Comparison on short-term safety outcomes between off-pump and on-pump coronary artery bypass grafting by experienced surgeons: a single center study with 31 075 cases / 中华心血管病杂志

Objective: To compare the short-term outcomes between off-pump and on-pump coronary artery bypass graft (CABG) by experienced surgeons with similar surgical team in a single large-volume cardiac surgery center. Methods: A total of 31 075 patients with multivessel coronary disease who underwent isolated off-pump or on-pump CABG between January 1, 2009 and December 31, 2019 by experienced surgeons in Fuwai hospital were enrolled in this retrospective study. Patients was divided into on-pump CABG group and on-pump CABG group on an intention-to treat basis. Short term safety endpoints, including 30 days mortality, composite endpoint of major morbidity or mortality, prolonged postoperative length of stay (PLOS), and prolonged ICU length of stay (PICULOS), and distal anastomosis were compared between the two groups. Mortality was evaluated on 30 days post operation, other endpoints were collected before discharge. After 1∶1 propensity-score matching of baseline characteristics for on-pump and off-pump CABG, postoperative endpoints were compared with use of McNemar's test and further adjusted with the use of a logistic regression model. Results: After propensity-score matching, 10 243 matched pairs of patients were included in the final analysis, there were 4 605(22.5%) females and mean age was (60.7±8.6) years. The standardized differences were less than 5% for all baseline variables in matched cohort. Univariate analysis indicated lower risk of 30 days mortality (0.2% vs. 0.7%, P<0.001), major morbidity or mortality (5.7% vs. 8.8%, P<0.001), PLOS (3.2% vs. 4.9%, P<0.001), PICULOS (9.4% vs. 12.2, P<0.001), and lower number of distal anastomosis ((3.3±0.8) vs. (3.6±0.8), P<0.001) in off-pump CABG group than in on-pump CABG group. After adjustment of cofounders, multivariate analysis showed that off-pump CABG was still associated with a lower risk of 30 days mortality (OR=0.29, 95%CI: 0.09-0.87, P=0.027), composite endpoint of major morbidity or mortality (OR=0.60, 95%CI: 0.53-0.68, P<0.001), PLOS (OR=0.64, 95%CI 0.54-0.75, P<0.001), PICULOS (OR=0.76, 95%CI: 0.69-0.84, P<0.001). Conclusions: Off-pump CABG is related with superior short-term safety outcomes than on-pump CABG by experienced surgeons in our center.

Outcomes of Ebstein's Anomaly Patients Treated with Tricuspid Valvuloplasty or Tricuspid Valve Replacement: Experience of a Single Center / 中华医学杂志(英文版)

<p><b>Background</b>The incidence of Ebstein's anomaly is extremely low, and except for the Mayo Clinic, no cardiac center has reported on a sufficient number of patients. The aim of our study was to report the outcomes of Ebstein's anomaly patients treated with tricuspid valvuloplasty (TVP) or tricuspid valve replacement (TVR).</p><p><b>Methods</b>TVP or TVR was performed in 245 patients from July 2006 to April 2016. We reviewed patients' records and contacted patients via outpatient service and over the telephone.</p><p><b>Results</b>The mean follow-up time was 43.6 ± 32.6 months, and 224 (91.4%) patients underwent follow-up. The mean operative age was 31.2 ± 15.7 years. TVR was performed in 23 patients, and TVP was performed in 201 patients. The 30-day mortality rate was 1.3%, and the overall survival rate was 97.9% at 5 and 10 years. The early mortality rate of the TVP group was lower than that of the TVR group (0.5% vs. 8.7%, P = 0.028), and the overall mortality rate of the TVP group was lower than that of the TVR group, without statistical significance (1.0% vs. 8.7%). After propensity score matching, the rates of mortality and New York Heart Association class ≥ III were lower in the TVP group than those in the TVR group without statistical significance. Seven patients with Type B Wolff-Parkinson-White (WPW) syndrome underwent one-stage surgery, and arrhythmias disappeared. Six patients suffered from episodes of left ventricular outflow tract obstruction (LVOTO) during surgery. Severe LVOTO could be treated with reoperation of the atrialized right ventricle.</p><p><b>Conclusions</b>Ebstein's anomaly patients treated with TVP or TVR can experience optimal outcomes with midterm follow-up. However, TVP should be the first-choice treatment. Optimal outcomes can be obtained from one-stage operation in patients with Type B WPW syndrome. Severe LVOTO during surgery might be related to improper operation of the atrialized right ventricle.</p>

