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@#Objective To explore the predictive value of systolic pulmonary artery pressure (SPAP) on autonomic nerve excitation in patients with valvular disease, so as to provide reference for the formulation of clinical intervention plans. Methods The clinical data of patients with valvular disease who received surgical treatment in the General Hospital of Northern Theater Command from August 28, 2020 to February 3, 2021 were prospectively collected. According to the standard deviation of normal-to-normal R-R intervals (SDNN) of the heart rate variability (HRV) of the long-range dynamic electrocardiogram (ECG) 7 days before the operation, the patients were divided into three groups: a sympathetic dominant (SE) group (SDNN≤50 ms), a balance group (50 ms<SDNN<100 ms) and a parasympathetic dominant (PSE) group (SDNN≥100 ms). The correlation between the changes of echocardiographic indexes and autonomic nerve excitation among the groups and the predictive values were analyzed. Results A total of 186 patients were enrolled, including 108 males and 78 females aged 55.92±11.99 years. There were 26 patients in the SE group, 104 patients in the balance group, and 56 patients in the PSE group. The left anteroposterior diameter (LAD), left ventricular end diastolic inner diameter, ratio of peak E to peak A of mitral valve (Em/Am), left ventricular end diastolic volume, left ventricular end systolic volume and SPAP in the SE group were higher than those in the balance group (P<0.05), while peak A of tricuspid valve (At) and left ventricular ejection fraction (LVEF) were lower than those in the balance group (P<0.05). The LAD and Em/Am in the balance group were significantly higher than those in the PSE group (P<0.05). Multivariate analysis showed that patients in the SE group had lower At (right atrial systolic function declines), lower LVEF and higher SPAP than those in the balance group (P=0.04, 0.04 and 0.00). When HRV increased and parasympathetic nerve was excited in patients with valvular disease, Em/Am decreased (left atrial function and/or left ventricular diastolic function declined) with a normal LAD. Pearson analysis showed that there was a linear negative correlation between SPAP and SDNN, with a coefficient of −0.348, indicating that the higher SPAP, the lower HRV and the more excited sympathetic nerve. Receiver operating characteristic curve showed that when SPAP≥45.50 mm Hg (1 mm Hg=0.133 kPa), the sensitivity and specificity of sympathetic excitation in patients with valvular disease were 84.60% and 63.70%, respectively. Conclusion Parasympathetic excitation is an early manifestation of the disease, often accompanied by decreased left atrial function and/or left ventricular diastolic function. Sympathetic nerve excitation can be accompanied by the increase of SPAP and the decrease of left ventricular and right atrial systolic function. SPAP has a unique predictive value for the prediction of autonomic nerve excitation in patients with valvular disease.
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According to the pathophysiological characteristics, upper gastrointestinal bleeding can be divided into acid related disease bleeding and esophageal and gastric varices bleeding. Esophageal and gastric variceal bleeding is a common critical condition of Portal hypertension, with dangerous onset and high mortality. With the improvement of endoscopic treatment technology, endoscopy has become the first line treatment plan for esophageal and gastric variceal bleeding. The commonly used endoscopic management methods for varicose veins include variceal ligation, tissue glue combined with sclerosing agent embolization, ultrasound guided coil combined with tissue glue embolization, and other management measures. Early identification of gastrointestinal bleeding related to varicose veins, stratified diagnosis and treatment of high-risk patients, reasonable selection of endoscopic examination timing, and personalized decision-making of treatment choices are key to improving efficacy.
