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Objective To evaluate the correlation between preoperation hepatic function and mortality after heart transplantation using the Receiver Operating Characteristic(ROC) cures and Kaplan-Meier survival analysis.Meanwhile determining the Optimal Operating Point(OOP) and doubtable value interval of the significant indicator for studing it with short to medium term survival analysis.Methods To collect statistical data of 91 cases with heart transplantation in the heart transplantation centre of Anzhen Hospital from January 2009 to June 2014,including the last preoperation hepatic function index.Containing alanine aminotransferase (ALT),aspartate aminotransferase (AST),total protein (TP),albumin (ALB),ratio of albumin and globulin(A/G),serum total bilirubin(STB),connect bilirubin(CB),ratio of connect bilirubin and serum total bilirubin CB/STB,etc.Plotting the ROC curves for all variables in perioperation using SPSS 17.0 statistical software,firstly.Next,to determine the significant indicator according to the area under the ROC curve (AUC) (AUC ＞ 0.7),and to find OOP/Youden index and doubtable value interval of the significant index.And then,total cases were divided into three groups according to doubtable value points.Finally,using Kaplan-Meier survival analysis to reveal the variation tendency of three survival cures for different groups.Results The ratio of albumin and globulin is the sole variable associated with mortality in perioperation,and AUC =0.825(SE =0.056,P =0.000,95％ CI =0.715～0.936).Paients whose A/G≤1.13 had significantly lower survival rates than the other two groups in short to medium postoperative term,P ＜0.001.But after 32 months,the variation tendency of three groups tended to stability.Conclusion The preoperative ratio of albumin and globulin of patient and postoperative mortality were related,but the correlation decreased with the increase of time.The short to medium term survival rates declined significantly for patients whose A/G≤ 1.13.So preoperative A/G could forecast the prognosis of paitents as reference indicator.
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Objective To analyze statistically complications associated with usage of extracorporeal membrane oxygenation after cardiac surgery in 82 cases.This report reviews our experience in extracorporeal membrane oxygenation support treatment in adult patients with cardiac failure after cardiac surgery.Methods To collect statistical data of 82 adult patients with extracorporeal membrane oxygenation support in one ward of Anzhen Hospital from January 2008 to January 2012,including renal failure,infection,haemorrhage,limb ischemia,microembolus,hemolysis,hypohepatia,lymphatic leakage,etc.Results The complication rate was 53.7％ (44 cases).Renal failure morbidity and mortality rates were the highest (36.6％,56.7％).Infection was the second highest(34.1％,40.0％).To analyse the relationship between application timing of continuous renal replacement therapy and mortality of extracorporeal membrane oxygenation by using regression analysis method,P =0.012.Both are related,and mortality increase with time.Conclusion Renal failure and infection are the main complications of adult receiving extracorporeal membrane oxygenation with cardiac surgery,and had significant effect on the prognosis.Application timing of continuous renal replacement therapy and mortality of extracorporeal membrane oxygenation are related.Prevent early and treat timely should be benefit to the patients wih high-risk factors.
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Objective To investigate a new strategy of bone marrow transplantation (BMT) for donor-specific tolerance induction after heart transplantation. Methods Donor bone marrow cells (BMCs)were harvested simultaneously with donor cardiac graft using modified perfusion method (PM) ,then stored in a -80 ℃ refrigerator after filtration and centrifugation. Whole BMCs (IBM-BMT) (monocytes 1.2 ×107/kg,CD34+ cells 2.38× 105/kg) in host iliac bones were injected into the bone marrow cavity 40 days after heart transplantation. Preconditoning regimens that consisted of fludarabine, antithymoctye globin and total lymphoid irradiation were performed 3 days before BMT. Tacrolimus (Tac) was administrated intravenously after BMT or orally in conjunction with mycophenolate mofetil (MMF) 3 weeks later.Cyclosporine and MMF were orally administrated 6 weeks later. Donor chimerism was detected using short tandem repeats-polymerase chain reaction in monocytes from peripheral blood at the 2nd,4th, 8th or 12th week after BMT or BMCs at the 4th, 8th or 12th week after BMT. Intramyocardium electrocardiography examination or endomyocardial biopsy was performed weekly or monthly respectively. Mixed lymphocyte reactions (MLR) were performed 3 months after BMT. Results Donor chimerism in monocytes in peripheral blood or BMCs in iliac bones measured at the 1 st,2nd and 3rd month after BMT was 26.3%, 19.1%,4.8% ,and 46.3%, 24.4%, 7.6%, respectively. After 3-month follow-up, there was no rejection confirmed by endomyocardial biopsy or intramyocardium electrocardiography. Echocardiography revealed that the diastolic and systolic function of the cardiac graft was maintained well 3 months after BMT. MLR revealed donor-specific hyporesponsiveness while immunocompetence was preserved to third-party antigens. Conclusion These findings indicate that the two-stage BMT strategy is a safe and feasible method for the induction of donor-specific tolerance via stable mixed chimerism and needs to be further confirmed after a long-term observation.
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Objective It was demonstrated that pulsatile perfusion (PP) is more physiologic and better than non-pulsatile perfusion (NPP) in maintaining blood circulation in vital organs. The purpose of this study was to determine the effect of PP on cerebral cortical blood flow(CCBF) after deep hypothermic circulatory arrest(DHCA) and the duration of safe DHCA. Methods Thirty-nine adult healthy mongrel dogs of either sex, weighing 10-15 kg were divided into two groups: PP group (n = 18) and NPP group (n = 21) . The animals were anesthetized with intravenous pentobarbital 25mg?kg-1 . After tracheal intubation the animals were mechanically ventilated. Right femoral artery and vein were cannulated for intra-arterial pressure monitoring and infusion. The chest was opened and heart exposed. CPB was started after insertion of venous drainage catheter into right atrium and arterial cannula into ascending aorta. The bypass pump was shut off when the brain was cooled to 20℃. Circulatory arrest was maintained for 40 min, 60min or 80 min respectively. CCBF was measured during cooling and rewarming at 35℃, 30℃, 25℃and 20℃ by hydrogen clearance technique. Results During cooling CCBF gradually decreased and there was no difference in CCBF between the groups. After 40 min DHCA during rewarming CCBF increased significantly faster in PP group than in NPP group during the early period but CCBF returned to pre-cooling baseline level at the end of rewarming in both groups. After 60 min DHCA during rewarming when brain temperature returned to 30℃ and above , CCBF increased significantly faster in PP group than that in NPP group and returned to pre-cooling baseline level at the end of rewarming in both groups. Electron microscopic examination revealed that ultrastructure of neurons was normal after 40 min DHCA in both groups. After 60 min DHCA the ultrastructure was normal in PP group but swelling of neurons andedema of mitochondria could be seen in NPP group. After 80 min DHCA marked neuronal damages could be seen in both groups.Conclusions The results of our study suggest that PP improves CBF after DHCA and can protect brain from ischemic and hypoxic damages induced by DHCA and the duration of safe DHCA at 20℃ should be less than 60 min.