Surgical treatment of 22 patients with anomalous origin of one pulmonary artery branch / 中华实用儿科临床杂志

Objective To study the surgical treatment and outcome of anomalous origin of one pulmonary artery branch(AOPA).Methods Twenty-two patients (13 boys and 9 girls)with AOPA underwent surgical treatment,the age ranged from 1.5 months to 19.0 years old.Fifteen patients had anomalous origin of right pulmonary artery (AORPA),7 patients had anomalous origin of left pulmonary artery(AOLPA).The aorta-pulmonary window or interrupt aorta arch was found in the patients with AORPA,and the tetralogy of Fallot was only found in the patients with AOLPA.Eighteen procedures were performed by median sternotomy and cardiopulmonary bypass(CPB),4 cases were performed by off-CPB.The anomalous pulmonary artery was cut from the aorta at its origin and anastomosed to the lateral aspect of the main pulmonary artery,which sometimes artificial grafts or autologous pericardial were employed.Results One patient died during the operation because of crisis of pulmonary hypertense,and another patient died postoperatively of serious sepsis,the others were discharged healed.The mortality rate was 9％.The follow-up periods ranged from 6 to 149 months.All the patients were excellent but 1 patient was found a mild stenosis in the originate of right pulmonary artery.Conclusions It is important to correctly diagnosis and surgically treat for the patients with AOPA in time.A suitable surgical option by the pathological variation can obtain excellent result.

Coronary artery bypass grafting for Kawasaki disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2% - 3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.</p><p><b>METHODS</b>Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5 +/- 0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.</p><p><b>RESULTS</b>One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months), clincal angina disappeared or improved. Cardiac function was in Class I - II (NYHA).</p><p><b>CONCLUSION</b>CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.</p>

Value of estimated glomerular filtration rate and serum creatinine for predicting long-term survival in Chinese patients after isolated coronary artery bypass graft surgery / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the predictive value of glomerular filtration rate (GFR) estimated by the Cockcroft-Gault formula or the modification of diet in renal disease (MDRD) equation and serum creatinine for in-hospital and long-term mortality post coronary artery bypass graft surgery (CABG).</p><p><b>METHODS</b>Clinical data of 5559 consecutive patients undergoing isolated CABG were retrospectively analyzed. The main outcomes were in-hospital mortality and long-term mortality. Estimated GFR was calculated by the Cockcroft-Gault formula and MDRD equation respectively. Receiver-operating characteristic curves and Cox's analysis were used for the comparison.</p><p><b>RESULTS</b>Follow-up was complete in 5485 patients (97.6%). Analysis of receiver-operating characteristic curves showed that GFR estimated by the Cockcroft-Gault formula had a maximal accuracy for predicting in-hospital mortality (area under the curve: 0.755, P < 0.01). Multivariate logistic analysis and the Cox's analysis results indicated estimated GFR < 60 mlxmin(-1)x1.73 m(-2) base on the Cockcroft-Gault formula was an independent risk factor for in-hospital and long-term mortality (hazard ratio 4.51 for in-hospital mortality, P < 0.01; hazard ratio 1.54 for long-term mortality, P < 0.01), both Cockcroft-Gault formula and MDRD equation were superior to serum creatinine for predicting in-hospital and long-term mortality post CABG.</p><p><b>CONCLUSION</b>GFR estimated by the Cockcroft-Gault formula was superior to GFR estimated by the MDRD equation for predicting in-hospital mortality, and estimated GFR was superior to serum creatinine for predicting in-hospital and long-term mortality.</p>

