmid vector pCMV-(Kozak) TFPI was constructed. Forty-eight Japanese white rabbits were randomly divided into 3 groups with 16 rabbits in each group: TFPI group, empty plasmid control group and empty control group. Animal model of common carotid artery bypass grafting was constructed. Before anastomosis, vein endothel iocytes were transfected with cationic l iposome containing the plasmid pCMV- (Kozak) TFPI (400 μg) by pressurizing infusion (30 min) in TFPI group. In empty plasmid control group, vector pCMV- (Kozak) TFPI was replaced by empty plasmid pCMV (400 μg). In empty control group, those endothel iocytes were not interfered. After operation, vein grafts were harvested at 3 days for immunohistochemical, RTPCR and Western-blot analyses of exogenous gene expression and at 30 days for histopathology measurement of intimal areas, media areas and calculation of intimal/media areas ratio. Luminal diameter and vessel wall thickness were also measured byvessel Doppler ultrasonography and cellular category of neointima was analyzed by transmission electron microscope at 30 days after operation. Results Human TFPI mRNA and protein were detected in TFPI group. The mean luminal diameter of the TFPI group, empty plasmid control group and empty control group was (2.68 ± 0.32) mm, (2.41 ± 0.23) mm and (2.38 ± 0.21) mm respectively. There were statistically significant differences between TFPI group and control groups (P lt; 0.05). The vessel wall thickness of the TFPI group, empty plasmid control group and empty control group was (1.09 ± 0.11) mm, (1.28 ± 0.16) mm and (1.34 ± 0.14) mm respectively. There were statistically significant differences between TFPI group and other control groups (P lt; 0.01). The mean intimal areas, the ratio of the intimal/media areas of the TFPI group were (0.62 ± 0.05) mm2and 0.51 ± 0.08 respectively, which were reduced compared with those of the two control groups(P lt; 0.05). The mean media areas had no significant differences among three groups (P gt; 0.05). Through transmission electron microscope analyses, no smoothmuscle cells were seen in neointima of TFPI group in many visual fields, but smooth muscle cells were found in neointima of two control groups. Conclusion Human TFPI gene transfection reduced intimal thickness in vein grafts.
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.
【Abstract】ObjectiveTo compare the hemodynamic changes during operation of portal venous intubation or splenic venous intubation in extracorporeal venous bypass of swine orthotopic liver transplantation.MethodsThirty couples of healthy Duloke pigs were selected to perform orthotopic liver transplantation. According to the difference of cannula vessel of portal venous system during extracorporeal venous bypass, these pigs were divided into two groups: portal venous intubation group (n=15) and splenic venous intubation group (n=15). Hemodynamic changes were monitored continuously.ResultsTwo recipients died in portal venous intubation group, one died of unsmooth bypass in the operation, the other died of DIC. In splenic venous intubation group there was only one recipient death, who died of hemorrhagic shock. The time of anhepatic phase of splenic venous intubation group was (44.5±7.6) min, it was significantly shorter than portal venous intubation group(51.5±8.7) min(P＜0.05). Hemodynamic changes in phase Ⅲ and phase Ⅳ of portal venous intubation group were significantly different with that of splenic venous intubation group(P＜0.05). ConclusionApplication of bypass through splenic venous intubation during extracorporeal venous bypass of swine orthotopic liver transplantation can shorten the time of anhepatic phase, keep the hemodymamics relative stable in operation, and reduce the occurrence of postoperative correlative complication. It is an effective venovenous bypass pathway.
Objective To evaluate the influence of diabetes on coronary artery bypass graft (CABG) surgery using bilateral internal mammary artery (BIMA). Methods From December 2015 to August 2017, 182 patients (153 males, 29 females, age of 56.5±6.8 years) underwent CABG using BIMA. The propensity score was used to create matched diabetes (n=66) and non-diabetes (n=66) cohorts. The operative data, post-operative outcomes and coronary computed tomographic angiography (CTA) of the diabetes group (53 males, 13 females, age of 57.8±7.2 years) and the non-diabetes group (56 males, 10 females, age of 56.3±6.0 years) were analyzed retrospectively. Results There was no peri-operative mortality. There was no difference in operative sternal wound complication (P=0.466), or graft patency (P=0.730 for internal mammary arteries and 0.684 for saphenous vein grafts) between the matched diabetes and the non-diabetes groups. However, patients with elevated glycated hemoglobin (HbA1c) (n=54) had more sternal wound complications (P=0.006). The level of Hb1Ac of the patients with sternal wound complication was significantly higher than that of the patients without sternal wound complication. Conclusion BIMA grafting may be performed routinely even in diabetic patients, without increased complications. However, elevated HbA1c level should be avoided to reduce sternal wound complication.
Abstract: There is a 1% - 4% incidence of cardiac disease in pregnancy, and rheumatic heart disease is the most common diagnosis. On the condition that medical treatment is inefficacious, an open heart surgery should be performed. Because of the changes in physiological functions, there is a major difference between pregnant patients and the general population in perioperative management of valve replacement. Now , the pregnancy is not an absolute contraindication for cardiopulmonary bypass, though the incidence of mortality and birth defects remains high. It is helpful in decreasing complications and increasing survival rate by improving themethods of cardiopulmonary bypass, postoperative monitoring, anticoagulation etc. In this article, the progress in t reatments of perioperative period of cardiac valve replacement during pregnancy is reviewed.