Long-dated Follow-up Of Coronary Artery Bypass Grafting

Coronary Heart Disease is a great threaten to man-kind health, whichpeople had done an untiring research on rebuilding the blood supply of themyocardium. With no doubt, Coronary Artery Bypass Grafting is one of greatinventions in the human History of Medicine.In1946, Vineberg carried out the first Internal Mammary Artery myocardialImplantation, which was fashionable but had obvious defect, because itneeded a long-term to rebuild the collateral circulation; In1964, Garrett wasforced to anastomose ascending aorta and anterior descending branch withgreat saphenous vein; from1967`s first successful CABG created by Favaloro,Coronary Artery Bypass Grafting had become world-acknowledged effectivesolution for CHD.However, CABG itself has some problems. In1977, world1`s firstPercutaneous Transluminal Coronary Angioplasty was made and CoronaryStent was applied to the clinical treatment which medical interventiontechnology sets a great challenge to CABG, so CABG chooses more patientswho have advanced age, multiple vessels lesion and comprehensive stenosis,congestive cardiac failure, left main stem lesion, acute hemorrhage caused byaborted PTCA, severe ventrical arrhythmia, severe angina pectoris out ofcontrol, emergency operation or combined with valvular heart disease, and thedifficulty steps into a higher level. As a result, the incidence rate ofcomplication and mortality has raised to some extent.Of course, the prevalence of CABG is inevitable, as off-pump CABG getspopular, minimally invasive CABG is to come into being because of demand,even so robot-subordinate CABG is reported. Proficiently handling thelong-dated effectiveness of patients after the operation is essential to everysurgeon, what is why we do the follow-up.We follow up the patients after operation for the long-dated clinical result, to estimate therapeutic effect, to help analyzing operation indication, merit anddemerit and to guide us that how to help patients to live through theperoperative period. Finally the purpose is to promote the quality of life,extent lifetime and comprehend the condition roundly.Objective:1Handle the basic methods of follow-up by referring to case history andenacting the rating scales.2Master the preoperative state (basic disease, heart condition, auxiliaryexamination, operation indication) and the announcements of preoperativeperiod.3Discuss and analyze the connection between data and operation and howmuch they are related, in order to find out factors influencing the prognosis,compare this among patients thus observe the effect.4Make the statistical analysis on the factors and roundly estimate theeffectiveness of CABG.Method:1The way is the Telephone: collect the case history of patients whose date ofhospitalization is from January.2006to December.2010(275in all).2Establish data base: enter related information and data of the patients.3Investigate documents: seek index about CABG from domestic and foreignheart disease association, determine the contents, reflect the status, provideinformation for reference.4Items of rechecking: ECG, UCG, coronary artery CT, blood test ofbiochemistry (myocardial enzyme, hepatic function, renal function,electrolytes, blood glucose, blood fat).5Analyze the data base: enact the table, find out the related connection.6Make the statistical treatment.Results:The operations are275in total, actually270are followed up, in which16are died(perioperative period or discharge from hospital). Complication:19reappearance of angina pectoris,6myocardial infarction,20congestive heart failure,19arrhythmia,6renal insufficiency,3second time operation,12hemorrhage events(anticoaugulant complication),14cerebrovascular events.There is3admissions to hospital second time, the mortality is5.92%, thesurvival rate is94.02%, the first-year-complication rate is12.12%, andfive-year is13.13%. All the patients take medicine orally and regularly,including nitroglycerin,β blocker inhibitors,calcium channel blocker,anticoagulants, antiplatelet drug,antilipemic agents. The restenosis rate is7.196%, the patency rate is93.904%, ECG,ultrasonic cardiogram and bloodbiochemistry do not prompt nomal in most patients.Conclusion:Investigation about follow-up indicates the patients who has the operationgets a well survival rate in the department of cardiac surgery in the secondaffiliated hospital of Hebei Medical University and the operation is effectiveand reliable solution to CHD. It is certified that the incidence rate ofcomplication can be reduced by taking medicine orally and regularly, five-yearsurvival rate can be increased too. So CABG is a effective method of savingserious people and improving quality of life.