Bessel acoustic-beam acoustic lens for extending the depth of field of detection in optical-resolution photoacoustic microscopy.

As an important part of optical-resolution photoacoustic microscopy, the acoustic lens is responsible for efficient collection of photoacoustic signals. The spherical focused acoustic lens is commonly used in photoacoustic microscopy because of its efficient detection of the photoacoustic signal in the focus area. However, the narrow depth of field of the spherical focused acoustic lens limits the expansion of the depth of field of the photoacoustic microscopy. To solve this problem, a Bessel acoustic-beam acoustic lens is proposed. The Bessel acoustic-beam acoustic lens replaces the spherical concave surface with a conical concave surface to generate a Bessel acoustic beam with non-diffraction. Using the simulation model of Bessel acoustic-beam acoustic lens constructed by COMSOL Multiphysics, it is verified theoretically that the Bessel acoustic-beam acoustic lens can improve the depth of field of detection by ∼2 times. The Bessel acoustic-beam acoustic lens can further promote the capability of high-speed and large volumetric imaging of optical-resolution photoacoustic microscopy and will be helpful in the acquisition of physiological and pathological processes.

CYP2C19 genotype and platelet aggregation test-guided dual antiplatelet therapy after off-pump coronary artery bypass grafting: A retrospective cohort study.

Background: Dual antiplatelet therapy (DAPT) is recommended in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB). Clopidogrel is less effective among patients with loss-of-function (LoF) of CYP2C19 alleles, while ticagrelor has direct effects on P2Y12 receptor. Whether a CYP2C19 genotype plus platelet aggregation test (PAgT)-guided DAPT after CABG could improve clinical outcomes remain uncertain. Materials and methods: From August 2019 to December 2020, 1,134 consecutive patients who underwent OPCAB received DAPT for 1 year after surgery in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. According to the actual treatment they received in real-world, 382 (33.7%) of them received a traditional DAPT: aspirin 100 mg qd + clopidogrel 75 mg qd, no matter the CYP2C19 genotype and response in platelet aggregation test (PAgT). The other 752 (66.3%) patients received an individual DAPT based on CYP2C19 genotype and PAgT: aspirin 100 mg qd + clopidogrel 75 mg qd if CYP2C19 was extensive metabolizer, or moderate metabolizer but normal response in PAgT; aspirin 100 mg qd + ticagrelor 90 mg bid if CYP2C19 was poor metabolizer, or moderate metabolizer but no or low response in PAgT. One-year follow-up was achieved for all patients. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, and stroke. The safety outcome was thrombolysis in myocardial infarction (TIMI) criteria major bleeding. Results: Compared with the traditional DAPT group, the risk of MACE in the individual DAPT group was significantly lower (5.5 vs. 9.2%, HR 0.583; 95% CI, 0.371-0.915; P = 0.019), mainly due to the decreased risk of MI (1.7 vs. 4.2%, HR 0.407; 95% CI, 0.196-0.846; P = 0.016). The risk of TIMI major bleeding events was similar between the two groups (5.3 vs. 6.0%, RR 0.883; 95% CI, 0.537-1.453; P = 0.626). Conclusion: For patients who underwent OPCAB, individual DAPT (CYP2C19 genotype plus PAgT-guided strategy) was associated with a lower risk of MACE and a similar risk of major bleeding.

Predictors of vein graft disease progression between one week and one year after surgical coronary revascularization: Impact of secondary prevention medications.

