An Evaluation of Histomorphometric Properties of Coronary Arteries, Saphenous Vein, and Various Arterial Conduits for Coronary Artery Bypass Grafting
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The p urpose. Preservation of native properties of autologous vein for coronary artery bypass grafting. Materials and methods. The use of preoperative ultrasound marking saphenous veins, ultrasonic harmonic scalpel, axial intraoperative marking outs. Results. The use of techniques proposed by sparing with explantation and transposition outs in the coronary arteries, in contrast to the classical methods, can significantly increase the duration of the functioning autovenous coronary bypass grafts in patients with coronary heart disease in the long term. Conclusions. Studies have shown that improving techniques of careful explantation outs for coronary artery bypass grafting and qualitative positioning in the coronary arteries, contribute to a better patency vein grafts in the late postoperative period.
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Objective To summarize and analyze the Clinical experience and surgical results of re-operative coronary artery bypass grafting(Re-CABG).Methods 25 patients who underwent Re-CABG in Fuwai Hospital from March,1997 to May,2007 were analyzed.There were 22 males and 3 females aged from 50 to 72(62.5±8.1) years old.The average interval between the two graftings was 48.7±35.2 months(range,3-109 months).Results There were no operative death and myocardial infarction.The patients were followed up for 38.7±30.6 months(range,8-90 months),and no recurrent angina pectoris or related events occurred.Conclusion Satisfactory outcome of Re-CABG can be acheived if proper indication was chosen and reasonable management was performed.
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Fifty five patients with 108 coronary bypass saphenous vein grafts were studied at necropsy. The mean duration of the grafts was 153 days (SD 516). The luminal narrowing of the native coronary arteries proximal to, at, and distal to the vein graft anastomoses and the narrowing of the non-grafted arteries were evaluated planimetrically. Twenty nine per cent of coronary arteries distal to graft anastomoses showed at least 76% narrowing and 50-75% occlusion was seen in 39% of such arteries. Fifty three per cent of non-grafted arteries showed at least 76% luminal narrowing and 26% had 50-75% narrowing. Six patients (11%) had surgically induced dissection of coronary arteries. Seventy seven vein grafts (71%) showed no appreciable luminal narrowing. Problems related to operative technique caused 30% of the deaths.
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Pleural effusions after coronary artery bypass grafting (CABG) occur in up to 89% of patients undergoing the procedure. Effusions present days to months after surgery, and fluid characteristics relate to timing factors. Most of the effusions are left-sided and resolve spontaneously. Pleural effusions requiring treatment occur in a small percentage of patients who have undergone CABG. Post-CABG pleural effusions in temporal relation to malignant effusions are not widely reported. This report describes a 50-year-old man presenting with a malignant left-sided pleural effusion 3 months after CABG, with characteristics resembling a late post-CABG effusion.
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Objectives: The long-term patency rates for individual and sequential saphenous vein grafts (SVG) as coronary bypass conduits are angiographically compared; the impact of native coronary vessel characteristics is investigated. Methods: A total of 875 distal coronary anastomoses on 500 SVGs were assessed in 430 patients at an average of 5.8±3 years after a coronary revascularization procedure. Results: The patency rates of sequential conduits were markedly higher than those of individual ones (82 vs. 68%, P = 0.0005). Also, the anastomoses on the sequential conduits had better patency (75 vs. 68%, P < 0.03). This difference was even more pronounced in coronary arteries of poor quality and small (≪1.5 mm) diameter (57 vs. 28% for the sequential grafts and individual grafts, respectively, P = 0.001). Also, when the most distally located coronary artery on a sequential graft was of poor run-off, the patency rate for the entire conduit was considerably low (42.5%). Conclusions: The patency of a sequential vein graft conduit is generally better than that of an individual one, especially for poor run-off coronary vessels, provided that the most distally located anastomosis is done on a good coronary artery in terms of quality and diameter. Using a minimal length of conduits is another advantage. However, failure of a single sequential conduit jeopardizes all the anastomoses along that graft segment. Besides, sequential grafting is technically more demanding, and the technical expertise in performing a sequential anastomosis is probably among the important determinants of short- and long-term patency.
