Development and validation of a nomogram for predicting intraoperative hypotension in cardiac valve replacement.

Background: Cardiac valve replacement risks include intraoperative hypotension, endangering organ perfusion. Our nomogram predicted hypotension risk in valve surgery, guiding early intervention. Methods: Analyzing 561 patients from July to November 2022, we developed a nomogram to predict hypotension in valve replacement patients, validated using data from December 2022 to January 2023 on 241 patients, with robust statistical confirmation. Results: Our study identified age, hypertension, left ventricular ejection fraction and serum creatinine as hypotension predictors. The resulting nomogram, validated with high concordance index and area under the curve scores, provided a clinically useful tool for managing intraoperative risk. Conclusion: For valve replacement patients, factors like age, hypertension, low left ventricular ejection fraction and high serum creatinine predicted hypotension risk. Our nomogram enabled clinicians to quantify this risk and proactively manage it.

Use of del Nido cardioplegia in acute aortic dissection surgery.

OBJECTIVE: Del Nido cardioplegia solution provides a depolarized hyperkalemic arrest lasting up to 60 minutes. Single-dose del Nido cardioplegia solution may offer an alternative myocardial protection strategy to conventional whole blood cardioplegia following acute aortic dissection surgery. METHODS: We retrospectively reviewed 122 consecutive patients with acute aortic dissection undergoing arch reconstruction surgery procedure with cardioplegia arrest from January 2017 to December 2019. Patients exclusively received with whole blood cardioplegia (n = 60, January 2017-December 2018) or del Nido cardioplegia (n = 62, January 2018-December 2019). Preoperative and postoperative data were retrospectively reviewed. RESULTS: No significant difference between two groups in mortality (4/60 vs 3/62, p = 0.964), cardiopulmonary bypass time (168.0 ± 10.5 minute vs 165.0 ± 12.5 minute, p = 0.154), aortic cross-clamp time (91.8 ± 9.0 minute vs 93.2 ± 9.5 minute, p = 0.405), selective antegrade cerebral perfusion time (21.8 ± 5.0 minute vs 22.4 ± 4.7 minute, p = 0.496) and postoperative vasoactive inotropic score (34.8 ± 1.9 vs 35.2 ± 2.1, p = 0.272), neurological complications rate (8/60 vs 12/62, p = 0.523), renal insufficiency rate (5/60 vs 7/62, p = 0.807) and the troponin T level (304.8 ± 111.3 vs 315.0 ± 94.9, p = 0.588), respectively. Mean volume of crystalloid was significantly higher in the del Nido group compared to the whole blood cardioplegia group (1010.2 ± 20.3 mL vs 300.0 ± 19.6 mL, p < 0.001). Patients requiring defibrillation was 7/62 vs 28/60 (p < 0.001), with statistical difference in both groups. CONCLUSION: Short-term outcomes in acute aortic dissection surgery using del Nido cardioplegia solution were acceptable and comparable to conventional multi-dose whole blood cardioplegia. Del Nido cardioplegia technique is associated with lower defibrillations rate and requires a reduced frequency of infusions that results in longer durations between infusions and may be a feasible alternative to conventional whole blood cardioplegia solution in acute aortic dissection surgery.

Therapeutic Effect of Perioperative Mild Hypothermia on Postoperative Neurological Outcomes in Patients with Acute Stanford Type A Aortic Dissection.

