Heart Surgery Forum最新文献

Background: Ventricular septal rupture (VSR) following myocardial infarction (MI) is a rare but lethal complication. We analyzed the long-term results and risk factors for survival in the treatment of VSR.

Methods: From January 2012 to December 2021, 115 consecutive patients with post-MI VSR were admitted to our hospital. Depending on different treatment methods patients were divided into following three groups: medical, transcatheter intervention, and surgical repair. During the study, relevant clinical data, operation-related conditions, and follow-up data were analyzed. The Kaplan-Meier method and log-rank test were used to determine the cumulative incidence of mortality. The independent risk factors for patient mortality were evaluated by multivariate logistic regression.

Results: The mean follow-up time was 43.4 ± 34.7 months. The overall in-hospital, 30-day, and long-term mortality rates were 24.3%, 38.3%, and 51.3%, respectively. In the medical group, the in-hospital and 30-day mortality rates were 46.7 % (21/45) and 82.2 % (37/45), respectively, with only three patients alive at follow-up. In the transcatheter intervention group, 30-day and long-term mortality rates were 12% and 28%, respectively. In the surgical repair group, 30-day and long-term mortality rates were 8.9% and 22.2%, respectively. Compared with the surgery-group patients, patients with transcatheter intervention had a longer time from VSR to intervention. Logistic regression analysis revealed that age, previous infarction, Killip class, serum creatinine, Troponin T, N-terminal pro-B-type natriuretic peptide, and medical strategy were risk factors for all-cause mortality.

Conclusions: The 30-day and long-term outcomes of patients treated with surgical repair and transcatheter intervention were significantly better than medically treated patients.

Objective: To investigate the lipoprotein(a) [Lp(a)] to prealbumin (PA) ratio and the N-terminal pro-brain natriuretic peptide (NT-proBNP) to left ventricular ejection fraction (LVEF) ratio for the prediction of major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).

Methods: A 1:1 matched case-control study was performed to retrospectively analyze ACS patients who underwent PCI from January 2022 to June 2022. Patients with MACE were selected as the case group (n = 55), and age- and gender-matched patients without MACE were selected as the control group (n = 55). Clinical data for the two groups was compared by univariate and multivariate logistic regression analysis. Risk factors and the odds ratio (OR) for MACE in ACS patients were evaluated, and receiver operating characteristic curve (ROC) were used to evaluate the Lp(a)/PA ratio, the NT-proBNP/LVEF ratio, and their combination for the prediction of MACE in ACS patients.

Results: The MACE and non-MACE groups showed statistically significant differences for time from onset to PCI, LVEF, NT-proBNP, white blood cell (WBC), Lp(a), PA, Lp(a)/PA, NT-proBNP/LVEF, number of catheterizations, number of implanted stents >2, and support diameter >3 (p < 0.05). Multivariate logistic regression analysis showed that LVEF, Lp(a)/PA and NT-proBNP/LVEF were independent risk factors for MACE. ROC curve analysis for Lp(a)/PA showed that the area under the curve (AUC) for the prediction of MACE was 0.779 (0.693-0.864), the cut-off point was 1.36, the sensitivity was 69.1%, and the specificity was 74.5%. The AUC for NT-proBNP/LVEF in predicting MACE was 0.827 (0.75-0.904), the cut-off point was 61.04, the sensitivity was 65.5%, and the specificity was 92.7%. For the combination of Lp(a)/PA and NT-proBNP/LVEF, the AUC for the prediction of MACE was 0.889 (0.830-0.947), the cut-off point was 0.37, the sensitivity was 81.8%, and the specificity was 81.8%.

Conclusion: The combination of Lp(a)/PA and NT-proBNP/LVEF at admission showed good predictive value for the occurrence of MACE in ACS patients after PCI.

Background: The relationships between serum levels of homocysteine (Hcy), soluble stromelysin 2 (sST2), and tumor-associated cancer antigen 125 (CA-125) and heart failure requires further investigation. The aim of the present study was to evaluate the levels of Hcy, sST2 and CA-125 in patients with congestive heart failure and to correlate these with cardiac function, thereby providing a reference for the clinical diagnosis and treatment of heart failure.

Methods: Seventy patients with chronic heart failure (CHF) diagnosed between August 2020 and July 2022 were classified into heart failure groups II (n = 25), III (n = 23) and IV (n = 22). Seventy individuals with normal physical examination results were selected as the healthy group. Serum Hcy, sST2 and CA-125 levels for all participants were evaluated and correlated with each other and with cardiac function classification. The diagnostic value of individual Hcy, sST2, CA-125 levels for CHF was evaluated, as well as a combination of these factors.

Results: Hcy, sST2, and CA-125 levels were lower in the healthy group than in the heart failure group. Moreover, a progressive increase in Hcy, sST2, and CA-125 levels were observed in heart failure groups II, III, and IV. Individual Hcy, sST2 and CA-125 levels, as well as a combination of these factors, were significantly correlated with cardiac function classification (p < 0.05). Hcy, sST2 and CA-125 levels each showed diagnostic value for CHF, with the three combined having the best diagnostic value.