Estimated glomerular filtration rate as a risk factor for long-term survival in Chinese renal insufficiency patients after isolated coronary artery bypass graft surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the eGFR as a risk factor for long-term (4-year) outcome in Chinese renal insufficiency patients after isolated coronary artery bypass grafting (CABG) at our institution.</p><p><b>METHODS</b>From January 1999 to September 2003, 3371 consecutive patients who underwent isolated CABG were retrospectively reviewed. Of these patients, 549 (16.29%) patients were female, 1979 (58.71%) patients with hypertension, 866 (25.69%) patients with diabetes, 1130 (33.52%) patients with hyperlipidemia, 1011 (29.99%) patients with left main stenosis > 50%, and 1150 (34.11%) patients undergoing off-pump procedures. The mean age was (60 +/- 9) years old. Estimated GFR was calculated using the Cockcroft-Gault formula. The main outcomes were in-hospital mortality, in-hospital morbidity and long-term mortality. COX analysis was used in this study.</p><p><b>RESULTS</b>There were 649 patients with glomerular filtration rate estimates < 60 ml/(min.1.73 m(2)) and 2722 patients with glomerular filtration rate estimates > 60 ml/(min.1.73 m(2)). The in-hospital mortality and follow-up mortality was higher in the estimated glomerular filtration rate < 60 ml/(min.1.73 m(2)) group (2.77% vs. 0.77%, P < 0.01), (6.81% vs. 2.63%, P < 0.01). The COX analysis result confirmed eGFR < 60 ml/(min.1.73 m(2)), derived using the Cockcroft-Gault formula (HR: 1.948, 95%CI: 1.357 to 2.797, P < 0.01) was an independent risk factor for long-term mortality in patients after coronary artery bypass grafting surgery.</p><p><b>CONCLUSIONS</b>The estimated glomerular filtration rate < 60 ml/(min.1.73 m(2)) derived using the Cockcroft-Gault formula is an independent risk factor for long-term mortality in patients after coronary artery bypass grafting surgery.</p>

Diagnostic value of NT-proBNP in identifying aortic stenosis patients with heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the diagnostic value of NT-proBNP in aortic stenosis (AS) patients with heart failure.</p><p><b>METHOD</b>We measured the whole venous blood of NT-proBNP with enzyme linked immuno sorbent assay (Biomedica, Vienna, Austria) in 40 AS patients with heart failure and 76 normal subjects and assessed the diagnostic value of NT-proBNP for heart failure.</p><p><b>RESULTS</b>NT-proBNP levels were significantly higher in AS patients with heart failure compared to controls (P < 0.01). The level of NT-proBNP increased in proportion to the increase of NYHA functional classes (all P < 0.01). The level of NT-proBNP was similar between compensated heart failure group and control group (P > 0.05) and significantly (8 times) increased in decompensated heart failure group (P < 0.01 vs. control group). NT-proBNP level was also significantly higher in LVEDD > 50 mm group than that in LVEDD ≤ 50 mm group (P < 0.05) and in LVEF ≤ 60% group than that in LVEF > 60% group (P < 0.01). Patients with atrial fibrillation also had higher NT-proBNP levels compared to those with sinus rhythm (P < 0.05). The NT-proBNP value of 1360 ng/L was determined as the best cutoff value for the diagnosis of AS patients with heart failure (AUC = 0.762, P < 0.01) and decompensated heart failure (AUC = 0.997, P < 0.01), the sensitivity, specificity and accuracy were 67.50% and 100.00%, 96.05% and 96.05% and 86.21% and 95.83%, respectively. Log (NT-proBNP) was positively related with NYHA functional class and negatively related with LVEF in univariate analysis and multiple regression analyses (P < 0.05). NT-proBNP was independent correlative with NYHA functional class and LVEF.</p><p><b>CONCLUSIONS</b>NT-proBNP has a fairly good diagnostic potential for the identification of AS patients with heart failure. The accuracy is 86.21% for the diagnosis of AS patients with heart failure and 95.83% for decompensated heart failure with the diagnostic cutoff value of 1360 ng/L.</p>

