Association of incomplete revascularization with long-term survival after off-pump coronary artery bypass grafting

Background

We evaluated the effect of incomplete revascularization (IR) on the long-term outcomes after off-pump coronary artery bypass grafting.

Materials and methods

Of 1553 patients with triple-vessel disease who had undergone consecutive off-pump coronary artery bypass grafting, 1351 (87.0%) had complete revascularization (CR) and 202 had IR (13.0%). After propensity score patient matching, we had 200 patients in each group. Cardiac survival and major adverse cardiac and cerebrovascular events (MACCE) were assessed before and after patient matching. Subgroup analysis was performed to evaluate the interaction between the left ventricular ejection fraction (LVEF) and the completeness of revascularization. The follow-up duration was 60 mo.

Results

In the all-patient analysis, the CR group had a lower incidence of in-hospital mortality, cardiac mortality, and MACCE (P = 0.033, P < 0.001, and P = 0.003, respectively). The 5-year cardiac survival was 96.5% ± 0.6% in the CR group and 88.9% ± 2.5% in the IR group (P < 0.001), with a freedom from MACCE rate of 85.4% ± 1.2% and 78.8% ± 3.4%, respectively (P = 0.015). After patient matching, the CR group showed superior 5-year cardiac survival compared with the IR group (96.2% ± 1.4% versus 88.8% ± 2.5%, P = 0.022), with a similar freedom from MACCE rate. IR was identified as an independent predictor of cardiac death (hazard ratio 2.76, 95% confidence interval 1.62–4.70; P < 0.001). IR predicted cardiac death more distinctly in patients with a low LVEF (hazard ratio 5.29, 95% confidence interval 1.71–16.39; P = 0.004) than in those with a preserved LVEF (hazard ratio 2.04, 95% confidence interval 1.02–4.08; P = 0.045).

Conclusions

CR in off-pump coronary artery bypass grafting was related to superior cardiac survival after 5 years of follow-up compared with IR. The benefit of CR was more distinct in those with a low LVEF. CR should be achieved whenever possible, especially in patients with a low LVEF.     

Minimally invasive coronary artery bypass grafting via a small thoracotomy versus off-pump: a case-matched study

Objective: The minimally invasive coronary artery bypass grafting (MICS CABG) operation performed via a small thoracotomy has not previously been examined in a direct comparison to sternotomy off-pump coronary artery bypass grafting (OPCAB). Methods: We matched, according to age, gender, left ventricular function, and median number of distal anastomoses, 150 patients who underwent MICS CABG via small left thoracotomy, and 150 patients who received sternotomy OPCAB. All operations were performed by the same surgeon. Results: There was no perioperative mortality (0/300). In the MICS CABG group, pump assistance was used in 28/150 (19%) patients, and conversion to sternotomy occurred in 10/150 (6.7%) patients. In the OPCAB group, conversion to on-pump occurred in 3/150 (2.0%) patients. There were four (2.7%) reoperations for bleeding and one (0.7%) for anastomotic revision in each group. The median hospital length of stay was 5 days for MICS CABG (average 5.4), and 6 days for OPCAB (average 7.2) (P = 0.02). New-onset atrial fibrillation occurred in 35 (23%) MICS CABG patients and in 42 (28%) OPCAB patients (P = 0.3). No wound infection occurred with MICS CABG versus six (4.0%) with OPCAB (P = 0.03). A self-limiting left pleural effusion developed in 22 (15%) MICS CABG patients and in six (4.0%) OPCAB patients (P = 0.002). The median time to return to full physical activity was 12 days in MICS CABG patients versus >5 weeks in OPCAB patients (P < 0.001). Conclusions: MICS CABG is a valuable alternative for patients in need of multivessel CABG. The operation appears at least as safe as OPCAB, and associated with shorter hospital length of stay, less wound infections, and faster postoperative recovery than OPCAB.     