Conclusions: Abnormally high levels of Hcy, sST2 and CA-125 occur in CHF patients and are positively correlated with cardiac function classification. Individual levels of these factors, and particularly a combination of the three, show good sensitivity and specificity for CHF diagnosis that could be widely used in clinical practice.

An anomalous left coronary artery originating from the pulmonary artery (ALCAPA) refers to the abnormal origin of the left coronary artery either from the main pulmonary artery, pulmonary artery sinus, or the left and right pulmonary arteries, with the main pulmonary artery or pulmonary artery sinus being the most common sites. If not diagnosed and treated promptly, this condition can result in death within the first year of life in 90% of patients. Asymptomatic children can survive into adulthood, but they are at a high risk of sudden death. In this article, we report a case of a 24-year-old pregnant woman who was diagnosed with ALCAPA during prenatal examination. The pregnancy was successfully maintained until 36 weeks, after which a cesarean section was performed. The patient was then admitted to the cardiac surgery department to improve cardiac function, and six weeks later, a successful left coronary artery transplantation was performed. The patient was discharged and followed up for three months, during which her condition remained stable.

Background: This study aimed to compare the outcomes of the percutaneous femoral access and open surgical cutdown access approaches in patients undergoing thoracic/abdominal endovascular aortic repair.

Methods: We retrospectively reviewed the medical records of 59 patients who underwent a thoracic/abdominal endovascular aortic repair at a single tertiary care hospital between 2015 and 2022. Based on their femoral access type, the patients were categorized into the "percutaneous" or "cutdown" groups. Using a computerized sheet, relevant patient data (including demographic information and patient risk factors) were collected. The operative duration, complication rates, mortality rates, intensive care unit admission and stay durations, and total hospital stay were compared between the two groups. The primary outcomes were differences in the postoperative morbidity and mortality associated with the two approaches.

Results: The cutdown and percutaneous groups comprised 24 (41%) and 35 (59%) patients, respectively. The two groups displayed comparable demographic and clinical characteristics (p > 0.05). However, the vascular anatomy differed with the common femoral artery diameter being larger in the percutaneous group compared to the cutdown group (9.63 ± 1.81 mm vs. 8.49 ± 1.54 mm, p = 0.028). The ratio of the sheath diameter to the common femoral artery diameter was significantly lower in the percutaneous group than in the cutdown group (0.73 ± 0.16 vs. 0.85 ± 0.20, p = 0.027). A ratio of ≥0.74 was associated with a higher risk of complications (odds ratio, 12.0; 95% confidence interval, 1.4-102.2; p = 0.023) and mortality (odds ratio, 5.79; 95% confidence interval, 1.13-29.6; p = 0.035). Additionally, the operative duration was significantly shorter in the percutaneous group than in the cutdown group (141.43 ± 97.05 min vs. 218.46 ± 126.31 min, p = 0.001). Compared to the cutdown group, the percutaneous group experienced a shorter total hospital stay (21.54 ± 21.49 days vs. 11.60 ± 12.09 days, p = 0.022) and lower intensive care unit-admission rates (66.7% vs. 40%, p = 0.044).

Conclusion: The percutaneous approach is a viable and more time-efficient alternative to the traditional cutdown method for delivering vascular endografts. It is associated with a significantly shorter operative duration and briefer hospital stays. Additionally, the ratio of the sheath diameter to the common femoral artery diameter can help surgeons preoperatively predict and anticipate the risks of complications and mortality. Future in-depth research is necessary to better understand the association between this ratio and postoperative outcomes and complications.

Deep sternal wound infection (DSWI) is a life-threatening complication after cardiac operations, especially after coronary artery bypass grafting (CABG) in diabetic patients. Bilateral pectoralis major muscle flaps have been performed to treat DSWI. Two diabetic patients suffering from DSWI after CABG were treated by bilateral pectoralis major muscle flaps in our hospital. Both patients were discharged with full recovery. Satisfactory results can be obtained with bilateral pectoralis major muscle flaps following tissue debridement and drainage. This procedure should be performed when DSWI occurs in diabetic patients after CABG.

No abstract present.

Background: Postoperative delirium (POD) and neurological dysfunction are very common following cardiac surgery and deteriorate the patient's prognosis and the outcome of surgical procedures. A clinically effective management strategy or drug is not yet available for POD. Additionally, it is unknown whether remote ischemic preconditioning (RIPC) has neuroprotective and anti-delirium benefits in patients who undergo cardiac surgery.

Methods: This study examined whether RIPC can improve POD and neurological function in cardiac surgery patients. We screened 510 consecutive adult patients aged 18 and older who underwent cardiac surgery between January 2018 and December 2022. Then, 448 of these patients were recruited in the trial as the intention to treat (ITT) group, who were then randomly assigned to receive either a control (n = 223) or RIPC treatment (n = 225). The primary outcome measures were hospitalization postoperative delirium, six-month modified Rankins scale (mRS), hospital cerebral infarction, 30-day overall mortality, neuron-specific enolase (NSE) and S-100b levels, related adverse effects, hospital costs, and hospital stay.