Clinical analysis of unroofed coronary sinus syndrome with atrioventricular canal defect / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze symptoms, associated anomalies, diagnostic approach, and surgical procedures in patients with unroofed coronary sinus syndrome and atrioventricular canal defect.</p><p><b>METHODS</b>The clinical data of 20 patients with unroofed coronary sinus syndrome from September 1999 to October 2007 were reviewed retrospectively. There were 10 male and 10 female patients. The age ranged from 6 months to 38 years old, with a mean of (11.4 +/- 11.0) years old. The body weight ranged from 6.7 to 73.0 kg, with a mean of (28.4 +/- 21.3) kg. There were 18 cases of partial atrioventricular canal defect, 2 cases of complete atrioventricular canal defect, and 12 cases of common atrium. The initial diagnosis of unroofed coronary sinus syndrome was made by the surgeon at repair of a partial or complete atrioventricular canal defect in 20 patients. Complex unroofed coronary sinus with left superior vena cava (LSVC) directly draining into the left atrium was found in 11 cases, 1 case of LSVC was ligated, 10 cases were reconstructed the intraatrial baffle or the intracardiac tunnel to drain LSVC to right atrium. The other 9 patients with simple unroofed coronary sinus were repaired with other procedures. The associated cardiac lesions were corrected concomitantly.</p><p><b>RESULTS</b>Death occurred in 1 patient with complex congenital cardiac disease due to pulmonary infection. In the 14 early survivors, who had been followed up from 4 months to 3 years, there was no death and severe complications.</p><p><b>CONCLUSIONS</b>When associated with a partial or complete atrioventricular canal defect, LSVC and a common atrium, unroofed coronary sinus syndrome should be considered as a possible additional finding. Repair according to the type of unroofed coronary sinus syndrome is effective.</p>

Extracorporeal membrane oxygenation for treatment of cardiorespiratory function failure in adult patients / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the experience on venoarterial extracorporeal membrane oxygenation (ECMO) in adult patients with cardiac failure.</p><p><b>METHODS</b>From February 2005 to June 2008, 45 patients (male 34, female 11) undergoing cardiogenic shock required temporary ECMO support. Average age was (49.0 +/- 14.1) years. Average body weight was (67.0 +/- 12.8) kg. Coronary heart disease occupied in 21 cases, valve disease occupied in 8 cases, and cardiomyopathy occupied in 7 cases. All the patients could be divided into 3 groups: post-cardiotomy (group 1, n = 31), post-transplantation (group 2, n = 5), decompensate of chronic heart failure (group 3, n = 9). Fourteen patients need cardiac resuscitation before ECMO support. ECMO implantation was performed through the femoral vessels or axillary artery or through the right atrium and ascending aorta.</p><p><b>RESULTS</b>Average support duration of ECMO was (126.7 +/- 104.3) h. Twenty-seven patients could be successfully weaned from support (60.0%), additionally, 5 were bridged to heart transplantation. The in-hospital mortality was 42.2% (19/45). Twenty-six patients (57.8%) could be successfully discharged. The discharge rate was 58.1% in group 1, 4/5 in group 2 and was 4/9 in group 3. Twelve patients were re-operated for hemostasis. Three patients need femoral arterial thrombectomy because of ischemia of lower extremity. Additional intra-aortic balloon pumps were used in 11 patients, with 6 patients successfully discharged. The mortality rate for patients with acute renal failure treated by continuous renal replacement therapy under ECMO support was obviously high (7/9). The dominant mode of death was multisystem organ failure (9/19).</p><p><b>CONCLUSION</b>Early indication, control of complications, and paying attention to the treatment after ECMO support could improve our results with increasing experience.</p>

Clinical application of BVS5000 left ventricular assist device in heart failure patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Mechanical ventricular assistance is an important therapeutic method for severe heart failure patients. A variety of ventricular assist devices have been designed for use. The purpose of this report was to describe the experience of using Abiomed BVS5000 as a means of left ventricular support as a clinical treatment for heart failure patients.</p><p><b>METHODS</b>From February 2004 to April 2006, 12 male patients were supported with Abiomed BVS5000 left ventricular assist device (LVAD) at Fu Wai Hospital. The average age was (55.2 +/- 9.6) years (range 39 to 68 years). The mean body surface area was (1.76 +/- 0.1) m(2) (range 1.6 to 1.9 m(2)). Devices were inserted for post-cardiotomy shock after coronary artery bypass graft in 11 patients (92%) and in 1 dilated cardiomyopathy patient for acute cardiogenic shock. Modified cannulation methods by inserting the arterial cannulae in femoral artery and inserting the venous cannula in left atrium through a segment of bovine jugular vein were used in 7 patients. In this way, the device could be taken off without re-sternotomy when support was finished. A comparison was made between the modified method and routine left atrium-to-ascending aorta cannulating method.</p><p><b>RESULTS</b>The median duration of support was 5 (3 - 43) days, with support flow rate of 3.8 - 4.5 L/min. There were 9 (75%) patients weaned from support and 8 (67%) patients discharged from the hospital. Four (33%) patients were dead. The most common morbidity was adverse neurological events. There is no statistical difference between modified and routine method on average in BVS5000 support duration, in assisted flow rate, in mechanical ventilation duration, in the intensive care unit stay and thoracic drainage.</p><p><b>CONCLUSIONS</b>The Abiomed BVS5000 is valuable to support patients with acute cardiogenic shock for short-term use. By the modified cannulating method, the weaning procedure can be effectively simplified. Optimization of inserting indication remains challenging and attributes to a successful assist program.</p>

