ObjectiveTo summarize the perioperative management strategies and early results of modified Morrow expanded operation and coronary artery bypass grafting (CABG) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and coronary atherosclerotic heart disease.MethodsBetween January 2012 and December 2017, in the Second Inpatient Department of Fuwai Hospital, 32 patients (20 females and 12 males) underwent modified expanded Morrow operation and CABG. The median age was 53.7±8.7 years (interquartile range 37 to 67 years). Preoperative chest distress symptom was found in 24 patients, chest pain symptom was found in 14 patients, history of syncope in 6 patients. Cardiac echocardiography, electrocardiogram, chest X-ray, magnectic resonance imaging (MRI) were performed routinely after operation and follow-up to analyze structure and function of heart and mitral valve.ResultsAll patients underwent modified and expanded Morrow combined with CABG. The preoperative left ventricular outflow tract peak pressure difference (LVOTG) was 40 to 152 (79.6±28.7) mm Hg. Four patients underwent myocardial bridge releasing in the same period, mitral valve replacement in 2 patients, mitral valve angioplasty in 3 patients, Maze operation in 2 patients and tricuspid valveoplasty in 3 patients. There was no hospital mortality. CABG surgery in patients with branches included anterior descending artery in 26 patients, diagonal branch in 16 patients, left circumflex in 8 patients, right coronary artery in 11 patients. There were 15 patients with one coronary artery (CA) bypass graft, 5 patients with two CA bypass grafts, and 12 patients with 3 CA bypass grafts. The average of CA bypass grafts was 1.9±0.6. The postoperative ICU time ranged from 1–13 (4.1±2.8) days and postoperative hospital stay ranged from 7 to 30 (12.6±5.5) days. No severe postoperative complications were found and 1 patient had postoperative incision healing. The postoperative new arrhythmia included left bundle branch block in 6 patients. Compared with the preoperative values, postoperative left ventricular outflow tract peak pressure (79.6±28.7 mm Hg vs. 10.8±5.9 mm Hg, P<0.001), interventricular septum thickness (1.9±0.4 cm vs. 1.3±0.5 cm, P<0.001) were decreased obviously. Mitral valve closure is good or only mild reflux, mitral valve forward movement (SAM sign) disappeared. The patients were followed up for 6-68 months, with an average of 38.8±20.6 months. All patients were followed up with symptoms disappeared or only mild symptoms. NYHA classification decreased Ⅰ to Ⅱ grade after surgery, without long-term mortality, complications or reoperation.ConclusionFor patients with hypertrophic obstructive cardiomyopathy with coronary atherosclerotic heart disease, the application of improved expand morrow operation at the same time undergoing coronary artery bypass grafting is safe. It can significantly improve patients' survival and reduce symptoms, play a synergistic effect, and do not increase the patient's surgical complications.
ObjectiveTo investigate the incidence and risk factors of preoperative deep vein thrombosis (DVT) in patients with periprosthetic hip fractures. Methods This retrospective clinical cohort study enrolled 95 patients with periprosthetic hip fractures who met predefined inclusion and exclusion criteria between January 2016 and December 2025. The cohort included 28 males and 67 females, with a mean age of 72.9 years (range, 39-96 years). According to Vancouver classification, there were 1 case of type A, 32 cases of type B1, 59 cases of type B2, 1 case of type B3, and 2 cases of type C. The interval from injury to hospital admission ranged from 1 to 150 days (mean, 10.9 days). All patients received bilateral lower-extremity venous ultrasonography for preoperative DVT screening. Patients were divided into DVT-positive and DVT-negative groups according to ultrasound findings. Univariate analyses were conducted to compare demographic data (age, gender), underlying comorbidities (hypertension, diabetes mellitus, coronary atherosclerotic heart disease, cerebral infarction, etc.), Vancouver fracture type, injury-to-admission interval, and laboratory indicators (prothrombin time, activated partial thromboplastin time, thrombin time, international normalized ratio, D-dimer, fibrinogen, hemoglobin, red blood cell count, hematocrit, platelet count, serum albumin, triglycerides, total cholesterol, apolipoprotein, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol) between the two groups. The risk factors of preoperative DVT in periprosthetic hip fractures were further screened by logistic regression analysis. Results The overall preoperative prevalence of DVT was 28.42% (27/95) among patients with periprosthetic hip fractures. Subgroup analysis stratified by thrombus location showed 1 case (1.05%) of proximal DVT, 2 cases (2.11%) of distal axial DVT, and 24 cases (25.26%) of calf muscular vein thrombosis. Univariate analysis revealed significant intergroup differences in the prevalence of history of coronary atherosclerotic heart disease and preoperative D-dimer levels between DVT-positive and DVT-negative groups (P<0.05). Receiver operating characteristic curve analysis was performed to assess the predictive efficacy of preoperative D-dimer for preoperative DVT. The area under the curve was 0.667 (95%CI: 0.545, 0.772) (P=0.016). The optimal D-dimer cutoff value was 5.26 mg/L, with a sensitivity of 0.667 and specificity of 0.618. Stratified analysis based on this cutoff demonstrated that patients with D-dimer≥5.26 mg/L had a markedly higher incidence of DVT than those with D-dimer<5.26 mg/L [40.91% (18/44) vs. 17.65% (9/51); χ2=6.283, P=0.012]. logistic regression analysis further verified that history of coronary atherosclerotic heart disease and preoperative D-dimer≥5.26 mg/L were independent risk factors for preoperative DVT (P<0.05). ConclusionThe incidence of preoperative DVT is considerably high in patients with periprosthetic hip fractures. History of coronary atherosclerotic heart disease and elevated preoperative D-dimer (≥5.26 mg/L) are independent risk factors for preoperative DVT in patients with periprosthetic hip fractures, which should be paid great attention to clinically.