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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 2, March/April 2017
78
AFRICA
internal mamarian artery (RIMA) and the radial artery were
prepared as arterial grafts, whereas the great sapheneous vein
was used as a venous graft.
The total genomic DNA in the patients’ peripheral whole
blood samples was isolated using GenXtract solution according to
the manufacturer (Vienna-Lab Diagnostic GmbH). Afterwards,
target DNA regions were amplified with multiflex polymerase
chain reaction (PCR) using biotinylated primers, and amplified
products were controlled with 3% agorose gel. After observing
the amplicons belonging to the test strip containing immobilised
allele-specific nucleotide probes on nitrocellulose membrane using
CVD strip assay (Vienna-Lab Diagnostic GmbH), a hybridisation
process was performed with profiblot T48 (Tecan) hybridisation
instruments. Bound biotinylated sequences were detected using
streptavidin-alkaline phosphatese and colour substrates.
Statistical analysis
Statistical analysis was performed using SPSS software version
12.0 (SPSS Inc, Chicago, IL, USA). Numerical parameters are
expressed as mean, median and standard deviations.
Results
Mean age of the patients was 26.35
±
3.51 (19–30) years, and 90%
were male (
n
=
18) (Table 1). More than half of the patients had
normal body mass index (BMI), and all had an urban lifestyle.
Detailed medical information was gathered about familial and/
or sporadic diseases, personal history, habits and family history
(Table 2). One patient had diabetes, three had hypertension, 11
(55%) had dyslipidaemia, and 16 (80%) were smokers. Eight of
the patients (40%) had a left ventricular ejection fraction (LVEF)
<
50%, and functional capacity was poor in only two (10%)
patients (NYHA III–IV).
The stents of the two patients who had coronary angioplasty
and were operated on for stent re-stenosis, had been implanted
one and five months earlier due to acute myocardial infarction.
Isolated CABG was performed in 19 patients, whereas right
CABG was performed concomittantly with aortoplasty in only
one patient due to aortic stenosis (Table 3). Cardiac stabilisation
without perfusion, using various techniques of cardiac arrest
(off-pump CABG), was performed in seven out of 11 patients
with single-vessel bypass surgery and two out of three patients
with dual-vessel bypass surgery. Other patients were operated on
under cardiopulmonary bypass (CPB).
Isothermic hyperkalaemic blood cardioplegia was used for
cardiac arrest. Mitral protection was provided by inducing
moderate hypothermia and antegrade and/or the administration
of blood cardioplegia. Bypass was performed with the LIMA
flap to the left anterior descending artery (LAD) in all patients
except three; two patients with peripheral artery disease due to
vasculitis, and one who had right CABG surgery only. Bypass
Table 1. Demographic characteristics of the patients
Age (mean
±
SD), years
26.35
±
3.51 (19–30)
Gender
Male,
n
(%)
18 (90)
Female,
n
(%)
2 (10)
BMI, kg/m
2
,
n
(%)
> 30
3 (15)
20–30
14 (70)
<
20
3 (15)
Geographical region
Rural,
n
(%)
0 (0)
Urban,
n
(%)
20 (100)
SD: standard deviation; BMI: body mass index.
Table 2. Baseline characteristics of patients
Patient characteristics
Number of patients Percent
Hypertension
3
15
Diabetes
1
5
Hyperlipidaemia
11
55
Familial
5
25
Vasculitis
Takayasu arteritis
2
10
Carotid artery disease
2
10
Positive family history
7
35
Smoking
16
80
Alcohol use
3
15
Echocardiography
LVEF > 50%
12
60
LVEF
<
50%
8
40
Valvular pathology
4
20
Coronary angiography
Single-vessel disease
10
50
Dual-vessel disease
3
15
Multi-vessel disease
7
35
NYHA
I–II
18
90
III–IV
2
10
Previous MI
6
30
Previous interventions
CABG
0
0
PTCA/stent
2
10
Renal insufficiency
0
0
Chronic pulmonary diseases
1
5
LVEF: left ventricular ejection fraction; NYHA: NewYork Heart
Association; MI: myocardial infarction; CABG: coranary artery bypass
grafting; PTCA: percutaneous transluminal coranary angioplasty.
Table 3. Surgical information
Surgery
Number of patients
Isolated CABG
19
Off-pump
9
On-pump
11
Total perfusion time (mean
±
SD), min
65.6
±
24.6
Aortic cross-clamp time (mean
±
SD), min
42
±
22.3
Number of vessels with bypass surgery
Single
11
Double
3
Multiple
6
Graft type
LIMA
17
RIMA
1
Radial artery
1
Saphaneous vein
19
CABG: coranary artery bypass grafting; SD: standard deviation;
LIMA: left internal mammary artery; RIMA: right internal mammary
artery.