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Objective:To evaluate the perioperative and follow-up data of carotid artery stenting (CAS)+ coronary artery bypass grafting (CABG) and CABG alone, and to assess the safety and efficacy of CAS in the treatment of severe stenosis of the carotid artery in combination with asymptomatic carotid artery stenosis.Methods:A retrospective analysis of 700 CABG patients combined asymptomatic carotid artery severe stenosis at Beijing Anzhen Hospital, Beijing Chaoyang Hospital, and Beijing Tiantan Hospital from January 2018 to December 2022 was performed. According to whether or not underwent CAS treatment, they were divided into the CAS-CABG group(116 cases)and the CABG-only group(584 cases). The mean age of the CAS-CABG group was (64.8±7.3) years, and all of them underwent unilateral CAS surgery only; the mean age of the CABG only group was (65.5±7.6) years. The main results of the patients in the two groups were compared at 30 days after the operation and follow-up period.Results:The early postoperative stroke rate was significantly lower in the CAS-CABG group(2.6% vs. 9.1%, P=0.02), while the combined procedure did not increase the rates of mortality and adverse events during follow-up. Subgroup analysis revealed that there was no significant difference in stroke rates between the two procedures for asymptomatic unilateral carotid artery stenosis, advanced age, history of atrial fibrillation, and history of stroke were independent risk factors for early stroke in CABG for asymptomatic unilateral carotid artery stenosis. Conclusion:CAS-CABG is safe and effective in the treatment of coronary artery disease combined with asymptomatic carotid artery stenosis, and can reduce the incidence of early postoperative stroke in patients. CABG patients with asymptomatic carotid stenosis should be rationally screened for prophylactic CAS to reduce the risk of postoperative stroke in these patients.
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@#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.
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Objective:To explore the feasibility and predictive value of Transit-Time Flow Measurement(TTFM) processed by Fast Fourier Transform(FFT) in evaluating the patency of grafts after coronary artery bypass grafting(CABG).Methods:The TTFM waveforms recorded during the operation of 114 CABG patients in our hospital from January 2015 to February 2017 were processed by FFT, the patients were followed up with CTCA after operation to evaluate the predictive value for graft failure.Results:320 grafts were grafted with the patency rate of 80.3%(257/320). The patency rate of LIMA group was 89.4%(101/113), and SVG group was 75.4%(156/207). H0, H1, H0/H1, and P1 of all grafts, H1and P1 in LIMA group, and H0, H1, P1 in SVG group were significantly different( P<0.05). In logistic regression, decreasing of H0( OR=0.92, 95% CI: 0.90-0.95) and increasing of P1( OR=2.26, 95% CI: 1.64-3.10) in all graft groups increased the risk of graft failure. In the LIMA group, increasing of H1( OR=3.57, 95% CI: 1.79-7.12) and P1( OR=1.53, 95% CI: 1.01-2.33) increased the risk of graft failure. In the SVG group, decreasing of H0( OR=0.83, 95% CI: 0.77-0.89) and H1( OR=0.05, 95% CI: 0.02-0.14), increasing of P1( OR=9.53, 95% CI: 3.04-29.86) increased the risk of graft failure. The ROC curve showed that H0 and P1 had a moderate degree of predictive accuracy in all graft groups. H1 and H0/H1 had a moderate degree of predictive accuracy in LIMA group, and H0 and H1 had a high degree of prediction, P1 had a moderate degree of predictive accuracy in SVG group. Conclusion:TTFM waveform processed by FFT has predictive value for the patency rate of CABG.
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Hybrid coronary revascularization has been developing for more than 20 years since it was first proposed by Angelini in 1996. HCR combines the benefit of surgical anastomosis of the left internal mammary artery to the left anterior descending coronary artery graft along with stenting of non-LAD lesions with percutaneous coronary intervention, and achieves complete revascularization. In this review, we have summarized the current state of the art of HCR, including the history, conception, types, patient selection, perioperative antiplatelet strategies, surgical techniques, clinical results as compared with conventional coronary artery bypass grafting and PCI, and the future of HCR.
