Clinical Study On The Effect Of Coronary Endarterectomy On The Patency Of Bypassed Vessels And Animal Experiments On The Development Of "suture-free" Biological Valve

Purpose:Through observation and comparison,Coronary Artery Bypass Grafting(CABG)combined with Coronary Endarterectomy(CE)was accepted.In the treatment of patients with Diffuse Coronary Artery Disease(DCAD),the differences in bypass vessel status and patency rate of each target in the early and middle stages after surgery;Through analysis and exploration,it may affect the implementation of Coronary Artery Bypass Grafting(CABG)combined with Coronary Endarterectomy(CE).In the treatment of Diffuse Coronary Artery Disease(DCAD),in the early and middle stages after surgery,risk factors affecting bypass vessel status and bypass vessel patency rate in the target of each target;Through observation and comparison,Coronary Artery Bypass Grafting(CABG)combined with Coronary Endarterectomy(CE)was implemented.Different types of antiplatelet drug regimens adopted after surgery for patients with Diffuse Coronary Artery Disease(DCAD).Analyze the effect of antiplatelet drug therapy methods under different schemes on bridging vessel status and bridging vessel patency rate of each target.Method:The patient case database for this study was taken between January 2018 and December 2019;National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences;The clinical data of 92 patients(92 cases)who had undergone Coronary Artery Bypass Grafting(CABG)combined with Coronary Endarterectomy(CE)were analyzed;In this study,a patient case database was established,of which eighty patients(80 cases)were enrolled after surgery(30 days or more after surgery).From December 2019 to September 2020,Coronary CT Angiography(CTA)examinations were performed in the surgical sites and target bypass vessels through outpatient or telephone follow-up.The scientific method of this study is a retrospective study.According to the patient case database established in this study,case-control study was adopted for postoperative follow-up of patients.According to the patient case database established in this study,whether Coronary artery vessels of each target of bypass surgery had undergone Coronary Endarterectomy(CE)surgery,It is used to treat Diffuse Coronary Artery Disease(DCAD).The patient case database established in this study was divided into the Coronary Artery Bypass Grafting(CABG)group(also,the CABG-NOCE group),And in the Coronary Artery Bypass Grafting and Coronary Endarterectomy(CABG&CE)group(also,the CABG-CE group).Each bypass vessel used in this study,namely CABG-CE group bypass vessel and CABG-NOCE group bypass vessel,was divided into veins(Great Saphenous Vein,Great Saphenous Vein,Great Saphenous Vein,Great Saphenous Vein,GSV)bridging vein(V),or Artery(Internal Mammary Artery;Radial Artery,Radial Artery,RA)bridge vessel(A).Through analysis and comparison,in this study,the targets of the two groups of bypass surgery,the different surgical treatment methods(CABG-NOCE group,CABG-CE group),and the target targets of different bypass surgery were selected as bridging vessels(vein bridging vessels,artery bridging vessels).After the completion of the surgery,the early,middle and long term,To explore and study the risk factors that affect the patency rate of the vessels of the target targets of each bypass operation.In the case database established in this study,all patients received resistant platelet therapy after surgery to prevent reocclusion and reocclusion after bypass surgery.There were three different regiments of resistant platelet therapy:aspirin alone(A),ticagrelor combined with aspirin(B),and clopidogrel combined with aspirin(C).Based on the patency status of the surgical targets followed up after hand surgery,the effect of different resistant platelet drug regimens and different antiplatelet drug therapies on bridging vessel status and bypass vessel patency rate of each target target was an alyzed and compared.Result:In this study,the median follow-up time for early and mid-stage patients was 18 months(range,4-28 months).In this study,a total of 130 vein bridging vessels(V)were used in CABG-NOCE group among the bypass vessels in the early and mid-stage patients;After the operation,there were 112 venous bridging vessels with patency after coronary artery CT examination(CTA)(patency rate,86.15%);A total of 44 arterial bridge vessels(A)were used.After the operation,there were a total of 39 arterial bridge vessels with patency after coronary artery CT examination(CTA)(patency rate,88.64%).In CABG-CE group,a total of 42 venous bridge vessels(V)were applied.After the operation,there were a total of 30 venous bridging vessels with patency after coronary artery CT examination(CTA)(patency rate,71.43%);A total of 46 arterial bridge vessels(A)were used.After the operation,there were a total of 40 arterial bridge vessels with patency after coronary artery CT examination(CTA)(patency rate,86.96%).The patency rate of bypass vessels was compared between the two groups(CABG-NOCE group:CABG-CE group).There was a significant difference in the patency rate of venous bypass vessels(V)(CABG-NOCE-V group,patency rate,86.15%;CABG-CE-V group,71.43%,P=0.0360);No significant difference was found in patency of arterial bridge vessel(A),which was not statistically significant(CABG-NOCE-A group,patency rate,88.64%;CABG-CE-A group,89.96%,P=0.8077).In this study,the multi-factor Logistic regression method was adopted,Various possible preoperative and postoperative risk factors for coronary artery bypass grafting combined with endarterectomy were comprehensively included.The risk factors of coronary artery bypass grafting combined with coronary