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Abstract Introduction: At present, there are few reports regarding the issue of aortic reoperation due to its complexity and high risk and individual differences among patients. Methods: From November 2016 to December 2017, the data from 35 cases of aortic reoperation at our institution, out of 212 consecutive aortic repairs, were reviewed. We retrospectively summarized and analyzed their surgical indications, operative data, time interval from previous aortic repair, and outcomes. The time intervals until reoperation were analyzed for differences. Results: Patients' mean age was 40.9±14.5 years, and 25 of them were men (71.4%). The indications for reoperation were aortic valvular problem (14.3%), aneurysmal dilatation (25.7%), pseudoaneurysm formation due to anastomotic leakage (43.2%), and aortic dissection (17.1%). For patients who had underwent primarily emergency operations due to aortic dissection, the time interval until reoperation (4.8±3.2 years) was significantly shorter than that of the whole group (5.5±3.6 years, P<0.01). Among the 35 reoperations, Sun's procedure was selected for 16 patients (45.7%) with total aortic arch reconstruction. The average follow-up was 12 months (range 9-15 months). Hospital mortality was 5.7% (two patients). Among the hospital survivors there were no cases of death, rupture of residual dissection, paraplegia, or central nervous system complications during the follow-up period. Conclusion: Patients with acute aortic dissection required repeat surgery significantly earlier compared to other diseases. As to reoperation strategy, we recommend Sun's procedure as the choice for extended arch reconstruction since minimal effect on overall mortality and complication rates were found.
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Objective To explore the pathogen characteristics and related factors of nosocomial infection in adult ICU pa-tients after cardiac surgery, and provide a basis for the rational and standardized use of antibiotics and the control of nosocomial infection.Methods Patients in ICU after adult cardiac surgery from January 2015 to December 2017 were studied.Through the nosocomial infection monitoring and reporting system(HIS and LIS system), data of infected sites, specimens, pathogen and drug-sensitivity results were recorded, and the clinical data were collected and the related factors of nosocomial infection af-ter cardiac surgery were analyzed.Results 213 patients with nosocomial infections were diagnosed , and the nosocomial infec-tion rate was 3.59％.There were 261 cases of nosocomial infection, with a total infection cases rate of 4.39％.232 strains of pathogen were detected.Gram-negative bacteria173 strains(74.57％), klebsiella pneumoniae and acinetobacterbaumannii ac-count for 65(28.07％) and 37(15.95％)strains respectively.35 strains of gram-positive bacteria account for 15.08％, 12 strains of staphylococcus aureus account for 5.17％.24 strains of fungi account for 10.34％, 12 strains of candida albicans(5. 17％) were the most.The resistance rates of klebsiella pneumoniae to amoxicillin/kclavitrate, piperasil/tazobatan, tigacy-cline, tobramycin, and impenan were all<10％.Acinetobacter baumannii show high resistance rate to commonly used antibi-otics other than tigacycline(2.70％).The resistance rates of staphylococcus aureus and staphylococcus epidermis to vancomy-cin and linazolamide were 0.Logistic regression analysis showed that preoperative and postoperative stroke, secondary endotra-cheal intubation, postoperative low cardiac output, postoperative stroke, mechanical ventilation time >48 h, and postoperative ICU stay>72 h were related factors of postoperative nosocomial infection .Conclusion The main pathogen of nosocomial in-fection in ICU after adult cardiac surgery is gram-negative bacteria.Klebsiella pneumoniae, the most common bacteria, has a low resistance rate to antibiotics, while the secondary acinetobacter baumannii has a high resistance rate .According to the fac-tors related to nosocomial infection after cardiac surgery , prevention measures should be formulated .According to the results of pathogen and drug sensitivity, antimicrobial drugs should be selected reasonably so as to postoperative nosocomial infection and the occurrence of drug-resistant strains could be controlled effectively .
