The heart surgery forum最新文献

Williams-Beuren syndrome (WBS) is a genetic disease involving the gene deletion of a chromosome. It is sporadically caused by the disruption of the elastin gene at the locus 7q11.23, and it occurs in as many as 1:7,500 individuals [Zucker 2018]. WBS includes cardiac lesions and a wide spectrum of congenital malformations with cardiovascular disorders, representing the most worrisome ones. The most typically frequent cardiovascular anomalies primarily comprise supravalvular aortic stenosis, peripheral pulmonary stenosis, mitral regurgitation, and aortic coarctation [Matisoff 2015]. Other main features include central nervous system and connective tissue involvement, mainly with a characteristic elfin face, mental and growth retardation, and hypercalcemia. We report a rare case of WBS with right pulmonary arteriovenous fistula (PAVF), associated with supravalvular aortic membrane stenosis, mitral regurgitation, and aortic coarctation. The patient underwent two-stage surgical treatment with satisfactory results at 5 years of follow-up.  This case study was approved by the local research ethics board. Written informed consent was obtained from this patient.

Coronary artery bypass grafting (CABG) is the primary surgical treatment for coronary artery disease (CAD). However, long-term clinical practice has confirmed the poor long-term patency of saphenous vein grafts (SVG), prompting surgeons to investigate alternatives, such as the use of radial artery (RA) grafts. In this report, we review and discuss the current status of radial artery application during CABG and current controversies in the field. Ultimately, evidence indicates that RA-CABG is associated with good long-term patency and is suitable for patients with severe stenosis. However, the compensatory capacity of the ulnar artery should be assessed prior to RA harvesting. Given that the RA is prone to spasms, routine application of calcium channel blockers is recommended. Several studies also have indicated that sequential grafting is an effective method for maximizing radial artery application and that patency rates are similar for the radial artery and right internal mammary artery. In contrast, the use of the bilateral internal mammary arteries is technically more demanding and exhibits a significant volume-outcome relationship. The decision to use the right internal mammary artery or radial artery should be based on individual patient characteristics and the experience of the surgical team.

Background: Acute kidney injury (AKI) is one of the most important complications after cardiac surgery and is one of the main causes of morbidity and mortality. Diabetes mellitus also is one of the main risk factors for renal dysfunction in coronary artery bypass graft (CABG). In this study, we aimed to compare the early postoperative period results of type 2 diabetes patients taking oral antidiabetics (OAD) or insulin medications, with microalbuminuria and normal creatinine levels after CABG.

Methods: Eighty patients with type 2 diabetes and taking OAD or receiving insulin medication all with normal creatinine levels with microalbuminuria were included in this study. Preoperative creatinine values of the patients, albumin levels in spot urine, creatinine levels on the postoperative 3rd day, duration of ventilation, amount of drainage, length of stay in the intensive care unit, length of stay in the hospital, mediastinitis, and mortality rates were recorded.

Results: A statistically significant increase in creatinine was found in both taking OAD type 2 diabetes and insulin medication with microalbuminuria. When the two groups were compared with each other, the increase in creatinine levels of the patients using insulin was higher than the patients taking OAD. It also was statistically significant.

Conclusion: According to the result of our study, it can be suggested that postoperative creatinine elevation is observed in patients with type 2 diabetes mellitus with microalbuminuria and with normal creatinine levels, either having insulin medication or not. The elevation is higher in patients having insulin medication, while other results are similar, except for impaired renal function.

Objective: Acute type A aortic dissection (AAD) is a serious life-threatening cardiovascular emergency with high in-hospital mortality without aggressive clinical treatment. The study intended to identify the relationship between platelet (PLT) to platelet distribution width (PDW) ratio (PPR) and in-hospital mortality in postoperative patients with type A AAD.

Methods: A total of 171 type A AAD patients were recruited in this retrospective study from January 2017 to December 2019. Receiver operating characteristics (ROC) were exploited to determine the best cut-off value of PPR, and then patients were sub-grouped into the low-PPR group and high-PPR group, according to the optimal value of PPR. Finally, univariate, and multivariate analyses were carried out to examine the prognostic value of PPR.

Results: The value of PPR was 9.76, and the mortality was statistically higher in the low-PPR group than in the high-PPR group (29.1% vs. 6.0%, P < 0.01). The area under the ROC curve (AUC) of PPR was 0.724 (95% CI, 0.633-0.815; P < 0.001) with a 56.4% sensitivity and 80.6% specificity. Multivariate analysis showed that serum PPR was an independent factor associated with in-hospital mortality (hazard ratio (HR): 1.151; 95% confidence interval (CI): 1.035 -1.297; P = 0.010).

Conclusion: Serum PPR can be used as an independent predictor of in-hospital mortality in postoperative patients with type A AAD.

Aims: The study aimed to investigate the protective effects and regulatory mechanism of sevoflurane postconditioning (SPC) in pulmonary apoptosis induced by cardiopulmonary bypass (CPB).

