Peri-operative application of intra-aortic balloon pumping reduced in-hospital mortality of patients with coronary artery disease and left ventricular dysfunction / 中华医学杂志(英文版)

BACKGROUND@#There are few reports of peri-operative application of intra-aortic balloon pumping (IABP) in patients with coronary artery disease (CAD) and different grades of left ventricular dysfunction. This study aimed to analyze the early outcomes of peri-operative application of IABP in coronary artery bypass grafting (CABG) among patients with CAD and left ventricular dysfunction, and to provide a clinical basis for the peri-operative use of IABP.@*METHODS@#A retrospective analysis of 612 patients who received CABG in the General Hospital of People's Liberation Army between May 1995 and June 2014. Patients were assigned to an IABP or non-IABP group according to their treatments. Logistic regression analysis was performed to investigate the influence of peri-operative IABP implantation on in-hospital mortality. Further subgroup analysis was performed on patients with severe (ejection fraction [EF] ≤ 35%) and mild (EF = 36%-50%) left ventricular dysfunction.@*RESULTS@#Out of 612 included subjects, 78 belonged to the IABP group (12.7%) and 534 to the non-IABP group. Pre-operative left ventricular EF (LVEF) and EuroSCOREII predicted mortality was higher in the IABP group compared with the non-IABP group (P < 0.001 in both cases), yet the two did not differ significantly in terms of post-operative in-hospital mortality (P = 0.833). Regression analysis showed that IABP implantation, recent myocardial infarction, critical status, non-elective operation, and post-operative ventricular fibrillation were risk factors affecting in-hospital mortality (P < 0.01 in all cases). Peri-operative IABP implantation was a protective factor against in-hospital mortality (P = 0.0010). In both the severe and mild left ventricular dysfunction subgroups, peri-operative IABP implantation also exerted a protective role against mortality (P = 0.0303 and P = 0.0101, respectively).@*CONCLUSIONS@#Peri-operative IABP implantation could reduce the in-hospital mortality and improve the surgical outcomes of patients with CAD with both severe and mild left ventricular dysfunction.

Optimal Timing of Surgical Revascularization for Myocardial Infarction and Left Ventricular Dysfunction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The optimal timing of surgical revascularization for patients presenting with ST-segment elevation myocardial infarction (STEMI) and impaired left ventricular function is not well established. This study aimed to examine the timing of surgical revascularization after STEMI in patients with ischemic heart disease and left ventricular dysfunction (LVD) by comparing early and late results.</p><p><b>METHODS</b>From January 2003 to December 2013, there were 2276 patients undergoing isolated coronary artery bypass grafting (CABG) in our institution. Two hundred and sixty-four (223 male, 41 females) patients with a history of STEMI and LVD were divided into early revascularization (ER, <3 weeks), mid-term revascularization (MR, 3 weeks to 3 months), and late revascularization (LR, >3 months) groups according to the time interval from STEMI to CABG. Mortality and complication rates were compared among the groups by Fisher's exact test. Cox regression analyses were performed to examine the effect of the time interval of surgery on long-term survival.</p><p><b>RESULTS</b>No significant differences in 30-day mortality, long-term survival, freedom from all-cause death, and rehospitalization for heart failure existed among the groups (P > 0.05). More patients in the ER group (12.90%) had low cardiac output syndrome than those in the MR (2.89%) and LR (3.05%) groups (P = 0.035). The mean follow-up times were 46.72 ± 30.65, 48.70 ± 32.74, and 43.75 ± 32.43 months, respectively (P = 0.716). Cox regression analyses showed a severe preoperative condition (odds ratio = 7.13, 95% confidence interval 2.05-24.74, P = 0.002) rather than the time interval of CABG (P > 0.05) after myocardial infarction was a risk factor of long-term survival.</p><p><b>CONCLUSIONS</b>Surgical revascularization for patients with STEMI and LVD can be performed at different times after STEMI with comparable operative mortality and long-term survival. However, ER (<3 weeks) has a higher incidence of postoperative low cardiac output syndrome. A severe preoperative condition rather than the time interval of CABG after STEMI is a risk factor of long-term survival.</p>

