Reduction ascending aortoplasty in adult patients undergoing aortic valve replacement: Aorta diameter change, mid- and long-term clinical results / 中国胸心血管外科临床杂志

@#Objective    To assess mid- and long-term outcomes and share our clinical method of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospectively analyzed clinical data of 41 adult patients with aortic valve disease and ascending aortic dilatation before and after operation of RAA+AVR in Fuwai Hospital from January 2010 to July 2017. There were 28 male and 13 female patients aged 28-76 (53.34±12.06) years. Twenty-three patients received AVR+RAA using the sandwich technique (a sandwich technique group), while other 18 patients received AVR+ascending aorta wrap (a wrapping technique group). Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative AAD in the sandwich technique group and the wrapping technique group (47.04±3.44 mm vs. 46.67±2.83 mm, P=0.709) was not statistically different. The mean postoperative AAD (35.87±3.81 mm vs. 35.50±5.67 mm, P=0.804), and the mean AAD at the end of follow-up (41.26±6.54 mm vs. 38.28±4.79 mm, P=0.113) were also not statistically different between the two groups. There were statistical differences in AAD before, after operation and at follow-up in each group. All 41 patients were followed up for 23-108 (57.07±28.60) months, with a median follow-up of 51.00 months. Compared with that before discharge, the AAD growth rate at the last follow-up was –1.50-6.78 mm/year, with a median growth rate of 0.70 mm/year, and only 3 patients had an annual growth rate of above 3 mm/year. Conclusion    Mid- and long-term outcomes of RAA in adult patients undergoing AVR with both methods are satisfying and encouraging.

Study of preventing venous graft restenosis by local application of simvastatin and mechanical preconditioning / 中国胸心血管外科临床杂志

@#Objective    To investigate the effect of simvastatin and mechanical pretreatment on intimal hyperplasia of venous graft and its mechanism. Methods    Twelve New Zealand rabbits were selected and randomly divided into 4 groups: a blank control group, a simvastatin topical treatment group, a mechanical precondition group and a combined group (n=3 in each group). Ultrasound was used to evaluate the changes of graft wall and blood flow velocity in the graft, and pathological section was used to evaluate the intimal hyperplasia. Human umbilical cord endodermal cells were cultured in vitro. A simvastatin group and a solvent control group were set to detect YAP phosphorylation, downstream target gene expression and cell proliferation. Results    Vascular ultrasound showed that except the simvastatin topical treatment group, the flow velocity in vein grafts in the other three groups significantly increased 21 days after surgery compared with 7 days after surgery (P<0.01). Pathological sections showed that the thickness of new intima in the simvastatin topical treatment group, mechanical precondition group, combined group and blank control group were 45.56±4.11 μm, 201.28±16.71 μm, 143.57±7.82 μm, 249.45±13.33 μm, respectively, and there were statistical differences compared with the blank control group (P<0.05). In vitro results showed that compared with the solvent control group, cell death was observed in high concentration simvastatin (5 mmol/L) group, cell proliferation was inhibited in low concentration simvastatin (2.5 mmol/L) group (P<0.05), the expression of YAP protein in the simvastatin group was unchanged, but the expression of phosphorylated YAP protein significantly increased (P<0.05), and the expression of downstream target gene ccn1 was down-regulated (P<0.001). Conclusion    Intravascular local application of simvastatin and mechanical preconditioning alone or in combination can inhibit intimal hyperplasia of venous graft. High concentration of simvastatin has cytotoxicity, while low concentration of simvastatin has inhibitory effect on cell proliferation. Simvastatin can inhibit the formation of new intima by inhibiting the entry of YAP into the nucleus and reducing the transcription of cell proliferation-related target gene ccn1.

Assessment of the internal mammary artery using ultrasound in patients with coronary artery disease before coronary artery bypass grafting / 中国胸心血管外科临床杂志