心脏不停跳非体外循环冠状动脉旁路移植术的进展

近年来，随着手术器械的发展，心脏不停跳非体外循环下冠状动脉旁路移植术(OPCAB)逐渐被广泛接受和应用。与常规冠状动脉旁路移植术(CCABG)比较，OPCAB的主要优势为血液中多种炎性介质浓度明显降低，避免了体外循环(CPB)带来的全身系统性炎性损害，减少了并发症，降低了手术死亡率。特别对那些不能采用CPB或采用CPB有风险的高危患者优势更明显。CCABG的手术适应证同样适用于OPCAB，但OPCAB具有相对的禁忌证。OPCAB多采用胸骨正中切口，左前外侧切口适用于左前降支单支病变。OPCAB术后早期结果类似CCABG，但中远期结果有待进一步观察。OPCAB大多数旁路移植血管数低于CCABG，有不能完全再血管化的可能，对OPCAB是否会影响吻合的精确性和旁路血管的长期通畅率有不同意见。OPCAB的优势明确，但仍不能完全替代CCABG，手术的同时应作好CPB准备，必要时改行CCABG。     

1198例非体外循环冠状动脉旁路移植术的早期临床分析

目的　总结分析非体外循环冠状动脉旁路移植术 (OPCAB)的早期临床结果和经验体会。方法　 1996年 10月至 2 0 0 2年 5月在国内 15个冠心病微创外科中心完成非体外循环冠状动脉旁路移植术 1198例 ,占同期冠心病手术的 79 5 % ,OPCAB实施率 (即OPCAB占单纯冠状动脉旁路移植术的百分比 )为 85 2 %。年龄平均 (6 1 6± 9 0 )岁 ,男性占 77 3%。 18 7%为左主干病变 ,76 9%为 3支病变。左心室射血分数平均 0 5 6± 0 17。其中二次手术者占 1 5 % ,急诊手术占 9 9%。结果　 2 2例为小切口单支病变旁路移植手术 ,其余均为正中切口、多支病变的OPCAB手术。远端吻合口为 (3 1± 0 9)个 ,乳内动脉桥占 6 5 6 % ,桡动脉桥占 18 0 % ;5 2 %病人使用主动脉内球囊反搏。住院死亡 14例 ,病死率 1 2 %。其中术后心跳骤停或室颤 7例 ,大出血 2例 ,昏迷伴肾功能衰竭 2例 ,大面积脑梗塞 2例 ,呼吸衰竭 1例。并发症中 ,围术期心肌梗死占 0 4% ,急性左心功能衰竭占 0 3% ,严重心律失常占 1 2 % ,呼吸系统并发症占 2 0 % ,器质性神经系统并发症占 1 2 % ,新发或加重的肾功能不全占 0 7% ,出血二次开胸占1 0 % ,胸骨愈合不良占 0 6 %。结论　OPCAB手术安全可行 ,早期效果满意 ,远期效果有待进一步观察。OPCAB具备一     

Mid-term outcomes of coronary endarterectomy combined with coronary artery bypass grafting

Open in a separate window OBJECTIVESThe aim of this study was to evaluate the mid-term outcome of coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) and explore the potential risk factors for adverse events.METHODSA total of 208 consecutive patients underwent CE between 2008 and 2018 in our centre, of which 198 were included in this retrospective cohort study. The primary end point was major adverse cardiovascular and cerebrovascular events (MACCEs). Kaplan–Meier analysis was performed to evaluate event-free survival, whereas subgroup analysis and Cox regression were used to explore risk factors for the outcomes.RESULTSThe median follow-up time was 34.7 months. CE + CABG was performed mainly on the left anterior descending artery (42.3%) or right coronary artery (42.3%). Both operative mortality and incidence of perioperative myocardial infarction were 1.5%. The overall survival at 3 and 5 years was 98.0% and 95.9%, whereas the MACCE-free survival was 93.7% and 89.4%, respectively. No significant difference in the incidence of MACCE was observed between on-pump and off-pump CE (P = 0.256) or between left anterior descending artery and non-left anterior descending artery endarterectomy (P = 0.540). Advanced age (>65 years) was associated with a higher risk of MACCE both in univariate [hazard ratio (HR) 3.62, 95% confidence interval (CI) 1.37–9.62; P = 0.010] and multivariate analysis (HR 3.59, 95% CI 1.32–9.77; P = 0.013).CONCLUSIONSWhen performed by experienced surgeons, CE + CABG could be an acceptable approach to achieve complete revascularization of diffusely diseased coronary arteries with satisfactory outcomes, although advanced age might increase the risk of MACCE.     

