Background:Coronary artery bypass grafting (CABG) was a critical intervention for patients with obstructive coronary artery disease, yet managing thrombotic complications post-surgery remains challenging. Aspirin was the standard antiplatelet therapy following CABG; however, the potential benefits of dual antiplatelet therapy (DAPT) with clopidogrel were not well-defined in this setting. This study evaluates the impact of DAPT compared to aspirin alone on prognosis and adverse events in the first month after CABG. Methods:This retrospective cohort study analyzed data from 281 patients undergoing CABG from August 2020 to July 2023. Using propensity score matching (PSM), these patients were separated into two groups based on their postoperative medication: the aspirin alone group (ASA, n = 117) and the dual antiplatelet therapy group (DAPT, n = 117). PSM ensured balanced baseline characteristics. Graft patency, platelet function, and postoperative adverse events were evaluated, with statistical significance set at a P-value < 0.05. Categorical variables were reported as frequencies and percentages [n (%)] and analyzed using Chi-square test. Continuous variables with a normal distribution were presented as mean ± standard deviation (SD) and analyzed using t test. Results:DAPT resulted in significantly lower rates of saphenous vein graft occlusion compared to aspirin alone (17.09% vs. 29.06%, P = 0.030). Inhibition of platelet aggregation (IPA) was enhanced in the DAPT group (64.35% vs. 62.46%, P = 0.010), and thromboxane B2 levels were consistently lower on days 7, 14, and 30 post-surgery (P = 0.009, P = 0.005, and P = 0.002, respectively). Although adverse cardiovascular events did not significantly differ, minor bleeding, such as epistaxis, was more common in the DAPT group (6.84% vs. 0.85%, P = 0.041). Regression analysis showed DAPT reduced the odds of adverse events (OR: 0.452, 95% CI: 0.253-0.816, P = 0.008). Conclusion:DAPT with clopidogrel and aspirin improves graft patency and platelet inhibition in the first month following CABG, though it was associated with increased minor bleeding events.

Background:Acute kidney injury (AKI) is a significant and prevalent complication of coronary artery bypass graft (CABG) surgery. Advanced age is an independent predictor of AKI; however, the existing research on AKI in elderly patients after CABG is limited. This study sought to employ machine-learning techniques to predict patients at high risk of developing AKI following CABG, using preoperative and intraoperative variables. Methods:Patients were retrospectively enrolled in this study between January 2019 and December 2020. The following nine machine-learning algorithms were used to predict postoperative AKI events: logistic regression (LR), simple decision tree (DT), random forest (RF), support vector machine (SVM), extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), gradient bosting, light gradient boosting machine (lightGBM), and K-nearest neighbor (KNN). SHapley Additive exPlanations (SHAP) values were employed to determine the contribution of each feature to the models and to assess feature importance. Receiver operating characteristic (ROC) curves were plotted, and the areas under the curves (AUCs) of the ROC curves were calculated to evaluate the predictive performance of the various machine-learning models for AKI. Results:A total of 2,155 participants were included in the study. The RF model had the highest AUC [0.737, 95% confidence interval (CI): 0.687-0.784], while the KNN model had the lowest AUC (0.644, 95% CI: 0.581-0.704). Certain variables, including age, the estimated glomerular filtration rate (eGFR), uric acid (UA), alanine aminotransferase (ALT), and B-type natriuretic peptide (BNP) at the baseline, as well as surgery duration and the intraoperative use of an intra-aortic balloon pump (IABP), were identified as significant risk factors for postoperative AKI. Conclusions:Machine-learning models can effectively predict the risk of AKI in elderly patients after CABG surgery. Among all the machine-learning models examined, the RF model showed the best performance.

