Total Arterial Off-Pump Coronary Artery Bypass Grafting: A 10-Year Experience / 中华医学杂志(英文版)

<p><b>Background</b>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.</p><p><b>Methods</b>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.</p><p><b>Results</b>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 of ischemic 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.</p><p><b>Conclusions</b>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.</p>

The use of skeletonized internal mammary artery for coronary artery bypass grafting / 解放军医学杂志

Objective To summarize the early and mid-term results and experience of skeletonized internal mammary artery (IMA) harvesting in coronary artery bypass grafting (CABG). Methods The clinical data of 56 patients (46 males and 10 females, aged 61.8±7.7 years) having undergone conventional CABG with skeletonized IMA harvesting from Jan. 2014 to Oct. 2015, were retrospectively reviewed. The patients' demographic information, major complications, perioperative related parameters and early postoperative results were collected and recorded. All the patients were followed up postoperative, and major adverse events were collected. Results 59 IMAs were harvested from 56 patients, including 55 left internal mammery artery (LIMA) and 4 right internal mammery artery (RIMA). Bilateral IMAs were harvested in 3 patients. The mean harvesting time was 55.5±13.0 minutes. According to the sequence of harvesting, all the patients were divided into group 1 (first 29 patients) and group 2 (later 27 patients). There was no significant difference in success rate of harvesting or graft flow between two groups (30.4±14.4ml/ min vs 30.3±16.0ml/min, P=0.986). The harvesting time was significantly shorter in group 2 than in group 1 (P=0.001). The mean number of anastomosis was 2.96±0.89. There was no hospital death and severe complications such as myocardial infarction, reexploration for bleeding, or deep wound infection, or non-union of the sternum. All patients were followed up for 1-23 months postoperatively. There was no death or any major adverse cardiovascular events during the follow-up period, except one patient died of acute pulmonary embolism 3 months postoperatively. Conclusion Skeletonized IMA harvesting can be safely and reliably applied to CABG with excellent early and mid-term results.

Semi-skeletonized Internal Mammary Grafts and Phrenic Nerve Injury: Cause-and-effect analysis / 华中科技大学学报（医学）（英德文版）

Phrenic nerve injury after cardiac surgery increases postoperative pulmonary complications. The purpose of this study was to analyze the causes and effects of phrenic nerve injury after cardiac surgery. Prospectively collected data on 2084 consecutive patients who underwent cardiac surgery from Jan. 1995 to Feb. 2002 were analyzed. Twenty-eight preoperative and operation related variables were subjected to logistic analysis with the end point being phrenic nerve injury. Then phrenic nerve injury and 6 perioperative morbidities were included in the analysis as variables to determine their independent predictive value for perioperative pulmonary morbidity. An identical approach was used to identify the independent risk factors for perioperative mortality. There were 53 phrenic nerve injuries (2.5 %). There was no phrenic nerve injury in non-coronary surgery or coronary surgery using conduits other than the internal mammary artery. The independent risk factors for phrenic nerve injury were the use of internal mammary artery (Odds ratio (OR)=14.5) and the presence of chronic obstructive pulmonary disease (OR=2.9). Phrenic nerve injury was an independent risk factor (OR=8.1) for perioperative pulmonary morbidities but not for perioperative mortality. Use of semi-skeletonized internal mammary artery harvesting technique and drawing attention to possible vascular or mechanical causes of phrenic nerve injury may reduce its occurrence. Unilateral phrenic nerve injury, although rarely life-threatening, is an independent risk factor for postoperative respiratory complications. When harvesting internal mammary arteries, it should be kept in mind avoiding stretching, compromising, or inadvertently dissecting phrenic nerve is as important as avoiding damage of internal mammary artery itself.