@#Objective    To investigate the feasibility and effectiveness of using ultrasound to evaluate the internal mammary artery (IMA) and explore the related factors affecting the quality of IMA. Methods    From July 2020 to January 2021, for patients who underwent coronary artery bypass grafting at the Department of Cardiovascular Surgery, Fuwai Hospital, ultrasound was applied to measure bilateral IMA at the parasternal second intercostal space. There were 62 males and 18 females with an average age of 59.9±8.3 years. The clinical data of the patients were recorded and analyzed. Results    A total of 160 IMA were measured. The IMA was detected in 99.4% (159/160), and the one that was not measured was proved to be occluded by enhanced CT. A total of 157 (98.1%) IMA intima were smooth, 2 (1.3%) were found to have uneven intimal thickening and less smooth, and only 1 (0.6%) was occluded. The intravascular diameter, peak systolic flow rate, peak diastolic flow rate, and blood flow rate of the left second intercostal IMA were 1.9±0.3 mm, 66.8±17.7 cm/s, 6.4 (0.0, 9.7) cm/s, 19.7±9.4 mL/min; and those of the right one were 2.1±0.3 mm, 69.7±18.5 cm/s, 6.0 (0.0, 9.2) cm/s and 22.8±11.5 mL/min, respectively. IMA vessel diameter and blood flow were greater on the right than those on the left side in the same individual (P<0.01). In univariate analysis, sex and body surface area were the factors that influenced the size of the IMA vessel among different individuals, and by linear regression analysis, the size of the IMA vessel was only related to body surface area among different individuals. On univariate analysis, diabetes mellitus was the only factor affecting IMA blood flow, with a mean reduction in blood flow of 18.4% (left) and 21.7% (right) in the diabetic group (P<0.05). Conclusion    Preoperative evaluation of the IMA using ultrasound over the parasternal second intercostal space is easy, noninvasive, and has a high success rate. The internal diameter of the IMA is positively correlated with body surface area, and blood flow is significantly reduced in patients with diabetes.

Clinical efficacy of reduction ascending aortoplasty with wedge resection in adult patients undergoing aortic valve replacement: A single-center retrospective study / 中国胸心血管外科临床杂志

@#Objective    To assess mid-term outcomes of reduction ascending aortoplasty (RAA) in adult patients undergoing aortic valve replacement (AVR). Methods    We retrospecctively analyzed clinical data of 30 adult patients with aortic valve diseases and ascending aortic dilatation in Fuwai Hospital from 2010 to 2019. There were 20 males and 10 females with an age of 38-72 (55.73±9.95) years. All patients received AVR+RAA using the wedge resection technique. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. Results    There was no perioperative death. The mean preoperative and postoperative AAD in all patients were 48.23±3.69 mm and 37.60±5.02 mm, respectively. And the mean AAD of follow-up was 40.53±4.65 mm. There was a statistical difference in AAD between preoperation and postoperation, postoperation and final follow-up, preoperation and final follow-up. The median follow-up time was 28.50 (12-114) months. The median rate of increase in AAD postoperatively was 0.76 mm per year. And the rate of increase was ≥3 mm per year in 5 patients, while ≥5 mm per year in 4 patients with indications for reoperation. Conclusion    Mid-term outcomes of RAA in adult patients undergoing aortic valve replacement using the wedge resection technique are satisfying and encouraging. However, some patients still need surgical re-intervention.

Status and clinical significance of thrombocytopenia after cardiac surgery in adults / 中国胸心血管外科临床杂志

@#Objective    To observe the status of thrombocytopenia in adult patients after cardiac surgery, and to explore its mechanism and clinical significance. Methods    Retrospective analysis of 240 patients after cardiac surgery in the 2nd ward of surgical intensive care unit (ICU) of Fuwai Hospital from May to June 2020 was conducted, including 137 males and 103 females with a mean age of 56.0±12.0 years. According to postoperative platelet status, the patients were divided into a thrombocytopenia group and a non-thrombocytopenia group. The clinical baseline data, preoperative platelet count, postoperative minimum platelet count, volume of drainage, transfusion of blood products, mechanical ventilator time, ICU stay, hospital stay and complications were compared between the two groups. Results    The mean preoperative platelet count was 199×109/L±55×109/L and the mean postoperative platelet nadir was 109×109/L±37×109/L, with a mean reduction rate of 44.1%±15.8%. The platelet count of 235 (97.9%) patients after operation was lower than that before operation. Among them, 98 (40.8%) patients had platelet count<100×109/L, 46 (19.2%)<75×109/L and 8 (3.3%)<50×109/L. Results of multivariable logistic analysis showed that cardiopulmonary bypass time>120 min (OR=2.576, 95%CI 1.313-5.053, P<0.05) was an independent risk factor for postoperative thrombocytopenia. Mechanical ventilator time (25.5± 16.8 h vs. 17.3±8.5 h, P<0.05), ICU stay (85.2±54.7 h vs. 60.0±33.9 h, P<0.05) and hospital stay (15.8±6.2 d vs. 14.2±3.9 d, P<0.05) were longer in the thrombocytopenia group (<100×109/L) compared with the non-thrombocytopenia group (>100×109/L). More drainage volume [685 (510, 930) mL vs. 560 (440, 790) mL, P<0.05] and complications occurred in the thrombocytopenia group. In multivariable analysis, thrombocytopenia was significantly inversely associated with prolonged ICU stay (OR=2.993, 95%CI 1.622-5.524, P<0.05). Conclusion    Thrombocytopenia occurs commonly after adult cardiac surgery, and the incidence in different types of surgery varies. Postoperative thrombocytopenia is related to the prolonged recovery. Extracorporeal circulation may be a contributing factor to thrombocytopenia, and further studies investigating mechanism and strategies to reduce postoperative thrombocytopenia are needed.