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@#Objective To study the relationship between preoperative heart rate variability (HRV) and postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB). Methods A retrospective analysis was performed on the clinical data of 290 patients who were admitted to the Department of Cardiovascular Surgery, General Hospital of Northern Theater Command from May to September 2020 and received OPCAB. There were 217 males and 73 females aged 36-80 years. According to the incidence of POAF, the patients were divided into two groups: a non-atrial fibrillation group (208 patients) and an atrial fibrillation group (82 patients). The time domain and frequency domain factors of mean HRV 7 days before operation were calculated: standard deviation of all normal-to-normal intervals (SDNN), root mean square of successive differences, percentage difference between adjacent normal-to-normal intervals that were greater than 50 ms, low frequency power (LF), high frequency power (HF), LF/HF. Results The HRV value of patients without POAF was significantly lower than that of patients with POAF (P<0.05). The median SDNN of the two groups were 78.90 ms and 91.55 ms, respectively. Age (OR=3.630, 95%CI 2.015-6.542, P<0.001), left atrial diameter (OR=1.074, 95%CI 1.000-1.155, P=0.046), and SDNN (OR=1.017, 95%CI 1.002-1.032, P=0.024) were independently associated with the risk of POPAF after OPCAB. Conclusion SDNN may be an independent predictor of POAF after OPCAB.
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Objective:To evaluate the feasibility and safety of total aortic arch surgery under mild hypothermicvia single upper hemisternotomy approach.Methods:From January 2019 to July 2019, 35 patients(31 male and 4 female) with Stanford A type aortic dissection were diagnosed, who were(43.7±5.7)years old. Aortic arch surgeries were carried out under mild hypothermic via single upper hemisternotomy approach and the perioperative mortality, time of cardiopulmonary bypass(CPB), aortic cross clamp(ACC), circulation arrest(CA) and morbidity of neurological dysfunction were respectively were recorded.Results:All patients were finished aortic arch surgery under mild hypothermic single upper hemisternotomy approach, with 8.6% of mortality(3 patients died perioperation). The time of CPB, ACC and CA were respectively(202±53)min, (128±28)min and(8±3)min. There were 6 cases of transient neurological dysfunction(17.1%) and 1 case of permanent neurological dysfunction(2.9%).Conclusion:Aortic arch surgery under mild hypothermic for Standford A dissectionvia single upper hemisternotomy approach is safe and feasible.
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Objective:To evaluate the long-term results of combined ganglion plexus ablation(GPA) during radiofrequency ablation(RF) with long-standing persistent atrial fibrillation(LSP-AF).Methods:This retrospective study sample consisted of 268 patients with LSP-AF underwent valve operations concomitant RF maze Ⅳ procedure. Data were collected prospectively on perioperative outcomes, rhythm status, survival, and clinical events. Propensity score matching conducted by RF and RF+ GPA resulted in 102 patients per group.Results:Independent predictors for rhythm success at 1 year were combined GPA( OR=0.205, P=0.005), smaller left atrium size( OR=1.091, P=0.000); at 5-year and 8-year were a shorter history of AF( OR=1.069, P=0.023; OR=1.066, P=0.030), and smaller left atrium size( OR=1.091, P=0.000; OR=1.086, P=0.000). After matching, RF+ GPA group had significantly higher sinus rhythm(SR) without antiarrhythmic drugs(AADs) at 6 months(91.3% vs. 79.8%, P=0.026), 1-year(90.2% vs. 78.5%, P=0.028), but there were no difference between the two groups at 5-year(64.8% vs. 64.4%, P=0.956), and 8-year(53.3% vs. 50.6%, P=0.711). During the 6 postoperative months, fewer patients in the RF+ GPA group underwent follow-up cardioversions(2.0% vs. 8.8%, P=0.030). Actuarial survival curves did not differ significantly between the 2 groups( HR=1.327, 95% CI 0.4633-3.802, P=0.598). Conclusion:The combination of GPA can be effective at the early postoperative stage for SR restoration in Maze Ⅳ procedures for the treatment of LSP-AF in heart valve surgeries, particularly for lower AADs use and lower cardioversions. However, this effect will gradually diminish after one year.
