Objective To evaluate the guiding role of CYP2C19 gene assay in dual antiplatelet therapy(DAPT) after off-pump coronary artery bypass grafting ( OPCABG ) .Methods The patients who received scheduled OPCABG between May 2017 and May 2018 were recruited in this study.According to the results of CYP2C19 gene assay, the patients who carried CYP2C19 gene *2/*2,*2/*3 and*3/*3 mainly causing slow metabolism of clopidogrel were randomly divided into two groups: the clopidogrel group(patients receiving 100mg/qd aspirin plus 75mg/qd clopidogrel after surgery ), the ticagrelor group(patients receiving 100mg/qd aspirin plus 90mg/bid ticagrelor after surgery).Patients in the two groups underwent plate-let aggregation rate test first day before surgery and the 1, 4, 7 days antiplatelet therapy after surgery.And the major adverse cardiac events(MACE) was investigated 30 days after surgery in the two groups.Results A total of 244 patients were recrui-ted in the study with the clopidogrel group(n=122) and the ticagrelor group(n=122).The platelet aggregation rate after one day of postoperative DAPT in the ticagrelor group was lower than that in the clopidogrel group[(28.5 ±9.7)％ VS(51.8 ± 16.8)％, P<0.05].After 4 days of postoperative DAPT, platelet aggregation rate in the ticagrelor group maintained a stable and desired level.The MACE 30 days after surgery in the clopidogrel group and the ticagrelor group were 3.3％ and 1.6％ re-spectively, and ticagrelor plus aspirin reduced MACE in patients undergone coronary endarterectomy , P=0.043.Conclusion According to the results of CYP2C19 gene assay, ticagrelor replacing clopidogrel could shorten the duration of desired platelet aggregation rate in patients with DAPT after OPCABG , and may be reduce the risk of MACE after OPCABG and coronary end-arterectomy.

Objective To evaluate the efficacy and clinical significance of medical chemical glue as an external stent in improving the fluency rate of venous bypass graft after coronary artery bypass grafting .Methods Randomly selected 200 pa-tients from April 2010 to December 2016 included who were underwent coronary artery bypass grafting in Beijing Anzhen Hospi-tal.All patients had different degrees of angina , and coronary angiography showed multi-branches artery lesion.They were ran-domly divided into two groups, 100 in each group.Spray gel group: coronary artery bypass grafting simultaneously spraying medical chemical glue on the surface of the bridge vessel.Unsprayed gel group:simple coronary artery bypass grafting.All 200 patients were followed up in June 2018.The follow-up content mainly included: recent recurrence of angina pectoris, recent echocardiography and electrocardiogram report, coronary CTA or coronary angiography results, and current living conditions. The data obtained were collectively summarized and compared .Results The follow-up rate was 96％ in the sprayed group, and 92％ in the unsprayed group.Compared with the unsprayed group , the incidence of chest pain and angina pectoris was significantly lower in the sprayed group(23.96％ vs.40.22％, P<0.05), the venous occlusion rate of the vein bypass graft in the sprayed group was significantly lower(29.17％ vs.55.43％, P<0.01), the probability of death due to cardiac causes in the sprayed group was significant decrease(1.04％ vs.6.52％, P<0.05), the number of patients with the main adverse cardiac and cerebral events(MACCE) in the sprayed group was significantly lower(9.38％ vs.21.74％, P<0.01), all with statistically significant differences .The number of patients with heart failure and recurrent myocardial infarction was lower in the sprayed group, but there were no statistically significant differences .Conclusion Medical chemical glue as an external stent does play a role in improving the venous patency rate after coronary artery bypass grafting , and it is reliable for the preven-tion and treatment of vein bypass vascular stenosis after coronary artery bypass grafting .

Objective: To observe the cardiomyocytes regeneration after myocardial infarction in Chinese small pigs, analyze the mechanism of myocardial fibrosis after myocardial regeneration. Methods: Nine Chinese small pigs, weight 18-20 kg, 6 pigs in the experimental group(to ligate LAD at the equal blood flow point), and 3 in the control group(no any operation was performed). Monitor the hemodynamics of the left ventricle. Cardiac specimens were taken after 4 weeks of LAD ligation, the left ventricle was divided into 17 segments, and fixed in 4% paraformaldehyde for 1 week. Hematoxylin-Eosin/(HE) staining, PTAH、Ki-67-DAB and α-sarcomeric-actin-DAB staining for pathological observation. Results: Four weeks of LAD ligation, different range of infarct size could be found in all the 17 segment of left ventricle. There was significant systolic pressure difference between the proximal and distal part in the left ventricular cavity. After 4 weeks of LAD ligation, there were a large number of new cardiomyocytes around the infarction area, which connected with the original mature cardiomyocytes directly. Large number of disassembled cardiomyocytes in the infarcted area and myocardial fibers were broken, cell structure disappeared, and nuclei were scattered in fibrotic tissues. Conclusion New cardiomyocytes after myocardial infarction were derived from the mature cardiomyocytes. Myocardial regeneration, cell disintegration, and myocardial fibrosis were performed synchronously under the influence of myocardial tension.