Mechanical circulation support as emergency bridging for heart transplantation / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the experience of patients in acute cardiogenic shock required insertion of mechanical circulation support devices (MCS) before undergoing standard pretransplant evaluations.</p><p><b>METHODS</b>From February 2005 to August 2007, 10 patients including 7 male and 3 female required emergency bridging placement of MCS. Average age was (40 +/- 16.2) years old. Mean body weight was (70.8 +/- 18.1) kg. There were 5 patients of dilated cardiomyopathy, 2 patients of arrhythmic right ventricular cardiomyopathy, 2 patients of ischemic cardiomyopathy and 1 patient of end-stage valvular heart disease. All patients were accompanied with acute decompensation of congestive heart failure. Before implantation of MCS, all patients received treatment of three or more inotropic drugs at maximal dosages, 6 patients suffered from ventricular tachycardia, 4 patients required cardio-pulmonary resuscitation treatment and 3 patients suffered from definite function defect of liver and kidney. MCS included ECMO for 8 patients, BVS5000 and MEDOS for 1 patient respectively.</p><p><b>RESULTS</b>The duration of MCS supporting was 3 to 44 d with a mean of (11.5 +/- 13.9) d. Four patients were successfully supported for getting heart transplantation, 1 patient received kidney transplantation simultaneously. Two patients recovered from acute heart failure, discharged and remained on regular heart transplantation list. One patient died from cerebral embolism after 44 days' support and 1 died from multiple organ failure after 3 days' support. Because of severe infection, MCS treatment of 2 patients was terminated ahead of schedule by their family and the patients were lost finally.</p><p><b>CONCLUSIONS</b>The use of MCS devices for acute catastrophic situation appears warranted despite the abbreviated transplant evaluations. It is important for improving the outcomes with beginning MCS support before multiple organ system failure occurs, and accurately identifying individuals who can benefit from MCS.</p>

Clinical experience of BVS5000 left ventricular assist devices in heart failure patients / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the experience of Abiomed BVS5000 as a mean of left ventricular support on clinical treatment for severe heart failure patients.</p><p><b>METHODS</b>From February 2004 to April 2006, 12 male patients were supported with Abiomed BVS5000 as a left ventricular assist device. The average age was (55.2 +/- 9.6) years old (range from 39 to 68 years old). Mean body surface area was (1.76 +/- 0.1) m2 (range from 1.6 to 1.9 m2). Devices were inserted for post-cardiotomy shock after coronary artery bypass grafting in 11 patients (92%) and in 1 dilated cardiomyopathy patient for acute cardiogenic shock. Modified cannulation methods by inserting the arterial cannulae in femoral artery and inserting the venous cannula in left atrial through bovine jugular vein were used in 7 patients. In this way, the device could be taken off without resternotomy when support was finished. A comparison was made between the modified method and routine left atrium-to-ascending aorta cannulating method.</p><p><b>RESULTS</b>The average duration of support was (8.8 +/- 11.2) d (range from 3 to 43 d), with support flow rate of 3.8 to 4.5 L/min. There were 9 patients (75%) weaned from support and 8 patients (67%) discharged from the hospital Four patients (33%) were dead. The most common morbidity was adverse neurologic events. There was no statistic difference between modified and routine method on average BVS5000 support duration, assisted flow rate, mechanical ventilation duration, stay of intensive care unit and thoracic drainage.</p><p><b>CONCLUSIONS</b>The Abiomed BVS5000 is valuable to support patients with acute cardiogenic shock for short-term use. With using modified cannulating method, the weaning procedure can be effectively simplified.</p>

Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD) may be associated with myocardial ischaemia. The clinical outcome in patients with surgical treatment for symptomatic myocardial bridging remains undetermined. This study assessed the middle- and long-term results of surgical treatment for symptomatic myocardial bridging.</p><p><b>METHODS</b>From 1997 to 2006, 37,463 patients received selective coronary angiography in the Fuwai Cardiovascular Hospital, Beijing, China. Of these, 484 patients had angiographic diagnosis of myocardial bridging. Of the 484 patients, 35 underwent surgery for treatment of myocardial bridging with significant systolic arterial compression. Among the surgical treatment patients, 24 presented with other cardiac disorders, and the remaining 11 symptomatic patients with isolated myocardial bridging were included in the follow-up study.</p><p><b>RESULTS</b>The angiographic prevalence of myocardial bridging was 1.3% in this study. The coronary angiographies of the 11 patients revealed myocardial bridging in the middle segment of LAD causing systolic compression > or = 75% (ranging from 75% to 90%). The mean age of patients was 48.4 years. Surgical myotomy was performed in 3 patients and coronary artery bypass grafting (CABG) in 8 patients. Eight patients were operated on with an off-pump approach and 3 with a cardiopulmonary bypass technique after median sternotomy. Conversion to on-pump CABG surgery was necessary in 1 patient because of perforation of the right ventricle. The left internal mammary artery was used in all patients with CABG. The acute clinical success rate was 100% with respect to the absence of myocardial infarction, death or other major in-hospital complications. All of the patients were followed up clinically. The median follow-up was 35.3 months (range: 6 to 120 months). Nine patients were free from symptoms and one of them continued taking beta blockers. The remaining 2 patients with myotomy had atypical chest pain. One received coronary angiography again and no stenosis was found two years after operation; while exercise testing was performed in the other patient and revealed no evidence of myocardial ischaemia. None of the patients sustained a myocardial infarction or other major adverse cardiac events (death or vessel revascularization) during follow-up.</p><p><b>CONCLUSIONS</b>Myocardial bridging is a relatively common angiographic finding. Surgical myotomy or CABG should be limited to patients who are refractory to oral medication. Surgical relief of myocardial ischaemia due to systolic compression of intramyocardial coronary arteries can be accomplished with low operative risk and excellent middle- and long-term results.</p>

Results of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate effectiveness of surgical correction in patients with anomalous origin of the coronary artery from the pulmonary artery.</p><p><b>METHODS</b>Between April 1999 and August 2005, 12 patients with anomalous origin of the coronary artery from the pulmonary artery underwent surgical correction. There were 8 patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), and 4 patients with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA). Eight patients underwent direct aortic reimplantation, and 4 patients underwent a Takeuchi procedure (intrapulmonary artery baffle with an autologous pericardial patch). Simultaneous mitral annuloplasty was performed in 7 patients of ALCAPA with moderate and severe mitral regurgitation. One patient of ARCAPA was associated with an atrial septal defect (ASD) which was closed with an amplatzer septal occluder through right atrium under transesophageal echocardiography (TEE) without CPB.</p><p><b>RESULTS</b>There were neither early and late deaths nor postoperative complications. Follow-up of all patients ranged from 7 to 83 months (mean, 32 +/- 24 months). The left ventricular function after operation improved from a preoperative fractional shortening (FS) of 0.21 +/- 0.09 to 0.35 +/- 0.06 (P = 0.006) for patients with ALCAPA. Preoperative mitral regurgitation decreased in 7 patients of ALCAPA after mitral annuloplasty at the follow-up. All patients were doing well and their exercise tolerance improved to normal. They were free from symptoms.</p><p><b>CONCLUSIONS</b>Reestablishment of a two-coronary system is necessary for patients with anomalous origin of the coronary artery from the pulmonary artery. The left ventricular function improved after 2-coronary repair. We recommend that the simultaneous mitral annuloplasty should be performed at the time of operation for patients who have moderate and severe mitral regurgitation with ALCAPA. Surgical correction of ARCAPA and ARCAPA show good early and mid-term results, long-term results need to be followed up.</p>

