The feasibility and safety of total arterial coronary revascularization with 2 arterial conduits in patients with impaired left ventricular function was evaluated. Data were prospectively collected on all patients with multiple vessel discase and moderately or severely impaired left ventricular function, who underwent coronary surgery with the intention of total arterial revascularization with 2 conduits between March 1995 and August 2002. One hundred and seventy-nine patients were included in the study. Acute coronary insufficiency was present in 3 patients and 43 had unstable angina. Severe left ventricular impairment was present in 29 patients. There were 17 redo operations including 3 redo-redo procedures. Eighty-two percent of patients had a Y graft configuration from the left internal mammary artery (right internal mammary artery 40.8%, radial artery 33.5%, other 7.8%). The perioperative mortality was 2.2%, myocardial infarction 1.7% and stroke 0.6%. Total arterial revascularization in patients with ischaemic left ventricular dysfunction can be safely performed with 2 arterial conduits. The radial artery provides conduit length greater than the right internal mammary artery and allows full revascularization despite left ventricular dilatation.
Angina, Unstable/complications ; Angina, Unstable/*surgery ; *Coronary Artery Bypass/methods ; Prospective Studies ; Radial Artery/*transplantation ; Vascular Surgical Procedures/methods ; Ventricular Dysfunction, Left/etiology ; Ventricular Dysfunction, Left/*surgery

Acute Coronary Syndrome ; complications ; Aged ; Anaphylaxis ; chemically induced ; Angina, Unstable ; etiology ; therapy ; Contrast Media ; adverse effects ; Dextrans ; adverse effects ; Drug Hypersensitivity ; complications ; Humans ; Male

Essential thrombocythemia (ET) is a clonal disorder of myeloid stem cells that causes thrombocytosis. As a result, ET can lead to vascular thrombosis and tissue ischemia; the association of coronary artery abnormalities such as myocardial infarction or unstable angina is rare. Here we describe a 45-year-old male patient with essential thrombocythemia who presented with unstable angina. Elective coronary angiography showed total occlusion of mid right coronary artery and mid left anterior descending coronary artery. ET was confirmed by a bone marrow biopsy; treatment was started with antiplatelet therapy including aspirin and clopidogrel along with cytostatic therapy with hydroxyurea and anagrelide. After the initiation of the treatment, the platelet count decreased to 20 s 10(4)/microliter. In addition, percutaneous coronary angioplasty was successfully performed with stent placement at the right coronary artery without hemorrhagic or thrombotic complications.
Thrombocythemia, Hemorrhagic/complications/*drug therapy ; *Stents ; Quinazolinesherapeutic use ; Middle Aged ; Male ; Hydroxyureaherapeutic use ; Humans ; *Angioplasty, Transluminal, Percutaneous Coronary ; Angina, Unstable/etiology/*therapy

OBJECTIVETo summarize the experience of combined off-pump coronary artery bypass grafting (OPCAB) and pulmonary resection.

METHODSSeven patients with unstable angina or a history of myocardial infarction and pulmonary disease underwent combined OPCAB and pulmonary resection. All of them underwent coronary angiography, and neither coronary angioplasty nor stenting was feasible. OPCAB preceded the lung resections. The preferred approach to the heart and lung was by sternotomy. Left upper lobectomy was performed in 2 patients, right upper lobectomy was performed in 1 patient, right lower lobectomy was performed in 1 patient, right upper and middle bilobectomy was performed in 1 patient, left lung volume reduction surgery (LVRS) was performed in 1 patient and bilateral LVRS was performed in 1 patient.

RESULTSThere were no hospital mortality in this group of patients, however there were one late death. Sternal dehiscence occurred in 1 patient which was observed with a need for re-sternotomy and atrial fibrillation was observed in 1 patient. Five patients were diagnosed as malignant tumor by pathology test, and 2 patients were severe chronic obstructive pulmonary disease (COPD). Follow-up ranging from 2 months to 31 months was available for these patients. None of the patients showed evidence of myocardial ischemia after surgery. In one patient, who underwent right upper and middle bilobectomy, local recurrence was found at 19 months after surgery.

CONCLUSIONSOPCAB carried out simultaneously with lung resection is a safe and effective approach in patients diagnosed with concomitant coronary artery and pulmonary disease. OPCAB may decrease the incidence of postoperative complications.

Aged ; Angina, Unstable ; complications ; surgery ; Coronary Artery Bypass, Off-Pump ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Lung Diseases ; complications ; surgery ; Male ; Middle Aged ; Pneumonectomy ; adverse effects ; methods ; Postoperative Complications ; prevention & control ; Treatment Outcome

OBJECTIVETo observe the intervention of Xuezhikang (XZK) on patients of acute coronary syndrome (ACS) with different levels of blood lipids.

