Objectives preliminary experience on endarterectomy and To summarize our off-pump coronary bypass grafting in patients with diffuse coronary artery disease. Methods Over a 3year period, 53 patients （41 male） with di...Objectives preliminary experience on endarterectomy and To summarize our off-pump coronary bypass grafting in patients with diffuse coronary artery disease. Methods Over a 3year period, 53 patients （41 male） with diffuse coronary artery disease underwent off-pump coronary endarterectomy and bypass grafting at our institution. Patients＇ age ranged from 55 to 79 years. Prior to surgery, 70% of patients were in CCS angina class 2 （n=5） or 3 （n=32）, and nearly half of them （26/53） had history of myocardial infarction. Most patients （n= 50） had triple vessel lesions, with left main stem involvement in 9. Their left ventricular ejection fraction ranged from 26% to 65% （mean 52%）. At the end of operation, a flow-meter was routinely applied to measure the perfusion flow of each postendarterectomy graft. Results In total, 70 endarterectomies were performed in 53 patients, including 38 in left anterior descending artery （LAD）, 8 in circumflex artery and 24 in right coronary artery. Four operations were emergency or urgent in nature. Five patients received on-lay venous patch after endarterectomy in LAD, followed by left internal mammary artery （LIMA） grafting on the patch. The graft conduits included 53 LIMAs and 2 radial arteries, and saphenous veins in others. Mean number of grafts per patient was 3.75. The overall index of complet-eness of revascularization reached 1.03±0.07. There was no death in this group of patients during their post-operative hospital stay （mean duration = 9 days）. Intra-operatively, 63 （90%） out of the 70 grafts after coronary endarterectomy showed satisfactory flow. Two patients had perioperative neither experienced signifi myocardial infarctions but cant hemodynamic deteriations. Conclusions Off-pump coronary endarterectomy with bypass grafting is technically feasible and can be coronary improve zation. performed safely in patients with diffuse artery disease. This strategy may help to the completeness of myocardial revasculariation.展开更多
Background： It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease （CAD）. Coronary endarterectomy （CE） offers an alternative choice of coronary...Background： It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease （CAD）. Coronary endarterectomy （CE） offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft （CABG） was discussed in the treatment for the diffused CAD. Methods： From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE ＋ CABG were pertbrmed, which was about 17.2% （38/221） of the cohort. All these patients were divided into two groups： CE ＋ CABG group （Group A） and CABG alone group and postoperative complications and in-hospital mortality were Chi-square test and Student＇s t-test respectively. （Group B）. All clinical data were compared between the two groups, analyzed. The categorical and continuous variables were analyzed by Results： Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was perfbrmed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A （3/38）, which was more often than that in Group B （3/183）. At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent （50/50）. There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions： Coronary endarterectomy ＋ CABG can oilier satisfactory result for patients with diffused CAD in a short-term after the operation.展开更多
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...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.展开更多
文摘Objectives preliminary experience on endarterectomy and To summarize our off-pump coronary bypass grafting in patients with diffuse coronary artery disease. Methods Over a 3year period, 53 patients （41 male） with diffuse coronary artery disease underwent off-pump coronary endarterectomy and bypass grafting at our institution. Patients＇ age ranged from 55 to 79 years. Prior to surgery, 70% of patients were in CCS angina class 2 （n=5） or 3 （n=32）, and nearly half of them （26/53） had history of myocardial infarction. Most patients （n= 50） had triple vessel lesions, with left main stem involvement in 9. Their left ventricular ejection fraction ranged from 26% to 65% （mean 52%）. At the end of operation, a flow-meter was routinely applied to measure the perfusion flow of each postendarterectomy graft. Results In total, 70 endarterectomies were performed in 53 patients, including 38 in left anterior descending artery （LAD）, 8 in circumflex artery and 24 in right coronary artery. Four operations were emergency or urgent in nature. Five patients received on-lay venous patch after endarterectomy in LAD, followed by left internal mammary artery （LIMA） grafting on the patch. The graft conduits included 53 LIMAs and 2 radial arteries, and saphenous veins in others. Mean number of grafts per patient was 3.75. The overall index of complet-eness of revascularization reached 1.03±0.07. There was no death in this group of patients during their post-operative hospital stay （mean duration = 9 days）. Intra-operatively, 63 （90%） out of the 70 grafts after coronary endarterectomy showed satisfactory flow. Two patients had perioperative neither experienced signifi myocardial infarctions but cant hemodynamic deteriations. Conclusions Off-pump coronary endarterectomy with bypass grafting is technically feasible and can be coronary improve zation. performed safely in patients with diffuse artery disease. This strategy may help to the completeness of myocardial revasculariation.
文摘Background： It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease （CAD）. Coronary endarterectomy （CE） offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft （CABG） was discussed in the treatment for the diffused CAD. Methods： From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE ＋ CABG were pertbrmed, which was about 17.2% （38/221） of the cohort. All these patients were divided into two groups： CE ＋ CABG group （Group A） and CABG alone group and postoperative complications and in-hospital mortality were Chi-square test and Student＇s t-test respectively. （Group B）. All clinical data were compared between the two groups, analyzed. The categorical and continuous variables were analyzed by Results： Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was perfbrmed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A （3/38）, which was more often than that in Group B （3/183）. At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent （50/50）. There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions： Coronary endarterectomy ＋ CABG can oilier satisfactory result for patients with diffused CAD in a short-term after the operation.
文摘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.