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Objective:To study the association between high-normal thyroid-stimulating hormone(TSH) and new onset postoperative atrial fibrillation(POAF) after off-pump coronary artery bypass graft(OPCABG).Methods:Between July 2017 and January 2019, a total of 219 patients who underwent OPCABG in Beijing Chaoyang Hospital were retrospectively analyzed. The patients were divided into two groups, POAF group(64 cases) and non-POAF group(155 cases), in accordance with the occurrence of POAF. POAF was compared across groups with TSH quartile groups with euthyroidism. The perioperative clinical parameters of the two groups were analyzed by univariate analysis. Then, statistically significant factors in the univariate analysis were subjected to multivariate logistic regression analysis to determine if it was an independent risk factor for POAF. Results:Compared with TSH Q4 and TSH Q1- Q3, the incidence of POAF was statistically different( P=0.008). Logistic regression analysis showed that age≥60 years( OR=2.672, P=0.010), HCY≥18 μmol/L( OR=1.956, P=0.039), and high-normal thyroid-stimulating hormone( OR=2.856, P=0.036) were the independent risk factors of POAF after OPCABG. Conclusion:High-normal thyroid-stimulating hormone is the independent risk factor of POAF after OPCABG.
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Objective:To investigate the best neutralization ratio of protamine and heparin during off-pump coronary artery bypass grafting(OPCABG) by analyzing the advantages and disadvantages of heparin residue after OPCABG.Methods:From July 2018 to January 2019, 112 patients undergoing elective OPCABG were included in this study. The patients’ whole blood was drawn at 2 time points, including before entering operating room and entering intensive care unit, to receive thrombelastography(TEG) and heparinase-modified thromboelastography(hmTEG) . Conventional coagulation indexes such as activated coagulation time(ACT) were also detected. All the patients were divided into 3 groups, the non-heparin residue group(30 cases), heparin residue group 1(42 cases) and heparin residue group 2(40 cases) according to the laboratory results of TEG, hmTEG and ACT. We observed the dosage of each group of protamine and heparin, as well as the ratio of heparin and protamine. The changes of R time in TEG and ACT between 3 groups were analyzed and compared. Postoperative chest tube drainage at postoperative 12 h and 48 h, cTnI peak value, incidence of perioperative myocardial infarction(MI), incidence of reoperation and poor wound healing, amount of blood loss and transfusion, and acute renal injury were compared between the 3 groups.Results:No significant trio-group differences existed in basic clinical characteristics(all P>0.05). Postoperative R(CKH)time was similar in the 3 groups( P>0.05). Comparing with heparin residue group 1 and heparin residue group 2, the ACT after protamine neutralizing heparin and postoperative R time were decreased, the dosage of protamine, ratio of heparin and protamine, cTnI peak value were increased in the non-heparin residue group( P<0.05). Comparing with heparin residue group 2, the dosage of heparin, postoperative chest tube drainage at postoperative 12h and 48h, amount of blood transfusion and transfusion probability were significantly decreased in non-heparin residue group( P<0.05), but compared with group 1 of heparin residue, there was no significant difference in the above indexes( P>0.05). The perioperative myocardial infarction, incidence of reoperation and poor wound healing, postoperative acute renal injury and time of in ICU stay showed no significant differences between the 3 groups( P>0.05). Conclusion:Moderate heparin residue after OPCAB suggests that it has myocardial protective effect, and does not significantly increase the risk of bleeding. A large number of heparin residues can affect the coagulation function and lead to bleeding tendency, increase the amount of blood loss and transfusion. It is reasonable to make ACT after protamine neutralize heparin higher than the level of ACT before operation, and not higher than 20% of the level before operation.
