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@#Objective To compare the clinical effects of coronary artery bypass grafting (CABG) via the left anterior small thoracotomy (LAST) versus lower-end sternal splitting (LESS) approach in the treatment of coronary heart disease. Methods The patients who underwent LAST CABG in Tianjin Chest Hospital from October 2015 to December 2020 were allocated to an observation group (LAST group), and the patients who underwent LESS CABG at the same period were allocated to a LESS group. Propensity score matching method was applied with a ratio of 1∶1. The baseline data, perioperative data and grafts data were compared between the two groups after matching. Results Before matching, there were 110 patients in the LAST group, and 206 patients in the LESS group. After matching, there were 110 patients in each group. In the LAST group, there were 83 males and 27 females with an average age of 60.6±8.3 years. In the LESS group, there were 80 males and 30 females with an average age of 61.0±9.6 years. There was no statistical difference in baseline data between the two groups after matching (P>0.05). The hospital stay time (t=2.255, P=0.025) and ventilator using time (t=−2.229, P=0.027) in the LAST group were significantly shorter than those in the LESS group. There were no statistical differences between the two groups in the postoperative hospital stay time, ICU stay time, postoperative left ventricular ejection fraction, postoperative left ventricular end-diastolic diameter, average number of grafts, secondary intubation, secondary thoracotomy, postoperative wound infection, sternal complications, postoperative atrial fibrillation, postoperative pulmonary infection or main adverse cardiovascular and cerebrovascular events (P>0.05). There was no statistical difference in the distribution of target vessels in the anterior descending branch, diagonal branch or posterior descending branch between the two groups (P>0.05). The grafts of the LAST group were significantly more than those of the LESS group in the area of obtuse marginal branch and posterior ventricular branch, and the grafts of the LESS group were significantly more than those of the LAST group in the area of right coronary artery (P<0.05). Post-operative computerized tomography angiography indicated that 1 patient in the LAST group had obtuse marginal branch vein bridge vessel occlusion, and the bridge vessels in the other patients were unobstructed. Conclusion Minimally invasive CABG via both LAST and LESS approaches is safe and effective. LAST approach can achieve complete revascularization for multi-vessel lesions, and it is safe and reliable, with the advantages of less trauma and aesthetic appearance. However, it requires a certain learning curve of surgical techniques and certain surgical indications.
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Objective:To evaluate the effect of coronary artery anatomical score(SYNTAX score) on in-hospital mortality of CABG patients.Methods:The clinical data of patients who were performed with a CABG surgery alone in the Department of Cardiovascular Surgery, Tianjin Chest Hospital from July 2017 to December 2018 were collected. The clinical end point was all-cause in-hospital death or against-advice discharge after surgery. Univariate analysis and multivariate logistic regression analysis were performed on the clinical data of the patients to obtain the risk factors affecting the in-hospital death of CABG in our center, to evaluate the influence of SYNTAX score on the in-hospital death of CABG. Results:Univariate logistic analysis showed that age, critical condition, creatinine level, serum albumin level, NT-proBNP level, NYHA grade, internal mammary artery use, SYNTAX score were correlated with in-hospital mortality. Multivariate analysis showed that age(≥75 years old), history of diabetes mellitus, critical state, creatinine clearance rate < 85 ml/min, albumin <35 g/L, NYHA Ⅲ-Ⅳ, SYNTAX score(≥29) were independent risk factors for in-hospital mortality after CABG. Conclusion:Coronary artery anatomy score - SYNTAX score(≥29) was an independent risk factor for in-hospital mortality in CABG patients in our hospital.
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Objective To evaluate the effects of preoperative continued dual antiplatelet therapy (DAPT) with aspirin and clopidogrel on early outcomes in patients underwent off-pump coronary artery bypass grafting (OPCABG). Methods A single-center study was conducted. The 279 unstable angina patients underwent first-time isolated OPCABG at our institution from January 2015 to May 2016 were divided into DAPT group (preoperative aspirin 100 mg/d and clopidogrel 75 mg/d were given until the time of surgery, n=148) and control group (stopped DAPT for 5 days before surgery, n=131). The total chest-tube output, blood-product transfusion requirements, re-exploration rate for bleeding, major adverse cardiac events (MACE) and other in-hospital outcomes were collected and compared between the two groups. Results There were no significant differences in demographic and preoperative clinical characteristics between the two groups. The total chest-tube drainage volume and perioperative transfusion requirements (rate and volume) including red blood cell, fresh plasma and platelets were statistically higher in the continued DAPT group than those of control group (P < 0.05). There were no significant differences in hemostatic re-exploration rate, length of operation, postoperative nonfatal myocardial infarction, ICU stay, ventilation time and duration of postoperative hospitalization between the two groups. Stroke and other severe outside chest bleeding and all-cause mortality were not observed in both groups during the postoperative period and prior to discharge. Conclusion Preoperative continued DAPT is associated with the increased chest-tube drainage and higher blood-product transfusion requirements but it does not increase the dection rate of thoracotomy because of bleeding. This antiplatelet strategy does not alter other investigated outcomes in primary isolated OPCABG patients. The preoperative DAPT may be able to be safely continued in patients referred for primary isolated OPCABG.
