Objective:To investigate the harvest site complication and long term graft patency rate between autologous radial artery and great saphenous vein for coronary artery bypass grafting(CABG) in elder patients.Methods:We retrospectively analyzed 332 patients at(66.0±4.9) years of age who received CABG with autologous radial artery and great saphenous vein at the same time in our hospital from 2004 to 2010,and compared their early harvest site complication and long term graft patency rate between those 2 kinds of vessels.Before harvest,the radial artery was routinely examined by Doppler ultrasound,and calcium antagonist was used for anti-spasm after the procedure.Result:The in-hospital death were 6/332(1.8%) of patients.There were no significant differences in harvest site pain,hematoma and the limitation of activity between 2 kinds of grafting vessels,P005.While the incidences of numbness,swelling and infection in radial artery harvest site were obviously lower than those in great saphenous vein,P0.05 respectively.There were 307/332(92.5%) of patients follow-up by December 2012 and 177 patients received coronary angiography or CTA examination for graft patency at(58.0±23.7) months after the procedure.The graft patency rates of radial artery and great saphenous vein were 149/177(84.2%) vs.126/177(71.2%),P0.05.Conclusion:With pre-operative ultrasound evaluation and suitable anti-spasm treatment,radial artery could be a better alternative vessel for CABG than that of great saphenous vein in elder patients.

We studied the impact of diabetes mellitus (DM) on the radial artery (RA) in 30 patients with DM and 30 non-diabetic patients undergoing coronary artery bypass grafting with autologous RA. RAs were recorded as normal if there was no cellular or stromal tissue between the endothelium and the internal elastic lamina. The RA was normal in 26.7% of diabetic and 76.7% of non-diabetic patients ( p = 0.000298). Intimal thickness index and intima:media ratio were higher in the former than in the latter ( p < 0.05; p < 0.05), with no significant difference in luminal narrowing ( p > 0.05). Electron microscopy scores were lower in the non-diabetic group ( p < 0.001); endothelial nitric oxide synthase (eNOS) protein expression and optical density were higher ( p < 0.001). Von Willebrand factor and endothelin-1 messenger RNA (mRNA) levels were higher in the DM patients ( p < 0.001). The quality of the RA in patients with DM was thus inferior to that in non-diabetic patients. Care should be taken when selecting RA as a conduit in patients with DM.

Objective To summanrize the operative method and follow-up data of total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta (Sun's procedure) for acute Stanford type A aortic dissection.Methods Between August 2004 and March 2012,73 patients with acute type A aortic dissection underwent this procedure.60 males and 13 females ranging in age from 26 to 79 years (mean age,49,6 years).Right axillary or femoral artery cannulation was routinely used for cardiopulmonary bypass.Cerebral protection was achieved by bilatero-antegrade or selected hrain perfusion.The stented elephant trunk was implanted throuugh the aortic arch under hypothermic circulatory arrest.The stented elephant trunk was a 10cmlong self expandable graft.Patent false lumina were evaluated using computed tomography 3 months and once each year after discharge to evaluate the postoperative time course of the residual false lumen.Results Mean cardiopulmonary bypass time was (248.1±69.8)min,and selected cerebral perfusion time was (38.2±10.5)min.Hospital morality was 6.85 ％ (5/73).Thrombus obliteration of the residual false lumen in the descending thoracic aorta was observed in 9 1.7％ of the aortic dissections 3 months postoperatively.The mean follow-up time was(36.4 ± 31.6)months (range,2 to91 months).Survival at 1,5,7 years was 97％,87％ and 81％,respectively.Conclusion Total aortic arch replacement combined with transaortic stented paft implantation into the descending aorta is an effective treatment and n more promising choice for acute type A aortic dissection.