雷米芬太尼在非体外循环冠状动脉搭桥术"快通道"麻醉中的应用

目的 研究雷米芬太尼用于非体外循环下冠状动脉搭桥术"快通道"麻醉的临床效果.方法 48例行非体外循环下冠状动脉搭桥术患者随机均分为雷米芬太尼组(R组)和芬太尼组(F组).记录两组诱导前(T0)、插管后2 min(T1)、切皮后2 min(T2)、锯胸骨后2 min(T3)、关胸时(T4)、手术结束后30min(T5)的HR,MAP、CVP,肺小动脉楔压(PAWP)、肺毛细血管楔压(PCWP)、术后拔管时间、ICU停留时间和住院时间.结果 R组与F组比较血流动力学和住院时间差异无统计学意义.R组在拔管时间和ICU停留时间上显著短于F组(P<0.01).结论 雷米芬太尼用于非体外循环下冠状动脉搭桥术"快通道"麻醉安全性高、效果明显.     

Coronary artery and graft spasm after off-pump coronary artery bypass grafting

We report a case of a 52-year-old man with severe coronary artery and graft spasm after triple-vessel off-pump coronary artery bypass grafting. Emergent coronary angiography was performed to identify the location and severity of the spasm. Intracoronary injections of several vasodilators failed to relieve the spasm. Observational treatments including intra-aortic balloon pump and inotropic drugs to increase coronary flow were performed until the spasm resolved. The patient recovered and was discharged. A follow-up coronary angiography revealed patent native coronary artery and bypass grafts without evidence of residual spasm.     

非体外循环与体外循环冠状动脉旁路移植血管中远期通畅率比较

目的 比较非体外循环不停跳与体外循环冠状动脉旁路移植手术后中远期移植血管的通畅率.方法 对同一术者行冠状动脉旁路移植手术后5年以上病例50例.按手术方式分为两组.第1组采用传统体外循环下进行冠状动脉旁路移植(体外循环组,25例);第2组采用非体外循环不停跳技术进行冠状动脉旁路移植(非体外循环组,25例).对所有病例进行冠状动脉造影随访,比较两组移植血管的通畅情况.结果 两组均男21例,女4例.第1组手术年龄(55.4±8.9)岁;随访70～110个月,平均(86.52±12.48)个月;移植血管共83支,其中动脉移植血管41支,静脉移植血管42支,平均移植血管(3.32±0.63)支/例;随访移植血管通畅61支,狭窄6支,闭塞16支,动脉移植物通畅率为78.05%,静脉通畅率69.05%,总通畅率73.49%.第2组手术年龄(58.2±9.09)岁;移植血管共65支,其中动脉移植血管31支,静脉移植血管34支,平均移植血管(2.52±0.71)支/例,随访64～99个月,平均(82.68±12.48)个月;随访移植血管通畅47支,狭窄4支,闭塞14支,动脉移植物通畅率为74.19%,静脉通畅率70.59%,总通畅率72.31%.结论 非体外循环不停跳冠状动脉旁路移植手术移植血管中远期通畅率与传统体外循环手术一致,均可达到较好的中远期疗效.

