ObjectiveTo summary the safety and efficiency of the minimally invasive direct cardiac surgery (MIDCS) approach in elderly patients with heart disease. MethodsWe retrospectively analyzed the clinical data of 60 patients underwent MIDCS in Beijng Anzhen Hospital between April 2010 and January 2013. There were 34 males and 26 females with mean age of 66.4±4.8 years and mean weight of 66.1±10.6 kg. ResultsMean cardiopulmonary bypass time and aortic cross-clamp time was 141.2±57.2 minutes and 99.8±37.6 minutes respectively. A total of 37 patients (90.2%) recovered to beat automatically after heart ceased operation. Median mechanical ventilation time was 17.1±9.1 hours. Mean intensive care unit stay was 22.1±12.2 hours. Mean post operative hospital stay was 7.0±2.5 days. Mean incision length was 5.3±0.9 cm. Mean pericardial draining volume was 466.6±412.1 ml in the first day after operation. No transfusion occurred in 27 (45.0%) patients. Early postoperative mortality was 3.3% (2/60). There were 2 patients of reexplorations for bleeding, 1 patient of the twice tracheal intubation, 1 patient of cardiac arrest after operation, 2 patients of poor healing of skin incision, and 1 patient of injury of right phrenic nerve. When leaving hospital, 47 patients were in heart functional class Ⅰ, 8 patients in class Ⅱ, and 3 patients in class Ⅲ. ConclusionMIDCS is associated with good operative effect in the near future with superior safety and broad application range in elderly patients with heart disease.
Objective To analyze the medium-and long-term r esults of tricuspid valve replacement(TVR), to summarize the experience in opera tive therapy for tricuspid valve disease. Methods From January 1998 to May 2006, sixty seven patients had undergone TVR. The etiology was rheumatic disease in 25 cases, congenital disease in 37 cases, degenerative disease in 1 case, infective endocarditis in 3 cases, a nd cardiac tumor in 1 case. All operations were performed under general anesthes i a and by cardiopulmonary bypass. Bioprostheses was replaced in 28 patients, whil e mechanical valve was replaced in 39 patients. Associated procedure included mi tral valve replacement in 13 cases, mitral valve replacement and aortic valve replac ement in 12 cases, repair of ventricular septal defect in 1 case, repair of atri al septal defect in 1 case, and radioablation of atrial fibrillation in 3 case s. Results The operative mortality was 11.94% (8/67)，among these patients , 6 cases died of serious heart failure,1 case died of ventricular fibrillation, 1 case died of multi organ failure. During follow-up, 1 patient died of biopro thesis dysfunction 1 year after the operation, 1 patient died of cerebral emboli s m 6 years after the operation. Through statistical analysis, it showed that the mortality of TVR in rheumatic tricuspid valve disease was higher than that in co ngenital tricuspid valve disease ［5.56%（2/36）vs. 24.00% (6/25); χ2=4.425 , P=0.036］; the mortality in second time operation was higher than that in first time operation ［30.00%（3/10）vs. 8.77% (5/57);χ2=3.646，P=0.033 ］; while there was no significant difference in immediate and long-term result s with different choice of bioprosthetic or mechanical valve in TVR (χ2=0.002 , P=0.961). Conclusion Operative an d follow-up mortality is high in the TVR, valve replac ement is the last selection for the treatment of serious tricuspid disease, appr opriate operative technique and perioperative therapy is the key for success o f the operation.
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.