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Objective To investigate the aberrant expression of long non-coding RNA(lncRNA) in chronic thromboembolic pulmonary hypertension,and explore the lncRNA role in pathogenesis of CTEPH.Methods A total of 5 pulmonary artery endarterium tissue of CTEPH patients and 5 pulmonary artery endarterium tissue of healthy controls were collected.Using high-throughput gene microarray technology to detect two groups of lncRNA and mRNA expression spectrum,build lncRNA-mRNA express network,Pathway and GO analysis to explore the gene function.Results Differential expression of 185 lncRNA was observed in the CTEPH tissues compared with healthy control tissues.Further analysis identified 464 regulated enhancerlike lncRNA and overlapping,antisense or nearby mRNA pairs.Coexpression networks were subsequently constructed and investigated.The expression levels of the lncRNA,NR_036693,NR_027783,NR_033766 and NR_001284,were significantly altered.Gene ontology and pathway analysis demonstrated the potential role of lncRNA in the regulation of central process,including inflammatory response,response to endogenous stimulus and antigen processing and presentation.Conclusion Differentially expressed lncRNA may exert a partial role in CTEPH,the results of this study will help in the future about diagnosis and treatment of CTEPH.
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Objective To retrospectively analysis whether the existence of deep vein thrombosis(DVT) in chronic thromboembolic pulmonary hypertension (CTEPH)) has an influence on the efficacy of pulmonary thromboendarterectomy.Methods The data of 75 patients with CTEPH having undergone PTE in Beijing Chaoyang Hospital from Sep 2004 to Mar 2016 were retrospectively reviewed.We classified them into two different groups which were DVT (+)group (32) and DVT (-) group (43) according to the present of DVT.Clinical data,hemodynamics,blood gas analysis and so on of both groups were compared.Results There were 1 patient died after PEA surgery in DVT(+)group and 7 patients died after PEA surgery in DVT (-) group(3.1％ vs 16.3％,P =0.033).The incidence of severe pulmonary reperfusion injury and the neurological disorders postoperatively in DVT(-) group was significantly higher than that in DVT(+) group (46.5 ％ vs 21.9％,P =0.028;32.6％ vs 12.5％,P =0.044).Compared with DVT(+) group,the content of C-react protein (CRP) was higher in DVT (-) group [(0.9 ± 0.7) mg/dl vs (0.5 ± 0.4) mg/dl,P =0.005].Furthermore,DVT(-) group had a significantly greater proportion of Jamieson Ⅲ or V than DVT(+) group,while the cardiopulnonary bypass time [(289.8 ± 54.3) min vs (259.8 ±45.5) min,P=0.014],aorta cross clamp time[(137.3 ±31.6) min vs(119.5±29.3) min,P=0.015] and deep hypothermia circulatory arrest were significantly longer in DVT(-) group than in DVT(+) group.Postoperative hemodynamics and blood gas index were obvious improved in both groups,but the postoperative pulmonary artery systolic pressure (PAPS) [(59.6 ± 17.9) mmHg vs (48.5 ± 9.7) mmHg,P =0.001],the pulmonary vascular resistance (PVR) [(30.44 ± 22.97) kPa · S · L-1 vs (18.34 ±8.09) kPa · S · L 1,P =0.002] in DVT(-) group were significantly higher than those in DVT(+) group.In addition,the incidence of residual pulmonary hypertension in DVT(-) group was significantly higher than in DVT(+) group.Conclusion Pulmonary thromboendarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement with favorable outcomes of heart and lung function.The recovery of the PAPS,PVR in patients with DVT are significantly better than those in patients without DVT,and the incidence of postoperative complication is significantly lower in patients with DVT.