Abstract：

Objective Off-pump coronary artery bypass grafting (OPCAB) is used more widely in recent years in China. However, there is an argument on benefits and risks of off-pump surgery. Many studies shown that OPCAB had more benefits in short-term outcomes than conventional coronary artery bypass grafting(CCABG). But evidences from other studies suggested that OPCAB resulted in less long-term graft patency as compared with on-pump surgery. This study examined the longterm graft patency of OPCAB and CCABG performed by one surgeon. Methods 50 patients who had received surgical revascularization by a surgeon for more than 5 years were reviewed, 25 patients received conventional coronary artery bypass grafting ( group 1 ) and 25 patients received OPCAB ( group 2). All patients had angiograms for compareing the graft patency between the two groups. Results Among 25 patients in group 1,21 were male and 4 were female. The mean age of patients at surgery was (55.4 ±8.9) years. 15 cases had unstable angina, 16 patients had old myocardial infarction and 6 cases had diabetes.The ejection fraction (EF) was 0.58 ±0.14. The mean number of bypasses per patient was 3.32 ±0.63. Mean duration of operation was (3.58 ± 0. 82) hours. Mean follow-up duration was ( 86.52 ± 12.48) months. 83 grafts were evaluated for patency ( open vs. closed) and were graded by Fitzgibbon as grade A ( excellent graft), B ( impaired graft, with a stenosis of ≥50%, or a diameter less than 50% of the grafted artery), or O ( completely occluded). The graft patency was 73.49%, 61grafts were graded as Fitzgibbon A, 6 grafts as Fitzgibbon B and 16 grafts as Fitzgibbon 0. 25 patients were in group 2, 21males and 4 females. The mean age of patients at procedure was (58.2 ± 9.09) years, 11 patients had unstable angina, 13 patients had old myocardial infarction and 6 cases had diabetes. The ejection fraction (EF) was 0.59 ± 0. 14. Conclusion No 2011.03.013 difference in long-term graft patency was identified between on-pump and off-pump coronary artery bypass grafting. Off-pump oronary artery bypass grafting preformed by an experienced surgeon may gain similar long-term graft patency to that of conventional bypass.     

冠状动脉硬化性心脏病合并左锁骨下动脉严重狭窄非体外循环下同期手术的临床经验

目的探讨非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路治疗冠状动脉硬化性心脏病(冠心病)合并锁骨下动脉重度狭窄的手术方法及效果.方法2003年1月～2004年5月,我院治疗须行冠状动脉旁路移植术同时合并左锁骨下动脉近端重度狭窄3例,术中先行主动脉-锁骨下动脉旁路,左乳内动脉获得满意的流量后,再行非体外循环冠状动脉旁路移植.结果手术时间210～340 min,平均283 min,出血量570～1 630 ml,平均963 ml.游离左乳内动脉后量杯测流量均＜5 ml/min,主动脉-锁骨下动脉旁路后量杯测流量均＞50 ml/min,乳内动脉远端与前降支吻合后流量仪测流量12～27 ml/min,平均20 ml/min.术后临床症状缓解,未发现冠脉-锁骨下动脉窃血综合征.3例随访3～6个月,平均5个月,无心绞痛发作.结论非体外循环冠状动脉旁路移植同时主动脉-锁骨下动脉旁路手术是治疗冠心病合并锁骨下动脉重度狭窄简单而有效的方法.     

非体外循环冠状动脉旁路移植术在高危冠心病中的应用

目的 探讨用非体外循环冠状动脉旁路移植术(OPCAB)的方法，以避免体外循环对冠心病高危因素患者产生的不良影响。方法 对100例冠心病患者行OPCAB，其中69例伴有冠心外科手术的高危因素。血管病变主要涉及左、右冠状动脉各分支。结果 手术死亡1例(1.4％)，手术转换2例(2．9％)，移植血管失功1例(1.4％)，术后非致命性心肌梗死4例(5．8％)，肾功能衰竭1例(1．4％)，胸骨感染1例(1．4％)，24小时内拔除气管内插管68例(98.6％)，接受输血17例(25．O％)。术后随访56例，随访时间1—13个月，死亡2例，心绞痛复发4例，充血性心力衰竭2例。术后无脑血管意外、再次手术止血、室性心律失常、下胶切口感染和呼吸衰竭等并发症发生。随访病例中14例做冠状动脉血管造影术，仅1例移植血管狭窄大于50％。所有乳内动脉血管桥均通畅。结论 对某些具有冠心外科手术高危因素的患者，采用OPCAB可降低并发症发生率和手术死亡率。然而，这种技术较适用于冠状动脉解剖条件较好的病例。远期结果需要长期随访进一步加以证实。     

