Xin Chen

The stented elephant trunk procedure combined total arch replacement for Debakey I aortic dissection: operative result and follow-up

The stented elephant trunk technique in aortic arch replacement combined with transaortic stented graft implantation into the descending aorta has been introduced as a means of eliminating the residual false lumen in the descending thoracic aorta and improving long-term outcomes of surgical intervention for Debakey I aortic dissection. This report summarizes the operative and follow-up data with this new procedure. Between August 2004 and May 2009, 28 stented elephant trunk operations were performed for Debakey I aortic dissection at Nanjing First Hospital. A 10 cm long woven Dacron graft was implanted through the aortic arch during hypothermic circulatory arrest. Patent false lumina were evaluated using computed tomography three months after the operation. Mean cardiopulmonary bypass time was 213.2±47.2 min, and selected cerebral perfusion time was 38.8±9.7 min. Hospital mortality was 14.3% (4/28). Thrombus obliteration of the residual false lumen in the descending aorta was observed in 91.7% of the aortic dissections three months postoperatively. The survival rate was 87.5% at five years and the freedom from reoperation rate was 91.7%. Total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective treatment for Debakey type I aortic dissection.

Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction

BackgroundThis study was undertaken to compare mitral valve repair and replacement as treatments for ischemic mitral regurgitation (IMR) with left ventricular dysfunction (LVD). Specifically, we sought to determine whether the choice of mitral valve procedure affected survival, and discover which patients were predicted to benefit from mitral valve repair and which from replacement.MethodsA total of 218 consecutive patients underwent either mitral valve repair (MVP, n = 112) or mitral valve replacement (MVR, n = 106). We retrospectively reviewed the clinical material, operation methods, echocardiography check during operation and follow-up. Patients details and follow-up outcomes were compared using multivariate and Kaplan-Meier analyses.ResultsNo statistical difference was found between the two groups in term of intraoperative data. Early mortality was 3.2% (MVP 2.7% and MVR 3.8%). At discharge, Left ventricular end-systolic and end-diastolic diameter and left ventricular ejection fraction (LVEF) were improved more in the MVP group than MVR group (P < 0.05), however, in follow-up no statistically significant difference was observed between the MVR and MVP group (P > 0.05). Follow-up mitral regurgitation grade was significantly improved in the MVR group compared with the MVP group (P < 0.05). The Kaplan-Meier survival estimates at 1, 3, and 5 years were simlar between MVP and MVR group. Logistic regression revealed poor survival was associated with old age(#75), preoperative renal insufficiency and low left ventricular ejection fraction (< 30%).ConclusionMitral valve repair is the procedure of choice in the majority of patients having surgery for severe ischemic mitral regurgitation with left ventricular dysfunction. Early results of MVP treatment seem to be satisfactory, but several lines of data indicate that mitral valve repair provided less long-term benefit than mitral valve replacement in the LVD patients.

Evaluation of preoperative intra-aortic balloon pump in coronary patients with severe left ventricular dysfunction undergoing OPCAB surgery: early and mid-term outcomes

BackgroundThe purpose of the present study was to evaluate the safety and the cost-effectiveness of using preoperative IABP as support compared with postoperative IABP treatment in coronary patients with severe left ventricular dysfunction (SLVD) who is undergoing off-pump coronary artery bypass surgery (OPCAB), including early outcomes, hospital mortality and morbidity, and mid-term follow-up outcomes.MethodsBetween March 2000 and December 2008, we prospectively and randomly studied the insertion of preoperative IABP in 115 (7.4%) and postoperative IABP in 106 (6.8%) of the 1560 consecutive patients. Group A is preoperative IABP therapy. Group B is postoperative IABP therapy.ResultsThere was no significant difference in the number of grafts used between the two groups. Completeness of revascularization did not differ between the two groups. The statistically significant difference was hospital mortality (2.6% in group A vs. 3.8% in group B) (p < 0.05). And there was significant reduction in postoperative low cardiac output, malignant arrhythmia, acute renal failure and length of stay in ICU in group A, compared with group B (p < 0.05). In the two groups, six-, 12-, 24- and 48-month survival rates were similar. In the study the degree of improvement in angina and quality of life did not differ significantly between the two groups.ConclusionThe use of preoperative IABP in SLVD patients undergoing OPCAB is of safety and effectiveness. The combined use of preoperative IABP and OPCAB allows complete revascularization in SLVD patients with an important reduction in operative mortality and excellent mid-term results.

Proteomic analysis of myocardial tissue from the border zone during early stage post-infarct remodelling in rats

Long‐term outcome of patients after myocardial infarction (MI) largely depends on the extent of post‐infarct remodelling. To explore the molecular mechanism of remodelling, comparative proteomic analysis was undertaken to identify differential myocardial proteome profiles expressed in the border zone of the post‐MI heart.