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Objective:To evaluate the long-term results of bipolar radiofrequency(BRF) ablation in restoring sinus rhythm in patients with permanent atrial fibrillation(AF) undergoing surgery for cardiac surgery.Methods:This retrospective study sample consisted of 268 patients with LSP-AF underwent cardiac operations concomitant BRF maze Ⅳ procedure. Data were collected prospectively on perioperative outcomes, rhythm status, survival, and clinical events.Results:15 patients died in the early postoperative period, perioperative mortality rate was 5.5%. The rate of stable sinus rhythm(sSR)was 86.6%, 75.4%, 67.7%, 57.8% in 1, 2, 5, 8 years after operation. Multivariate analysis proved the size of the left atrium( HR=1.073, P<0.001) and duration of AF( HR=1.070, P=0.025) to be an independent predictor of the radiofrequency ablation outcome. Conclusion:Bipolar radiofrequency maze procedure can effectively eliminate AF, maintain long-term of sinus rhythm. Bipolar radiofrequency maze procedure is a safe, easy and effective surgical option for the treatment of AF, with satisfactory long-term results, is worthy of promotion.
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Cholangiocarcinoma is a malignant tumor originating from bile duct epithelium, with insidious onset and high degree of malignancy. Most of the patients were diagnosed at the middle and late stages and the survival rate is very poor. The etiology of cholangiocarcinoma is still unknown. Billary intraepithelial neoplasia, intraductal papillary neoplasm of the bile duct, biliary mucinous cystic neoplasm and intraductal tubular/tubulopapillary neoplasm of the bile duct are considered as precancerous lesions of cholangiocarcinoma. Improving the understanding of precancerous lesions of cholangiocarcinoma, and early treatment of these lesions are important for enhancingthe patients’ quality of life. However, the current understanding of precancerous lesions of cholangiocarcinoma is limited. Development of molecular diagnostic technology is deeply needed. And sensitive and specific biomarkers are urgently needed for the early diagnosis of the high-risk persons accurately, so as to achieve " early detection, early diagnosis and early treatment" . This article reviews how to recognize and deal with precancerous lesions of cholangiocarcinoma.
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@#Tetralogy of Fallot is the most common cyanotic congenital heart disease. The pathological anatomy changes include ventricular septal defect, right ventricular outflow tract stenosis, aortic stradding and right ventricular hypertrophy. At present, the diagnostic criteria and treatment strategies of this disease are basically unified. However, there are controversies about the timing and method of surgical treatment. Based on the evidence-based information provided in the literature and the opinions of domestic experts of China, we formulate a consensus of Chinese experts to further standardize the surgical treatment of tetralogy of Fallot.
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@#Objective To analyze the recovery rule of atrial contractility (AC) function after Maze Ⅳ procedure of valvular atrial fibrillation (AF). Methods In our hospital from March 2016 to April 2018, 103 patients who underwent cryoablation Maze Ⅳ procedure due to mitral valve lesions associated with persistent or long-term persistent AF were enrolled. There were 42 males and 61 females, with an average age of 58.5±9.1 years. Electrocardiogram and echocardiography were followed up at discharge and 1, 3, 6, 12 months after procedure. A multivariate Cox analysis of predictive factors for AC recovery was applied. Results All the 103 patients were followed up for 1 year. The recovery rate of AC increased gradually after operation. It was not until 3 months after procedure that most of the right atrial contractility (RAC) was accompanied by synchronous recovery of the corresponding left atrial contractility (LAC, Kappa coefficient≥0.40, P<0.05). However, the coexistence of sinus rhythm (SR) and bilateral AC was not consistent well until 1 year after operation (Kappa coefficient≥0.40, P<0.05). One year after procedure, the recovery rates of SR and bilateral AC were 86.4% (89/103) and 66.0% (68/103) respectively. By Cox multivariate regression analysis, longer preoperative AF duration (P=0.040), larger preoperative left atrial diameter (LAD, P=0.003), and AC deletion 3 months after surgery (P=0.037) were predictive factors for AF recurrence in the middle and advanced stages (>3 months) after Maze surgery. At the same time, longer preoperative AF duration and larger preoperative LAD were also negative predictors of middle and late recovery of LAC and bilateral AC (All P<0.05). Receiver operating characteristic curve analysis showed that the best critical value of preoperative AF time and preoperative LAD for prediction of AC recovery was 37 months (sensitivity 99.6%, specificity 76.3%) and 60.5 mm (sensitivity 98.5%, specificity 78.9%), respectively. Conclusion The recovery of AC after Maze procedure is a dynamic improvement process. Early recovery of AC is beneficial to the stable maintenance of SR in the future. Prolonged duration of AF and enlarged LAD have adverse effects on the outcome of Maze Ⅳ procedure.