BACKGROUND: Atherosclerosis (AS) is defined as a chronic inflammatory disorder underly the pathogenesis of cardiovascular diseases (CVDs). Endothelial pyroptosis is associated with AS-like diseases and other CVDs. OBJECTIVE: This work was designed to expound on the effect of GATA-binding protein 1 (GATA1) on pyroptosis of human coronary artery endothelial cells (HCAECs) in AS. METHODS: HCAECs were treated with oxidized-low density lipoprotein (ox-LDL) to establish HCAEC injury models. Plasmids for overexpressing GATA1 or silencing retinoic acid-related orphan receptor α (RORα) were transfected into HCAECs. Thereafter, the mRNA levels of GATA1 and RORα in HCAECs were detected using real-time quantitative polymerase chain reaction. HCAEC viability was examined using the cell counting kit-8 method. The levels of pyroptosis-related proteins NOD-like receptor protein 3 (NLRP3), cleaved-Caspase-1, N-terminal of gasdermin D (GSDMD-N), and pyroptosis-related inflammatory cytokines interleukin (IL)-1β and IL-18 were determined using Western blot and enzyme-linked immunosorbent assays, respectively. The targeting relationship between GATA1 and RORα was verified using the chromatin-immunoprecipitation assay. Then, the rescue experiment was conducted to explore the effect of RORα on pyroptosis of ox-LDL-treated HCAECs. RESULTS: In ox-LDL-treated HCAECs, GATA1 and RORα expressions were decreased, HCAEC viability was reduced, and the levels of NLRP3, cleaved-Caspase1, GSDMD-N, IL-1β, and IL-18 were elevated. GATA1 overexpression increased HCAEC viability and attenuated pyroptosis. GATA1 bound to the RORα promoter region to stimulate RORα transcription, and RORα suppression facilitated ox-LDL-induced pyroptosis of HCAECs. CONCLUSIONS: GATA1 activated RORα transcription and therefore limited pyroptosis of ox-LDL-treated HCAECs.

Objective:To explore the clinical value of aspirin combined with atorvastatin in the prevention of new onset atrial fibrillation after off-pump coronary artery bypass grafting (OPCABG).Methods:208 patients with coronary artery bypass grafting in our hospital from June 2019 to June 2021 were selected as the research subjects and divided by a random number table method into groups. The control group (104 cases) was treated with aspirin before operation, and the observation group (104 cases) was treated with aspirin and atorvastatin before operation. ECG monitoring was carried out continuously for 7 days of patients in the two groups, and the occurrence and duration of AF were recorded. The clinical therapeutic efficacy, incidence and adverse reactions of AF, left atrial diameter and high-sensitivity C-reactive protein (hs-CRP) level were observed before and after treatment.Results:The incidence of AF in the observation group was significantly lower than that in the control group, the difference was statistically significant ( P<0.05). There was no statistical significant difference in the starting time of AF between the two groups after operation ( P>0.05). The duration of AF in the observation group was better than that in the control group, the difference was statistically significant ( P<0.05). Before treatment, there was no statistical significant difference in left atrial diameter and hs-CRP level between the two groups ( P>0.05). After treatment, the left atrial diameter in the observation group returned to that before treatment, and there was no statistical significant difference in the same group ( P>0.05). The left atrial diameter in the control group was higher than that before treatment, and there was statistical significant difference in the same group ( P<0.05). The level of hs-CRP was lower than that in the control group, the difference was statistically significant ( P<0.05). There were no adverse reactions in both groups. Conclusion:Aspirin combined with atorvastatin has a significant effect in preventing new onset AF after OPCABG. It can reduce the incidence of postoperative AF, shorten the duration of AF, effectively control the inner diameter of left atrium, reduce the degree of postoperative inflammatory reaction, and has no adverse effects. It is worthy of clinical application.

Introduction Whether mitral surgery should be performed simultaneously with coronary artery bypass grafting (CABG) in patients with moderate ischemic mitral regurgitation (MIMR) is controversial. This study was performed to introduce a method of off-pump mitral valvuloplasty after off-pump CABG (OPCABG) and compare it with OPCABG alone. Methods Eighty-three patients with MIMR underwent OPCABG. Among them, 21 patients (Group A) underwent posterior mitral annuloplasty without cardiopulmonary bypass, and 62 patients (Group B) underwent OPCABG alone. The primary endpoint of follow-up was the mitral regurgitation area. Results The mean mitral regurgitant area in Group A and B was 6.42 ± 1.02 and 5.49 ± 1.24 cm 2 preoperatively ( p = .479), 2.93 ± 1.35 and 3.28 ± 1.93 cm 2 at 1 week postoperatively ( p = .516), 3.06 ± 2.16 and 3.09 ± 1.85 cm 2 at 3 months postoperatively ( p = .839), and 3.02 ± 1.60 and 3.7 cm 2 (median) at 1 year postoperatively ( p = .043). There was less regurgitation in Group A at the mid-term. Intragroup comparison showed significant differences between the preoperative and postoperative values in both groups, with no difference in the regurgitant area at each postoperative time point in Group A but a significant difference between 3 months and 1 year postoperatively in Group B ( p = .042). Multiple linear regression showed that the mid-term mitral regurgitant area changes were negatively correlated with graft flow and positively correlated with age. Conclusion In patients with MIMR who underwent OPCABG plus off-pump mitral valve annuloplasty, the mitral regurgitant area was smaller and mitral regurgitation recurrence was less frequent at the mid-term follow-up.

