Clinical application of individualized total arterial coronary artery bypass grafting in coronary artery surgery.

BACKGROUND: Total arterial revascularization is associated with increased patency and long-term efficacy and decreased perioperative morbidity and mortality and incidence of cardiac-related events and sternal wound infection compared with conventional coronary artery bypass surgery (CABG), in which the left internal mammary artery (LIMA) is typically grafted to the left anterior descending artery with additional saphenous vein grafts often used. This study determined whether these favorable clinical results could be realized at the authors' institute. AIM: To summarize the early efficacy and clinical experience of individualized total arterial coronary artery bypass grafting surgery. METHODS: CABG was performed on 35 patients with non-single-vessel coronary artery disease by adopting total arterial grafts at Fourth Affiliated Hospital of Harbin Medical University between April 2016 and December 2019. LIMA was used in 35 patients, radial artery (RA) was used in 35 patients, and right gastroepiploic artery (RGEA) was used in 9 patients. Perioperative complications were observed, short-term graft patency rate was followed-up, and quality of life was assessed. RESULTS: All patients underwent off-pump coronary artery bypass and the surgeries were successful. All of them were discharged without any complications or deaths. During the follow-up, it was found that patients' angina symptoms were relieved and New York Heart Association classification for cardiac function was class I to class II. A total of 90 vessels were grafted with no occlusion for internal mammary artery, three occlusions for RA, and one occlusion for RGEA. CONCLUSION: The individualized total arterial strategy based on the vessels targeting individual anatomic characteristics can achieve complete revascularization with satisfactory short-term grafting patency rate.

Simple transabdominal minimally invasive direct coronary artery bypass surgery with right gastroepiploic artery.

For three patients with isolated right coronary artery disease who had drug resistance and were intolerant to interventional therapy, simple transabdominal small incision bypass grafting of the right gastroepiploic artery and the posterior descending branch of the right coronary artery was conducted without cardiopulmonary. All three patients were discharged smoothly without complications, and were followed up for three months, during which time the myocardial bridges were unobstructed and the cardiac functions were good. The surgery needs no thoracotomy and the injury is small, and avoids influences of sternum and pericardium adhesion on other cardiac surgery in the future. The risk of median sternotomy can be avoided for patients undergoing reoperation for coronary artery bypass surgery.

Effect of graft patency on the prediction of myocardial viability by dobutamine stress and myocardial contrast echocardiography before coronary artery bypass surgery.

BACKGROUND: Myocardial functional recovery after revascularization is considered the "gold standard" for myocardial viability (MV) assessment. However, the patency of the revascularized coronary artery affects myocardial functional recovery in patients subjected to coronary artery bypass grafting (CABG). The influence of graft patency on viability results has not been widely studied. PURPOSE: We evaluated the effect of graft patency on the prediction of MV after CABG by myocardial contrast echocardiography (MCE) and low-dose dobutamine stress echocardiography (LD-DSE). METHODS: Fifty-three subjects with chronic ischemic heart disease scheduled for CABG were divided randomly into groups A (n = 26) and B (n = 27). They underwent MCE and LD-DSE preoperatively. Patients were followed up 12 months after CABG. Group B patients underwent multislice computed tomography angiography to assess CABG patency, and patients with obstructed grafts were excluded. Group A patients were not subjected to multislice CT angiography. The accuracy of MCE and LD-DSE for assessing MV between the two groups was compared. RESULTS: The accuracy and positive predictive values of MCE and LD-DSE for predicting MV were higher in group B than in group A (p < 0.05). CONCLUSIONS: Preoperative LD-DSE and MCE ability to predict MV depends on the patency of CABG.

Andrographolide inhibits intimal hyperplasia in a rat model of autogenous vein grafts.