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Objective To investigate the normal aortic valve histological manifestation and histopathological changes of degenerative aortic valve.Methods In Tianjin Chest Hospital,there were patients due to aortic valve disease undergoing aortic valve replacement surgery in the Department of Cardiovascular Surgery,and in 22 cases,their pathological aorta tricuspid valves were successfully excised from May 2009 to May 2010.The aortic valve tissues were collected,and according to hematoxylin and eosin (HE) staining of the degenerative calcified aortic valves with stenosis,they were divided into pathological valvular calcification locus group and non calcification locus group.Six morphologically normal aortic valve tissues were taken as a control group.The situation of collagen fibers,elastic fibers and collagen content in normal and disorder valves were analyzed by using of IDA-2000 high definition color medical image analysis system.Results With the naked eye,the thickness of the valve leaves with stenosis was increased,and at the valve leaf close to the side of arota,calcified foci were produced.Under light microscope,inflammatory changes were found in the aortic valve endothelium,in the tubular wall,there were aggregations of newly formed capillary with relatively thin wall,cholesterol crystals,cells similar to foam cells and diffuse and nodular calcification commonly seen,Compared with the normal valve,the ratio between collagenous and elastic fibers no matter at calcified or non-calcified region was greater in pathological valve [(3.19-± 1.01)％,(2.62-± 0.34)％ vs.(1.89-± 0.29)％,both P ＜ 0.05],collagen content (ratio =collagen/valve area) was also higher [(65.17 ± 11.48)％,(39.25-± 11.15)％ vs.(22.99 ± 4.78)％,P ＜ 0.05] in pathological valve,and the changes in calcified region were more significant than those in non-calcified region (both P ＜ 0.05).Conclusions Proliferation of collagen and degradation of elastic fibers are obvious in degenerative aortic valve,and the changes are more prominent at calcified region.
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Objective To investigate the diagnosis and treatment in patients with acute myocardial infarction (AMI) and complicated left ventricular wall rupture (LVWR). Methods A retrospective analysis was made on the clinical features, diagnosis and successful treatment in three AMI patients with LVWR from December 2015 to April 2016. Results Three cases were included in this study. Case 1, the mesh like cardiac rupture after AMI was diagnosed by ultrasonic Doppler. Emergency revascularization was performed due to the combined cardiac shock, and the infarct related artery was opened. The vasoactive drugs were used after revascularization to reduce ventricular pressure load and volume load in the haemodynamic monitoring, and anticoagulation, antiplatelet agents were less used or discontinued to promote local thrombus healing of ventricular rupture. Case 2 was a recurrent myocardial infarction patient. LVWR was diagnosed by ultrasonic Doppler one day after emergency operation. The ruptured ventricular wall was encapsulated by thrombus. The drug therapy was effective in hemodynamic monitoring. LVWR was further confirmed by cardiac CT after clinical stabilization. Case 3 was diagnosed LVWR by ultrasonic Doppler four days after AMI. Because the ruptured ventricular wall was limited by incompletely organized thrombus, and the haemodynamic condition was stable, selective surgical repair of rupture after coronary angiography was performed. Conclusion The effective drug therapy combined with percutaneous coronary intervention and surgical repair can reduce the risk of death in patients with LVWR after AMI.