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Objective To compare clinical effects and complications of patients with diabetes in off-pump coronary artery bypass grafting(OPCAB) between endoscopic saphenous vein harvesting(EVH) and conventional saphenous vein harvesting(CVH).Methods Sequence comparison analysis the clinical data of 339 patients with DM who underwent OPCAB in our department from Nov 2011 to Nov 2014.269 cases by EVH,70 cases by CVH.Observing two groups of patients with deprecated rate of SVG,intraoperative SVG blood flow and the value of PI,lower limb wound complications such as incision infection,poor healing,lower limb local hematoma and pain.SVG patency rate of part patients was follow-up by CT coronary angiography.Results To compare the two groups of patients by EVH and CVH,the perioperative death was 8 cases in EVH group (2.4％),2 cases in C VH group (2.9％).The deprecated SVG of patients was 3.9％ vs 2.9％.The blood flow was (17.36 ±11.24) ml/min vs(17.11 ± 8.37) ml/min,PI was 2.78 ± 2.37 vs 2.22 ± 2.17.The incision infection was 0 vs 4.4％,poor healing was 0.9％ vs 8.8％.The lower limb local hematoma was 5.7％ vs 1.5％.The visual pain analogue scale(VAS) was 0.53 ± 1.71 vs 1.26 ± 2.13 3 days after operation.The numbness of lower limb was 9.7％ vs 22.1％.The Edema of the legs was 8.5％ vs 19.1％ 7 days after operation.60 cases were follow-up by CT coronary angiography,the SVG patency rate was91.4％ vs 94.6％ 1 year after operation,83.3％ vs 86.1％ 2 years after operation,72.2％ vs 73.7％ 3 years after operation respectively.Conclusion EVH technology for SVG in the patients combined DM has good clinical result,the recent patency rate of SVG is perfect,postoperative limb complications is decreased by EVH.
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Objective To evaluate the feasibility,validity and safety of pulmonary endarterectomy for patients with chronic thromboembolic pulmonary hypertension.Methods 50 patients undertook pulmonary endarterectomy operations were enrolled in this study.Of them,38 were males (76％),the average age was (43.35 ± 12.51) years,23 patients had deep venous thrombosis.Obvious pulmonary hypertension and hypoxemia were observed in all patients.Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest.Preoperative systolic pulmonary artery pressure was(104.16 ± 16.95) mmHg,pulmonary vascular resistance was(129.68 ± 50.88) kPa · s · L-1,central venous pressure was (14.91 ± 4.88) mmHg,and cardiac output was (3.28 ± 1.04) L/min.Results The average time of cardiopulmonary bypass was(294.37 ± 94.01) min,aortic cross clamp time was(127.93 ± 35.57) min,circulatory arrest time was(34.30 ±21.74) min.Post-operative mechanical ventilation time was (97.24 ±70.53) hours,and the ICU stay was (9.52 ± 12.96) days.There were 4 patients that died after PEA surgery for postoperative residual pulmonary hypertension of reperfusion pulmonary edema.Post-operation,all patients had significant decrease in systolic pulmonary artery pressure (54.11 ± 16.86) mmHg and pulmonary vascular resistance(20.55 ± 15.17) kPa · s · L-1,and central venous pressure (9.00 ± 3.09) mmHg,and great improvement in cardiac output (5.75 ± 1.48) L/min.6-months follow-up showed that the cardiac function of 44 (95.7 ％) cases returned to NYHA class Ⅰ or Ⅱ,with great improvement in computed tomography pulmonary angiography.All patients go back to normal work and physical exercise at 1-year follow-up.Conclusion Conclusions According the successful experience of surgery for CTEPH patients,pulmonary endarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement,with favorable outcomes of heart and lung function in short and middle time follow-up.