Objective: To evaluate the feasibility and validity of combined directly epicardial and transapical endocardial substrate ablation guided by Carto mapping for ventricular tachycardia(VT) with left ventricular aneurysm(LVA) intra-operation in a swine model. Methods: Twenty-four swine models with sustained VT and LVA were randomly divided into study group(radiofrequency ablation, RFCA, from epicardium via direct-view and endocardium via transapical access, 12 cases) and control group(endocardial RFCA via retrograde transaortic access, 12 cases). Substrate mapping for captured abnormal potentials via endocardium and epicardium was used to precisely locate the low-voltage areas. After ablation in two groups, VT was induced again to compare the effectiveness of different RFCA strategies. Results: Three dimensional electro-anatomic mapping was implemented successfully in two groups under open chest. And VT substrates were largely located in the border zone of LVA. All objects in the study group underwent endocardial ablation via transapical access smoothly without operative failure. When VT inducing again, 2 cases of study group was with inducible VT, however, VT recurrence in control group was 5 cases, P=0.04. Conclusion Combined direct epicardial and transapical endocardial substrate mapping and ablation appeared to be feasible and effective for treating VT with LVA under thoracotomy.

Objective To evaluate the mean blood flow(MF) and pulsatility index(PI) of individual and sequential sa-phenous vein grafts in posterior descending artery(PDA) in the same patient undergone off-pump coronary artery bypass grafting (OPCABG).Methods 140 patients with coronary artery disease were studied.Sequential surgical technique using single large saphenous vein was used in grafts of diagnostic artery(DIAG)(side-side), obtuse marginal artery(OM)(side-side), and PDA( end-side) .Bulldog clamps were used to temporarily arrest the anastomoses of DIAG and OM near the large saphenous vein .Thus the sequential graft became to the single graft , the MF and PI of PDA were recorded in the simulating single graft by the transit-time flow measurement(TTFM), after that, bulldog clamps were removed and the MF and PI of PDA were recorded again in the real sequential graft.The data were compared.Six months later after surgery, coronary CTA were done in all pa-tients in clinic.Results The MF of single graft and sequential graft was(22.5 ±13.1)ml/min and(22.2 ±12.9)ml/min(P>0.05).The PI of single graft and sequential graft was 2.43 ±0.94 and 2.38 ±0.88(P>0.05).The patency of all grafts is good in all patients after 6 months follows-up.Conclusion There ars no hemodynamic differences between individual and sequential grafts in PDA.It is reasonable that the short-term surgical result is the same in individual and sequential grafts in PDA.

Objective To evaluate the clinical efficacy of early coronary artery bypass grafting(CABG) to treat ST-segment elevation myocardial infarction(STEMI).Methods We retrospectively analyzed the clinical data of 196 patients within 2 weeks of STEMI attack undergoing CABG in our department from September 2010 to December 2014.According to the time-interval between onset of STEMI and the beginning of CABG,all subjects were divided into group Ⅰ (≤6 h,n =46),group Ⅱ (7-72 h,n =37),group Ⅲ (4-7 d,n =52) and groupⅣV (8-14 d,n =61).After CABG,patients' perioperative complications and survival status were analyzed under different surgical time-interval windows to assess the clinical efficacy of early surgical intervention in patients with STEMI.Results Overall in-hospital mortality was 9.18％ (18/196),from group Ⅰ to group ⅣV,the mortality was 10.87％ (5/46),21.62％ (8/37),5.77％ (3/52) and 3.28％ (2/61) respectively.In all groups,comparing with survivals,nonsurvivals were often women (61.11％ vs.24.16 ％,P =0.002),were more often companied by cardiac shock(83.33％ vs.24.16％,P ＜ 0.001),and had higher preoperative cardiac troponin Ⅰ(cTnⅠ) levels [(14.1 ± 8.4) ng/ml vs.(4.7 ± 3.8) ng/ml,P ＜ 0.001].Multi-variable logistic regrassion analysis revealed that age,female,cardiac shock,renal insufficiency and serum levels of cTnⅠ were independent risk factors affecting postoperative death.Conclusion Under optimal preoperative management strategies,CABG is relatively feasible and effective with the time-interval window as delay as possible after 3 days of STEMI attack.

Objective Saphenous vein graft(SVG) re-stenosis has an severe adverse effect on the long-term prognosis of coronary artery bypass grafting.Intimal hyperplasia(IH) is the prima~ cause and basic pathology of SVG re-stenosis.Comparing to arterial graft IH,different factors promotc IH of SVG.In this review,we summarized the special factors promoting IH of SVG.

