The attosecond (10−18 s) light pulse represents the fastest time scale currently mastered by the scientific community, which enables the observation of electron dynamics within atoms and molecules, offering powerful tools to probe chemical reaction mechanisms and advance research in photovoltaic materials and biological processes. In this work, we investigate the generation of visible attosecond optical pulses via spectral broadening in Hollow-Core Fiber (HCF), followed by coherent recombination using a Three-Channel Light Field Synthesizer (TCLFS). The influence of the input pulse duration on Group Delay Dispersion (GDD), Third-Order Dispersion (TOD), and spectral broadening is systematically analyzed. Furthermore, the effects of GDD, TOD, and the carrier–envelope phase (CEP) on waveform synthesis are quantitatively examined for the first time. These findings provide valuable insights into dispersion management strategies essential for developing high-quality visible attosecond light sources, paving the way for future applications in ultrafast spectroscopy and light field-driven electron dynamics.

Unidirectional liquid transport, which operates without external energy input, has garnered remarkable interest in the global energy sector. A crucial breakthrough in this field involves understanding how liquids spread on the peristome surface of Nepenthes alata. This study, inspired by the microstructural traits of the Nepenthes peristome, has brought about the development of a biomimetic surface on metal substrates using nanosecond laser processing on inclined bases. This process replicates the natural peristome's microstructure, which allows for controlled liquid spread on the surface. The research also examines how wettability influences unidirectional liquid spread. Additionally, it involves adjusting the microstructure parameters on the biomimetic surface, which leads to variations in edge curvature and microcavity wedge angles. More importantly, this study comprehensively investigates the relationship between these structural changes and the phenomenon of unidirectional liquid transport. The findings suggest that altering edge curvature and microcavity wedge angles can manage the directional spread of liquids. The optimized surface, with ideal curvature and wedge angles, achieves liquid movement speed up to 12.03 mm s(-1). This represents a notable improvement, 2.2 and 2.7 times faster than the original structure, respectively. These findings provide valuable insight into the design of energy-independent unidirectional liquid spreading surfaces on metal substrates.

Pupil filtering is an effective method to modulate the 3D point spread function distribution of an optical system. Based on vector Debye-Wolf diffraction integral and a new fusion optimization algorithm, an improved method is described for efficiently designing the most widely-used concentric multi-belt pupil filters. The main advantage of this method is that it actively selects the minimum belt width and the total belt number for facilitating low-cost batch processing. Pupil filters for visible and near-infrared bands have been separately designed for improving the spatial resolution of optical imaging and ultrafast laser processing. The method has been experimentally demonstrated for suppressing the optical focal spot. The proposed method can be readily modified for designing more sophisticated multi-level pupil filters for practical applications in high-resolution imaging and fine laser micromachining.

Objectives:Off-pump coronary artery bypass grafting (OPCAB) surgery is controversial in part because of the surgeon's experience, which correlates with how the surgeon is trained. Because the training model of OPCAB is not uniform, the quality control in the training process seems to be more important and needs to be further discussed.Methods:Nine surgeons accepted and completed an OPCAB training course at a single center to become independent surgeons. This training program is characterized by 6 progressive levels supervised by experienced trainers. In total, 2307 consecutive cases of OPCAB performed by the 9 trainee surgeons were analyzed for monitoring and evaluation in quality control. The funnel plots and cumulative summation (CUSUM) analysis method were used to evaluate the performance of each surgeon.Results:The mortality and complications of each surgeon were all within the 95% confidence interval of funnel plots. The CUSUM learning curves of first 3 trainees was analyzed and showed that the trainees need to complete approximately 65 cases to cross the CUSUM learning curve to reach a steady state.Conclusions:The trainees can directly receive the OPCAB training course under the guidance of experienced surgeons with a rigorous schedule. It is feasible to perform quality control by funnel plots and CUSUM method in OPCAB surgery to ensure the safety of the training course.