METHODSAdopting the double blind randomized controlled method, 105 patients of ACS were divided into two groups. The 53 patients in the treated group, 26 with normal blood lipids (NBL) and 27 with hyperlipemia (HL) were treated with conventional western medicine plus XZK 1.2 g per day for 12 weeks. The 52 patients in the control group, 25 with NBL and 27 with HL, were treated with conventional western medicine alone. Besides, a healthy control group consisted of 40 subjects was set up. The changes of brachial arterial endothelium-dependent diastolic function (FMD) before and after treatment was observed, the changes of blood levels of nitric oxide (NO), endothelin-1 (ET-1), C-reactive protein (CRP) and lipids were also recorded.

RESULTSBefore treatment, FMD value and serum NO level were lower and ET-1 and CRP levels in ACS patients were higher than those in the healthy subjects, and a significant correlation existed between CRP, NO and FMD with LDL-C. After treated for 12 weeks, FMD value and serum NO level increased, levels of ET-1 and CRP decreased significantly in the treated group, showing significant difference to those in the control group (P < 0.05, P < 0.01). Serum levels of TC, TG and LDL-C in the treated group lowered significantly. HDL-C level in patients with HL increased significantly while in those with NBL, it showed a trend of increasing but with no statistical significance.

CONCLUSIONApplying XZK in ACS patients in early stage, either with NBL or with HL, could improve the endothelial function, antagonize inflammatory response to stabilize the atheromatous plaque.

Adult ; Aged ; Angina, Unstable ; blood ; complications ; drug therapy ; Biological Products ; Cholesterol ; blood ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Hyperlipidemias ; blood ; complications ; drug therapy ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; Myocardial Infarction ; blood ; complications ; drug therapy ; Phytotherapy

OBJECTIVETo study the lipid regulatory effect of Xuezhikang (XZK) and its effects on serum oxidized low density lipoprotein (OX-LDL), C-reactive protein (CRP) and fibrinogen (FIB) in patients with unstable angina pectoris (UAP).

METHODSUAP patients with hyperlipidemia were treated with XZK 0.6 g, orally taken, twice a day for 2 successive months followed by half dosage for 2 months. To UAP patients with normal blood lipids, Vit E was given orally for 4 months. Levels of blood lipids, OX-LDL, CRP, FIB at the time of entry, 1st and 2nd month of the therapeutic course were observed and end-point events in the two groups was compared.

RESULTSXZK can reduce the serum level of total cholesterol, low density lipoprotein after being administered for 1 month, and the effect further elevated after 2 months. Its effect in lowering triglycerides and increasing high density lipoprotein initiated after 2 months administration. Compared with effect of Vit E, XZK can significantly lower the serum OX-LDL, CRP and FIB after 2 months administration, and reduce the end-point events in 4 months.

CONCLUSIONXZK has good regulatory effect on blood lipids, it also can inhibit the development of inflammation in coronary plaque, therefore, is beneficial to the prognosis of UAP patients.

Adult ; Aged ; Angina, Unstable ; blood ; complications ; drug therapy ; C-Reactive Protein ; metabolism ; Cholesterol ; blood ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Fibrinogen ; metabolism ; Follow-Up Studies ; Humans ; Hyperlipidemias ; blood ; complications ; drug therapy ; Lipoproteins, LDL ; blood ; Male ; Middle Aged ; Oryza ; Phytotherapy

