The heart surgery forum最新文献

Objective: To evaluate whether M2 macrophage-derived exosomes protect against MI/R injury and reveal the protective mechanism of exosomes [Kourembanas 2015].

Methods: I/R model injury was induced by temporary left anterior descending coronary artery occlusion in Sprague-Dawley (SD) rats, macrophages isolated from bone marrow-derived macrophages (BMDMs) were induced to M2 polarization, and H9C2 cells subjected to hypoxia/reperfusion (H/R) were used to establish an in vitro model. I/R-induced rats and H/R-induced H9C2 cells were treated with M2-exos in vivo and in vitro, respectively. Masson staining was performed to observe myocardial fibrosis in rats. Immunohistochemical (IHC) staining of myocardial tissues showed the expression of NLRP3 inflammasome activation and pyrolysis. Exosomes derived from IL-4-treated macrophages (M2-exos) were detected by transmission electron microscopy (TEM), nanoparticle tracking analysis (NTA) and western bolt. Western bolt was performed to determine the protein level, including NLRP3, pro-caspase-1, cleaved caspase-1, pro-IL-1β, cleaved IL-1β, gasdermin D (GSDMD), and N-terminus of gasdermin D (GSDMD-N).

Results: Activity of NLRP3 inflammasome and existence of pyroptosis in the rats subjected to MI/R were significantly higher than those in the control (P < 0.05). Moreover, we confirmed the accumulation of ROS during I/R injury in cardiomyocytes. M2-exos protected against I/R injury and reduced activity of NLRP3 inflammasome and existence of pyroptosis, accompanied with attenuating oxidative stress. In vitro studies showed similar effects, H9c2 cells co-cultured with M2-exos could attenuated H/R-induced cell injury, while M2-exos suppressed the expression of NLRP3 inflammasome and pyroptosis (P < 0.05).

Objective: To investigate the utility of systemic immune-inflammation index (SII) and inflammatory panel in predicting the risk of postoperative atrial fibrillation (PoAF) among patients undergoing elective isolated coronary artery bypass grafting (CABG).

Methods: A total of 116 patients (mean age: 61.9 ± 9.8 years, 78.4% were males) undergoing   isolated CABG were included in this retrospective study. Patients were divided into two groups, including those who developed PoAF (N = 26) and those without PoAF (N = 90). Inflammatory panel was evaluated in both groups.

Results: Patients with PoAF had significantly higher values for P-wave dispersion (PWD; 53.9 ± 5.9 versus 40.2 ± 5.1, P < .001), HATCH score (2.4 ± 1.3 versus 1 ± 1.1, P < .001), and left atrial dimension (4.0 ± 0.3 versus 3.8 ± 0.2 cm, P = .003). In the multivariate analysis with inclusion of PWD, HATCH score and SII, only SII (OR 1.007, 95% CI 1.002 to 1.012, P = .003) and PWD (OR 1.86, 95% CI 1.225 to 2.757, P = .002) were shown to be independent predictors of increased risk for PoAF.

Conclusion: Preoperative SII seems to be a non-invasive readily available marker that significantly predicts the risk of PoAF in patients undergoing isolated CABG.

Objective: This study aimed to evaluate the efficacy and safety of high-frequency oscillation ventilation combined with volume guarantee (HFOV-VG) in preterm infants with acute hypoxemic respiratory failure (AHRF) after patent ductus arteriosus ligation.

Methods: We retrospectively analyzed the clinical data of 41 preterm infants, who were ventilated for AHRF after patent ductus arteriosus ligation between January 2020 and January 2022. HFOV alone was used in 20 of the 41 infants, whereas HFOV-VG was used in the other 21 infants.

Results: There was no statistically significant difference in the demographic information and baseline characteristics of preterm infants included in the study. The average frequency tidal volume (VThf) of the HFOV-VG group was lower than that of the HFOV group (2.6 ± 0.6 mL versus 1.9 ± 0.3 mL, P < .001). In addition, the incidence of hypocapnia and hypercapnia in infants supported with HFOV-VG was significantly lower (15 versus 8, P < .001; 12 versus 5, P < .001). Furthermore, the duration of invasive ventilation in the HFOV-VG group also was lower than in the HFOV group (3.7 ± 1.2 days versus 2.1 ± 1.0 days, P < .01).

