Prosthesis-patient mismatch in the mitral valve position: the initial result of a single-institutional observational study in China / 中华外科杂志

<p><b>OBJECTIVE</b>To analysis the causes of valve prosthesis-patient mismatch (PPM) after mitral valve replacement in Chinese patients.</p><p><b>METHODS</b>Consecutive 100 patients for elective mitral valve replacement from January 2009 to June 2009 were enrolled and followed for this study. There were 37 males and 63 females. The mean age at operation was (52 ± 9) years (ranging 32 to 76 years). The predominant mitral valve lesion was stenosis in 60 patients, regurgitation in 14 patients and mixed in 26 patients. Among them, 63 patients were combined tricuspid valve regurgitation. Mitral valve effective orifice area was measured by Doppler echocardiography in 100 patients who received mitral valve replacement and indexed for body surface area (EOAI). PPM was defined as not clinically significant if the EOAI was above 1.2 cm(2)/m(2), as moderate if it was >0.9 and ≤ 1.2 cm(2)/m(2), and as severe if it was ≤ 0.9 cm(2)/m(2). By using the criteria, all 100 patients were classified to two groups: PPM group and no PPM group. The clinical characteristic of the patients between the two groups was compared to determine the causes of PPM and the predictors of outcomes after mitral valve replacement, such as the gender, age, valve prosthesis type, size, body surface area, and mitral valve lesion, et al.</p><p><b>RESULTS</b>Of the 100 patients after MVR, 52 (52.0%) had significant PPM, 51 (51.0%) had moderate PPM, and 1 (1.0%) had severe PPM. In comparison to patients in no PPM group, patients in PPM group had a significantly larger body surface area [(1.76 ± 0.17) m(2) vs. (1.59 ± 0.13) m(2), P < 0.01] and higher prevalence of male gender (55.8% vs. 16.6%, P < 0.01). The other preoperative and operative data were similar in both groups, such as the valve prosthesis type, size, and mitral valve lesion, et al. There were no significant differences in postoperative Doppler-echocardiographic data of cardiac structure and heart function between the two groups (P > 0.05).</p><p><b>CONCLUSIONS</b>The higher incidence of PPM in mitral valve position was in male or large body surface area patients. At the time of operation, surgeons should consider the related factors, such as the patient's gender and body surface area, et al. A larger prosthesis size might be implanted to avoid PPM in mitral valve position.</p>

Effects of peri-operative intra-aortic balloon pump support in high EuroSCORE patients undergoing cardiac surgery / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the effects of perioperative intra-aortic balloon pump (IABP) support in EuroSCORE high-risk patients undergoing cardiac surgery, and evaluate the risk factors associated with mortality and midterm survival.</p><p><b>METHODS</b>Fifty-eight patients with EuroSCORE of no less than 6 underwent cardiac surgery and received peri-operative IABP support, including 29 with preoperative IABP support, 21 with intra-operative IABP support, and 8 with postoperative IABP support. The patients who survived the surgeries were followed up for at least 1 year.</p><p><b>RESULTS</b>Complications related to IABP support occurred in 2 cases (3.45%). The in-hospital mortality was 6.89% (4/58) in this series. Patients with intra-operative IABP had a lower ejection fraction, and those with pre-operative IABP showed more frequent unstable angina and recent myocardial infarction. The number of emergency procedures was also significantly higher in patients with pre-operative IABP support. Patients with intra- or postoperative IABP support had a longer ICU stay. The 1-year follow-up was completed in 54 patients and 4 deaths were recorded, with a 1-year survival of 86.21%. The 1-year survival rate was significantly higher in patients with preo- and intra-operative IABP support than those with post-operative IABP.</p><p><b>CONCLUSION</b>Peri-operative IABP support benefit cardiac support for cardiac surgery, and its preoperative use does not increase the surgical risk. Early prophylactic IABP support according to the EuroSCORE can improve the outcome of the high-risk cardiac surgery.</p>

Live three-dimensional and two-dimensional transesophageal echocardiography for evaluating functional anatomy of mitral regurgitation: a comparative study / 南方医科大学学报

<p><b>OBJECTIVE</b>To compare the accuracy of live three-dimensional (Live-3D-TEE) and two-dimensional transesophageal echocardiography (2D-TEE) in the evaluation of functional anatomy of mitral regurgitation. METHDOS: Thirty-eight consecutive patients with severe mitral regurgitation were enrolled prospectively. The accuracy of Live-3D-TEE and 2D-TEE for functional assessment of mitral regurgitation was evaluated against surgical findings.</p><p><b>RESULTS</b>The accuracy in etiological assessment of mitral regurgitation was 94.7% with Live-3D-TEE and 89.5% with 2D-TEE (P=0.09). For assessment of lesions of the mitral valve, Live-3D-TEE showed an overall accuracy of 93.2%, significantly higher than that of 2D-TEE (88.6%, P=0.001). Live-3D-TEE also showed a significantly higher accuracy than 2D-TEE in localization of mitral valve lesions (93.3% vs 86.7%, P=0.000).</p><p><b>CONCLUSION</b>Both Live-3D-TEE and 2D-TEE allow accurate assessment of the etiology of mitral regurgitation, but Live-3D-TEE can be more accurate in the evaluation of the lesions of the mitral valve and their localization.</p>