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Objective To explore the effect of different processing techniques to priming and the prognosis in infants dur-ing cardiac surgery under cardiopulmonary bypass(CPB).Methods 90 cases of pediatric patients under 5kg undergoing CPB open heart surgery were randomly selected, in group A(n=30), stored blood was added to the reservoir after crystalloid prim-ing, then zero balanced ultrafiltration(ZBUF) for the mixed priming solution; in group B(n=30), stored blood was cleaned by cell saver first, then added to the reservoir; in group C(n=30) , ZBUF technique was combined with cell saver for the priming.Modified ultrafiltration(MUF) was set up afer weaning bypass in all three groups, crystalloid solution was added to the reservoir to replace the residual blood to the patients.The general information, the quality and processing time of the mixed priming solution, the lactate level, free hemoglobin(f-Hb), inflammatory factor(IL-6/TNF-α) from T0 to T4, the positive ino-tropic drug lasting time , mechanical ventilation time and ICU time were all recorded .Results There were no statistical differ-ences among 3 groups for general condition.The lactate, f-Hb, IL-6 and TNF-αlevel in B and C group from T1 to T4 was sig-nificantly lower than A group , but no statistical meaning between B and C group .B and C group can significantly reduced the positive inotropic drug lasting time , mechanical ventilation time and ICU time .Conclusion To infants, blood priming pretrea-ted by cell saver can improve the quality of blood protection significantly than traditional ZBUF , also get labor saving and time saving effects, finally improve the prognosis.
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Structural heart disease includes congenital cardiovascular structural abnormalities, valvular heart disease and cardiomyopathy, which shows the common features of cardiac anatomical structure and hemodynamic abnormalities, especially anatomical abnormalities. Echocardiography, especially three-dimensional (3D) ultrasound, is good at displaying anatomical structure and blood flow abnormalities. As a non-invasive method of examination, it has advantage in the evaluation of such heart diseases. In recent years, the gradual rise of 3D printing technology can make physical printing, and the printed heart model can stereoscopically display abnormal state of heart diseases. Ultrasound combined with 3D printing technology may provide more intuitive and accurate information for the assessment of structural heart disease.
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Objective To compare the treatment effects between minimally invasive transthoracic device closure and traditional surgery on ventricular septal defect (VSD) in infants. Methods Data of 91 infants of VSD, who were less than 6 years old, were retrospectively analyzed from October 2013 to February 2015 in the department of cardiac surgery in Tianjin Chest Hospital. According to the operation mode, patients were divided into minimally invasive transthoracic device closure of VSD (closure) group (n=13) and traditional VSD repair under cardiopulmonary bypass (CPB, repair group, n=78) group. The preoperative cardiac ultrasound was used to determine the type of VSD, the distance from the margin of VSD to aortic and tricuspid valve, pulmonary artery pressure and other cardiac malformations. The intraoperative and postoperative monitoring included blood transfusion volume, valve regurgitation, mechanical ventilation time, intensive care unit (ICU) residence time, hospitalization time and hospitalization cost. The patients were followed up regularly after surgery to collect data including arrhythmia, hemolysis, valve regurgitation and residual shunt of VSD. Results There was no operative mortality in 91 patients. In closure group 1 case was converted to traditional repair surgery under CPB. There were significantly less values in ICU residence time and hospitalization time in closure group than those of the repair group[(13.2±11.7) h vs. (77.2±55.8) h, and (10.0±3.2) d vs. (15.8± 6.7) d, P0.05). Conclusion In the comparison of the recent or short-term clinical curative effect of VSD treatment in infants, the minimally invasive transthoracic VSD device closure is better than the traditional VSD repair treatment. Long term effects need to be further observed and followed up.
