Objective To compare the economic outcome between on-pump and off-pump coronary artery bypass grafting (CABG). Methods Six hundred seventy-nine patients were divided into on-pump and off-pump groups. Twelve variables with respect to costs were obtained for each group during hospital stay. Results There was no significant difference in total mean cost between two groups. For off-pump patient, the costs of medication, operation, blood transfusion, bed occupancy, and nursery were significantly less than those of on-pump CABG surgery was (P0.05). Conclusion Costs of OPCAB are not significantly lower than on-pump CABG due to higher material costs.

Objective To introduce the clinical experience of Bentall procedure with composite tissue valve conduit. Methods Five patients were diagnosed as severe aortic regurgitation with dilatation of Valsava sinus and sinotubular junction and ascending aorta. Mean age of patients was (55.8?9.4) years (range 47～67). After median sternotomy , cardiopulmonary bypass was established using a single two-stage venous cannula. Temperature was brought to 28℃. After the ascending aorta was occluded, an aortotomy was made and aortic valve was excised. Aorta was removed from sinuses of Valsalva except for generous buttons around coronary ostia. After sizing the aortic annulus, an appropriate-size tissue valve and woven dacron conduit (3 mm greater in diameter than the tissue valve) were chosen to build a composite conduit. It was attached to annulus of aortic valve with pledget-reinforced horizontal mattress stitches to replace the aortic valve and ascending aorta as an en bloc procedure (Bentall procedure). In 2 cases, Coronary artery bypass grafting was performed with greater saphenous vein anastomosed distally to left anterior descending artery and proximately to conduit. Results All cases recovered uneventfully and they were discharged without any postoperative complications. Echocardiography was repeated before discharge. Mean aortic pressure gradient was (18.3?7.6) mmHg. Left ventricular dimension was significantly reduced [(58.8?6.3)mm vs. (43.7?3.1)mm]after operations(P0.05). Follow-up was 2 to 8 months. Conclusion With composite tissue valve conduit, Bentall procedure to replace the aortic valve and ascending aorta as an en bloc procedure is feasible and safe for the elderly patients. A long-term follow-up for the function and structure of tissue valve is needed.

Objective To summarize the clinical experience of coronary angiography before coronary artery grafting (CABG) with concomitant valvular surgery in patients with valvlar disease. Methods From April 2000 to May 2005, two hundred and eleven patients over 50 years old (mean age 60 3.5) with valvlar diseases were studied retrospectively. Coronary angiography was utilized for patients who were found to have risk factors for atherosclerosis. Coronary stenosis over 50% of its calibre was considered positive, and 75% stenosis (including LMCA stenosis more than 50%) was used as the indication for coronary artery bypass surgery. Results Coronary angiography was employed in 128 patients and 30 cases (23.4%) had coronary artery stenosis exceeding 50%. CABG was concomitantly performed during cardiac valvular surgery in 24 patients. In-hospital mortality in patients with valve surgery alone was 0.5%, which was significantly lower compared with patients with valve surgery combined with CABG group (4.2%)(P

Objective To introduce experience of harvesting great saphenous vein (GSV) and surgical techniques to avoid infectious complication in coronary artery bypass grafting (CABG). Methods One thousand and one hundred twenty CABG, including 523 conventional CABG (CCABG) and 597 off-pump coronary artery bypass grafting (OPCAB), were performed by the same surgical team. One thousand and fifty GSV were used as the conduit. Left internal mammary artery was routinely anastomosed to left anterior descending artery(LAD), and GSV and/or radial artery to the other target vessels. Preoperative selection of GSV, operative procedure of harvesting, meticulous postoperative supervision and appropriate treatment of the incision, and the control of risk factors as diabetes mellitus, which composed an integral part of periopertive strategies, are critical to avoid infectious complication. Results No infection occurred. Recovery of two patients with diabetes mellitus was complicated by delayed healing of incision. In ten patients there was a slight exudation from the incision, and they healed without infection after the addition of 2~3 interrupted sutures. Healing was not delayed. Swelling of the involved legs occurred in the majority of patients, and numbness along the incision was also documented in some patients, and it usually recovered to normal three months after operation, after being followed-up for 3 months to 2 years. Conclusion Infection can be completely avoided after the planned procedure of harvesting GSV and meticulous perioperative care.

Objective To introduce the strategies of coronary artery bypass grafting (CABG) surgery for elderly patients over 65 years old. Methods Three hundred and ninety four elderly patients were retrospectively studied, 92.4% of whom were complicated with other diseases. Off-pump CABG (OPCAB) was used in 248 cases (62.4%). For the remaining patients with severely compromised cardiac function or small target vessel with diffuse lesion, conventional CABG (CCABG) was selected. Left internal mammary artery (LIMA) was harvested with extrapleural harvesting technique and grafted to left anterior descending artery (LAD) in 96.2% of patients. Saphenous vein or radial artery was utilized for the other coronary arteries. Transit-time flowmeter (TTFM) was utilized to make sure that grafts were patent with satisfactory blood flow. Perioperative blood sugar level was controlled at 6-10mmol/L by insulin. Results Grafts of per patient were 3.14?0.55 for on-pump CABG and 2.40?0.81 for OPCAB. Three patients died resulting in a mortality of 0.76%. The incidence of complication was 2.28%. The rest recovered uneventfully. Intubation time of OPCAB was significantly shorter than that of CCABG. Patients were discharged within 11.84?4.95 days after operation. Conclusion Good short-term result, namely low incidence of mortality and complication, could be obtained in elderly patients over than 65 years old undertaking CABG.