Meta-analysis for outcomes of acute kidney injury after cardiac surgery

Abstract This study aimed to investigate the outcomes of acute kidney injury (AKI) after cardiac surgery by the meta-analysis. Electronic databases PubMed and Embase were searched for relative studies from December 2008 to June 2015. For eligible studies, the R software was conducted to meta-analyze outcomes of AKI patients (AKI group) and none-AKI patients after cardiac surgery (NO AKI group). The chi-square-based Q test and I 2 statistic were used for heterogeneity analysis. Pu200a<u200a0.1 or I 2u200a>u200a50% revealed significant heterogeneity among studies, and then a random effects model was used; otherwise a fixed effect model was performed. Eggers test was performed for publication bias assessment. Subgroup analysis was performed by stratifying AKI definitions and study type. Totally 17 studies with 9656 subjects (2331 in the AKI group and 7325 in the NO AKI group) were enrolled. Significantly higher renal replacement therapy (RRT) (OR=23.67, 95%CI: 12.58–44.55), mortality (OR = 6.27, 95%CI: 3.58–11.00), serum creatinine (SMD = 1.42, 95%CI: 1.01–1.83), and hospital length of stay (LOS) (SMD = 0.45, 95%CI: 0.02–0.88) were shown in the AKI group compared with patients in the NO AKI group. Subgroup analysis showed that results of only 3 subgroups were reversed indicating that the definition of AKI did not affect its outcomes. Publication bias was only found among studies involving mortality and serum creatinine, but the 2 outcomes were not reversed after correction. This meta-analysis confirmed the worse outcomes of AKI in patients after cardiac surgery, including higher RRT rates, mortality, and longer hospital LOS than those of NO AKI patients.

An excellent result of surgical treatment in patients with severe pulmonary arterial hypertension following mitral valve disease

ObjectiveObserve the efficacy of surgical treatment in patients with severe pulmonary arterial hypertension caused by mitral valve disease.MethodsWe examined the results of surgical treatment in 32 patients with mitral valve disease and severe pulmonary arterial hypertension (pulmonary arterial systolic pressureu2009≥u200980xa0mmHg) retrospectively. Operative and postoperative data collection included type of the surgery, cardiopulmonary bypass time, cross-clamp time and the mortality rate. Pulmonary arterial systolic pressure, left atrial diameter, left ventricular end-diastolic diameter, and left ventricular ejection fraction were recorded and compared.ResultsA total number of 32 patients had the operation of mitral valve replacement. Among those subjects, twenty-seven patients were surgically replaced with mechanical prosthesis and five patients with tissue prosthesis. Only one patient died of pneumonia, with a mortality rate of 3.1xa0%. The statistical results of preoperative and postoperative echocardiographic data showed significant decrease in pulmonary arterial systolic pressure (101.2u2009±u200920.3 versus 48.1u2009±u200914.3xa0mmHg, Pu2009<u20090.05), left atrial diameter(67.6u2009±u200915.7 versus 54.4u2009±u200911.4xa0mm, Pu2009<u20090.05) and left ventricular end-diastolic diameter (52.3u2009±u20099.5 versus 49.2u2009±u20095.9xa0mm, Pu2009<u20090.05). There was no significant change in left ventricular ejection fraction (59.2u2009±u20096.5 versus 57.9u2009±u20097.6, Pu2009=u2009NS). At the time of follow-up, twenty-eight (96.6xa0%) patients were classified in New York Heart Association functional class I or II, one(3.4xa0%) in class III, with the mortality rate is zero percent.ConclusionsMitral valve replacement can be performed successfully in patients with mitral valve disease and severe pulmonary arterial hypertension with an acceptable perioperative risk.

Off-pump versus on-pump coronary artery bypass surgery for the treatment of left main with triple coronary artery disease

Objective:To obtain early results of off-pump coronary artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery(CCAB). Methods:Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January I999 and May 2006. Non-randomized, retrospective data analysis included demographic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results: The number of distal anastomosis and grafts varied from 3 to 6. The average number per patient was similar in the two groups (OPCAB group:3.76±0.98, CCAB group:3.81±1.02). Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance (P＞0.05). The frequency of atrial fibrillation (AF), IABP usage, mediastinitis,re-operation for bleeding (or tamponade) were similar in the two groups (P＞0.05). Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in thc OPCAB group compared with CCAB group(P＜0.05).Conclusion: Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.

Monocyte chemotactic protein 1 increases homing of mesenchymal stem cell to injured myocardium and neovascularization following myocardial infarction

Abstract Objective To investigate the effect of MCP-1 on mesenchymal stem cells(MSCs) homing to injured myocardium in a rat myocardial infarction(MI) model. Methods Rat myocardial infarction model was established by permanent left anterior descending branch ligation. Mesenchymal stem cells from donor rats were cultured in IMDM and labeled with BrdU. The Rats were divided into two groups. Monocyte chemotactic protein 1(MCP-1) expression were measured by in situ hybridization and immunohistochemistry in the sham operated or infarcted hearts at 1, 2, 4, 7, 14 and 28 days post operation in MCP-1 detection group. The rats were injected with MCP-1, anti-MCP-1 antibody or saline 4 days after myocardial infarction in intervention group. Then, a total of 5 × 10 6 cells in 2.5 ml of PBS were injected through the tail vein. The number of the labeled MSCs in the infarcted hearts was counted 3 days post injection. Cardiac function and blood vessel density were assessed 28 days post injection. Results Self-generating MCP-1 expression was increased at the first day, peaked at the 7 th day and decreased thereafter post MI and remained unchanged in sham operated hearts. The MSCs enrichment in the host hearts were more abundant in the MI groups than that in the non-MI group( P = 0.000), the MSCs enrichment in the host hearts were more abundant in the MCP-1 injected group than that in the anti-MCP-1 antibody and saline injected groups ( P = 0.000). Cardiac function was improved more in MCP-1 injected group than anti-MCP-1 antibody and saline injected groups( P = 0.000). Neovascularization in MCP-1 injected group significantly increased compared with that of other groups( P =0.000). Conclusion Myocardial MCP-1 expression was increased only in the early phase post MI. MCP-1 may enhance MSCs homing to the injured heart and improve cardiac function by promoting neovascularization.