BACKGROUND:The role and function of microRNA (miRNA, miR)-140-5p in the calcification of vascular smooth muscle cells (VSMCs) have been explored in this study. METHODS:The calcium nodules formed in transfected and β-glycerophosphate (β-GP)-treated VSMCs were observed using Alizarin Red S staining, and alkaline phosphatase (ALP) activity was determined. VSMC apoptosis was detected with flow cytometry assay. The target gene of miR-140-5p was predicted and confirmed with dual-luciferase reporter assay. Relative expressions of miR-140-5p, toll like receptor 4 (TLR4) and vascular calcification-related proteins (α-smooth muscle actin, α-SMA; Msh Homeobox 2, MSX2; bone morphogenetic protein 2, BMP2; Kruppel-like factor 4, KLF4; Runt-related transcription factor 2, RUNX2) were measured through quantitative real time polymerase chain reaction (qRT-PCR) and western blot. RESULTS:MiR-140-5p upregulation reversed the effects of β-GP on downregulating miR-140-5p and α-SMA expressions, enhancing ALP activity, calcium nodule formation and cell apoptosis, and upregulating levels of MSX2, BMP2, KLF4 and RUNX2. TLR4 was the target of miR-140-5p, and offset the effects of miR-140-5p on β-GP-induced VSMCs. CONCLUSIONS:MiR-140-5p upregulation represses β-GP-induced calcification of VSMCs via targeting TLR4, providing a potential therapeutic method for vascular calcification.

目的 评价健康教育联合程序化随访计划对心脏搭桥术后患者遵医行为及心理应激的影响.方法 方便选取2019年8月至2020年1月安贞医院心胸外科收治的心脏搭桥手术患者100例,随机分为对照组和观察组,各50例.对照组行常规护理,观察组在常规护理基础上行程序化随访计划,两组均干预6个月.比较两组干预后遵医行为情况,干预前后心理应激、希望水平及心功能指标.结果 干预后,观察组遵医行为率(96.00％)显著高于对照组(72.00％);积极行动、与他人保持密切联系对目前及未来的态度评分分别为(13.92±1.54)分、(13.53±2.18)分和(12.83±2.16)分,均显著高于对照组;观察组血清BNP、CRP水平及HYHA分级分别为(18.21±2.45)pg/mL、(8.22±1.25)mg/mL和(1.58±0.21)级,均显著低于对照组;观察组心理应激项目HAMA、HAMD和MADRS评分分别为(18.53±8.45)分、(20.64±3.23)分和(22.80±3.11)分,均显著低于对照组;以上差异均具有统计学意义(P<0.05).结论 健康教育联合程序化随访计划可提高心脏搭桥术后患者遵医行为,降低机体心理应激反应,改善心功能,具有临床推广价值.

Objective:To investigate the early effect of different antithrombotic therapy in patients with coronary endarterectomy(CE) combined with off-pump coronary artery bypass grafting(OPCABG).Methods:Between January and December 2021, 154 consecutive patients including 120 males and 34 females with the age ranged from 39 to 78 years and an average of(62.6±7.2) years who underwent CE+ OPCABG were evaluated retrospectively. According to the postoperative anticoagulant therapy, patients were divided into two groups: Aspirin+ low molecular weight heparin group(n=81, LMWH group) and Aspirin+ ticagrelor group(n=73, ticagrelor group). The data of both preoperative and postoperative hemoglobin level and blood transfusion after the surgery were collected. The dynamic changes of electrocardiogram and cTnI level were observed within 48 h after the surgery.Results:There was no perioperative death, and all the patients were discharged 5-13 days postoperatively. After the initiation of anticoagulant therapy, the lowest hemoglobin value in the LMWH group and ticagrelor group was(88.3±14.6)g/L vs.(89.5±11.6)g/L( P>0.05), blood transfusion was performed in 8 vs. 5 patients with hemoglobin below 70g/L( P>0.05), peak cTnI within 48 h of surgery was 850.55(410.63, 1 662.63)pg/ml vs. 1 184.60(667.50, 3 169.63)pg/ml( P<0.05), the number of patients with perioperative myocardial infraction within 48h after the surgery confirmed by electrocardiogram was 2(2.5%) vs.2(2.5%), P>0.05. Conclusion:There was no significant difference between the two anticoagulant treatments in preventing perioperative myocardial infarction after CE+ OPCABG surgery. LMWH did not increase the risk of postoperative bleeding compared with ticagrelor. In addition, aspirin+ LMWH reduced the levels of peak TnI within 48 h of surgery, which may be associated with better long-term postoperative outcomes, but further research is needed to confirm this.