BACKGROUND: Postoperative patients of acute Stanford type A aortic dissection (AAAD) often experience complications consisting of nervous system injury. Mild hypothermia therapy has been proven to provide the therapeutic effect of cerebral protection. We aimed to investigate the therapeutic effects of perioperative mild hypothermia on postoperative neurological outcomes in patients with AAAD. METHODS: A prospective randomized controlled study was conducted on adult patients undergoing aortic dissection surgery between February 2017 and December 2017. Patients in the treatment group underwent mild hypothermia (34° to 35°C) immediately after surgery, and in the conventional therapy group, patients were rewarmed to normal body temperature (36° to 37°C). Postoperative time to regain consciousness, postoperative serum neuron-specific enolase (NSE) and S-100ß levels, cerebral tissue oxygen saturation, presence of delirium or permanent neurological dysfunction, intensive care unit (ICU) and hospital stay duration, and 28-day mortality were compared. RESULTS: We enrolled 55 patients who underwent AAAD surgery and were randomly allocated into to 2 groups, 27 patients in the treatment group and 28 patients in the conventional therapy group. Compared with the conventional therapy group, postoperative time to regain consciousness was much shorter for patients in the mild hypothermia group (12.65 hours, interquartile range [IQR] 8.28 to 23.82, versus 25.80 hours, IQR 14.00 to 59.80; P = .02), and the rate of regaining consciousness in 24 hours after surgery was much higher (74.07% versus 46.42%; P = .037). At the same time, the ICU stay of patients in the mild hypothermia therapy group was significantly shorter than that in the conventional therapy group (5.53 ± 3.13 versus 9.35 ± 8.76 days; P = .038). Cerebral tissue oxygen saturation, incidence of delirium or permanent neurological dysfunction, duration of hospital stay, and 28-day mortality showed no statistical difference. Postoperative serum NSE and S-100ß levels increased compared with preoperative baseline values in both groups (P < .05), and the serum NSE levels of patients in the mild hypothermia therapy was significantly lower than the conventional therapy group 1 hour (P = .049) and 6 hours (P = .04) after surgery. There was no difference in the chest drainage volume or shivering between the 2 groups 24 hours after surgery. CONCLUSIONS: Perioperative mild hypothermia therapy is able to significantly reduce brain cell injury and shorten the postoperative time to regain consciousness, thus improving the neurological prognosis of patients with AAAD.

Therapeutic effect of mild hypothermia on the inflammatory response and outcome in perioperative patients with acute Stanford type A aortic dissection: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective To explore the therapeutic effect of mild hypothermia on the inflammatory response, organ function and outcome in perioperative patients with acute Stanford type A aortic dissection (AAAD). Methods From February 2017 to February 2018, 56 patients with AAAD admitted in our department were enrolled and randomly allocated into two groups including a control group and an experimental group. After deep hypothermia circulatory arrest during operation, in the control group (n=28), the patients were rewarmed to normal body temperatures (36 to 37 centigrade degree), and which would be maintained for 24 hours after operation. While in the experimental group (n=28), the patients were rewarmed to mild hypothermia (34 to 35 centigrade degree), and the rest steps were the same to the control group. The thoracic drainage volume and the incidence of shivering at the first 24 hours after operation, inflammatory indicators and organ function during perioperation, and outcomes were compared between the two groups. There were 20 males and 8 females at age of 51.5±8.7 years in the control group, 24 males and 4 females at age of 53.3±11.2 years in the experimental group. Results There was no obvious difference in the basic information and operation information in patients between the two groups. Compared to the control group, at the 24th hour after operation, the level of peripheral blood matrix metalloproteinases (MMPs) was lower than that in the experimental group (P=0.008). In the experimental group, after operation, the awakening time was much shorter (P=0.008), the incidence of bloodstream infection was much lower (P=0.019). While the incidence of delirium, acute kidney injury (AKI), hepatic insufficiency, mechanical ventilation duration, intensive care unit (ICU) stays, or hospital mortality rate showed no statistical difference. And at the first 24 hours after operation, there was no difference in the thoracic drainage volume between the two groups, and no patient suffered from shivering. Conclusion The mild hypothermia therapy is able to shorten the awakening time and reduce the incidence of bloodstream infection after operation in the patients with AAAD, and does not cause the increase of thoracic drainage volume or shivering.

Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery?