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Objective To evaluate the performance of the Sino System for Coronary Operative Risk Evaluation ( SinoSCORE) on in-hospital mortality and postoperative complications in patients undergoing coronary artery bypass grafting (CABG) in a single heart center. Methods From January 2007 to December 2008, clinical information of 201 consecutive patients undergoing isolated CABG in our hospital was collected. The SinoSCORE was used to predict hospital mortality and major complications[sternal wound infection, postoperative renal failure, multiple organ dysfunction syndrome, perioperative intra-aortic balloon pumps ( IABP), etc.]after CABG among our study participants, which was initially designed as CBAG operative risk scoring system and included 11 risk factors. We estimated the predictable capability of SinoORE model by the means of analysing the calibration and discrimination characters of this risk scoring system. Calibration was evaluated with the method of Hosmer-Lemeshow goodness-of-fit test. Discrimination was tested by determining the area under the receiver operating characteristic (ROC) curve. The optimal cut-off point for SinoSCORE predicting major complications was obtained by the Youden index. Results Of all our study patients, the observed in-hospital mortality was 1.99% (4/201). The overall mean baseline age was ( 63.3 ± 9.2 ) years and 24.4% ( 49/201 ) were female. The predicted mortality cakulated by the SinoSCORE was 2.88% which was slightly higher than the actual mortality. SinoSCORE model slwed very high discriminatory ability and the good calibration power in predicting in-hospital mortality: Hosmer-Lemeshow calibration test:x2 =4. 304, P =0.744 and area under ROC was 0. 81 (95% CI: 0.687 -0.932). As for the major postoperative complications after CABG,SinoSCORE model still achieved a satisfactory performance with the good predictive value for the main complications risk evaluation such as postoperative renal failure, multiple organ dysfunction syndrome and IABP. Hosmer-Lemeshow: P =0.75, P =0. 75, P = 1.00; Areas under ROC respectively at was 0. 768 ( 95 % CI: 0.613 - 0. 924 ). 0. 832 ( 95 % CI: 0. 732 - 0. 932 )and 0. 737 (95% CI: 0. 607 -0. 867 ). The optimal cut-off points for SinoSCORE model predicting each of the above three major postoperative complications was ultimately determined to be 4.5. Conclusion In our patient database, the SinoSCORE model proved a good preoperative risk model in predicting both in-hospital mortality and major complications after CABG, which provides a realistic estimation of hospital death and post-operative complications risk for patients undergoing CABG. Sinoscore model is a suitable operative risk estimation system for Chinese CABG patients.
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Objective Hypothyroidism may have adverse effects on the post-operative outcomes. We evaluated the outcomes of coronary artery bypass grafting (CABG) in patients who had both coronary artery disease (CAD) and hypothyroidism.Methods Among 1347 patients undergoing CABG between September 2002 and June 2009, hypothyroidism was diagnosed in 21 patients (Group A, with 6 men and 15 women) and treated with thyroxin replacement therapy. The average age of patients in group A was(60.4 ± 10.2). Hypothyroidism was identified with tests for thyroid functions. CABG in 4 patients was performed with extracorporeal circulation, three of them received on-pump beating heart CABG, and in 17 patients was performed with off pump CABG( OPCAB). CABG was performed following the improvement of FT3, FT4 and TSH with the use of levothyroxine for all patients in group A Twenty patients with CAD in the absence of hypothyroidism ( group B) served as control, 4 of these patients underwent CABG with extracorporeal circulation. Data of thyroid function and hemodynamics pre-, post- and during operation were analyzed. Results Serum thyroid hormones, such as FT3, were measured with sensitive and specific radioimmunoassays peri-operatively. In the patients receiving CABG without extraorporeal circulation, the mean serum FT3 concentrations were ( 1. 39 ± 0. 36 ) pg/ml pre-operatively and ( 1.29 ± 0. 32 ) pg/ml post-operatively ( P = 0.18 ) for 17 cases in group A, and were (2.28 ±0.36)pg/ml and (2.19 ±0.34) pg/ml respectively (P =0.24)for 16 cases in Group B. In the patients receiving CABG with extracorporeal circulation, the mean serum FT3 concentrations were( 1.53 ±0.51 )pg/ml pre-operatively and (0.85 ± 0.40) pg/ml post-operatively ( P = 0. 04 ) for 4 cases in group A, and were ( 2.08 ± 0.24) pg/ml vs. ( 1.96 ±0. 26) pg/ml ( P = 0. 26 ) for 4 cases in group B. The CIs of patients in group A and group B were ( 2.7 ± 1.4)L · min-1 · m-2 vs. (2.8 ±1.5) L · min-1 · m-2, P=0.53). One patients with severe hypothyroidism and underwent CABG with extracorporeal circulation in Group A died of refractory bradycardia after failure in heart resuscitation. Twenty survivors in group A underwent coronary artery bypass on-beating heart. All survivors had improvement in cardiac function during 2to 30 months of follow-up, their preoperative ejection fraction (EF) was 0.48 ± 0.17 and follow-up EF was 0.55 ± 0. 21. All 20 patients in group B were alive. There was no significant difference between group A and B in hemodynamics, prognosis, duration of hospitalization [( 12.2 ±4.7 ) day vs. ( 10. 1 ± 3.9 ) day, P = 0.17], time to extubation [( 17.6 ± 9. 1 ) h vs.(15.1 ± 13.7) h, P =0.12]. Conclusion CABG in patients with both CAD and hypothyroidism is relatively safe. Proper peri-operative nanagement, combined with on-beating heart techniques of CABG, may decrease the operation risks. Off pump CABG had little effect on serum concentrations of FT3. Peri-operative thyroid replacement therapy was critical for patients with hypothyroidism. Patients with severe hypothyroidism who underwent CABG with extracorporeal circulation were at high risk.