Conclusion: Compared with HFOV alone, HFOV-VG decreases VThf levels and reduces the incidence of hypercapnia and hypocapnia in preterm infants with acute hypoxic respiratory failure after patent ductus arteriosus ligation.

Heart failure (HF), a clinical syndrome most commonly occurring due to ischemic heart disease, causes significant morbidity and mortality. The benefits of revascularization versus medical treatment for ischemic heart failure remain controversial. Thus, we assessed a patient diagnosed with ischemic heart failure before and 3 months after coronary artery bypass grafting by myocardial radionuclide imaging. Findings of Tc-99m sestamibi myocardial perfusion imaging revealed that the degree and area of ischemia were significantly reduced, and the systolic function of the left ventricle improved compared with the preoperative value. This suggests the benefit of revascularization in cases of ischemic heart failure.

Background: Ventricular septal defect (VSD) and atrial septal defect (ASD) are congenital heart diseases. The techniques of transthoracic closure (TC) and percutaneous closure (PC) for the treatment of VSD and ASD have continuously improved and matured. This study aimed to retrospectively analyze the therapeutic effects of TC and PC on VSD and ASD patients.

Methods: We retrospectively reviewed 928 patients (552 VSD and 376 ASD) who had undergone TC or PC guided by transesophageal ultrasound at the Department of Cardiac Macrovascular Surgery of the First Affiliated Hospital of Nanchang University between August 2010 and August 2020. We collected and evaluated the clinical data of the patients, including age, gender, weight, inlet and outlet diameters of defect, and the operation results of TC and PC. Descriptive statistics were used to analyze means and standard deviations (SD), and the Chi-square test was used to evaluate the difference between groups.

Results: Among the 928 patients who were treated with the closure operation, there were no casualties, with 907 patients (97.7%) showing successful closure. Among the 552 VSD patients who were treated with TC, 540 showed successful close, while 12 cases required extracorporeal circulation after the failure of TC. Among the 376 patients with ASD, 256 patients were treated with TC, of which 251 were successful, and five were failures, including three shedding cases. In addition, among the 120 patients who were treated with PC, 116 were successful, and four were failures, including two shedding cases. Postoperative follow up for patients with successful closure operations demonstrated that the complications of aortic and tricuspid regurgitation, hydro-pericardium, III° atrioventricular block, shedding of closure umbrella, hemolysis, and thrombosis had not occurred.

Conclusion: Closure operation of VSD and ASD by esophageal ultrasound has the advantages of lower trauma and blood loss, shorter hospital stay, simple operation, fewer postoperative complications, and significant therapeutic efficacy.

Background: Acute kidney injury (AKI) is one of the most frequent complications after coronary artery bypass grafting. Previous studies have shown that diabetes is a key pathogenic factor. But how diabetes is related to AKI in off-pump CABG patients still is in debate. Here, we aim to study the relationship between diabetes and AKI after off-pump coronary artery bypass grafting (off-pump CABG).

Methods: Patients who underwent off-pump CABG from April 2017 to December 2020 in The First Affiliated Hospital of USTC were enrolled in this retrospective study. AKI was defined and classified, according to the criteria proposed by the Acute Kidney Injury Network. The incidence risk of acute kidney injury was measured by logistic regression and compared.

Results: A total of 395 patients, who underwent off-pump CABG, were included in this study. The postoperative acute kidney injury rate for a patient with diabetes was significantly higher than for patients without diabetes (x2 = 5.09, P = 0.024). Logistic regression analysis showed that patients with diabetes have a much higher risk with acute kidney injury occurring after off-pump coronary artery bypass grafting (OR 1.852, 95% CI 1.161 - 2.954, P = 0.01).

Conclusions: Diabetes is an independent risk factor for postoperative AKI for patients undergoing off-pump CABG.