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Objective To investigate the effect of rhBNP in treating pulmonary hypertension after mitral value replacement (MVR) compared with PGE1.Methods 60 patients with pulmonary hypertension after MVR were randomly divided into 3 groups(control group, PGE1 group and rhBNP group).Hemodynamic factors(MAP, CVP, mPAP, etc.) were monitored before and after taking medicine at 1 h, 6 h, 24 h, respectively including drug withdrawal 2 h.TXA2 and cGMP were analyzed by ELISA.To observe the levels of TXA2 and cGMP in plasma before and after treatment with rhBNP and PGE1 for three times (24 h, 1 week and 3 months).Information about patients'mechanical ventilation time was also recorded.Results Patients' mechanical ventilation time in PGE1 group was the shortest.MAP, mPAP, PRVI, PAWP were reduced after treatment by medicine 1 h for in PGE1 group.However, these indexes were rebound after drug withdrawal.mPAP, PRVI, PAWP in rhBNP group decreased after treatment by medicine at 6 h.The decreased level of mPAP was less than that in PGEI group.In control group, TXA2 went down and cGMP went up after operation.After taking medicine at 24 h, TXA2 decreased and cGMP increased in both PGE1 and rhBNP group.The increased level in rhBNP group was higher than that of control group.With medicine, the decreased level of TXA2 in PGE1 was also higher than that in rhBNP group.The going-up of cGMP in rhBNP was higher than that in PGE1.Conclusion Both rhBNP and PGE1 can reduce pulmonary artery pressure, PGE1 is more effective than that of rhBNP.
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Objective To study in vitro hydrodynamics of a pneumatic pulsatile ventricular assist device developed ex?clusively by China, and establish an animal model for the detection by the device. Methods The hydromechanics experi?ment was performed on an in vitro test loop using MEDOS-System to drive the ventricular assist device, and lycerl-water so?lution was used as circulating medium. The changes of afterload pressure and the output of the pump were monitored, and the impermeability and stability were also assessed after the experiment. Six adult dogs were used as the experimental animals. The device worked in the left heart assistance mode for 1 hour then the ventricular fibrillation was induced by potassium chloride, and then defibrillated after 5 min while the device remained working. The hemodynamics data were monitored con?secutively during the trial. Results The ventricular assist device worked stably and reliably during the hemodynamic exper?iment. The pump can generate more than 4 L/min flow against the afterload pressure of 100 mmHg. There were no significant changes in heart rate at different time points in experimental dogs after left ventricular assist. Comparison between after auxil?iary immediately and former auxiliary, the diastolic blood pressure of dogs increased 30 mmHg with the ventricular assist, and the diastolic pressure increased 19 mmHg. No obvious fluctuation in blood pressure was found during the auxiliary pro?cess. The diastolic blood pressure stayed at 60 mmHg when the heart was in ventricular fibrillation, and returned to normal after electrical defibrillation. Conclusion The ventricular assist device works stably in vitro test, and the pump can meet the need of adult’s ventricular assist. It is effective and security to dogs in short term. The effects of long-term use need to be future proved.
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Objective To investigate the effect of hypoxic preconditioning on the biological function of bone mar-row-derived endothelial progenitor cells (BM-EPCs). Methods Mononuclear cells were collected by density gradient cen-trifugation from the bone marrow of rats. The isolated cells were cultivated in dishes coated with the vitronectin from rat plas-ma,filled with the endothelial cell basal medium-2. Cells were then cultured under the conventional culture conditions (37℃and 5%CO2). The cultured cells were divided into control group and hypoxia training group after four-day culture. Cells of the control group were cultured in previous conditions for another three days. However, cells of the hypoxia training groups were cultured in previous conditions for 0, 1 and 2 days,and then under the hypoxic condition (1%O2+5%CO2+94%N2) for another 72 hours, 48 hours and 24 hours, respectively. After seven days,cells in all of groups were collected for the following study. The immunofluorescence labeling and cell analyzer were used to indentify BM-EPCs. The tube formation of BM-EPCs was tested by Matrigel assay. Annexin V/PI antiapoptotic assay was used to detect the apoptotic rate of BM-EPCs. Results The early apoptotic rate of BM-EPCs was increased obviously with extended hypoxia. There was no significant dif-ference in the early apoptotic rate of BM-EPCs between control group (0.89±0.20)%and hypoxic 24-h group (1.33±0.07)%(P>0.05). There was significant increase in the early apoptotic rate of BM-EPCs in hypoxic 48-h group (3.25±0.12)%and hypoxic 72-h group (7.48 ± 1.53)%(P<0.05). Compare with control group, the tube formation ability was significantly in-creased in hypoxic 24-h group (P<0.01), but the tube formation ability was significantly decreased in hypoxic 48-h group and hypoxic 72-h group (P<0.01). Conclusion After hypoxic preconditioning for 24 hours, the apoptotic rate was not obvi-ous in BM-EPCs, but the tube formation ability was markedly increased.
