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Objective:This study was performed to assess the effect of glycemic control on atrial fibrillation recurrence rates after heart surgery concomitant with Cox-Maze Ⅳ ablation.Methods:A retrospective analysis was performed on 317 diabetic patients with atrial fibrillation who underwent cardiac surgery combined with Cox-Maze Ⅳ ablation in our hospital from May 2016 to February 2020. The patients were followed up for(37.7±27.7) months, and the data of atrial fibrillation recurrence and clinical outcome were collected and compared. The limited cubic spline model was used to analyze the dose-relationship between HbA1c level and the recurrence of atrial fibrillation. The univariate and multivariate Cox proportional regression analysis was used to explore the risk factors of recurrent atrial fibrillation after Cox-Maze Ⅳ ablation. Results:Higher glycated hemoglobin(HbA1c) at the time of ablation was associated with higher post-ablation recurrence rates. The cumulative survival freedom from atrial fibrillation recurrence for patients with HbA1c ≥7.4% at time of operation at 12, 24, 36 and 48 months were 96.3%、75.8%、52.7% and 35.7%, respectively( P<0.001). Besides, the rates of all-cause mortality, cardiac mortality and rehospitalization were significantly lower in patients with HbA1c<7.4%(1.7% vs. 6.3%, P=0.03; 1.1% vs. 5.6%, P=0.02 and 5.7% vs. 20.4%, P=0.01). The multivariate Cox regression model showed that HbA1c was an independent risk factor for atrial fibrillation recurrence( P<0.05). Conclusion:Higher preoperative HbA1c levels were associated with increased recurrence of atrial fibrillation and adverse clinical outcomes in patients undergoing cardiac surgery combined with Cox-Maze Ⅳ ablation.
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Objective:To summarize the experience of reoperation for 23 cases of cardiac myxoma recurrence.Methods:From January 2002 to December 2018, 1106 patients with cardiac myxoma underwent surgical treatment. Among them, 23 patients underwent reoperation after recurrence. 10 males and 13 females with an average age of (50.5±10.8) years old. There were 22 patients with secondary operation and 1 patient with four operations. 3 cases with mitral insufficiency and 1 case with tricuspid insufficiency. There were 20 patients with NYHA Ⅰ-Ⅱ and 3 patients with Ⅲ-Ⅳ. A total of 1 083 patients with cardiac myxoma undergoing primary operation were selected as the control group. The operation time, cardiopulmonary bypass time, aortic clamping time, ICU monitoring time, ventilator assisted breathing time, postoperative hospital stay, in-hospital mortality and cardiac ejection fraction at discharge were compared between the two groups.Results:8 cases (34.8%) had the first onset in the left atrial septum, and 15 cases (65.2%) in other parts. Recurrence site: left atrium in 17 cases(73.9%), left ventricle in 2 cases (8.7%), right atrium in 3 cases (13.0%), right ventricle in 1 case (4.3%). Reoperation accounted for 2.1% of cardiac myxoma surgery in the same period. The median recurrence time of 13 patients was 24 months. During the same period, mitral valve replacement was performed in 2 cases, mitral valvuloplasty in 1 case and tricuspid valve plasty in 1 case. The average operation time was (3.9±2.8) h, cardiopulmonary bypass time was (107.6±33.8) min, aortic clamping time was (64.9±23.8) min, ICU monitoring time was (20.1±16.0) h, ventilator assisted breathing time was (16.9±8.5) h, cardiac ejection fraction at discharge was 0.51±0.10, postoperative hospital stay was (8.3±1.5) days. The median follow-up time was 5 (1-18) years. One case (4.3%) died of all causes. There was no significant difference in ICU monitoring time, ventilator assisted breathing time, discharge cardiac ejection fraction, postoperative hospital stay and hospital mortality between reoperation patients and one operation ( P>0.05). Conclusion:Atypical cardiac myxoma has a high recurrence tendency after operation. Regular follow-up after the first operation of cardiac myxoma is a necessary means to early detect recurrence and avoid complications. Reoperation after recurrence can still achieve satisfactory results.
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Objective:To investigate the difference between the short-term and long-term survival rates of patients undergoing tricuspid valve replacement with biological and mechanical valves.Methods:273 patients who received tricuspid valve replacement were selected from our Hospital from November 1993 to August 2018. The mean follow-up time was(8.2±5.6) years. The total follow-up rate was 95%. Kaplan-Meier method was used to make survival curves of the two groups and log rank test was used to compare the differences between the two groups. In addition, this study made the comparison of preoperative, intraoperative and postoperative information and long-term survival rate between these two groups.Results:There was no significant difference in demographic characteristics and baseline between mechanical valve group and biological valve group. 16 patients died in the mechanical valve group and 22 in the biological valve group. In the mechanical valve group, 14 cases died of postoperative low cardiac output syndrome and 2 cases died of gastrointestinal hemorrhage. 22 patients were died of low cardiac output syndrome. The auxiliary time in the mechanical valve group was longer than that in the biological valve group[(151.76±70.30)min vs.(131.62±60.25)min, P=0.013)]. There was no significant difference in long-term survival rate between the two groups in Kaplan- Meier survival curve( P=0.234). Conclusion:There is no difference in short-term and long-term survival rate between mechanical valve and biological valve in tricuspid valve replacement.