Abstract:Objective To investigate the expression and significance of Voltage-gated Cl channel-3 （ClC-3） in acute cardiac allograft rejection in rats. Methods The model of heterotopic cardiac allograft of SD to Wistar rats was established. The rats were divided into two groups： control group and cyclosporin A（CsA） treated group （CsA group）. Living span of the transplants in eight rats of each group were observed. Allograft samples were harvested separately on the day 1, 3, 5, 7 after operation （n = 6）. The rejection was evaluated by routine pathological examinations. The myocardial apoptosis by terminal deoxylnucleotidyl transferase mediated-dUTP nick end labeling （TUNEL） method and the local expression of ClC-3 were detected by reverse transcriptase polymerase chain reaction （RT-PCR）. Results The allografts survival time was significantly longer in CsA group compared with that in control group （15.4±5.1dvs. 7.6±1.5d, P〈0.05）. There was lesser pathological changes in CsA group than that in control group. The apoptosis index were significantly higher in control group and the expression of ClC-3 was significantly lower（P〈0.05）. CsA could inhibit the rise of apoptosis index and the decrease of the ClC-3 expression. Conclusion The ClC-3 expression is closely related with the severity of myocardial necrosis and apoptosis index, which indicates that ClC-3 plays a very important role in the necrosis and apoptosis during acute cardiac allograft rejection of rat.
Objective To evaluate the cardiac protection function of high thoracic epidural anesthesia (HTEA) for patients with acute coronary syndrome or heart failure. Methods A literature search was conducted with computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1990 to May 2010. Further searches for articles were conducted by checking all references describing cardiac protection studies with HTEA. All included articles were assessed and data were extracted according to the standard of Cochrane review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results A total of 28 articles involving 1 041 patients were included. The results of meta-analyses showed that, a) cardiac function: HTEA could significantly improve ejection fraction of left ventricle (WMD= –?10.28, 95%CI –?14.14 to –?6.43) and cardiac output (WMD= –?1.26, 95%CI –?1.63 to –?0.89), contract left ventricular diastolic dimension (WMD= 5.02, 95%CI 3.72 to 6.32), increase E peak (WMD= –?17.50, 95%CI –?29.40 to –?5.59) and decrease A peak (WMD= 27.36, 95%CI 24.46 to 30.26); b) ischemic degree for patients with heart failure: the change of NST-T (WMD= 1.45, 95%CI 1.12 to 1.78) and ∑ST-T (WMD= 1.02, 95%CI 0.78 to 1.26) got significantly decreased after HTEA; c) ischemic degree for patients with acute coronary syndrome: HTEA could obviously lessen the times (WMD= 4.24, 95%CI 0.48 to 8.00) and duration (WMD= 23.29, 95%CI 4.66 to 42.11) of myocardial ischemia, decrease the times of heart attack (WMD= 3.44, 95%CI 0.92 to 5.97), and decrease the change of NST-T (WMD= 1.10, 95%CI 0.84 to 1.36) and ∑ST-T (WMD= 1.33, 95%CI 1.01 to 1.65); d) hemodynamic change for patients with acute coronary syndrome: HTEA could obviously decrease heart beat (WMD= 8.44, 95%CI 3.81 to 13.07) and systolic arterial pressure (WMD= 2.07, 95%CI 0.81 to 3.34), but not decrease the diastolic blood pressure (WMD= 2.06, 95%CI –?0.52 to 4.64) so as to avoid influencing the infusion of coronary artery; and e) influence on Q-T interval dispersion: HTEA could significantly decrease Q-Td (WMD= 9.51, 95%CI 4.74 to 14.27), Q-Tcd (WMD= 11.82, 95%CI 5.55 to 18.09), and J-Td (WMD= 9.04, 95%CI 2.30 to 15.79). Conclusions High thoracic epidural anesthesia can obviously improve the systolic and diastolic function of left ventricle, decrease the heart beat and stabilize hemodynamic change, lessen the times and duration for myocardial ischemia, reserve the ST segment change, contract Q-T interval dispersion, which has to be further proved with more high quality studies.
