Coronary Artery Bypass, Off-Pump ; methods ; Coronary Artery Disease ; surgery ; Humans ; Male ; Middle Aged ; Saphenous Vein ; transplantation

Aged ; Coronary Artery Bypass, Off-Pump ; methods ; Coronary Artery Disease ; surgery ; Female ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo analyze retrospectively 1018 patients who underwent coronary artery bypass grafting surgery (CABG) in order to summarize surgical techniques and clinical outcome.

METHODSFrom 1997 through 2004, data of same surgeon for 508 patients who underwent conventional coronary artery bypass surgery on pump (CCABG) and 510 patients who underwent off-pump CABG (OPCAB) were collected and analyzed retrospectively. Eight hundred and fifty-two patients had unstable angina, 582 patients were over 60 years old (57.2%) and 784 patients had concomitant diseases including valve lesion, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect, stroke, chronic obstructive pulmonary diseases, renal failure and cancer. A hundred and fifty-six patients had left main stem (LIMS) stenosis and 671 patients, triple-vessel disease.

RESULTSTotal mortality was 0.39% (4-case death) and morbidity, 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 use was 93.8% of the patients, 29 patients were implanted intra-aortic balloon pump intraoperatively. Follow-up was 4 months to 7 years.

CONCLUSIONSScientific surgical strategies, excellent surgical techniques and improvement of cardiac anesthesia and cardiopulmonary bypass make the mortality and morbidity decrease significantly, CABG surgery is safe and effective in patients with coronary artery disease.

Aged ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; methods ; mortality ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; mortality ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate myocardial protection and prognosis of the different operative procedures of coronary artery bypass grafting (CABG) for the senile patients with coronary artery disease.

METHODSFrom July 2008 to June 2009, 125 cases (age ≥ 65 years old) underwent CABG were divided into 3 groups.Group A (70 cases) undertook off-pump CABG, group B (33 cases) undertook on-pump beating heart CABG. group C (22 cases) undertook on-pump CABG with cardiac arrest. Serum level of cardiac troponin I (cTnI) and creatine kinase MB isoenzyme (CK-MB) activity were examined right before operation and 0, 24, 72 and 168 h after operation. The complications during perioperative period and the mortality were investigated.

RESULTSNo significant difference was found in the right before operation and 168 h after operation of the serum level of cTnI and CK-MB in the 3 groups (P > 0.05). The serum level of cTnI and CK-MB activity of group A was the lowest and group B was lower than group C. Group A was the best concerning the complications during perioperative period. The mortality of group A was lower than group B but no significant difference was found in the mortality between group A and C. No significant difference was found in the complications during perioperative period and the mortality between group B and C.

CONCLUSIONOff-pump CABG could reduce myocardial injury and the complications during perioperative period in the senile patients.

Aged ; Aged, 80 and over ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; methods ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; surgery ; Female ; Humans ; Male ; Prognosis

OBJECTIVETo retrospectively analyze the experiences, indications, technique, and results of coronary artery bypass grafting (CABG) in patients over 70 years old.

METHODSNinety-one patients received coronary artery bypass grafting from March 2004 to March 2008. Ages ranged from 70 to 83 years old, 22 patients over 75 years old. Conventional CABG (CCABG) in 72 patients, off-pump CABG (OPCAB) in 19 patients. Clinical data has no significant differences in two groups. The rate of using left internal mammary artery was 96.7%. The number of grafts in CCABG and OPCAB group were 2 to 5 (3.5 +/- 0.8) and 1 to 4 (2.9 +/- 0.7) respectively.

RESULTSIn-hospital death in 2 cases, both were from chronic obstructive pulmonary disease and pulmonary infection. Cerebral infarction in 1 case and pulmonary infection in 2 cases in CCABG group, but no significant difference between two groups, and no difference in intubation, ICU stay, respiratory failure, renal function failure. But number of grafts in CCABG was significantly more than that in OPCAB (P < 0.01). Postoperative follow-up was 3 to 36 months, 1 case with recurrent angina in OPCAB.

CONCLUSIONSAccording to the characteristic of coronary artery disease in elderly, fully revascularization and improving myocardial blood supply, patients over 70 years old with CABG can obtain the same efficacy as younger patients. There were not significant difference between CCABG and OPCAB.