Robotic surgery versus conventional open chest surgery for heart tumor: a propensity score matching analysis / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare conventional open chest surgery and robotic surgery for their efficacy, short?term outcomes and patient selection in the treatment of heart tumors. Method The clinical data were collected from 225 patients (a total of 228 operations) who underwent cardiac neoplasm resection in our hospital between January, 1993 and April, 2016. A propensity score matching (PSM) was established according to the vital baseline data of the patients receiving conventional open chest surgery (n=125) and robotic surgery (n=60) after screening. The patients were matched for propensity into 60 pairs, and the efficacy, short?term outcomes and patient selection were compared between the two groups.</p><p><b>RESULTS</b>Before PSM, the patients in conventional surgery group had significantly greater tumor size (P<0.001) and a higher proportion of patients with New York Heart Association functional class III and IV (P<0.001). The patients' baseline data were nearly balanced (P=0.982) between the two groups after matching. No significant differences were found between the two groups in cardiopulmonary bypass time (P=0.256), crossclamp time (P=0.862), in?hospital mortality (P=1.000), arrhythmia (P=1.000), delayed mechanical ventilation (>24 h; P=0.209), thoracic complications (P=0.611) or systemic embolism (P=1.000). The survival rates were 100% in both groups in the 6?month follow?up after the operation, and no significant difference was found between the two groups in the incidence of major adverse cardiac and cerebrovascular events within 6 months (P=0.438).</p><p><b>CONCLUSION</b>Robotic heart tumor resection has a favorable efficacy with a good short?term prognosis, and can serve as an alternative for treatment of solitary lesions in low?risk patients receiving operations for the first time.</p>

Effects of Surgical Ventricular Restoration on Left Ventricular Shape, Size, and Function for Left Ventricular Anterior Aneurysm / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Surgical ventricular restoration (SVR) has been performed to treat left ventricular (LV) aneurysm. However, there is limited analysis of changes in LV shape. This study aimed to evaluate the changes in LV shape induced by SVR and the effects of SVR on LV size and function for LV aneurysm.</p><p><b>METHODS</b>Between April 2006 and March 2015, 18 patients with dyskinetic (dyskinetic group) and 12 patients with akinetic (akinetic group) postinfarction LV anterior aneurysm receiving SVR with the Dor procedure at Chinese People's Liberation Army General Hospital were enrolled in this study. A retrospective analysis was carried out using data from the echocardiography database. LV shape was analyzed by calculating the apical conicity index (ACI). LV end-diastolic volume index, end-systolic volume index, and ejection fraction (EF) were measured. One-way analysis of variance was used to compare means at different time points within each group.</p><p><b>RESULTS</b>Within one week after SVR, LV shape became more conical in the two groups (ACI decreased from 0.84 ± 0.13 to 0.69 ± 0.11 [t = 5.155, P = 0.000] in dyskinetic group and from 0.73 ± 0.07 to 0.60 ± 0.11 [t = 2.701, P = 0.026] in akinetic group; LV volumes were decreased significantly and became closer to normal values and EF was improved significantly in the two groups). On follow-up at least one year, LV shape remained unchanged in dyskinetic group (ACI increased from 0.69 ± 0.11 to 0.74 ± 0.12, t = -1.109, P = 0.294), but became more spherical in akinetic group (ACI significantly increased from 0.60 ± 0.11 to 0.75 ± 0.11, t = -1.880, P = 0.047); LV volumes remained unchanged in dyskinetic group, but increased significantly in akinetic group and EF remained unchanged in the two groups.</p><p><b>CONCLUSIONS</b>SVR could reshape LV to a more conical shape and a more normal size and improve LV function significantly early after the procedure in patients with dyskinetic or akinetic postinfarction LV anterior aneurysm. However, LV tends to be more spherical and enlarged in the akinetic group on at least 1-year follow-up.</p>

