Yongxin Sun

Randomized Study of Mononuclear Bone Marrow Cell Transplantation in Patients With Coronary Surgery

BACKGROUNDnMononuclear bone marrow cell (MN-BMC) transplantation has great clinical potential to promote myocardiogenesis and angiogenesis. This randomized study was designed to assess the feasibility and safety of MN-BMC transplantation during coronary artery bypass grafting (CABG) in patients with ischemic heart failure.nnnMETHODSnThirty-six patients were prospectively enrolled and randomized to a MN-BMC group (n = 18) and a control group (n = 18). A mean number of 6.59 x 10(8) +/- 5.12 x 10(8) MN-BMC were injected into the infarcted and marginal areas during CABG in the MN-BMC group. The patients in the control group underwent CABG alone. All patients were followed up to 6 months.nnnRESULTSnThere was one death in the MN-BMC group and no death in the control group. Two patients developed ventricular arrhythmia in the MN-BMC group. Compared with baseline and the control group, therapeutic effects of MN-BMC transplantation were observed over time. Heart function (New York Heart Association) was significantly improved and angina pectoris was alleviated in the MN-BMC group. Left ventricular ejection fraction in the MN-BMC group was greater than the control group. The thickness and motion velocity of the infarcted wall were significantly increased in the MN-BMC group. More pronounced perfusion improvements of ischemic regions and LV were observed in the MN-BMC group. There was one late death in the MN-BMC group. No procedure-related complications occurred.nnnCONCLUSIONSnMN-BMC transplantation improves cardiac function and regional perfusion in ischemic heart failure patients during CABG. A large cohort with long-term follow-up is needed to further evaluate the safety of MN-BMC transplantation.

Should sinus of Valsalva be preserved in patients with bicuspid aortic valve and aortic dilation

BackgroundnIt is recommended that dilated ascending aortas (≥45 mm) should be replaced at the time of aortic valve replacement (AVR) for bicuspid aortic valve (BAV). The risk of progressive sinus of Valsalva dilatation after AVR and ascending aorta replacement is less clear.nnnMethodsnWe identified 156 patients (age 56.2±10.8 years, 46 females) who underwent AVR and ascending aorta replacement in our institution from 2010-2014, 124 (79%) of whom had BAV. Aortic root and ascending aorta sizes were determined from preoperative and the most recent echocardiograms. The mean follow-up time was 34.4±22.3 months, and 97% of patients completed the follow-up.nnnResultsnThe operative mortality rate was 1.3%. During a follow-up of up to 75.2 months, there were no late reoperations for aortic root dissection or rupture. The mean preoperative aortic root diameters in the tricuspid aortic valve (TAV) and BAV groups were 42.2±5.4 and 37.5±5.4 mm, respectively (P=0.69). After operation, most of the patients had reduced aortic root sizes, as the mean postoperative root diameters in the TAV and BAV groups were 39.6±5.2 and 35.7±5.1 mm, respectively (P=0.99).nnnConclusionsnTo avoid the risks associated with aortic root replacement, it is reasonable to spare the aortic roots in the setting of AVR and ascending aorta replacement for BAV with a dilated ascending aorta and relatively normal sinuses of Valsalva.

Secondhand Smoking and Matrix Metalloproteinase-2 and -9 Gene Expression in Saphenous Veins of Women Nonsmokers

BACKGROUNDnActive smoking upregulated matrix metalloproteinase-2 (MMP-2) and MMP-9 gene expression in saphenous veins (SVs) before coronary operation. However, little is known about the effects of secondhand smoke (SHS), a smoking status that is more widely harmful to the general population, on MMP gene expression in SVs. Health effects of SHS were investigated mainly in nonsmokers married to smokers. Because the vast majority of women are nonsmokers in China, we had an opportunity to evaluate the relations between SHS and MMP gene expression in SVs of women patients before operation.nnnMETHODSnA total of 258 woman patients were divided into three groups: control group, nonsmokers; SHS group, patients exposed to SHS until operation; active smoking group, patients who smoked a minimum of 1 package of cigarettes every day for more than 20 years. Messenger RNA and protein levels of MMP-2 and MMP-9 were analyzed. Saphenous vein graft patency after coronary operation was evaluated.nnnRESULTSnThe clinical backgrounds in the three groups were comparable. Compared with the control group, MMP-2 and MMP-9 gene expression was significantly increased in the SHS and active smoking groups (p<0.05). The degree of MMP gene expression changed by SHS or active smoking was comparable. A significant difference of SV graft patency was found among the three groups. An association of increased MMP gene expression with lowered SV graft patency was found in follow-up.nnnCONCLUSIONSnOur data revealed that SHS had similar power as active smoking to affect MMP gene expression in SVs before operation and SV graft patency after coronary operation in women nonsmokers.

