OBJECTIVETo evaluate the efficacy of one-stop hybrid coronary revascularization [simultaneous minimally invasive direct coronary artery bypass surgery (MIDCAB) and percutaneous coronary intervention (PCI) procedures performed in an enhanced (or called "hybrid") operative unit] for the treatment of unprotected left main coronary artery (ULMCA) disease.

METHODSFrom June 2007 to April 2009, 14 patients [13 male, mean age: (60.4 +/- 15.4) years] underwent the one-stop hybrid approach in the "hybrid" operating room. Proximal lesions were evidenced in 5 patients and distal or bifurcation lesions in 11 patients. MIDCAB procedure for grafting of the left intramammary artery (LIMA) with the left anterior descending (LAD) artery was first performed via lower partial ministernotomy on the beating heart, followed by PCI on the LMCA disease and non-LAD coronary lesions.

RESULTSOperation was successful in all patients underwent the one-stop hybrid procedure. LIMA grafts were used in all 14 patients and confirmed to be patent by angiography. A total of 25 non-LAD coronary lesions were treated by PCI and 29 stents (27 drug-eluting stents and 2 bare-mental stents) were implanted to 23 lesions and coronary angioplasty was performed in the remaining lesions. There was no death, perioperative myocardial infarction, stroke or repeat revascularization during the procedure and the follow-up period. All the patients remained free from angina during the 7.9 months (range 1 - 15 months) follow-up period. LIMA grafts and stents were patent in 5 patients at 1-year follow-up.

CONCLUSIONSOur initial experience demonstrates that one-stop hybrid coronary revascularization provides a reasonable, feasible and safe alternative for selected patients with LMCA diseases.

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; therapy ; Female ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; methods ; Treatment Outcome

BACKGROUND: Periprocedural treatment with high-dose statins is known to have cardioprotective and pleiotropic effects, such as anti-thrombotic and anti-inflammatory actions. We aimed to assess the efficacy of high-dose rosuvastatin loading in patients with stable angina undergoing off-pump coronary artery bypass grafting (OPCAB). MATERIALS AND METHODS: A total of 142 patients with stable angina who were scheduled to undergo surgical myocardial revascularization were randomized to receive either pre-treatment with 60-mg rosuvastatin (rosuvastatin group, n=71) or no pre-treatment (control group, n=71) before OPCAB. The primary endpoint was the 30-day incidence of major adverse cardiac events (MACEs). The secondary endpoint was the change in the degree of myocardial ischemia as evaluated with creatine kinase-myocardial band (CK-MB) and troponin T (TnT). RESULTS: There were no significant intergroup differences in preoperative risk factors or operative strategy. MACEs within 30 days after OPCAB occurred in one patient (1.4%) in the rosuvastatin group and four patients (5.6%) in the control group, respectively (p=0.37). Preoperative CK-MB and TnT were not different between the groups. After OPCAB, the mean maximum CK-MB was significantly higher in the control group (rosuvastatin group 10.7+/-9.75 ng/mL, control group 14.6+/-12.9 ng/mL, p=0.04). Furthermore, the mean levels of maximum TnT were significantly higher in the control group (rosuvastatin group 0.18+/-0.16 ng/mL, control group 0.39+/-0.70 ng/mL, p=0.02). CONCLUSION: Our findings suggest that high-dose rosuvastatin loading before OPCAB surgery did not result in a significant reduction of 30-day MACEs. However, high-dose rosuvastatin reduced myocardial ischemia after OPCAB.
Angina, Stable ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Creatine ; Fluorobenzenes ; Humans ; Incidence ; Myocardial Ischemia ; Myocardial Revascularization ; Pyrimidines ; Risk Factors ; Sulfonamides ; Transplants ; Trinitrotoluene ; Troponin T ; Rosuvastatin Calcium

BACKGROUND: This study was aimed to assess improvement in myocardial perfusion after TMR by measuring regional myocardial blood flow(RMBF) in porcine model of chronic myocardial ischemia. MATERIAL AND METHOD: Ameroid ring was placed around the proximal left circumflex coronary artery in fourteen pigs. After 4 weeks, the control group(7 pigs) underwent rethoracotomy only, and the TMR group(7 pigs) underwent Ho:YAG laser TMR at the circumflex territory. After another 4 weeks, the animals were sacrificed for the measurement of RMBF using colored microspheres. The ratio of RMBF between the circumflex territory and the interventricular septum was calculated and compared. RESULT: At 4 weeks after ameroid constriction, RMBF of the circumflex territory decreased to 46~89% of RMBF of the interventricular septum. In five of six animals in the TMR group, RMBF of the circumflex territory at 8 weeks after ameroid constriction was higher compared with RMBF at 4 weeks after ameroid constriction. However, the improvement was statistically significant only in two animals. In three of the four animals in the control group, RMBF of the circumflex territory also increased at 8 weeks compared with RMBF at 4 weeks. The degree of increase in RMBF was not different between the control and the TMR groups. CONCLUSION: In porcine model of chronic myocardial ischemia, the degree of increase in RMBF of the ischemic area after Ho:YAG TMR was not different from the increase by development of native collateral circulation. Perfusion of ischemic myocardium after TMR is not thought to improve to the degree that can be demonstrated by currently available method of assessment such as radioisotope myocardial scintigraphy.
Animals ; Collateral Circulation ; Constriction ; Coronary Artery Disease ; Coronary Vessels ; Laser Therapy ; Microspheres ; Myocardial Ischemia* ; Myocardial Perfusion Imaging ; Myocardial Revascularization ; Myocardium ; Perfusion ; Swine ; Transmyocardial Laser Revascularization*