Coronary artery spasm after off-pump coronary artery bypass grafting

BACKGROUND: Coronary artery spasm (CAS) in the immediate postoperative period has been recognized as a possible cause for perioperative myocardial ischaemia after off-pump coronary artery bypass grafting (CABG). It varies in severity and can be associated with circulatory collapse and death. The purpose of this study was to present our experiences on CAS after off-pump CABG and detail its management. METHODS: The case reports of three patients with similar clinical presentations of ischaemic heart disease who underwent CABG using an off-pump technique are reviewed. Severe manifestations of CAS in the immediate postoperative period with documented angiographic findings are presented. RESULTS: Three patients (two men and one woman) with angina pectoris were diagnosed with coronary artery disease using coronary angiography. The elective off-pump CABG was uneventful; however, severe manifestation of myocardial ischaemia with abrupt onset developed at the intensive care unit. All three patients underwent immediate coronary angiography to verify the diagnosis of CAS. Apart from intracoronary nitroglycerine infusion and medical support with inotropic agents, extracorporeal membranous oxygenation was carried out because of severe haemodynamic deterioration in one case, while support was required with intraaortic balloon pumping in another. All three patients made a full recovery. CONCLUSION: Coronary artery spasm can severely complicate the postoperative course for patients undergoing off-pump CABG, leading to myocardial ischaemia or infarction, life-threatening arrhythmias, persistent hypotension and even cardiac arrest. Early awareness and diagnosis of CAS with the establishment of appropriate management strategies may prevent its potentially lethal consequences.     

Safe evolution towards routine off-pump coronary artery bypass: negotiating the learning curve

Objective: Off-pump coronary artery bypass (OPCAB) hopes to avoid morbidity associated with cardiopulmonary bypass, improving clinical outcomes. Yet its technical difficulty and unfamiliarity raise concern that adoption of OPCAB might be associated with poorer outcomes during each surgeon's ‘learning curve’. We examined trends in patient selection over time as a single surgeon's practice evolved to routine OPCAB. Methods: Between 10-1-96 and 12-31-01, 1479 consecutive patients had isolated coronary artery bypass grafting (CABG). Clinical data were gathered prospectively and reviewed retrospectively. Trends in adoption of OPCAB and clinical outcomes were examined. Results: There were 756 OPCAB and 723 CABG/cardiopulmonary bypass patients. The practice evolved from 90% conventional CABG to 93% OPCAB. An abrupt transition coincided with evolution of techniques to expose the obtuse marginal arteries, and improvements in suction-based coronary stabilizers. Mortality was 1.0% for the off-pump group and 2.1% for the on-pump group. Careful patient selection helped maintain acceptable outcomes during the ‘learning curve’. Patients with depressed left ventricular ejection fraction, left main disease, and complex three vessel disease were excluded from OPCAB until significant experience (>200 cases) was attained. Presently, all isolated coronary bypass cases are candidates for OPCAB except patients with ischemic ventricular arrhythmias, those in cardiac arrest, and those for whom previous left pneumonectomy or deep pectus excavatum prevent rightward mobilization of heart. Conclusions: Despite a significant learning curve, evolution to routine OPCAB can be achieved while maintaining good patient outcomes. The development of specialized techniques, coronary stabilizers, and apical suction devices allows the application of OPCAB to virtually all coronary bypass patients, as surgeon experience matures.     