Introduction The distal end anastomosis is critical to the entire sequential grafts in coronary artery bypass grafting (CABG), but caliber mismatch diminishes the quality of the anastomosis. We aimed to introduce a modified distal end side-to-side (deSTS) anastomosis to handle the size mismatch and compared with classic distal end end-to-side (deETS) anastomosis. Methods From January 2014 to December 2018, 185 patients who underwent off-pump CABG with size mismatched sequential vein grafts (≥3.5 mm) and target coronaries (1.0–1.5 mm) at the distal end anastomoses were included. We retrospectively reviewed the data of the patients, perioperative and follow-up outcomes were analyzed. Results The deSTS group ( n = 67) showed higher anastomotic flow (19.8 ± 8.0 vs 14.9±6.8 mL/min; p < 0.001) and lower pulsatility index (2.7 ± 0.8 vs 3.2 ± 1.0; p = 0.001) than the deETS group ( n = 118). Higher incidence of in-hospital myocardial infarction (MI) was found in the deETS group but without significant difference (9.0% vs. 15.3%; p = 0.220). Kaplan-Meier analysis illustrated a relatively lower MI and major adverse cardiovascular and cerebrovascular events (MACCE) incidence in the deSTS group, and the deSTS group was associated with a reduction in long-term death, MI and MACCE in the adjusted Cox regression model. In addition, relatively higher graft patency was found in the deSTS group. Conclusions The deSTS anastomosis showed superiority in solving size mismatch in sequential CABG, including better intraoperative flow dynamics, ideal long-term graft patency and reduced the incidence of perioperative and follow-up adverse events especially in MI.

Abstract Objective To explore the role of genetic testing of VKORC1 and CYP2C9 in determining the dosage of warfarin after aortic valve replacement. Methods A total of 172 patients receiving warfarin after aortic valve replacement were divided into a control group (n = 86) and an experimental (n = 86) group based on acceptance of genetic testing. In the experimental group, three loci of VKORC1 and CYP2C9 were tested by polymerase chain reaction-restriction fragment length polymorphism technique, and the initial dose of warfarin was determined based on the genetic testing results and warfarin oral-dose table recommended by U.S. Food and Drug Administration (FDA). In the control group, warfarin (3 mg per night) was used as the initial dose. The international normalized ratio (INR) of each patient was continuously monitored after medication. The percentages of patients meeting the target INR in the two groups at specific time points and at 3-month follow-up after discharge from the hospital were monitored, and the incidence of various adverse events was compared between the groups. Results Based on the results of genetic testing, 68 patients received 3–4 mg/d (79.1%), 10 patients received 0.5–2 mg/d (11.6%), and eight patients received 5–7 mg/d (9.3%) as the initial dosages of warfarin in the experimental group. The percentages of the patients meeting the target INR on the third and sixth day of postoperative medication were 45.3% and 73.3%, respectively, in the experimental group, and 29.8% and 58.3%, respectively, in the control group. The INR critical values during hospitalization occurred in 2.3% in the experimental group and in 7.1% in the control group, while the percentage of the patients meeting the target INR after 3 months was 86.1% in the experimental group and 83.1% in the control group. Conclusion Genetic testing may guide the selection of the initial dose of warfarin after heart valve replacement to rapidly achieve a stable dose.