OBJECTIVE: This study aimed to detect the predictors of vein graft disease (VGD) progression between 1 week and 1 year after surgery and to evaluate the impact of secondary prevention medications. METHODS: A total of 218 consecutive patients underwent surgical coronary revascularization were evaluated by coronary computed tomography angiography both at 1-week and 1-year follow-up. Logistic regression analyses were performed to investigate the predictors of VGD progression. A risk score (0-4) was set up to evaluate implementation result of secondary prevention measures according to 1-year follow-up result. Association between VGD progression and the risk score was assessed. RESULTS: VGD progression occurred in 11.3% of saphenous vein grafts (SVG) and 22.1% of patients. At the patient level, poor vein graft (odds ratio [OR] = 4.25), noncontrolled hyperlipidemia (OR = 3.01), and diabetes mellitus (DM) (OR = 2.96) were predictors, while diameter of SVG (mm, OR = 0.35) was protective factor. At the graft level, DM (OR = 3.52), noncontrolled hyperlipidemia (OR = 2.33), and peripheral artery disease (PAD) (OR = 2.20) were predictors, while number of SVGs (OR = 0.63), diameter of SVG (mm, OR = 0.39), and mean graft flow >25 ml/min (OR = 0.35) were protective factors. VGD progression was significantly associated with the risk score at both the patient (OR = 1.52) and the graft level (OR = 1.38). CONCLUSIONS: Poor vein graft, noncontrolled hyperlipidemia and DM were predictors of VGD progression between 1 week and 1 year after surgery at the patient level, while larger SVG diameter was a protective factor. DM, PAD and noncontrolled hyperlipidemia were predictors at the graft level, while a number of SVGs, larger SVG diameter, and mean graft flow >25 ml/min were protective factors. Implementation failure of secondary prevention medications was associated with VGD progression from as early as 1 year after surgery.

Tanshinone IIA Ameliorates Progression of CAD Through Regulating Cardiac H9c2 Cells Proliferation and Apoptosis by miR-133a-3p/EGFR Axis.

BACKGROUND: Coronary artery disease (CAD) leads to the highest mortality worldwide, seriously threatening human health. Tanshinone IIA (Tan IIA), which could be extracted from Danshen, is applied in the treatment of cardiovascular and cerebrovascular diseases. MicroRNAs (miRNAs, miRs) play pivotal roles in cell proliferation and cell apoptosis of the cardiovascular system. The aim of the present study was to explore the role of Tan IIA in CAD in vitro and the underlying molecular mechanism. METHODS: Real-time polymerase chain reaction (RT-PCR) and Western blot were used for the detection of miRNA/mRNA and protein, respectively. Target genes of miR-133a-3p were searched in TargetScan, and the targeting relationship was verified by dual-luciferase reporter assay. Cell proliferation was determined using a Cell Counting Kit-8 (CCK-8) and EdU labeling. Cell apoptosis was detected by flow cytometry and TUNEL staining. RESULTS: In the present study, lower miR-133a-3p level and higher epidermal growth factor receptor (EGFR; the target of miR-133a-3p) level were found in H2O2-induced H9c2 cells. In addition, Tan IIA upregulated miR-133a-3p and downregulated EGFR expression. Moreover, Tan IIA promoted cell proliferation and suppressed apoptosis and enhanced G0/G1, which was reversed by miR-133a-3p inhibitor, while siRNA-EGFR abolished the effects induced by miR-133a-3p in H2O2-induced H9c2 cells. CONCLUSION: Tan IIA reversed H2O2-induced cell proliferation reduction, cell apoptosis induction, and G0/G1 arrest reduction in H9c2 cells by miR-133a-3p/EGFR axis. The findings suggested a potential molecular basis of Tan IIA in treating patients with CAD.

Pericardial fluid levels of growth differentiation factor 15 in patients with or without coronary artery disease: a prospective study.