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Objective To investigate the role of stromal cell-derived factor-1α(SDF-1α)/CXCR4 signal pathway in the therapeutic effects of hypoxic preconditioning endothelial progenitor cell (HEPC) transplantation on acute myocardial in-farction Methods Bone marrow endothelial progenitor cells (EPCs) were isolated from syngeneic adult male Wistar rats. EPCs were cultured under normoxic condition for 4 days and 1%O2+5%CO2+94%N2 condition for 3 days. The effect of HEP-Cs on the migration ability of 100μg/L SDF-1αwas observed. Western blot assay was used to detect the expression of CX-CR4, the solo receptor of SDF-1α on cells surface. Then, 26 syngeneic adult male Wistar rats were randomized into 3 groups:control group (n=8),EPCs group (n=9) and HEPCs group (n=9). The acute myocardium infarction animal model was established. At infarction, the rats received 5-points peri-infarct intramyocardial injections of PBS 200μL, 2×106 EPCs and 2 × 106 HEPCs. After 4 weeks, the haemodynamics parameters of cardiac function were analyzed by echocardiography. Results Compare with EPCs, the migration ability of HEPCs towards SDF-1α was increased significantly. The result of Western blot analysis showed an increased CXCR4 expression on the cell surface. After 4 weeks of transplantation, the left ventricular end systolic diameter and ejection fraction (EF%) were much improved in HEPCs group than those of EPCs group and control group (P＜0.05). Compare with control group, the left ventricular end-diastolic diameter was significantly im-proved in EPCs and HEPCs groups (P＜0.05). There was no significant difference in the improvement of the left ventricular end-diastolic diameter between HEPCs and EPCs groups (P>0.05). Conclusion SDF-1α/CXCR4 pathway was up-regu-lated by HEPCs, which showed the therapeutic effects via EPCs. The adjustment of SDF-1α/CXCR4 signaling pathway is an effective method for the treatment of ischemic heart diseases.
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Objective To evaluate the relationship between the change of Heart-fatty acid-binding protein and myocardial injury/infarction in postoperative of off-pump coronary artery bypass grafting (OPCAB).Methods 59 patients (male 37 and female 22,from 46 to 83 years old) who were the first time to undergoing OPCAB were included in this study.Serial venous blood samples were taken at after induction of anesthesia,the OPCAB finished (after the last anastomosis),entered ICU,2,4 and 8 hours after the patient entered ICU,and at 1 and 2 day postoperative to test H-FABP.The cTnI and CK-MB were tested at 4 and 8 hours,after entering ICU,and at 1 and 2 days postoperative.Patients were divided into 3 groups by the changes of ECG and the level of cTnl at 8 hours after they entered ICU:normal group (group I,cTnI ＜0.1 ng/ml),myocardial injury group(group Ⅱ,cTnI 0.l-1.0 ng/ml) and.myocardial infarction group(group Ⅲ,cTnI ＞ 1.0 ng/ml).Results The level of H-FABP released was significantly higher in the myocardial infarction group than normal group and myocardial injury group (P ＜ 0.01).There is good correlation between the H-FABP and cTnI or CK-MB.But the peak level of H-FABP is earlier (finished OPCAB) (P ＜ 0.05),and it peaked early at 2h after entered ICU (P ＜ 0.01),it began to decrease at 4 hours after entered ICU and returned to baseline at 1 day postoperative,while the cTnI and CK-MB peaked at postoperative day 1 and 8h after entered ICU respectively,and maintained in higher level at postoperative 2 days.Conclusion There is good correlation between the H-FABP and perioperative myocardial infarction in OPCAB,and it has superiority compared with cTnI,which is as gold standard for perioperative myocardial infarction,on a certain degree.It can benefit from early detection of H-FABP for myocardial infarction in perioperative of OPCAB.