Long-term outcomes of off-pump coronary artery bypass grafting in patients aged over 75 years / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the long-term outcomes of off-pump coronary artery bypass grafting (OPCAB) in patients aged over 75 years and analyze the risk factors affecting the outcomes of the procedure.</p><p><b>METHODS</b>Clinical data were reviewed for 97 consecutive patients aged 75 years or above receiving OPCAB at our center between November, 2000 and November, 2013. The perioperative data including length of ICU stay, duration of mechanical ventilation, incidence of postoperative complications and mortality rate of the patients were analyzed. The follow-up data of the patients were also analyzed including all-cause mortality rate and major adverse cardiac and cerebral events (MACCE, including myocardial infarction, cerebrovascular event, and repeated revascularization).</p><p><b>RESULTS</b>The perioperative mortality rate was 3.09% (3/97) in these patients. Of the 97 patients analyzed, 91 (93%) were available for follow-up for 29-192 months (with a median of 95.61∓34.07 months). The 10-year survival rate of the patients was 62% with a 10-year MACCE-free survival rate of 47.4%. During the follow-up, 6 (6.8%) patients underwent repeated revascularization procedures, 12 (12.37%) had cerebrovascular accidents and 5 (5.15%) had myocardial infarction. Logistic regression analysis showed that hypertension (OR=1.388, P=0.043) and diabetes (OR=1.692, P=0.017) were independent predictors of MACCE, and incomplete revascularization did not increase the risk of postoperative MACCE.</p><p><b>CONCLUSION</b>OPCAB is safe and effective in elderly patients with good long-term outcomes. Hypertension and diabetes are independent risk factors of MACCE, and adequate control of blood pressure and blood glucose can reduce the incidence of postoperative MACCE. Incomplete revascularization is not detrimental to the long-term outcomes of OPCAB in elderly patients.</p>

Surgical ventricular restoration versus isolated coronary artery bypass grafting for left ventricular aneurysm: comparison of mid- to long-term outcomes / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the mid- to long-term outcomes of patients receiving isolated coronary artery bypass grafting (CABG) versus surgical ventricular restoration (SVR) plus CABG for left ventricular aneurysms.</p><p><b>METHODS</b>The clinical data were retrospectively analyzed in 205 patients with left ventricular aneurysms admitted to our hospital between January, 1997 and December, 2012, including 115 patients receiving SVR plus CABG and 90 undergoing isolated CABG. By matching preoperative echocardiographic parameters including aneurysm size, left ventricular ejection fraction (LVEF), left ventricular end-systolic volume index (LVESVI) and EuroSCORE risk factors, 32 patients receiving SVR plus CABG and another 32 with isolated CABG were enrolled in this study. The patients were compared for survival rates, major adverse cardiac or cerebrovascular events (MACCEs), left ventricular geometry and function at 1, 3 and 5 years of follow-up.</p><p><b>RESULTS</b>Compared with the patients receiving isolated CABG, those receiving SVR and CABG showed greater improvements in echocardiographic parameters and NYHA functional class. The differences in the echocardiographic parameters between the two groups gradually reduced with time and became comparable at 5 years after the operation (P>0.05). No significant difference was found in the mid- to long-term survival or the incidence of MACCEs between the two groups (P>0.05).</p><p><b>CONCLUSION</b>Compared with isolated CABG, SVR plus CABG does not reduce the incidence of MACCEs or improve the mid- to long-term survival rate of patients with left ventricular aneurysm with a LVESVI <60 mL/m(2).</p>

Different approaches to revascularization for complex coronary artery disease and left ventricular dysfunction: analysis of perioperative outcomes / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the perioperative outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of complex coronary artery disease and left ventricular dysfunction.</p><p><b>METHDOS</b>The clinical data of 966 patients admitted to our hospital from January 2003 to December 2013 with coronary artery disease and left ventricular dysfunction (ejection fraction ≤50%) were retrospectively reviewed. Among the patients, 386 underwent CABG and 580 received PCI. After matching for EuroSCORE risk factors and preoperative echocardiographic parameters, 135 patients with CABG and 135 with PCI were enrolled in this study. With hospital mortality and perioperative major complications as the endpoints, the early outcomes of the procedures were evaluated. Perioperative echocardiography was performed to evaluate the change of left ventricular geometry and function.</p><p><b>RESULTS</b>Compared with CABG group, PCI group had significantly higher incidences of chronic lung disease (8.1% vs 0.7%, P=0.003) and recent myocardial infarction (64.4% vs 31.9%, P=0.000) but significantly lower left-main disease (12.6% vs 23.7%, P=0.018); the other baseline characteristics were comparable between the two groups. Patients with CABG had a greater number of treated target vessels than those with PCI (2.90±0.81 vs 1.67±0.73, P=0.000), and complete revascularization was more common in CABG group (94.8% vs 51.8%, P=0.000). No significant difference was found in perioperative variations of LVEF between the two groups, but patients with CABG had a greater variation in LVEDD than those with PCI. The hospital mortality and other major complications were similar between the two groups.</p><p><b>CONCLUSION</b>Both CABG and PCI are safe and reliable revascularization strategies for complex coronary artery disease and left ventricular dysfunction, but CABG can achieve a higher rate of complete revascularization and better improves the left ventricular function.</p>