Objective To review the experience of surgical management of coronary artery disease associated with valvular heart disease. Methods From 1998 to 2004, fifty-seven patients with coronary artery lesion and valvular disease underwent coronary artery bypass grafting with concomitant valvular operation. The mean age of the patients was 60 years. Heart function (NYHA) was class II in 9 patients, class III in 37, class IV in 11. 37 patients had mitral valve lesion, 11 aortic valve lesion, and 9 with lesions of both valves. 26 cases had single-vessel disease, 20 with double-vessel disease,11 with triple-vessel disease, and 9 with main artery lesion. After cardiac arrest with the aid of cold cardioplegia under moderate cardiopulmonary bypass, distal anastomosis of the saphenous vein (SV) to the target vessels was first performed followed by valve replacement (49 patients) or valvular plasty (8 patients). The left mammary artery was grafted to the left anterior descending artery before aortic declamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping was 112.6 min. Results Except one patient, no mortality and severe morbidity occurred during hospitalization. Heart function was improved to class I-II and no one died during follow-up period. Conclusion CABG combined with valve surgery can be safely performed with good results.

Objective To summarize the operative techniques and clinical outcome of 582 patients undergoing off-pump coronary artery bypass grafting (OPCAB). Methods 582 patients who underwent off-bump coronary artery bypass were retrospectively studied. Results One patient was re-explored for bleeding. The other patients experienced a good recovery without complications. The mean mechanical ventilation time was 3.2?1.2h, and the mean hospital stay time was 7?1.6d. All the patients were free from angina after the operation. 2 patients died of arrhythmia. Conclusions OPCAB can reduce the time of postoperative recovery and decrease the incidence of complication and mortality. OPCAB is a good choice for high-risk patients.

Objectives To analyze retrospectively 1120 patients who underwent coronary artery bypass grafting surgery (CABG) in order to evaluate surgical techniques and clinical outcome. Methods From 1997 through April of 2005, data of 597 patients who underwent conventional coronary artery bypass surgery on pump (CCABG) and 523 patients who underwent off-pump CABG (OPCAB) all performed by the same surgeon were collected and analyzed retrospectively. Eight hundred and fifty-two patients had unstable angina, 640 patients were over 60 years old (57.1%) and 862 patients had concomitant diseases involving valves, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect, stroke, COPD, renal failure and cancer. A hundred and seventy-six patients had LIMS stenosis and 738 patients with triple-vessel disease. Results Total mortality was 0.36% (4-case death), and morbidity of 1.6% (sternal dehiscence, stroke and mediastinitis). The grafts per patient with CCABG and OPCAB were 3.3?0.6 vs. 2.5?0.4. Left internal mammary artery (LIMA) was used in 94% of the patients, and IABP was given in 31 patients early postoperatively. Follow-up period was 4 months to 7 years. Conclusions Rational and appropriate surgical strategies, excellent surgical techniques, improvement in anesthesia, and CPB significantly lower mortality and morbidity of CABG, which has become safe and effective in patients with coronary artery disease.

Objective To study the clinical characteristics and surgical treatment of left ventricular outflow tract obstruction (LVOTO) caused by congenital accessory mitral valve (AMV) tissue. Methods Two cases were treated in our department. Pre-operatively, case 1 was diagnosed as congenital heart disease with severe LVOTO and anterior mitral valve cleft; case 2 was diagnosed as congenital atrial septal defect combined with AMV and mild LVOTO as well as mild mitral valve regurgitation. Both patients were operated on under CPB. In case 1, LVOTO was caused by AMV which belonged to Type I (fixed type). In case 2, the AMV was type II (mobile type). Results Both AMV tissues were resected through atrial septum, and combined cardiac disorders were repaired simultaneously. The operations were successful and the patients were discharged with good results. Echocardiography revealed that the LVOTO almost disappeared. Conclusions LVOTO caused by AMV is a rare congenital heart disorder. AMV may be removed with acceptable postoperative outcome. Prophylactic removal of AMV tissue should not be attempted in patients with no or mild LVOTO and no other associated heart defects. These patients should be followed and observed periodically by Doppler echocardiography to identify any progression in LVOTO.

Objective To study the clinical manifestations of cardiac myxoma and the morbidity, mortality and recurrence rate following surgery in our institution. Methods From December 1989 to November 2004, 71 patients underwent complete excision of primary or recurrent intracardiac myxoma. Pre-operative diagnosis was established by echo-cardiography. All patients underwent operation soon after the diagnosis of myxoma was made. Combined cardiac disorder was also treated synchronously. The excised myxoma was histopathologically studied routinely. Results Myxoma most commonly occurred in the fourth decade of life. Its commonest location (92.9%) was the left atrium (LA), but 3 patients had myxoma in the right atrium (RA), one in the right ventricle (RV), and one in the left ventricle (LV). Patients with LA myxoma simulated mitral stenosis clinically, whereas patients with RA and RV myxoma presented features of right heart failure. Patients with LV myxoma had the symptoms of the left ventricular outlet tract obstruction. 6 patients had history of embolism. Combined cardiac diseases included coronary heart disease (2 cases), rheumatic mitral stenosis (2 cases), and severe mitral insufficiency (3 cases), and severe tricuspid insufficiency (4 cases). One patient had myxoma recurrence for three times after his first surgery, and died in the fourth operation. All the other patients survived the operation with the condition improved during the follow-up period. No late deaths were observed. Conclusions Echocardiography is the ideal diagnostic tool. Immediate surgical treatment is indicated in all patients. Cardiac myxoma can be excised with a low rate of mortality and morbidity. Close follow-up for detecting recurrence is necessary.