Pathological changes of radial artery used for coronary artery bypass grafting and its related risk factors for intimal hyperplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To examine the degree of intimal hyperplasia and the prevalence of atherosclerosis in radial arteries taken from the patients undergoing coronary artery bypass grafting (CABG), and to analyze the risk factors to obtain some helpful information for choosing arterial conduits.</p><p><b>METHODS</b>Forty-one radial arteries and 11 internal mammary arteries samples were collected. The average age of patients was 48.5 years, and they all were male. Intimal hyperplasia, atherosclerosis, medial calcification were evaluated by routine histological methods, and the severity of diseases was measured on the percentage of luminal narrowing and the intima-to-media ratio (the intima area/media area). The risk factors for coronary heart disease were also analyzed.</p><p><b>RESULTS</b>Ninety-three percent (38 of 41) of radial arteries showed mild intimal hyperplasia, which was not regarded to influence blood flowing after CABG. As a part of them, 54% (22/41) of radial arteries had a lower than 25% of luminal narrowing, meanwhile 39% (16/41) of radial arteries had the percentage of luminal narrowing between 25% and 50%. Only 7% (3 of 41) of radial arteries were found to have occlusive lesions, which made arterial lumen decreased more than 75%. The 3 patients including 2 with severe atherosclerosis and another 1 aged 17 years was involved by fibromuscular dysplasia. The later vessel was discarded after harvesting. The percentage of luminal narrowing and the intima-to-media ratio were higher in radial artery than that in internal mammary artery (t = 3.00, 2.49, P < 0.05). The two parameters were positively correlated with age (r = 0.398, 0.310, P < 0.05), but this study failed to show any relationship between intimal hyperplasia of radial artery and coronary lesions and other risk factors. Medial calcification was not found by routine histological method in all cases.</p><p><b>CONCLUSION</b>Only mild intimal hyperplasia and no medial calcification are found in radial arteries used for CABG in the patients. Because the risk factors could not yet predict the severity of radial arterial lesions, this study strongly suggests that the Doppler ultrasonography and pre-operation clinical consideration should be emphasized to screen out some arteries with occlusive lesions.</p>

Effects of intraoperative hybrid procedures for the treatment of congenital heart disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>A hybrid operation is a joint procedure involving the interventional cardiologist and the cardiac surgeon concomitantly to optimize surgical management for complex congenital heart disease. We analyzed the feasibility and efficacy of this procedure in 20 patients with congenital heart disease.</p><p><b>METHODS</b>Data from 20 patients who underwent intraoperative hybrid procedures from March to October 2005 were analyzed. Two groups were identified: (1) Balloon valvuloplasty group: pulmonary atresia with intact ventricular septum in neonate (n = 3) and severe pulmonary stenosis in infants (n = 4); (2) Device closure group: atrial septum defects (ASD) in child (n = 7), adult ASD (n = 3) and multiple ventricular septum defect (VSD, n = 3). Pulmonary balloon dilation under the guidance of echocardiography together with modified Blalock-Taussig shunt procedure and PDA ligation were applied to patients in balloon valvuloplasty group. For ASD patients, the occluder was placed via right atria after opening the chest either with median sternotomy (4 case) or with submaxillary minimally invasive incision (6 cases), PDA ligation was performed in 1 patient and 2 coronary artery bypass surgeries were performed in 2 adult ASD patients complicating CHD. For multiple VSD, perimembranous VSD was closed surgically and muscular VSD closed by occluder via tricuspid valve approach under cardiopulmonary bypass.</p><p><b>RESULTS</b>All operations were successful and 1 infant received another conventional valvuloplasty due to the pulmonary restenosis after initial balloon valvuloplasty and 1 patient's muscular VSD was closed by conventional procedure after unsuccessful device closure. No device-related complications were found during follow-up (1-6 months).</p><p><b>CONCLUSION</b>Our results showed that intraoperative hybrid procedure was feasible and effective in selected patients with congenital heart disease.</p>