Symmetry主动脉吻合器在心脏不停跳冠状动脉旁路移植术中的应用

目的　总结非体外循环心脏不停跳冠状动脉旁路移植术 (Off-pumpcoronaryarterybypassgrafting ,OPCAB)中使用Symmetry主动脉吻合器的近期效果。　方法　 2 0 0 2年 9月～ 2 0 0 3年 6月 ,2 0 4例冠心病行OPCAB ,其中 16 7例使用大隐静脉移植物 ,应用Symmetry主动脉吻合器 10 0例。　结果　使用吻合器 14 2个 ,吻合失败弃用 2个 ,3个吻合口漏血需手工修补 ,成功率 96 5 % (137 14 2 ) ,近端吻合口 (1 4± 0 5 )个 例 ,远端吻合口 (3 5± 0 8)个 例。近端吻合口血流量 (46 5± 2 2 3)ml min。吻合器安装时间 (4 0± 1 1)min ,吻合口完成时间均在 10s以内 ,手术时间 (3 2± 0 4 )h。手术死亡率 1% (1 10 0 ) ,无围手术期心肌梗塞、脑卒中等并发症 ,出血二次开胸 1例 ,但非吻合口出血。术后引流量 (5 4 1± 2 74 )ml,输血率 36 0 % (36 10 0 )。术后住院 (7 8± 1 6 )天。　结论　Symmetry主动脉吻合器可安全有效地应用于CABG术 ,近期临床效果满意 ,可缩短吻合时间和手术时间 ,避免主动脉钳夹 ,降低卒中并发症     

Off-pump coronary artery bypass grafting: A single center experience

Background Coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) is gaining popularity as an effective alternative to conventional CABG using cardiopulmonary bypass. With the advent of mechanical tissue stabilization systems and intra coronary shunts the technique of off-pump CABG (OPCAB) is now applicable to revascularize the patients with multi-vessel disease. Methods A total of 293 patients underwent surgical myocardial revascularization without cardiopulmonary bypass between July 1996 and October 2000 at our hospital. Of these, 245 patients received 2 or more grafts: two in 193 patients, 3 in 46 patients and 4 in 7 patients. A mechnical tissue stabilization system (CTS or Octopus II/III) was used in all patients. In majority of the patients intra coronary shunts were also used. A total of 550 distal anastomoses were made and the vessels grafted were LAD (n=245), diagonal (n=90), ramus intermedius (n=16), obtuse marginal branches (n=58), distal right coronary artery (n=88) and posterior descending artery (n=52). Results There was no incidence of perioperative myocardial infarction. Three patients had transient ST segment elevation postoperatively which was normalized in the first few hours. Hospital mortality was 0.4%. No patient needed reexploration for bleeding. No patient had neurological event or pulmonary problems. All these patients except one were discharged from the hospital between 6 and 9 days. Conclusion In selected patients multi vessel OPCAB is a safe and reproducible technique and the mechanical tissue stabilization systems have made the procedure less difficult to perform. Its usefulness is more pronounced in high risk patients with comorbidities and the patients who undergo this procedure are free from major complications.     

非体外循环冠状动脉旁路移植术治疗重症冠状动脉粥样硬化性心脏病

目的探讨非体外循环冠状动脉旁路移植术治疗重症冠状动脉粥样硬化性心脏病(冠心病)的可行性. 方法回顾分析2002年1月～12月37例重症冠心病的临床资料.均采用全麻,胸骨正中切口,游离左乳内动脉及大隐静脉.心脏稳定器局部固定心肌,显露目标冠状动脉,切开后置入冠状动脉内血液分流器.一般先做左乳内动脉与左冠状动脉前降支的吻合,其余血管桥先做桥血管与主动脉的近心端吻合,然后再做桥血管与冠状动脉的吻合. 结果全组病例均在非体外循环下完成手术,搭桥1～6支,(3.2±0.5)支.术后10 d死亡1例,其余36例未发生围术期心肌梗死,无呼吸功能不全、肾功能不全、脑血管意外等严重并发症. 结论在成熟的手术技术和严格的围手术期管理的条件下,非体外循环冠状动脉旁路移植术治疗重症冠心病可行.     