Echocardiographic Follow-up of Robotic Mitral Valve Repair for Mitral Regurgitation due to Degenerative Disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Mitral valve (MV) repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation (MR). However, there has been limited information regarding the echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV.</p><p><b>METHODS</b>A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients (79.8%), artificial chordae in 20 (23.8%), and ring annuloplasty in 79 (94.1%). Eighty-one (96.4%) of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up.</p><p><b>RESULTS</b>At a median echocardiographic follow-up of 36.0 months (interquartile range 14.3-59.4 months), four patients (4.9%) developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 (Z = -8.456, P < 0.001), LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm (t = 15.131, P < 0.001), LVEDD from 51.0 ± 5.0 to 43.3 ± 2.2 mm (t = 14.481,P< 0.001), and LVEF from 67.3 ± 7.0% to 63.9 ± 5.1% (t = 4.585, P < 0.001).</p><p><b>CONCLUSION</b>Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up.</p>

Ultrasound-guided cannulation of the internal jugular vein in robotic cardiac surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Robotic assisted minimally invasive cardiac sugery is a new technique that uses small port sites and peripheral vessel cannulation for cardiopulmonary bypass (CPB) has been used. The right internal jugular vein (IJV) is commonly used for intraoperative venous access to the central circulation and identified with an external landmark. Previous studies have demonstrated the superiority of ultrasound guidance over external landmark technique in anaesthetic and intensive care settings. The aim of the present study was to delineate the utility of ultrasound-guided cannulation of the IJV during establishment of peripheral CPB in robotic cardiac surgery.</p><p><b>METHODS</b>We prospectively studied 296 adult patients undergoing ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery at our institute from January 2007 to October 2012 (ultrasound group). The success rate, the first attempt success rate, access time and the complication rate of ultrasound-guided method were compared with the landmark-guided method used for 302 historical control patients (landmark group).</p><p><b>RESULTS</b>In the ultrasound group, 296 consecutive adult patients underwent ultrasound-guided right IJV cannulation during establishment of peripheral CPB in robotic cardiac surgery. In the landmark group, 302 patients underwent right IJV cannulation using the landmark-guided technique. The success rate and the frst attempt success rate in the ultrasound group were significantly higher than that in the landmark group (100% vs. 88.1%, P < 0.000 and 98.6% vs. 38.4%, P < 0.000). Average access time in the ultrasound group was shorter than that in the landmark group ((6.3 ± 13.6) seconds; interquartile range (4 - 62) seconds vs. (44.5 ± 129.5) seconds; interquartile range (5 - 986) seconds). The complication rate in the ultrasound group was significantly lower than that in the landmark group (0.3% vs. 8.3%, P < 0.000).</p><p><b>CONCLUSION</b>Compared with the landmark-guided approach, ultrasound-guided cannulation of the right IJV significantly improves success rate, decreases access time and reduces complication rate during establishment of peripheral CPB in robotic cardiac surgery.</p>

Clinical factors influencing surgical approach selection of robotic-enhanced minimally invasive coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate clinical factors that influence the selection of minimally approach between minimally invasive direct coronary artery bypass (MIDCAB) and totally endoscopic coronary artery bypass (TECAB).</p><p><b>METHODS</b>From February 2007 to January 2013, patients were selected under uniform criteria. A total of 202 patients including 142 male and 60 female patients with age range from 33 to 80 years and average age of (59 ± 10) years were included and were all routinely prepared for TECAB. Either TECAB or MIDCAB was performed based on the intraoperative condition. There were 90 patients who underwent TECAB (TECAB group) and 112 patients who received MIDCAB surgery (MIDCAB group). Univariate analysis was used to compare preoperative, intraoperative and early postoperative parameters. Logistic multivariate regression analysis was used to discuss independent influencing factors of minimally invasive approach selection.</p><p><b>RESULTS</b>All of the patients successfully received TECAB or MIDCAB surgery without mortality, severe complications or conversion to sternotomy. The early and midterm follow up of graft patency (by computed tomography angiography) was satisfactory. The mean operative time was (160 ± 64)minutes, mean graft flow was (27 ± 18) ml/min. Univariate analysis showed that sex ratio (3.5 vs.1.8, t = 4.350, P = 0.037), weight [(69 ± 11)kg vs.(72 ± 11)kg, t = -1.979, P = 0.049], multivessel coronary disease (43.3% vs.60.7%, t = 6.051, P = 0.014), and learning curve case (4.4% vs.14.3%, t = 5.418, P = 0.02) were significant predictors of conversion to MIDCAB. By multivariate analysis, multivessel coronary disease (HR = 1.964, 95%CI: 1.049-3.680, P = 0.035) and learning curve case (HR = 4.538, 95%CI: 1.219-16.891, P = 0.024) were independent influencing factors of MIDCAB approach.</p><p><b>CONCLUSIONS</b>Robotic-assisted minimally invasive coronary artery bypass grafting can be performed safely and effectively either by TECAB or MIDCAB. Multivessel coronary disease and early learning curve cases are independent influencing factors of minimally invasive approach selection.</p>

