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 analyze the hemodynamic changes during coronary artery bypass grafting with or without cardiopulmonary bypass.Methods Thirty patients undergone coronary artery bypass grafting from January to June,2006 were retrospectively analyzed.Among them,12 patients were operated on with cardiopulmonary bypass(CCABG)and 18 without cardiopulmonary bypass(OPCAB).The stabilizator(type Octops III)was used to fix target vessels in OPCAB group.In CCBAG group,the extracorporeal circulation was used routinely,and internal mammary artery and saphenous vein were used to anastomose with target branches of coronary artery.The hemodynamic changes at different time points during and after operation were monitored,and the relevant parameters were also recorded.Results The anaesthesia time,intraoperative blood loss and fluid input,and ventilating time after operation in CCABG group were significantly higher than those in OPCAB group,and the postoperative haematocrit(HCT)was significantly lower in CCABG group than that in OPCAB group(P

Objective To search for the factors which may be responsible to the increase in plasma homocysteine(Hcy)levels after surgery.Methods Blood samples were taken from 40 patients(20 patients with coronary artery bypass and the remainders with off-pump coronary artery bypass)1 day before operation and 1,3,5 and 7 day(s)after operation.Hcy,copper,ceruloplasmin,ferrei ion,folate,vitamin B12 and C-reactive protein(CRP)were then measured using clinical chemistry methods.Results The plasma concentrations of ceruloplasmin,copper and Hcy increased significantly at 3rd,4th and 6th day after operation respectively.The plasma concentrations of ferreous ion and vitamin B12 declined obviously at 3rd day after operation,and then increased slowly.In contrast,the plasma concentration of CRP increased significantly at 3rd day after operation,then decreased gradually to normal level.No significant changes were found in folate level before and after operation.Those findings mentioned above showed no significant difference between the two groups.Conclusions The increased plasma concentration of Hcy after operation may be caused by the internal metabolism of copper rather than by the coronary artery bypass.

Objective To investigate the morphological and functional changes in the heart of patients with giant left ventricle after valve surgery,and to explore the relationship between the morphology of left ventricle and its function.Methods 86 patients with severely dilated left ventricle underwent echocardiographic examination before and 7-14 days after operation.Left ventricle diameters were measured(LVEDD,LVESD)and matched to the body surface area(LVEDDI,LVESDI).Left ventricular ejection fraction(EF)and fractional shortening(FS)were calculated.Results Left ventricular dimensions significantly decreased 7-14 days after operation.LVEDD was 76.48?5.21mm before operation and 62.58?12.62mm after operation(P

Objective: The study was to analyze hemodynamic changes of blood flow of left internal mammary artery (LIMA) in off-pump coronary bypass surgery (OPCAB). Methods: From January 2002 to August 2002, a total of 65 patients received intraoperative hemodynamic assessment of their bypass grafts by transit-time flowmeter(TTFM) during OPCAB. All operations and flow measurements were performed by the same surgeon (GCQ). The mean age of patients was (64.3?0.94) years(range 47 to 75 years), There were 50 men and 15 women. One-vessel disease was in 7 patients, two-vessel disease in 26, three-vessel disease in 32, and left main stem disease (isolated or associated) in 22. Left anterior descending artery (LAD) was routinely bypassed with LIMA. The blood flow of LIMA was measured immediately after completion of the anastomosis to LAD (early phase) and before sternum closure (late phase) using transit-time flowmeter. Results: The mean flow significantly decreased from (29.91?3.32) ml/min in early phase to (25.12?2.56) ml/min, P

Objective: To discuss the values of serum S100 protein in evaluating the cerebral injuries during and after cardiopulmonary bypass (CPB). Methods: 40 patients (25 valve replacement, 13 simple congenital heart disease, 2 valve replacement plus CABG) were studied. Serum S100 protein was serially assessed at different time intervals and the patients' neuropyscological complications were recorded. Results: S100 was not detected before CPB, and it reached its peak level at the termination of CPB, then gradually decrease to the preoperative levels. Three patients with the highest level appeared neuropyscological mobidity. Conclusion: S100 protein has significant change during CPB, and may reflect both the severity of the cerebral injury and increased permeability of the blood brain barrier. Its level has very great significance in evaluating cerebral injuries.

0.05). Accordingly, statistics shows that the mean value of PI is 2.56?2.35. Conclusion: The referential range of PI for Chinese CABG patients is 2.56?2.35.

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.