1.Outcomes of coronary artery bypass grafting in patients under 45 years old with coronary artery disease combined insulin-treated diabetes mellitus
Yang LI ; Ran DONG ; Taoshuai LIU ; Kun HUA ; Jubing ZHENG ; Shaoyou ZHOU ; Ning ZHOU ; Zhuhui HUANG
Chinese Journal of Thoracic and Cardiovascular Surgery 2019;35(8):479-483
Objective To investigate the outcomes of coronary artery bypass grafting(CABG) in insulin-treated diabetes mellitus(DM) patients with coronary artery disease(CAD) (age≤45 years old),and analyze the risk factors of major adverse cardiac and cerebrovascular events(MACCE) by logistic regression.Methods Data on 239 CAD patients combined with DM aged ≤45 who underwent CABG in our hospital were collected retrospectively from October 2007 to October 2016.There were 216 males and 23 females,the mean age was (42.15 ±2.59) years old.The mean LVEF was 0.59 ±0.09.43 patients (18.0%) had left main stenosis,and the average diseased vessel number was 3.20 ± 0.76.Results One patients (0.4%)in-hospital died of heart failure.Patients received (3.12 ±0.81) bypass grafts overall,12 patients (5.0%) were total artery revascularization.3 patients (1.3%) needed reoperation for bleeding and the perioperative atrial fibrillation rate was occured in 23 patients (9.6%).The follow-up rate was 95% (226 cases),the median follow-up time was 5 years (1-9 years).8 patients (3.3%) died of all cause-mortality,and 183 patients (81.0%) were freedom from MACCE.The higher level of BMI、cholesterol and creatinine,LVEF ≤0.35,postoperative blood loss ≥ 1 000 ml and ventricular arrhythmia were the independent risk factors of MACCE.Conclusion CABG procedure in CAD patients under 45 years old accompanied DM is safety and reliable both in early and long-term outcomes.
2.Surgical efficacy of anterior or posterior ventricular septal rupture in patients with myocardial infarction
Yang ZHAO ; Wei FU ; Xiaolong MA ; Zhuhui HUANG ; Taoshuai LIU ; Ran DONG
Chinese Journal of Thoracic and Cardiovascular Surgery 2020;36(5):291-295
Objective:To explore the clinical characteristics and outcomes of patients with myocardial infarction(MI) accompanied by ventricular septal rupture(VSR) at anterior versus inferior septum.Methods:Sixty patients with MI and VSR who had been treated by surgery between January 2009 and December 2018 were selected for a retrospective study, and allocated into either anterior septal group(AS group, n=43) or inferior septal group(IS group, n=17) based on the VSR site. The primary outcomes included major adverse cardiovascular events(MACCEs), cardiac death, MI, heart failure(HF), stroke and revascularization, with a median follow-up of 4.94 years.Results:There were 8 cases died in the perioperation, including 6 patients in the AS group, 1 case for gastrointestinal bleeding after using the extracorporeal membrane lung, 2 cases for low cardiac output after the second thoracotomy exploration and 3 for postoperative pulmonary infection. While in the IS group 2 patients died, 1 for low cardiac output after the second thoracotomy exploration and 1 for postoperative heart failure. Compared with those in IS group, patients of AS group were more likely to be composed of male patients(44.2% vs 11.8%, P=0.019), with low left ventricular ejection fraction(0.47±0.09 vs 0.56±0.06, P=0.001), shorter interval from MI to operation[(52.9±35.3)days vs(79.6±65.1)days, P=0.045], shorter CPB time[(137.9±48.6)min vs(169.9±42.3)min, P=0.024], shorter cross-clamp time[(82.4±32.1)min vs(107.0±30.4)min, P=0.011], and lower postoperative LVEDD[(49.1±5.7)mm vs.(52.9±4.8)mm, P=0.029]. There was no difference in perioperative complications between the two groups(including in hospital death, HF, ventricular fibrillation, pericardial tamponade and secondary thoracotomy). Additionally, long-term follow-up showes that there was also no difference in MACCEs, death, MI, HF, stroke and revascularization between the two groups( P>0.05). Conclusion:The perioperative risk and outcomes of surgery for MI patients with AS or IS are similar.
3.Study of quantitative flow ratio-guided surgical coronary artery revascularization strategy
Cong CHEN ; Yang ZHAO ; Kui ZHANG ; Pengyun YAN ; Haiming DANG ; Taoshuai LIU ; Yue SONG ; Jubing ZHENG ; Yang LI ; Lisong WU ; Jian CAO ; Ran DONG
Chinese Journal of Thoracic and Cardiovascular Surgery 2022;38(5):272-276
Objective:To explore the feasibility of applying quantitative flow ratio(QFR) to assess the degree of coronary artery functional stenosis before surgery, and to guide coronary artery bypass grafting(CABG) revascularization strategy.Methods:The study prospectively included a total of 154 patients who were electively treated with CABG in the 11th ward of the Department of Cardiac Surgery of Beijing Anzhen Hospital from January 2019 to September 2020, and their coronary angiography visually showed stenosis of the coronary artery to perform QFR analysis to know the diseased blood vessels. For functional stenosis, the surgeon was blinded to the results of QFR analysis before surgery. Collect its baseline data, perioperative data and recent clinical outcomes for summary analysis.Results:One year later, the coronary artery CTA showed that the occlusion rate of functionally significant disease(QFR<0.8) was 5.5%, and that of non-functionally significant disease(QFR≥0.8) was 15.6%. There was no difference in angina class or repeat interventions between patients with or without occluded bypass grafts.Conclusion:According to QFR analysis, coronary arteries with functional non-significant disease have a higher risk of grafts failure than those with functionally significant disease. For coronary arteries with negative QFR lesions, the risk of occlusion of arterial grafts is higher than that of venous. However, this finding is not significantly related to clinical prognosis, because patients with patency or occlusion of the grafts in non-significant lesions have not found excessive angina pectoris or repeated coronary interventions. QFR-guided selection of coronary surgery strategies is safe and feasible.