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Kabukcu, H. K.; Simsek, S.; Sahin, N.; Titiz, T. A.; Ozdem, S.; Mete, A. Author Information
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ЦЕЛЬ ИССЛЕДОВАНИЯ
Изучить эффективность коронарного шунтирования (КШ) у больных с диаметром коронарных артерий (КА) менее 1,5 мм по сравнению с результатами шунтирования у пациентов с более крупными сосудами.МАТЕРИАЛ И МЕТОДЫ
Проанализированы ранние и годичные результаты КШ в двух псевдорандомизированных группах больных: в исследуемой 1-й группе — 100 пациентов со множественными поражениями КА диаметром менее 1,5 мм в зоне микрохирургических анастомозов и во 2-й группе сравнения, в которой КШ выполнялось с КА диаметром более 1,5 мм (тоже 100 наблюдений). 1-я группа разделена на 2 подгруппы — пациенты с КА ≤1,5 мм (n=61) и с КА ≤1 мм (n=39). Пациентам с подозрением на клинику ишемической болезни сердца при годичном наблюдении были проведены клинические обследования с контрольной мультиспиральной компьютерной томографией или прямой шунтографией.РЕЗУЛЬТАТЫ
При исследовании госпитальных результатов единственный случай периоперационного инфаркта миокарда с последующим летальным исходом отмечен в группе с КА ≤1 мм. Через год зафиксировано 6 (11,3%) случаев рецидива стенокардии выше I функционального класса у пациентов с КА ≤1,5 мм, 11 (30,6%) случаев с шунтированием КА ≤1 мм и 8 (9,2%) случаев у больных после шунтирования КА >1,5 мм. В группе с КА ≤1,5 мм умерло 2 (3,8%) пациента, в группе с КА ≤1 мм — 1 (2,7%) пациент, в контрольной группе летальные случаи не зарегистрированы. Частота повторных реваскуляризаций примерно одинаковая и статистически не различалась — по 1 случаю в каждой из исследуемых подгрупп (1,9% у пациентов с КА ≤1,5 мм и 2,9% — с КА ≤1 мм соответственно) и 2 (2,3%) случая в группе сравнения. По данным шунтографии в течение года после операции в исследуемой группе было 8 случаев несостоятельных аутовенозных шунтов к КА ≤1,5 мм и 9 случаев — к КА ≤1 мм, из которых в 2 наблюдениях выявлено поражение маммарных шунтов. В контрольной группе неудовлетворительные результаты к КА >1,5 мм зарегистрированы в 7 случаях и 1 случай окклюзии аутовенозного шунта к ветви КА ≤1 мм.ЗАКЛЮЧЕНИЕ
Наше исследование свидетельствует о высокой эффективности выполнения полной реваскуляризации миокарда у больных с КА ≤1,5 мм. В группе с КА ≤1 мм в госпитальном периоде отмечалась тенденция к развитию периоперационного инфаркта миокарда с летальным исходом и большая частота окклюзий шунтов у пациентов через год, в связи с чем необходима дальнейшая разработка техники и тактики шунтирования артерий ≤1 мм в зоне анастомозов.Coronary arteries
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Objective:To review the clinical experience in 113 patients undergone coronary artery bypass grafting(CABG).Methods:From May 2003 to May 2009,113 patients undergone CABG were clinically analyzed.Results:The numbers of arterial grafts and venous grafts were 113 and 249 respectively.Postoperative complications were low output syndrome in 5 cases.There were 2 postoperative deaths with perioperative mortality of 1.8%.Conclusion:Properselection of indications,early detection and correct management of postoperative complications are the keys to ensure the operation success.
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Objective:To sum up the experience of emergency coronary artery bypass(ECABG) procedure to increase the rate of success. Methods:A retrospective study of 31 patients undergoing ECABG procedure from March 2004 to June 2008 was carried out. Results:Among 31 patients,ECABG succeeded in 28 patients,and the success rate was 90.3%. Conclusion:ECABG is an effective procedure for cardiac surgery patients. The adequate perioperative management is the key factor for increasing the rate of success of ECABG.
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