Comparison on short-term safety outcomes between off-pump and on-pump coronary artery bypass grafting by experienced surgeons: a single center study with 31 075 cases / 中华心血管病杂志

Objective: To compare the short-term outcomes between off-pump and on-pump coronary artery bypass graft (CABG) by experienced surgeons with similar surgical team in a single large-volume cardiac surgery center. Methods: A total of 31 075 patients with multivessel coronary disease who underwent isolated off-pump or on-pump CABG between January 1, 2009 and December 31, 2019 by experienced surgeons in Fuwai hospital were enrolled in this retrospective study. Patients was divided into on-pump CABG group and on-pump CABG group on an intention-to treat basis. Short term safety endpoints, including 30 days mortality, composite endpoint of major morbidity or mortality, prolonged postoperative length of stay (PLOS), and prolonged ICU length of stay (PICULOS), and distal anastomosis were compared between the two groups. Mortality was evaluated on 30 days post operation, other endpoints were collected before discharge. After 1∶1 propensity-score matching of baseline characteristics for on-pump and off-pump CABG, postoperative endpoints were compared with use of McNemar's test and further adjusted with the use of a logistic regression model. Results: After propensity-score matching, 10 243 matched pairs of patients were included in the final analysis, there were 4 605(22.5%) females and mean age was (60.7±8.6) years. The standardized differences were less than 5% for all baseline variables in matched cohort. Univariate analysis indicated lower risk of 30 days mortality (0.2% vs. 0.7%, P<0.001), major morbidity or mortality (5.7% vs. 8.8%, P<0.001), PLOS (3.2% vs. 4.9%, P<0.001), PICULOS (9.4% vs. 12.2, P<0.001), and lower number of distal anastomosis ((3.3±0.8) vs. (3.6±0.8), P<0.001) in off-pump CABG group than in on-pump CABG group. After adjustment of cofounders, multivariate analysis showed that off-pump CABG was still associated with a lower risk of 30 days mortality (OR=0.29, 95%CI: 0.09-0.87, P=0.027), composite endpoint of major morbidity or mortality (OR=0.60, 95%CI: 0.53-0.68, P<0.001), PLOS (OR=0.64, 95%CI 0.54-0.75, P<0.001), PICULOS (OR=0.76, 95%CI: 0.69-0.84, P<0.001). Conclusions: Off-pump CABG is related with superior short-term safety outcomes than on-pump CABG by experienced surgeons in our center.

Clinical Efficacy and Outcome of Modified Extended Morrow Procedure in Children With Hypertrophic Obstructive Cardiomyopathy / 中国循环杂志

Objectives: Modified extended Morrow procedure for treatment of children with hypertrophic obstructive cardiomyopathy (HOCM) is a complicated and challenging procedure. Our study sought to assess the effect and outcome of modified extended Morrow procedure in children with HOCM. Methods: From January 2010 to July 2017, 50 consecutive pediatric (age≤14 years) patients with HOCM underwent transaortic modified extended Morrow procedure in Fuwai Hospital. Clinical data of these patients were analyzed retrospectively. Pre-operative and post-operative echocardiography data were analyzed, including left atrial size, left ventricular end diastolic diameter, left ventricular ejection fraction, left ventricular outflow tract peak pressure, ventricular septal thickness, mitral systolic anterior motion and grade of mitral regurgitation. Results: Mean age at the time of operation was (84.4±57.7) month (6 month -14 year). Mean body weight at the time of surgery was (28.4±20.7) kg (4.3-92.0) kg. There were 2 deaths after the operation. Three patients had postoperative complete heart block and received permanent pacemaker implantation. After myectomy, left ventricular outflow tract gradient decreased from (74.8±25.0) mmHg to (19.6±17.3) mmHg (P<0.001); the postoperative thickness of ventricular septum decreased from (21.2±9.7) mm to (14.3±6.7) mm (P<0.001); mitral regurgitation degree reduced from 2.2±1.0 to 0.67±0.72, P<0.001). Concomitant surgical procedures were required in 22 patients (44.0%). There was no late death during a follow-up of (27.7±14.0) months. Patients' symptoms were significantly improved post operation and all surviving patients were in New York Heart Association functional class I or II during follow-up. Conclusions: Modified extended Morrow procedure is safe and effective in children with HOCM, post-procedural clinical outcome is excellent, and this procedure can significantly improve the quality of 1ife and the long-term prognosis in these patients.