Aged ; Aged, 80 and over ; Coronary Artery Bypass ; methods ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; surgery ; Female ; Humans ; Male ; Retrospective Studies ; Treatment Outcome

BACKGROUNDRight ventricular function plays an important role in the hemodynamic derangement during off-pump coronary artery bypass (OPCAB) surgery. Pressure-volume loops have been shown to provide load-independent information of cardiac function. Therefore, the aim of this study was to investigate the feasibility of construction of right ventricular pressure-volume loops with pressure and volume data measured by a volumetric pulmonary artery catheter (PAC) and to evaluate right ventricular systolic and diastolic function by end-systolic elastance (E(ES)) and end-diastolic stiffness (E(ED)) in OPCAB surgery.

METHODSTwenty-eight patients who underwent OPCAB surgery were included. After anesthesia induction, a volumetric PAC was placed via the right internal jugular vein. Data were recorded at: anesthesia steady-state before skin incision (T1); 5 minutes after the stabilizer device was placed for anastomosis on the heart's anterior wall (T2), lateral wall (T3), posterior wall (T4), respectively; after sternal closure (T5). Three sets of data were collected at each time point: first, hemodynamic variables were measured; second, right ventricular E(ES) and E(ED) were calculated; third, right ventricular pressure-volume loops were constructed with pressure and volume data measured from end-diastole point, end-isovolumic systole point, peak-ejection point, end-systole point and end-isovolumic diastole point.

RESULTSRight ventricular pressure-volume loops generally shifted to the left during OPCAB surgery. Especially, the end-diastolic point shifted upward and to the left at T2-T5 compared with that at T1. Decrease in right ventricular ejection fraction, stroke volume index and end-diastolic volume index occurred (P < 0.05) at T4 compared with values at T1. Pulmonary vascular resistance index at T4 increased relatively compared with that at T2 and T3. The change of E(ES) was not statistically significant during operation. Right atrial pressure increased only during coronary anastomoses (T2-T4, P < 0.05), whereas E(ED) increased throughout OPCAB surgery (P < 0.05).

CONCLUSIONSRight ventricular pressure-volume loops can be constructed using a volumetric PAC. Right ventricular systolic dysfunction occurred during anastomoses on the heart's posterior wall not due to impaired myocardial contractility but as a result of reduced preload and a relative increase in afterload. Right ventricular diastolic function was impaired throughout OPCAB surgery.

Aged ; Blood Pressure ; Coronary Artery Bypass, Off-Pump ; methods ; Female ; Hemodynamics ; Humans ; Male ; Middle Aged ; Ventricular Function, Right ; physiology

OBJECTIVETo summarize the experience of minimally invasive robotic coronary bypass on beating heart using da Vinci S in China.

METHODSFifty-six patients underwent selected robotic coronary bypass on beating heart from April 2007 to December 2008. All the patients had history of angina and the coronary arteriography showed severe stenosis in the left anterior descending artery (LAD), of which 10 cases had right coronary artery or left circumflex coronary (LCX) stenosis. The age was 33 to 74 years old, with a mean of (55.8 +/- 9.4) years old. The weight was (71.4 +/- 13.2) kg. All the patients had good lung function and had no medical history of pleurisy and thoracic surgery. CT scan of double internal thoracic artery (ITA) was routinely checked preoperatively. The procedures included: (1) The robotically assisted endoscopic atraumatic coronary artery bypass surgery. The approach was via a small left anterior thoracotomy (6 to 8 cm) after robotic ITA was taken down. The ITA was manually anastomosed to the LAD or LCX on beating heart. (2) Totally endoscopic coronary bypass graft on beating heart. After ITA harvesting, the endo stabilizer was inserted via the fourth port in the xiphoid area under endoscopic vision. The left ITA to the LAD grafting was done using U-clips on beating heart in a totally endoscopic manner using da Vinci S system through 4 ports. For all patients the ITA flow was checked by the Doppler flowmeter after anastomosis was completed. After the surgery was completed, the thoracic port was checked carefully to avoid bleeding. The operating procedures and a variety of clinical parameters were recorded and analyzed. (3) Stent placement after robotic surgery in a hybrid manner. The graft patency rate was evaluated by CT or arteriography.

RESULTSAll patients successfully accepted robotic minimally invasive coronary bypass on the beating heart using da Vinci S surgical system without complications. The mean graft flow was (23.2 +/- 16.7) ml/min. And there was no surgical conversion and surgical death. Fifty-three patients received ITA to LAD grafts and 3 patients received double coronary artery bypass grafts as well. Ten cases received stent placement in separate session. The CT scan and angiography revealed patent grafts in all patients. There were no post-operative complications. All patients were discharged from hospital.