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@#Objective To analyze factors affecting the recovery of postoperative left ventricular function in patients with valvular disease combined with heart failure with reduced ejection fraction [HFrEF, left ventricular ejection fraction (LVEF)<40%]. Methods The clinical data of 98 patients with valvular disease combined with HFrEF who underwent surgeries in our hospital from January 2011 to June 2018 were retrospectively analyzed, including 75 males and 23 females aged 9-78 (55.3±11.9) years. Results A total of 15 patients were dead after the operation, including 4 deaths within 3 months and 11 mid-long-term deaths after the operation. Ninety-one patients were followed up for more than 6 months (10 months to 8.6 years). The postoperative cardiac function (NYHA) of 91 patients was classⅠ-Ⅱ, the LVEF of 18 (19.8%) patients increased more than 10%, that of 47 (51.6%) patients maintained at the preoperative level, and that of 26 (28.6%) patients decreased. Postoperative LVEF was more prone to recover in HFrEF patients with sinus rhythm before operation (P=0.038), valvular disease mainly in aortic valve (P=0.026), obvious reduction of left ventricular end diastolic diameter in early postoperative period (P=0.017), and higher systolic pulmonary artery pressure (SPAP) before operation (P=0.018). The risk factors for postoperative LVEF deterioration included large left atrium before operation (P=0.014), smaller left ventricle end systolic diameter before operation (P=0.003), and fast heart rate after operation (P=0.019). Conclusion Mitral valve prolapse patients with obviously increased left ventricular diameter should receive operation as soon as possible. HFrEF patients with aortic valve disease should receive operation positively. The operation efficacy is satisfactory in the HFrEF patients with high SPAP.
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To evaluate the long term cardiopulmonary function after Fontan operation. Methods 10 patients who received Fontan operation were followed for(26 ±4) years in our hospital. 7 males and 3 females,(30. 7 ± 13. 2) years old(20 -60 years). All patients were diagnosed by echocardiography, CTA, 24 h ECG, cardiac catheterization, pulmonary angiography, radionuclide pulmonary blood perfusion and cardiopulmonary exercise test. Results Echocardiography shows: LVEF(0. 49 ± 0. 04), more than moderate atrioventricular valve regurgitation in 7 cases. CTA shows: there was no anastomotic stenosis, arteriovenous fistula in 4 cases. 24 h ECG shows: sinus rhythm in 7 cases, frequent paroxysmal atrial tachycardia in 1 case, atrial flutter in one and atrial fibrillation in one. Cardiac catheterization and pulmonary angiography show: the average pulmonary artery pressure(17. 8 ±2. 0)mmHg, average pulmonary resistance(4. 17 ±0. 56) woods. Radionuclide pulmonary blood perfusion shows: pulmonary blood of upper lung was reduced significantly with unbalanced distribution. Cardiopulmonary exercise test shows: both of lung ventilation function and heart reserve function decreased moderately or severely. Protein losing enteropathy was found in 1 case. Conclusion The decrease of cardiopulmonary function is found after Fontan operation during the long-term follow up for 20 years, especially for cardiac function. More attention should be paid to the early postoperative atrioventricular valve regurgitation. Unbalanced distribution of pulmonary blood is Found in long term. The incidence of arrhythmia after extra conduit Fontan operation is lower than other methods.