Surgical management of traumatic tricuspid insufficiency

This study reviews our experience with traumatic tricuspid insufficiency (TTI) following blunt chest trauma.

Impact of Presurgical Mild Acute Respiratory Distress Syndrome on Surgical Mortality After Surgical Repair of Acute Type A Aortic Dissection

To evaluate the impact of presurgical mild acute respiratory distress syndrome (ARDS) on surgical mortality in patients undergoing surgical repair of acute type A aortic dissection by means of deep hypothermic circulatory arrest (DHCA) in a single-center, retrospective study.From January 2011 to December 2015, 333 eligible patients were divided into either a mild-ARDS group (n = 136) or a no-ARDS group (n = 197). The definition of mild ARDS referred to the recent revision of ARDS definition (Berlin criteria). The surgical mortality and major postoperative morbidity were investigated and analyzed.A total of 136 patients developed presurgical mild ARDS, with an incidence of 40.8%. No significant difference emerged between the 2 groups in major postoperative morbidity except for pulmonary complications. Multivariate logistic regression displayed that the risk of postoperative pulmonary complications in patients with presurgical mild ARDS was 4.25 times that in patients without presurgical ARDS (OR = 4.25, 95% CI 2.05-7.72). Twenty-four patients died after surgery, with significantly higher surgical mortality in the mild-ARDS group compared with the no-ARDS group (12.5% versus 3.6%, P = 0.002). Kaplan-Meier curves showed a poor surgical survival in the mild-ARDS group (χ2=12.958, Log-Rank P < 0.001). And Cox regression revealed the hazard ratio for surgical mortality in the mild-ARDS group compared with the no-ARDS group was 2.52 (95%CI 1.41-5.32, P = 0.016).Presurgical mild ARDS increased postoperative respiratory morbidity, and then increased surgical mortality after surgical repair of acute type A aortic dissection by means of DHCA.

Benefits of Early Surgery on Clinical Outcomes after Degenerative Mitral Valve Repair

BACKGROUNDnThis study aimed to evaluate the clinical trends of mitral valve repair for degenerative mitral regurgitation and the benefit of early surgical intervention on repair durability in a high-volume center.nnnMETHODSnFrom January 2003 to December 2015, 1,903 consecutive patients with severe degenerative mitral regurgitation underwent mitral valve repair at our institution. The timing of surgical intervention was evaluated by guideline-related indications including symptoms, atrial fibrillation, left ventricular dysfunction, and pulmonary hypertension. Clinical outcomes and risk factors for recurrent mitral regurgitation were analyzed.nnnRESULTSnOver 13 years from 2003 to 2015, trends of preoperative characteristics demonstrated that the proportion of asymptomatic patients substantially increased. The 8-year overall survival, freedom from reoperation for mitral valve, and freedom from recurrent mitral regurgitation were 96%, 96%, and 85%, respectively. Ejection fraction less than 60%, left ventricular end-diastolic dimension greater than 60 mm, isolated anterior leaflet lesion, and intraoperative mild residual mitral regurgitation were independent predictive factors for recurrent mitral regurgitation. The incidence of recurrent mitral regurgitation was significantly lower in the early intervention group (3% versus 18%, p < 0.01). In subgroup analysis of asymptomatic patients, the incidence of recurrent mitral regurgitation was significantly lower in patients without guideline-related indications (3% versus 31%, p < 0.0001).nnnCONCLUSIONSnEarly surgical intervention for severe degenerative mitral regurgitation before symptoms, atrial fibrillation, and ventricular dysfunction are associated with excellent clinical outcomes. Besides complexity of leaflet lesion and repair quality, surgical timing also significantly affects repair durability. Early surgical intervention should therefore be recommended to reduce recurrent mitral regurgitation.