Transmycardial laser revascularization has made its position as a sole therapy for patients with chronic angina nonamenable to maximal medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass grafting. We report three cases of transmyocardial laser revascularization as a sole therapy for patients with recurrent angina after CABG.
Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Humans ; Transmyocardial Laser Revascularization

The management of patients with ischemic heart disease is rapidly evolving. During the past several years, refinement of techniques related to mechanical revascularization (ie, percutaneous coronary intervention and coronary artery bypass grafting) for ischemic heart disease have resulted in improved patient outcomes and, subsequently, an increase in the number of patients undergoing therapeutic coronary artery interventions. Despite advances in cardiopulmonary bypass and myocardial protection, postoperative adverse events after coronary artery bypass grafting (CABG) are mostly related to the use of cardiopulmonary bypass, global cardiac arrest, and hypothermia. Through the recent development of effective devices for target vessel exposure and stabilization, off-pump coronary artery bypass grafting (OPCAB) has gained widespread use as an alternative technique and is now challenging conventional on-pump CABG as the standard for surgical therapy in multivessel disease. Use of the left internal thoracic artery (ITA) for the left anterior descending coronary artery with supplemental saphenous vein grafts has been the standard CABG. Development of a lower saphenous vein graft patency rate compared with that of ITA has encouraged surgeons to examine CABG with total arterial grafts to improve the long-term outcome of myocardial revascularization. Total arterial revascularisation offers further advantages over conventional CABG. The use of in situ or composite bilateral ITA grafts eliminates the need to manipulate on the aorta, which is a major cause of stroke after CABG. Total arterial revascularisation is compatible with, and may indeed facilitate, the rapidly increasing techniques of OPCAB. These recent advances in the field of CABG have resulted in improved patient outcome and improved long-term myocardial revascularization outcome.
Aorta ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Heart Arrest ; Humans ; Hypothermia ; Mammary Arteries ; Myocardial Ischemia* ; Myocardial Revascularization ; Percutaneous Coronary Intervention ; Saphenous Vein ; Stroke ; Transplants

The management of patients with ischemic heart disease is rapidly evolving. During the past several years, refinement of techniques related to mechanical revascularization (ie, percutaneous coronary intervention and coronary artery bypass grafting) for ischemic heart disease have resulted in improved patient outcomes and, subsequently, an increase in the number of patients undergoing therapeutic coronary artery interventions. Despite advances in cardiopulmonary bypass and myocardial protection, postoperative adverse events after coronary artery bypass grafting (CABG) are mostly related to the use of cardiopulmonary bypass, global cardiac arrest, and hypothermia. Through the recent development of effective devices for target vessel exposure and stabilization, off-pump coronary artery bypass grafting (OPCAB) has gained widespread use as an alternative technique and is now challenging conventional on-pump CABG as the standard for surgical therapy in multivessel disease. Use of the left internal thoracic artery (ITA) for the left anterior descending coronary artery with supplemental saphenous vein grafts has been the standard CABG. Development of a lower saphenous vein graft patency rate compared with that of ITA has encouraged surgeons to examine CABG with total arterial grafts to improve the long-term outcome of myocardial revascularization. Total arterial revascularisation offers further advantages over conventional CABG. The use of in situ or composite bilateral ITA grafts eliminates the need to manipulate on the aorta, which is a major cause of stroke after CABG. Total arterial revascularisation is compatible with, and may indeed facilitate, the rapidly increasing techniques of OPCAB. These recent advances in the field of CABG have resulted in improved patient outcome and improved long-term myocardial revascularization outcome.
Aorta ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels ; Heart Arrest ; Humans ; Hypothermia ; Mammary Arteries ; Myocardial Ischemia* ; Myocardial Revascularization ; Percutaneous Coronary Intervention ; Saphenous Vein ; Stroke ; Transplants