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From August 1st to 7th, 2017, the breastfeeding knowledge of medical staff were collected from 52 medical health institutions in 29 provinces through a network system. A total of 35 243 questionnaires were included in the study to analyze the current status of breastfeeding knowledge and related factors. The qualified rate of breastfeeding knowledge questionnaires for medical staff in this study was 75.3% (26 546/35 243). Compared with those in the eastern region and those who were mothers, the qualified rate of breastfeeding knowledge of medical staff in the central region or the western region and medical staff who were fathers or expectant parents was lower, with OR (95%CI) values about 0.71 (0.67-0.75), 0.66 (0.61-0.72), 0.63 (0.55-0.72) and 0.87 (0.80-0.95), respectively. Compared with those attaining high school education or below and those with children aged<1 month, the qualified rate of breastfeeding knowledge was higher in medical staff with bachelor′s degree, graduate degree or above, and with children aged 1-5, 6-23 and ≥24 months, with OR (95%CI) values about 1.92 (1.80-2.05), 2.16 (1.94-2.42), 2.28 (1.93-2.70), 2.41 (2.06-2.83) and 1.99 (1.72-2.32), respectively.
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Objective To evaluate the feasibility and safety of Sun's procedure for Stanford A type aortic dissection through single upperhemisternotomy approach ( from the Strernal Notch to the level of fourth intercostal space ) .Methods 58 patients(39 male and 19 female) with Stanford A type aortic dissection were retrospective for this study, who were(46.3 ±9. 5) years old.Sun's prcedure were carried out through single upperhemisternotomy approach and the perioperative characteris-tics were recorded.Results All patients were finished Sun's procedure through single upperhemisternotomy approach, with 5.2％ of mortality(3 patients died postoperation).The time of cardiopulmonary bypass, aortic cross clamp and circulation ar-rest were respectively(181.6 ±25.5)min,(114.2 ±19.8)min and(29.0 ±5.8)min.Non serious adverse event were found after 2 to 15 months follow-up.Conclusion Sun's procedure through single upperhemisternotomy approach was one of the safe and feasible treatment for Stanford A type aortic dissection , which can reduce the operative wound and improve the patients ' satisfactory.
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Objective To understand correlation between maternal drug use and environmental exposure during pregnancy and delivery pattern and allergy in infants and toddlers,and provide theoretical bases for the early prevention and intervention of infantile allergies.Methods Case control study based on cross-sectional investigation was conducted.Thirty-three cities were selected in China.Randomly cluster sampling method was used to select a community in each city as the study sample,the women with infants aged 0-24 months were interviewed in the form of face-to-face questionnaire survey.Infants and toddlers were divided into two groups:case group,including 2113children who had allergic symptoms and were diagnosed with allergic disease,and control group,including 6303 children who never had symptoms of allergic disease.Results Children whose parents had allergic disease histories were more likely to have allergic disease (OR=3.950) compared with the children whose mother or father had allergic disease histories (0R=2.277).Maternal use of antibiotics (OR=1.396),disinfector exposure (0R=1.386),smoking exposure (OR=1.301) during pregnancy and cesarean delivery (OR=1.255) were risk factors for allergic disease in infants and toddlers,the differences were significant (P＜0.05).Conclusion It is essential to conduct primary prevention of infant allergy during pregnancy,and it is necessary to avoid unnecessary cesarean delivery and irrational antibiotic use,disinfector and smoking exposures during pregnancy.
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Objective To construct the growth percentile curves of weight-,length/height-,head circumference and BMI for 1 to 4 year-olds who had been breastfed in urban areas.Methods Data was from the longitudinal study on 1 025 breastfed children aged 1 to 4 years,in 8 urban areas during 2008-2012.MLwiN2.25 was selected to construct the multi-level models of weight-for-age,length for-age,head circumference-for-age and BMI-for-age.The models included many growth relevant factors including gender,age,family and social demographic characteristics,perinatal factors,parent biological characteristics,dietary patterns and diseases of childen.Based on these models,predicted values (P3,P15,P50,Ps5,P97) were estimated to fit the percentiles reference curves.Results The percentiles reference curves of weight-,length/height,head circumferenceand BMI-for-age for the 1-4 year-olds who had been breastfed in the urban areas were developed.Differences of all the indicators between boys and girls were statistically significant (P＜0.001).Weight,length/height,head circumference and BMI were higher in boys than those in girls,with an average differences as 0.56-0.76 kg,0.89-1.12 cm,0.64-0.91 cm and 0.31-0.52 kg/m2.Conclusion The percentiles reference curves on growth,constructed by the longitudinal observational data and scientific method,were important in reflecting the development ofbreastfed children in urban areas.