Objective To evaluate the clinical therapeutic effect and safety of western medicine plus Shenfu Injection versus simple western medicine in heart failure (HF) patients. Methods Such databases as CNKI (January 1979 to 2009), VIP (January 1989 to December 2009), CBM (1978 to 2009), PubMed (1978 to December 2009), The Cochrane Library (Issue 4, 2009) and relevant journals were searched, and the literature of randomized controlled trials comparing the combination of western medicine and Shenfu Injection with simple western medicine in HF patients was included. The quality of studies was evaluated according to the methods of the Cochrane Collaboration, the data were extracted; and meta-analyses were performed with RevMan5.0.2 software. Results Sixteen trials involving 1 117 patients were included. The results of meta-analyses showed that compared with the simple western medicine treatment, the combination of western medicine and Shenfu Injection therapy significantly improved the symptoms, clinical comprehensive effect (RR=3.30, 95%CI 2.22 to 4.92, Plt;0.000 01), TCM syndrome and patient’s quality of life (RR=6.85, 95%CI 2.90 to 16.17, Plt;0.000 01), increased left ventricular ejection fraction (WMD=3.54, 95%CI 2.78 to 4.30, Plt;0.000 01), and reduced LVSD (WMD=2.43, 95%CI 1.04 to 3.82, P=0.000 6). Meanwhile, only one trail indicated that the combination of western medicine and Shenfu Injection might increase the six-minute walking distance, reduce the level of IL-6 and TNF-α, and eliminate the Lee’s HF and LVD-36 questionnaire integral. Conclusion The therapeutic effect of combining western medicine with Shenfu Injection therapy on HF patients is better than that of simple western medicine treatment.
Objective To investigate the risk factors and the prevention and cure methods of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Methods From March 2004 to July 2008，twentythree patients with ischemic stroke after mechanical heart valve replacement had been researched(ischemic stroke group). One hundred and twenty patients who had undergone mechanical heart valve replacement were randomly chosen in the same period as control group. Gender, age, the dose of warfarin , anticoagulation intensity(INR), INR review interval, left atrial diameter and heart rhythm were compared between the two groups, and the risk factors of ischemic stroke were analyzed by logistic regression analysis. Results (1) Patients in ischemic stroke group all discharged from hospital after treatment, and they were followed up for 1 month-3 years after discharged. All the patients’ neurological complications improved obviously, and no recurrent embolism and severe hemorrhage was found. (2) There was no statistical significance between two groups in gender, age and the dose of warfarin（Pgt;0.05）. (3) Nonconditional logistic regression analysis on influence factors showed that atrial fibrillation（P=0.000）, left atrial enlargement（P=0.002）, low anticoagulation intensity（P=0.012） and longtime INR review interval（P=0.047）were the risk factors of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement. Conclusions (1)The prognosis of ischemic stroke during low intensity anticoagulation therapy after mechanical heart valve replacement is better than that of intracranial hemorrhage, and the occurrence of ischemic stroke is related to many risk factors. (2)The influences of risk factors should be minimized in order to avoid ischemic stroke. (3) Early low intensity anticoagulation therapy is safe and effective for patients with ischemic stroke after heart valve replacement.
Objective To evaluate the feasibility to fabricate tissue engineered heart valve leaflet with poly hydroxybutyrate co hydroxyvalerate (PHBV) scaffold. Methods Constructive characteristics of PHBV were observed by scanning electron microscope. PHBV was implanted subcutaneously in rabbit and extirpated at 2,4,6,8, and 10 weeks in order to study its biocompatibility and biodegradability. Cell growth curve, smooth muscle α actin and ultra microscopic characteristics were observed in canine aortic valve interstitial cells. The cells were seeded on the PHBV and their function of prostaglandin I 2 (PGI 2) synthesis was determined. Results Porous diameter of PHBV was 130μm, PHBV had good biocompatibility and completely degraded at the end of the 10th week. Smooth muscle α actin were expressed in canine aortic valve interstitial cells and grew well. Cells implanted on PHBV grew well, PGI 2 were synthesized and secreted( P lt;0.05). Conclusion It is feasible to fabricate a tissue engineering heart valve leaflet in vitro with PHBV scaffold.