OBJECTIVE:To explore the impact of age and diabetes mellitus (DM) on the ultrastructure of radial artery (RA).METHODS:From June 2009 to December 2010, 64 patients underwent coronary artery bypass grafting (CABG) with autologous RA: 14 patients aged beyond 65 years without DM [9 male patients and 5 female patients, age (70 ± 4) years] and 18 patients aged beyond 65 years with DM [11 male patients and 7 female patients, age (68 ± 5) years], 20 patients aged under 60 years without DM [13 male patients and 7 female patients, age (53 ± 5) years] and 12 patients aged under 60 years with DM [7 male patients and 5 female patients, age (51 ± 6) years]. Four groups were subjected to routine electron microscopic examination and transmission electron microscopic examination.RESULTS:There were significant differences in percentage of endothelial denudation among four groups according to scanning electron microscopic evaluation (χ² = 18.082, P = 0.000). To compare with each other, there were significant differences between DM elderly patients and non-DM elderly patients, also between DM young patients and non-DM young patients according to scanning electron microscopic evaluation. There were no significant differences between DM elderly patients and DM young patients, also between non-DM elderly patients and non-DM young patients. Foam cells and the tendency of smooth muscle cells moving to intima could be visualized in DM patients according to transmission electron microscope. According to semiquantitative electron microscopic evaluation, non-DM young patients got the lower total scores than DM young patients (1.32 ± 0.20 vs. 4.38 ± 0.30) while non-DM elderly patients got the lower total scores than DM elderly patients (1.43 ± 0.20 vs. 4.67 ± 0.30). According to factorial design, there were significant differences between DM patients and non-DM patients (F = 41.22, P = 0.000). There were no differences between elderly patients and young patients (F = 1.24, P = 0.270). There is no interaction (F = 1.05, P = 0.309) between age and DM.CONCLUSIONS:After preoperative assessment with modified Allen's test and Doppler analysis, RA used as graft in the elderly has similar quality and function with young patients, and it may lead to a high patency in long term. However, the quality of RA in patients with DM is in bad condition, and further research on patency needs to be done.

Aims Long-term outcome of patients after myocardial infarction (MI) largely depends on the extent of post-infarct remodelling. To explore the molecular mechanism of remodelling, comparative proteomic analysis was undertaken to identify differential myocardial proteome profiles expressed in the border zone of the post-MI heart.Methods and results Two-dimensional gel electrophoresis and matrix-assisted laser desorption/ionization tandem time-of-flight mass spectrometry were used to identify the differential protein profiles expressed in the border zone at specific time points (Days 0, 1, 4, and 10 post-infarction) in a permanent rat MI model. We identified 96 differential protein spots, corresponding to 69 proteins. Cluster analysis exhibited five main temporal expression patterns corresponding to the three phases of early stage remodelling. The alteration in expression was supported by reverse transcription-polymerase chain reaction, western blotting, and immunohistochemical analysis of three selected proteins. Bioinformatics analysis revealed that the proteins in each pattern were functionally related to specific cell processes in remodelling, such as ischaemia, inflammation, and proliferation.Conclusion A differential myocardial proteome profile was identified in the border zone during early stage post-infarct remodelling. Bioinformatics analysis indicated a possible role of these proteins in remodelling. Proteomics data provided the basis for further functional study of these proteins and for identifying potential molecular targets with therapeutic anti-remodelling effects.

Objective To study the effect of coronary artery bypass grafting(CABG) on coronary heart disease and hypothyroidism and the management strategies during pre-operation.Methods Clinic data about 11 patients who underwent CABG for coronary heart disease and hypothyroidism from January 2006 to September 2009 were retrospectively analyzed.Results The number of bypassed blood vessels was 2-4(2.96±0.51).The stay time in ICU and the time of tracheal intubation were 50.2±11.6h and 14.5± 6.9h,respectively.Two patients underwent a second tracheal intubation due to low cardiac output.The patients were followed up for an average time of 24.5±16.7 months with a 100% survival rate.Conclusion CABG is a rather good procedure for coronary heart disease accompanying hypothyroidism.Early and appropriate thyoid replacement therapy can prevent the complications and risk of CABG.