Comparative study on the ultrastructures of radial and internal mammary arteries used for coronary artery bypass grafting / 中华病理学杂志

<p><b>OBJECTIVE</b>The radial artery differs from internal mammary artery in its vascular biology and long-term patency after coronary artery bypass grafting (CABG). This study was designed to investigate their ultrastructural differences that may have implications in arterial remodeling and graft failure.</p><p><b>METHODS</b>Thirty-four radial artery and 11 internal mammary artery samples were obtained from patients underwent CABG, and subjected to routine electron microscopic examination. A semi-quantitative method was used to evaluate secretary endothelial cells, endothelial denudation, synthetic smooth muscle cells (SMCs), matrix accumulation, lipid deposition and medial submicroscopic calcification.</p><p><b>RESULTS</b>Compared with internal mammary arteries, the radial arteries had more secretory endothelial cells (47.1%, 16/34 vs 27.2%, 3/ 11) and synthetic type SMCs in a background (14.4% vs 0.9%) that had more intimal lipid deposition and matrix accumulation (14.7%, 5/34 vs 9.1%, 1/11). Matrix vesicles and calcifications were frequently present in the media of both types of arteries. The calcifications, however, could not be visualized by routine histological stains, and therefore, named as submicroscopic calcification in this study. Fewer endothelial denudations were observed in the radial arteries, but no differences in medial lipid deposition and submicroscopic calcification were observed between these two types of arteries. The ultrastructural features and the arrangement of medial SMCs in radial arteries were similar to those of internal mammary arteries.</p><p><b>CONCLUSIONS</b>Radial arteries have a higher SMC proliferative potential and more actively secretory status of endothelial cells, which may enhance the remodeling process and correlate with a decreased long-term patency. Better preservation of endothelial cells in radial arteries could be attributed to the "no touch" technique utilized in surgical harvesting. The significance of submicroscopic medial calcification during graft remodeling requires further investigations.</p>

Surgical treatment of active infective endocarditis / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the recent experience of surgical management of the active infective endocarditis (IE) disease in Fuwai Hospital.</p><p><b>METHODS</b>From October 1, 1996 to December 31, 2003, 54 patients with active IE underwent heart operation in Fuwai Hospital. There were 41 males, 13 females, with an average age of 35 years old and an average weight 58 kg. Of the cases, 23 had congenital anomalies of the heart, and 1 had rheumatic valvulitis. Streptococci were found in 20 patients, staphylococci in 3, enterococci in 1, enterococcus in 2 and G(+) cocci in 1. Pre-operative cardiac classification (NYHA): class I was in 6 cases, class II in 12 cases, class III in 7 cases and class IV in 29 cases. Systemic embolization occurred in 23 cases and pulmonary infarction in 2 cases. Emergent operations were performed in 27 cases because of heart failure (8 cases), embolism (4 cases), aggressive infection (3 cases), heart failure plus embolism (2 cases), heart failure with aggressive infection (4 cases), aggressive infection with embolism (2 cases) and all the three factors (4 cases). The operations included aortic valve replacement (25 cases), aortic and mitral valves replacement (15 cases), mitral valve replacement (6 cases), mitral valve repair (3 cases), pulmonic valve replacement (1 case) and intracardiac shunt repair (4 cases).</p><p><b>RESULTS</b>The operative mortality was 17% (5 operative death and 4 lost in following-up after being discharged). All of operative deaths were due to infection. Fourteen patients had operative complications. The morbidity included peri-prosthetic leakage (8 cases), prosthetic IE (5 cases), residual intracardiac shunt (2 cases), complete heart block (2 cases), myocardial infarction, ventricular fibrillation, pulmonary trunk stenosis, and mitral regurgitation (1 case in each). Post-operative cardiac classification (NYHA): class I was in 41 cases, class II in 3 cases, class III in 1 case. Two patients were re-operated because of peri-prosthetic leakage, and then they were cured. Re-operation was also performed in other 3 patients. Unrelated late sudden death occurred in 1 patient and hemiplegia caused by anticoagulant intracranial hemorrhage in another patient.</p><p><b>CONCLUSION</b>Acceptable results can be achieved with active surgical intervention in active patients with IE.</p>