Objective To introduce a new type of bileaflet mechanical prosthetic heart valve （GK bileaflet valve）and evaluate clinically the early hemodynamic effect and short term follow-up after its replacement. Methods Sixty-one patients with heart valve diseases were operated upon. The mitral valve replacement was performed in 34 patients, aortic valve replacement in 16 patients and double valve replacement in 11 patients. A total of 72 GK bileaflet mechanical valves were implanted, 45 in mitral position, and 27 in aortic position. Blood consistency and hemodynamics were monitored. Follow-up was carried out routinely to check whether there were some valve-related complications. Results There was no early mortality （〈30 d）. Only one patient died of trauma 2 months after the operation. Follow-up was 100% and extended 1 to 2. 5 years. Without valve-related complications all patients had lived for more than 1 to 2.5 years. In 98% （60/61） of survivors heart functional performance had improved to New York Heart Association class Ⅰ or Ⅱ . Conclusion Early clinical results and short term follow up demonstrate that GK bileaflet prosthetic heart valve exhibits excellent hemodynamic properties, satisfied blood consistency and a low incidence of valve-related complications. Midterm and long-term results should be observed further.
Abstract: Objective To observe the combined protective effects of U50 488H and hypothermia preservation on isolated rabbit hearts preconditioned. Methods Forty rabbits were randomly divided into five groups, 8 rabbits in each group. The perfusion model of isolated rabbit hearts was established by the Langendorff device. In the control group: the isolated rabbit hearts were preserved with the University of Wissconsin solution (UW ) for six hours; groupI : the isolated rabbit hearts were preconditioned with St. ThomasII cardioplegic solution containing U50 488H (1. 6mmo l/L ) and then preserved with hypothermic preservation for four hours; groupII ; the precondition was the same as group II , hypothermic preservat ion fo r six hours; group III : the precondit ion was the same as group I , hypothermic preservation for eight hours; group IV : the precondit on was the same as group I , hypothermic preservation for ten hours. The cardiac function, myocardial sarcoplasmic reticulum calcium ion adenosine triphosphatase (SRCa2+ -ATPase) act ivity and calcium ion concentrations in mitochondria were determined at thirty minutes after reperfusion. Results As the hypothermic preservation time increased from four to ten hours, the recovery rate of each index of cardiac function, coronary artery flow (Cf) and SRCa2+ -ATPase activity also decreased, but the calcium ion concentrations in the mitochondria increased. Cardiac function index recovery rates in group I and group II w ere higher than those in group III and groupIV respectively (P lt; 0. 05, 0. 01) ,meanwhile recovery rates of cardiac function index in group III were higher than that in group IV (P lt; 0. 05). Recovery rate of Cf in groupII ( 84. 56%±10. 38%)were higher than those in group III (79. 45%±9. 67% ) and group IV (68. 31%±6. 84% , P lt;0.01) , meanwhile the recovery rate of Cf in group III was higher than that in group IV (P lt; 0. 05). SRCa2+ -A Tpase activity in group II (4. 43±0. 41μmo l/m g?h)were higher than those in control group (3. 04±0. 22Lmo l/mg?h ) , group III (3. 26±0. 29Lmo l/m g?h) and group IV (2. 57±0. 63Lmo l/m g?h, P lt; 0. 05) , SRCa2+ -ATPase activity in group III was higher than that in group IV (P lt; 0. 01). The calcium ion concentrations in mitochondria in group II (38176±4. 30μmo l/g ?dw ) and in the control group (40. 23±3. 75μmol/g ?dw )were less than those in group III (43125±5116μmol/g?dw ) and groupIV (45. 78±3. 26μmol/g?dw , P lt; 0. 05, 0. 01) respect ively. Conclusion The hypothermic preservation time for isolated dono r’s hearts p re-treated with St. Thomas II cardioplegic solution containing U 50 488H should the kep tunder 8h. The myocardial protection effects of both UW solution and U50 488H- containing St. Thomas II cardioplegic solution on isolated dono r’s hearts appear to be the same at 6 hours.