随着生活水平的改善、人口老龄化的日益严重和冠状动脉粥样硬化性心脏病(冠心病)介入治疗水平的不断提高,需要接受冠状动脉旁路移植术(coronary artery bypass grafting,CABG)的老年冠心病患者越来越多.

OBJECTIVE To compare the morphometry and endothelial nitric oxide synthase (eNOS) expression of radial artery (RA) between young and elderly patients with coronary atherosclerotic heart disease. METHODS From February 2008 to June 2009, 219 patients underwent coronary artery bypass grafting (CABG) with autologous RA, 57 patients aged beyond 70 years and 64 patients aged under 60 years. Before RA was harvested, a modified Allen test was routinely performed. If positive, RA would be further evaluated with Doppler ultrasound examination. In both groups RA was collected for HE staining to evaluate percentage of luminal narrowing (LN) and relationship between intima and media width at maximum intimal thickness (IMR). Immunofluorescence and Western blot were used to investigate the location and expression level of eNOS within the wall of RA. RESULTS Morphometry of RA in both young and elderly patients represented mild or moderate intimal hyperplasia, and medial calcification was not found. LN in elderly patients was (22 ± 6)%, while in young patients, it was (23 ± 6)%. IMR in elderly patients was 0.36 ± 0.21, while in young patients, it was 0.42 ± 0.19. There was no significant difference in both LN and IMR between two groups (P > 0.05). Immunofluorescence indicated RA in both groups revealed a high expression of eNOS in intima and media, particularly in the smooth muscle of media. The values of relative integrated optical density in elderly patients was 1.21 ± 0.13, while in young patients, it was 1.25 ± 0.12. Also there was no significant difference in the expression level of eNOS within the wall of RA (P > 0.05). CONCLUSION After preoperative assessment with modified Allen's test and Doppler analysis, RA used as graft in the elderly has similar quality and function with young patients, and it may lead to a high patency in long term.

Objective To observe the expression of integrin-linked kinase(ILK) and matrix metalloproteinases-9(MMP-9) in human non-small cell lung cancer(NSCLC) and investigate the correlation of ILK and MMP-9 expression with the prognosis of NSCLC.Methods The expression of ILK and MMP-9 in 75 specimens of NSCLC resected from January 2002 to January 2004 were detected by immunohistochemistry.According to the median of integral optical density(IOD),all patients were divided into the high or low ILK expression group and the high or low MMP-9 expression group.The relativity of ILK and MMP-9 was determined,and the relationship of survival time with clinical features including expression of ILK and MMP-9 was compared by Log-rank test.Results Both ILK and MMP-9 were expressed in NSCLC specimens.The expression between ILK and MMP-9 was positively correlated in 75 patients of our group(r=0.79,P<0.05).Patients with lower expression of ILK and MMP-9 had a significantly longer survival time than those with higher expression of ILK and MMP-9 in the postoperative follow-up(χ2=15.067,14.301,P<0.05).The survival time was not correlated with sex,age,smoking history or pathological type(χ2=0.450,0.078,1.460,1.623,P>0.05),while tumor diameter,lymph node metastasis,TNM stage,the expression of ILK and MMP-9 significantly influenced the survival time(χ2=3.963,15.169,20.529,15.067,14.301,P<0.05).Conclusion The expression of ILK and MMP-9 affects the prognosis of NSCLC.MMP-9 may advance infiltration and metastasis of tumor cells through ILK pathway.In summary,the expression of ILK and MMP-9 may play an important role in the evaluation of prognosis for patients with NSCLC.