BACKGROUND: Growth differentiation factor 15 (GDF15) has already been reported as a novel efficient biomarker in patients with coronary artery diseases (CAD). However, very little is demonstrated about the potential impact of pericardial fluid GDF-15 accumulation on CAD. The aim of this study was to evaluate pericardial fluid and plasma GDF15 levels in patients with ischemic heart disease. METHODS: In this study, 42 consecutive patients (21 patients with significant CAD; 21 patients without CAD) undergoing open heart surgery were recruited in this study. Pericardial fluid were obtained at the time of surgery, and GDF15 levels in the samples were measured by enzyme-linked immunosorbent assay. Plasma glucose, creatinine, CK-MB, cTnI and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements were performed. RESULTS: The plasma GDF15 levels were markedly higher than the pericardial fluid levels both in the CAD group and non-CAD group (1,174.0±148.7 vs. 677.8±77.2 pg/mL, P<0.01; 925.8±127.4 vs. 617.4±76.2 pg/mL, P<0.01). The levels of pericardial fluid GDF15, was not statistically different between the CAD and non-CAD groups (P>0.05). An obvious correlation was observed between plasma and pericardial fluid GDF15 concentration both in the CAD group and non-CAD group (R=0.53, P<0.01; R=0.54, P<0.01). An obvious positive correlation was found between pericardial fluid GDF15 and plasma creatinine levels in CAD patients but not in non-CAD patients (R=0.65, P<0.01). In the CAD group, an obvious correlation was also observed between pericardial fluid GDF15 levels and NT-ProBNP (R=0.63, P<0.01), while no relationship was found in non-CAD group. There was a positive correlation between pericardial fluid GDF15 and LVEF in non-CAD group but not in CAD group patients (R=-0.44, P<0.05). CONCLUSIONS: Our study first revealed an association between pericardial fluid GDF15 and baseline characteristics. Pericardial fluid GDF15 levels are associated with cardiac and kidney function in patients with coronary artery disease and may be a valuable marker for assessing CAD severity and predicting its complications.

Predictors of early vein graft failure after off-pump coronary artery bypass grafting: angiocomputed tomographic results of 233 patients.

OBJECTIVES: Low saphenous vein graft (SVG) patency has become the bottleneck in surgical revascularization. This study aimed to identify the predictors of early vein graft failure (VGF) after off-pump coronary bypass grafting (OPCAB). METHODS: A total of 233 patients who had OPCAB were postoperatively evaluated by coronary computed tomography angiography. Logistic regression analyses were performed to detect the predictors of early VGF (FitzGibbon-B/O) at both the patient and the graft level. RESULTS: Overall FitzGibbon-A patency of SVG at 1 week after OPCAB was 94.1% (659/700). At the patient level, a patient who had at least 1 VGF was regarded as an event, and increased preoperative platelet count [odds ratio (OR) 9.848], quantity of perioperatively transfused red blood cells (RBC) (U, OR 1.544) and creatinine clearance rate (CCr) (ml/min, OR 1.037) were predictors of early VGF, whereas use of a left internal mammary artery graft was a protective factor (OR 0.348). At the graft level, when VGF was regarded as an event, increased preoperative platelet count (OR 17.450), CCr (ml/min, OR 1.034), quantity of perioperatively transfused RBC (U, OR 1.505) and endarterectomy (OR 5.499) were predictors of early VGF. Under the same circumstances, dual antiplatelet therapy (OR 0.419), recipient vessel diameter (mm, OR 0.052), graft run-off (ml/min, OR 0.949), preoperative RBC count (×1012, OR 0.576) and a side-to-side (when compared with end-to-side) anastomosis (OR 0.276) were protective factors. The patency of SVGs sutured to vessels with a larger diameter (>1.5 mm) was significantly higher than that of the others (96.6% vs 91.1%). SVGs with greater run-off (>25 ml/min for each anastomosis) were significantly more patent than others (95.1% vs 88.7%). CONCLUSIONS: Early SVG patency after OPCAB was satisfactory. Increased preoperative platelet count, more perioperative RBC transfusions and higher CCr were predictors of patients with early VGF, whereas use of a left internal mammary artery graft was a protective factor. Increased preoperative platelet count, higher CCr, more perioperative RBC transfusions and endarterectomy were predictors of VGF, whereas dual antiplatelet therapy, larger recipient vessel diameter, greater graft run-off, higher preoperative RBC count and side-to-side anastomosis were protective factors. Recipient diameter >1.5 mm and graft run-off >25 ml/min were cut-off values for detecting VGF.

Perivascular adipose tissue-derived stromal cells contribute to vascular remodeling during aging.