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Objective To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD).Methods From 2005 to 2014,101 elderly patients (≥ 80 years)with LMCAD underwent off-pump CABG in our hospital.Among them,82 were male and 19 were female,with an average age of(81.4 ± 1.7)years.Seventy-six cases(75.2 ％) had significant left main stenosis (≥ 70 ％) and twenty-five cases had left main stenosis less than 70％.The average left ventricular end diastolic diameter was(48.2 ± 8.3) cm;left ventricular ejection fraction was more than 50％ in 89 cases and 30％ to 50/％ in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition,56 patients had New York Heart Association functional classification Ⅰ to Ⅱ,and 45 patients had classification]] to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰ to Ⅲll,two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG.Results The average operation time was(3.9 ± 0.8) h,the average number of bridging vessels were (3,0 ± 1.0) roots,ICU monitoring time was(50.2 ± 46.0) h,and ventilator assisted breathing time was (42.9 ± 68.5) h.Six patients (5.9 ％) had secondary thoracotomy hemostasis,five(4.9 ％) had secondary tracheal intubation,and four(4.0 ％)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases (2.9 ％) during operation and in 11 cases(10.9 ％) after operation.Two cases (2.0 ％) had perioperative myocardial infarction and 8 cases (7.9％) died after operation during hospitalization.The median follow-up time was 6(1-11)years,and 17(16.8％)had all-cause mortality.Conclusions Although the two independent high-risk factors,old age and left main stenosis often coexist,off-pump CABG and perioperative management are still safe and effective treatments.
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Objective@#To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD).@*Methods@#From 2005 to 2014, 101 elderly patients(≥80 years)with LMCAD underwent off-pump CABG in our hospital.Among them, 82 were male and 19 were female, with an average age of(81.4±1.7)years.Seventy-six cases(75.2%)had significant left main stenosis(≥70%)and twenty-five cases had left main stenosis less than 70%.The average left ventricular end diastolic diameter was(48.2±8.3)cm; left ventricular ejection fraction was more than 50% in 89 cases and 30% to 50% in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition, 56 patients had New York Heart Association functional classification Ⅰ to Ⅱ, and 45 patients had classification Ⅲ to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰto Ⅲ, two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG.@*Results@#The average operation time was(3.9±0.8)h, the average number of bridging vessels were(3.0±1.0)roots, ICU monitoring time was(50.2±46.0)h, and ventilator assisted breathing time was(42.9±68.5)h.Six patients(5.9%)had secondary thoracotomy hemostasis, five(4.9%)had secondary tracheal intubation, and four(4.0%)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases(2.9%)during operation and in 11 cases(10.9%)after operation.Two cases(2.0%)had perioperative myocardial infarction and 8 cases(7.9%)died after operation during hospitalization.The median follow-up time was 6(1-11)years, and 17(16.8%)had all-cause mortality.@*Conclusions@#Although the two independent high-risk factors, old age and left main stenosis often coexist, off-pump CABG and perioperative management are still safe and effective treatments.
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Objective To investigate the effect of body mass index on early postoperative clinical outcomes following off-pump coronary artery bypass grafting. Methods A total of 1062 patients that received OPCABG in Beijing Anzhen Hospital were recorded continuously from January 2015 to May 2015. The patients were divided into normal weight group(n=360), overweight group(n=527) and obesity group(n=175) according to their body mass index. The following outcomes in the ear-ly postoperative period were compared among the three groups: hospital mortality, atrial fibrillation and intra aortic balloon counter pulsation usage, multiple organ failure score system, postoperative score for cardiac surgery, sequential organ failure assessment score, respiratory index, and pressure-adjusted heart rate. Results The lowest mortality rate was observed in the overweight group(0.6％) in comparison with the normal weight group(2.2％) and obesity group(1.1％)(P<0.01). The lowest rate of atrial fibrillation was observed in the obesity group(20. 1％) in comparison with the normal weight group (22.1％) and overweight group(20. 7％)(P <0. 01). The IABP usage rate was the highest in the normal weight group (8. 1％), followed by the overweight group(6. 0％) and the obesity group(2. 9％)(P<0. 01). On the operation day and the first day after operation, the MODS, SOFA and PSCS scores of the obese group were significantly higher than those of the nor-mal weight group(P <0. 01). PaO2/FiO2 in the obese group was significantly lower than that in the normal weight group (P<0. 01). PAHR in the obese group was significantly higher than that in the normal weight group(P<0. 01). Conclusion High BMI groups were associated with lower rates of mortality, atrial fibrillation, and IABP utilization. The lowest mortality rate was observed in the overweight group.