Objective:To describe a distal anastomosis support (DAS) technique, and retrospectively investigate the effect of DAS on the mid-term graft patency of patient with small posterior descending artery.Methods:Between January and December 2016, 100 patients with triple-vessel disease and small PDA who continuously underwent off-pump coronary artery bypass grafting (OPCABG) (OPCABG group, n=50) and OPCABG with DAS for anastomosis of PDA grafted by saphenous vein (SVG) (OPCABG+ DAS group, n=50) were evaluated retrospectively. The dynamic changes of electrocardiogram and TnI level were observed within 48h after the surgery. All patients came back to follow-up visit 6th, 12th, 24th and 36th postoperative month. The primary endpoint was the graft failure (FitzGibbon B or O) of SVG-PDA on the follow-up CTA.Results:There was no death during the operation. There was no acute inferior wall myocardial infarction confirmed by electrocardiogram. Peak TnI within 48h of surgery was 0.74(0.98)ng/ml vs. 0.92(1.29)ng/ml, P>0.05, and the number of patients with peak TnI≥70×ULN was 3(6%, 3/50) vs.5(10%, 5/50), P>0.05. There was no postoperative death, and all the patients were discharged 5-15 days postoperatively. We found significantly improved cumulative graft patency in OPCABG+ DAS group at 36 months after operation [85.7%(42/49) vs. 68.0%(34/50), P<0.05). In multivariate logistic regression analysis, PDA with atherosclerotic lesions ( OR=6.513, 95% CI: 1.279-33.180, P=0.024), and peak TnI≥70×ULN within 48 h of surgery ( OR=5.948, 95% CI: 1.128-31.368, P=0.036) were independent predictors of graft failure, whereas concomitant DAS ( OR=0.222, 95% CI: 0.069-0.713, P=0.011) was significant protective factor. Conclusion:Concomitant DAS conferred superior mid-term patency of SVG-PDA in patients with small PDA. Adding the DAS procedure to OPCABG may be a promising surgical option for small PDA with atherosclerotic lesions.

We wish to thank Lobo Filho and colleagues1Lobo Filho J.G. Lobo Filho H.G. Pimentel M.D. Composite graft for calcified ascending aorta in coronary artery bypass grafting.Ann Thorac Surg. 2022; 114: 352Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar for their comments on our technique. Indeed, the use of composite internal thoracic artery (ITA) grafts is a feasible technique to address ascending aortic calcification during off-pump coronary artery bypass grafting (CABG), which avoids manipulation of the ascending aorta, thus minimizing the risk of plaque detachment. However, the use of bilateral ITAs (BITAs) or total arterial revascularization is not widely adopted for several reasons. Firstly, literature indicates that BITAs should be avoided in patients with higher operative risks due to the prolonged cross-clamp time.2Lytle B.W. Blackstone E.H. Loop F.D. et al.Two internal thoracic artery grafts are better than one.J Thorac Cardiovasc Surg. 1999; 117: 855-872Abstract Full Text Full Text PDF PubMed Scopus (773) Google Scholar Secondly, the survival benefit was evident only in patients with a preserved ejection fraction of >0.40, and higher mortality rates were observed in older patients with a lower ejection fraction.3Endo M. Tomizawa Y. Nishida H. Bilateral versus unilateral internal mammary revascularization in patients with diabetes.Circulation. 2003; 108: 1343-1349Crossref PubMed Scopus (68) Google Scholar,4Konstanty-Kalandyk J. Piatek J. Rudzinski P. et al.Clinical outcome of arterial myocardial revascularization using bilateral internal thoracic arteries in diabetic patients: a single centre experience.Interact Cardiovasc Thorac Surg. 2012; 15: 979-983Crossref PubMed Scopus (13) Google Scholar Despite the improved graft patency, no significant difference was observed in 10-year mortality between traditional CABG and BITAs.5Taggart D.P. Benedetto U. Gerry S. et al.Bilateral versus single internal-thoracic-artery grafts at 10 years.N Engl J Med. 2019; 380: 437-446Crossref PubMed Scopus (313) Google Scholar Thirdly, harvesting of BITAs requires a longer learning curve compared with unilateral ITA or vein grafts. Moreover, the higher risk of sternal infection associated with BITAs is another concern that dampens the enthusiasm for using composite ITA or BITAs, especially in diabetic patients. Despite the increasing use of the composite ITA or BITA grafts, nowadays traditional CABG is still the gold standard in many centers and remains the most widely adopted technique. Therefore, our technique based on the Foley catheter provides a simple, effective, and inexpensive approach to minimizing trauma to the ascending aorta and neurologic complications secondary to plaque detachment.6Wang C. Ma W.G. Yu Y. Li J.X. Gu C.X. New proximal anastomosis technique for calcified ascending aorta in coronary artery bypass grafting.Ann Thorac Surg. 2021; 112: e307-e310Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar This clamp-less approach is particularly suitable for patients with severe ascending aortic calcification. The relatively high incidence of stroke in our experience was mainly a result of the severely calcified ascending aorta in these patients, which entailed very high risk of plaque detachment even with minimal or no manipulation. Nevertheless, we believe that our technique and the use of the composite ITA or BITA grafts both represent viable and effective approaches to calcified ascending aorta, but with different indications. There is no “one-size-fits-all” solution for such patients, and the choice of the most appropriate grafting technique should always be comprehensive and individualized. Randomized controlled studies in larger patient populations are warranted to decide the best indications for available techniques. Composite Graft for Calcified Ascending Aorta in Coronary Artery Bypass GraftingThe Annals of Thoracic SurgeryVol. 114Issue 1PreviewThe technical approach proposed by Wang and colleagues,1 in addition to being cost-effective and reproducible, is an option to minimize trauma to the ascending aorta by avoiding partial clamping of this vessel. However even the minimal aortic manipulation resulting from this technique still presents a risk of atheroembolism.2 This can be illustrated by the incidence of stroke in 6.6% of patients in which the proposed technique was adopted and of 13.2% in the control group, creating debate on whether the occurrence of these events is directly related to manipulation of the ascending aorta despite the presence of additional factors for stroke in the studied patients. Full-Text PDF