BACKGROUND: Over the past decade, minimally invasive mitral valve surgery (MIMVS) has grown in popularity. Less invasive approaches to mitral valve surgery are increasingly used for improved cosmesis. We sought to compare these minimally invasive approaches fairly with conventional full sternotomy approaches by using propensity-matching methods. METHODS: From January 2011 to January 2017, a total of 1120 isolated mitral valve operations were performed at our institution. Data were retrospectively collected on all patients, and a logistic regression model was created to predict selection to a minimally invasive versus conventional sternotomy approach. Propensity scores were then generated based on the regression model and matched pairs created using 1:1 nearest neighbor matching. There were 165 matched pairs in the analysis (sternotomy, n = 165;MIMVS, n = 165). Clinical outcomes included bypass and cross-clamp time, length of hospitalization, morbidity, and mortality. Patient details and follow-up outcomes were compared using multivariate, and Kaplan-Meier analyses. RESULTS: The minimally invasive approach led to slightly longer cardiopulmonary bypass time (99 ± 25 vs 88 ± 17 min, p <0.001), and cross-clamp time (65 ± 13 vs 49 ± 11 min, p<0.001). Overall, no significant differences existed among major in-hospital complications between groups. There were no differences between the matched groups in 30-day mortality (1.2% vs 0.6%, p >0.05). However, Chest tube drainage was lower at 6 and 24 h after a minimally invasive approach (30 ± 5 mL) and 120 ± 20 mL than after conventional sternotomy 175 ± 50 mL and 400 ± 150 mL at these times (p < 0.001). Transfusion was less frequent after minimally invasive surgery than after conventional surgery (15.7% vs 40.6%, p < 0.001). Patients undergoing minimally invasive surgery spent less time on ventilation support (6.2 ± 1.1 h vs 10.4 ± 2.7, p < 0.001). The multivariable regression analysis showed the full sternotomy was an independent risk factor for the propensity-adjusted likelihood of postoperative transfusion, re-exploration for bleeding, and postoperative ventilation support (p < 0.05). But the duration of cardiopulmonary bypass time was not an independent risk factor. The mean duration of survival follow-up was 4.4 ± 1.2 years. However, comparison of survival curves between the two groups revealed no significant difference (P = 0.203). With regard to freedom from valve-related morbidity, there was no significant difference between groups (P = 0 .574). CONCLUSION: Within that portion of the spectrum of mitral valve surgery in which propensity matching was possible, minimally invasive mitral valve surgery has cosmetic, blood product use, and respiratory advantages over conventional surgery, and no apparent detriments. However, minimally invasive mitral valve surgery required a slightly longer cardiopulmonary bypass time and cross-clamp time. Minimally invasive mitral valve surgery represents a safe and effective surgical technique that we believe should be used more routinely in the surgical management of mitral valve disease. MIMVS provides equally durable midterm results as the standard sternotomy approach.

Aortic arch reconstruction: deep and moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion.

OBJECTIVE: To compare the effects of moderate and deep hypothermic circulatory arrest (DHCA) with selective antegrade cerebral perfusion (SACP) during aortic arch surgery in adult patients and to offer the evidence for the detection of the temperature which provides best brain protection in the subjects who accept aortic arch reconstruction surgery. METHODS: A total of 109 patients undergoing surgery of the aortic arch were divided into the moderate hypothermic circulatory arrest group (Group I) and the deep hypothermic circulatory arrest group (Group II). We recorded the data of the patients and their cardiopulmonary bypass (CPB) time, aortic clamping time, SACP time and postoperative anesthetized recovery time, tracheal intubation time, time in the intensive care unit (ICU) and postoperative neurologic dysfunction. RESULTS: Patient characteristics were similar in the two groups. There were four patients who died in Group II and 1 patient in Group I. There were no significant differences in aortic clamping time of each group (111.4±58.4 vs. 115.9±16.2) min; SACP time (27.4±5.9 vs. 23.5±6.1) min of the moderate hypothermic circulatory arrest group and the deep hypothermic circulatory arrest group; there were significant differences in cardiopulmonary bypass time (207.4±20.9 vs. 263.8±22.6) min, postoperative anesthetized recovery time (19.0±11.1 vs. 36.8±25.3) hours, extubation time (46.4±15.1 vs. 64.4±6.0) hours; length of stay in the intensive care unit (ICU) (4.7±1.7 vs. 8±2.3) days and postoperative neurologic dysfunction in the two groups. CONCLUSION: Compared to deep hypothermic circulatory arrest, moderate hypothermic circulatory arrest can provide better brain protection and achieve good clinical results.