Aging is an independent risk factor for vascular diseases. Perivascular adipose tissue (PVAT), an active component of the vasculature, contributes to vascular dysfunction during aging. Identification of underlying cell types and their changes during aging may provide meaningful insights regarding the clinical relevance of aging-related vascular diseases. Here, we take advantage of single-cell RNA sequence to characterize the resident stromal cells in the PVAT (PVASCs) and identified different clusters between young and aged PVASCs. Bioinformatics analysis revealed decreased endothelial and brown adipogenic differentiation capacities of PVASCs during aging, which contributed to neointimal hyperplasia after perivascular delivery to ligated carotid arteries. Mechanistically, in vitro and in vivo studies both suggested that aging-induced loss of peroxisome proliferator-activated receptor-γ coactivator-1 α (PGC1α) was a key regulator of decreased brown adipogenic differentiation in senescent PVASCs. We further demonstrated the existence of human PVASCs (hPVASCs) and overexpression of PGC1α improved hPVASC delivery-induced vascular remodeling. Our finding emphasizes that differentiation capacities of PVASCs alter during aging and loss of PGC1α in aged PVASCs contributes to vascular remodeling via decreased brown adipogenic differentiation.

Chordal replacement versus quadrangular resection in degenerative posterior mitral leaflet repair.

BACKGROUND: As an alternative to quadrangular resection (QR), little is known of the potential of chordal replacement (CR) for treating posterior mitral leaflet (PML) prolapse when comparing these two techniques. This study aimed to assess mid- to long-term outcomes of CR versus QR for isolated degenerative PML (idPML) repair. METHODS: We reviewed 112 consecutive patients using CR or QR for idPML repair from 4/2010 to 12/2015. Outcomes were compared before and after propensity score matching. RESULTS: CR was more used through the minimally invasive approach (CR 59.4% vs. QR 9.4%, P<0.001). At discharge mitral regurgitation (MR) was successfully rectified to a mild or less degree in both groups (CR P<0.001, QR P<0.001; between groups: P=0.337). Group CR showed much shorter postoperative time (CR 9.9±4.0 vs. QR 14.0±8.3 days, P<0.004) and higher event-free survival rate between matched patients [56 months, CR 85.7% vs. QR 30.8%, P (log-rank) =0.017], however QR showed better freedom from above-mild recurrent MR (MR ≥2.5+) during follow-up [60 months, CR 50.2% vs. QR 96.3%, P (log-rank) =0.061]. Cox regression analysis might suggest that CR technique was a risk factor for recurrent MR [CR over QR, hazard ratio (HR) 2.149; 95% CI: 0.974-4.744; P=0.058; adjusted for surgical approach, gender, age, preoperative MR and ejection factor (EF)]. CONCLUSIONS: CR is more often used with the minimally invasive approach with less complications and shorter hospital stay. Nonetheless, CR is associated with recurrent MR development over time. Retaining of MV competence after CR demands attention and further investigation.

Long-term outcomes of multiple and single arterial off-pump coronary artery bypass grafting.

BACKGROUND: To compare the clinical outcomes between multiple arterial (MA) and single arterial (SA) off-pump coronary artery bypass grafting (OPCAB) when applied to left main coronary disease or three-vessel disease. METHODS: A total of 537 patients with left main coronary disease or three-vessel disease underwent MA OPCAB (n=114) or SA OPCAB (n=423) in our center from January 2006 to December 2008. The propensity score matching (PSM) was used to obtain the risk-adjusted outcome. Both the perioperative and long-term results were analyzed. RESULTS: The median follow-up time was 117 months (interquartile range, 110 to 128 months). There was no statistical difference in postoperative mortality and the volume of drainage. The intensive care unit (ICU) length of stay (LOS) of the MA group was shorter than that of the SA group {1 [1-2] vs. 2 [1-3], P=0.001). In the long term, the mortality (5.7% vs. 17.5%, P=0.006), cardiac mortality (1.0% vs. 8.8%, P=0.008), fatal myocardial infarction (MI) rate (0.0% vs. 6.1%, P=0.015) and incidence of readmission for heart failure (19.8% vs. 37.7%, P=0.003) were lower in the MA group than in the SA group. The distributions of NYHA class (P<0.001) and CCS class (P<0.001) were better in the MA group than in the SA group. There was no significant difference in other outcomes. These results were consistent with the K-M curves of freedom from the adverse events. CONCLUSIONS: MA OPCAB was as safe as SA OPCAB, providing better perioperative recovery and better long-term clinical outcomes in the treatment of left main coronary disease or three-vessel disease.