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Objective To evaluate the short term outcome after mitral valve replacement with the Perimount bovine pericardial valve. Methods Eighty-eight patients underwent mitral valve replacement with the bovine pericardial valve in hospital were included in this study. Postoperative general condition including mortality and cerebral hemorrhage was observed. The hemodynamic and New York heart disease association (NYHA) heart function classification were recorded by Doppler echocardiograms before operation, postoperative 1 week, 3 months and 1 year after mitral valve replacement. Values of the different time points of NYHA, left atrial diameter (LA), left ventricular end diastolic diameter (LVDD), left ventricular end systolic diameter (LVSD), left ventricular ejection fraction (LVEF) and pulmonary artery pressure (PAP) were compared. The hemodynamic parameters were also compared including the peak cross valve pressure (PG), mean cross valve pressure (MG), peak cross valve velocity (PV) and effective orifice area (EOA) 1 week, 3 months and 1 year after surgery. Results There were two cases (2.3%) dead in one year (one died of cerebral hemorrhage and another one died of thromboembolism). There was 1 perivalvular leakage (1.2%). There was no endocarditis or structural valve deterioration. NYHA cardiac function was improved at postoperative 3 months and 1 year (P < 0.05). The values of LA, LVDD and PAP were significantly decreased at postoperative 1 week, 3 months and 1 year compared with those before operation (P<0.05). Values of LVSD and LVEF were significantly decreased at postoperative 1 week compared with those before operation (P<0.05). The value of LVEF was significantly increased at postoperative 3 months and 1 year (P<0.05). Compared with postoperative 1 week, the values of LA and LVEF were significantly increased at postoperative 3 months and 1 year (P < 0.05). There were no significant differences in PG, MG, PV and EOA between postoperative 1 week, 3 months and 1 year. Conclusion With the excellent performance of cardiac function recovery, left ventricular restoration and hemodynamic, the Perimount bovine pericardial valve remains a reliable choice as a mitral tissue valve.
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Objective To analyze the benefits and risks of preoperative aspirin treatment in elderly patients undergoing off-pump coronary artery bypass (OPCAB) grafting.Methods From January 2010 to June 2014 in Tianjin Chest Hospital,1 501 consecutive patients aged ＞65 years with mean age (71.1 ± 4.2) years who underwent selective first-time isolated off-pump coronary artery bypass surgery were included in this research.They were divided into 2 groups:aspirin group (longterm use of entericcoated aspirin tablets within 5 days before operation,n =369) and aspirin withdrawal group (aspirin withdrawal for 5 days and over before operation,n=1 132).Univariate analysis and a logistic regression were used to compare the postoperative events between the two groups.To adjust for the remaining differences between groups,propensity score was enrolled into the logistic regression model.Results There were no significant differences between the two groups in all-cause in-hospital mortality,postoperative myocardial infarction,cerebrovascular events,postoperative renal failure,blood dialysis and reoperation for bleeding (all P＞＞ 0.05),but more frequency of red blood cell transfusions were found in aspirin group than in aspirin withdrawal group [74.0％(273/369)vs.62.5％(707/1 132),adjusted OR=1.50,95％CI:1.13-2.00,P＜0.01].Conclusions Preoperative aspirin treatment can increase the incidence of red blood cell transfusion,but cannot increase the incidence of reoperation for bleeding,and has no effect on the postoperative outcomes such as all-cause in-hospital mortality,cerebrovascular events,postoperative myocardial infarction,postoperative renal failure or blood dialysis in patients undergoing selective isolated OPCAB.
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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 study the clinical efficacy of Off-Pump Coronary Artery Bypass Grafting (OPCABG) in the patients who have left main coronary artery stenosis and three-vessel lesion with low ejection fraction.MethodsFrom January 2010 to December 2010,28 cases with low ejection fraction,left main coronary artery stenosis and three-vessel lesion and received OPCABG were analyzed retrospectively.All cases underwent OPCABG under general anesthesia.The Hb,PLT,ALT,AST,BUN and Cr count before and 3 days after operation were recorded.LVEF andLVEDbeforeand 3monthsafter operationwererecorded.Thedata were compared.Results one case died of respiratory failure caused by pulmonary infection.The mortality rate was 3.75 ％.The value of six parameters are: Hb ( [ 137.94 ± 19.40 ],[ 111.06 ± 12.71 ] g/L),PLT ( [ 210.43 ±48.26 ] × 109/L,[ 148.4 ± 52.20 ] × 109/L),ALT ( [ 27.66 ± 11.51 ] U/L,[ 29.02 ± 16.40 ] U/L),AST ([26.55 ± 10.12] U/L,[27.75 ±8.14] U/L),BUN([6.51 ± 1.00] mmol/L,[6.88 ± 2.53] mmol/L),Cr ([96.35 ± 15.25]μmol/L,[95.11 ± 24.38 ] μmol/L).Comparison of the values showed that Hgb and PLT were different significantly before and 3 days after operations.There was no significant difference in the levels of ALT,AST,BUN and Cr before and after the treatment.Three months later,LVEF and LVED were significantly different from that before treatment ( P ＜ 0.05 ),with LVEF of( [ 36.23 ± 3.41 ] ％,[ 47.23 ± 5.13 ] ％ ) and LVED of( [62.23 ±5.93]mm,[58.08 ±5.02] mm).ConclusionOPCABG produces a satisfactory outcome in the patients who have left main coronary artery stenosis and three-vessel lesion combined with low ejection fraction.There is limited impact of OPCABG on the other organs.The long-term effect and prognosis are still need to be followed-up and analyzed.