The saphenous vein is considered a common conduit for coronary artery bypass grafting. A major limitation involved is the high graft occlusion rate. We evaluated the effect and mechanism of andrographolide on intimal hyperplasia (IH) of autografted rat veins. For this purpose, 140 female Sprague-Dawley rats were randomly divided into experimental (andro) and control groups. Andro rats received andrographolide (200 mg/kg) lavaged once daily for 2 days before surgery while controls received normal saline. The external jugular vein was grafted into the ipsilateral carotid artery. The animals were killed at 1/3 days and 1/2/4/6/8 weeks postoperatively. The neointima to media area (I/M) ratio was determined. Expression of the p65, E-selectin and MMP-9 proteins/mRNA was also determined. Autografted rat veins displayed IH postoperatively. In andro rats, compared with controls, IH was significantly reduced (P < 0.01) at 2/4/6/8 weeks but not at 1/3/7 days postoperatively. Andrographolide also significantly (P < 0.05) reduced the expression of E-selectin and MMP-9 proteins/mRNAs at 2/4/6/8 weeks postoperatively whereas p65 protein/mRNA was significantly (P < 0.05) diminished at 1/3 days and 1/2/4/6/8 weeks postoperatively as compared with controls. Therefore, it was concluded that andrographolide inhibited IH in autografted rat veins through the suppression of p65, E-selectin, and MMP-9 at the transcriptional level.

Pachymic acid, a novel compound for anti-rejection: effect in rats following cardiac allograft transplantation.

BACKGROUND: Pachymic acid (PA), a natural triterpenoid, is known to significantly reduce cell proliferation and induce apoptosis in vitro through initiation of mitochondria dysfunction. However, its effect on immune cells and anti-rejection following organ transplantation remains unknown. METHODS: In this study, we investigated PA as a treatment to control acute rejection occurred in rats which had accepted cardiac transplantation. We measured apoptosis of peripheral blood lymphocyte (PBLs), and CD4(+) lymphocyte, as well as the number of CD4(+) and CD8(+) lymphocytes and the effect of PA on acute rejection in rats 7 days after cardiac transplantation. RESULTS: PA treatment might decrease allograft rejection, protect PBLs from apoptosis, and reduce the percentage of CD8(+) lymphocyte. PA neither regulated the number nor the apoptosis rate of CD4(+) lymphocyte. CONCLUSIONS: Our findings indicated that PA has an anti-apoptotic effect acting on PBLs through a novel mechanism involving stabilization of the PBLs mitochondrial transmembrane potential, an anti-rejection effect in rats after cardiac transplantation and an inhibiting effect to CD8(+) lymphocyte.

Effects of spironolactone on electrical and structural remodeling of atrium in congestive heart failure dogs.

BACKGROUND: Renin-angiotensin-aldosterone system has been demonstrated to be associated with both congestive heart failure (CHF) and atrial fibrillation (AF). This study investigated the effects of spironolactone, a kind of aldosterone antagonist, on atrial electrical remodeling and fibrosis in CHF dogs induced by chronic rapid ventricular pacing. METHODS: Twenty one dogs were randomly divided into sham-operated group, control group, and spironolactone group. In control group and spironolactone group, dogs were ventricular paced at 220 beats per minute for 6 weeks. Additionally, spironolactone at 15 mg x kg(-1) x d(-1) was given to dogs 1 week before rapid ventricular pacing until pacing stopped. Transthoracic and transoesophageal echocardiographic examinations were performed to detect structural and functional changes of the atrium. Swan2 Ganz floating catheters were used to measure hemadynamics variances. Atrial effective refractory period (AERP), AERP dispersion (AERPd), intra- and inter-atrium conduction time (CT) and intra-atrium conduction velocity (CV) were determined. The inducibility and duration of AF were also measured in all groups. Finally, atrial fibrosis was quantified with Masson staining. RESULTS: AERP did not change significantly after dogs were ventricular paced for 6 weeks. However, AERPd, intra- and inter-atrium CT increased significantly, and CV decreased apparently, which was negatively correlated to the atrial fibrosis (r = -0.74, P < 0.05). Simultaneously, left atriums were enlarged and cardiac hemadynamics worsened in pacing dogs. Although spironolactone could not affect cardiac hemadynamics effectively, it can obviously improve left atrial ejection fraction (P < 0.05). Spironolactone treatment did not alter AERP duration, but this medicine dramatically decreased AERPd (P < 0.05), shortened intra- and inter-atrium conduction time (P < 0.05), and increased atrium CV. Moreover, spironolactone decreased the inducibility and duration of AF (P < 0.05), as well as atrial fibrosis (P < 0.01) induced by chronic rapid ventricular pacing. CONCLUSION: Spironolactone contributes to AF prevention in congestive heart failure dogs induced by chronic rapid ventricular pacing, which is related to atrial fibrosis reduction and independent of hemadynamics.