Propensity matching study of mitral valve management strategy during coronary artery bypass grafting in patients with moderate ischemic mitral insufficiency / 中华胸心血管外科杂志

Objective:To explore the surgical strategy of coronary artery bypass grafting(CABG) for moderate ischemic mitral regurgitation(IMR), and to clarify the impact of mitral valve surgical intervention(MVS) on the long-term prognosis of such patients.Methods:The clinical data of 234 consecutive patients with moderate IMR who received CABG from January 2013 to December 2018 were retrospectively included, with 184 males and 50 females. The age ranged from 29 to 78 years, with a mean of(61.5 ± 8.7) years old. According to whether MVS was performed at the same time, they were divided into CABG group(108 cases, CABG alone) and CABG+ MVS group(126 cases, CABG+ MVS at the same time). The long-term cardiac events, all-cause deaths, major cardiovascular and cerebrovascular adverse events(MACCE) and other end events were followed up. A matching queue was established by propensity matching score for statistical analysis.Results:After propensity matching score, a matching queue was established, including 78 pairs of patients. Survival analysis showed that the incidence of long-term cardiac events and postoperative new onset atrial fibrillation in CABG+ MVS group was significantly higher( P<0.05). However, there was no significant difference between the two groups in all-cause mortality, cardiogenic mortality, and the incidence of MACCE events( P>0.05). Cox regression analysis showed that simultaneous CABG+ MVS was a risk factor for long-term cardiac events and new postoperative atrial fibrillation. The results of subgroup studies showed that for patients without tricuspid regurgitation before operation, left ventricular end diastolic diameter>55 mm, and left ventricular ejection fraction(LVEF) ≤0.55, the probability of cardiac events after MVS at the same time of CABG was higher( P<0.05). However, patients with no tricuspid regurgitation before operation, left ventricular end diastolic diameter>55 mm, LVEF≤0.55, and left atrial diameter≥40 mm had a higher probability of atrial fibrillation after MVS at the same time of CABG( P<0.05). Conclusion:CABG can improve left ventricular remodeling in patients with moderate IMR, whether MVS intervention is performed at the same time or not, and the long-term survival rate of both is similar. CABG+ MVS in the same period can maintain a low residual reflux, but the incidence of long-term cardiac events and arrhythmias is high. The longer-term prognosis needs to be further studied. The surgical strategy of such patients should be selected individually according to the specific situation and the surgical quality in medical centers.

The study of hemodynamic mechanism of a novel endovascular stent on complicated abdominal aortic aneurysms / 中华胸心血管外科杂志

Objective@#To detect the hemodynamic mechanism of the novel endovascular stent on complicated abdominal aortic aneurysms by Computational Fluid Dynamics(CFD) firstly, and then compare the effect of the novel endovascular stent and the streamliner multilayer flow modulator(SMFM) stent.@*Methods@#All medical images were obtained by computed tomography. A semiautomatic segmentation protocol within Mimics(v17.0; Materialise, Leuven, Belgium) was used to extract the threedimensional aortic aneurysms. The stents was generated numerically and fitted along the aortic aneurysms. The lumen volume represented the fluid domain that was discretised in smaller volumes, which defined a mesh within the ICEM software(Ansys ICEM CFD v15.0). Hemodynamic analysis was performed with software Fluent 16.0.@*Results@#Both kinds of stents can change the pattern of flow distribution. Compared with SMFM, the novel endovascular stent can significantly reduce the flow velocity in aneurysms, the shear force and the pressure on the aneurysms wall.What’s more, the flow velocity of the branch artery was accelerated by the novel endovascular stent.@*Conclusion@#The novel endovascular stent can significantly reduce the flow velocity in aneurysms, the shear force and the pressure on the aneurysms wall, and acceleratethe the flow velocity of the branch artery.