Does the site of coronary endarterectomy have an impact on the clinical outcomes and graft patency?

OBJECTIVES: To explore whether coronary endarterectomy (CE) sites have obvious impacts on the clinical outcomes and graft patency in off-pump coronary artery bypass (OPCAB). METHODS: The patients who underwent OPCAB with CE in our unit between January 2009 and December 2016 were included. The patients and the grafts were grouped according to the CE sites. The primary end points were mid-term main adverse cardiovascular and cerebrovascular events. RESULTS: In total, 290 patients who underwent OPCAB with CE were included. CE of the left anterior descending artery (LAD), left circumflex artery and the right coronary artery was performed in 46, 30 and 194 patients, respectively. There were 60, 42 and 217 grafts anastomosed to LAD-CE, left circumflex artery-CE and right coronary artery-CE sites in 290 patients. CE was not performed in the 20 patients requiring multivessel CE. There was no significant difference in perioperative outcomes. The average follow-up time was 51 months (12-103 months). There was no significant difference in mid-term death, main adverse cardiovascular and cerebrovascular events, myocardial infarction (MI), stroke, Canadian Cardiovascular Classification for angina class and 1-year graft patency among the 3 groups. However, the rate of New York Heart Association (NYHA) class III or IV (LAD vs left circumflex artery: 59% vs 25%, P = 0.011; LAD vs right coronary artery: 59% vs 27%, P < 0.001) was higher in the LAD group than in the other groups. These results were consistent with the Kaplan-Meier curves of freedom from the adverse events. CONCLUSIONS: CE sites had no obvious impact on mid-term death, main adverse cardiovascular and cerebrovascular events, MI, stroke, Canadian Cardiovascular Classification for angina class and 1-year graft patency in patients who underwent OPCAB with CE. The patients undergoing LAD-CE had higher rates of NYHA class III or IV.

17ß-estradiol promotes recovery after myocardial infarction by enhancing homing and angiogenic capacity of bone marrow-derived endothelial progenitor cells through ERα-SDF-1/CXCR4 crosstalking.

17ß-estradiol (E2) has been shown to mediate endothelial progenitor cells (EPCs) to repair infarcted myocardium. Both estrogen receptor α (ERα) and stromal derived factor-1 (SDF-1)/CXCR4 signaling pathways may play a critical role in regulating homing and angiogenesis of EPCs in this process. However, the interaction between ERα and SDF-1/CXCR4 signaling pathways remains unclear. In response to E2, the expression of SDF-1 and CXCR4 in EPCs from ovariectomized BALB/C mice was obviously up-regulated, in addition, the migration and tube formation of EPCs in vitro were also significantly enhanced. However, ERα antagonist (MMP) and CXCR4 inhibitor (AMD3100) significantly decreased the migration and tube length of EPCs, even if mediated by E2. The combined treatment of MMP and AMD3100 exerted more inhibitory effects on migration and tube formation of EPCs induced by E2. In in vivo studies, ovariectomized mice were induced acute myocardial infarction (AMI), and divided into four groups (n = 6): non-preconditioned EPCs (3 × 106) group, E2-preconditioned EPCs group, MMP + AMD3100 preconditioned EPCs group, and EPCs pretreated with E2 + MMP + AMD3100 group. E2 group displayed a greater number of homing EPCs, increased capillary density in infarcted myocardium, decreased left ventricular (LV) fibrosis. Nevertheless, these effects of E2 were almost completely blocked by the combined treatment of MMP and AMD3100. E2 can produce cardiovascular protective effects in AMI setting by enhancing homing and angiogenic capacity of EPCs through ERα and CXCR4 signaling pathways, which means that ERα and CXCR4 pathways are effective targets for the development of treatment strategies for AMI.

Long non-coding RNA H19 contributes to hypoxia-induced CPC injury by suppressing Sirt1 through miR-200a-3p.