Direct ultrafast laser photoinscription of transparent materials is a powerful technique for the development of embedded 3D photonics. This is particularly adaptable for astrophotonic devices when a number of inputs are required. The process relies essentially on volume fabrication of waveguiding structures in flexible 3D designs and refractive index contrast parameters adjustable for specific spectral ranges. This enables 3D geometry and thus avoids in-plane crossings of waveguides that can induce losses and cross talk in multi-telescope beam combiners. The additional novel capability of the technique allows for the fabrication of high aspect ratio nanostructures nonperturbatively sampling the optical field. Combining ultrafast laser micro- and nanoprocessing with engineered beams, we present here results for the development of chip-sized silica glass integrated robust 3D three-telescope beam combiners in the near-IR range, as well as embedded diffraction gratings, for phase closure analysis and spectro-interferometry applications in astronomy.

Superhydrophobic surfaces with low adhesion and self-cleaning properties have broad application prospected in various fields. However, the current methods for preparing low-adhesion superhydrophobic surfaces typically require toxic chemicals or fluorination modifications, which are prone to environmental pollution and health hazards, and still face challenges for applications in industries such as food and medical care. This paper aims to prepare anisotropic gradient array surfaces (AGAS) with low adhesion on stainless steel substrates by WEDM, without the need for modification with low-surface-energy materials. AGAS can achieve a stable Cassie state with a low adhesion performance by controlling the dimensional parameters and structural inclination of columnar arrays. Experiments and numerical simulations show that owing to the anisotropic gradient structure, pinning and de-pinning occur asymmetrically in time at the contact lines of the leading and trailing edges of droplets impacting the AGAS. On AGAS, droplets can jump and roll in the direction of gradient descent during the impact process to complete self-cleaning. Due to the discontinuity of the solid-liquid-gas three-phase contact line and the stepped arrangement of the column array, the prepared surface can achieve low adhesion and self-cleaning properties for many common liquid foods in daily life, including milk and juice.

Abstract Background Asymptomatic graft failure after coronary bypass grafting surgery (CABG) may have negative impact on the patients’ short- and long-term outcomes. Cardiac computed tomography angiography (CTA) has been proved to be another choice to detect graft failure besides coronary artery angiography in several studies. We aimed to identify the rate and predictors of asymptomatic graft failure detected by CTA before discharge. Methods and results A total of 955 grafts of 346 consecutive asymptomatic patients who received CTA examination after CABGs were included in this retrospective study from July 2017 to Dec 2019. We divided 955 grafts into the patent group and occluded group by CTA results. Logistic regression model at graft-level were established to determine predictors of the early asymptomatic graft occlusion. The overall asymptomatic graft failure rate was 4.71% (45/955), and there was no difference between the arterial and venous conduits in different target territories (P > 0.05). The logistic regression at graft-level analysis showed that female (OR 3.181, CI 1.58–6.40, P = 0.001), composite grafting (OR 6.762, CI 2.26–20.28, P = 0.001), pulse index value (OR 1.180, CI 1.08–1.29, P < 0.001) and new postoperative atrial fibrillation (POAF) (OR2.348, CI 1.15–4.78, P = 0.018) were independent risk factors that affect graft failure, while early postoperative dual-antiplatelet treatment with aspirin and clopidogrel was a protective factor (OR 0.403, CI 0.19–0.84, P = 0.015). Conclusions Early asymptomatic graft failure is associated with both patient and surgical factors including female gender, high PI value, composite graft strategy and the new POAF. However, the early dual- antiplatelet therapy with aspirin and clopidogrel may be useful for preventing graft failure.

Objective:To analyze and compare difference of ultrasonic blood flow of left internal mammary artery(LIMA) and right internal mammary artery(RIMA)as graft to left anterior descending artery(LAD) in patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods:From October 2017 to October 2019, a total of 363 patients who underwent OPCAB including 329 patients in LIMA-LAD group and 34 patients in RIMA-LAD group, were included in this study. Transthoracic ultrasound examination on IMA was performed before OPCABG. The blood flow , the value of PI(pulsation index) and diastolic flow(DF) of LIMA and RIMA to left anterior descending were measured and recorded by intraoperative TTFM. Patients underwent coronary artery CT examinations at 1 week after OPCABG to discover the patency of grafts.Results:The pre-operative diameter of RIMA was larger and the blood flow and pulsation index of RIMA was better than that of LIMA before OPCABG( P<0.001). But there was no significant difference in the flow, pulsation index and DF value of graft between the two groups after IMA were anastomosed to LAD( P>0.05). In situ skeletonized graft of RIMA did not show the advantage of increased blood flow. Compared with the preoperative parameters of flow of internal mammary artery, both the left and right grafts of IMA were significantly better in blood flow and pulsation index( P<0.001). Considering the remarkable difference in age between the two groups, Flow, PI and DF were compared again after propensity score matching, and there was still no statistical difference between the two groups( P>0.05). A total of 313 patients in LIMA-LAD group completed coronary CTA examination one week after surgery, among which 4 grafts had different degrees of problems. A total of 34 patients in RIMA-LAD group completed coronary CTA examination, one case indicated that the CTA imaging in distal segment was not clear, and the other results had no obvious abnormality. There was no significant difference in postoperative rate of coronary CTA completion( P=0.381) and rate of graft failure( P=0.405) between the two groups. Conclusion:Compared with the preoperative parameters of blood flow of internal mammary artery, both the left and right IMA grafts are significantly better in flow and pulsation index. The pre-operative diameter of RIMA is larger and the blood flow and pulsation index of RIMA is better than that of LIMA before OPCABG. But there is no significant difference in the flow, pulsation index and DF value of graft between the two groups after IMA are anastomosed to LAD. In situ skeletonized graft of RIMA do not show the advantage of increased blood flow.