The study of hemodynamic mechanism of a novel endovascular stent on complicated abdominal aortic aneurysms / 中华胸心血管外科杂志

Objective:To detect the hemodynamic mechanism of the novel endovascular stent on complicated abdominal aortic aneurysms by Computational Fluid Dynamics(CFD) firstly, and then compare the effect of the novel endovascular stent and the streamliner multilayer flow modulator(SMFM) stent.Methods:All medical images were obtained by computed tomography. A semiautomatic segmentation protocol within Mimics(v17.0; Materialise, Leuven, Belgium) was used to extract the threedimensional aortic aneurysms. The stents was generated numerically and fitted along the aortic aneurysms. The lumen volume represented the fluid domain that was discretised in smaller volumes, which defined a mesh within the ICEM software(Ansys ICEM CFD v15.0). Hemodynamic analysis was performed with software Fluent 16.0.Results:Both kinds of stents can change the pattern of flow distribution. Compared with SMFM, the novel endovascular stent can significantly reduce the flow velocity in aneurysms, the shear force and the pressure on the aneurysms wall.What’s more, the flow velocity of the branch artery was accelerated by the novel endovascular stent.Conclusion:The novel endovascular stent can significantly reduce the flow velocity in aneurysms, the shear force and the pressure on the aneurysms wall, and acceleratethe the flow velocity of the branch artery.

Research progress on the treatment of isolated tricuspid regurgitation / 中国胸心血管外科临床杂志

@#With the prevalence of atrial fibrillation and the increasing use of intracardiac pacemakers, the incidence of isolated tricuspid regurgitation is gradually increasing. Severe isolated tricuspid regurgitation has a seriously negative effect on the survival rate and life quality of patients. As the major invasive therapy, surgery is not routinely carried out due to high perioperative mortality. This article attempts to summarize the etiology, natural course and adverse consequences of isolated tricuspid regurgitation, current treatment strategies, surgical indications and techniques, efficacy evaluation, prognostic factors and transcatheter treatment progress of isolated tricuspid regurgitation, aiming to provide references for cardiologists and further researches.

Design of an axial blood pump of diffuser with splitter blades and cantilevered main blades / 生物医学工程学杂志

An implantable axial blood pump was designed according to the circulation assist requirement of severe heart failure patients of China. The design point was chosen at 3 L/min flow rate with 100 mm Hg pressure rise when the blood pump can provide flow rates of 2-7 L/min. The blood pump with good hemolytic and anti-thrombogenic property at widely operating range was designed by developing a structure that including the spindly rotor impeller structure and the diffuser with splitter blades and cantilevered main blades. Numerical simulation and particle image velocimetry (PIV) experiment were conducted to analyze the hydraulic, flow fields and hemolytic performance of the blood pump. The results showed that the blood pump could provide flow rates of 2-7 L/min with pressure rise of 60.0-151.3 mm Hg when the blood pump rotating from 7 000 to 11 000 r/min. After adding the splitter blades, the separation flow at the suction surface of the diffuser has been reduced efficiently. The cantilever structure changed the blade gap from shroud to hub that reduced the tangential velocity from 6.2 m/s to 4.3-1.1 m/s in blade gap. Moreover, the maximum scalar shear stress of the blood pump was 897.3 Pa, and the averaged scalar shear stress was 37.7 Pa. The hemolysis index of the blood pump was 0.168% calculated with Heuser's hemolysis model. The PIV and simulated results showed the overall agreement of flow field distribution in diffuser region. The blood damage caused by higher shear stress would be reduced by adopting the spindle rotor impeller and diffuser with splitter blades and cantilevered main blades. The blood could flow smoothly through the axial blood pump with satisfactory hydraulics performance and without separation flow.