Cardiomyocyte death is the chief obstacle that prevents the heart function recovery in myocardial infarction (MI)-induced heart failure (HF). Cardiac progenitor cells (CPCs)-based myocardial regeneration has provided a promising method for heart function recovery after MI. However, CPCs can easily lose their proliferation ability due to oxygen deficiency in infarcted myocardium. Revealing the underlying molecular mechanism for CPC proliferation is critical for effective MI therapy. In the present study, we set up a CoCl2-induced hypoxia model in CPCs. We found that the expression of long non-coding RNA H19 was significantly down-regulated in CPCs after hypoxia stimuli. In addition, H19 suppression attenuated the proliferation and migration of CPCs under hypoxia stress. Furthermore, we discovered that H19 regulated the proliferation and migration of CPCs through mediating the expression of Sirt1 which is a target of miR-200a-3p under hypoxia. In conclusion, our findings demonstrate a novel regulatory mechanism for the proliferation and migration of CPCs under hypoxia condition, which provides useful information for the development of new therapeutic targets for MI therapy.

LncRNA-MALAT1 promotes CPC proliferation and migration in hypoxia by up-regulation of JMJD6 via sponging miR-125.

The death of cardiomyocytes after myocardial infarction (MI) often leads to ventricular remodeling as well as heart failure (HF). The cardiac progenitor cells (CPCs) have the ability to regenerate functional heart muscle in patients after MI, which provides a promising method for MI-induced HF therapy. However, to date, CPCs can easily lose their proliferation ability in the infarcted myocardium. Therefore, exploring the mechanism for CPC proliferation is essential for CPC-based therapy in MI-induced HF. A previous study indicated that a hypoxic environment is essential for CPC proliferation, but the mechanism is not yet clear. In this work, we discovered that CoCl2-induced hypoxia can promote CPC proliferation and migration. Additionally, long non-coding RNA MALAT1 expression was significantly up-regulated in the CoCl2-induced hypoxia CPC model. MALAT1 suppression inhibited CPC proliferation and migration under hypoxic conditions. In addition, MALAT1 acted as a sponge for miR-125. The miR-125 inhibitor restored the proliferation and migration potentials of CPCs after a MALAT1 knockdown in hypoxia. A further study demonstrated that JMJD6 was a target of miR-125 whose expression was negatively regulated by miR-125. JMJD6 knockdown blocked miR-125 inhibitor's protective effect on CPC function in hypoxia. Ultimately, our finding demonstrated that MALAT1 can modulate CPC proliferation and migration potential through the miR-125/JMJD6 axis in hypoxia. Our finding provided a new regulatory mechanism for CPC proliferation in hypoxia, which provided a new target for MI-induced HF therapy.

Ten-year real-life effectiveness of coronary artery bypass using radial artery or great saphenous vein grafts in a single centre Chinese hospital.

OBJECTIVES: Long-term effectiveness of coronary artery bypass grafting using radial artery (RA) or great saphenous vein (SVG) grafts as a second conduit was compared. METHODS: Patients received simple elective off-pump coronary artery bypass involving both the left internal thoracic artery (LITA) and the left anterior descending artery between January 1999 and December 2005 at Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China. RA graft patients (n = 147 LITA + RA and n = 61 LITA + RA + SVG) were matched with SVG graft patients (n = 208 LITA + SVG). Mean follow-up was 86.5 months. RESULTS: Baseline characteristics were comparable before and after surgery. Intraoperative hospital mortality was not significantly different. In all, 378 (90.9%) patients completed postoperative follow-up (197 in the RA and 181 in SVG). Overall survival was significantly better in the RA group (Log-rank, P = 0.017) with 88% 10-year survival in the RA group and 81% in the SVG group. All-cause mortality was significantly lower in the RA group (hazard ratio 0.42, 95% confidence interval 0.20-0.88, P = 0.020). Major adverse cardiovascular event-free survival was significantly better in the RA group than in the SVG group (Log-rank, P = 0.019). No significant difference in the length of postoperative angina relief was found. CONCLUSIONS: Using the RA as the secondary graft for coronary artery bypass grafting improved long-term postoperative survival and reduced the incidence of postoperative major adverse cardiovascular events.

Off-pump coronary artery bypass surgery outcomes in patients with ischaemic left ventricular systolic dysfunction with or without detected viable myocardium.