目的:通过分析急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的临床资料,探讨影响其30 d内生存状况的相关因素.方法:回顾性分析2006年1月-2019年11月北京大学人民医院心外科收治的29例AMI合并VSR患者的临床资料.所有患者中共有24例(82.8％)患者接受了手术治疗修补VSR,其中18例(75％)患者同期实施冠状动脉旁路移植术(CABG).对比生存组与死亡组病例的临床资料,分析影响患者30 d内生存状况的相关因素.结果:未接受手术的患者VSR发生后30 d内病死率显著高于接受手术的患者(100％∶33.3％,P=0.011).死亡组患者AMI后至VSR出现的时间更短[(2.43±1.72) d∶(6.79±5.77)d,P=0.019],急诊手术比例更高(8.3％∶58.3％,P=0.027);而生存组患者同期行CABG的比例更高(93.8％∶37.5％,P=0.007),且CABG是手术患者围术期预后的独立性保护因素(OR 0.58,95％CI 0.005～0.721,P=0.027).结论:在修补AMI后VSR的同时,实施CABG有助于改善患者的围术期预后,应尽可能地根据术前造影结果实现完全的血运重建治疗.

Background A large number of studies have shown that BIMA grafting is superior to single internal mammary artery grafting in cardiac function protection and long-term survival after surgery. While, there is still no consensus on how is the best configuration to use BIMA. This study aims to compare intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA. Methods There were 74 patients who underwent CABGs with bilateral internal mammary artery with different configurations we included. According to the different target territories that RIMA grafted to, the patients were divided into bilateral group (group I) with 20 cases and left group (group II) with 54 cases. Intraoperative blood flow, early clinical results and early postoperative patency of different configurations of BIMA were compared. Results There was no difference in the early postoperative death and major complications between group I and Group II( P >0.05). Compared with the LIMA in group II, the LIMA in group I had a slightly higher DF value (76.7 ± 6.2 vs 73.1 ± 6.8, P = 0.040). Compared with the RIMA in group II, the RIMA in group I had a slightly higher MGF (51.7 ± 34.4 ml/min vs 31.4 ± 21.4 ml/min, P = 0.024). There was no difference in the other TTFM parameters of LIMA and RIMA between group I and Group II(P>0.05). Further subgroup analysis revealed that compared with free RIMA in group II, in situ RIMA had a higher DF value (71.4 ± 7.8 vs 61.8 ± 18.1, P = 0.025). The PI of LIMA in free RIMA subgroup was higher than the PI of LIMA in in-situ RIMA subgroup (3.0 ± 1.6 vs 2.1 ± 1.0, P = 0.018). The results of early postoperative CTA examination showed that all IMAs grafts were completely patent. Conclusions The use of BIMA for CABG is safe and efficacious, RIMA used in right coronary artery received more satisfactory graft flow. BIMA with no stenosis and occlusion in the early stage, therefore is the ideal and stable coronary bypass graft.

