Hui-Li Gan

Statins decrease adverse outcomes in coronary artery bypass for extensive coronary artery disease as well as left main coronary stenosis.

The aim of this study was to evaluate the effects of preoperative and postoperative statins on coronary artery bypass grafting (CABG) for extensive coronary artery disease as well as left main coronary stenosis (LMS). The data of 626 cases of extensive coronary artery disease as well as LMS patients in Anzhen Hospital between January 1998 and March 2008 for CABG procedure were retrospectively analyzed, and were classified as preoperative statin therapy group (Group A, n = 320) or preoperative no statin therapy group (Group B, n = 306). Propensity scores were estimated to determine the probability of inclusion into statin therapy group, resulting in the successful matching of 267 pairs. The incidence of in-hospital death, and atrial fibrillation or flutter and disabling stroke was higher in Group B than in Group A. The actuarial freedom from late events at 5 yrs were 98.75%+/- 0.73% for the postoperative statin therapy group and 88.33%+/- 3.71% for the postoperative no statin therapy group respectively, P= 0.000. The logistic regression revealed that CRP (>5.0 mg/L), and elevated Troponin I, and emergent procedure, and preoperative IABP support, and EF < 40% were the independent risk factors, and preoperatively statins was the protective factor for the perioperative death; and the Cox proportional hazard also revealed that preoperative IABP support and preoperative cardiac arrest, and EF < 40% were independent risk factors, and postoperatively statins were the protective factor for the late cardiac events. Preoperative statin therapy could provide protective effect in the perioperative period. Postoperative statin usage could provide protective effect on the late cardiac events.

The Classification and Surgical Strategy of Intracardiac Leiomyomatosis

BACKGROUND There is a great deal of heterogeneity in the surgical strategy to treat intracardiac leiomyomatosis (ICL), leading to a need to create a theoretical tool to clarify this situation. METHODS The data of 14 cases of ICL surgically treated in Anzhen Hospital from February 1995 to February 2009 were retrospectively reviewed. A system for classifying ICL was proposed based on four features of the lesion: size of intracardiac component; extent of inferior vena cava (IVC) involvement; venous pathway from uterus to IVC; and laterality of the lesion in the pelvis. The 14 cases of ICL were treated through multiple surgical strategies. RESULTS There were no operative deaths. The follow-up was 73.1 +/- 59.2 months and one patient died from recurrence due to incomplete excision 5 months after the primary procedure. The 5-year survival rate calculated through Kaplan-Meier survival curve was 93.16 +/- 4.98%. Of the surviving patients, 13 had ICL, 10 were in the New York Heart Association (NYHA) class I, and three were in NYHA class II. CONCLUSION The surgical treatment of ICL can obtain a good mid- to long-term survival rate and satisfactory heart function, and the proposed classification system for ICL may be helpful to guide the selection of the surgical strategy for ICL, and may serve as the future basis for standardising the reporting of ICL management.

Surgical treatment of intracardiac leiomyomatosis

OBJECTIVES Confusion exists regarding surgical algorithms for treating intracardiac leiomyomatosis. This report outlines the surgical management and outcomes of patients with intracardiac leiomyomatosis. METHODS Sixteen cases of intracardiac leiomyomatosis surgically treated in Anzhen Hospital from February 1995 to July 2010 were reviewed retrospectively. According to relative size and location of intracardiac leiomyoma maximum diameter relative to diameter of inferior vena cava, the 16 cases were classified as type A, B, C, or D. RESULTS Of the 16 cases in this series, there were 7 type A, 2 type B, 3 type C, and 4 type D. No patients died during surgery. Mean follow-up was 90 ± 57.1 months (cumulative, 120.2 patient-years; range, 2-190 months). One patient died of recurrence 5 months after the surgery because of incomplete resection. Another patient with type D also died of recurrence 2 years after the primary procedure. A patient with type D died suddenly 10 years after the primary procedure. The 5-year and 10-year survivals calculated by the Kaplan-Meier method were 87.1% ± 8.6% and 72.5% ± 15%. Of the 13 surviving patients, 11 were in New York Heart Association functional class I and 2 were in functional class II. CONCLUSIONS Surgical treatment of intracardiac leiomyomatosis can result in satisfactory midterm to long-term survival and satisfactory heart function. Multiple surgical strategies should be tailored to the anatomic characteristics of the intracardiac leiomyoma. Recurrence of intracardiac leiomyomatosis after the resection procedure may result in unfavorable late result.