OBJECTIVE:To compare the relief effect of diltiazem, papaverine and nitroglycerin on radial artery spasm in elderly patients with coronary atherosclerotic heart disease. METHODS:Sixty patients aged beyond 70 years underwent coronary artery bypass grafting (CABG) with autologous radial artery from July 2009 to March 2010. Redundant radial artery was collected and the relief function of different drugs was evaluated through "organ bath" technique in vitro. All the patients were randomly divided into 3 groups based on different antispasmodic drugs: diltiazem, papaverine and nitroglycerin. Thirty seconds free blood flow of radial artery and hemodynamic parameters (heart rate, mean arterial pressure and central venous pressure) were assessed before and after intra-radial administration of diltiazem, papaverine and nitroglycerin in vivo. RESULTS:All three drugs could relieve radial artery spasm in different levels and the eventual relief rate was over 80%. Only nitroglycerin could relax radial artery completely, the relief capacity of nitroglycerin, diltiazem and papaverine decreased in order. There was no significant difference in the hemodynamic parameters before and after the injection. Blood flow of radial artery increased in nitroglycerin group [(42 ± 10) ml/30 s vs. (28 ± 7) ml/30 s, P < 0.05] while there was no significant difference in diltiazem [(23 ± 10) ml/30 s vs. (25 ± 8) ml/30 s, P > 0.05] and papaverine group [(25 ± 10) ml/30 s vs. (24 ± 9), P > 0.05]. CONCLUSIONS:Nitroglycerin could relieve vasospasm of radial artery effectively and increased blood flow. Nitroglycerin is the suitable antispasmodic drug for radial artery in the elderly patients with coronary atherosclerotic heart disease compare with diltiazem and papaverine.

The stented elephant trunk technique in aortic arch replacement combined with transaortic stented graft implantation into the descending aorta has been introduced as a means of eliminating the residual false lumen in the descending thoracic aorta and improving long-term outcomes of surgical intervention for Debakey I aortic dissection. This report summarizes the operative and follow-up data with this new procedure. Between August 2004 and May 2009, 28 stented elephant trunk operations were performed for Debakey I aortic dissection at Nanjing First Hospital. A 10 cm long woven Dacron graft was implanted through the aortic arch during hypothermic circulatory arrest. Patent false lumina were evaluated using computed tomography three months after the operation. Mean cardiopulmonary bypass time was 213.2±47.2 min, and selected cerebral perfusion time was 38.8±9.7 min. Hospital mortality was 14.3% (4/28). Thrombus obliteration of the residual false lumen in the descending aorta was observed in 91.7% of the aortic dissections three months postoperatively. The survival rate was 87.5% at five years and the freedom from reoperation rate was 91.7%. Total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective treatment for Debakey type I aortic dissection.

OBJECTIVE To explore the clinical experiences, efficacies and postoperative left ventricular remodeling changes of surgical ventricular reconstruction in the treatment of post-infarction left ventricular aneurysm. METHODS The investigators reviewed retrospectively the clinical data, operative approaches and follow-up outcomes of consecutive 194 patients with post-infarction left ventricular aneurysm, who underwent surgical ventricular reconstruction between January 1997 and December 2009. There were 54 cases in the linear group and 137 cases in the endoventricular patch plasty group. The changes of ventricular remodeling were measured by peri-operative and follow-up echocardiography. RESULTS All patients underwent surgery with a mean cardiopulmonary bypass duration of (103 ± 35) min and aortic cross clamp duration of (62 ± 26) min. There were 8 per-operative deaths with a mortality rate of 2.2%. Angina pectoris of other cases disappeared and heart function greatly improved. After operation, the ventricular remodeling results showed that in the linear group, there was not significant difference in the changes of ventricular remodeling of post-op 2 weeks, 6 months, 1 year and 5 years versus pre-operation. However, in the endoventricular patch group, the changes of ventricular remodeling of post-op 2 weeks and follow-up 6 months versus pre-operation were significantly reduced (P < 0.05). End-systolic volume (LVESV) reduced from (129 ± 27) ml to (65 ± 8) ml and end-systolic volume index (LVESVI) decreased from (104 ± 14) ml/m(2) to (44 ± 6) ml/m(2) and the subgroup of LVEF < 35% was the most significant in the changes of LVESV and LVESVI. But LVEF improved significantly at post-operation and follow-up (from preoperation 42% ± 11% to 52% ± 7% during follow-up). CONCLUSIONS For patients with infarction left ventricular aneurysm, left ventricular reconstruction is quite effective. The choice of operative approaches is determined by the size and range of ventricular aneurysm. Both string suture and endoventricular patch plasty technique can yield similarly satisfactory surgical outcomes. After operation, ventricular volume significantly decreases and cardiac function greatly improves.