Relationship Between Soluble ST2, Galectin-3 and Clinical Prognosis of Ventricular Septal Myectomy in Patients With Obstructive Hypertrophic Cardiomyopathy / 中国循环杂志

Objective: To explore the relationship between plasma levels of soluble ST2 (sST2), galectin-3 (Gal-3) and clinical prognosis of ventricular septal myectomy in patients with obstructive hypertrophic cardiomyopathy (HOCM). Methods: A total of 200 consecutive HOCM patients received modified Morrow surgery in our hospital from 2011-03 to 2016-02 were studied. According to plasma levels of sST2, patients were divided into 3 groups: Low sST2 group (sST2<9.05 ng/ml), Middle sST2 group (sST2 9.05-16.74 ng/ml) and High sST2 group (sST2>16.74 ng/ml); based on plasma levels of Gal-3, patients were divided into another 3 groups: Low Gal-3 group (Gal-3<6.19 ng/ml), Middle group (Gal-3 6.19-8.22 ng/ml) and High Gal-3 group (Gal-3>8.22 ng/ml); in addition, Control group, n=42 volunteers without heart disease. Plasma levels of sST2 and Gal-3 were measured by ELISA, compared between Control group and HOCM group (n=42 patients with matched gender and age to Control group). The predictive value of sST2 and Gal-3 on major endpoint events including all cause death or cardiovascular hospitalization were assessed by Cox regression analysis.Results: Compared with Control group, plasma levels of sST2 and Gal-3 were increased in HOCM patients, P<0.01. The patients were followed-up for the average of 26 months, Kaplan-meier survival analysis showed that the incidences of composite endpoint event were similar at different levels of sST2 and Gal-3 (log-rank P=0.06 and P=0.68). Cox regression analysis indicated that either sST2 or Gal-3 could not independently predict the endpoint events, both P>0.05, while age was an independent risk factor for composite endpoint event occurrence (HR=1.06, 95% CI 1.02-1.11, P<0.01). Conclusion: Plasma levels of sST2 and Gal-3 were not related to clinical prognosis of ventricular septal myectomy in HOCM patients even they had increased sST2 and Gal-3; while advanced age was the independent predictor for endpoint event occurrence.

Predictive value of qualitative assessment of general movements for adverse outcomes at 24 months of age in infants with asphyxia / 中国当代儿科杂志

<p><b>OJBECTIVE</b>To investigate the predictive value of the qualitative assessment of general movements (GMs) for adverse outcomes at 24 months of age in full-term infants with asphyxia.</p><p><b>METHODS</b>A total of 114 full-term asphyxiated infants, who were admitted to the neonatal intensive care unit between 2009 and 2012 and took part in follow-ups after discharge were included in the study. All of them received the qualitative assessment of GMs within 3 months after birth. The development quotient was determined with the Bayley Scales of Infant Development at 24 months of age.</p><p><b>RESULTS</b>The results of the qualitative assessment of GMs within 3 months after birth showed that among 114 infants, 20 (17.5%) had poor repertoire movements and 7 (6.1%) had cramped-synchronized movements during the writhing movements period; 8 infants (7.0%) had the absence of fidgety movements during the fidgety movements period. The results of development quotient at 24 months of age showed that 7 infants (6.1%) had adverse developmental outcomes: 6 cases of cerebral palsy and mental retardation and 1 case of mental retardation. There was a poor consistency between poor repertoire movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=-0.019; P>0.05). There was a high consistency between cramped-synchronized movements during the writhing movements period and the developmental outcomes at 24 months of age (Kappa=0.848; P<0.05), and the results of predictive values of cramped-synchronized movements were shown as follows: predictive validity 98.2%, sensitivity 85.7%, specificity 99.1%, positive predictive value 85.7%, and negative predictive value 99.1%. There was a high consistency between the absence of fidgety movements during the fidgety movements period and the developmental outcomes at 24 months of age (Kappa=0.786; P<0.05), and its predictive values were expressed as follows: predictive validity 97.4%, sensitivity 85.7%, specificity 98.1%, positive predictive value 75.0%, and negative predictive value 99.1%.</p><p><b>CONCLUSIONS</b>Cramped-synchronized movements and absence of fidgety movements can predict adverse developmental outcomes at 24 months of age in full-term infants with asphyxia.</p>