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Objective Background Pulmonary endarterectomy (PEA) is a safe and effective surgical treatment for chronic thromboembolic pulmonary hypertension. University of California at San Diego Medical Center is widely recognized as the world's leading referral center for PEA surgery with extensive surgical experience, which has surgically treated about 2400 patients till 2009, which account for more than 50% of the total cases in the world. Methods During visiting in UCSD, 32 pulmonary endarterectomy operations were performed by Prof. Stuart W Jamieson and Mechel M Madani. In these patients, 17 were males (53%), the average age was (47.56 ± 16.04 ) years, 47% with prior history of pulmonary embolism and/or deep vein thrombosis. Obvious pulmonary hypertension and hypoxemia were observed in all patients. Bilateral pulmonary endarterectomy was performed under cardiopulmonary bypass with profound hypothermic circulatory arrest. Results According to the classification of surgical specimens, 21.8% are type Ⅰ , 28.1% are type Ⅱ and 37.5% are type Ⅲ. The average time of cardiopulmonary bypass (CPB) was (236.32 ± 37.27) mins. The aortic cross clamp time was ( 111.69 ± 28.14) mins. The circulatory arrest time was (38.00±13.58 ) mins [ right side (21.39 ± 9.57 ) mins and left side ( 16.61 ± 6.83) mins]. Postoperatively the average mechanical ventilation time was ( 66.23 ± 99.24) hours, and the ICU stay was (4.62 ± 4.50 ) days.There was no postoperative moorality. All cases had significant decrease in systolic pulmonary artery pressure [(81.03 ± 16.92)mm Hg vs. (51.20±12.16) mm Hg] and pulmonary vascular resistance [(88.91 ±42.32) kPa · s · L-1 vs. (34.38 ±15.68 ) kPa · s · L-1 ], great improvement in cardiac output [(3.65 ±1.08 ) L/min vs. ( 5.85 ± 1.21 ) L/min ] and central venous pressure [(13.07 ± 2.11) cmH2O vs. ( 9.86 ± 3.02 ) cmH2O] postoperatively compared to preoperative data. Shortterm follow-up showed that the cardiac function of all cases returned to NYHA class Ⅰ or Ⅱ, with great improvement in CTPA.Conclusion PEA is definitive treatment of chronic thromboembolic pulmonary hypertension. According the successful experience of UCSD PEA team, first and foremost pulmonary endarterectomy is a bilateral procedure, because chronic thromboembolic pulmonary hypertension is mostly a bilateral disease. Second, cardiopulmonary bypass with the aid of deep hypothermia and circulatory arrest are essential to operator in recognizing the true endarterectomy plane of the media and in following the specimen to its feathered tail end in each branch, using these approaches can effectively reduce pulmonary hypertension and provide good hemodynamic and symptomatic results. Third, PEA remains an uncommon procedure in China. Only a few centers can perform high qualified PEA surgery. In most of inexperienced centers, type Ⅰ and type Ⅱ disease should be choose to operation.Patients with sPAP ≥100 mm Hg, PVR ≥ 100 kPa · s · L-1 or type Ⅲ disease will face more dangers peri-operation.