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Objective We want to study the therapeutic efficiency of autologous ADMSC transplantation in myocardial infarction.And we try to find out a good way to improve the therapeutic efficiency by using the combination of gene therapy and cell therapy.Anti-apoptotic protein XIAP was selected to fight against the ischemic environment of myocardic infaction.Methods ADMSC was isolated from rat inguinal fat tissue.ADMSC was cultivated with DMEM.XIAP experession plasmid was elertco-transduced to ADMSC.The anti-apototic function of XIAP was tested by serum stavation induced apotosis.The method of ligation of the left anterior descending artery was used to prepare the Myocardial infarction model.Then rats were randomly separated into three groups to receive direct epicardial injections of normal saline,or ADMSCs cell suspension or XIAP modified ADMSCs cell suspension at five sites in central zones of myocardial infarction and border zone.Cardiac function and the infarct size were evaluated 4 weeks after ADMSCs transplantation.Results West blotting suggest that,XIAP over-expression block serum starvation induced apotosis.It showed that there are significant statistic difference among XIAP modified ADMSC transplantation group,ADMSC transplantation group and control group 4 weeks after myocardial infarction (P ＜ 0.05).Left ventricular ejection fraction(LVEF) showed a significant improvement in ADMSCs transplantation group compared to control group (P ＜0.05).Left ventricular end systolic diameter(LVDs) and left ventricular end diastolic diameter(LVDd) of ADMSCs group were smaller than control group(P ＜ 0.05).The area of myocardial infarction was significantly reduced in the ADMSCs transplantation group compared to the saline group(P ＜0.05).Compared to ADMSCs transplantation group,effect of the XIAP modified ADMSC in rats with myocardial infarction is more obvious.The reduction of LVEF of XIAP modified ADMSCs group was signific antly lower(9％) than the ADMSCs group(16％) (P ＜ 0.01).Infarction area in XIAP modified ADMSCs group(3.26 ±0.95)％ was smaller than ADMSCs group(5.17 ±2.03)％ (P ＜0.05).Conclusion Autologus ADMSC transplantation is an efficient therapeutic tool in myocardial infarction therapy.Over expression of XIAP can partly inhibit lowserum induced apotosis of ADMSC in vitro,and it can improve left ventricular function better in vivo.Over expression XIAP of ADMSC can improve the therapeutic efficiency compare to ADMSC transplantation.
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Objective To evaluate the early diagnostic value of Heart-type fatty acid-binding protein(H-FABP) for myocardial infarction in patients post off-pump coronary artery bypass (OPCAB).Methods Between March 2009 and July 2009,59 patients had been undergone OPCAB for the first time.They were divided into 3 groups (normal group,myocardial injury group and myocardial infarction group) by myocardial-bound creatiue kinase (CK-MB) 、cardiac troponio Ⅰ (cTnI) 、electrocardiogram (ECG) and echocardiogram.Serial blood samples were taken during perioperation to quantify blood levels of H-FABP,CK-MB,cTnI.Results The average H-FABP value for the patients in the myocardial infarction group is higher than the others ( P ＜ 0.01 ).H-FABP reached the peak valve at 2 hours and decreased at 4 hours after the patients arrived at ICU.H-FABP got back to the baseline one day postoperation.Receiver operating characteristic curves( ROC curve) demonstrated that H-FABP had greater diagnostic ability of myocardial infarction postoperation with area under the curve at the time of arriving at ICU ( 0.900,95％ CI 0.818 -0.981 )and 2 hours later (0.832,95％ CI 0.718 -0.946).At the time of arriving at ICU,sensitivity of H-FABP for diagnosis was 90.9％ and specificity was 77.1％.At the point of 2 hours later,sensitivity was 72.7％ and specificity was 75.0％.Conclusion The H-FABP seems to be an excellent early biomarker of cardiac necrosis after OPCAB.