To deal with calcified ascending aorta during coronary artery bypass grafting, we describe an alternative technique to create a clampless proximal anastomosis using a Foley catheter and polypropylene suture. In 30 patients, the number of distal anastomoses averaged 3.1 ± 0.7, and mean time of proximal anastomosis was 18.9 ± 1.3 minutes. Neither early nor late death occurred. Stroke occurred in 2 high-risk patients. At mean 1.6 ± 0.5 years of follow-up, 1 patient sustained recurrent angina, and graft patency was 93%. These favorable outcomes show that this alternative technique is a safe and effective approach to calcified ascending aorta in coronary artery bypass grafting.

Neurological complications are one of the most common complications after coronary artery bypass grafting. With the development of off-pump coronary artery bypass grafting (OPCABG), the incidence of postoperative neurological complications caused by aortic intubation decreased significantly; however, the continuous suture of the great saphenous vein-aortic anastomosis in the coronary artery bypass grafting requires the operation of surgical clamp and perforation on the ascending aorta, which may lead to potential plaque detachment. Calcification of ascending aorta is an independent risk factor for cerebrovascular events after OPCABG. Therefore, it is crucial to explore and operate on the ascending aorta. There are three main methods of proximal anastomosis in OPCABG: (1) partial blocking of ascending aorta with side wall clamp for anastomosis; (2) application of proximal anastomosis auxiliary device (Enclose, Heartstring, etc.) for proximal anastomosis; and (3) original auxiliary device (urethra catheter-water sac) or no-clamp surgical techniques for proximal anastomosis.

OBJECTIVES This analysis aimed to compare both short- and long-term outcomes of hybrid coronary revascularization (HCR) with different techniques and coronary artery bypass grafting (CABG). METHODS Twenty-three studies were included, covering 10 468 different patients, among whom 2403 patients underwent HCR with either simultaneous or staged method and 8065 patients underwent CABG. RESULTS Compared with CABG, HCR had a statistically significant lower risk of stroke [odds ratio (OR) = 0.55, P = 0.049], major adverse cardiac and cerebrovascular events (OR = 0.69, P = 0.024) and blood transfusion (BT) (OR = 0.39, P < 0.001), whereas no significant differences were detected in mortality, myocardial infarction and repeat revascularization. A network meta-analysis showed that simultaneous HCR had significantly better outcomes in stroke (OR = 0.24, P = 0.01) and major adverse cardiac and cerebrovascular events (OR = 0.29, P < 0.001), and staged HCR had a significantly better outcome in BT (OR = 0.31, P < 0.001). According to the frequentist statistic results, simultaneous HCR had the highest probability of being the best treatment in terms of mortality (84%), stroke (97%), myocardial infarction (88%) and major adverse cardiac and cerebrovascular events (99%), whereas staged HCR had the highest probability of being the best in postoperative repeat revascularization (59%) and BT (83%). However, long-term results showed no significant difference between the HCR and CABG techniques. CONCLUSIONS HCR appears to be a feasible option for multivessel coronary artery disease patients. Compared to traditional CABG, HCR had lower risk of adverse events in the short term, but in the long term, survival rate and freedom from major adverse cardiac and cerebrovascular events rate were similar between groups.