endarterectomy for different bridging vessel types,early and middle patency rates were discussed respectively in three cases of artery bridging vessel,vein bridging vessel,and all artery and vein bypass vessels.For all venous bypass vessels,in this study,whether to combine the implementation of different cardiac surgical procedures(OR,3.630:95%CI,1.258-10.472;P=0.0171);Whether patients were complicated with hyperlipidemia after surgery(OR,0.221;95%CI,1.258-10.472;P=0.0313);Whether the target vessels of the patients were combined with coronary endarterectomy(OR,0.186;95%CI,0.060-0.582;P=0.0038).Within the scope of all venous bypass vessels in this study,the above three included considerations showed significant differences,with statistical significance.For all artery bypass vessels in this study,no significant differences were found among the included considerations within the scope of all artery bypass vessels,which was not statistically significant.For all bypass vessels,in this study,whether patients with postoperative hyperlipidemia(OR,0.344;95%CI,0.120-0.988;0.0475);Whether the target vessel of the patient's surgery was combined with coronary endarterectomy(OR,0.317;95%CI,0.125-0.804;P=0.0155),the above two included considerations showed significant differences in the scope of venous bypass vessels in this study,which was of statistical significance.Coronary artery CT(CTA)results were obtained by postoperative follow-up,and further analysis was made in combination with the antiplatelet drug regimen used by the patient.Among patients treated with ticagrelor or aspirin(B),a statistically significant difference was found in the patency rate of venous bypass vessels(CABG-NOCE-V-B group,patency rate,100.00%;CABG-CE-V-B group,71.43%,P=0.0.0005).Conclusion:In order to treat Diffuse Coronary Artery Disease(DCAD),Coronary Artery Bypass Grafting was implemented.Coronary Endarterectomy(CE)combined with CABG had more effect on the patency of the venous bridge in the early and middle stages after the operation.Purpose:Through observation and comparison,Coronary Artery Bypass Grafting(CABG)combined with Coronary Endarterectomy(CE)was accepted.In the long-term post-operation situation of patients with Diffuse Coronary Artery Disease(DCAD)treated,the differences between venous bypass vessel status and patency rate of each target were analyzed;Through analysis and exploration,it may affect the implementation of Coronary Artery Bypass Grafting(CABG)combined with Coronary Endarterectomy(CE).In the treatment of Diffuse Coronary Artery Disease(DCAD),the long-term risk factors of venous bypass vessel status and vascular patency rate of each target after operation are analyzed;Through observation and comparison,Coronary Artery Bypass Grafting(CABG)combined with Coronary Endarterectomy(CE)was implemented.Different types of antiplatelet drug regimens adopted after surgery for patients with Diffuse Coronary Artery Disease(DCAD).Analysis of different schemes,anti-platelet therapy,postoperative long-term,the venous bypass vessel status of each target target,venous bypass vessel patency rate.Method:The patient case database for this study was taken between January 2009 and December 2019;National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences;In all cases,those who had undergone Coronary Artery Bypass Grafting(CABG)combined with Coronary Endarterectomy(CE),A total of 172 patients(172 cases)were enrolled;In this study,172 patients(172 cases)were enrolled in a patient case database after surgery(30 days after surgery).From December 2019 to September 2020,the patients underwent Coronary CT Angiography(CTA)surgery through outpatient or telephone follow-up,and showed the status and patency of the venous bypass vessels of all target subjects in the long term.The scientific method of this study is a retrospective study.In view of the patient case database established in this study,the self-control study was adopted for postoperative follow-up of patients.According to the patient case database established in this study,whether Coronary artery vessels of each target of bypass surgery had undergone Coronary Endarterectomy(CE)surgery,It is used to treat Diffuse Coronary Artery Disease(DCAD)The patient case database established in this study was divided into the Coronary Artery Bypass Grafting(CABG)group(also,the CABG-NOCE group),And in the Coronary Artery Bypass Grafting and Coronary Endarterectomy(CABG&CE)group(also,the CABG-CE group),There are two different types.For each bypass vessel in this study,CABG-CE group or CABG-NOCE group,the type of bypass vessel used is the Great Saphenous Vein(GSV)bridge vessel(V).Through analysis and comparison,the targets of bypass surgery in the two groups in this study,the different surgical treatment methods(CABG-NOCE group,CABG-CE group),the long-term status of the target vessels of each bypass surgery after the completion of the operation,To explore and study the risk factors that affect the patency rate of various target bridging targets.In the case database established in this study,all patients received resistant platelet therapy after surgery to prevent the bypass surgery,and the vein bypass vessels were obstructed and occluded again.There were three different regiments of resistant platelet therapy:aspirin alone(A),ticagrelor combined with aspirin(B),and clopidogrel combined with aspirin(C).Through the follow-up after hand surgery,the long-term status of venous bypass vessels and the patency status of venous bypass vessels of each target were obtained after operation.Analyze and compare the effects of different resistant platelet drug regimens and different antiplatelet drug therapies on the vascular status and vascular patency