Partial aortic root remodeling for root reconstruction in patients with acute type A dissection.

In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sinus with just one trimmed Dacron graft. Between February 2001 and May 2010, we performed partial aortic root remodeling in 40 patients, who underwent emergency surgical intervention. The dissected sinuses were excised leaving a 3-5 mm rim of the aortic wall from the attached aortic valve cusps. A short piece (4-5 cm) of collagen coated woven polyester vascular prosthesis was trimmed with one or two "tongues" to reconstruct the non-coronary sinus and/or the right coronary sinus, but without using separated patches. Additional procedures were including hemi-arch replacement in 11 patients, and total arch replacement plus stent-elephant trunk in 20 patients. The mean follow-up time was 36.4±3.6 months. In-hospital mortality was only 5.0% (2/40); furthermore, 3 (8.6%) patients underwent re-operation of the aortic valve and 2 (5.7%) patients died during follow-up. At the end of follow-up, trivial or no aortic regurgitation was found in 33 patients, but mild aortic regurgitation was found in 2 patients. Our data suggest that the early and mid-term results of partial aortic root remodeling were favorable, and it restored valve durability and function. Thus, the use of technique for root reconstruction in patients with acute type A dissection should be vigorously encouraged.

[Clinical application of extracorporeal membrane oxygenation for severe heart failure during peri-operative period of end-stage cardiopathy].

OBJECTIVE: To summarize the clinical effect and experience of extracorporeal membrane oxygenation (ECMO) support for severe heart failure during peri-operative period of end-stage cardiopathy. METHODS: From June 2007 to July 2010, 6 patients with severe heart failure during peri-operative period of end-stage cardiopathy received ECMO support. The changes in the hemodynamics and outcome of the patients during the use of ECMO were investigated. RESULTS: The duration of ECMO assistance ranged from 23 to 168 hours with a mean of 78 hours. The hemodynamics after using ECMO was much improved than before ECMO [mean arterial pressure (mm Hg, 1 mm Hg=0.133 kPa): 78.13±8.01 vs. 47.75±5.21, central venous pressure ( mm Hg ): 11.03±3.21 vs. 19.36±4.51, cardiac output (L/min): 4.93±1.01 vs. 3.50±0.81, cardiac index (L×min(-1)×m(-2)): 2.71±0.51 vs. 1.91±0.40, pulmonary artery wedge pressure ( mm Hg ): 12.72±6.52 vs. 20.22±6.91, venous oxygen saturation: 0.66±0.13 vs. 0.54±0.07], and the amount of using inotropic drug was significantly reduced compared with that before ECMO [dopamine (µg×kg(-1)×min(-1)): 5.05±0.85 vs. 14.20±5.05, epinephrine (µg×kg(-1) ×min(-1)): 0.05±0.01 vs. 0.24±0.04, all P<0.05]. All patients were successfully weaned from ECMO. After weaning, 3 patients recovered and discharged, and the hospital discharge rate was 50%, while 3 patients died of multiple organ failure (MOF). Major complication was bleeding, disseminated intravascular coagulation, infection, embolism. CONCLUSION: ECMO is an important extracorporeal method to support life. ECMO is an effective measure of treatment for end-stage cardiopathy patients with peri-operative severe heart failure. It is important to properly select patients for ECMO.

Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction?