Background With the ageing of China’s population, the incidence and mortality of coronary atherosclerotic heart disease (CAD) is increasing year by year, which brings a heavy burden to the family and society [1]. We aimed to analyse the strategy of coronary artery bypass grafting (CABG) in the right coronary artery and to compare the haemodynamic characteristics of the sequential grafts with those of single grafts and to observe the patency rate of those grafts for 1 week after the operation. Methods A total of 242 patients (178 men, mean age 62.6 ± 8.8 years) underwent right coronary artery bypass grafting in our hospital from October 2016 to January 2019. The blood flow (Q, ml/min), pulsatility index (PI) and related parameters of the grafts were measured and recorded by TTFM during the CABG. The patency of the grafts was evaluated by coronary computed tomography (CT) for 1 week after the operation. Results The most common material used for the graft in the right coronary system of CABG is the greater saphenous vein (92.3%), followed by the radial artery (5.5%) and the internal mammary artery (1.9%). The highest frequency target of the right coronary artery is the posterior descending artery (PDA) (47.6%), followed by the right main coronary artery (RCA) (29.1%) and the posterior branch of the left ventricle (PL) (23.3%). The proportion of single grafts was the highest for the right coronary artery in CABG (178 cases, 67.9%), followed by a graft of the PDA-PL (42 cases, 16.0%) and other sequential grafts among the different coronary artery systems (including the system of the left anterior descending artery (LAD) and the left circumflex (LCX)). Whether there were sequential grafts of the PDA-PL or other sequential grafts among the different systems of the coronary artery, the instantaneous flow of a group of sequential grafts was higher than that of a single graft, and the difference had statistical significance ( P < 0.01). However, there were no significant differences in the flow between the groups of sequential grafts ( P = 0.410). Diastolic flow (DF) in the group of sequential grafts of the right coronary system was better than that in the non-sequential group ( P < 0.001), and the difference had statistical significance. There was no significant difference between the DF of the groups of the other system of sequential grafts and that of the right coronary sequential grafts. Coronary artery CT suggested that there were 11 cases of poorly developing grafts or stenosis and occlusion a week after the operation, and those phenomenon mainly occurred in the group with a single graft. There was only one case that was occluded in the group of other systems of sequential grafts, and statistically significant differences existed between the two groups ( P < 0.01). Conclusions In our centre, the most common form of CABG in the right coronary artery system is a non-sequential vein bridge to the PDA. Whether there are sequential grafts of the PDA-PL or other sequential grafts among the different coronary artery systems, the instantaneous flow of a group of sequential grafts is higher than that of a single graft. DF in the group of sequential grafts of the right coronary system was better than that in the non-sequential group.

Objective:To observate the changing trend of flow of in-situ bilateral internal mammary artery as grafts during perioperative period in patients undergoing coronary artery bypass grafting(CABG), and to compare the parameters of flow between LIMA and RIMA.Methods:A total of 57 patients , 50 males and 7 femails, mean aged(57.8±10.1) years, underwent bilateral IMA CABG in our hospital from August 2016 to January 2019. Transthoracic ultrasound of IMA examination was performed before CABG. The blood flow, the PI(pulsation index) and other parameters were measured and recorded by intraoperative TTFM.Results:There was no significant difference of the average diameter and PI between LIMA and RIMA, but the preoperative flow of RIMA is higher( P=0.026) in our study. There was no significant difference of the average flow and PI between LIMA and RIMA recorded by TTFM( P>0.05), but the higher diastolic flow(DF) in LIMA grafts( P=0.022) compared with RIMA grafts may be associated with the different target sites( P<0.05). Compared with the preoperative flow and PI of IMA, the intraoperative flow and PI of both LIMA and RIMA grafts were better( P<0.001). Conclusion:Compared with the preoperative flow of IMA, both flow of LIMA and RIMA are better. In spite of the targets exist difference , there are no significant difference of the average flow and PI between LIMA graft and RIMA graft recorded by TTFM.