Clinical features and management of complete heart block after transaortic extended septal myectomy in patients with hypertrophic obstructive cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the clinical features, precaution and management of complete heart block (CHB) after transaortic extended septal myectomy operation (extended Morrow procedure) in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>METHODS</b>From October 1996 to December 2011, 10[6 men; mean age (45.4 ± 15.8) years, range 13-60 years] out of 160 consecutive HOCM patients underwent extended Morrow procedure developed CHB postoperatively. Their clinical data were retrospectively analyzed. Baseline transthoracic echocardiography showed that the left ventricular outflow tract (LVOT) gradients was from 68 to 149 (105.1 ± 25.9) mm Hg (1 mm Hg = 0.133 kPa), ECG showed right bundle branch block in 5 patients and atrial fibrillation, atrial premature beats or ST-T segment changes in other 5 patients. Besides extended Morrow procedure, concomitant surgical procedures included mitral valve replacement (MVR) in 2 (2/10) and MVR plus coronary artery bypass grafting in another 2 (2/10) patients. Follow-up data were obtained by subsequent clinic visits in outpatient department and telephone interviews.</p><p><b>RESULTS</b>The in-hospital mortality was 20% (these two patients died of low cardiac output syndrome and multiple organs failure). Four patients underwent MVR simultaneously survived the operation. Postoperative echocardiography demonstrated a reduced LVOT gradient[(13.6 ± 9.7) mm Hg, P < 0.001]. Permanent pacemakers were implanted in all 8 survived patients at 6 days to 7 months after operation. No other severe complications were observed. During follow-up [from 4 to 72 (19.4 ± 22.1) months], there was no death, 1 patient readmitted to our center at 71 months post operation to change the pacemaker because of low voltage of previously implanted pacemaker. Physical capacity and quality of life improved significantly post operation in these 8 patients. The NYHA functional class remained at I-II post operation and during follow up.</p><p><b>CONCLUSIONS</b>CHB is a severe complication after extended Morrow procedure for patients with HOCM and timely permanent pacemaker implantation is mandatory for patients with post procedure CHB.</p>

Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Myocardial bridging with systolic compression of the left anterior descending coronary artery (LAD) may be associated with myocardial ischaemia. The clinical outcome in patients with surgical treatment for symptomatic myocardial bridging remains undetermined. This study assessed the middle- and long-term results of surgical treatment for symptomatic myocardial bridging.</p><p><b>METHODS</b>From 1997 to 2006, 37,463 patients received selective coronary angiography in the Fuwai Cardiovascular Hospital, Beijing, China. Of these, 484 patients had angiographic diagnosis of myocardial bridging. Of the 484 patients, 35 underwent surgery for treatment of myocardial bridging with significant systolic arterial compression. Among the surgical treatment patients, 24 presented with other cardiac disorders, and the remaining 11 symptomatic patients with isolated myocardial bridging were included in the follow-up study.</p><p><b>RESULTS</b>The angiographic prevalence of myocardial bridging was 1.3% in this study. The coronary angiographies of the 11 patients revealed myocardial bridging in the middle segment of LAD causing systolic compression > or = 75% (ranging from 75% to 90%). The mean age of patients was 48.4 years. Surgical myotomy was performed in 3 patients and coronary artery bypass grafting (CABG) in 8 patients. Eight patients were operated on with an off-pump approach and 3 with a cardiopulmonary bypass technique after median sternotomy. Conversion to on-pump CABG surgery was necessary in 1 patient because of perforation of the right ventricle. The left internal mammary artery was used in all patients with CABG. The acute clinical success rate was 100% with respect to the absence of myocardial infarction, death or other major in-hospital complications. All of the patients were followed up clinically. The median follow-up was 35.3 months (range: 6 to 120 months). Nine patients were free from symptoms and one of them continued taking beta blockers. The remaining 2 patients with myotomy had atypical chest pain. One received coronary angiography again and no stenosis was found two years after operation; while exercise testing was performed in the other patient and revealed no evidence of myocardial ischaemia. None of the patients sustained a myocardial infarction or other major adverse cardiac events (death or vessel revascularization) during follow-up.</p><p><b>CONCLUSIONS</b>Myocardial bridging is a relatively common angiographic finding. Surgical myotomy or CABG should be limited to patients who are refractory to oral medication. Surgical relief of myocardial ischaemia due to systolic compression of intramyocardial coronary arteries can be accomplished with low operative risk and excellent middle- and long-term results.</p>