Surgical treatment with modified Morrow procedure in hypertrophic obstructive cardiomyopathy / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of ventricular septal myectomy (modified Morrow procedure) in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>METHODS</b>From June 2003 to March 2011, 38 patients (26 male and 12 female) with HOCM underwent modified Morrow procedure. The mean age was 36.3 years (ranging from 18 to 64 years). The diagnosis was made by echocardiography and spiral CT. The mean systolic gradient between the left ventricle and the aorta from transthoracic echocardiography (TTE) was (89±31) mmHg (ranging from 50 to 184 mmHg, 1 mmHg=0.133 kPa) before operation. There was moderate or severe systolic anterior motion (SAM) in 38 cases and mitral regurgitation in 29 cases. Ventricular septal myectomy with modified Morrow procedure was performed in all 38 cases. TEE was used intraoperatively to evaluate the results of the surgical procedures. After 1 to 2 weeks of operation, TTE was performed to evaluate the effect of operation. All patients were followed up with TTE after operation.</p><p><b>RESULTS</b>All patients were discharged without complications. Intraoperative TEE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from (95±36) mmHg before procedures to (14±11) mmHg after operation (t=13.265, P=0.000), and the thickness of ventricular septum was decreased from (28±8) mm to (12±3) mm (t=11.656, P=0.000). TTE showed that the mean systolic gradient between the left ventricle and the aorta was decreased from (89±31) mmHg preoperatively to (18±13) mmHg (t=12.729, P=0.000) in 1 to 2 weeks after operation. Mitral regurgitation and SAM were significantly improved or disappeared (t=7.930, t=5.213, both P=0.000). During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only and syncope was abolished, and TTE showed that the pressure gradient was kept on the postoperative level or slightly decreased (P=0.494).</p><p><b>CONCLUSIONS</b>Ventricular septal myectomy with modified Morrow procedure is a mostly effective method for patients with HOCM. Good surgical exposure and the hypertrophied septum thoroughly excised are paramount for successful surgery.</p>

Transesophageal echocardiography guided cannulation for peripheral cardiopulmonary bypass during robotic cardiac surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Minimally invasive cardiac surgery and closed chest cardiopulmonary bypass (CPB) techniques continue to evolve. Previous reports have demonstrated the benefits of fluoroscopy guided cannulation for endovascular CPB during port access cardiac surgery. However, few data are available on the role of transesophageal echocardiography (TEE) guided cannulation for peripheral CPB during robotic cardiac surgery. The purpose of this study was to evaluate TEE guided cannulation for peripheral CPB during robotic cardiac surgery.</p><p><b>METHODS</b>We performed a retrospective analysis of intraoperative data of 129 consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB from September 2007 to August 2011, which was established using femoral arterial inflow and kinetic venous drainage by way of the femoral vein and right internal jugular vein and a transthoracic aortic cross clamp. TEE was used to guide cannulation of the inferior vena cava (IVC), superior vena cava (SVC), and ascending aorta (AAO). The success rate and the complication rate of TEE guided cannulation for peripheral CPB were evaluated and compared with the results of fluoroscopy guided cannulation in a historical control group.</p><p><b>RESULTS</b>One hundred and twenty-nine consecutive patients underwent robotic cardiac surgical procedures requiring peripheral CPB. There were 67 female (51.9%) and 62 male (48.1%) patients, ranging in age from 13 to 70 years (mean (43.94 ± 13.82) years) and body surface area 1.32 to 2.39 m(2) (mean (1.71 ± 0.20) m(2)). Some 61 (47.3%) patients underwent mitral valve repair, 27 (20.9%) mitral valve replacement, 27 (20.9%) left atrial myxoma removal, and 14 (10.9%) ventricular septal defect repair. Of the 129 patients, TEE guided cannulation of the IVC or SVC was successful in all patients (100%), and no puncture related complications occurred in all patients. Of the 129 patients, successful cannulation of the AAO was achieved in all patients (100%), and aortic perforation occurred in 1 patient (0.78%) under TEE guidance. Of the 42 patients in the historical control group, successful cannulation occurred in 39 patients (92.86%), and major complications occurred in 3 patients (7.14%) under fluoroscopy guidance. TEE guided cannulation of the AAO significantly improved success rate (100% vs. 92.86%, P = 0.014) and decreased complication rate (0.78% vs. 7.14%, P = 0.046).</p><p><b>CONCLUSION</b>TEE may be useful in guiding successful placement of the cannulae in the IVC, SVC, and AAO in the establishment of peripheral CPB during robotic cardiac surgery.</p>