BACKGROUND: The aim of the current study was to assess the effects of total arterial myocardial revascularization (TAMR) with bilateral internal mammary arteries. MATERIAL AND METHOD: 139 consecutive patients who underwent off pump coronary artery bypass surgery from January 2000 to December 2001 were included in the current retrospective study. Patients were divided into those receiving bilateral internal mammary artery, BITA (n=85) and those receiving single internal mammary artery, SITA (n=54). RESULT: There was only one death in each group. No significant differences were noted in the total ICU and hospital stay; 2.4+/-1.7 and 11.2+/-17.7 days, in the BITA group, respectively and 2.8+/-2.7 and 9.7+/-7.1 days in the SITA group, respectively (P>0.05). The mean number of distal anastomosis of 3.9+/-0.7 was slightly higher in the BITA group compared to the SITA group, which was 3.1+/-0.8. Myocardial infarction occurred in 7 patients (BITA group: 2, SITA group: 5) and deep sternal infection necessitating reoperation occurred in 4 patients (BITA group: 3, SITA group: 1). Coronary angiogram was performed in the immediate postoperative period in 104 patients (BITA group: 64/85, SITA group: 40/54). Of these patients, stenosis in the LAD anastomosis site occurred in 4 patients (BITA group: 2, SITA group: 2). A total of 8 anastomotic sites were stenotic in the entire series of which percutaneous intervention was performed in 3 patients and none required reoperative coronary artery bypass. CONCLUSION: The results of the current data did not show a significant difference in patency rate with bilateral internal mammary artery use for CABG supporting the feasibility of its use as a viable alternative method for TAMR.
Constriction, Pathologic ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump* ; Humans ; Length of Stay ; Mammary Arteries* ; Myocardial Infarction ; Myocardial Revascularization ; Postoperative Period ; Reoperation ; Retrospective Studies ; Skeleton* ; Surgical Procedures, Minimally Invasive ; Transplants*

OBJECTIVETo approach the long term safety and efficacy of transmyocardial laser revascularization (TMLR, holmium: YAG) combined with off-pump coronary artery bypass (OPCAB) compared with OPCAB alone in patients with ischemic cardiac disease.

METHODSBetween 1999 and 2005, 80 patients with diffusely diseased target vessels from two centers in Beijing were enrolled to the study and randomized to receive either TMLR/OPCAB (n = 40) or OPCAB (n = 40) operation. Baseline demographics and operative characteristics were similar between groups. Follow-up (mean 3.4 +/- 1.7 years) included CCS angina class and NYHA classification assessments, 6 minutes walking test (6MWT) and echocardiography.

RESULTSPerioperative mortality was 5% in both groups. No death occurred during follow up. At the end of follow-up, patients at both groups experienced significant improvement on angina score compared with baseline, and angina score was also significantly lower (1.21 +/- 0.42 vs. 1.57 +/- 0.87, P = 0.03) and 6MWT-distance significantly increased (518.0 +/- 65.5 m vs. 473.8 +/- 65.8m, P = 0.006) in OPCAB/TMLR group than that in the OPCAB group. Fewer patients developed recurrent severe angina and received re-CABG/PCI in OPCAB/TMLR group than that in the OPCAB (1 vs. 6 cases, P = 0.113). NYHA and LVEF were similar between the groups at the end of follow up.

CONCLUSIONOur study showed that the addition of TMLR to OPCAB is superior in improving angina and exercise tolerance, but there is no further improvement in cardiac function compared to OPCAB alone.

Aged ; Angioplasty, Laser ; Combined Modality Therapy ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; methods ; Prospective Studies ; Retrospective Studies

The isolated coronary ostial stenosis is a lesion of the aortic wall that encroaches on the orifice of the left main coronary artery, atherosclerosis is belived to be a common cause and premenopausal female patients are most commonly affected. Stenosis of the left coronary ostium is a critical lesion which requires urgent myocardial revascularization including a surgical intervention because this lesion jeopardizes such a large volume of left ventricular myocardium. We report the case of a patient in whom percutaneous transluminal coronary angioplasty (PTCA) was performed successfully for the stenotic lesion of distal anastomotic site after surgical ostioplasty with autologous pericardium.
Angioplasty, Balloon, Coronary ; Atherosclerosis ; Constriction, Pathologic* ; Coronary Vessels ; Female ; Humans ; Myocardial Revascularization ; Myocardium ; Pericardium*

OBJECTIVETo discuss the choice of surgical methods and the safety and efficacy of off-pump coronary artery bypass grafting (OPCAB) in elderly patients.

METHODSFrom Sept. 1997 to Feb. 2003, 63 cases over the age of seventy (including seventy) undertook OPCAB in our department. We compared the clinical data of those patients with that of 94 cases undertook conventional coronary artery bypass grafting (CABG) at the same age group and that of 58 cases younger than seventy received OPCAB.

RESULTSThe clinical outcomes of OPCAB is better than that of CABG in elderly patients concerning inotropic drug, postoperative transfusion, re-operation, intubation time, complications incidence and in-hospital mortality. Furthermore, there is no significant difference of complication incidence and in-hospital mortality between the elderly OPCAB group and the younger OPCAB group.

CONCLUSIONSOPCAB is a safe and efficacious method of myocardial revascularization in the elderly.

Aged ; Aged, 80 and over ; Blood Transfusion ; statistics & numerical data ; Cardiotonic Agents ; administration & dosage ; Coronary Artery Bypass, Off-Pump ; mortality ; standards ; Hospital Mortality ; Humans ; Myocardial Revascularization ; Postoperative Complications ; epidemiology ; Retrospective Studies