Aim: We investigated the Results of coronary artery bypass grafting (CABG) performed on non-dialysis patients with renal dysfunction at our hospital. Methods: Fourteen hundred and eighty-two patients who underwent isolated CABG between January 2007 and December 2018 were classified into 3 groups: C-group (544 non-dialysis patients with stage 3a-5 chronic kidney disease [CKD]); N-group (785 patients with stage 1-2 CKD identified as those with normal renal function); and H-group (153 hemodialysis patients). A propensity score matching was performed, we compared 1050 cases of the matched 525 cases between the C-group and the N-group, and 264 cases of 132 cases between C- group and H-group, respectively. Results: In surgical mortality, no significant difference was observed between the C-group and the N-group/the H-group and even after matching. In hospital mortality rate, the C-group was significantly higher than the N-group (p=0.002), but there was no significant difference between the C-group and the H-group (p=0.122). After the matching, in-hospital mortality was significantly higher than in N-group (p=0.014) and significantly lower than in H-group (p=0.019). In long-term postoperative results, the C-group was worse than the N-group, but better than the H-group and even after matching. The survival rates in descending order by CKD stage were N-group, stage 3a, stage 3b, and stage 4/stage 5/H-group, with a significant difference. The long-term postoperative survival rates in stage 4, stage 5, and H-group were all equivalent. Conclusion: There was no significant difference in surgical mortality from C-group compared with N-group or H-group. In long-term postoperative outcomes, the C-group was worse than the N-group, but better than the H-group. However, the long term result of CKD stage 4 and 5 may have poor results comparable to those in the dialysis patients.
Objective: In coronary artery bypass grafting (CABG), we perform proximal anastomosis of the free right internal thoracic artery (RITA) on the hood of the saphenous vein graft (SVG) close to its aortic anastomosis. Our aim was to assess the operative results of CABG using a free RITA and the related flow measurement data. Patients and methods: We retrospectively reviewed 24 patients who underwent solitary CABG using a free RITA proximally anastomosed to a SVG. We measures graft flow after completing all anastomoses, with stable hemodynamics. We recorded the mean flow in the free RITA before and after clamping the SVG, and in the flow of SVG before and after free RITA clamping. Results: The mean (± standard deviation) number of reconstructed coronary arteries using a free RITA was 1.6 ± 0.6. Twenty-one patients underwent angiography, and all RITAs were patent. The average mean free RITA flow was 42.4 ± 18.0 mL/min. In two patients, free RITA flow was < 20 mL/min, and both patients received a free RITA individual graft for a coronary artery with low-grade proximal stenosis. We performed clamping tests in 20 patients and found no significant difference between mean flows in the free RITAs with and without SVG clamping and in the SVGs with and without free RITA clamping. Conclusion: The free RITA and SVG grafts did not affect each other regarding mean flow measurements. The proximal site of SVG is an acceptable proximal anastomotic site for a free RITA. The coronary artery with severe proximal stenosis is recommended as a target of the free RITA.
Objective: Delirium is a morbid and costly problem. Though melatonin receptor agonist (Ramelteon) is also reported to decrease delirium, the effect of orexin receptor antagonist (Suvorexant) is unclear. We examine the effectiveness of Suvorexant in decreasing postoperative delirium in comparison with Ramelteon retrospectively. Materials and methods: We reviewed 138 patients (29 women, mean age 69.7 ± 3.4 years) who underwent coronary artery bypass grafting (CABG) alone. Patients have divided into three groups; patients received orexin receptor antagonist (S-group, n=45), patients received melatonin receptor agonist (R-group, n=26), and patients not received neither orexin receptor antagonist nor melatonin receptor agonist (N-group, n=67), and the following data were analyzed in three groups. Results: Intensive Care Unit Delirium Screening Checklist Score was significantly lower in S-group compared with N and R-group (N: S: R=2.4 ± 2.0: 0.9 ± 1.1: 2.2 ± 1.4, p<0.001). Although POD was present in two patients (4.4%) in S-group, seven patients (26.9%) in R-group and twenty patients in N-group (29.9%) developed (p=0.002). In S-group, hospital stay (N: S: R=23.6 ± 8.9: 18.8 ± 2.9: 20.7 ± 4.4 days, p=0.005) was significantly shorter than in R and N-group. Conclusion: Orexin receptor antagonists has shown positive outcomes in the prevention of delirium after CABG. Large trials are necessary to further comparing the efficacy of Suvorexant to other sleep modulating options.
75-year-old female was admitted to our hospital from a distant region due to rest angina and syncope. She had been medicated as an atypical chest pain or ischemic heart disease for 20 years in the neighborhood hospitals. She complained of chest pain mainly at rest and sometimes had syncope. Although coronary arteriography including the ergonovine spasm provocation test was performed once time, she was not diagnosed as coronary spastic angina. After the internet search, she was admitted to our hospital to investigate her chest symptom and syncope. Pharmacological spasm provocation tests including acetylcholine or ergonovine provoked two vessel spasm. Her chest symptoms improved after the administration of another coronary vasodilator. If cardiologists had no solid technology about pharmacological spasm provocation tests, there are less cardiologists who are familiar with coronary spasm in the future especially even in Japan.
Distal thromboembolism can develop in patients with acute myocardial infarction, but is rare in non-culprit lesions. Here, we report a case of acute myocardial infarction in which myocardial damage may have been caused by thrombi originally located in the non-culprit lesion. An 81-year-old woman presented with back pain and was diagnosed with ST-segment elevation acute myocardial infarction. Emergency coronary angiography demonstrated total occlusion in the mid-portion of the left anterior descending coronary artery and severe stenosis in the mid-portion of the right coronary artery. Collateral flow to the right coronary artery from the first septal perforator of the left anterior descending coronary artery, which branched before the total occlusion of the left anterior descending coronary artery, was observed. After recanalization of the left anterior descending coronary by thrombus aspiration, thrombi originally located in the right coronary artery migrated to the distal part. Myocardial imaging with thallium-201 and technetium-99m-pyrophosphate showed damaged but viable myocardium in the inferior wall of the mid-left ventricle.