Analysis on the risk factors of intracardial thrombus after prosthetic valve replacement: a 1-year follow-up study / 中华外科杂志

<p><b>OBJECTIVE</b>To analysis the risk factors predicting intracardial thrombus after prosthetic valve replacement.</p><p><b>METHODS</b>The clinical data of 29 cases from January 2005 to April 2009 with intracardial thrombus after prosthetic valve replacement during a 1-year follow-up was retrospectively analyzed. There were 11 male and 18 female, aged from 12 to 70 years with a mean of 48 years. The risk factors of intracardial thrombus were examined by univariate and multivariate analysis.</p><p><b>RESULTS</b>Univariate analysis found that bioprosthetic valve replacement, anticoagulation using aspirin, valve replacement at mitral position, atrial fibrillation, preoperative and postoperative internal diameter of left atrium, postoperative fibrinogen were predict factors of intracardial thrombus after prosthetic valve replacement (P < 0.05). Logistic regression analysis showed valve replacement at mitral position (OR = 9.815, P < 0.05), atrial fibrillation (OR = 5.267, P < 0.05), preoperative internal diameter of left atrium (OR = 4.529, P < 0.05) were significant risk factors of intracardial thrombus after prosthetic valve replacement.</p><p><b>CONCLUSIONS</b>Valve replacement at mitral position, atrial fibrillation, and preoperative internal diameter of left atrium are the correlated risk factors of intracardial thrombus after prosthetic valve replacement. Anticoagulation after prosthetic valve (especially bioprosthetic valve) replacement should be standardized to prevent intracardial thrombus formation.</p>

Surgical treatment of isolated right-sided infective endocarditis / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the surgical treatment and outcomes of isolated right-sided infective endocarditis.</p><p><b>METHODS</b>From January 1994 to February 2009, 28 patients with isolated right-sided infective endocarditis underwent operation whose clinical data was retrospectively reviewed. There were 18 male and 10 female, age ranged from 10 to 72 years with a mean of 38 years. All of the patients presented intermittent fever, 14 patients presented heart failure (NYHA class III or IV), 25 patients had a history of pulmonary embolism or pneumonia, 18 patients had positive culture; 27 patients had intra-cardiac vegetations confirmed by echocardiogram. All the operations were performed under cardiopulmonary bypass. Antibiotic therapy continued for another 2 to 3 weeks after surgery.</p><p><b>RESULTS</b>One patient had underwent re-operation due to mediastinal bleeding, 2 patients needed mechanical ventilation for more than 1 week after surgery, renal dysfunction occurred in 3 patients. After surgery, 11 patients presented with mild or moderate tricuspid regurgitation before discharge. One patient (3.6%) died in hospital after surgery due to severe infection and multi-organ failure, the other 27 patients were cured and discharged. Patients were followed up for 6 months to 15 years.NYHA class decreased in all patients, and the symptoms of heart failure improved significantly after surgery. No recurrent case was found.</p><p><b>CONCLUSIONS</b>Surgery is an effective treatment for isolated right-sided infective endocarditis with congenital heart disease or right heart implants. Good outcomes are observed in these settings.</p>

Structural and functional changes of postoperative small left ventricle patients / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the perioperative features of surgical treatment in valvular patients with small left ventricle, and investigate the postoperative early structural changes of left ventricle and its correlation with cardiac function.</p><p><b>METHODS</b>A total of 51 patients with small left ventricle underwent mitral valve replacement from January 2003 to August 2008. There were 7 males and 44 females with mean age of (48 +/- 5) years old. The mean pathologic course was (18 +/- 9) years old. The concomitant procedures included aortic valve replacement in 6 cases, coronary artery bypass grafting in 1 case, tricuspid valvular plasty in 48 cases, left atrial thrombi scavenging in 36 cases, and left atrium folding in 42 cases.</p><p><b>RESULTS</b>The perioperative mortality was 3.9% (2/51). Fourteen patients (27.5%) suffered from severe low-output syndrome in the earlier period postoperatively. Among them, 5 patients needed secondary cardiopulmonary bypass (CPB) to assist circulation, with the result of 1 patient died of weaning off CPB unsuccessfully, 1 patient revived with intra-aortic balloon pump assisted for another 2 d after termination of CPB and another 1 patient died of multiple organ failure (MOF) 10 d later. Eleven cases complicated with MOF. Five patients complicated with ventricular arrhythmia. The echocardiographic examinations showed that the left ventricular dimensions didn't expand significantly postoperatively at 7 to 14 d postoperatively. Left ventricular end-diastolic diameter (LVEDD) was (36.5 +/- 3.2) mm preoperatively and (38.6 +/- 5.3) mm postoperatively (P > 0.05). Preoperative LVEDD index (LVEDDI) was (45.9 +/- 3.8) ml/m(2) and postoperative LVEDDI was (48.2 +/- 7.4) ml/m(2) (P > 0.05). The contract function of left ventricle was improved postoperatively but with no statistical significance. Ejection fraction was 48.6% +/- 6.7% preoperatively and 52.8% +/- 8.3% postoperatively. Left ventricular fraction shortness was 25.5% +/- 3.3% preoperatively and 27.1% +/- 1.3% postoperatively.</p><p><b>CONCLUSIONS</b>For the patients with small left ventricle usually, the postoperative emphases should be put on the management of low output syndrome. The decreased dimension of left ventricle doesn't expand in the early period after valvular operation.</p>