Methods: Twenty-four healthy dogs were divided into a control (C group), ischemia/reperfusion (I/R group), sevoflurane postconditioning (S group), and wortmannin group (S+W group). At 10 min after the establishment of CPB, the left pulmonary artery was blocked. When the pulmonary artery was reopened, 2% sevoflurane was administered. Wortmannin was delivered 10 min before the pulmonary artery was open. Before thoracotomy was implemented (T1), when the artery was reopened (T2) and 2 h after CPB (T3), blood and the inferior lobe of the left lung were isolated and subjected to gas analysis, pathological examination, western blot, and TUNEL staining.

Results: No obvious changes were observed in the C group throughout the experiment. The conditions of all treated groups progressively deteriorated, and no difference could be found except in the number of apoptotic cells of T3 between the S+W and I/R groups. At T2, the treated groups showed similar conditions. At T3, the lung function and structure of the S group were improved in I/R and S+W groups. The S group showed the highest p-Akt expression, the lowest cleaved-caspase 3 expression, and apoptotic cell percentage.

Conclusions: Ischemia-reperfusion of the lung during CPB reduces lung function and injures the pulmonary structure via inducing lung apoptosis. Sevoflurane postconditioning preserves lung function and structure by alleviating apoptosis via activation of PI3K/Akt.

Mitral valve leaflet aneurysm (MVA) is a rare and potentially devastating complication of infective endocarditis. Here, we report the case of a 49-year-old man with mitral endocarditis who had an anterior MVA without aortic morphologic change and only mild regurgitation. By real-time 3D transesophageal echocardiography (TOE), we found two perforations and a hard mass in the aneurysm accompanied with severe regurgitation. The patient underwent valve replacement surgery combined with anti-infection treatment and was successfully discharged. In addition to the case report and literature review related to MVA, we also summarize the application value of RT-3D TOE in these cases.

Purpose: This study aimed to compare postoperative ejection fraction (EF) in response to coronary artery bypass grafting (CABG) among patients with preoperative EF <35% and >35%.

Methods: A retrospective study was conducted in a single institution using clinical data of 660 patients undergoing elective on-pump CABG in 2018-2019. Patients were classified into two groups based on preoperative left ventricle ejection fraction (<35% and >35%). The primary endpoint was the change of postoperative ejection fraction.

Results: In this study, 72 patients had preoperative left ventricle ejection fraction <35% (group A) while the other 588 patients had ejection fraction >35% (group B). Among both groups, the duration of cardiopulmonary bypass (CPB) and aortic clamp (AxC) were not significantly different (P > 0.05). The transformation of pre- and postoperative EF in groups A and B was significantly different (2.91+10.31 vs. -0.14+4.57, P < 0.001). There was a significant difference in the duration of ICU stay (73.42+112.55 vs. 34.43+64.99, P < 0.001) and postoperative ventilatory support (25.54+43.92 vs. 16.42+45.87, P < 0.008) between group A and B.

Conclusion: Low preoperative EF showed better improvement in cardiac function after surgery. We concluded that the result could be affected by revascularization of hibernating myocardium.

Background: The indications and outcome of surgery for Acute type A aortic dissection (ATAAD) in elderly patients are still debated, especially when they were above 80 years old.  Case presentation: This report describes the case of an octogenarian patient with ATAAD who underwent total arch replacement (TAR) combined with stented elephant trunk (SET) implantation.

Conclusion: Emergent surgery should be performed on the ATAAD octogenarians without serious preoperative complications. Acceptable outcomes could be received by total arch replacement combined with SET implantation.

Background: This meta-analysis aimed to compare the potential effects of local anesthesia (LA) and general anesthesia (GA) for transcatheter aortic valve implantation (TAVI).

Measurements: All relevant studies were searched from Pubmed, EMbase, Web of Science, and the Cochrane Library (January 1, 2016, to June 1, 2021). The main outcomes of this literature meta-analysis were 30-day mortality, procedural time, new pacemaker implantation, total stay in the hospital, use of the vasoactive drug, and intra-and postoperative complications and emergencies, including conversion to open, myocardial infarction, pulmonary complication, vascular complication, renal injury/failure, stroke, transesophageal echocardiography, life-threatening/major bleeding, cardiac tamponade, and emergency PCI. Pooled risk ratio (RR) and mean difference (MD) together with a 95% confidence interval (CI) were calculated.

Results: A total of 17 studies, including 20938 patients, in the final analysis, fulfilled the inclusion criteria. Intra-and postoperative complications (myocardial infarction, vascular complication, renal injury/failure, stroke, and cardiac tamponade) undergoing TAVI in severe AS patients under GA do not offer a significant difference compared with LA. No differences were observed between LA and GA for new pacemaker implantation, total stay in the hospital, transesophageal echocardiography, and emergency PCI. LA has lower mortality compared with GA (RR 0.69, P = 0.600), pulmonary complications (RR 0.54, P = 0.278), life-threatening/major bleeding (RR 0.85, P = 0.855), and lower times of conversion to open (RR 0.22, P = 0.746). LA has many advantages, including a shorter procedure duration (MD=-0.38, P = 0.000) and reduction of the use of the vasoactive drug (RR 0.57, P = 0.000).

Conclusions: For TAVI, both LA with or without sedation and GA are feasible and safe. LA appears a feasible alternative to GA for AS patients undergoing TAVI.