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Identifying coronary artery bypass grafting patients at high risk for adverse long-term prognosis using serial health-related quality of life assessments

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中华医学杂志(英文版) 2024年第9期137卷 1069-1077页

作者： Wang Juncheng Liu Hanning Yue Chao Yang Limeng Yang Kai Zhao Yan Ren Huan Zhang Ying Zheng Zhe National Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China Department of Cardiovascular Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China Department of Vascular Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China Department of Cardiac Surgery Wuhan Asia Heart Hospital Wuhan Hubei China

Background: Patients who undergo coronary artery bypass grafting (CABG) are known to be at a significant risk of experiencing long-term adverse events, emphasizing the importance of regular assessments. Evaluating health-related quality of life (HRQoL) serves as a direct method to gauge prognosis. Our objective is to ascertain the prognostic significance of consecutive HRQoL assessments using the Physical Component Summary (PCS) and Mental Component Summary (MCS) derived from the Short-Form 36 (SF-36) health survey in CABG patients.Methods: The study population consisted of 433 patients who underwent isolated elective CABG at Fuwai Hospital between 2012 and 2013. SF-36 assessments were conducted during both the hospitalization period and follow-up. The primary endpoint of the study was all-cause mortality, while the secondary outcome was a composite measure including death, myocardial infarction, stroke, and repeat revascularization. We assessed the relationships between the PCS and MCS at baseline, as well as their changes during the first 6 months after the surgery (referred to as ΔPCS and ΔMCS, respectively), and the observed outcomes.Results: The patients were followed for an average of 6.28 years, during which 35 individuals (35/433, 8.1%) died. After adjusting for clinical variables, it was observed that baseline MCS scores (hazard ratio [HR] for a 1-standard deviation [SD] decrease, 1.57; 95% confidence interval [CI], 1.07–2.30) and ΔMCS (HR for a 1-SD decrease, 1.67; 95% CI, 1.09–2.56) were associated with all-cause mortality. However, baseline PCS scores and ΔPCS did not exhibit a significant relationship with all-cause mortality. Notably, there was a dose-response relationship observed between ΔMCS and the likelihood of all-cause mortality (HRs for the 2nd, 3rd and 4th quartiles compared to the 1st quartile, 0.33, 0.45 and 0.11, respectively).Conclusions: Baseline MCS and changes in MCS were independent predictors for long-term mortality of CABG. Better mental health status and recovery indicated better

关键词： coronary artery bypass grafting coronary artery disease Prognosis Quality of life Short-Form 36 Risk factor Serial measurements

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coronary artery bypass grafting for Kawasaki disease

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Chinese Medical Journal 2010年第12期123卷 1533-1536页

作者： GUO Hong-wei CHANG Qian XU Jian-ping SONG Yun-hu SUN Han-song HU Sheng-shou Department of Surgery Fu Wai Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing 100037 China

Background Kawasaki disease （KD） is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting （CABG） in patients with KD. Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient （mean 2.5±0.8）. Various bypass grafts were used in patients, i.e. the left internal mammary artery （LIMA） in 3 patients, bilateral internal mammary artery （IMA） in 2 patients, LIMA plus gastroepiploic artery （GEA） in 1 patient and total saphenous vein grafts （SVGs） in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass （CPB）, after being supported with intra-aortic balloon pump （IABP）, the patient was weaned from CPB successfully. Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months （mean 27 months）, clincal angina disappeared or improved. Cardiac function was in Class I-II （NYHA）.Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

关键词： coronary artery bypass grafting Kawasaki disease myocardial ischemia coronary aneurysm coronary aneurysmectomy

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Impact of coronary artery bypass grafting surgery on the chorioretinal biomicroscopic characteristics

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世界临床病例杂志 2023年第28期11卷 6754-6762页

作者： Mansoor Shahriari Homayoun Nikkhah Mohammad Parsa Mahjoob Nazanin Behnaz Shahriar Barkhordari Kasra Cheraqpour Department of Ophthalmology Imam Hossein Educational HospitalTehran ***Iran Department of Ophthalmology Torfe Medical CenterTehran ***Iran Cardiovascular Diseases Imam Hossein Educational HospitalTehran ***Iran Department of Ophthalmology Shahid Beheshti University of Medical SciencesTehran ***Iran Department of Ophthalmology Farabi Eye HospitalTehran ***Iran