Impact of prior percutaneous coronary intervention on outcome of coronary artery bypass graft surgery / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To determine the impact of prior percutaneous coronary intervention (PCI) on outcome of coronary artery bypass graft (CABG) surgery.</p><p><b>METHODS</b>Perioperative data were collected from 1306 patients undergoing CABG from January 2002 to November 2010, including 117 patients with prior PCI and 1 189 patients without prior PCI. Among 117 patients with prior PCI, 99 patients had a single PCI procedure and 18 had multiple PCI procedures. The surgical outcomes including in-hospital mortality and major adverse cardiac events were compared between two groups.</p><p><b>RESULTS</b>Patients with prior PCI were younger, less likely to have triple vessel and left main stem disease, and less recent myocardial infarction. Interval time between PCI and CABG was (13.39 ± 13.81) months. There were no significant difference in in-hospital mortality (1.7% compared with 0.5 % P=0.156) and major adverse cardiac events (including postoperative myocardial infarction, stroke, and in-hospital death,2.6% compared with 1.1% P=0.167) between two groups.</p><p><b>CONCLUSION</b>There was no association between prior PCI and isolated CABG. Good outcomes can be obtained in the group of patients undergoing CABG who have had previous PCI.</p>

Early and midterm outcomes of coronary artery bypass grafting in octogenarians / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the early and midterm postoperative outcomes and analyze risk factors of coronary artery bypass grafting (CABG) in octogenarians.</p><p><b>METHODS</b>Clinical data of 38 patients aged 80 years or greater receiving isolated coronary artery bypass grafting from September 2001 to November 2010 were reviewed. There were 33 male and 5 female patients, aging from 80 to 87 years with a mean of (82.6 ± 1.2) years. Twelve patients underwent conventional (on-pump) CABG and 26 patients underwent off-pump CABG. The number of bypass grafts was 1 to 5 (mean 2.5 ± 1.1). Left internal mammary artery was used in 37 (97.3%) patients.</p><p><b>RESULTS</b>The perioperative mortality was 2.6% (1/38). Postoperative complications included stroke (4 cases), respiratory infection (1 case). The atrial arrhythmias occurred in 25 patients. Intensive care unit and hospital length of stay lasted (3.8 ± 1.4) days and (15 ± 6) days, respectively. Totally 38 patients were followed up for 4 to 70 months. Six patients died during the follow-up period. The 92.6% patients recovered without any cardiac events.</p><p><b>CONCLUSIONS</b>Isolated CABG can be performed safely with acceptable postoperative morbidity and mortality in octogenarians. Appropriate surgical strategy and intensive perioperative treatment must be enhanced in octogenarians who underwent CABG.</p>

Clinical analysis of robotic mitral valve repair / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the safety and efficacy of robotic mitral valve repair using da Vinci S Surgical system. Method From January 2007 to April 2011, over 400 cases of robotic cardiac surgery have been performed, in which 60 patients with isolated mitral valve insufficiency underwent robotic mitral valve repair, including 42 male and 18 female patients with a mean age of (44 ± 13) years (ranging from 14 to 70 years). Forty-eight patients were in NYHA class I-II and 12 patients in class III. Fourteen patients were concomitant with atrial fibrillation. Surgery approach was achieved through 4 right chest ports with femoral perfusion and Chitwood aortic occlusion. Antegrade cold blood cardioplegia was administered directly via chest for myocardial protection. The transesophageal echocardiography was used intraoperatively to estimate the surgical results.</p><p><b>RESULTS</b>All patients had successful valve repair including quadrangular resections, sliding plasties and chordal replacement. There was no conversion to median sternotomy. The mean cardiopulmonary bypass and arrested heart time were (132 ± 30) min and (88 ± 22) min. One patient had hemolysis after operation, and required mitral valve replacement. Echocardiographic follow-up revealed trace to mild regurgitation in 2 patients with a mean of (16 ± 9) months.</p><p><b>CONCLUSION</b>Robotic mitral valve repair is safe and efficacious in the patients with isolated mitral valve insufficiency.</p>

