Background:
Vein graft occlusion is deemed a major challenge in coronary artery bypass grafting. Previous studies implied that the no-touch technique for vein graft harvesting could reduce occlusion rate compared with the conventional approach; however, evidence on the clinical benefit and generalizability of the no-touch technique is scare.
Methods:
From April 2017 to June 2019, we randomly assigned 2655 patients undergoing coronary artery bypass grafting at 7 hospitals in a 1:1 ratio to receive no-touch technique or conventional approach for vein harvesting. The primary outcome was vein graft occlusion on computed tomography angiography at 3 months and the secondary outcomes included 12-month vein graft occlusion, recurrence of angina, and major adverse cardiac and cerebrovascular events. The generalized estimate equation model was used to account for the cluster effect of grafts from the same patient.
Results:
During the follow-up, 2533 (96.0%) participants received computed tomography angiography at 3 months after coronary artery bypass grafting and 2434 (92.2%) received it at 12 months. The no-touch group had significantly lower rates of vein graft occlusion than the conventional group both at 3 months (2.8% versus 4.8%; odds ratio, 0.57 [95% CI, 0.41–0.80];
P
<0.001) and 12 months (3.7% versus 6.5%; odds ratio, 0.56 [95% CI, 0.41–0.76];
P
<0.001). Recurrence of angina was also less common in the no-touch group at 12 months (2.3% versus 4.1%; odds ratio, 0.55 [95% CI, 0.35–0.85];
P
<0.01). Rates of major adverse cardiac and cerebrovascular events were of no significant difference between the 2 groups. The no-touch technique was associated with higher rates of leg wound surgical interventions at 3-month follow-up (10.3% versus 4.3%; odds ratio, 2.55 [95% CI, 1.85–3.52];
P
<0.001).
Conclusions:
Compared with the conventional vein harvesting approach in coronary artery bypass grafting, the no-touch technique significantly reduced the risk of vein graft occlusion and improved patient prognosis.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03126409.
Introduction:Left main coronary artery (LMCA) atresia is a quite rare congenital malformation, which may present with various symptoms. Past literatures were sporadic without recent summary of world-wide cases. We hereby report an adult case of LMCA atresia with concomitant mitral regurgitation and also summarize all cases found in published literatures.Case presentation:A 48-year old female presented with sudden dyspnea. Preliminary impression was acute heart failure caused by mitral regurgitation. Preoperative coronary angiography demonstrated that there was no left coronary ostium and multiple collateral vessels arising from right coronary artery. The diagnosis of left main coronary atresia was made and the patient received successful valvuloplasty and coronary artery bypass grafting with left internal mammary artery anastomosed to the left anterior descending (LAD) artery. She recovered well and 3-month follow-up showed the graft was patent.Conclusion:This case highlights the importance of angiography for diagnosis of LMCA and performance of CABG once diagnosed.
For CCTGA children with degraded mLV, the two-stage double switch procedure can be performed with low mortality and morbidity and may be an appealing alternative to conventional repair. mLV retraining should be performed as early as possible. The second-stage atrial-arterial switch procedure showed satisfactory early and mid-term results. More attention should be paid to the long-term function of the mLV and the aortic valve.
Foreign body ingestion is a common presentation in the emergency room. However, the complication such as penetrating renal trauma due to sharp objects ingestion is relatively rare. We herein describe an unusual case of penetrating renal trauma in the absence of any other urinary symptoms. A 53-year-old man who had a history of iron wire ingestion went to our hospital, on examination, he only had slight abdominal tenderness due to swallowing a ball pen and 1 cap nut 1 day before, radiological imaging showed penetrating renal trauma, the blood test showed his renal function is normal. Surgical strategies were recommended to remove the pen and the iron wire simultaneously, nonetheless the patient eventually agreed to only receive surgical removal of the swallowed ball pen and cap nut, meanwhile leave the kidney untreated. During 30 months follow-up by phone and regular outpatient examination, he recovered unevenly and had no special complaint. Such cases remind us that chronic penetrating renal trauma due to foreign object ingestion may have no obvious symptoms. It is easily to be neglected. We should try to minimize the possibility of missed lesions by adhering to a meticulous examination technique.
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