4.Surgical treatment and prognosis of myocardial infarction complicated with ventricular septal perforation
Taoshuai LIU ; Weiye LIU ; Zhuhui HUANG ; Yang ZHAO ; Jubing ZHENG ; Ran DONG
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2021;28(09):1061-1065
Objective To investigate the surgical methods and efficacy of myocardial infarction combined with ventricular septal perforation. Methods The clinical data of 60 patients with myocardial infarction combined with ventricular septal perforation admitted to the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, from 2009 to 2018 were retrospectively analyzed. There were 39 males and 21 females, aged 63.3±8.3 years. Results Among the 60 patients, 43 (71.7%) patients were perforated in the apex, 11 (18.3%) in the posterior septum and 6 (10.0%) in the anterior septum. There were 24 (40.0%) patients of single coronary artery disease. Fourteen (23.3%) patients received intra-aortic balloon counterpulsation before surgery. The waiting time from ventricular septal perforation to surgery was 48.3 (3-217) d. All patients underwent ventricular septal perforation repair, among whom 53 (88.3%) patients received ventricular aneurysm closure or resection, and 49 (81.7%) patients received coronary artery bypass graft with an average of 2 distal anastomoses during the same period. Perioperative complications in the hospital included 8 (13.3%) deaths, 8 (13.3%) heart failure, 5 (8.3%) ventricular fibrillation, 3 (5.0%) pericardial tamponade, and 11 (18.3%) secondary thoracotomy and 11 (18.3%) residual shunt. Except for 8 patients who died in the hospital, the other 52 cured and discharged patients were followed up. The median follow-up time was 4.9 years. The 2-year and 5-year survival rate of the patients was 95.8%, and the 8-year survival rate was 89.0%. Major adverse cardiovascular events incidence was 19.2%, including 3 (5.8%) deaths, 5 (9.6%) heart failure, 2 (3.8%) myocardial infarction, and 4 (7.7%) cerebrovascular events. Conclusion For patients with ventricular septal perforation after myocardial infarction, surgery is an effective treatment method. Although the perioperative mortality rate is high, satisfactory long-term results can be achieved by carefully choosing the operation timing and methods.
5.Outcomes of coronary artery bypass grafting inpatients under 45 years with acute myocardial infarction
LI Yang ; DONG Ran ; LIU Taoshuai ; ZHENG Jubing ; ZHOU Ning ; ZHOU Shaoyou ; HUANG Zhuhui ; ZHAO Yang ; ZHANG Kui
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2019;26(11):1107-1112
Objective To investigate the early and long-outcomes of coronary artery bypass grafting(CABG) in acute myocardial infarction (AMI) patients with coronary artery disease(CAD)(age≤45 years). Methods Data of 596 adult CAD patients (include AMI and Angina) who underwent CABG in our hospital were collected retrospectively from May 2010 to October 2018. In an AMI group, 234 were male patients with an average age of 41.59±3.79 years; 26 were female patients with an average age of 41.64±3.03 years. In an angina group, 280 were male patients with an average age of 42.19±2.90 years; 56 were female patients with an average age of 41.54±3.52 years. Preoperative baseline variables, perioperative mortality, major adverse cardiac and cerebrovascular events (MACCE) were compared between two group. Results There was no significant difference in all preoperative variables. Seven patients were died and the hospital mortality rate was 1.23% (1.54% vs. 0.89%, P=0.477). The complications including reoperation for bleeding, cerebral infarction, renal failure and atrial fibrillation arrhythmia were without significant difference between two group (P>0.05). The intensive care unit stay duration (30.66±27.46 h vs. 23.96±15.11 h), intubation duration (22.54±22.31 h vs. 18.64±11.81 h) and hospitalization costs (97 186±33 741¥ vs. 90 081±24 537¥, P=0.003) were greater in the AMI group. The hospital mortality rate and complications rate were without significant difference between STEMI (ST segment elevated myocardial infarction) and NSTEMI (non-ST-segment elevated myocardial infarction) subgroups (P>0.05). The follow-up rate was 92.6% (546 patients) and the follow-up time was 4 (0.5 to 8.5) years. All cause-mortality rate was 3.85%(21 patients), and freedom MACCE was 72.2%. The freedom from MACCE, recurred angina and cerebral infarction were without significant difference, but AMI was associated with higher rate of PCI procedure. Conclusion CABG procedure in CAD patients under 45 years accompanied AMI is safety and reliable both in early and the long-term outcomes.