Effects of ischemic preconditioning and synchronized coronary venous retroperfusion in an off-pump coronary artery bypass grafting model

Off-pump coronary artery bypass grafting (CABG) has become a popular procedure. However, temporary occlusion of the target vessel is sometimes a threat to the patients. Although ischemic preconditioning (IP) has been proposed to reduce myocardial injury, its effects remain controversial. The coronary veins represent an alternate route for delivery of therapeutic agents and arterial blood to the acutely ischemic myocardium. The aim of this study was to investigate the protective effect against myocardial ischemia and reperfusion injury of combined IP and synchronized coronary venous retroperfusion (SCVR) in an off-pump CABG model. Twenty-one pigs were assigned to 3 groups of 7 animals. In the control group, the left anterior descending coronary artery (LAD) was occluded for 45 min followed by 2 h of reperfusion using a left intrathoracic artery (LITA) bypass circuit. In the IP group, LAD occlusion was done for 5 min with 15 min of reperfusion, followed by 45 min of LAD occlusion. In the SCVR group, pretreatment before LAD occlusion was the same as in the IP group. Then, SCVR was commenced just after the start of LAD occlusion for 45 min. The percent systolic shortening of ischemic myocardium (measured by sonomicrometry) after reperfusion via the LITA was significantly (p < 0.001) greater in the SCVR group (14.6 +/- 3.3%) than in the control group (-1.6 +/- 5.6%, 95%CI: -24.3 - -8.1) or the IP group (0.7 +/- 8.0%, 95%CI: -22.0 - -5.8) after 30 min of reperfusion, and this difference persisted throughout the reperfusion period. Infarct size (expressed as a percentage of the area at risk) was significantly (p < 0.001) smaller in the SCVR group (2.4 +/- 2.7%) than in the control group (83.0 +/- 2.3%, 95%CI: -99.0 - -62.4) or the IP group (42.0 +/- 23.0%, 95%CI: -58.0 - -21.3). Combined SCVR and IP had a potent myocardial protective effect in the present off-pump CABG model. This method may be clinically feasible and may be able to prolong a safe coronary occlusion.     

冠心病患者非体外循环冠状动脉旁路移植术后新发房颤与血清微小RNA-146a、微小RNA-499的关系

目的:探讨血清微小RNA(miR)-146a、miR-499与冠心病患者非体外循环冠状动脉旁路移植术(OPCABG)后新发房颤的关系。方法:选取郑州大学第一附属医院2019年8月至2021年8月收治的118例冠心病患者作为研究对象,所有患者均行OPCABG术治疗,术后接受为期7 d观察,将观察期间发生房颤患者纳入发生组...     

Anaesthesia for off-pump coronary artery bypass grafting

Achieving surgical revascularization of the heart, while avoiding the insult of cardiopulmonary bypass, is particularly desirable in specific high-risk patient groups. The relatively recent advances in surgical technique allowing high-quality grafting without mechanical arrest have led to an increase in popularity of off-pump coronary artery bypass surgery. Nonetheless, operating on the beating heart, manipulating it and purposely inducing ischaemia, invariably has significant haemodynamic consequences which must be carefully yet aggressively managed. To compound the situation, the intraoperative monitoring typically employed to evaluate cardiac function, such as electrocardiography and echocardiography, are of limited efficacy at crucial moments in the procedure. It is therefore essential that the anaesthetist is able to assimilate information from a multitude of sources in order to safely navigate the patient through a period of continually changing cardiovascular stress.     

Anaesthesia for off-pump coronary artery bypass grafting

Achieving surgical revascularization of the heart, while avoiding the insult of cardiopulmonary bypass, is particularly desirable in specific high-risk patient groups. The relatively recent advances in surgical technique allowing high-quality grafting without mechanical arrest have led to an increase in popularity of off-pump coronary artery bypass surgery. Nonetheless, operating on the beating heart, manipulating it and purposely inducing ischaemia, invariably has significant haemodynamic consequences which must be carefully yet aggressively managed. To compound the situation, the intraoperative monitoring typically employed to evaluate cardiac function, such as electrocardiography and echocardiography, are of limited efficacy at crucial moments in the procedure. It is therefore essential that the anaesthetist is able to assimilate information from a multitude of sources in order to safely navigate the patient through a period of continually changing cardiovascular stress.