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ObjectiveTo access the predictive value in Postoperative mortality in patients undergoing coronary artery bypass grafting(CABG) by seven different Risk scoring system.MethodsTo collect the clinical information of patients undergoing CABG in our department.SinoSCORE,Additive EuroSCORE,Logistic EuroSCORE,OPR,Cleveland model,Parsonnet score,QMMI was used to predict postoperative mortality for all patients,and calculate the mean predictive postoperative mortality.To devided the patients to six group:group Ⅰ (0 - 1.99％ ),group Ⅱ (2.00％ - 3.99％ ),group Ⅲ (4.00％ - 5.99％ ),group Ⅳ ( 6.00％ - 7.99％ ),group Ⅴ (8.00％ - 9.99％ ),group Ⅵ ( ＞ 10％ ) by predictive postoperative mortality.Access the performance of risk scoring system predict the mortality through compare the predictive mortality and the observed mortality in different Risk stratification.To use Hosmer-Lemeshow goodness-of-fit test access the calibration.Discrimination was tested by determining the area under the receiver operating characteristic(ROC) curve(AUG).ResultsThe overall mean baseline age was ( 62.8 ± 8.8 ) years.The observed mortality in all our study patients was 1.99 ％ ( 22/1103 cases).The predictive mortality calculated by SinoSCORE,Additive EuroSCORE,Logistic EuroSCORE,OPR,Cleveland model,Parsonnet score and QMMI were 3.01％,4.38％,3.83％,1.69％,4.42％,6.71％ and3.71％.And the most closest is OPR,SinoSCORE,QMMI.Group tests confirmed Logistic EuroSCORE Overestimated the mortality in all the group.Predicted mortality calculated by Additive EuroSCORE was lower than the actual mortality in group Ⅵ and higher than the observed mortality in other group.SinoSCORE、Cleveland model、Parsonnet score、QMMI Overestimated the mortality in all the group expect group Ⅰ.OPR forecast a lower mortality Compared with observed mortality in group Ⅰ and group Ⅳ and a Slightly higher mortality in group Ⅱ,group Ⅲ.To use Hosmer - Lemeshow goodness-of-fit test access the calibration.The text proved all the risk scoring system had a good calibration for postoperative mortality (P ＞ 0.05 ).Discrimination was tested by ROC,only SinoSCORE ( AUC =0.751 ＞ 0.70) showed high discriminatory ability in predicting mortality.ConclusionSinoSCOBE have a good forecast performance for the postoperative mortality in the patients undergoing CABG in our department in seven different Risk scoring system.And SinoSCORE could be used in preoperative risk assessment.
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Objective To evaluate the outcome of the cardiac catheter angiograplasty for patients after Norwood procedure. Methods 13 patients, who had undergone Norwood procedure (prior to Glenn procedure)received cardiac catheterization and angiography. lnterventional therapy was performed in 12 patients as indicated. Results Angioplasty was carried out for re-coarctation in 6 of the13 patients. 1 patient with left pulmonary artery stenosis received balloon dilation and 3 months later a stent implantation. A stent was implanted to improve the pulmonary blood flow in 2 patients with Sano-Shunt stenosis and 1 patient with BT-Shunt stenosis. Transcatheter coil embolization was performed in 3 of the 4 patients with systemic to pulmonary collateral vessels. The other one was scheduled for Glenn procedure the next day. Conclusion The incidence of hemodynamic restrictions after Norwood procedure is high (12 of 13 patients). Postoperative angiography and hemodynamic assessment for diagnosis and interventional treatment for new pulmonary artery or aortic arch stenosis is necessary after Norwood procedure.