目的:研究非常规情况下使用大隐静脉(SVG)替代原位左侧乳内动脉(LIMA)作为前降支(LAD)的桥血管是否有助于提升桥流量等相关参数,同时观察静脉桥围术期的临床表现,以指导临床实践.方法:选取2017年11月-2019年9月于我院心外科实施冠状动脉旁路移植术(CABG)患者共计374例,其中LIMA-LAD组332例,SVG-LAD组42例.入选人群术中使用瞬时血流仪(TTFM)测量并记录桥血流量(MGF)、搏动指数(PI)和舒张期血供比例(DF)等参数.术后1周行冠状动脉(冠脉)CT检查明确桥血管通畅情况.结果:相较于LIMA-LAD组,SVG-LAD组的术中瞬时桥MGF更高[(29.70±20.97) ml/min:(37.85±23.28) ml/min,P =0.021],PI(2.65±1.01:2.12±0.68,P＜0.001)也更优.使用倾向性评分校准年龄因素后,尽管流量上SVG-LAD组仍高于LIMA-LAD组,但差异不具有统计学意义[(29.92±21.92) ml/min:(37.27±24.31) ml/min,P=0.109],而PI方面SVG-LAD组则依然更优(2.74±1.02:2.07±0.63,P＜0.001).两组术后围术期心肌梗死发生率和肌酸激酶同工酶(CK-MB)水平无统计学差异.术后1周LIMA-LAD组313例完成冠脉CT检查,其中4例存在不同程度的问题.SVG-LAD组40例均完成冠脉CTA检查,结果未见明显异常.两组冠脉CT完成率和桥失败率无统计学差异.结论:SVG-LAD搭桥并不具有高流量优势,但相较于LIMA,SVG桥的PI更优.术后1周冠脉CT检查未显示SVG桥和LIMA桥在通畅率方面存在统计学差异.

Background: Owing to the high patency, the use of the left internal mammary artery (LIMA) for left anterior descending artery (LAD) grafting has been a cornerstone of coronary artery bypass graft surgery (CABG). However, for some patients whose LIMA cannot be used, surgeons have to choose the other conduit materials to revascularize the LAD. The purpose of this study was to explore the difference of different conduit materials used for LAD in the parameters measured by transit-time flow measurement (TTFM) and the early graft patency detected by computed tomography angiography.Methods: We retrospectively collected the data of 410 patients who undergoing isolated primary OPCAB with intraoperative TTFM data. According to the strategy of the left descending artery (LAD) revascularization, 410 patients were assigned to three groups: a left internal mammal artery (LIMA)group(n=333), a right IMA group (n=34) and a great saphenous vein (SVG) group (n=43). The baseline and perioperative blood parameters were compared for the three groups, as well as the early graft patency rates. Results: Compared with the LIMA-LAD group, the SVG-LAD group had a significantly higher mean graft flow volume(37.15±23.29vs29.71±20.94ml/min, P=0.036),however, a lower pulsatility index (2.07±0.62vs 2.65±1.01,P＜0.001).There was no significant difference between the two groups in DF(P＞0.05).Compared with the RIMA-LAD group, the SVG-LAD group just had a lower pulsatility index(2.07±0.62vs 2.56±0.96,P=0.029).However, there was no significant difference between the two groups in MGF and DF(P＞0.05).Compared with the LIMA-LAD group, the RIMA-LAD group had a bit lower DF(70.76±11.87vs74.06±7.09,P=0.018),while there was no difference in MGF and PI between the two groups(P＞0.05). The patency rate of the LIMA-LAD group was 98.72% (309/313), the RIMA-LAD group was 97.06% (33/34), and the SVG-LAD group was 100%. There was no difference among the three groups in patency rate(P=0.405).Conclusions: We conclude that in patients whose LIMA cannot be used，the in-suit RIMA and the SVG are comparable and even better than the LIMA in the blood flow parameters measured by TTFM. In our study，the early patency before discharge of RIMA-LAD and SVG-LAD are comparable with the LIMA-LAD.

Fabric core conveyor belt rubber bearing (CBRB) with low cost and a simple manufacturing process has been proposed to further popularize seismic isolation technology in low-rise buildings, and four samples of such bearings have been produced, including four-layer, five-layer, five-layer with inner pattern and six-layer fabric core CBRBs. The vertical compression and the compression shear test are carried out to evaluate the performances of the four bearings. Results show that the vertical stiffness of the CBRB increases as the number of fabric core layer increases, while the damping ratio decreases, and the bearings can withstand a vertical pressure of 10 MPa. In addition, these bearings work very well within 100% shear strain, and the horizontal stiffness of the bearings decreases with increasing shear strain. In the meantime, as the number of fabric core layer increases, the effective horizontal stiffness of the bearings increases under 4 MPa compressive stress, and the damping ratio coefficient of the bearing is about 15%, when bearing sliding does not occur. The ultimate shear strain reached up to 200% for the four-layer bearing with obvious interlayer cracks, which means that the bonding quality between layers is the key influencing factor on the ultimate shear strain. In short, the proposed low-cost bearing has low horizontal stiffness and good energy dissipation capacity, so it is suitable for low-rise buildings in economically underdeveloped, high intensity areas, which can significantly improve their earthquake resistance and reduce casualties and property losses.