Objective:To explore the correlation between serum high mobility group protein B1 (HMGB1) and severity of coronary artery disease.Methods:From January 2018 to March 2019, 170 patients who underwent coronary angiography and were definitely diagnosed with coronary heart disease in Beijing Anzhen Hospital were divided into single-vessel lesion group(65 cases), double-vessel lesion group(55 cases) and three-vessel lesion group(50 cases) according to the results of coronary angiography.Sixty healthy persons in the same period were set as the control group.The serum levels of HMGB1, endothelin-1, C-reaction protein (CRP), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) were detected, and the severity of coronary artery disease was evaluated according to Gensini score standard.Results:The serum HMGB1 of patients with single vessel disease was (7.35±0.75) μg/L, that of double vessel disease group was (11.56±1.16) μg/L, that of three vessel disease group was (14.36±1.46) μg/L, and that of control group was (3.22±1.52) μg/L.The difference between the two groups was statistically significant ( F=14.235, P<0.001). The serum endothelin-1 in single vessel disease group was (198.56±19.86) ng/L, that in double vessel disease group was (226.54±22.64) ng / L, that in three vessel disease group was (435.65±43.95) ng/L, and that in control group was (120.47±13.27) ng/L.The difference between the two groups was statistically significant ( F=16.337, P<0.001). The serum CRP of patients with single vessel disease was (6.21±0.61) ng/L, that of double vessel disease group was (8.54±0.84) ng/L, that of three vessel disease group was (11.36±1.16) ng/L, and that of control group was (3.39±1.56) ng/L.The difference between the two groups was statistically significant ( F=15.206, P<0.001). Serum LDL-C was (3.23±0.33) mmol/L in single vessel disease group, 4.12±0.42 mmol/L in double vessel disease group, (6.23±0.63) mmol/L in three vessel disease group and (2.25±1.45) mmol/L in control group.The difference between the two groups was statistically significant ( F=22.017, P<0.001). Serum HDL-C was (4.02±0.42) mmol/L in single vessel disease group, (2.35±0.25) mmol/L in double vessel disease group, (1.79±0.29) mmol/L in three vessel disease group and (4.60±1.69) mmol/L in control group.The difference between the two groups was statistically significant ( F=18.564, P<0.001). The Gensini score of single vessel disease group was (10.36±2.26), that of double vessel disease group was (16.74±1.04) and that of three vessel disease group was (23.36±2.36). The difference between the two groups was statistically significant ( F=23.014, P<0.001). The levels of HMGB1, endothelin-1, CRP and LDL-C in patients with coronary heart disease were significantly higher than those in the control group, while the levels of HDL-C were significantly lower than those in the control group (all P<0.05). The higher the number of diseased vessels, the higher the levels of HMGB1, endothelin-1, CRP, LDL-C and Gensini score, the lower the level of HDL-C.Multiple linear regression analysis showed that HMGB1, endothelin-1, CRP and LDL-C were risk factors of Gensini score (standard coefficient was 0.480, 0.087, 0.173, 0.197, t=8.351, 9.047, 12.476, 11.692, all P<0.01); HDL-C level was a protective factor of Gensini score (standard coefficient -0.352, t value was 16.582, P<0.001). Pearson linear correlation analysis showed that serum HMGB1 level was positively correlated with endothelin-1, CRP and LDL-C ( r=0.536, 0.659, 0.724, all P<0.05), and negatively correlated with HDL-C ( r=-0.669, P<0.05). Conclusion:There are obvious inflammatory reaction and lipid metabolism disorder in patients with coronary heart disease.The level of HMGB1 in peripheral blood is closely related to the severity of coronary artery disease.

目的 探讨冠心病病人冠状动脉旁路移植术前后中医证型的特点及演变规律.方法 对450例冠心病病人行冠状动脉旁路移植术前后进行中医证候分型,常见有气虚、阳虚、阴虚、血瘀、痰浊、寒凝等证型,按术前、术后1周、术后4周、术后12周不同时间段进行统计分析.结果 术前中医辨证临床证型本虚证以气虚证246例(54.7％)、标实证以血瘀证254例(56.4％)为最常见;术后1周以气虚证269例(60.0％)、痰浊证257例(57.4％)最为常见;术后4周则以气虚证272例(62.8％)、痰浊证258例(59.6％)最为常见,术后12周则以气虚证217例(50.8％)、血瘀证230例(53.9％)最为常见,经冠状动脉旁路移植术治疗后,术后1周与术前比较,血瘀证减轻,术后12周与术后1周比较,血瘀证加重,本虚证和标实证与术前比较差异有统计学意义(P<0.05).中医症状以胸痛、胸闷等标实证较术前明显缓解(P<0.05).结论 冠心病病人经冠状动脉旁路移植术可改善冠心病气滞证和血瘀证,但仍不能从根本上改变冠心病的本虚标实病机特点,益气活血对术后临床治疗具有重要意义.

