Abstract： Objectives To evaluate the early and mid-term follow-up outcomes of “one-stop” hybrid coronary revascularization strategy for patients with multivessel coronary artery disease. Methods From June 2007 to December 2009, 104 consecutive patients underwent “one-stop”hybrid coronary revascularization in Fu Wai Hospital. There were 93 male patients and 11 female patients with mean age of （61.8±10.2）years（ranging from 35 to 81 years）. All the patients had multivessel coronary artery disease including left anterior descending （LAD）coronary artery stenosis, and underwent “one-stop”hybrid coronary revascularization. “One-stop”hybrid procedure was first performed through a lower partial sternotomy at the second left intercostal space. The distal anastomosis of in situ left internal mammary artery （LIMA）to LAD graft was completed. Angiography was performed immediately to confirm patency of the LIMA graft after closure of the thorax. A 300 mg loading dose of clopidogrel was administered through a nasogastric tube after confirmation of LIMA graft patency. Intravenous unfractionated heparin was administered to obtain an activated clotting time of greater than 250 s. Then percutaneous coronary intervention（PCI）was performed on the non-LAD lesions. Results All the patients underwent“one-stop”hybrid coronary revascularization including grafted LIMA to LAD，and one hundred and ninety one drug eluting stents and three bare metal stents were used for other non-LAD lesions. No death event occurred during surgery and in hospital. All the patients were followed up for a mean duration of 1.5 years. There was no myocardial infarction, neurologic event or death occurred during follow-up except one patient with stent stenosis who was treated by PCI. Conclusion “One-stop” hybrid coronary revascularization is a feasible and safe alternative for patients with multivessel coronary artery disease.
ObjectiveTo evaluate the safety, efficacy, and advantages of transcarotid artery revascularization (TCAR) in patients with high-risk carotid artery stenosis. MethodsThe patient was a 76-year-old male with severe symptomatic stenosis of the right internal carotid artery, complicated by multiple high-risk factors (such as cardiac insufficiency, history of coronary stent implantation, aortic calcification). Given his unsuitability for carotid endarterectomy and the high perioperative risk associated with transfemoral carotid artery stenting, TCAR was performed. The procedure involved puncturing the common carotid artery via a small cervical incision to establish a temporary carotid-to-femoral venous reversed-flow pathway. Following balloon predilation, a stent was deployed, and the reversed-flow system was used to divert potential plaque debris outward, thereby reducing the risk of intraoperative cerebral embolism. ResultsThe procedure was completed successfully. The operation time was approximately 70 min, the estimated blood loss was 20 mL. Postoperatively, the patient did not experience complications such as stroke, neurological deficit, or hyperperfusion syndrome. Although carotid sinus reflex-induced hypotension occurred, which stabilized after pharmacological management. The results of following-up at 3 months showed the stent was patent with no evidence of in-stent restenosis. ConclusionsThe findings of this case indicate that TCAR combines the cerebral protection advantages of carotid endarterectomy with the minimally invasive features of transfemoral carotid artery stenting. Its reversed-flow mechanism helps effectively prevent intraoperative embolism, offering a safe and viable revascularization option for patients with high-risk carotid artery stenosis.
Objective To compare the in-hospital and midterm outcomes after simultaneous hybrid coronary revascularization (HCR) with off-pump coronary artery bypass grafting (OPCAB) in diabetic patients with multivessel coronary artery disease. Methods One hundred thirty-two diabetic patients with multivessel coronary artery disease underwent one-stop HCR at Fuwai Hospital from January 2010 to January 2015. These patients were 1∶2 matched with those who underwent OPCAB using propensity score matching. Results Simultaneous HCR had less chest tube drainage (618 (420, 811) ml vs. 969 (711, 1 213)ml, P<0.001), lower transfusion rate (19.7%vs. 34.1%, P=0.026), shorter mechanical ventilation time (11.6 (8.2, 14.8) h vs. 16.0 (12.1, 18.7) h, P<0.001), and shorter stay in intensive care unit (21.5 (18.8, 42.0) hvs. 44.6 (23.7, 70.1) h, P<0.001) than OPCAB. During over median 40 months follow-up, simultaneous HCR offered similar major adverse cardiac or cerebrovascular events (MACCE) rate (6.8%vs 9.0%, P=0.826), but lower stroke rate (0% vs 3.0%, P=0.029), compared with OPCAB. Conclusion For selected patients with diabetes, simultaneous HCR provides a safe and effective revascularization alternative. It decreases perioperative invasiveness and incurred similar and favorable midterm outcomes with OPCAB.