OBJECTIVES: The prognostic value of myocardial viability before coronary bypass grafting remains controversial. The present study evaluated the effects of off-pump coronary artery bypass (OPCAB) grafting on patients with coronary artery disease (CAD) with or without viable myocardium (VM) preoperatively detected via nuclear imaging. METHODS: A total of 115 consecutive patients with 3-vessel disease and impaired left ventricular ejection fraction (LVEF ≤ 45%) who underwent OPCAB grafting were recruited in this prospective study. The patients were divided into 2 groups based on myocardial viability, the non-viable myocardium (NVM, 55 patients) and VM (60 patients) groups. Positron emission tomography and radionuclide imaging examination were applied to evaluate the myocardium viability. A Kaplan-Meier analysis was conducted to evaluate the 1-year survival rate. RESULTS: The preoperative data were similar between groups. An improvement in the LVEF was observed in both groups 12 months after OPCAB grafting (P < 0.05). A binary logistic regression revealed that NVM was an independent predictor of a 5% improvement in LVEF at 6 months (P = 0.012). The rate of main adverse cardiovascular and cerebrovascular events (MACCEs) rate at 1 year was similar between the 2 groups (P = 0.06). At 1 year, the death rates were 14.5% in the NVM group and 5% in the VM group (P = 0.17). A Cox regression analysis revealed that NVM and age were independent predictors of mortality [the hazard ratio for death associated with NVM and age were 1.62, 95% confidence interval (CI) = 1.16-2.89, P = 0.036 and 1.05, 95% CI = 0.98-1.12, P =0.025, respectively]. CONCLUSIONS: The MACCEs and mortality rates of the NVM group were higher than those of the VM group. However, OPCAB surgery improved LVEF, regardless of myocardium status. Therefore, the assessment of myocardial viability might not be the sole deciding factor in decision-making process regarding OPCAB surgery.

Plasma levels of matrix metalloproteinase 9 in patients undergoing off-pump coronary artery bypass grafting.

BACKGROUND: Matrix metalloproteinase 9 (MMP9) has recently emerged as a risk predictor in patients with cardiovascular diseases. However, little is known about the significance of increased plasma MMP9 in patients with perioperative myocardial injury. We aimed to investigate the role of MMP9 in the occurrence of myocardial injury during off-pump coronary artery bypass grafting (OPCAB). METHODS: A total of 34 consecutive patients with coronary artery diseases (CAD) were recruited in this prospective, observational study. All patients were operated for OPCAB surgery. Serial blood samples were collected preoperatively and 12 hours after surgery. MMP9, together with cardiac troponin I (cTnI), creatinine kinase myocardial b fraction (CK-MB), C-reactive protein (CRP), and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in plasma were measured at each time-point. RESULTS: MMP9 levels increased significantly at 12 hours after surgery, attaining nearly 2 times the baseline levels (P=0.0001). There was a significant correlation between preoperative (pre-OP) circulating levels of MMP9 and the left ventricular ejection fraction (LVEF) (r=0.48; P=0.004) as well as European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (r=0.43; P=0.012). Patients were in New York Heart Association (NYHA) functional class III or IV heart failure showed a significantly higher MMP9 levels (1,348.0±337.2 vs. 630.4±93.0 ng/L, P=0.012) as compared to the patients in NYHA functional class I and II. No significant correlation was observed between MMP9 and age (P=0.612), serum creatinine (P=0.185), CRP (P=0.207), NT-proBNP (P=0.058). A significant correlation was observed in these data between the post-OP MMP9 and cTnI (r=0.35; P=0.003). CONCLUSIONS: Our study first established a connection between MMP9 and OPCAB procedure, suggesting that MMP9 could be a novel biomarker for identifying perioperative myocardial injury in patients undergoing OPCAB.

Outcomes of off-pump versus on-pump coronary artery bypass graft surgery in patients with severely dilated left ventricle.