BACKGROUND Most patients with cardiovascular disorders suffer from coronary artery diseases,which can be treated successfully using coronary artery bypass grafting(CABG).One of the unpleasant events following CABG is postoperative vision loss(POVL).Vulnerability of retinal vessels to hemodynamic changes,an expectable event following CABG,may contribute to the development of POVL,which might be associated with the changes in the choroidal and retinal structures.AIM To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer(NFL)thickness,and progression of diabetic and hypertensive retinopathy after CABG.METHODS In this prospective,cross-sectional study,49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery.RESULTS Among the study participants,56%were male with a mean age of 62.84 years±10.49 years(range 33–80 years).Diabetes mellitus was observed in eight participants(32%).None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy,central retinal artery occlusion,and cortical blindness.The mean value of the preoperative best corrected visual acuity was 0.11±0.10 logMAR(range,0–0.4),which worsened to 0.15±0.08 logMAR(range,0–0.4)after CABG(P=0.031).No significant difference was observed between the preand postsurgical choroidal(P=0.853)and macular(P=0.507)thickness,NFL thickness in the subfoveal(P>0.999)and peripapillary areas(P=0.659),as well as the severity of diabetic and hypertensive retinopathy.CONCLUSION CABG may reduce visual acuity without affecting ocular structures.Postoperative vision reduction might be attributable to molecular or cellular variations,changes in visual pathway function,or central nervous system.

关键词： coronary artery bypass grafting Nerve fiber layer Diabetic retinopathy Hypertensive retinopathy

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Effect and cost of perioperative use of antibiotics in coronary artery bypass grafting： a randomized controlled study

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Chinese Medical Journal 2011年第5期124卷 699-703页

作者： ZHOU Zi-jun ZHENG Ying-li HU Yong-hua School of Public Health Peking University Beijing 100191 China Department of Pharmacy Beijing Fuwai Cardiovascular Hospital Beijing 100037 China

Background Bacterial infections remain a serious complication following coronary artery bypass grafting （CABG）. The objective of the study was to determine the effectiveness of a guideline for the appropriate use of antibiotics in CABG during the perioperative period.Methods Six hundred and fourteen hospitalized patients who had undergone CABG from January to June 2006 were randomly allocated to an intervention group and a control group. The data on the hospital stay, days of antibiotic used, types of prophylactic antibiotics used, surgical wound infection and pulmonary infection and antibiotic costs for the patients were compared.Results The postoperative hospitalization days of the intervention group were significantly fewer than that for the control group （P 〈0.05）. The time of antibiotic use and post-infection treatment time were also significantly less in the intervention group than in the control group （P 〈0.05）. The average hospital daily cost and total cost of antibiotics were less in the intervention group than in the control group （P 〈0.05）. Compared with the control group, prophylactic antibiotic use in the intervention group was more reasonable. Conclusions The guideline for the appropriate use of antibiotics in CABG during the perioperative period is effective strategies for reducing antibiotic costs, the time of antibiotic use and post-infection treatment time without compromising the patients＇ clinical outcome.

关键词： coronary artery bypass grafting perioperative period antibiotics cost intervention

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Sudden cardiovascular collapse caused by carbon dioxide embolism during endoscopic saphenectomy for coronary artery bypass grafting

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Chinese Medical Journal 2006年第4期119卷 345-348页

作者： CHEN Xin-chun TANG Xiao-yang JIANG Yi-fan PAN Yan-bing FU Cheng-zhang Department of Anesthesia First Affiliated Hospital of Nanjing Medical University Nanjing 210029 China

Endoscopic vein harvesting （EVH） for coronary artery bypass grafting （CABG） has gained increasing acceptance as a less invasive alternative to conventional open vein harvesting. With this procedure, carbon dioxide （CO2） is insufflated to create a subcutaneous tunnel to facilitate the harvest of the great saphenous vein. The technique seems to be safe because there are no adverse hemodynamic consequences or systemic CO2 absorption during EVH. We report a case of massive right heart gas embolism which occurred during a routine EVH performance of the saphenous vein. Techniques for early diagnosis of this rare but life-threatening complications, transesophageal echocardiography （TEE） is a sensitive tool in detecting CO2 embolism [except end-tided CO2 （ETCO2）] and pulmonary arterial pressure （PAP） monitoring. The rapid recovery of CO2 embolism in the patient who underwent EVH with CO2 insufflation and CABG surgery was due to immediate and accurate diagnosis and prompt treatment.

关键词： anesthesia coronary artery bypass grafting carbon dioxide

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Total Arterial Off-Pump coronary artery bypass grafting： A 1O-Year Experience

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Chinese Medical Journal 2018年第18期131卷 2179-2184页

作者： Biao Yuan Hong-Wei Qi Jian-Gang Zhao Xi-Zheng Wang Nan Chen Feng-Hua Zhao Li-Fang Wang Huan-Ying Dong Cardiovascular Center Beijing Tongren Hospital Capital Medical University Beijing 100730 China