Hybrid coronary revascularization (HCR) combines the advantages of minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI), and avoids its relative shortcomings, which has received particular attention in recent years. HCR seems to have become the third revascularization strategy for multi-vessel disease in coronary heart diseases. However, the clinical researches on HCR are still limited. This article will systematically review the comparison of HCR with coronary artery bypass grafting (CABG) and PCI, the results of HCR in specific patients, and the clinical results of different HCR strategies.
ObjectiveTo investigate the effect of human adipose-derived stem cells (hADSCs) on pressure ulcers in mouse.MethodsThe subcutaneous adipose tissue from voluntary donation was harvested. Then the hADSCs were isolated and cultured by mechanical isolation combined with typeⅠcollagenase digestion. The 3rd generation cells were identified by osteogenic, adipogenic, chondrogenic differentiations and flow cytometry. The platelet rich plasma (PRP) from peripheral blood donated by healthy volunteers was prepared by centrifugation. The pressure ulcer model was established in 45 C57BL/6 mice by two magnets pressurized the back skin, and randomly divided into 3 groups (n=15). The wounds were injected with 100 μL of hADSCs (1×106 cells) transfected with a green fluorescent protein (GFP)-carrying virus, 100 μL human PRP, and 100 μL PBS in hADSCs group, PRP group, and control group, respectively. The wound healing was observed after injection. The wound healing rate was calculated on the 5th, 9th, and 13th days. On the 5th, 11th, and 21st day, the specimens were stained with HE staing, Masson staining, and CD31 and S100 immunohistochemical staining to observe the vascular and nerve regeneration of the wound. In hADSCs group, fluorescence tracer method was used to observe the colonization and survival of the cells on the 11th day.ResultsThe cultured cells were identified as hADSCs by induced differentiation and flow cytometry. The platelet counting was significantly higher in PRP group than in normal peripheral blood group (t=5.781, P=0.029). General observation showed that the wound healing in hADSCs group was superior to those in PRP group and control group after injection. On the 5th, 9th, and 13th days, the wound healing rate in hADSCs group was significantly higher than those in PRP group and control group (P<0.05). Histological observation showed that compared with PRP group and control group, inflammatory cell infiltration and inflammatory reaction were significantly reduced in hADSCs group, collagen deposition was significantly increased, and skin appendage regeneration was seen on the 21st day; at each time point, the expression of collagen was significantly higher in hADSCs group than in PRP group and control group (P<0.05). Immunohistochemical staining showed that the number of neovascularization and the percentage of S100-positive cells in hADSCs group were significantly better than those in PRP group and control group on the 5th, 9th, and 13th days (P<0.05). Fluorescent tracer method showed that the hADSCs could colonize the wound and survive during 11 days after injection.ConclusionLocal transplantation of hADSCs can accelerate healing of pressure ulcer wounds in mice and improve healing quality by promoting revascularization and nerve regeneration.
ObjectiveTo summarize the experience of 4 patients with a great saphenous venous graft patency after 15 years of postoperitive great saphenous venous sequential aortic coronary artery bypass grafting. MethodWe retrospectively analyzed the clinical data of 4 patients accepted great saphenous vein aortic coronary artery bypass graft under moderate hypothermia cardiopulmonary bypass from November 1989 to December 1992 year. There were 3 males and 1 female with a mean age of 48.3 years ranging from 40-58 years. We harvested great saphenous vein under groin 45-50 cm. The proximal and distal anastomoses were performed with parachute technique under two clamps technique. Coronary artery bypass graft was performed by two sequential grafts routinely. Aspirin was given through nasal tube 6 hours after operation. The risk factors of arteriosclerosis were controlled by patients themselves after discharge. ResultFour patients received coronary angiography in 15, 16, 18, and 21 years after surgery and the grafts and both proximal and distal anastomoses were patent. The patients lived about 20 years without angina. Conclusioncarefully dealing with the vein graft, taking sequential bypass grafting to guarantee parabolic curve and meticulous anastomosis are preconditional and necessary for long-term patency.