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Objective To evaluate the right ventricular function of chronic thromboembolic pulmonary hypertension (CTEPH) after pulmonary thromboendarterectomy (PTE) by Doppler echocardiography. Methods In 16 patients with CTEPH,end-diastolic left ventricular diameter(LVDd), end-diastolic right ventricular areas (RVEDA), end-systolic right ventricular areas (RVESA), right ventricular fractional area change (RVFAC), pulmonary accelerative time (Pact), pressure gradient of tricuspid valve regurgitation (PGT1), area of tricuspid valve regurgitation (AT1) were measured by echocardiography. Results Fifteen and thirty days after surgery,the LVDd and Pact had increased,RVEDA, RVESA,PGT1 and AT1 had decreased while RVFAC had increased in all cases. Conclusions PTE may effectively improve the right ventricular function of patients with CTEPH.
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Objective: To review the experience of using the transit time flow measurement(TTFM) in coronary artery bypass grafting(CABG). Methods: From Sept.2001 to May, 2002,90 cases underwent CABG. Among them, 40 cases with off-pump beating heart (OPCAB) and 50 with conventional coronary bypass grafting. All graft patency were verified intraoperatinlly with TTFM. The flow value of left internal mammary artery (LIMA) in 30 cases was also detected by the same way before grafting to left anterior descending (LAD). Results: There was no operative death and severe complications. The mean flow value of LIMA in 30 cases was (42.9?33.0)ml/min. The actual blood flow value, measured simultaneously by exsanguination was (37.4?28.8)ml/min. Excellent correlation was demonstrated. The mean pulsatility index value (PI) was 1.00?0.04. The flow curve showed both diastolic and systolic filling. The mean flow value of LIMA to LAD, saphenous vein graft (SVG) or radial artery (RA) to circumflex coronary artery (LCX) or diagonal (D), SVG or RA to right coronary artery (RCA) or post anterior artery (PDA) were (29.9?9.5)ml/min, (33.7?17.5)ml/min and (31.5?19.2)ml/min. The PI values were 2.47?0.88, 4.00?1.90 and 2.60?1.30, respectively. The typical flow curve was shown in all LIMA to LAD, and SVG (or RA) to LCX (or D). Blood flow filling was mainly during diastole with minimal systolic peaks during the isovolumetric ventricular contraction. SVG or RA to RCA presents a particular flow pattern characterized by a dual filling. 6 grafts were revised basing on unsatisfied flow curves, PI, and the mean flow or all of them. Significant technical error such as conduit kinking, stenosis of distal anastomosis was found. Conclusion: The patency of graft in CABG can be verified in intraoperatively by use of TTFM. The decision of checking or revising a graft can be made basing on parameters acquired from the TTFM device. To correctly analyze the parameters warrants good clinical results.
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Objective: To evaluate the effect, tolerance and safety of low-dose oral amiodarone in the prevention of AF after coronary artery bypass grafting (CABG). Methods: Between 1998 and 1999, 235 adult patients underwent CABG. They were given 0 6 g of amiodarone (80 patients) or placebo (155 patients) daily for 7 days before surgery and 0 2g of amiodarone or placebo daily for 30 days postoperatively. Results: The incidence of postoperative AF was significantly (P=0 001) lower in treatment group (10%) as compared with placebo (21 94%). Only 3 cases had pro-arrhythmic effects and no side effects in treatment group. Conclusion: 1.Perioperative low-dose oral amiodarone significantly reduced the ventricular rate and reduced occurrence and duration of atrial fibrillation after CABG. 2.Low-dose amiodarone is well tolerated and decreased the risks of severe side effects and pro-arrhythmic effects, especially for these patients with high risk factors in perioperative period.