CONCLUSIONSAs a new advanced approach of revascularization, robotic ITA harvesting and coronary anastomoses can be safely performed with the da Vinci S system. The procedure is minimally invasive and can offer enhanced ability to control precise and stable operative manipulations.

Adult ; Aged ; Coronary Artery Bypass, Off-Pump ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Robotics

OBJECTIVESTo analyze the safety and efficiency of robotically assisted coronary artery bypass grafting (RACABG) on beating heart using da Vinci S system.

METHODSFrom January 2007 to March 2011, 105 patients underwent RACABG on beating heart through minithoracotomy. There were 77 male and 28 female patients, aged from 33 to 77 years with a mean of (59 ± 10) years. After establishment of single left lung ventilation, the 3 trocars of da Vinci system were inserted into the left hemithorax, and robotic system was used to harvest the left internal mammary artery (LIMA) and/or right internal mammary artery (RIMA) from the subclavian vein to the internal mammary artery (IMA) bifurcation with skeletonized technique. After positioning the stabilizer, the LIMA was anastomosed manually to the left anterior descending or diagonal branch sequentially on beating heart through left minithoracotomy. The graft flow was evaluated by the Doppler flow meter after anastomosis was completed, and the graft patency was also evaluated by CT angiography or arteriography after surgery.

RESULTSAll patients had successful RACABG on the beating heart, and the mean graft flow was (21 ± 13) ml/min. One patient suffered from cardiac arrest after the first postoperative day, but he recovered soon and CT angiography showed that graft was patent. One patient with preoperative stroke had postoperative pulmonary infection, and was discharged after treatment. After 4 to 5 days, 4 patients received stent placement in right coronary artery or circumflex coronary in distinct hybrid session. There were no deaths or stroke or reintervention. All patients were discharged without complications and followed up. CTA or angiography revealed patent grafts in all patients, and the mean time of follow-up was (30 ± 12) months.

CONCLUSIONSRobotically assisted coronary artery bypass grafting on beating heart can be performed safely using da Vinci S system. It is a new advanced approach of revascularization not only for patients with single vessel but with multi-vessel lesions as well.

Adult ; Aged ; Coronary Artery Bypass, Off-Pump ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Robotics ; Treatment Outcome

Aged ; Balloon Valvuloplasty ; methods ; Coronary Artery Bypass, Off-Pump ; methods ; Coronary Artery Disease ; surgery ; Humans ; Male ; Middle Aged ; Pulmonary Valve Stenosis ; surgery

OBJECTIVETo evaluate the early and medium-term curative effect of water sac blocking used in the proximal anastomosis during off-pump coronary artery bypass (OPCAB) in the patients with serious calcified ascending aorta.

METHODSThirty-one patients with serious calcified ascending aorta who underwent OPCAB were enrolled in this study from January 2005 to May 2009 as experimental group in which the water sac blocking was used in the proximal anastomosis during OPCAB. There were 23 male and 8 female patients with the age of (69±8) years. Sixty-three patients without calcified ascending aorta who underwent OPCAB at the corresponding period were selected randomly as control group in which lateral-mural clamp on ascending aorta was used in the proximal anastomosis during OPCAB. There were 39 male and 24 female patients with the age of (60±9) years. Preoperative and postoperative heart functional indexes were compared in 3 months and the short and the mid-term outcomes were followed up.

RESULTSNo deaths happened in the two groups. Postoperative incidence rate of cerebral stroke in control group was relatively higher than experimental group, but there was no significant difference between the two groups (P<0.05). All the patients had no symptoms 3 months after operation. Heart function and ejection fraction were increased significantly (P<0.05), meanwhile left ventricular end-diastolic diameter were decreased notably (P<0.05). The follow-up rate was 91.5% and the survival rate was 96.0% and left ventricular function decreased slightly (P<0.05) up to the end of November 2009. Seven patients more than two years after operation received coronary angiography which showed proximal anastomotic stoma was patent.

CONCLUSIONFor patients with serious calcified ascending aorta, the short and medium-term result of water sac blocking used in proximal anastomosis was simple, effective and safe.

Aged ; Anastomosis, Surgical ; methods ; Aorta ; surgery ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome