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Preliminary results of combined carotid endarterectomy and off-pump coronary artery bypass grafting in patients with coexistent carotid and coronary artery diseases

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Chinese Medical Journal 2009年第24期122卷 2951-2955页

作者： CHEN Xu-jun CHEN Xin XIE Dong-hua SHI Kai-hu XU Ming Department of Thoracic and Cardiovascular Surgery Nanjing First Hospital Affiliated to Nanjing Medical University Nanjing Jiangsu 210006 China Division of Cardiovascular Medicine Department of Medicine Duke University Medical Center Durham USA

Background Coexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy （CEA） and off-pump coronary artery bypass grafting （CABG） in patients with coexistent carotid and coronary artery diseases. Methods Between January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart Institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out. Results A total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was （25.5_±7.0） minutes. The mean number of distal grafts per patient was 3.30±0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was （11.3±5.4） hours, （2.1±0.9） days, and （12.5±6.1） days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients （92.16%） with a mean follow-up of （39.5±12.5） months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred. Conclusion Combined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.

关键词： coronary artery bypass, off-pump endarterectomy, carotid, coronary artery disease carotid stenosis

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Is the use of cardiopulmonary bypass for isolated coronary artery bypass an independent predictor of mortality and morbidity in patients with severe left ventricular dysfunction？

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Chinese Medical Journal 2008年第23期121卷 2397-2402页

作者： QIU Zhi-bing CHEN Xin XU Ming SHI Kai-hu JIANG Yin-shuo XIAO Li-qiong Department of Cardiothoracic Surgery Nanjing First Hospital Affiliated to Nanjing Medical University Nanjing Heart Institute Nanjing Jiangsu 210006 China

Background Patients presenting with severe left ventricular dysfunction （SLVD） undergoing conventional coronary artery bypass grafting （CCABG） are at an increased risk of perioperative mortality and morbidity. The aim of this study was to assess the risk factors responsible for mortality and morbidity among patients with SLVD by comparing CCABG and oft-pump coronary artery bypass surgery （OPCAB）. Methods We retrospectively evaluated 186 consecutive patients with SLVD who underwent coronary artery bypass grafting （CABG）, including 102 by CCABG and 84 by OPCAB. Registry database, medical notes, and charts were studied for preoperative and postoperative data of the patients. Different variables and risk factors （preoperative, intraoperative, and postoperative） were evaluated and compared. The morbidity and mortality outcomes were compared in the two groups. The follow-up results and quality of life were assessed after surgery. Results The two groups had similar percentage of patients with preoperative high-risk profiles and no significant differences were found between groups in baseline variables such as age or comorbidities. There was a significant difference in the number of grafts used between the two groups. CCABG patients received （3.6±0.5） grafts per patient, while OPCAB patients had （2.7±0.6） grafts （P 〈0.05）. Completeness of revascularization was also significantly different between the two groups （CCABG 91.1% vs OPCAB 73.8%, P 〈0.05）. The hospital mortality was similar in the two groups （4.8% in OPCAB vs 5.9% in CCABG）. The risk-adjusted mortality, according to the calculated propensity score, did not reach statistical significance in the two groups. In this study, OPCAB seemed to have a beneficial effect on reducing reoperation for bleeding, blood transfusion requirement, and the length of stay at ICU. But the incidence of perioperative myocardial infarction was more common in the off-pump group （P 〈0.05）. The degree of improvement in angina and quality

关键词： coronary artery bypass, off-pump cardiopulmonary bypass left ventricular dysfunction

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off-pump anteroapical aneurysm plication for left ventricular post-infarction aneurysm： long-term results

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Chinese Medical Journal 2012年第18期125卷 3228-3235页

作者： HUANG Xin-sheng GU Cheng-xiong YANG Jun-feng WEI Hua LI Jing-xing YU Yang FANG Ying LIU Rui LI Hai-tao ZHOU Qi-wen Department of Cardtiac Surgery Beijing An Zhen Hospital CapitalMedical University China Beijing 100029

Background The temporal response to off-pump anteroapical aneurysm plication has not been well defined. We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair. Methods From March 2005 to May 2010, 163 （115 men and 48 women） consecutive patients were operated on for post-infarction left ventricular aneurysm （LVA）, 54 patients underwent patch remodeling （group A） and 109 patients underwent off-pump anteroapical aneurysm plication repair （group B）. All patients had simultaneous coronary revascularization, other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six. Follow-up ranged from 1 to 5 years, short-term and mid-term outcomes, including complications, cardiac function, and mortality, were assessed. Results Early mortality was 1.8% for all patients （group A 1 death vs. group B 2 deaths, not significant （NS））. Peri-operative support included intraaortic balloon pumping in 16 （9.8%）, （group A 6 patients vs. group B 10 patients, NS） and inotropic drugs in 84 （51.5%）, （group A 34 vs. group B 50, NS）. During a mean follow-up of （3.7±0.8） years, eight patients died, with four due to cardiac-related causes. No patient required transplantation, and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia. Survival at 1 and 5 years was 95% and 86%, respectively. It did not differ significantly between group A and group B. Functional class improved from 2.90±0.59 to 1.65±0.54 among the mid-term survivors （P 〈0.001）, with no significant difference between the two groups. Pre-operative risk factors for mortality or poor function were ejection fraction （EF）〈0.35 （OR=7.9, 95% CI 1.6-40.0）; congestive heart failure （CHF）（OR=4.4, 95% CI 1.0-19.0）; end-systolic volume index （ESVI）〉80 ml/m2 （OR=3.7, 95% CI 1.0-14.0）; and advanced age 〉70 years （OR=2.4, 95% CI 1.0-12.0）.

关键词： coronary artery bypass, off-pump cardiac surgical procedures, aneurysm myocardial infarction

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