Objective To identify the risk factors of major bleeding in patients undergoing off-pump coronary artery by-pass grafting( OPCAB) .Methods Data on coronary artery disease patients who underwent off-pump CABG between December 2009 and December 2014 were reviewed.Baseline characteristics were compared between patients with clopidogrel discontinua-tion ≥5 days and <5 days.Univariate and multivariate logistic regression analyses were performed to investigate the risk fac-tors of perioperative major bleeding.Major bleeding was defined as the Universal Definition of Perioperative Bleeding(UDPB) class 3 -4.Results A total of 3988 patients who underwent OPCAB were included in this study.Major bleeding rate was 9.23%(n=368).Multivariable regression analysis showed that female sex(OR=1.99, 95%CI:1.57-2.52), age(OR=1. 02, 95%CI:1.00-1.03), lower BMI(BMI≤25 kg/m2)(OR=1.40,95%CI:1.12-1.75), decreased GRF(GFR<60 ml/min)(OR=1.43,95%CI:1.01-2.02), decreased preoperative Hct(Hct <0.40)(OR =1.57, 95%CI: 1.23-1.99) and clopidogrel discontinuation <5 days(OR=1.97, 95%CI:1.58-2.44) conferred a higher risk of perioperative major bleeding during OPCABG.Conclusion Female, advanced age, lower BMI, decreased GRF, decreased preoperative Hct and clopi-dogrel discontinuation<5 days are independent risk factors of perioperatice major bleeding in patients undergoing OPCAB .Pre-dicting risk of major bleeding can help sugeons to optimize perioperative management .

Objective    To evaluate the efficacy and clinical significance of bipolar radiofrequency ablation in the treatment of left ventricular aneurysm with ventricular arrhythmias guided by CARTO mapping system. Methods    From September 2009 to December 2015, 56 patients with ventricular aneurysm following myocardial infarction were enrolled. All patients suffered different levels of angina pectoris symptoms evaluated by Holter (the frequencies of ventricular arrhythmias more than 3 000 per day). They were divided into two groups according to random ballot and preoperative communication with patients' family members: a bipolar radiofrequency ablation group (n=28, 20 males, 8 females, mean age of 61.21±1.28 years) receiving off-pump coronary artery bypass grafting (OPCABG), ventricular aneurysm surgery combined with bipolar radiofrequency ablation, and a non-bipolar radiofrequency ablation group (n=28, 22 males, 6 females, mean age of 57.46±1.30 years) receiving OPCABG and single ventricular aneurysm surgery. The grade of cardiac function and ventricular arrhythmia was compared between the two groups during pre-operation, discharge and   follow-up. Results    All patients were discharged successfully. There was no in-hospital death in both two groups. One patient in the non-radiofrequency group had cerebral infarction. All patients were re-checked with Holter before discharge and the frequency of ventricular arrhythmias significantly decreased compared to that of pre-operation in both groups, and was more significant in bipolar radiofrequency ablation group (1 197.00±248.20 times/24 h vs. 1 961.00±232.90 times/24 h, P<0.05). There was significant difference in duration of mechanical ventilation and ICU stay between the two groups (P<0.05). The left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) significantly improved (P<0.05) after operation in both groups. Conclusion    The clinical efficacy of bipolar radiofrequency ablation in the treatment of ventricular aneurysm with ventricular arrhythmia guided by CARTO mapping is safe and effective, but its long-term outcomes still need further follow-up.

Objective To establish a close clinical and easy to operate animal artery bypass grafting model by using vascular anastomosis wheel.Methods 15 rabbits that weighted 2.5-3.5 kg were studied.Each animal underwent an end-toend anastomosis of jugular vein and carotid artery by vascular anastomosis wheel.Carotid ultrasound and flow detection were taken immediately and 2 months after surgery respectively,as well as morphology and pathology were recorded to analyze and evaluate the intimal hyperplasia of vein graft and arteriovenous anastomotic site.Results 14 rabbits were successfully established CABG model,however 1 rabbit died of respiratory inhibition caused of excessive anesthesia.Compared with normal carotid artery,the vein bridge showed significantly lower blood flow [(50.81 ± 1.33) ml/min vs.(70.59 ± 0.68) ml/min,P ＜0.01,higher PI(2.15 ±0.07vs.1.22 ±0.04,P ＜0.01)] immediately after surgery.Compared with the vein grafts immediately after surgery,the vein grafts 2 months after surgery showed significantly lower blood flow [(27.46 ± 2.15) ml/min vs.(50.81 ± 1.33) ml/min,P ＜ 0.01].Compared with normal jugular vein,the vein grafts 2 months after surgery showed significantly higher intimal hyperplasia[(160.30 ± 1.78) μm vs.(49.06 ± 2.76) μm,P ＜ 0.01],and higher number of elastic plates(12.36 ± 0.25vs.3.21 ± 0.15,P ＜ 0.01).Conclusion The use of vascular anastomosis wheel to establish an artery bypass graft model can imitate the pathological changes of vein grafts after CABG,which can provide an ideal animal model for various researches on vein grafts.