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Objective To understand correlation between maternal drug use and environmental exposure during pregnancy and delivery pattern and allergy in infants and toddlers,and provide theoretical bases for the early prevention and intervention of infantile allergies.Methods Case control study based on cross-sectional investigation was conducted.Thirty-three cities were selected in China.Randomly cluster sampling method was used to select a community in each city as the study sample,the women with infants aged 0-24 months were interviewed in the form of face-to-face questionnaire survey.Infants and toddlers were divided into two groups:case group,including 2113children who had allergic symptoms and were diagnosed with allergic disease,and control group,including 6303 children who never had symptoms of allergic disease.Results Children whose parents had allergic disease histories were more likely to have allergic disease (OR=3.950) compared with the children whose mother or father had allergic disease histories (0R=2.277).Maternal use of antibiotics (OR=1.396),disinfector exposure (0R=1.386),smoking exposure (OR=1.301) during pregnancy and cesarean delivery (OR=1.255) were risk factors for allergic disease in infants and toddlers,the differences were significant (P＜0.05).Conclusion It is essential to conduct primary prevention of infant allergy during pregnancy,and it is necessary to avoid unnecessary cesarean delivery and irrational antibiotic use,disinfector and smoking exposures during pregnancy.
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Objective To construct the growth percentile curves of weight-,length/height-,head circumference and BMI for 1 to 4 year-olds who had been breastfed in urban areas.Methods Data was from the longitudinal study on 1 025 breastfed children aged 1 to 4 years,in 8 urban areas during 2008-2012.MLwiN2.25 was selected to construct the multi-level models of weight-for-age,length for-age,head circumference-for-age and BMI-for-age.The models included many growth relevant factors including gender,age,family and social demographic characteristics,perinatal factors,parent biological characteristics,dietary patterns and diseases of childen.Based on these models,predicted values (P3,P15,P50,Ps5,P97) were estimated to fit the percentiles reference curves.Results The percentiles reference curves of weight-,length/height,head circumferenceand BMI-for-age for the 1-4 year-olds who had been breastfed in the urban areas were developed.Differences of all the indicators between boys and girls were statistically significant (P＜0.001).Weight,length/height,head circumference and BMI were higher in boys than those in girls,with an average differences as 0.56-0.76 kg,0.89-1.12 cm,0.64-0.91 cm and 0.31-0.52 kg/m2.Conclusion The percentiles reference curves on growth,constructed by the longitudinal observational data and scientific method,were important in reflecting the development ofbreastfed children in urban areas.
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Objective To evaluate the surgical strategy for pulmonary valve preservation in repair of tetralogy of Fallot (TOF) and analyze the outcomes in young children patients.Methods A total of 211 TOF younger children less than threeyear-old between January 2009 and December 2015 had received pulmonary valve-sparing(PVS) surgical repair.At the end of the procedure,the peak RV/LV pressure ratio(PRV/PLV) and transannular pressure gradient were performed in all patients.114 patients had higher PRV/PLV rati ≥ 0.8.The former 54 patients,right ventricle infundubulum sparing (RVIS) stragery were made to relieve the RVOTO.However,only 8 patinets of the later 60 cases had received RVIS in TOF repair,whose systemic blood pressure was instable with the large dose of dopamine≥10 μg · kg-1 · min-1 and epinephrine≥0.05 μg · kg-1 · min-1 or the transannular pressure gradient≥30 mmHg (1 mmHg =0.133 kPa).114 patients were divided by two group(52 cases in PVS group and 62 cases in RVIS group) and compared by the early outcomes.Results The median cardiopulmonary bypass time of RVIS group was significantly more than that of PVS group[(110.3 ± 12.0)min vs(77.7 ± 10.0)min].The postoperative index of the patients in PVS group,including transannular pressure gradient [(21.0 ± 5.4) mmHg vs (16.0 ± 3.6) mmHg,P ＜ 0.05],PRV/PLV ratio(0.82 ± 0.03 vs.0.67 ± 0.12,P ＜ 0.01),median using time of dopamine and epinephrine[(6.03 ±9.60)days vs.(4.20 ±1.90)days,P＜0.01],median extubation time[(81.2 ±27.6)h vs.(38.5 ±33.0) h,P ＜ 0.01],ICU stay time [(6.3 ± 1.7) days vs.(4.3 ± 1.9) days,P ＜ 0.01],using of peritoneal dialysis (8/52 vs 4/62,P ＜ 0.01)were more than those in RVIS group.There was no difference of mortality between two groups.Fellow up 12-50 months,there was no difference of LVEF,MPI and TAPSE between two groups.However,the severity of pulmonary regurgitation in patients of PVS group was significant less than those of RVIS group.Conclusion PVS and RVIS in TOF repair could decrease the severity of pulmonary regurgitation after operation.