BACKGROUND: Adverse effects of cardiopulmonary bypass can be avoided by "Off-pump" coronary artery bypass (OPCAB) surgery. Recent studies have reported that OPCAB had the most beneficial impact on patients at highest risk by reducing bypass-related complications. The purpose of this study is to compare the outcome of OPCAB and conventional coronary artery bypass grafting (CCAB) in patients with poor left ventricular (LV) function. MATERIAL AND METHOD: From March 1997 to February 2004, seventy five patients with left ventricular ejection fraction (LVEF) of 35% or less underwent isolated coronary artery bypass grafting at our institute. Of these patients, 33 patients underwent OPCAB and 42 underwent CCAB. Preoperative risk factors, operative and postoperative outcomes, including LV functional change, were compared and analysed. RESULT: Patients undergoing CCAB were more likely to have unstable angina, three vessel disease and acute myocardial infarction among the preoperative factors. OPCAB group had significantly lower mean operation time, less numbers of total distal anastomoses per patient and less numbers of distal anastomoses per patient in the circumflex territory than the CCAB group. There was no difference between the groups in regard to in-hospital mortality (OPCAB 9.1% (n=3) Vs. CCAB 9.5% (n=4)), intubation time, the length of stay in intensive care unit and in hospital postoperatively. Postoperative complication occurred more in CCAB group but did not show statistical difference. On follow-up echocardiography, OPCAB group showed 9.1% improvement in mean LVEF, 4.3 mm decrease in mean left ventricular end-diastolic dimension (LVEDD) and 4.2 mm decrease in mean left ventricular end-systolic dimension (LVESD). CCAB group showed 11.0% improvement in mean LVEF, 5.1 mm decrease in mean LVEDD and 5.5 mm decrease in mean LVESD. But there was no statistically significant difference between the two groups. CONCLUSION: This study showed that LV function improves postoperatively in patients with severe ischemic LV dysfunction, but failed to show any difference in the degree of improvement between OPCAB and CCAB. In terms of operative mortality rate and LV functional recovery, the results of OPCAB were as good as those of CCAB in patients with poor LV function. But, OPCAB procedure was advantageous in shortening of operative time and in decrease of complications. We recommend OPCAB as the first surgical option for patients with severe LV dysfunction.
Angina, Unstable ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography ; Follow-Up Studies ; Hospital Mortality ; Humans ; Intensive Care Units ; Intubation ; Length of Stay ; Mortality ; Myocardial Infarction ; Operative Time ; Postoperative Complications ; Risk Factors ; Stroke Volume ; Ventricular Dysfunction, Left* ; Ventricular Function, Left*

BACKGROUND: We analyzed the result of the "Off-Pump" Coronary Artery Bypass grafting (OPCAB) performed to minimize inflammatory responses to cardiopulmonary bypass and myocardial ischemia during the aortic cross-clamp period. MATERIAL AND METHOD: The preoperative diagnosis operative procedure mortality complication and postoperative course of the 50 patients who underwent OPCAB between January 1998 and September 1998 were analyzed. There were 34 males and 16 females with mean age of 60+/-9 years. Preoperative clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and clinical diagnoses were unstable angina in 31(62%) stable angina in 16(32%) and postinfarction angina in 3(6%) patients. Preoperative angiographic diagnoses were three-vessel disease in 25(50%) two-vessel disease in 5(10%) one-vessel disease in 7(14%) and left main disease in 13(26%) patients. There were elective operation in 37 cases and urgent operation in 13 cases. RESULT: The mean number of grafts was 3.2+/-1.2 per patient. Grafts used were unilateral internal thoracic artery in 43 greater saphenous vein in 37 radial artery in 7 bilateral internal thoracic arteries in 4 and right gastroepiploic artery in 2 cases Forty sequential anastomoses were performed in 18 cases. Vessels accessed were left anterior descending artery in 48 diagonal branch in 41 obtuse marginal branch in 30 right coronary artery in 24 posterior descending artery in 9 ramus intermedius in 5 and posterolateral branch in 5 anastomoses. Predischarge coronary angiography performed in 44 patients demonstrated the patency rate of 89.5%(128/143) Operative mortality was 2%(1/150) Postoperative complications were arrhythmia in 5 graft occlusion that needed reoperation in 4. perioperative myocardial infarction in 2 femoral artery thromboembolism developed after the application of IABP in 1 postoperative transient delirium in 1 peripheral compression neuropathy in 1 case. Sixteen patients(32%) were extubated at the operating room and the other patients were extubated at the mean 13+/-20 hours after the operation. Mean duration of stay in intensive care unit was 49+/-46 hours. Thirteen patients(26%) required blood transfusions perioperatively and the amount of perioperative blood transfusion was mean 0.70+/-1.36 pack/patient. CONCLUSIONS: OPCAB is suggested to be the ideal technique with less postoperative complication less hospitalization time and less cost.
Angina, Stable ; Angina, Unstable ; Arrhythmias, Cardiac ; Arteries ; Blood Transfusion ; Cardiopulmonary Bypass ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Coronary Vessels ; Delirium ; Diagnosis ; Female ; Femoral Artery ; Gastroepiploic Artery ; Hospitalization ; Humans ; Intensive Care Units ; Male ; Mammary Arteries ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Operating Rooms ; Postoperative Complications ; Radial Artery ; Reoperation ; Saphenous Vein ; Surgical Procedures, Minimally Invasive ; Surgical Procedures, Operative ; Thromboembolism ; Transplants*