Prognostic value of plasma big endothelin-1 in patients with moderate to severe chronic ischemic mitral insufficiency after mitral valvuloplasty / 中华胸心血管外科杂志

Objective Big endothelin-1(big ET-1) is associated with the prognosis of various cardiovascular diseases. This study is to explore the predictive value of plasma big ET-1 level for long-term outcome after mitral valvuloplasty in patients with moderate to severe chronic ischemic mitral insufficiency .Methods A total of 142 consecutive patients with moderate to severe chronic ischemic mitral regurgitation who underwent coronary artery bypass grafting and mitral valvuloplasty were enrolled at our center from January 2009 to December 2015.The clinical baseline data were collected and recorded.All patients were followed up.The mortalities and major adverse cardiovascular and cerebrovascular events during the follow-up period were re-corded.Results A total of 142 patients were enrolled, with mean age of(59.4 ±8.3) years.During(51.9 ±22.6) months follow-up, 19 cases(13.4％) died and 35 cases(24.6％) had major adverse cardiovascular and cerebrovascular events.Uni-variate and multivariate Cox regression analysis showed that big ET-1 was an independent risk factor for all-cause mortality (HR=3.970, 95％CI:1.535-10.268) and major adverse cardiovascular and cerebrovascular events(HR=2.754, 95％CI:1.238-6.129).In addition, left ventricular ejection fraction, pulmonary hypertension and stroke history were independent risk factors for all-cause mortality , while left ventricular ejection fraction , stroke history were independent risk factors for major adverse cardiovascular and cerebrovascular events.Conclusion Long-term outcomes of simultaneous coronary artery bypass grafting and mitral valvuloplasty for moderate to severe ischemic mitral insufficiency are satisfactory and big ET-1 is an inde-pendent risk factor for long-term outcomes of these patients.

Relationship between fibroblast growth factor 21 and blood glucose after cardiac surgical operation / 中华老年心脑血管病杂志

Objective To study the relationship between fibroblast growth factor 21 (FGF21) and blood glucose (BG) after cardiac surgical operation.Methods Eighty-six coronary atherosclerotic heart disease patients without DM were divided into postoperative normal BG group (n=46) and postoperative elevated BG group (n =40).Their preoperative baseline data were recorded,their plasma FGF21 level was measured before and after operation.The relationship between FGF21 and BG was analyzed by dual regression analysis.Results The serum FGF21 level was signifycantly higher in two groups after operation than before operation (7.49±0.53 μg/L vs 3.04±0.26 μg/L,P＜0.01) and in postoperative normal BG group than in postoperative elevated BG group (5.84±0.72 μg/L vs 2.84±0.46 μg/L,P＜0.01).The circulating FGF21 level was related with the postoperative elevated BG level (OR =10.67,95％CI:2.34-48.63,P＜0.01).Conclusion BG is closely related with FGF21 after coronary bypass,which is of great importance for the management of BG after cardiac surgical operation.

Mid-term outcomes in patients undergoing tricuspid valve repair with rheumatic tricuspid valve disease / 中华胸心血管外科杂志

Objective The aim of this study was to summarize the characteristics of rheumatic tricuspid valve disease ( RTVD) and to evaluate the mid-term outcomes in patients undergoing tricuspid valve repair with RTVD. Methods Between January 2009 and June 2016, 251 consecutive patients with rheumatic heart disease( RHD) underwent left-sided valvular re-placement by a single surgeon. We analyzed 39 patients with RTVD which was diagnosed during the operation. Among them, 32 patients, with moderate or higher tricuspid regurgitation( TR) , were compared with other 59 patients of functional tricuspid regurgitation( FTR) for a better understanding of the features of the RTVD. A total of 39 patients were categorized into 2 groups:Ring annuloplasty group(n=33) and non-Ring annuloplasty group(n=6) which consisted of modified De Vega annu-loplasty for 4 patients and edge-to-edge repair for 2. Meanwhile, 13 of them underwent concomitant tricuspid commissurotomy and 1 patient had a tricuspid leaflet augmentation procedure. We analyzed the mid-term outcomes of 22 patients( follow-up du-ration>1 year)with a mean follow-up duration of(45.5 ±25.1) months. Results Compared with FTR, patients with RTVD had higher preoperative TR grade(3.1 ±0.8 vs. 2.6 ±0.7, P=0.004) but with lower preoperative PASP[(53.8 ±19.4) mmHgvs.(63.6±21.5)mmHg,P=0.037)](1mmHg=0.133kPa) andtricuspidannulusdiameter(TAD) thatobserved bothinpreoperativeechocardiogramtests[(37.0±5.7)mmvs.(41.9±6.7)mm,P=0.018)]andintraoperativedetection [(35.6±4.1)mmvs.(39.9±6.5)mm,P=0.000)] . TherewasnoearlymortalityandresidualmoderateorhigherTR grades in either group. Compared with patients in non-ring annuloplasty group, patients in ring annuloplasty group showed low-er postoperative TR grade(0. 2 ± 0. 4 vs. 0. 7 ± 0. 5, P=0. 039) and acceptable TR grade(0. 8 ± 0. 5 vs. 1. 3 ± 1. 9, P>0. 050) during the mid-term follow-up. PASP, the peak diastolic velocity and pressure gradient across tricuspid valve were not different between groups in preoperative, postoperative and follow-up. Conclusion Compared with FTR, Patients with RTVD had lower preoperative PASP and TAD, but with a higher preoperative TR grade. In our study, ring annuloplasty showed simi-lar mid-term outcomes compared with other procedures.

Surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery / 中华胸心血管外科杂志

Objective To review the experience of the surgical treatment of adult patients with anomalous left coronary artery from the pulmonary artery(ALCAPA).Methods A retrospective,single institution review was conducted on nineteen adult patients with ALCAPA surgical treatment from February 2006 to October 2012.Of these patients,five were males and fourteen were females.The age was(35.3 ± 11.7) years.The weight was (61.2 ± 9.4) kg.Most patients showed some evidence of myocardial infarction or ischemia with either abnormal Q waves (4) or ST-T abnormality (13).Twelve patients with coronary angiography and four patients with coronary CT scan showed good coronary collateralization.The preoperative UCG showed the mean left ventricular ejection fraction(LVEF) was 0.60 ± 0.07,and the mean left ventricular end-diastolic dimension(LVEDD) was(52.4 ± 4.4) mm.Severe mitral regurgitation(MR) was seen in two patients,moderate in three patients and mild in four patients.The operative procedures included Takeuchi operation in seven patients,ligation of left coronary artery concomitant with coronary artery bypass graft in two patients,coronary artery re-implantation in ten patients.Of the ten patients with coronary artery re-implantation,two patients underwent mitral valve repair.Results There was no operative mortality.The mean cardiopulmonary bypass time was (144.5 ± 66.9) min and cross-clamp time was (96.4 ± 38.8) min,respectively.The mean mechanical ventilation time was(12.9 ± 3.7) h and intensive care unit time was(39.2 ± 12.5) h,respectively.The mean postoperative LVEF was 0.62 ± 0.04.No significant reduction in LVEDD (45.8 ± 5.5) mm,P ＞ 0.05.Mild and trivial MR were observed in one and four patients,respectively.Sixteen patients(84.2％) completed the follow up with a mean time of 19.2 months.All the patients survived with New York Heart Association class Ⅰ or Ⅱ.During the follow up period,no patient required reoperation or readmission.At the latest echocardiography,the mean LVEF of 0.63 ± 0.05 and mean LVEDD of(49.2 ± 4.6) mm did not significantly improved compared with the data preoperatively or postoperatively.Mild MR was detected in six patients,trivial in three patients during the follow-up period.Conclusion The adult patients with ALCAPA have a dormant disease process.Surgical treatment has been recommended at the time of diagnosis and the coronary re-implantation could be the first choice.As for the concomitant MR,the guideline for the adult MR should be followed.

Mid-term Outcomes of Surgical Effect in Patients With Hypertrophic Obstructive Cardiomyopathy Combining Mid Left Ventricular Obstruction / 中国循环杂志

Objective: To summarize the mid-term effect of modified extended Morrow procedure in patients with hypertrophic obstructive cardiomyopathy (HOCM) combining sub aortic valve obstruction and mid left ventricular obstruction. Methods: We studied 34 consecutive HOCM patients with sub aortic and midventricular obstruction who received modiifed extended Morrow procedure with extracorporeal circulation in our hospital from 1996-11 to 2015-01. Transthoracic echocardiography was conducted at pre-, post-operation and follow-up period to evaluate the changes of mid-ventricular gradient, subarctic gradient and each heart valve function. Results: The average follow-up time was (25.7 ± 14.9) months, 2 patients lost contact and no death occurred. In rest 32 patients, the mid ventricular gradient decreased from (60.3 ± 29.4) mmHg to (21.0 ± 19.8) mmHg, subaortic valve gradient decreased from (77.9 ± 26.2) mmHg to (11.6 ± 6.5) mmHg, the maximum ventricular septal thickness dropped from (25.2 ± 4.9) mm to (17.9 ± 7.2) mm, left atrial diameter reduced from (41.1 ± 7.8) mm to (37.6 ± 6.4) mm, left ventricular end-diastolic diameter increased from (39.8 ± 5.1) mm to (42.2 ± 4.3) mm, allP<0.05; there were 5 patients without obviously improved mid ventricular gradient because of insufifcient resection of septal myocardium in mid-ventricle. The post-operative NYHA classiifcation was improved,P<0.01, mitral valve regurgitation degree was decreased,P<0.01 and SAM phenomenon was disappeared. Complications included 3 (8.8%) patients of III atrio-ventricular block, 1 (2.9%) patient of re-admission due to poorly healed sternum combining pneumonia Conclusion: Modified extended Morrow procedure may relieve sub aortic valve and mid ventricular obstruction, therefore improve left ventricular diastolic function and prognosis in relevant patients.

