Progress in clinical studies in cardiovascular surgery 2022 / 中国胸心血管外科临床杂志

@#In 2022, many excellent clinical studies emerged in the field of cardiovascular surgery. Selecting papers published in The New England Journal of Medicine and other top medicine and cardiology journals, this review focused on the research progress on 7 topics in the field of cardiovascular surgery: coronary artery surgery, vascular surgery, valvular surgery, structural heart disease, congenital heart disease, heart transplantation, perioperative management, and special population.

Interpretation of methodological standards for the design, implementation, and analysis of randomized trials in cardiac surgery: A scientific statement from the American Heart Association in 2022 / 中国胸心血管外科临床杂志

@#Cardiac surgery presents specific challenges in conducting randomized controlled trials (RCTs). The American Heart Association made a scientific statement of methodological standards, with the purpose to review key concepts and standards in design, implementation, and analysis of cardiac surgery RCTs, and to provide recommendations. Recommendations include an evaluation of the suitability of the research question, clinical equipoise, feasibility of enrolling a representative patient cohort, impact of practice variations on the effect of the study intervention, likelihood and impact of crossover, and duration of follow-up. Trial interventions and study end points should be predefined, and adequate deliverability of the trial interventions should be ensured. Every effort must be made to keep a high completeness of follow-up. Trial design and analytic techniques must be tailored to the specific research question and trial setting. In this paper, the authors made an interpretation of this scientific statement based on their practical experience.

Insights into the clinical studies related to cardiovascular surgery from the American Heart Association’s Scientific Sessions 2021: Part one / 中国胸心血管外科临床杂志

@#In the American Heart Association’s Scientific Sessions 2021, the results of six clinical trials related to cardiovascular surgery were revealed. The PALACS trial demonstrated that posterior left pericardiotomy during open heart surgery was associated with a significant reduction in postoperative atrial fibrillation; the EPICCURE study found that injection of mRNA encoding vascular endothelial growth factor (VEGF-A mRNA) directly into the myocardium of patients undergoing elective coronary artery bypass grafting (CABG) improved patients’ heart function; the VEST trial once again proved the safety and potential value of external stent for vein graft. This article will interpret the above-mentioned three studies.

oncurrent surgical left atrial appendage occlusion should become routine procedure in cardiac surgery for atrial fibrillation patients — Commentary on LAAOS Ⅲ / 中国胸心血管外科临床杂志

@#Left atrial appendage occlusion is a common procedure for patients with atrial fibrillation history when they underwent cardiac surgery. Before the LAAOS Ⅲ research results, this operation has been lacking strong evidence-based support. LAAOS Ⅲ is a prospective, double-blind, international multicenter, randomized blinded trial. According to the results of LAAOS Ⅲ, the left atrial appendage occlusion can reduce the risk of stroke and systemic embolism. This article will perform detailed interpretation of LAAOS Ⅲ research.

Saphenous vein graft: the second choice of conduits in coronary artery bypass grafting / 中华胸心血管外科杂志

Despite the fact that the patency rate of saphenous vein graft(SVG) is less than those of arterial grafts,SVG is fully appreciated by cardiac surgeons and remains the most widely-used conduit for coronary artery bypass grafting(CABG).Recently,thanks to the growing understanding of the pathogenesis of vein graft failure(VGF),the emergence of new drugs and the improvement of surgical techniques,the patency rate of SVG has been well improved.This article reviews the history and the current understanding of SVG,the pathogenesis of VGF,the clinical strategies that may improve the patency rate and the research prospects in this filed.

Erythropoietin mobilizes renal progenitor cells to reduce ischemic reperfusion injury in rats with nephron-sparing surgery / 中华肾脏病杂志

Objective To investigate the effects of the erythropoietin (EPO) on ischemia reperfusion injury (IRI) in rats with nephron-sparing surgery (NSS). Methods Fifty-four Sprague Dawley rats were divided into 3 groups randomly after right kidney nephrectomy: Sham group, NSS group (PBS+NSS) and EPO group (EPO+NSS). During NSS, renal artery was clamped for 40 min to induce IRI. Sham group just adopted exposure renal artery without vascular clamped. Rats in NSS group were injected intraperitoneally with PBS for 3 days before NSS. Rats in EPO group were injected intraperitoneally with EPO for 3 days before NSS. After 12 h, 24 h, 72 h, blood sample and renal tissues were collected. The serum creatinine (Scr) and urea nitrogen (BUN) were evaluated. The pathology injury was evaluated by HE staining. The CD24/CD133 double-positived renal progenitor cells (RPCs) were tested by flow cytometry. The CD133 and PCNA protein were quantified by immunohistochemical staining. The expressions of Wnt7b and β-catenin protein were detected by Western blotting. Results Rats in NSS group had more elevated Scr, BUN and pathology injury scores 12 h, 24 h and 72 h after operation than those in Sham group (all P<0.05). Compared with those in the NSS group, the Scr and BUN in the EPO group were significantly lower 24 h after the surgery (all P<0.05), and the pathology injury score also decreased (P<0.05). The proportion of RPCs, expressions of CD133 and PCNA, and expressions of Wnt7b and β-catenin protein were significantly higher after 24 h of the surgery in NSS group than those in the Sham group (all P<0.05). While compared with those in the NSS group, the proportion of RPCs and expressions of CD133, PCNA, Wnt7b and β-catenin increased at the EPO group (all P<0.05). Conclusions EPO can reduce the IRI after NSS, and its mechanism may be related to the mobilization of the RPCs by the Wnt7b/β-catenin signal pathway.