Background： Arterial grafts had better mid-term and long-term patency than saphenous vein grafts in coronary artery bypass grafting （CABG）. We summarized our experience with total arterial off-pump coronary artery bypass grafting （OPCAB） and assessed the early clinical results, surgical complications, and follow-up. Methods： From January 2007 to May 2017,508 coronary artery disease patients undergoing total arterial OPCAB were enrolled. Clinical features, approaches, outcomes of surgical treatments, and follow-up data of these patients were studied retrospectively. A total of 122 patients underwent single left internal mammary artery （IMA）-left anterior descending artery grafts, whereas the other 386 patients underwent multiple vessel grafts. Results： The average distal anastomosis was 2.34 ± 0.97 （range： 1-4）. All the patients were discharged from hospital except one died. A total of 457 （90.32%） patients were followed up. In the 4-, 7-, and 10-year follow-up groups, the rate of death from any cause was 1.19%, 6.47%, and 10.67%; rate of cardiac death was 0.60%, 2.88%, and 3.33%; rate of repeat revascularization was 0.00%, 3.60%. and 8.67%; rate ofischemic symptoms was 1.79%, 7.91%, and 11.33%; and incidence of stroke was 2.38%, 4.32%, and 6.67%, respectively. Poor medication adherence was observed in 9.38% of the follow-up population. Conclusions： Total arterial OPCAB with bilateral IMA, radial artery, and right gastroepiploic artery grafting yielded satisfactory early and midterm outcomes in this patient group, without a significant increase in early mortality or morbidity. Moreover, the long-term outcomes are also positive.

关键词： coronary artery bypass grafting Gastroepiploic artery Off-Pump Skeletonized Internal Mammary artery Total Arterial Revascularization

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Very Long-term Outcomes and Predictors of Percutaneous coronary Intervention with Drug-eluting Stents Versus coronary artery bypass grafting for Patients with Unprotected Left Main coronary artery Disease

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Chinese Medical Journal 2016年第7期129卷 763-770页

作者： Xian-Peng Yu Chang-Yan Wu Xue-Jun Ren FeiYuan Xian-Tao song Ya-Wei Luo Ji-Qiang He Yue-Chun Gao Fang-Jiong Huang Cheng-Xiong Gu Li-Zhong Sun Shu-Zheng Lyu Fang Chen Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

Background： There are limited data on longer-term outcomes （〉5 years） for patients with unprotected left main coronary artery （ULMCA） disease who underwent percutaneous coronary intervention （PCI） in the drug-eluting stents （DES） era. This study aimed at comparing the long-term （〉5 years） outcomes of patients with ULMCA disease underwent PCI with DES and coronary artery bypass grafting （CABG） and the predictors of adverse events. Methods： All consecutive patients with ULMCA disease treated with DES implantation versus CABG in our center, between January 2003 and July 2009, were screened for analyzing. A propensity score analysis was carried out to adjust for potential confounding between the two groups. Results： Nine hundred and twenty-two patients with ULMCA disease were enrolled for the analyses （DES = 465 vs. CABG = 457）. During the median follow-up of 7.1 years （interquartile range 5.3-8.2 years）, no difference was found between PCI and CABG in the occurrence of death （P = 0.282） and the composite endpoint of cardiac death, myocardial infarction （MI） and stroke （P = 0.294）. Rates of major adverse cardiac and cerebrovascular events were significantly higher in the PCI group （P = 0.014） in large part because of the significantly higher rate of repeat revascularization （P 〈 0.001）. PC/was correlated with the lower occurrence of stroke （P = 0.004）. Multivariate analysis showed ejection fraction （EF）（P = 0.012）, creatinine （P = 0.016）, and prior stroke （P = 0.03 l） were independent predictors of the composite endpoint of cardiac death, MI, and stroke in the DES group, while age （P = 0.026） and EF （P = 0.002） were independent predictors in the CABG group. Conclusions： During a median follow-up of 7.1 years, there was no difference in the rate of death between PCI with DES implantation and CABG in ULMCA lesions in the patient cohort. CABG group was observed to have significantly lower rates of repeat revascularization but higher stroke rates compared with PCI. EF, creatinine, and prior stroke were independent predi

关键词： coronary artery bypass grafting Drug-eluting Stents Percutaneous coronary Intervention Unprotected Left Maincoronary artery

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SinoSCORE:a logistically derived additive prediction model for post-coronary artery bypass grafting in-hospital mortality in a Chinese population

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Frontiers of Medicine 2013年第4期7卷 477-485页

作者： Zhe Zheng Lu Zhang Xi Li Shengshou Hu behalf of the Chinese CABG Registry Study Department of Cardiovascular Surgery and State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China 不详