Medium-long Term Outcomes of Ventricular Septal Myectomy for Treating the Patients With Hypertrophic Obstructive Cardiomyopathy-A Single Center Experience / 中国循环杂志

Objective: To report the medium-long term survival rates of ventricular septal myectomy for treating the patients with hypertrophic obstructive cardiomyopathy and to analyze the predictive factors affecting the outcomes. Methods: A total of 655 consecutive patients who received ventricular septal myectomy in our hospital from 1984-10 to 2014-12 were retrospectively summarized. The cohort study was conducted with questionnaires by cardiovascular nurses. Result: The operative mortality was 1.4% (9/655). The mean follow-up time was (30.8 ± 30.9, from 3 to 213) months, there were 52/646 (7.9%) patients lost contact and 583 patients having NYHA classification at I or II during that period. The overall survival rates for 1 year, 5-year and 8-year were 98.3%, 90.5% and 88.3% respectively. There were 80 patients suffered from end point events including HCM-related death, heart transplantation, repeated myectomy, permanent pacemaker implantation and re-admission for ischemic stroke, tachyarrhythmia, myocardial ischemia or infarction, congestive heart failure. The end point events free survival rates for 1 year, 5-year and 8-year were 94.2%, 76.7% and 65.9% respectively. Multivariable Cox regression analysis presented that age>50 years (HR=2.16, 95% CI 1.36-3.46,P=0.001) and pre-operative atrial ifbrillation (FA) (HR=2.31, 95% CI 1.35-3.94,P=0.002) were the independent predictors for end point events occurrence. Conclusion: Ventricular septal myectomy may achieve good medium-long term survival rate with less adverse event in patients with hypertrophic obstructive cardiomyopathy. Elder than 50 years of age and with pre-operative FA were the independent predictors for adverse events occurrence.

Outcome analysis of ECMO applying in extracorporeal cardiopulmonary resuscitation in adult cardiac arrest patients / 中华胸心血管外科杂志

Objective Summarizing single clinical experience with extracorpomreal membrane oxygenation(ECMO) as a supplement to extracorporeal cardiopulmonary resuscitation(ECPR) in adult patients with cardiac arrest to explore new ideas.Methods We retrospectively analyzed the characteristics of 17 patients who underwent ECMO as part of ECPR from July 2005 to September 2014 at Fuwai Hospital,and analyzed the differences between the survival group(n =6) and the in-hospital death group.Results The mean CPR time was(44.53 ± 21.39) min.The support duration of ECMO was(106.38-± 70.43) h.12 patients of all were successfully weaned from ECMO,and 6 patients survived to hospital discharge.There were significant differences between the two groups in terms of the last serum creatinine and blood lactate acid level before ECMO,and the time to lactate normalization.11 patients died,7 patients developed bleeding,and 8 cases developed infection.Conclusion Single-center data showed that applying ECMO as a means of ECPR improved the survival rate in cardiac arrest patients.Additionally,creatinine and lactic acid were good indicators for assessing prognosis.Refractory circulatory dysfunction and neurologic complications have an adverse impact on the survival of cardiac arrest patients.

Risk factors analysis for patients aged over 65 years undergoing combined heart valve surgery and coronary artery bypass grafting / 中华胸心血管外科杂志

Objective To analyze the risk factors for in-hospital mortality in patients aged over 65 years undergoing heart valve surgery combined with coronary artery bypass grafting(CABG).Methods Between February 2002 and September 2014,540 patients aged over 65 years undergoing heart valve surgery combined with CABG in our institute were retrospectively studied.Univariate analyses and multivariate logistic regression analyses were performed to explore risk factors associated with in-hospital mortality.Results Overall in-hospital mortality was 4.26％.Univariate analysis depicted that chronic obstructive pulmonary disease (COPD) (P =0.001),last serum creatinine (P =0.043),unstable angina(P =0.046),Canadian Cardiovascular Society 111-ⅣV (P =0.005),number of diseased coronary vessels (P =0.043),cardiopulmonary bypass time-delayed (P =0.003),post-operative morbidity (P =0.000) had a significant impact on in-hospital mortality.Multivariate logistic regression analysis revealed that COPD (P =0.005,OR =5.598),CPB time-delayed (P ＜ 0.001,OR =1.011),re-exploration (P ＜0.001,OR =15.813),malignant arrhythmia (P =0.014,OR =4.900) were independent risk factors of in-hospital mortality.Conclusion The present research demonstrates that COPD,CPB time-delayed,re-exploration and malignant arrhythmia dramatically impacted the in-hospital mortality of patients aged over 65 years undergoing combined heart valve surgery and CABG.