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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 investigate the changes of human epidermal stem cells after transfected with human telomerase reverse transcriptase(hTERT)gene.Methods The plasmid pIRES2-EGFP and plasmid pIRES2-EGFP-hTERT encoding hTERT were transfected into in vitro cultured human fetal epidermal stem cells by liposome-mediated transfection.Then,the positive cells were selected with G418.The mRNA and protein expressions of hTERT were detected by reserve transcriptase-polymerase chain reaction(RT-PCR)and Western blot.The telomerase activity and the proliferation and cycle of human epidermal stem cells were detected by telomeric repeat amplification protocol(TRAP)-ELISA and flow cytometry respectively.Results RT-PCR and Western blot techniques detected weak mRNA and protein expressions of hTERT gene in untransfected and vacant vector transfected cells but high level of mRNA and protein expressions of hTERT gene in pIRES2-EGFP-hTERT transfected cells.Compared with untransfected and vacant vector transfected cells,the pIRES2-EGFP-hTERT transfected cells had higher telomerase activity,with lower proportion of cells at G_0/G_1 phase,higher proportion of cells at S and G_2/M phases and enhanced proliferation ability.Conclusion Transfection with hTERT gene can markedly enhance mRNA and protein expressions,telomerase activity and proliferation ability of hTERT gene of human epidermal stem cells euhured in vitro.
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OBJECTIVE To investigate the patterns of catheter related infection in critically ill patients after cardiac surgery with prolonged central venous catheters. METHODS The materials of culture of catheter tip and subcutaneous segments in 166 critically ill patients after cardiac surgery with prolonged central venous catheters were reviewed. RESULTS The positive pathogenic bacteria ratio of catheter tip segments was 41.0% and the positive ratio of catheter subcutaneous segments was 47.0%.Catheterization longer than 18 days,body temperature higher than 38.5 ℃ and insertion sites of femoral veins were the variables associated with significantly increased risk of catheter related infection. CONCLUSIONS The positive pathogenic bacteria ratio of central venous catheters in critically ill patients after cardiac surgery with prolonged central venous catheters is high,more attention must be paid to catheter related infection,and efficacious interventions must be laid down.
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<p><b>OBJECTIVE</b>To investigate the influence of high frequency partial liquid ventilation (HFJV) on the cardiopulmonary function in dogs with inhalation injury.</p><p><b>METHODS</b>Sixteen mongrel dogs inflicted by hot steam inhalation were subjected to severe inhalation injury and were randomly divided into control (C) and treatment (T) groups. The dogs in both groups were all given HFJV. In addition, the dogs in T group were simultaneously supplied with perfluorocarbon liquid (3 ml/kg) into the lungs slowly via tracheal intubation for liquid ventilation. The blood gas analysis, pulmonary compliance, airway resistance and hemodynamic parameters were determined at 30, 60 and 90 minutes after ventilation.</p><p><b>RESULTS</b>The PaO(2) in T group increased progressively, which was significantly higher than the post-injury value at all time points (P < 0.05). While the PaO(2) in C group exhibited no difference to the post-injury value at all time points. The PaCO(2) in T group increased obviously and was higher than the post-injury value at 60 and 90 post-ventilation minutes (P < 0.05). Furthermore, the PaO(2) in all the time points in T group was a little higher than that in C group (P > 0.05) and PaCO(2) in T group was much higher than that in C group at 90 min after ventilation (P < 0.05). But there was no difference between the two groups in terms of dynamic/static pulmonary compliance and airway resistance as well as the hemodynamics.</p><p><b>CONCLUSION</b>Compared with simple HFJV, high frequency partial liquid ventilation seemed to be beneficial to the oxygenation after inhalation injury and to be no influence on the hemodynamics.</p>