of venous bypass of various targets.Result:In this study,the median follow-up time for long-term patients was 34 months(range,3 to 121 months).In this study,a total of 123 vein bridging vessels(V)were used in CABG-NOCE group in long-term patients.After the operation,a total of 108(87.80%)of the venous bridging blood vessels were patency after coronary artery CT examination(CTA).A total of 123 vein bridge vessels(V)were applied in CABG-NOCE group.After the operation,a total of 83(67.48%)of the venous bridging blood vessels were patency after coronary artery CT examination(CTA).Two different surgical procedures were performed simultaneously on the same type of bypass vessel(vein bridge vessel,V)in the same patient(CABG-NOCE;CABG-CE group),and there was a significant difference in the patency rate of the venous bypass vessels of the surgical target(CABG-NOCE-V group,patency rate,87.80%;CABG-CE-V group,67.48%,P=0.0001).The results of CTA were further analyzed by postoperative follow-up.Significant differences in venous bypass vessel patency were found between the combination of ticagrelor and aspirin(B)and clopidogrel and aspirin(C)antiplatelet regiments(CABG-NOCE-V-B,96.88%;CABG-CE-V-B group,81.25%,P=0.0452);(CABG-NOCE-V-C group,patency rate,88.24%;CABG-CE-V-C group,61.76%,P=0.0004).Conclusion:In order to treat Diffuse Coronary Artery Disease(DCAD),Coronary Artery Bypass Grafting was implemented.In the case of Coronary Artery Bypass Grafting(CABG),the incidence of Coronary Artery Bypass Grafting(CABG)was higher than that in the case of Coronary Artery Bypass Grafting(CABG).In the long term after operation,the patency rate of venous bridge vessels is more affected.OBJECTIVES:Valvular heart disease is a common heart disease in adults.Valvular replacement is the most common treatment.With the growth of the population and the aggravation of aging,there will be more elderly patients with valvular diseases in the near future.Valve replacement requires suture of 12-15 stitches,which undoubtedly increases the operation time.Therefore,it is of great benefit to improve the surgical method of replacement and shorten the time of cardiopulmonary bypass for elderly high-risk patients with other diseases.However,the design of the prosthetic valve,which is already used in the clinic,has limited the development of the replacement surgery to be less invasive and easier to operate.At the same time,prolonged cardiopulmonary bypass is not only an independent risk factor for death in elderly patients,but also increases the cost of surgery and aggravates the burden of patients.Therefore,the design,development and testing of new suture-free prosthetic valves are very important for the development of valve replacement.We have independently developed and designed a new type of suture-free artificial biological valve,and applied for and obtained the national invention patent.It is of great scientific and instructive significance to the treatment of clinical valvular diseases.METHODS:1.According to the clinical needs,based on the "sutureless" artificial valve design already in clinical application at the present stage,with the support of 3D printing technology,the design and development of a new"no-suture" new biological valve from the main creation;2.Through the preclinical animal experiments of healthy mature small-tailed Han sheep,the safety and effectiveness of the self-innovated"unsutured" new biological flap were initially verified.Blood physiological and biochemical indexes and echocardiogram results were monitored.After the end point of the experiment,pathological anatomy was performed on the gross organs of the experimental animals,and pathological sections were made under light microscope and electron microscope to evaluate the histocompatibility of the self-innovated "sutureless" biological valve.RESULTS:The vital signs of small-tailed Han sheep were stable,and no iatrogenic death occurred.Postoperative complications such as severe infection,severe bleeding,thromboembolic disease,circulatory hemodynamic disturbance and other cardiac surgery fields,valve replacement surgery,perioperative and postoperative complications were not found.After the implementation of this new "unsutured" prosthetic valve replacement,the routine blood examination and common physiological function indexes of blood of healthy small-tailed Han sheep were used in the experiment,and no significant abnormal situation occurred.The results of color Doppler ultrasonography of the heart of two healthy small-tailed Han sheep in the experiment showed that there was no significant abnormality in the hemodynamic function indexes of the circulatory system of the healthy small-tailed Han sheep.Coronary Endarterectomy is an important procedure,performed adjunctive to the Coronary Artery Bypass Grafting,for purpose of solving the Diffuse Coronary Artery Disease,assuring a complete revascularization of the myocardium,and to prevent residual ischemia.Introduced in the 1950s,the Coronary Endarterectomy started as a treatment option for the diffusely diseased coronary arteries.In the early days,compared with the alone Coronary Artery Bypass Grafting,the Coronary Endarterectomy was initially associated with an increased operative morbidity and mortality.Nowdays,as the latest development of surgical technique and perioperative management have improved the surgical effect of the coronary endarterectomy.However,At the present,it is still uncertain for the prognosis after Coronary Endarterectomy(CE),there is also no unified guideline available for the antiplatelet or anticoagulation therapy.In this review article,we sought to briefly discuss the current situation and the perspective of the Coronary Endarterectomy.