BACKGROUND: This study was undertaken to compare mitral valve repair and replacement as treatments for ischemic mitral regurgitation (IMR) with left ventricular dysfunction (LVD). Specifically, we sought to determine whether the choice of mitral valve procedure affected survival, and discover which patients were predicted to benefit from mitral valve repair and which from replacement. METHODS: A total of 218 consecutive patients underwent either mitral valve repair (MVP, n = 112) or mitral valve replacement (MVR, n = 106). We retrospectively reviewed the clinical material, operation methods, echocardiography check during operation and follow-up. Patients details and follow-up outcomes were compared using multivariate and Kaplan-Meier analyses. RESULTS: No statistical difference was found between the two groups in term of intraoperative data. Early mortality was 3.2% (MVP 2.7% and MVR 3.8%). At discharge, Left ventricular end-systolic and end-diastolic diameter and left ventricular ejection fraction (LVEF) were improved more in the MVP group than MVR group (P < 0.05), however, in follow-up no statistically significant difference was observed between the MVR and MVP group (P > 0.05). Follow-up mitral regurgitation grade was significantly improved in the MVR group compared with the MVP group (P < 0.05). The Kaplan-Meier survival estimates at 1, 3, and 5 years were similar between MVP and MVR group. Logistic regression revealed poor survival was associated with old age(#75), preoperative renal insufficiency and low left ventricular ejection fraction (< 30%). CONCLUSION: Mitral valve repair is the procedure of choice in the majority of patients having surgery for severe ischemic mitral regurgitation with left ventricular dysfunction. Early results of MVP treatment seem to be satisfactory, but several lines of data indicate that mitral valve repair provided less long-term benefit than mitral valve replacement in the LVD patients.

The stented elephant trunk procedure combined total arch replacement for Debakey I aortic dissection: operative result and follow-up.

The stented elephant trunk technique in aortic arch replacement combined with transaortic stented graft implantation into the descending aorta has been introduced as a means of eliminating the residual false lumen in the descending thoracic aorta and improving long-term outcomes of surgical intervention for Debakey I aortic dissection. This report summarizes the operative and follow-up data with this new procedure. Between August 2004 and May 2009, 28 stented elephant trunk operations were performed for Debakey I aortic dissection at Nanjing First Hospital. A 10 cm long woven Dacron graft was implanted through the aortic arch during hypothermic circulatory arrest. Patent false lumina were evaluated using computed tomography three months after the operation. Mean cardiopulmonary bypass time was 213.2±47.2 min, and selected cerebral perfusion time was 38.8±9.7 min. Hospital mortality was 14.3% (4/28). Thrombus obliteration of the residual false lumen in the descending aorta was observed in 91.7% of the aortic dissections three months postoperatively. The survival rate was 87.5% at five years and the freedom from reoperation rate was 91.7%. Total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective treatment for Debakey type I aortic dissection.

[Surgical treatment of post-infarction left ventricular aneurysm: clinical analysis].

OBJECTIVE: To explore the clinical experiences, efficacies and postoperative left ventricular remodeling changes of surgical ventricular reconstruction in the treatment of post-infarction left ventricular aneurysm. METHODS: The investigators reviewed retrospectively the clinical data, operative approaches and follow-up outcomes of consecutive 194 patients with post-infarction left ventricular aneurysm, who underwent surgical ventricular reconstruction between January 1997 and December 2009. There were 54 cases in the linear group and 137 cases in the endoventricular patch plasty group. The changes of ventricular remodeling were measured by peri-operative and follow-up echocardiography. RESULTS: All patients underwent surgery with a mean cardiopulmonary bypass duration of (103 ± 35) min and aortic cross clamp duration of (62 ± 26) min. There were 8 per-operative deaths with a mortality rate of 2.2%. Angina pectoris of other cases disappeared and heart function greatly improved. After operation, the ventricular remodeling results showed that in the linear group, there was not significant difference in the changes of ventricular remodeling of post-op 2 weeks, 6 months, 1 year and 5 years versus pre-operation. However, in the endoventricular patch group, the changes of ventricular remodeling of post-op 2 weeks and follow-up 6 months versus pre-operation were significantly reduced (P < 0.05). End-systolic volume (LVESV) reduced from (129 ± 27) ml to (65 ± 8) ml and end-systolic volume index (LVESVI) decreased from (104 ± 14) ml/m(2) to (44 ± 6) ml/m(2) and the subgroup of LVEF < 35% was the most significant in the changes of LVESV and LVESVI. But LVEF improved significantly at post-operation and follow-up (from preoperation 42% ± 11% to 52% ± 7% during follow-up). CONCLUSIONS: For patients with infarction left ventricular aneurysm, left ventricular reconstruction is quite effective. The choice of operative approaches is determined by the size and range of ventricular aneurysm. Both string suture and endoventricular patch plasty technique can yield similarly satisfactory surgical outcomes. After operation, ventricular volume significantly decreases and cardiac function greatly improves.