ObjectiveTo explore the vascular conditions and the necessity of vascular reconstruction in the treatment of chronic ischemic diseases of lower extremities with tibial transverse transport (TTT) from the perspective of vascular surgery.MethodsA clinical data of 59 patients with chronic ischemic disease of lower extremities treated by TTT between February 2014 and July 2019 were analyzed retrospectively. Among them, there were 41 patients with diabetic foot (DF), including Wagner grade 3-4, Texas grade 2-3, and stage B-D lesions; the disease duration ranged from 0.7 to 2.4 years, with an average of 1.5 years, and 5 cases complicated with arteriosclerosis obliteran (ASO). There were 14 patients with ASO (Fontaine stage Ⅳ and Rutherford stage Ⅲ-Ⅳ) with an average disease duration of 10.8 months (range, 1.5-23.4 months). There were 4 patients with thromboangiitis obliteran (TAO) with an average disease duration of 12.3 months (range, 2.1-18.2 months), and the clinical stages were all in the third stage. In 18 patients that ankle brachial index (ABI) of anterior or posterior tibial artery was less than 0.6 before operation, or the blood flow of the three branches of inferior anterior tibial artery did not reach the ankle by imaging examination, vascular reconstruction was performed before TTT (5 cases of DF combined with ASO, 12 of ASO, 1 of TAO). After operation, the effectiveness was evaluated by ulcer wound healing, skin temperature, pain visual analogue scale (VAS) score, ABI, and CT angiography (CTA) examination.ResultsThe patients with DF were followed up 8-16 months (mean, 12.2 months); the ulcer wounds healed with a healing time of 5.1-9.2 weeks (mean, 6.8 weeks); CTA examination showed that the branches of inferior anterior tibial artery were opened in 5 patients after revascularization; and the tibial osteotomy healed for 5-14 weeks (mean, 8.3 weeks). The patients with ASO were followed up 13-25 months (mean, 16.8 months); the ulcer wounds healed with a healing time of 6.2-9.7 weeks (mean, 7.4 weeks). CTA examination showed that the branches of inferior anterior tibial artery were opened in 12 patients after revascularization; all tibial osteotomy healed, and the healing time was 4.5-14.4 weeks (mean, 10.2 weeks). The patients with TAO were followed up 12-23 months with an average of 12.3 months, and toe/limb amputation was performed after ineffective treatment. The patients were divided into two groups according to whether they were combined with revascularization or not. The ABI, VAS score, and skin temperature in the combined revascularization group significantly improved at 6 months after operation (P<0.05); while there was no significant difference in ABI at 6 months after operation in the TTT group (P>0.05), but the skin temperature and VAS scores significantly improved when compared with those before operation (P<0.05).ConclusionThe ABI of anterior or posterior tibial artery is more than 0.6, radiological examination shows that at least one of the three branches of inferior anterior tibial artery leads to ankle artery, which is a prerequisite for successful TTT in the treatment of chronic ischemic disease of lower extremities. DF is the indication of TTT. ASO can choose TTT, and TAO should use this technique cautiously.