BACKGROUND: Off-pump coronary artery bypass grafting (OPCAB) shows fewer side effects than cardiopulmonary bypass, and other benefits include myocardial protection, pulmonary and renal protection, coagulation, inflammation, and cognitive function. We analyzed the clinical results of our cases of OPCAB. MATERIAL AND METHOD: From May 1999 to August 2007, OPCAB was performed in 100 patients out of a total of 310 coronary artery bypass surgeries. There were 63 males and 37 females, from 29 to 82 years old, with a mean age of 62+/-10 years. The preoperative diagnoses were unstable angina in 77 cases, stable angina in 16, and acute myocardial infarction in 7. The associated diseases were hypertension in 48 cases, diabetes in 42, chronic renal failure in 10, carotid artery disease in 6, and chronic obstructive pulmonary disease in 5. The preoperative cardiac ejection fraction ranged from 26% to 74% (mean 56.7+/-11.6%). Preoperative angiograms showed three-vessel disease in 47 cases, two-vessel disease in 25, one-vessel disease in 24, and left main disease in 23. The internal thoracic artery was harvested by the pedicled technique through a median sternotomy in 97 cases. The radial artery and greater saphenous vein were harvested in 70 and 45 cases, respectively (endoscopic harvest in 53 and 41 cases, respectively). RESULT: The mean number of grafts was 2.7+/-1.2 per patient, with grafts sourced from the unilateral internal thoracic artery in 95 (95%) cases, the radial artery in 62, the greater saphenous vein in 39, and the bilateral internal thoracic artery in 2. Sequential anastomoses were performed in 46 cases. The anastomosed vessels were the left anterior descending artery in 97 cases, the obtuse marginal branch in 63, the diagonal branch in 53, the right coronary artery in 30, the intermediate branch in 11, the posterior descending artery in 9 and the posterior lateral branch in 3. The conversion to cardiopulmonary bypass occurred in 4 cases. Graft patency was checked before discharge by coronary angiography or multi-slice coronary CT angiography in 72 cases, with a patency rate of 92.9% (184/198). There was one case of mortality due to sepsis. Postoperative arrhythmias or myocardial infarctions were not observed. Postoperative complications were a cerebral stroke in 1 case and wound infection in 1. The mean time of respirator care was 20+/-35 hours and the mean duration of stay in the intensive care unit was 68+/-47 hours. The mean amounts of blood transfusion were 4.0+/-2.6 packs/patient. CONCLUSION: We found good clinical outcomes after OPCAB, and suggest that OPCAB could be used to expand the use of coronary artery bypass grafting.
Angina, Stable ; Angina, Unstable ; Angiography ; Arrhythmias, Cardiac ; Arteries ; Blood Transfusion ; Cardiopulmonary Bypass ; Carotid Artery Diseases ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Female ; Humans ; Hypertension ; Inflammation ; Intensive Care Units ; Kidney Failure, Chronic ; Male ; Mammary Arteries ; Myocardial Infarction ; Postoperative Complications ; Pulmonary Disease, Chronic Obstructive ; Radial Artery ; Saphenous Vein ; Sepsis ; Sternotomy ; Stroke ; Transplants ; Ventilators, Mechanical ; Wound Infection

From July 1994 to August 1995, 32 patients underwent coronary artery bypass surgery. There were 14 men and 18 women. The mean age was 59 years(range from 37 to 81 years). Preoperatively 26 patients had unstable angina pectoris and 6 patients had stable angina pectoris. Nine patients had previous myocardial infarction history. Five patients had preoperative left ventricular ejection fraction of 40% or less. The involved risk factors were as follows ; smoking 19 cases, hypertension 16 cases, hypercholesterolemia 14 cases, diabetes mellitus 6 cases, and obesity 3 cases. 21 patients had three-vessel disease, 7 patients had two-vessel disease, 2 patients had one-vessel disease and 2 patients had left main coronary artery disease. We performed 103 distal bypasses out of 32 cases, and the mean number of grafts per patients is 3.22. We used arterial grafts (left internal mammary artery ; 31, radial artery ; 2) in 32% of total grafts. Postoperative complications were low cardiac output, perioperative myocardial infarction, respiratory failure and atrial fibrillation, etc. Early mortality was 6.25% (2/32). The causes of deaths were low cardiac output (1), and perioperative myocardial infarction(1).
Angina, Stable ; Angina, Unstable ; Atrial Fibrillation ; Cardiac Output, Low ; Cause of Death ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Diabetes Mellitus ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Mammary Arteries ; Mortality ; Myocardial Infarction ; Obesity ; Postoperative Complications ; Radial Artery ; Respiratory Insufficiency ; Risk Factors ; Smoke ; Smoking ; Stroke Volume ; Transplants