Objective: Frailty is an increasingly recognized marker of poor surgical outcomes in cardiac surgery. Frailty first was described in the seminal "Fried" paper, which constitutes the longest-standing and most well-recognized definition. This study aimed to assess the impact of the Fried and modified Fried frailty classifications on patient outcomes following cardiac surgery.

Methods: The PUBMED, MEDLINE, and EMBASE databases were searched from January 2000 until August 2021 for studies evaluating postoperative outcomes using the Fried or modified Fried frailty indexes in open cardiac surgical procedures. Primary outcomes were one-year survival and postoperative quality of life. Secondary outcomes included postoperative complications, intensive care unit (ICU) length of stay (LOS), total hospital LOS, and institutional discharge.

Results: Eight eligible studies were identified. Meta-analysis identified that frailty was associated with an increased risk of one-year mortality (Risk Ratio [RR]:2.23;95% confidence interval [CI]1.17 -4.23), postoperative complications (RR 1.78;95% CI 1.27 - 2.50), ICU LOS (Mean difference [MD] 21.2 hours;95% CI 8.42 - 33.94), hospital LOS (MD 3.29 days; 95% CI 2.19 - 4.94), and institutional discharge (RR 3.29;95% CI 2.19 - 4.94). A narrative review of quality of life suggested an improvement following surgery, with frail patients demonstrating a greater improvement from baseline over non-frail patients.

Conclusions: Frailty is associated with a higher degree of surgical morbidity, and frail patients are twice as likely to experience mortality within one-year post-operatively. Despite this, quality of life also improves dramatically in frail patients. Frailty, in itself, does not constitute a contraindication to cardiac surgery.

Background: Double blood supply to the anterior descending artery is a rare finding of coronary angiography. However, infective endocarditis (IE) combined with anomalous double blood supply to the anterior descending artery has not been reported.

Case presentation: A 58-year-old male previously diagnosed with IE came to the emergency department with complaints of chest tightness and dyspnea. Further examination confirmed severe aortic valve regurgitation combined with IE and anomalous double blood supply to the anterior descending artery. The cardiopulmonary bypass surgery was performed by direct perfusion through the normal left and right coronary openings. After surgery, the heart started beating again normally without any cardiogenic ischemic events.

Conclusion: Cardiopulmonary bypass by direct perfusion was safe in the patient with anomalous double blood supply to the anterior descending artery.

Patients with organ malperfusion from acute aortic dissection (AAD) have poor outcomes, and the surgical indications for patients with AAD complicated by extensive cerebral infarction have not been established. Here, we report a successfully treated surgical case of a patient with cerebral infarction and Stanford type A, AAD. A 77-year-old man was admitted to the hospital with a chief complaint of left paresis. After confirming that there was no cerebral hemorrhage with a head computed tomography and an incision in the right neck, and the right internal carotid artery was ligated and closed, emergency surgery was performed with a 24 mm Triplex® raft. The ascending aorta was replaced, and a bypass was performed with a prosthetic graft from the right axillary artery. No cerebral hemorrhage or neurological issues were observed postoperatively, which indicates the possibility of surgical intervention as a treatment strategy for this disease.

Aim: This study aimed to evaluate the surgical procedures, outcomes, and prognostic factors in patients with ischemic heart disease who were operated on due to nonocclusive mesenteric ischemia (NOMI).

Material and methods: This research contains all patients diagnosed with congestive heart failure and NOMI between January 2011 to January 2020. The patients who had angiography or CT that showed occlusion of more than 50% in any of the main branches of the mesenteric artery or patients who presented with symptoms in correlation with a total occlusion were excluded from the study. Patients who underwent coronary heart surgery but were not diagnosed with congestive heart failure and those with atrial fibrillation also were excluded from the study. Patients divided into two groups, according to a medical database.

Results: A significant difference was found between the surviving and non-survivor groups in minutes, in terms of median time to segmenter intestinal resection (P = 0.042).

Conclusion: An early diagnosis and surgical segmental intestinal resection before peritonitis worsens can be the key to better prognosis for NOMI patients.