BACKGROUND: Currently, off-pump coronary artery bypass (OPCAB) grafting has been the standard procedure for surgical revascularization in patients with coronary artery disease (CAD). This study aimed to examine the safety and applicability of OPCAB compared with on-pump coronary artery bypass (ONCAB) in patients with severely dilated left ventricle. METHODS: A retrospective study of giant left ventricle patients [left ventricular end diastolic diameter (LVEDD) ≥ VE mm] undergoing coronary bypass grafting from 2009 through 2015 at a single center was conducted. Preoperative and intraoperative risk factors, and postoperative outcomes were analyzed. Survival analysis was carried to analyze survival rate during follow-up. RESULTS: A total of 24 patients underwent ONCAB, and 26 underwent OPCAB. Both groups had similar preoperative profiles. Two cases from each group died during in-hospital time. In comparison to OPCAB, there was longer operation and post-surgery intubation time and more renal dysfunction in ONCAB group (P<0.05). One-year survival between OPCAB and ONCAB were not significantly different (87.5% vs. 92.3%, P>0.05). CONCLUSIONS: OPCAB is a safe and feasible alternative for CAD patients with giant left ventricle, offering a significant advantage over ONCAB with regards to renal function, operation duration and length of ventilation.

Plasma levels of growth differentiation factor-15 are associated with myocardial injury in patients undergoing off-pump coronary artery bypass grafting.

Growth differentiation factor-15 (GDF-15) has recently emerged as a risk predictor in patients with cardiovascular diseases. We therefore aimed to investigate the role of GDF-15 in the occurrence of cardiac injury during off-pump coronary artery bypass grafting (OPCAB). 55 consecutive patients with coronary artery diseases were recruited in this prospective, observational study. All patients were operated for OPCAB surgery. Serial blood samples were collected preoperatively, 12 hours and 36 hours after surgery. GDF-15, together with C-reactive protein, cardiac troponin I, creatine kinase MB and N-terminal pro B-type natriuretic peptide levels in plasma were measured at each time-point. GDF-15 levels increased significantly at 12 hours after surgery, attaining nearly 2.5 times the baseline levels (p < 0.001). Postoperative GDF-15 levels correlated positively with cTnI (p = 0.003) and EuroSCORE II (p = 0.013). According to the ROC curves, postoperative plasma GDF-15 was found to be the best biomarker to predict perioperative cardiac injury, compared with cTnI, CK-MB and EuroSCORE II. Circulating GDF-15 is a promising novel biomarker for identifying perioperative myocardial injury in patients undergoing OPCAB.

Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting.

BACKGROUND: Robot-assisted coronary artery bypass grafts (RACAB) utilizing the da Vinci surgical system are increasingly used and allow the surgeon to conveniently harvest internal mammary arteries (IMAs). The aim of this study was to compare the outcomes of off-pump RACAB and minimally invasive direct coronary artery bypass grafting (MIDCAB) in the short and medium term. METHODS: We performed a retrospective review of 132 patients with single- or multiple-vessel coronary artery disease who underwent minimally invasive off-pump CABG (OPCAB) between May 2009 and May 2014. The patients were divided into two groups based on the surgical approach, MIDCAB and RACAB group. The anastomosis of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) was performed as regular OPCAB through the incision on the beating heart using regular stabilization devices (Genzyme Corporation). The preoperative, intraoperative, postoperative, and follow-up data, including major adverse cardiac and cerebrovascular events (MACCE), were compared. RESULTS: The preoperative data were similar. RACAB significantly shorten the intensive care unit (ICU) stay and postoperative compared with the MIDCAB group (P<0.05). There were 12 (19.7%) patients treated with a two-stage hybrid procedure in the MIDCAB group and 34 (47.9%) patients in the RACAB group (P=0.001). Thirty-day mortality was 1.6% in the MIDCAB group. There were 9 (14.7%) MIDCAB patients and 2 (2.8%) RACAB patients (P=0.013) that developed new arrhythmia. The two groups showed comparable mid-term survival (P=0.246), but the MACCEs were significantly different (P=0.038). CONCLUSIONS: RACAB may be a valuable alternative for patients requiring single or simple multi-vessel coronary artery bypass grafting (CABG). Although the mid-term mortality outcomes are similar, RACAB improves short-term outcomes and mid-term MACCE-free survival compared with MIDCAB.