This study aims to construct a logistically derived additive score for predicting in-hospital mortality risk in Chinese patients undergoing coronary artery bypass surgery(CABG).Data from 9839 consecutive CABG patients in 43 Chinese centers were collected between 2007 and 2008 from the Chinese coronary artery bypass grafting Registry.This database was randomly divided into developmental and validation subsets(9:1).The data in the developmental dataset were used to develop the model using logistic regression.Calibration and discrimination characteristics were assessed using the validation dataset.Thresholds were defined for each model to distinguish different risk groups.After excluding 275 patients with incomplete information,the overall mortality rate of the remaining 9564 patients was 2.5%.The SinoSCORE model was constructed based on 11 variables:age,preoperative NYHA stageⅢorⅣ,chronic renal failure,extracardiac arteriopathy,chronic obstructive pulmonary disease,preoperative atrial fibrillation or flutter(within 2 weeks),left ventricular ejection fraction,other elective surgery,combined valve procedures,preoperative critical state,and BMI.In the developmental dataset,calibration using a Hosmer-Lemeshow(HL)test was at P=0.44 and discrimination based on the area under the receiver operating characteristic curve(ROC)was 0.80.In the validation dataset,the HL test was at P=0.34 and the area under the ROC(AUC)was 0.78.A logistically derived additive model for predicting in-hospital mortality among Chinese patients undergoing CABG was developed based on the most up-to-date multi-center data from China.

关键词： coronary artery bypass grafting risk stratification in-hospital mortality

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Postoperative neuropsychological change and its underlying mechanism in patients undergoing coronary artery bypass grafting

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Chinese Medical Journal 2007年第22期120卷 1951-1957页

作者： YIN Yi-qing LUO Ai-lun GUO Xiang-yang LI Li-huan HUANG Yu-guang Department of Anesthesiology China-Japan Friendship HosptialBeijing 100029 China Department of Anesthesiology Peking Union Medical CollegeHospital Beijing 100730 China Department of Anesthesiology Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical. College Cardiovascular Institute Beijing 100037 China

Background The high incidence of neuropsychologic deficits after cardiac surgery, including cognitive dysfunction and mood status, has significantly influenced the prognosis, outcome of treatment and long-term quality of life of patients. With a circadian secretion pattern, melatonin and cortisol are capable of modulating the human physiological processes and neuropsychological status, whereas disorder of their secretion pattern may lead to many diseases. However, it is unclear whether neuroendocrine variations are related to the neuropsychologic status in patients undergoing coronary artery bypass grafting （CABG）. Methods Forty male patients scheduled for CABG with hypothermic cardiopulmonary bypass （CPB）（n=20） or off-pump coronary artery bypass （OPCAB）（n=20） were studied. Blood samples were taken intraoperatively at specific time-points and every 3 hours within the first postoperative 24 hours to determine plasma concentrations of melatonin and cortisol. A neuropsychologic test battery including depression and anxiety was administered preoperatively and 7 to 10 days postoperatively. Statistical methods included the nonparametric analysis, multiple linear regression and cosinor analysis. Results The patients in the CPB group exhibited more severe neuropsychologic deficits and more anxious than those in the OPCAB group after surgery. In both groups, patients were more depressed postoperatively than preoperatively and recovered 3 months after surgery. Depression and anxiety were correlated with some factors of cognitive dysfunctions. In the postoperative 24 hours, 2 patients in the CPB group, and 6 patients in the OPCAB group showed a circadian rhythm of melatonin secretion. As for cortisol secretion, there were 3 patients in the CPB group and 7 in the OPCAB group respectively. Parameters of circadian rhythm of melatonin in the CPB group and those of secretion rhythm of cortisol in both groups were correlated with depression and some neuropsychologic tests. Conclusions The incidence of neuropsychological d

关键词： neuropsychology melatonin cortisol circadian rhythm coronary artery bypass grafting anesthesia

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Early Results of coronary Endarterectomy Combined with coronary artery bypass grafting in Patients with Diffused coronary artery Disease

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Chinese Medical Journal 2015年第11期128卷 1460-1464页

作者： Li-Qun Chi Jian-Qun Zhang Qing-Yu Kong Wei Xiao Lin Liang Xin-Liang Chen Department of Cardiac Surgery Beijing Anzhen Hospital Capital Medical UnLversity Beijing 100029 China

Background： It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease （CAD）. coronary endarterectomy （CE） offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft （CABG） was discussed in the treatment for the diffused CAD. Methods： From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE ＋ CABG were pertbrmed, which was about 17.2% （38/221） of the cohort. All these patients were divided into two groups： CE ＋ CABG group （Group A） and CABG alone group and postoperative complications and in-hospital mortality were Chi-square test and Student＇s t-test respectively. （Group B）. All clinical data were compared between the two groups, analyzed. The categorical and continuous variables were analyzed by Results： Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was perfbrmed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A （3/38）, which was more often than that in Group B （3/183）. At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent （50/50）. There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions： coronary endarterectomy ＋ CABG can oilier satisfactory result for patients with diffused CAD in a short-term after the operation.

关键词： coronary artery bypass grafting coronary Endarterectomy Diffused coronary artery Disease

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