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Objeetive We sought to compare the safety and efficacy of cut-and-sew Cox-maze Ⅲ procedure for atrial fi brillation associated with degenerative mitral regurgitation,by comparing with patients without atrial fibrillation.Methods From May 2013 to November 2015,217 patients underwent mitral valve repair were enrolled,including 145 without atrial fibrillation(control group) and 28 received concomitant cut-and-sew Cox-maze Ⅲ procedure (treatment group).Propensity scores were calculated on the basis of 16 known preoperative factors and yielded the best matched patients.Safety and outcomes were compared between the two matched groups.Results 28 pairs of patients were matched successfully.No hospital deaths occurred and the major complications showed no statistical differences (P ＞ 0.05).Cardiopulmonary bypass time and crossclamp time,proportion of amiodarone use and temporary pacemaker use,and postoperative hospital stay in the treatment group were higher than those in the control group(P ＜0.001).Patients were followed up from 6 months to 3 years,and no patients occurred deaths and strokes.After 6 months,there were no significant differences in the rates of sinus rhythm and drug free between the two groups (P ＞ 0.05).In both groups,left atrial diameter and left ventricular diameter decreased,and ejection fraction increased compared with those before operation.Atrial function in the treatment group recovered 3 years after operation.At the latest follow-up,patients in both groups were all at NYHA functional class Ⅰ.Conclusion The additional cut-and-sew Cox-maze Ⅲ procedure for treatment of degenerative mitral disease complicated by atrial fibrillation does not increase the operative risks of mitral valve repair,and had early and mid-term outcomes similar to that of patients without atrial fibrillation.
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Objeetive We sought to compare the safety and efficacy of cut-and-sew Cox-maze Ⅲ procedure for atrial fi brillation associated with degenerative mitral regurgitation,by comparing with patients without atrial fibrillation.Methods From May 2013 to November 2015,217 patients underwent mitral valve repair were enrolled,including 145 without atrial fibrillation(control group) and 28 received concomitant cut-and-sew Cox-maze Ⅲ procedure (treatment group).Propensity scores were calculated on the basis of 16 known preoperative factors and yielded the best matched patients.Safety and outcomes were compared between the two matched groups.Results 28 pairs of patients were matched successfully.No hospital deaths occurred and the major complications showed no statistical differences (P ＞ 0.05).Cardiopulmonary bypass time and crossclamp time,proportion of amiodarone use and temporary pacemaker use,and postoperative hospital stay in the treatment group were higher than those in the control group(P ＜0.001).Patients were followed up from 6 months to 3 years,and no patients occurred deaths and strokes.After 6 months,there were no significant differences in the rates of sinus rhythm and drug free between the two groups (P ＞ 0.05).In both groups,left atrial diameter and left ventricular diameter decreased,and ejection fraction increased compared with those before operation.Atrial function in the treatment group recovered 3 years after operation.At the latest follow-up,patients in both groups were all at NYHA functional class Ⅰ.Conclusion The additional cut-and-sew Cox-maze Ⅲ procedure for treatment of degenerative mitral disease complicated by atrial fibrillation does not increase the operative risks of mitral valve repair,and had early and mid-term outcomes similar to that of patients without atrial fibrillation.