Evaluation of preoperative intra-aortic balloon pump in coronary patients with severe left ventricular dysfunction undergoing OPCAB surgery: early and mid-term outcomes.

BACKGROUND: The purpose of the present study was to evaluate the safety and the cost-effectiveness of using preoperative IABP as support compared with postoperative IABP treatment in coronary patients with severe left ventricular dysfunction (SLVD) who is undergoing off-pump coronary artery bypass surgery (OPCAB), including early outcomes, hospital mortality and morbidity, and mid-term follow-up outcomes. METHODS: Between March 2000 and December 2008, we prospectively and randomly studied the insertion of preoperative IABP in 115 (7.4%) and postoperative IABP in 106 (6.8%) of the 1560 consecutive patients. Group A is preoperative IABP therapy. Group B is postoperative IABP therapy. RESULTS: There was no significant difference in the number of grafts used between the two groups. Completeness of revascularization did not differ between the two groups. The statistically significant difference was hospital mortality (2.6% in group A vs. 3.8% in group B) (p < 0.05). And there was significant reduction in postoperative low cardiac output, malignant arrhythmia, acute renal failure and length of stay in ICU in group A, compared with group B (p < 0.05). In the two groups, six-, 12-, 24- and 48-month survival rates were similar. In the study the degree of improvement in angina and quality of life did not differ significantly between the two groups. CONCLUSION: The use of preoperative IABP in SLVD patients undergoing OPCAB is of safety and effectiveness. The combined use of preoperative IABP and OPCAB allows complete revascularization in SLVD patients with an important reduction in operative mortality and excellent mid-term results.

[Aortic arch operation under deep hypothermic circulatory arrest].

OBJECTIVE: To summarize the surgical experience of aortic arch operation under deep hypothermic circulatory arrest. METHODS: 22 patients suffering from aortic dissection or descending aorta aneurysm with the involvement of aortic arch received operation under deep hypothermic circulatory arrest. Eight patients underwent ascending aorta and partial aortic arch replacement, one patient received aortic root, ascending aorta, and partial aortic arch replacement, 2 patients received ascending aorta and total arch replacement, 2 patients received aortic valve replacement plus ascending aorta and partial aortic arch replacement, 8 patients underwent ascending aorta and total arch replacement plus elephant trunk technique (stunted elephant trunk used in 6 cases), and 1 patient received left partial aortic arch and descending aorta replacement. Coronary artery bypass grafting was performed concomitantly in 4 cases. RESULTS: Three patients died peri-operatively with a mortality rate of 13.6%. One patient had aortic dissection rupture before operation leading to cardiac tamponade, acute inferior myocardial infarction, and cardiac arrest. This patient received operation while resuscitation. After operation, the patient had severe right heart failure and died 16 hours later. One patient had bleeding and multi-organ failure, and died 3 days later. The third patient, with acute aortic dissection did not awake after operation, had pulmonary infection and multi-organ failure, and died 39 days later. Re-thoracotomy for bleeding was required in 3 cases; delayed awareness occurred in 3 cases; and 2 cases had renal failure after operation. CONCLUSIONS: Aortic arch operation includes partial aortic arch replacement, total arch replacement, and total arch replacement with elephant trunk technique. The operation procedure is selected according to the primary lesion and how aortic arch has been affected. Deep hypothermic circulatory arrest with selective cerebral perfusion facilitates complicated aortic arch operation, resulting in a reduction of mortality and morbidity for arch aneurysms or dissection.