Results: A statistically significant variation was not observed between the two groups in terms of the baseline clinical data. In contrast to the control group, the POD in the RIPC group was considerably alleviated. RIPC treatment also decreased the levels of NSE and S-100b, which alleviated nerve injury. The adverse impacts of RIPC-induced objective indicators of tissue or neurovascular damage were similar in both groups, showing no significant variations between the two. The hospital stays and hospitalization costs also decreased significantly in the RIPC-treated patients.

Conclusion: The study findings suggested that RIPC may benefit cardiac surgery patients by reducing POD, alleviating injury, and lowering hospital expenditures and length of stay. Cardiac surgery patients can be treated with RIPC, which is an effective and safe technique.

Background: Coronary artery disease (CAD) is one of the main causes of sudden death, but its exact pathogenesis requires further study. Thus, this study aimed to explore the immune and oxidative stress-related factors in CAD progression and their roles in CAD diagnosis.

Methods: Bioinformatics analysis was used in this study, and the GSE23561 dataset (training set) we used contained the transcriptome sequencing results of six CAD peripheral blood samples and nine control samples. The data were obtained and analysed by querying the Gene Expression Omnibus database. First, the differentially expressed immune and oxidative stress-related genes (DEIOGs) between the groups were identified. DEIOGs were then analysed based on Gene Ontology annotation and Kyoto Encyclopedia of Genes and Genomes pathway enrichment. A protein-protein interaction (PPI) network for DEIOGs was constructed using the Search Tool for the Retrieval of Interacting Genes/Proteins database, and hub genes were identified through the PPI network. Moreover, transcription factors and microRNAs (miRNAs) targeting hub genes were identified to explore the potential regulatory mechanisms of hub genes. The receiver operating characteristic (ROC) curve analysis was constructed to examine the role of hub genes in CAD diagnosis. Finally, the data of GSE23561 (validated set) were used to validate the diagnostic potential of these hub genes.

Results: Primarily, 66 DEIOGs were identified, which are involved in many important pathways related to CAD, such as the "mitogen-activated protein kinase (MAPK) signalling pathway" and "lipid and atherosclerosis". A PPI network of DEIOGs was then constructed, and 10 hub genes were identified sequentially. A total of 37 transcription factors and 481 miRNAs that played important roles in hub genes regulation were identified. The ROC curves indicated that five special hub genes (Fos, Il6, Jun, Mapk3, and Mmp9) could serve as potential diagnostic biomarkers for CAD.

Conclusions: Bioinformatics analysis technology was used to identify 10 hub DEIOGs that might play a crucial role in CAD progression, and five special hub genes (Fos, Il6, Jun, Mapk3, and Mmp9) could be regarded as potential biomarkers for CAD diagnosis. However, further studies are required to verify the functions of these hub genes.

Objective: Atherosclerosis (AS) as a major cause of cardiovascular diseases, is considered a chronic inflammatory disease and accelerates by inflammation, lipid metabolism disorder and other mechanisms. AS pathogenesis and its relationship with immune regulation and metabolic interactions is still not fully elucidated. The purpose of this study is to delve into the correlation between mitochondrial metabolism and immunity in AS, and identify potential therapeutic targets for clinical treatment.

Methods: Hub genes associated with mitochondrial metabolism and the pathogenesis of AS were identified by performing differentially expressed genes (DEGs) analysis and Weighted Gene Co-expression Network Analysis (WGCNA) based on two gene expression datasets (GSE100927 and GSE43292). And the biological processes and pathways of DEGs were determined through gene ontology (GO) and Gene Set Enrichment Analysis (GSEA) analysis. Then stepwise regression, random forest, and Lasso regression machine learning were used to evaluate the diagnostic value of hub genes. After that, the immune infiltration and single cell sequencing dataset GSE184073 were analyzed, and the immune cell composition in peripheral blood from AS patients using Mass Cytometry were detected to further consider the influence of immunoregulation.

Results: Ten hub genes associated with mitochondrial metabolism and AS pathogenesis were identified, including NDUFS4, AIFM3, IDUA, TNF, CHKA, SLC11A1, SLC35C1, SLC37A2, ARSB, SLC16A5. GO and GSEA analysis showed their correlation with immunity and inflammation. Lasso regression revealed that TNF and ARSB had relatively good diagnostic performance. Further exploration was conducted on the expression of these hub genes in the immune microenvironment and their correlation with different immune factors. Mass cytometry demonstrated the influence of the vascular immune microenvironment on the pathogenesis of AS.

Conclusions: Our study provides a more comprehensive understanding of the complex relationships between immune and metabolic factors and their impact on the microenvironment of AS. The identification of hub genes in AS may provide new targets for therapeutic intervention.