Robotically assisted coronary artery bypass grafting on beating heart / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the safety and efficiency of robotically assisted coronary artery bypass grafting (RACABG) on beating heart using da Vinci S system.</p><p><b>METHODS</b>From January 2007 to March 2011, 105 patients underwent RACABG on beating heart through minithoracotomy. There were 77 male and 28 female patients, aged from 33 to 77 years with a mean of (59 ± 10) years. After establishment of single left lung ventilation, the 3 trocars of da Vinci system were inserted into the left hemithorax, and robotic system was used to harvest the left internal mammary artery (LIMA) and/or right internal mammary artery (RIMA) from the subclavian vein to the internal mammary artery (IMA) bifurcation with skeletonized technique. After positioning the stabilizer, the LIMA was anastomosed manually to the left anterior descending or diagonal branch sequentially on beating heart through left minithoracotomy. The graft flow was evaluated by the Doppler flow meter after anastomosis was completed, and the graft patency was also evaluated by CT angiography or arteriography after surgery.</p><p><b>RESULTS</b>All patients had successful RACABG on the beating heart, and the mean graft flow was (21 ± 13) ml/min. One patient suffered from cardiac arrest after the first postoperative day, but he recovered soon and CT angiography showed that graft was patent. One patient with preoperative stroke had postoperative pulmonary infection, and was discharged after treatment. After 4 to 5 days, 4 patients received stent placement in right coronary artery or circumflex coronary in distinct hybrid session. There were no deaths or stroke or reintervention. All patients were discharged without complications and followed up. CTA or angiography revealed patent grafts in all patients, and the mean time of follow-up was (30 ± 12) months.</p><p><b>CONCLUSIONS</b>Robotically assisted coronary artery bypass grafting on beating heart can be performed safely using da Vinci S system. It is a new advanced approach of revascularization not only for patients with single vessel but with multi-vessel lesions as well.</p>

Inhibitory effect of fluvastatin on lysophosphatidylcholine-induced ventricular arrhythmias in rats / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the effect of fluvastatin on lysophosphatidylcholine (LPC)-induced ventricular arrhythmias and its mechanism.</p><p><b>METHODS</b>Twenty male SD rats were randomly allocated into two equal groups, namely LPC treatment group and fluvastatin pretreatment group. Langendorff apparatus was used for cardiac perfusion ex vivo with 5 µmol/L LPC for 5 min followed by washing for 30 min in LPC treatment group, and in fluvastatin pretreatment group, a 30-min perfusion with 10 µmol/L fluvastatin was administered before LPC perfusion. The LPC-induced nonselective cation current (I(NSC)) in the ventricular myocytes was recorded using the whole-cell voltage-clamp method.</p><p><b>RESULTS</b>Fluvastatin significantly inhibited LPC-induced ventricular tachyarrhythmia/fibrillation and I(NSC). The small G-protein Rho inhibitor (C3) and Rho-kinase inhibitor (Y-27632) in the pipette solution also suppressed LPC-induced I(NSC).</p><p><b>CONCLUSION</b>Fluvastatin offers cardiac protection against LPC by inhibiting LPC-induced I(NSC). LPC induces fatal arrhythmia via a Rho/Rho-kinase-mediated pathway.</p>