Annuloplasty band implantation in adults with partial atrioventricular septal defect: a propensity-matched study

OBJECTIVESnThe incidence of recurrent left atrioventricular valve (LAVV) regurgitation is generally high after repair of partial atrioventricular septal defect (AVSD). This study aimed to evaluate the effect of implanting an additional annuloplasty band into the LAVV during partial AVSD repair and to assess the late outcomes of recurrent LAVV regurgitation.nnnMETHODSnThis study enrolled 133 patients who underwent repair of partial AVSD at our institution from January 2005 to December 2015. All patients underwent repair of the ostium primum atrial septal defect and closure of the LAVV cleft; 37 patients underwent additional annuloplasty band implantation. To minimize differences in preoperative data, propensity score matching was used to identify 33 well-matched patient pairs.nnnRESULTSnCardiopulmonary bypass time and aorta cross-clamp time were significantly longer in the band implantation group (Pu2009<u20090.05). The 2 groups had similar durations of intensive care and hospital stay (Pu2009>u20090.05). There was 1 in-hospital death in the band implantation group. During follow-up, conduction block occurred in 6 patients in each group. After follow-up of more than 10u2009years, freedom from late recurrent LAVV regurgitation was 91% in the band implantation group and 57% in the isolated cleft closure group (Pu2009<u20090.05). In patients with preoperative severe regurgitation and moderate/mild regurgitation, the rates of freedom from recurrent LAVV regurgitation were 85% and 37%, respectively (Pu2009<u20090.05).nnnCONCLUSIONSnIn patients with moderate/severe LAVV regurgitation or severe annular dilation, additional band implantation significantly reduces the incidence of recurrent regurgitation and improves long-term outcomes.

Surgical and early outcomes for Type A aortic dissection with preoperative renal dysfunction stratified by estimated glomerular filtration rate

OBJECTIVESnThe aim of this study was to analyse the effect of preoperative renal dysfunction on surgical and early outcomes for patients with Type A aortic dissection (AAD).nnnMETHODSnFrom January 2016 to December 2016, 140 patients with AAD who underwent surgical treatment at our institution were retrospectively analysed. According to the estimated glomerular filtration rate (eGFR), preoperative renal dysfunction was divided into 4 groups: normal (eGFR ≥90u2009ml/min/1.73u2009m2, nu2009=u200976), mild (eGFR 60-89, nu2009=u200940), moderate (eGFR 30-59, nu2009=u200920) and severe (eGFR <30, nu2009=u20094).nnnRESULTSnMajor complications included prolonged ventilation requiring tracheotomy in 15 patients, renal replacement therapy (RRT) in 28 patients, stroke in 11 patients and paraplegia in 4 patients. The best cut-off value of the eGFR for predicting postoperative RRT was 70u2009ml/min/1.73u2009m2 (area under the receiver operating characteristic curve was 0.809). In-hospital mortality was 9.3% (6.5% in the normal group, 5% in the mild group, 20% in the moderate group and 50% in the severe group). Logistic regression analysis showed that age >60u2009years, moderate and severe renal dysfunction, coronary malperfusion and peripheral malperfusion were risk factors for in-hospital death.nnnCONCLUSIONSnTotal arch replacement can be safely performed in patients with AAD and preoperative mild renal dysfunction. Preoperative renal dysfunction is a risk factor for postoperative RRT, and eGFR is useful for predicting the requirement for postoperative RRT. Our surgical strategy for total arch replacement and stented elephant trunk for patients with AAD and mild preoperative renal dysfunction has excellent early outcomes.

Generation of an induced pluripotent stem cell line from a Loeys-Dietz syndrome patient with transforming growth factor-beta receptor-2 gene mutation

Loeys-Dietz syndrome (LDS) is an autosomal-dominant connective tissue disorder, commonly caused by genetic mutation of transforming growth factor-beta receptor (TGFBR)-1 or TGFBR2. This study describes the generation of human induced pluripotent stem cells (hiPSCs) from peripheral blood mononuclear cells obtained from an LDS patient with TGFBR2 mutation (R193W). Analysis confirmed the cells had a normal karyotype, expressed typical pluripotency markers, had the ability to differentiate into all three germ layers in vivo, and retained the TGFBR2 mutation from the derived hiPSCs. This iPSC line represents a potentially useful tool for investigating LDS disease mechanisms.

Successful management of a giant dissecting aortic aneurysm in a patient with Behcet’s disease

Thoracic aortic aneurysm with subsequent dissection is a very rare but dangerous complication of Behcets disease, which is a systemic syndrome that can involve blood vessels of all sizes. Surgical experience in dealing with this complication in patients with Behcets disease has been limited. We report a 20-year-old patient with Behcets disease who presented with a giant dissecting thoracic aortic aneurysm. The patient was successfully treated with an aortic root and arch replacement using a frozen elephant trunk technique. Timely surgical intervention and appropriate long-term medical management are important for these patients.