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Objective: To investigate the protective effect of 11,12-EET(11,12-epoxyeicosatrienoic acid)on myocardium of immature rabbit hearts from ischemic reperfusion injury. Methods: 16 isolated immature rabbit hearts were performed to ischemic reperfusion model in a Langendorff perfusion apparatus and randomlyassigned to on two groups. Control group, the hearts were arrested with St.Thomas No.2 solution and stored in the same solution (n=8). EET group, the hearts were arrested with St.Thomas No.2 plus 11,12-EET solution and stored in the same solution (n=8). These isolated rabbit hearts were stored for 8 hours at 4℃ hypothermia , and underwent 30 minutes of reperfusion (37℃). We measured the preischemia and postreperfusion indexes of left ventricle developed pressure (LVDP), left ventricle end-diastolic pressure (LVEDP), ?dp/pt_ max , myocardial water content (MWC), coronary blood effluent (CBE) and arrhythmia score (AS). The myocardial ultrastructure and value of creatine kinase (CK) and lactic dehydrogenase (LDH) were also observed. Results: (1) After 30 minutes reperfusion, the indexes of CK, LDH, CBE, AS,and the recovery rate of heart function were significantly better in EET group compared with controls. At the same time, no ultrastructural changes were found in the EET group while the capillary endothelial base membrane edema and mitochondrion edema was observed in the control group. (2) In EET group, compared with preischemia, there were no significantly changes of myocardial function at the end of 30-minutes reperfusion. Conclusion: These data suggest that 11,12-EET add to the St.Thomas No.2 solution could offer more little myocardial injury and little arrhythmia and provide better preservation of the isolated immature hearts.
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AIM: To study apoptosis and bcl-2 mRNA gene expression of cardiomyocytes in donor hearts of immature rabbits underwent prolonged protection by 11, 12-epoxyeicosatrienoic acid (11, 12-EET), and further probe into the possible mechanisms. METHODS: 24 isolated immature rabbit hearts were performed to the model in a Langendorff perfusion apparatus and randomly assigned to normal control group,ST control group and EET group. The isolated rabbit hearts in ST control group and EET group were stored for 24 hours with 4 ℃ hypothermia, and underwent 30 minutes of reperfusion (37 ℃). TUNEL and in situ hybridization (ISH) methods were applied in the present study and apoptotic cells and bcl-2 mRNA gene expression were observed. RESULTS: The numbers of apoptotic cardiomyocytes in ST group and EET group were higher than that in normal control group, and the numbers of apoptotic cardiomyocytes were significantly decreased in EET group and bcl-2 mRNA positive expression were higher than that in ST control group, respectively. CONCLUSIONS: There were apoptosis during the prolonged protection of donor heart in our study, and we proved that: ①11,12-EET could decrease cardiomyocyte apoptosis significantly. ②Up-regulation of the bcl-2 mRNA expression in cardiomyocytes may be one of the mechanism responsible for inhibition of cardiomyocyte apoptosis by 11, 12-EET.
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Objective To observe the protective effect of 11,12-epoxyeicosatrienoic acid(11,12-EET)on immature isolated rabbit hearts.Methods Forty-eight isolated immature rabbit hearts were randomly assigned to two groups: Control group,the hearts were arrested with St.Thomas No.2 solution and stored in the same solution ( n =24);EET group,the hearts were arrested with St.Thomas No.2 plus 11,12-EET solution and stored in the same solution ( n =24). All rabbit hearts were stored for 8,16 and 24 h with 4 ℃ hypothetmia, and underwent 30 min reperfusion ( 37 ℃ ). On the Langendorff perfusion apparatus,left ventricle developed pressure (LVDP),left ventricle end-diastolic pressure (LVEDP),+dp/pt max ,coronary blood effluent (CBE) and arrhythmias score were measured before and after ischemia. Myocardial water content,the value of creatine kinase (CK) and lactic dehydrogenase (LDH) were also measured,and myocardial ultrastructure observed. Results Postischemic recovery of myocardial function and myocardial edema were significantly better in EET group at different time points. The changes of arrhythmias score,CK,LDH and myocardial ultrastructure in EET group were superior to those in control group. After the hearts were preserved for 16 h ,the recovery of myocardial function and arrhythmias score in EET group were basically close to the measured values before heart preservation,while those in control group were significantly decreased. After the hearts were stored for 24 h ,all hearts in EET group beated again during reperfusion,but 5 hearts in control group could not beat anymore.Conclusion Addition of 11,12-EET into the St.Thomas No.2 cardioplegic solution could prolong the storage time and enhance the myocardial protective effect to the isolated immature hearts.