Surgical treatment of active infective endocarditis / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the recent experience of surgical management of the active infective endocarditis (IE) disease in Fuwai Hospital.</p><p><b>METHODS</b>From October 1, 1996 to December 31, 2003, 54 patients with active IE underwent heart operation in Fuwai Hospital. There were 41 males, 13 females, with an average age of 35 years old and an average weight 58 kg. Of the cases, 23 had congenital anomalies of the heart, and 1 had rheumatic valvulitis. Streptococci were found in 20 patients, staphylococci in 3, enterococci in 1, enterococcus in 2 and G(+) cocci in 1. Pre-operative cardiac classification (NYHA): class I was in 6 cases, class II in 12 cases, class III in 7 cases and class IV in 29 cases. Systemic embolization occurred in 23 cases and pulmonary infarction in 2 cases. Emergent operations were performed in 27 cases because of heart failure (8 cases), embolism (4 cases), aggressive infection (3 cases), heart failure plus embolism (2 cases), heart failure with aggressive infection (4 cases), aggressive infection with embolism (2 cases) and all the three factors (4 cases). The operations included aortic valve replacement (25 cases), aortic and mitral valves replacement (15 cases), mitral valve replacement (6 cases), mitral valve repair (3 cases), pulmonic valve replacement (1 case) and intracardiac shunt repair (4 cases).</p><p><b>RESULTS</b>The operative mortality was 17% (5 operative death and 4 lost in following-up after being discharged). All of operative deaths were due to infection. Fourteen patients had operative complications. The morbidity included peri-prosthetic leakage (8 cases), prosthetic IE (5 cases), residual intracardiac shunt (2 cases), complete heart block (2 cases), myocardial infarction, ventricular fibrillation, pulmonary trunk stenosis, and mitral regurgitation (1 case in each). Post-operative cardiac classification (NYHA): class I was in 41 cases, class II in 3 cases, class III in 1 case. Two patients were re-operated because of peri-prosthetic leakage, and then they were cured. Re-operation was also performed in other 3 patients. Unrelated late sudden death occurred in 1 patient and hemiplegia caused by anticoagulant intracranial hemorrhage in another patient.</p><p><b>CONCLUSION</b>Acceptable results can be achieved with active surgical intervention in active patients with IE.</p>

Surgical treatment of Williams syndrome combined with cardiovascular disease / 中华外科杂志

<p><b>OBJECTIVE</b>To introduce the experience of diagnosis and surgical treatment of Williams syndrome combined with cardiovascular disease.</p><p><b>METHODS</b>Between October 1996 and June 2003, 8 patients of Williams syndrome with cardiovascular disease were admitted in Fuwai hospital. Seven patients underwent surgical correction. One didn't undergo surgical procedure. There were 6 male and 2 female ranging from 1.5 to 12.0 years old (medium age 6.4). Three had localized type supravalvular aortic stenosis and 5 diffused type supravalvular aortic stenosis. In them, 2 patients were combined with peripheral pulmonary stenosis. Single patch aortoplasty were performed in 6 cases, and inverted bifurcated patch aortoplasty in one patient.</p><p><b>RESULTS</b>One patient died and one patient suffered renal insufficiency. In the early postoperative period, the mean speed of flow was reduced to 1.7 m/s from 4.6 m/s, and the mean systolic pressure gradient was reduced from 91 mm Hg to 18 mm Hg. Six patients were followed up 16 to 91 months. There were 5 cases in NYHA function class I, and one in class II.</p><p><b>CONCLUSION</b>Satisfied result can be achieved in surgical treatment of Williams syndrome with supravalvular aortic stenosis, but it is not in combined with peripheral pulmonary stenosis.</p>