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ObjectiveLevosimendan,a new calcium ion sensitizer,is currently used in the treatment of heart failure and as an option for patients with injury to the left heart or at high risk for surgery.The study tried to evaluate the effects of levosimendan and ulinastain for protecting myocardium from ischemia-reperfusion (I/R) injury to the isolated immature rabbit hearts and investigate the possible mechanism.MethodsFifty New Zealand long-ear white immature rabbits were anesthetized and heparinized.Their hearts were rapidly removed and mounted on modified Langendorff apparatus.A left ventricle pressure monitoring line was inserted through the left atrial and mitral valve.The hearts were equilibrated with oxygenated K-H solution at 37℃ for 10 minutes.The rabbit hearts were randomly divided into 5 groups with 10 hearts in each group.Hearts in group C were perfused with K-H solution,in group U were perfused with ulinastain (50000 U/kg),in group LI were perfused with Levosimendan 0.1 μmol/L,in group L2 were perfused with Levosimendan 0.3 μmol/L,and in group L + U were perfused with Ulinastain (50 000 U/kg) and Levosimendan 0.1μmol/L.The hearts were arrested with St-Thomas solution for 30 min.Hearts in each group underwent 30 min-reperfusion with the same solutions after 30 min-global myocardial ischemia.Heart rate ( HR) Jeft ventricular pressure ( LVP) and LVdp/dtMax were monitored.Effluent from coronary sinus was collected at time of ischemia /reperfusion for measuring the concentration of TNF-α,IL-6,CK and cTnI.ResultsLVP and LVdp/dt in group L1,L2 and L + U were better than those in group C and U.But the heart rates in group L2 were higher than in other groups.Concentrations of CK,cTnI,TNF-α and IL-6 in the effluent from coronary sinus at 0、10 and 30 min of reperfusion were significantly lower in group L + U than in the other groups.ConclusionLevosimendan may have the similar effects with ulinastain in reducing the reperfusion injury to the immature myocardium.The protective effect of levosimendan (0.1 μmol/L) in combination with ulinastain (50 000 U/kg) was better than that of levosimendan or ulinastain alone.
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Objective To observe the change of interleukin-8(IL-8) during perioperative period, and to define whether the increase of IL-8 in response to cardiac surgery is related to the presence of a certain allele in a functional polymorphism. To explore the relationship between postoperative inflammation and clinical outcome. Methods One hundred and forty-five patients undergoing selective off-pump coronary artery bypass (OPCAB) for the first time were enrolled. The IL-8 (-251A >T) polymorphisms were analyzed by using polymerase chain reaction (PCR) and gene sequencing. The plasma levels of cytokine, troponin T (TnT). creatine kinase-MB (CK-MB) and creatinine (Cr) were measured before and 4, 24 and 72 hours after operation by suspension array system. Results After surgery, the IL-8 concentration increased and reached the highest level at 4 hours after surgery [18.0 (8.4, 37.1) ng/L, P = 0.000], and then it decreased to the preoperative level at 3 days after surgery. Four hours after surgery, the patients with IL-8-251 AA homozygous genotype had higher concentration of IL-8 C33.1 (16.6, 49.5) ng/L, P =0.0353. They had higher TnT and CK-MB levels than patients homozygous for AT and TT genotype 4 hours after surgery [TnT:0.53 (0.43, 4.92) ng/ml, P = 0.037; CK-MB: 41.5 (28.8, 65.5) U/L, P=0.025], and patients homozygous for AT genotype had higher Cr level 24 hours after surgery C93.1 (76.4, 121.5) μmol/L, P = 0. 021]. The patients who underwent ventilation for more than 1 day or post-operative hospital stay for more than 14 days had higher IL-8 levels (P=0.036, 0.038). IL-8-251AA genotype was an independent risk factor for patients undergoing ventilation for more than 1 day (OR=11.80, 95% CI: 1.87-74.48) and post-operative hospital stay for more than 14 days (OR=38.00, 95% CI:4.15-347. 87) . Conclusions OPCAB results in postoperative inflammatory response. IL-8-251AA genotype is associated with longer mechanical ventilation and hospital staying. Genetic background might alter the extent of inflammatory response and relate to postoperative prognosis. 、
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From April 1990 to February 1991, 7 cases of complex congenital cardiac malformations were treated with transplantation of aortic valved homograft sterilized and preserved in our department. Conduit-constructing from right ventricle to pulmonary arteries and from left ventricles to pulmonary artries was performed in 2 and 5 cases repectiredly. When the bore between aortic homograft and artificial blood vessel was 2-4mm, good result could be achieved in clinical hemodynamics and pressure difference was seldom found. No death occurred in these cases. The follow-up with color Doppler echocardiography and cineangiography proved that anastomosis was unobstracted, extracardiac conduits had no distortion and compression, and no stenosis and incomptence were found in homograft valves.