Background: With the aging of China's population, the incidence and mortality of coronary atherosclerotic heart disease (CAD) are increasing year by year, which brings a heavy burden to the family and society [1]. To analyse the strategy of Coronary artery bypass grafting(CABG) in right coronary artery. To compare hemodynamic characteristics of the sequential grafts with those of single grafts and observe the patency rate of those grafts for one week after-operation.Methods: A total of 242 patients (178 male, mean age 62.6±8.8 years ) underment the right coronary artery bypass grafting in our hospital from October 2016 to January 2019 were collected. The blood flow (Q, ml/min) and pulsatility index (PI) and related parameters of grafts are measured and recorded by TTFM in CABG.The patency of grafts were evaluated by coronary computed tomography(CT) for one week after operation.Results: The most common material of graft in right coronary system of CABG is great saphenous vein(92.3%), followed by the radial artery and internal mammary artery. The highest frequency target of right coronary artery is posterior descending artery (PDA)(47.6%),followed by the Right main coronary artery (RCA )(29.1%) and Posterior branch of left ventricle (PL)(23.3%).The proportion of single graft is the largest in right coronary artery in CABG(178 cases，67.9%),followed by the proportion of the graft of PDA-PL (42cases，16.0%) and other sequential grafts among the different coronary artery system (including the system of Left anterior descending artery (LAD) and Left Circumflex (LCX)).The research shows that whether the sequential grafts of PDA-PL or with other sequential grafts among the different system of coronary artery the instantaneous flow of group of sequential grafts is higher than that of single graft, and the difference has statistical significance (P < 0.01) .But there was no statistical difference of the flow between groups of sequential grafts (P = 0.410).Diastolic flow (DF) in the group of sequential grafts of right coronary system is better than that in non-sequential group (P < 0.001), and the difference has statistical significance. There was no statistical difference between the DF of groups of other system of sequential grafts and that of right coronary sequential grafts .Coronary artery CT suggests that there was 11 cases existing poor development grafts or stenosis and occlusion in week after operation,and those phenomenon mainly occurred in the group of a single graft.There was only one case which be occluded in the group of other systems of sequential grafts, and statistically significant difference existed between two groups (P < 0.01).Conclusions: The most common form of CABG in right coronary artery system is non-sequential vein bridge to PDA in our center. Whether the sequential grafts of PDA-PL or other sequential grafts among the different coronary artery system the instantaneous flow of group of sequential grafts is higher than that of single graft. DF in the group of sequential grafts of right coronary system is better than that in non-sequential group.

目的:探讨原位左侧乳内动脉重建前降支术中瞬时血流(TTFM)指标,在右冠和回旋系统血流参数满意的3支病变患者中,对术后死亡和主要不良事件的预测价值.方法:回顾性分析2017年10月-2019年12月在本中心接受单纯初次传统正中切口的3支病变患者230例,均接受LIMA-LAD,且均满足右冠和回旋系统桥血管血流参数满意(PI＜5,MGF＞20 ml/min).其中ON-PUMP 111例,OFF-PUMP 119例,分别按前降支PI与MGF满意与否分组,分别对比PI和MGF满意与否对术后死亡和主要并发症的影响.结果:对OFF-PUMP手术分析结果发现,LIMA-LAD桥血管PI＞5组(5例)较PI≤5组(114例),术后死亡(20.0％∶0％,P=0.042)、术后IABP使用率(20.0％∶0％,P=0.042)及术后新发肾衰需CRRT治疗(40.0％∶0.9％,P=0.004)、术后重返手术室(40.0％∶1.8％,P=0.008)及术后二次插管(20.0％∶0％,P=0.042)发生率更高,复合终点事件有更高的趋势(50.0％∶8.8％,P=0.079).OFF-PUMP手术前降支MGF不满意组(24例)较满意组(95例),术后重返手术室(12.5％∶1.1％,P=0.026)及术后复合终点事件(25.0％∶6.3％,P=0.015)发生率更高,围术期心肌梗死发生率有更高趋势(16.7％∶4.2％,P=0.051).但单独ON-PUMP手术,按前降支PI和MGF分组,均未发现死亡和主要并发症方面有明显区别.结论:TTFM参数中PI和MGF在OFF-PUMP手术对围术期不良事件的预测价值更高.OFF-PUMP前降支桥血管PI＞5发生术后死亡、术后需要IABP治疗、术后新发肾衰需CRRT治疗、术后二次插管率更高.前降支桥血管血流＜20 ml/min发生术后重返手术室及术后复合终点事件发生率更高.但本研究未发现在ON-PUMP手术前降支血流和PI对不良事件的预测价值.