Risk Factor Analysis for the Prognosis in Elder Patients With Combined Aortic Valve Replacement and Coronary Artery Bypass Grafting / 中国循环杂志

Objectives: To analyze clinical characteristics with the early and late prognosis in elder patients with combined aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). Methods: A total of 232 patients≥65 years of age who received AVR-CABG in our hospital from 2004-02 to 2014-09 were retrospectively analyzed. The risk factors affecting the early and late prognosis in those patients were studied by multivariate Logistic regression analysis and Cox proportional hazards model. Results: The in-hospital death happened in 7/232 (3.0%) patients, early post-operative complication with prolonged mechanical ventilation time was 28 (12.1%) and bleeding was 14 (6.0%). The follow-up study was conducted in 225/232 (97.0%) survived patients from 3 months to 10 years at the mean of (41.2 ± 29.0) months; 6 (2.7%) patients had cardiac death, the major late post-operative adverse events were cardiac dysfunction (III to IV) or recurrence of angina (8.9%). Multivariate Logistic regression analysis revealed that female (P=0.019, OR=2.576), pre-operative atrial ifbrillation (AF) (P=0.012, OR=3.541) and CPB time (P=0.000, OR=3.781) were the independent risk factors affecting early post-operative outcome. Cox proportional hazards model presented that hyperlipidemia (P=0.025, HR=2.535), smoking (P=0.009, HR=3.414) and the history of PCI (P=0.013, HR=3.562) were the independent risk factors inlfuencing late prognosis of AVR-CABG. Conclusion: The overall effect of AVR-CABG in elder patients was satisfactory. Female, pre-operative AF, CPB time may affect the early post-operative outcome, while hyperlipidemia, smoking and PCI history could inlfuence the long-term prognosis in relevant patients.

Sequential vein bypass grafting is not associated with an increase of either in-hospital or mid-term adverse events in off-pump coronary artery bypass grafting / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The impact of sequential vein bypass grafting on clinical outcomes is less known in off-pump coronary artery bypass grafting (CABG). We aimed to evaluate the effects of sequential vein bypass grafting on clinical outcomes in off-pump CABG.</p><p><b>METHODS</b>From October 2009 to September 2013 at the Fuwai Hospital, 127 patients with at least one sequential venous graft were matched with 127 patients of individual venous grafts only, using propensity score matching method to obtain risk-adjusted outcome comparison. In-hospital measurement was composite outcome of in-hospital death, myocardial infarction (MI), stroke, requirement for intra-aortic ballon pump (IABP) assistance and prolonged ventilation. Major adverse cardiac events (MACEs: Death, MI or repeat revascularization) and angina recurrence were considered as mid-term endpoints.</p><p><b>RESULTS</b>No significant difference was observed among the groups in baseline characteristics. Intraoperative mean blood flow per vein graft was 40.4 ml in individual venous grafts groups versus 59.5 ml in sequential venous grafts groups (P < 0.001). There were no differences between individual and sequential venous grafts groups with regard to composite outcome of in-hospital mortality, MI, stroke, IABP assistance and prolonged ventilation (11.0% vs. 14.2%, P = 0.45). Individual in-hospital measurement also did not differ significantly between the two groups. At about four years follow-up, the survival estimates free from MACEs (92.5% vs. 97.3%, P = 0.36) and survival rates free of angina recurrence (80.9% vs. 85.5%, P = 0.48) were similar among individual and sequential venous grafts groups with a mean follow-up of 22.5 months. In the Cox regression analysis, sequential vein bypass grafting was not identified as an independent predictor of both MACEs and angina recurrence.</p><p><b>CONCLUSIONS</b>Compared to individual vein bypass grafting, sequential vein bypass grafting was not associated with an increase of either in-hospital or mid-term adverse events in patients undergoing off-pump CABG.</p>