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@#Objective To analyze the risk factors of new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). Methods From September 2011 to October 2013, 1 614 consecutive patients underwent elective coronary artery bypass grafting in Fuwai Hospital. There were 1 281 males and 333 females at average age of 60.3±8.4 years. Holter data recorded for 5 days after operation were collected and analyzed. The risk factors associated with POAF were assessed according to the baseline and intraoperative data, and the positive variables were stratified. Results A total of 314 patients (19.5%) developed new-onset POAF. The rate of POAF was elevating with the increase of age (P<0.001). Conclusion Age was an independent risk factor for POAF in patients undergoing elective CABG alone.
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@#Objective To explore our novel strategy of surgical treatment for ventricular septal rupture (VSR) and the long-term outcomes. Methods All the patients referred to the Center of Adult Surgery, Fuwai Hospital were treated with integration treatment of vasoactive agents, intra-aortic balloon pump, or left ventricular assist device. The timing of surgical treatment was individually customized. One hundred and five consecutive patients with VSR (63 males, 42 females ) presented at the mean age of 63 (range, 41 to 80) years. We retrospectively analyzed the results and followed up patients who survived the surgical procedure. Results They were divided into a hemodynamics stable group (25 patients, 2 received emergent operation and 23 received selective operation) and a hemodynamics unstable group (80 patients, 34 received vasoactive agents and selective operation, 4 received vasoactive agents and emergent operation, 20 received vasoactive agent, intra-aortic balloon counterpulsation (IABP), and selective operation, 16 received vasoactive agents, IABP, and emergent operation, 2 received vasoactive agents, IABP, ventilator support, and selective operation, 2 received vasoactive agents, IABP, and ventilator support and emergent operation, 2 received vasoactive agents, ventilator support, and selective operation). There were 3 in-hospital deaths. Ninety-nine patients were followed up, with a follow-up rate of 97.1%. The mean follow-up time was 76.56±47.78 months. There were 2 late deaths during follow-up. Conclusion The timing of surgical treatment for ventricular septal rupture should be individually customized. The long-term outcomes of ventricular septal rupture patients who survived the surgery are satisfactory.
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@#Objective To evaluate the long-term clinical effect and risk factors of tricuspid valve replacement (TVR) as a relief treatment for adult patients with congenitally corrected transposition of the great artery (CCTGA). Method We retrospectively analyzed the clinical data of 47 adult patients with CCTGA who underwent tricuspid valve replacement in Fuwai Hospital between 2000 and 2017 year. There were 27 males and 20 females with operation age of 14–62 (38.8±13.5) years. Preoperative echocardiography showed moderate or more tricuspid regurgitation in all patients. The basic data of patients before and during operation were recorded. Survival was followed up by telephone and ultrasound report. Results The average follow-up time was 6.5±3.7 years. The 1-year, 5-year and 10-year survival rate or the incidence of heart transplant-free was 94.6%, 90.5% and 61.7%, respectively. During the follow-up period, the long-term right ventricular ejection fraction of most patients (>90%) was still greater than or equal to 40%. Increased preoperative right ventricular end diastolic diameter (RVEDD) was a risk factor for death or heart transplantation (risk ratio 1∶11, P=0.04). The survival rate of patients with RVEDD (>60 mm) before operation was significantly reduced (P=0.032). Conclusion TVP is a feasible treatment for adult patients with CCTGA. The increase of preoperative RVEDD is a risk factor for long-term mortality.
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@#Objective To analyze the results of intra-aortic balloon pump (IABP) support in patients receiving coronary artery bypass graft (CABG) and the risk factors of postoperative death. Methods The clinical data of 334 patients undergoing CABG procedure and receiving IABP support in Fuwai Hospital from January 1999 to April 2012 were retrospectively analyzed. According to the IABP insertion timing, the patients were divided into three groups: pre-, intra- and postoperative IABP groups. There were 45 males and 11 females aged 60.5±10.7 years in the preoperative IABP group, 84 males and 23 females aged 61.1±8.4 years in the intraoperative IABP group and 119 males and 52 females aged 61.4±8.5 years in the postoperative IABP group. Outcomes of the three groups were compared, including mortality, major complications, ICU stay, hospital stay and total costs. Multivariable logistic regression analysis was used to predict independent risk factors for postoperative in-hospital death. Results The total in-hospital mortality was 16.8% (56/334). Mortality was significantly different among the pre-, intra- and postoperative IABP groups (3.6% vs. 23.4% vs. 17.0%, P=0.006). There was no significant difference in complications among the three groups (P=0.960). Multivariable logistic regression analysis indicated that independent risk factors for postoperative mortality included old age (OR=1.05, P=0.040), female (OR=3.34, P<0.001) and increasing left ventricular end-diastolic diameter (LVEDD, OR=1.06, P=0.040). Preoperative IABP support was protective factor (OR=0.10, P=0.050). Conclusion The results of IABP support in CABG patients are satisfactory, and patients with preoperative IABP have a lower mortality. Risk factors for postoperative death include old age, female and increasing LVEDD. Preoperative IABP support is a protective factor.
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@#Objective To evaluate a score system to allow stratification of complexity in degenerative mitral valve repair. Methods We retrospectively reviewed the clinical data of 312 consecutive patients who underwent surgery for mitral valve repair and whose preoperative echocardiography was referable in our hospital from January 2012 to December 2013. A scoring system for surgical complexity was used based mainly on the preoperative echocardiography findings. Complexity of mitral valve repair was scored as 1 to 9, and patients were categorized into 3 groups based on the score for surgical complexity: a simple group (1 point), an intermediate group (2-4 points) and a complex group (≥5 points). There were 86 males and 35 females in the simple group (n=121) with an average age of 51.6±12.6 years, 105 males and 53 females in the intermediate group (n=158) with an average age of 51.1±12.8 years and 25 males and 8 females in the complex group (n=33) with an average age of 49.3±13.0 years. Results There was significant difference in surgical complexity in different groups. In the simple, intermediate and complex groups, the mean cardiopulmonary bypass time was 111.7±45.5 min, 117.7±40.4 min and 153.4±74.2 min (P<0.001), the mean cross-clamping time was 77.5±33.8 min, 83.2±29.9 min and 108.8±56.2 min (P<0.001), and the mean number of repair techniques utilized was 2.1±0.4, 2.4±0.6 and 2.8±0.8 (P<0.001). However, there was no significant difference in the early and late outcomes in different groups. Conclusion It is feasible to use echocardiography to quantitatively evaluate the difficulty of mitral valvuloplasty.