Mean flow of saphenous vein graft and its influencing factors in patients performed coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the mean blood flow of saphenous vein (SV) graft and it's influencing factors in off-pump coronary artery bypass grafting by using transit-time flowmeter (TTFM).</p><p><b>METHODS</b>Three hundred and twenty-six patients were studied. After all anastomoses were completed, and hemo-dynamic status was stable, TTFM was utilized to measure and record the SV flow wave, pulsatility index (PI), value of mean flow, diastolic and systolic peak flow, vascular resistance, insufficiency ratio and mean blood pressure. The standard conditions of good graft status to define the normal mean flow included good diastolic augmentation of blood wave, PI less than 5, intraoperative and postoperative no significant change in electrocardiogram, and smoothly postoperative recovery.</p><p><b>RESULTS</b>Total mean flow calculated from that of all patients was (39 +/- 23) ml/min (10-153 ml/min). Majority mean value (60.1%, 196/326) was in the range of 20-50 ml/min. Statistics showed that mean flow was significantly related to vascular resistance and diastolic peak flow and PI rather than the other factors (r was -0.95, 0.77 and -0.51 respectively).</p><p><b>CONCLUSIONS</b>For the patients, over 15 ml/min mean flow of SV graft is acceptable, and over 35 ml/min is satisfactory. The diastolic peak flow and vascular resistance are two important factors influencing mean flow.</p>

Clinical analysis of 1018 cases of coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze retrospectively 1018 patients who underwent coronary artery bypass grafting surgery (CABG) in order to summarize surgical techniques and clinical outcome.</p><p><b>METHODS</b>From 1997 through 2004, data of same surgeon for 508 patients who underwent conventional coronary artery bypass surgery on pump (CCABG) and 510 patients who underwent off-pump CABG (OPCAB) were collected and analyzed retrospectively. Eight hundred and fifty-two patients had unstable angina, 582 patients were over 60 years old (57.2%) and 784 patients had concomitant diseases including valve lesion, hypertension, diabetes, myocardial infarction, left ventricular aneurysm with septal defect, stroke, chronic obstructive pulmonary diseases, renal failure and cancer. A hundred and fifty-six patients had left main stem (LIMS) stenosis and 671 patients, triple-vessel disease.</p><p><b>RESULTS</b>Total mortality was 0.39% (4-case death) and morbidity, 1.6% (sternal dehiscence, stroke and mediastinitis). The grafts per patient with CCABG and OPCAB were 3.3 +/- 0.6 vs. 2.5 +/- 0.4. Left internal mammary artery use was 93.8% of the patients, 29 patients were implanted intra-aortic balloon pump intraoperatively. Follow-up was 4 months to 7 years.</p><p><b>CONCLUSIONS</b>Scientific surgical strategies, excellent surgical techniques and improvement of cardiac anesthesia and cardiopulmonary bypass make the mortality and morbidity decrease significantly, CABG surgery is safe and effective in patients with coronary artery disease.</p>

Myocardial revascularization combined with concomitant valve operations: report of 45 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To introduce the experience in coronary artery bypass grafting (CABG) combined with concomitant valve operation.</p><p><b>METHODS</b>From 1998 to 2002, forty-five patients (38 men and 7 women) with coronary artery lesion and valve diseases underwent myocardial revascularization combined with concomitant valve operation. The mean age of the patients was 59 years (42 to 75 years). Heart function was Class II (NYHA) in 7 patients, Class III in 30, Class IV in 8. The value of ejection fraction was 0.32 to 0.50. Thirty patients had mitral valve lesion, 7 aortic lesion, and 8 both lesions. Seventeen patients had single-vessel diseases, 20 double-vessel diseases, 8 triple -vessel diseases, and 8 left main artery lesion. After cardiac arrest by cold blood cardioplegia under moderate cardiopulmonary bypass (CPB), distal anastomosis of the saphenous vein (SV) to the target vessels were firstly performed and followed by valve replacement (32 patients) or plasty (2). The left internal mammary artery (LIMA) was grafted to the left anterior descending artery (LAD) before aortic unclamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping time was 112.6 min.</p><p><b>RESULTS</b>No mortality occurred during hospitalization and all patients were discharged 9.2 days after operation. Cardiac function of all patients was improved to Class I-II and no patient died during follow-up.</p><p><b>CONCLUSIONS</b>CABG combined with valve surgery can be safely performed with good results.</p>