目的:探讨自拟益气养血汤治疗冠心病行冠脉旁路移植术后气血两虚证的临床效果.方法:将冠脉旁路移植术后中医辨证属气血两虚证患者320例随机分对照组和观察组,每组160例.两组均给予常规西药治疗,其中观察组加用自拟益气养血汤,疗程60d.采用西雅图心绞痛量表(SAQ)评估生活质量,比较两组患者治疗前后中医证候积分、生活质量情况,并对两组临床疗效进行评价.结果:围术期并发症两组差异无统计学意义(P>0.05).术后两组左心室大小、射血分数(LVEF)、肌钙蛋白、炎症因子及血红蛋白值比较,差异有统计学意义(P<0.05),其中观察组术后心肌酶明显低于对照组,射血分数及血红蛋白差值高于对照组;观察组中医证候积分低于对照组,SAQ各项得分明显高于对照组,差异有统计学意义(P<0.05).结论:自拟益气养血汤明显改善冠脉旁路移植术后气血两虚证患者的症状、体征、中医证候、生活质量及实验室检查等综合指标,进而提高术后疗效,值得临床推荐.

Objective:To explore the outcomes and mechanisms of coronary endarterectomy combined with electrocautery in patients with diffused coronary artery disease undergoing coronary artery bypass grafting (CABG).Methods:From January 2017 to September 2018, 300 patients undergoing CABG with left anterior descending artery endarterectomy were randomly divided into two groups, after fully informed the risks and other related issues regarding the operations. All the patients in the two groups were treated with CABG. In the study group, patients underwent electrocautery immediately after endarterectomy, whereas in the control group, patients underwent endarterectomy only. The electrocardiogram and serological examination (TNI, IL-6 and TNF-a) were performed at 2 h, 24 h, 72 h and 120 h after operation. The follow-up duration was 1 year.Results:Nine patients in the study group, and 25 patients in the control group had ST segment elevation. The levels of TNI, IL-6 and TNF-a were continuously increased in both groups, and reached the peak at 24 h, then decreased slowly. The levels of TNF-a were significantly lower at 2 h postoperatively in the study group ( P=0.01). There was no significant difference in the levels of TNI and IL-6 between the two groups. The levels of TNI, TNF-a and IL-6 were significantly lower in the electrocautery group at 24 h, 72 h, and 120 h after operation( P<0.05). One year after operation, incidences of ST segment elevation in the study group were significantly lower than that in the control group, and there was no significant difference in restenosis rate and myocardial infarction rate. Conclusion:Endarterectomy combined with electrocautery may prevent the restenosis of the lumen and blood turbulence, smooth the inner wall of the vessel, slow down the release of inflammatory factors in the peripheral blood, inhibit the expression of inflammatory factors in the vessels, and reduce the myocardial damage. The short-term effect was satisfactory; the long-term anti-inflammatory and antithrombotic effect still need further investigations.

Objective To review the clinical experience with on pimp mitral valve repair (MVP) and off-pump coronary artery bypass grafting (OPCABG) for coronary atherosclerotic heart disease (CAD). Methods From April 2017 to March 2018, a total of 32 patients received MVP combined with OPCABG in Beijing Anzhen Hospital. The echocardiographic results before and after the operation were compared and SPSS 20.0 statistical software was used to analyze the clinical data of these patients. Results There were 3.69 grafts per case. Artificial ring forming was performed in 26 cases, quadrangular resection in 4, chordal replacement in 2. No death of these patients occurred in the hospital. Thirty patients were followed up from 6 months to 30 mouths with improved heart function. Heart function was class Ⅰ in 26 and class Ⅱ in 4. The postoperative cardiac ultrasonography for reexaminations indicated that 8 with slight mitral regurgitation, 20 with mild regurgitation and 2 with moderate regurgitation. Patients' cardiac function and size of heart (LVESD, LVEDD and LVEF) were remarkably improved. Conclusions OPCABG and MVP should be performed concomitantly when CAD and mitral insufficiency disease present simultaneously. OPCABG operation at the same time line for the treatment of MVP effect is better. The patients' quality of life could be significantly improved. DOI: 10.11855/j.issn.0577-7402.2020.09.13