[Surgical treatment of obstructive hypertrophic cardiomyopathy with ventricular septal myectomy concomitant mitral valve replacement].

OBJECTIVE: To summarize the experiences and results of ventricular septal myectomy concomitant mitral valve replacement (MVR) for obstructive hypertrophic cardiomyopathy (OHCM). METHODS: From January 2000 to June 2007, 22 patients of OHCM with moderate or severe mitral regurgitation underwent concomitant ventricular septal myectomy concomitant MVR. There were 20 male and 2 female patients. The age ranged from 28 to 51 years old with a mean of (36 + or - 5) years old. The left ventricular out tract gradient pressure (LVOTGP) was 55 to 120 mm Hg (1 mm Hg = 0.133 kPa), with a mean of (88.0 + or - 15.8) mm Hg. The manifestation of pre-operative UCG, intra-operative transesophageal echocardiography (TEE) and post-operative UCG in 10 d, 6 months and 1 year were compared and analyzed. RESULTS: One patient died in hospital due to serious ventricular arrhythmias. The intra-operative TEE showed that the phenomenon of systolic anterior motion (SAM) of mitral valve disappeared in all patients. Twenty-one cases were followed-up. The intra-operative TEE and post-operative UCG in every period of all 21 cases survived indicated that the mean LVOTGP and interventricular septal thickness (IVST) decreased obviously (P < 0.01). CONCLUSION: Concomitant ventricular septal myectomy concomitant MVR is an effective and safe treatment for OHCM with moderate or severe mitral regurgitation, the short and mid-term outcome is excellent.

Is the use of cardiopulmonary bypass for isolated coronary artery bypass an independent predictor of mortality and morbidity in patients with severe left ventricular dysfunction?

BACKGROUND: Patients presenting with severe left ventricular dysfunction (SLVD) undergoing conventional coronary artery bypass grafting (CCABG) are at an increased risk of perioperative mortality and morbidity. The aim of this study was to assess the risk factors responsible for mortality and morbidity among patients with SLVD by comparing CCABG and off-pump coronary artery bypass surgery (OPCAB). METHODS: We retrospectively evaluated 186 consecutive patients with SLVD who underwent coronary artery bypass grafting (CABG), including 102 by CCABG and 84 by OPCAB. Registry database, medical notes, and charts were studied for preoperative and postoperative data of the patients. Different variables and risk factors (preoperative, intraoperative, and postoperative) were evaluated and compared. The morbidity and mortality outcomes were compared in the two groups. The follow-up results and quality of life were assessed after surgery. RESULTS: The two groups had similar percentage of patients with preoperative high-risk profiles and no significant differences were found between groups in baseline variables such as age or comorbidities. There was a significant difference in the number of grafts used between the two groups. CCABG patients received (3.6 +/- 0.5) grafts per patient, while OPCAB patients had (2.7 +/- 0.6) grafts (P < 0.05). Completeness of revascularization was also significantly different between the two groups (CCABG 91.1% vs OPCAB 73.8%, P < 0.05). The hospital mortality was similar in the two groups (4.8% in OPCAB vs 5.9% in CCABG). The risk-adjusted mortality, according to the calculated propensity score, did not reach statistical significance in the two groups. In this study, OPCAB seemed to have a beneficial effect on reducing reoperation for bleeding, blood transfusion requirement, and the length of stay at ICU. But the incidence of perioperative myocardial infarction was more common in the off-pump group (P < 0.05). The degree of improvement in angina and quality of life did not differ significantly between the two groups. CONCLUSIONS: Using cardiopulmonary bypass is not an independent predictor of mortality and morbidity in patients with SLVD. Isolated CABG can be safely performed in SLVD patients with acceptable postoperative morbidity and mortality in addition to encouraging home discharge rates and higher quality of life. Therefore, CCABG remains a viable option in selected patients with SLVD.