ABSTRACT
Objective:Based on past experience, to summarize a well-defined and applicable pathological classification scheme for rheumatic mitral valve disease from the point of view of the correlation with the selection of surgical methods.Methods:From January 2017 to January 2019, the cases undergoing mitral valve surgery due to rheumatic causes in our center were included. According to the degree of damage to the mitral valve leaflet, the damage to the junction, and the damage to the subvalvular structure in the junction, all the samples were divided into three pathological grades from mild to severe. The relevant clinical data of the included cases were summarized, the characteristics of each pathological grade and their correlation with surgical method were analyzed.Results:In two years, a total of 398 cases were included, of which 284 cases received rheumatic valvuloplasty, with an overall rate of 70%. Type Ⅰ was found in 58 cases, accounting for 15%, with plasty rate of 100%. Preoperative moderate-severe reflux accounted for 64%. Type Ⅱ was detected in 260 cases, accounting for 65%, with plasty rate of 76%(197/260). Preoperative moderate-severe stenosis accounted for 88%. In 80(20%) cases with type Ⅲ, the plasty rate was 36%(29/80), preoperative extremely severe stenosis accounted for 50% and preoperative moderate-severe reflux for 40%. In the cases receiving plasty, the mean MVOA and mean age decreased linearly with the increase in pathological grade. The proportions of preoperative LAAPD and E-wave, intraoperative aortic occlusion time and severe stenosis, mixed lesions and complete 4-step application increased linearly.Conclusion:Rheumatic mitral valvuloplasty has a huge room for improvement in China. Chinese Clinical Pathological Classification for Rheumatic Mitral Valve Disease provides a step-by-step route for the development of rheumatic mitral valvuloplasty.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.