Background: Cerebral embolization as a result of aortic manipulation has emerged as an important risk factor for the incidence of stroke after off-pump coronary artery bypass grafting (OPACB).Methods and Results: A new surgical technique for proximal anastomosis without using a side-biting clamp or any proximal anastomotic device in OPACB has been developed and successfully used for proximal anastomosis between a great saphenous vein or radial artery graft and the aorta in OPCAB of 138 patients, with good short-term results.Conclusions: This novel technique proximal anastomosis in OPACB can be completed in a safe, easy and economical fashion. (Circ J 2009; 73: 1342-1343)

OBJECTIVE:To investigate the difference between autologous radial artery (RA) and great saphenous vein (GSV) harvesting in the elderly aged 65 years and older in coronary artery bypass grafting.METHODS:171 patients aged 65 years and older underwent CABG with left internal mammary artery (LIMA), RA and GSV harvesting between January 2004 and June 2008. The harvesting time, length of conduits, intraoperative graft flow and harvest-site complications between RA and GSV was observed and follow-up was performed.RESULTS:A total of 171 RA and 171 GSV grafts were collected. The mean number of distal anastomoses was 3.20 +/- 0. 35. There was no significant difference in harvesting time, length of conduits and intraoperative graft flow between RA and GSV (29 +/- 10 min vs. 28 +/- 8 min, 18.2 cm +/- 1.5 cm vs. 21.3 cm +/- 5.7 cm and 41 ml/min +/- 19 ml/min vs. 34 ml/min +/- 9 m/min, P > 0.05), however, postoperatively,the length of wound healing and the incidence of infection, hematoma, exudation, paresthesia and tumescence of wound in RA was obviously lower than those in GSV (P < 0.05).CONCLUSIONS:Harvesting of RA in the elderly aged 65 years and older was superior to that of SVG and RA might play an more important role in CABG in the elderly.

BACKGROUND:As an increasing number of aging patients are being referred for coronary artery bypass grafting (CABG), the radial artery (RA) has gained increasing popularity as a conduit. The aim of this study was to investigate the effectiveness of RA in CABG for the elderly with coronary heart disease.METHODS AND RESULTS:Three hundred and twenty-six elderly patients underwent CABG with RA harvesting between January 2000 and June 2008. A total of 377 RA as grafts were collected. The mean number of distal anastomoses per patient was 3.1 while the mean for RA was 1.1. The operative mortality was 3.1%. Twenty patients developed atrial fibrillation, 7 experienced acute renal failure, 9 had neurological accidents, and 4 had myocardial infarction. There was no ischemic complication on hand. Paresthesia in the donor hand was found in 2 patients. A complete follow up was obtained in 77.2% of patients, with a mean time of 53.5 +/-35.9 months. RA patency displayed by coronary angiography was 95.83% after a mean time of 74 months of follow up.CONCLUSIONS:It was proven to be safe and effective to use RA as a secondary arterial graft after the left internal mammary artery in the elderly patients.

We describe a case of successful vegetectomy of the aortic valves for early infective endocarditis. An aortic vegetectomy was performed as an alternative to valve replacement for a 54-year-old man with three vegetations and mild regurgitation in aortic valve due to infective endocarditis. Postoperative clinical course was without signs of recurrent infection after follow-up of 19 months, and transesophageal echocardiography demonstrated aortic valve competence. We would suggest that vegetectomy with valve sparing may be a viable option in the context of early infective endocarditis involved aortic valve in selected patients.