Prognosis of Percutaneous Coronary Intervention and Coronary Artery Bypass Grafts for Ostial Right Coronary Lesions in Propensity‐Matched Individuals

OBJECTIVE Our aim was to evaluate the relative safety and efficacy of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus coronary artery bypass grafts (CABG) for the treatment of ostial right coronary stenosis (ORCS) lesions. METHODS Three hundred fifty-nine cases of ORCS lesion were treated via CABG (n = 232) or PCI (n = 127) procedures. Propensity scores for undergoing the CABG procedure were estimated and used to match 105 pairs of patients between the two groups. Kaplan-Meier major adverse cardiac and cerebrovascular events (MACCE)-free curves were constructed to compare long-term MACCE-free survival between the two groups. RESULTS For the 105 propensity-matched pairs, patients were more likely to undergo repeat revascularization with CABG in the PCI group than in the CABG group during the first 30 days (4 cases vs. 0 case, P= 0.043, χ(2) = 4.08) and the 1-year follow-up (5 cases vs. 0 case, P= 0.02, χ(2) = 5.17). With a mean follow-up of 12.04 ± 6.47 months and a total of 210.67 patient-years, the freedom from MACCE in the CABG group was significantly higher than that in the PCI group (Log rank test, χ(2) = 4.48, P= 0.03). There were no significant differences in the rates of death, myocardial infarction, nonfatal stroke, death/myocardium infarction/stroke, or repeated PCI between the two groups during the first 30 days and during the 1-year follow-up period. CONCLUSION For OCRS lesions, CABG provided greater protection than PCI procedure in terms of freedom from MACCE, mainly due to the reduced number of repeated revascularization procedures. CABG should be considered as first-choice revascularization strategy for ORCS lesions.

Ostial left main coronary artery stenosis as an additional risk factor in off-pump coronary artery bypass grafting

BACKGROUND Our aim was to determine whether general left main coronary artery stenosis (LMS) and ostial LMS pose additional risks after off-pump coronary artery bypass grafting (CABG) relative to non-left main coronary artery stenosis. METHODS From January 1, 2008, to December 31, 2009, 4366 patients underwent primary isolated off-pump CABG at Beijing Anzhen Hospital. Disease was retrospectively classified as non-left main disease (n = 3523), nonostial LMS (n = 765), and ostial LMS (n = 78). Groups were propensity score matched. Kaplan-Meier freedoms from major adverse cardiac and cerebrovascular events (MACCEs) were calculated. RESULTS During the first 30 postoperative days, mortality was significantly higher in the ostial LMS group (6.41%) than in non-left main disease (0.855%, χ(2) = 7.78, P = .005) and nonostial LMS (1.28%, χ(2) = 4.71, P = .03) groups. Incidence of MACCEs was significantly higher in the ostial LMS group (20.5%) than in non-left main disease (5.98%, P = .000) and nonostial LMS (9.62%, P = .002) groups. Odds ratio for early MACCEs of ostial LMS versus non-left main disease was 3.74 (95% confidence interval, 1.72-8.17). At mean follow-up 12.8 ± 7.5 months and cumulative follow-up 498.5 patient-years, difference among groups in freedom from MACCEs did not reach statistical significance (χ(2) = 2.39, P = .303). CONCLUSIONS Ostial LMS poses additional early risks of mortality and MACCEs in off-pump CABG. Off-pump CABG for ostial LMS should proceed with greater of intraoperative surveillance and lower threshold for converting to on-pump CABG.