Objective To systematically review the efficacy, safety and economic value of hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) for Chinese patients with multivessel coronary artery disease. Methods We searched PubMed, WanFang Data, CNKI, Web of Science and The Cochrane Library (Issue 2, 2016) to collect case-control studies about HCR versus CABG for Chinese patients with coronary multivessel disease from the January 1996 to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.1 software. Results A total of 9 studies, involving 1 231 patients were included. The results of meta-analysis showed that: compared with the CABG groups, HCR group had lower length of ICU stay (MD=–25.84, 95% CI –42.55 to –9.13,P=0.002) and intubation time (MD=–4.06, 95% CI –6.43 to –1.69,P=0.000 8). However, there were no significant differences between both groups in the length of hospital stay (MD=–0.64, 95% CI –2.53 to 1.25,P=0.51), the incidence of atrial fibrillation (OR=1.41, 95% CI 0.86 to 2.30,P=0.17) and renal failure (OR=1.56, 95% CI 0.89 to 2.74,P=0.12). No significant differences were found between both groups in mortality (OR=0.36, 95% CI 0.12 to 1.11,P=0.07), the incidence of myocardial infarction (OR=0.32, 95% CI 0.06 to 1.85,P=0.20) and the incidence of target vessel revascularization (OR=1.16, 95% CI 0.48 to 2.76,P=0.74). But the incidence of the stroke (OR=0.35, 95% CI 0.14 to 0.91,P=0.03) and MACCEs (OR=0.37, 95% CI 0.20 to 0.70,P=0.002) of the HCR group were lower than those of the patients of the CABG group. Conclusion The current evidence shows that, compared with the CABG groups, HCR had lower incidence of stroke and MACCEs, however, the safety and efficacy were not significantly different between both groups. Due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo compare the superiority of total arterial revascularization in patients with coronary artery disease (CAD) complicated with left ventricular dysfunction. MethodsThis retrospective study included the patients who were diagnosed with CAD and the left ventricular ejection fraction (LVEF) of ≤40% and underwent coronary artery bypass grafting (CABG) at our hospital from January 2016 to July 2019. The patients were divided into two groups according to the different types of bypass vessels: a total arterial revascularization group (TAR group) and a conventional group (a CON group). The clinical data were compared between the two groups to explore the incidence of important complications and evaluate the safety of total arterial revascularization and its protective effect on cardiac function. Results Finally 75 patients were enrolled including 52 males and 23 females with a mean age of (61.58±7.93) years. There were 35 patients in the TAR group and 40 patients in the CON group. The operation time and the drainage volume at 24 hours after operation in the TAR group were longer or more than those in the CON group (P<0.001), but there was no statistical difference in hospital stay, postoperative complications (such as respiratory failure, mediastinal infection, renal failure), intra-aortic balloon pump or extracorporeal membrane oxygenation use rate (P>0.05). After 2 years of follow-up, compared with the CON group, the cardiac function of the TAR group was significantly improved, the LVEF was higher, the left ventricular end diastolic diameter was reduced, and the graft stenosis rate was lower (all P<0.05). Conclusion Total arterial revascularization is a safe and feasible surgical method, which is helpful to improve the cardiac function and improve the quality of life.
Objective To compare the effectiveness, complications, and follow-up results between endovascular recanalization (EVR) and open surgical revascularization (OSR) in the treatment of peripheral pseudoaneurysm, so as to provide a reference for choosing a appropriate surgical procedure. Methods Clinical data of 62 cases of peripheral pseudoaneurysm between January 2001 and January 2012 were analyzed retrospectively. EVR was performed in 28 patients (EVR group) and OSR in 34 patients (OSR group). There was no significant difference in gender, age, cause of injury, tumor location, and diameter of tumor between 2 groups (P gt; 0.05). Results The operation time, blood loss, ICU monitoring time, and hospitalization time in EVR group were significantly shorter than those in OSR group (P lt; 0.05). In OSR group, 12 cases (35.29%) had early postoperative complications, including 2 deaths due to acute respiratory distress syndrome, 5 cases of pulmonary infection, 3 cases of wound infection, and 2 cases of deep vein thrombosis; in EVR group, 2 cases (7.14%) had early postoperative complications, including 1 case of hematoma at puncture site and 1 case of thrombosis in stent. There was significant difference in early postoperative complication incidence between 2 groups (χ2=6.691, P=0.008). The patients were followed up 12-39 months (mean, 26 months). In OSR and EVR groups after operation, the patency rates of the reconstructed vessels were 96.88% (31/32) and 92.86% (26/28) respectively at 12 months, showing no significant difference (χ2=0.014, P=0.905); the patency rates were 89.29% (25/28) and 84.00% (21/25) respectively at 24 months, showing no significant difference (χ2=0.322, P=0.570). Conclusion Compared with OSR, EVR is a minimally invasive, safe, and effective therapy for peripheral pseudoaneurysm with the advantages of less bleeding, shorter hospitalization time, and less complications. Long-term effectiveness still needs further observation, and patients have to take antiplatelet drugs for long time after EVR.