The Clinical Application Of Coronary Artery Bypass Grafting

Objective To summarize the results and experience of coronary artery bypass grafting for coronary artery disease.Methods Between April 1997 and Dec.2003,35patients underwent coronary artery bypass grafting.Male 27(77.1%),female 8(22.9%).coronary artery bypass grafting with extracorporeal circulation in 28 patients(80%),CPB is established with ascending aortic cannulation and placement of a single venous cannula, and carried out under mild hypothermia(32-34℃).Antegrade intermittent cold blood cardioplegia provides adequate myocardial protection,the first graft performed is usually to the inferior circulation,followed by the lateral wall,the diagonal system,and the left anterior descending artery,off-pump coronary artery bypass grafting(OPCAB)in 7 patients(20%),Median sternotomy is the most frequently used route for cardiac access, Once the conduit is obtained,the CTS retractor is positioned inferiorly in the sternal incision.Deep pericardial traction sutures elevate and rotate the heart,Stabilization of the target vessel for the anastomosis can be obtained either by using a OctopusⅡPlusstabilizer, A misted carbon dioxide blower and a intracoronary shunt are also employed,the first graft performed is usually to the left anterior descending artery,followed by the inferior circulation,the lateral wall,,and the diagonal system.There were 19 patients(54.3%) with myocardial infarction,22 patients(62.9%) with unstable angina pectoris,20 patients(57 %) with triple-vessel disease,and 2 patients(5.8%)urgent surgery.The mean left ventricular ejection fraction was(55.3±6.2)%.Results The number of distal anastomosis was 2.7,IMA was used in 33 patients(94.3%)and radial artery was used in3patients(8.6%),6 patients(17.1%) was combined with concomitant valve operation. There were 3 pastoperative deaths with hospital mortality of 8.8%.,1 patients(2.9 %)died of sudden cardiac death,2 patients(5.8%)died of congestive heart failure.The morbidity included 2(5.8%)reopen for bleeding,1(2.9%)pulmonary dysfunction,6(17.1%)fast atrial fibrillation,IABP was used in 2 patients(5.8%).There were no pastoperative death in patients combined with concomitant valve operation and There were no pastoperative death in patients with OPCAB.Conclusions Reasonable patient choice,advanced operative methods,excellent myocardial protection and perioperative treatments are important factors,the efficacy and safety of coronary artery bypass grafting are satisfactory.