Background: Early graft failure can affect the short- and long-term outcomes of patients undergoing coronary bypass grafting surgery (CABG). The aim of our study was to explore the predictive value of transit-time flow measurement (TTFM) parameters for early graft failure (before discharge) after CABG in different coronary territories and calculate the TTFM cut-off values. Methods: We analyzed a total of 761 grafts (360 patients) that were evaluated by intraoperative TTFM and computed tomography angiography prior to discharge. Logistic model was established to detect the parameters of TTFM to predict early graft failure and receiver operating characteristic curve analysis was used to calculate the cut-off values. Results: The overall early graft failure was 3.5%. The results demonstrated that compared with off-pump CABG, mean graft flow volume was higher (28.0 vs 21.0 mL/min, p = 0.000), but pulse index (PI) (2.3 vs 2.5, p = 0.049) and diastolic flow fraction (DF) (68.0% vs 71.0%, p = 0.001) were lower in on-pump CABGs. DF (73.0% vs 65.5%, p = 0.000) of arterial grafts was higher than that of venous grafts. DF (72.0% vs 62.0%, p = 0.000) in left was higher than that in the right coronary artery territories. The results of multivariate logistic analysis showed that not only in the overall (OR 1.18, 95% CI 1.07-I1.30, p = 0.001), but also the left (OR 1.21, 95% CI 1.03-1.41, p = 0.017) and right (OR 1.15, 95% CI 1.03-1.29, p = 0.017) coronary artery target territories, PI was a risk factor for early graft failure and the cut-off value was 3.4, 3.4, and 3.6, respectively. For grafts in left target territories, the results showed that DF (OR 0.94, 95% CI 0.91-0.97, p = 0.000) just in the univariate analysis was a risk factor that affected graft failure. Conclusions: The overall early graft failure was about 3.5%. High PI value is a risk factor for early graft failure in not only overall grafts but in grafts of different target territories. DF might be more useful for the quality evaluation of grafts in left than in right target territories. (C) 2020 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.

Introduction: For some patients whose LIMA cannot be used, surgeons have to choose other conduit materials to revascularize the LAD. This study was to explore the differences between SVG and LIMA used for LAD in terms of parameters measured by transit-time flow measurement (TTFM) and the early graft patency. Methods: A total of 374 patients who underwent CABG were included in this study. According to the strategy of the left descending artery (LAD) revascularization, 374 patients were assigned to two groups: a left internal mammal artery (LIMA)group(n=332) and a great saphenous vein (SVG) group (n=42). Results: Before propensity Score-Matched, compared with the LIMA-LAD group, the SVG-LAD group had a significantly higher MGF(37.85±23.28 vs 29.70±20.97ml/min, P=0.021),but a lower PI value (2.12±0.68 vs 2.65±1.01,P＜0.001).There was no significant difference between the two groups in terms of DF(P＞0.05). After 1:2 propensity Score-Matched, there were 114 patients were included (SVG-LAD 38, LIMA-LAD 76), there was no difference in the baseline data between the two groups. Compared with the LIMA-LAD group, the SVG-LAD group also had a lower PI value (2.07±0.63 vs 2.74±1.02,P＜0.001),and also a higher MGF(37.27±24.31 vs 29.92±21.92ml/min),but there was no statistically difference(P=0.109). There was no significant difference between the two groups in DF (P＞0.05). There was no difference among the two groups in patency rate(P=0.405). Conclusion: SVG-LAD has a higher MGF and a lower PI value than LIMA-LAD before PSM but just has a lower PI value than LIMA-LAD after PSM. There was no difference among the two groups in early patency rate.