目的总结老年冠心病患者行冠状动脉旁路移植术(CABG)中采集桡动脉(RA)后无相关并发症发生的临床经验。方法回顾性分析191例65岁以上老年冠心病患者(男121例,女70例;年龄65～83岁,平均年龄71.0岁)行CABG时运用RA的临床资料,观察围术期取材相关并发症的发生情况。结果RA远端吻合口数为1.30±0.25个/例,获取每支RA时间为25.0±7.5min。术后发生心房颤动14例,行二次开胸止血4例,心肌梗死3例,脑卒中4例,急性肾功能不全5例,急性呼吸功能不全6例。术中未见RA痉挛,术后无切口感染、切口血肿、患肢感觉和运动异常。住院死亡4例(2.1%)。随访187例,随访时间3～12个月,患者均生存,无远期死亡,桡动脉取材侧肢体感觉及运动功能良好。结论老年患者行CABG时采用RA做移植血管,术后并发症少、取材安全,RA在CABG中将发挥越来越重要的作用。

Objective To review the clinical experience and application of intra aortic ballon pump(IABP) in the patients needing emergency coronary artery bypass grafting(eCABG) and explore the proper time and indications of the counterpulsation.Methods Totally 31 cases who receiving IABP before eCABG from March 2000 to August 2008 were subjected.IABP catheter was placed through the internal femoral to aortic artery,and continuous measurement of hemodynamic parameters,including continuous cardiac output(CCO),cardiac index(CI),systolic arterial blood pressure(SABP),mean arterial blood pressure(MABP),and pulmonary capillary wedge pressure(PCWP) during perioperative period were performed.eCABG was carried out on 16 patients with cardiopulmonary bypass and 15 with off-pump.Results Twenty-nine patients were survival,and 2 patients died of multiorgan failure due to long term tracheal incubation.The duration of the IABP assist ranged from 20 to 109 h,with a mean of(32.8±16.9)h.All patients were removed IABP successfully.With the IABP treatment,the CCO,CI,SABP and MABP were significantly increased(P0.05),while PCWP was declined(P0.05).Conclusion IABP can effectively improve the hemodynamic status of patients,and installing IABP before the eCABG improves cardiac function effectively,increases the successful rate of operation,and ensures the usage of the internal mammary artery(or known as internal thoracic artery).

BACKGROUND:Coexistent carotid and coronary artery diseases are common and patients with them remain at a high risk for perioperative stroke or myocardial infarction after coronary bypass surgery. The aim of this study was to investigate the effect of combined carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (CABG) in patients with coexistent carotid and coronary artery diseases.METHODS:Between January 2002 and December 2007, consecutive patients with coexistent carotid and coronary artery diseases underwent one-stage unilateral CEA and off-pump CABG in Heart Institute of Nanjing First Hospital Affiliated to Nanjing Medical University. Perioperative complications were assessed and follow-up was carried out.RESULTS:A total of 51 cases of isolated off-pump CABG and unilateral CEA, including 34 right and 17 left, were performed. The mean blocked time of carotid artery in CEA was (25.5 +/- 7.0) minutes. The mean number of distal grafts per patient was 3.30 +/- 0.45. The mean ventilation time, intensive care unit stay, and postoperative hospital stay was (11.3 +/- 5.4) hours, (2.1 +/- 0.9) days, and (12.5 +/- 6.1) days respectively. None of the patients had stroke or myocardial infarct. There was one perioperative death due to acute cardiac failure, resulting in an operative mortality of 1.96%. Follow-up was completed for 47 patients (92.16%) with a mean follow-up of (39.5 +/- 12.5) months. None of the patients manifested stroke, new angina or newly developed cardiac infarct. No late death occurred.CONCLUSION:Combined CEA and off-pump CABG is a safe and effective procedure in selected patients with coexistent carotid and coronary artery diseases.