Effects of peri-operative intra-aortic balloon pump support in high EuroSCORE patients undergoing cardiac surgery / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the effects of perioperative intra-aortic balloon pump (IABP) support in EuroSCORE high-risk patients undergoing cardiac surgery, and evaluate the risk factors associated with mortality and midterm survival.</p><p><b>METHODS</b>Fifty-eight patients with EuroSCORE of no less than 6 underwent cardiac surgery and received peri-operative IABP support, including 29 with preoperative IABP support, 21 with intra-operative IABP support, and 8 with postoperative IABP support. The patients who survived the surgeries were followed up for at least 1 year.</p><p><b>RESULTS</b>Complications related to IABP support occurred in 2 cases (3.45%). The in-hospital mortality was 6.89% (4/58) in this series. Patients with intra-operative IABP had a lower ejection fraction, and those with pre-operative IABP showed more frequent unstable angina and recent myocardial infarction. The number of emergency procedures was also significantly higher in patients with pre-operative IABP support. Patients with intra- or postoperative IABP support had a longer ICU stay. The 1-year follow-up was completed in 54 patients and 4 deaths were recorded, with a 1-year survival of 86.21%. The 1-year survival rate was significantly higher in patients with preo- and intra-operative IABP support than those with post-operative IABP.</p><p><b>CONCLUSION</b>Peri-operative IABP support benefit cardiac support for cardiac surgery, and its preoperative use does not increase the surgical risk. Early prophylactic IABP support according to the EuroSCORE can improve the outcome of the high-risk cardiac surgery.</p>

Totally robotic mitral valve surgery in 60 cases / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of robotic mitral valve surgery using da Vinci S system.</p><p><b>METHODS</b>We conducted a retrospective review of 60 robotic mitral surgeries from March 2007 to December 2010. Of the 60 patients, 44 underwent mitral valve repair and 16 received mitral valve replacement. The surgical approach was through 4 right chest ports with femoral and internal jugular vein cannulations. Transesophageal echocardiography was used intraoperatively to estimate the surgical results.</p><p><b>RESULTS</b>None of the cases required a conversion to a median sternotomy. The mean cardiopulmonary bypass and cardiac arrest time was 132.2∓29.6 min and 88.1∓22.3 min for robotic mitral valve repair, and was 137.1∓21.9 min and 99.3∓17.4 min for robotic mitral valve replacement. Echocardiographic follow-up of all the patients revealed 3 cases of slight regurgitation in mitral valve repair group.</p><p><b>CONCLUSION</b>In selected patients with mitral valve disease, robotic mitral surgery can be performed safely.</p>

Prosthesis-patient mismatch in the mitral valve position: the initial result of a single-institutional observational study in China / 中华外科杂志

<p><b>OBJECTIVE</b>To analysis the causes of valve prosthesis-patient mismatch (PPM) after mitral valve replacement in Chinese patients.</p><p><b>METHODS</b>Consecutive 100 patients for elective mitral valve replacement from January 2009 to June 2009 were enrolled and followed for this study. There were 37 males and 63 females. The mean age at operation was (52 ± 9) years (ranging 32 to 76 years). The predominant mitral valve lesion was stenosis in 60 patients, regurgitation in 14 patients and mixed in 26 patients. Among them, 63 patients were combined tricuspid valve regurgitation. Mitral valve effective orifice area was measured by Doppler echocardiography in 100 patients who received mitral valve replacement and indexed for body surface area (EOAI). PPM was defined as not clinically significant if the EOAI was above 1.2 cm(2)/m(2), as moderate if it was >0.9 and ≤ 1.2 cm(2)/m(2), and as severe if it was ≤ 0.9 cm(2)/m(2). By using the criteria, all 100 patients were classified to two groups: PPM group and no PPM group. The clinical characteristic of the patients between the two groups was compared to determine the causes of PPM and the predictors of outcomes after mitral valve replacement, such as the gender, age, valve prosthesis type, size, body surface area, and mitral valve lesion, et al.</p><p><b>RESULTS</b>Of the 100 patients after MVR, 52 (52.0%) had significant PPM, 51 (51.0%) had moderate PPM, and 1 (1.0%) had severe PPM. In comparison to patients in no PPM group, patients in PPM group had a significantly larger body surface area [(1.76 ± 0.17) m(2) vs. (1.59 ± 0.13) m(2), P < 0.01] and higher prevalence of male gender (55.8% vs. 16.6%, P < 0.01). The other preoperative and operative data were similar in both groups, such as the valve prosthesis type, size, and mitral valve lesion, et al. There were no significant differences in postoperative Doppler-echocardiographic data of cardiac structure and heart function between the two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>The higher incidence of PPM in mitral valve position was in male or large body surface area patients. At the time of operation, surgeons should consider the related factors, such as the patient's gender and body surface area, et al. A larger prosthesis size might be implanted to avoid PPM in mitral valve position.</p>