High volume practice proved the safety of off-pump coronary artery bypass surgery in left main coronary artery lesions： a two-year single center experience

Background Left main coronary artery （LMCA） stenosis has been recognized as a risk factorfor early death among patients undergoing coronary artery bypass grafting （CABG）. This study aimed to assess if LMCA lesions pose an additional risk of early or mid-term mortality and/or a major adverse cardiac and cerebrovascular event （MACCE） after off-pump coronary artery bypass grafting （OPCABG）, compared with non-left main coronary artery stenosis （non-mainstem disease）.

Live three-dimensional transesophageal echocardiography in mitral valve surgery

Background Live three-dimensional transesophageal echocardiography （live-3D-TEE） is a new technique, but its clinical value is unclear at present. This study aimed to investigate the feasibility, imaging quality and accuracy of live-3D-TEE for assessing mitral valve morphology to determine if live-3D-TEE has important value in mitral valve surgery.Methods Twenty-four patients with mitral valve disease （mean age （47.1±11.6） years, mean weight （64.7±10.5） kg） underwent live-3D-TEE and two dimensional transesophageal echocardiography （2D-TEE） before and after mitral valve surgery. Sensitivity, specificity, and total consistency rates of live-3D-TEE for diagnosing ruptured chordae were calculated and compared to surgeon＇s findings. We also compared the diagnostic accuracy of mitral valve disease between live-3D-TEE and 2D-TEE.Results Live-3D-TEE allowed visualization of the anatomic structure of the heart online and clearly identified the valvular apparatus and their defects. Sensitivity and specificity for the detection of ruptured chordae by live-3D-TEE were 87.5% and 100% respectively, and the total consistency rate was 95.8%. Additional defects not diagnosted by 2D-TEE were found in three cases （12.5%） preoperatively by live-3D-TEE. Live-3D-TEE could evaluate the function of prosthetic or native valves immediately after operation. One case was re-repaired （4.2%） using guidance by live-3D-TEE.Conclusion Live-3D-TEE enabled evaluation of mitral valve function and provided adequate valuable information before and after mitral valve surgery. We conclude that live-3D-TEE can play an important role in mitral valve surgery.

Outcome of surgical treatment of post-traumatic tricuspid insufficiency

Objective： To investigate the optimal time and procedure of surgical treatment of traumatic tricuspid insufficiency. Methods： From May 1984 to September 2004, eight patients underwent operation for traumatic tricuspid valve insufficiency. All patients, male, aged from 7 to 67 years [ median： 38 years, mean： （ 38.5 ± 18. 1 ） years ]. The intervals between trauma and operation ranged from 1 month to 20 years [median： 19 months, mean： （52.5 ± 80.3） months） ]. In seven patients, tricuspid insufficiency was attributed to blunt chest trauma including vehicle accident in three patients and the other patient is a stab wound. Diagnosis was confirmed by echocardiography. Pre-operative cardiac functions in patients were classified as New York Heart Association （NYHA） classes Ⅱ-Ⅳ. During operation, the anterior leaflet of the tricuspid valve was completely or partially flailed as a result of chordal rupture in all patients. Chordal rupture of septal leaflet was found in one patient. Anterior leaflet was perforated in two patients. Septal leaflet was retracted and adherent to ventricular septum in two patients. Valve repair was intended for all patients. Finally, valve repair was performed successfully in 3 patients and tricuspid replacement was performed in 5 patients. Results： No early or late death occurred. With a follow-up through clinical manifestation and echocardiography for 7-129 months [median： 39 months, mean： （53.4 ± 42.8 ） months ], all patients were classified as NYHA class Ⅰ, without any changes. Conclusions： The satisfactory treatment of traumatic tricuspid insufficiency can be obtained by surgical treatment. Earlier surgery may increase the feasibility of tricuspid valve repair and prevent the deterioration of right ventricular function.

What can we learn from cases of internal mammary artery damage in coronary artery bypass graft?

From July 1997 to April 2017, 286 cases of internal mammary artery (IMA) damage were recorded out of the 10,360 coronary artery bypass graft (CABG) operations with IMA harvest, with an incidence up to 2.7%, which is relatively high. The main reason for such high incidence might be the surgeons’ experience and the learning curve. Although one surgeon (Huang FJ) performed all these operations, the cases were operated in many different hospitals, and more than 200 surgical assistants who were young and inexperienced harvested the IMA.

Relationship between heart rate and failure of biological valve： slowing the heart rate could delay the failure of biological valve？

For the patients with a relatively slow heart rate, the frequency of opening and closing of biological valves and the number ot impact ot mecnamcai stress upon biological valves were relatively less, so the mechanical wear was reduced. The question is whether this can slow the failure and calcification of the biological valve. A retrospective analysis replacement （MVR） cases was carried out. of 92 biological mitral valve during the period of 1996-2003