Yunqing Mei

Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass.

Background: Pulmonary complications following cardiac surgery with cardiopulmonary bypass (CPB) are often associated with significant morbidity and mortality. However, few reports have focused on evaluating intra- and post-operative independent risk factors for pulmonary complications following cardiac surgery with CPB. This study aimed to evaluate peri-operative independent risk factors for postoperative pulmonary complications through investigating and analyzing 2056 adult patients undergoing cardiac surgery with CPB. Methods: From January 2005 to December 2012, the relevant pre-, intra-, and post-operative data of adult patients undergoing cardiac surgery with CPB in the department of cardiovascular surgery of Tongji Hospital of Tongji University in Shanghai were investigated and retrospectively analyzed. The independent risk factors for pulmonary complications following cardiac surgery with CPB were obtained through descriptive analysis and then logistic regression analysis. Results: One hundred and forty-three adult patients suffered from pulmonary complications following cardiac surgery with CPB, with an incidence of 6.96%. Through descriptive analysis and then logistic regression, independent risk factors for postoperative pulmonary complications were as follows: older age (>65 years) (OR=3.31, 95%CI 1.71-7.13), preoperative congestive heart failure (OR=2.95, 95%CI 1.41-5.84), preoperative arterial oxygenation (PaO2) (OR=0.67, 95%CI 0.33-0.85), duration of CPB (OR=3.15, 95%CI 1.55-6.21), intra-operative phrenic nerve injury (OR=4.59, 95%CI 2.52-9.24), and postoperative acute kidney injury (OR=3.21, 95%CI 1.91-6.67). Postoperative pulmonary complication was not a risk factor for hospital death (OR=2.10, 95%CI 0.89-4.33). Conclusions: A variety of peri-operative factors increased the incidence of pulmonary complications following cardiac surgery with cardiopulmonary bypass.

Risk factors for ventilator dependency following coronary artery bypass grafting.

Background: Ventilator dependency following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for ventilator dependency following CABG. This study aimed to evaluate the independent risk factors for ventilator dependency following coronary artery bypass grafting (CABG). Methods: The relevant pre-, intra- and post-operative data of patients without a history of chronic obstructive pulmonary disease undergoing isolated CABG from January 2003 to December 2008 in our center were retrospectively analyzed. Elapsed time between CABG and extubation of more than 48 hours was defined as postoperative ventilator dependency (PVD). Results: The incidence of PVD was 13.8% (81/588). The in-hospital mortality in the PVD group was significantly higher than that in the non-PVD group (8.6% versus 2.4%, p=0.0092). Besides the length of ICU and hospital stay, PVD correlated with negative respiratory outcomes. The independent risk factors for PVD were preoperative congestive heart failure (OR=2.456, 95%CI 1.426-6.879), preoperative hypoalbuminemia (OR=1.353, 95%CI 1.125-3.232), preoperative arterial oxygen partial pressure (PO2) (OR=0.462, 95%CI 0.235-0.783) and postoperative anaemia (OR=1.541, 95%CI 1.231-3.783). Conclusions: Preoperative congestive heart failure, preoperative hypoalbuminemia, low preoperative PO2 and postoperative anaemia were identified as four independent risk factors for ventilator dependency following CABG.

Risk factors for late extubation after coronary artery bypass grafting

OBJECTIVE To evaluate the independent risk factors for late extubation after coronary artery bypass grafting (CABG). METHODS Preoperative, intraoperative, and postoperative characteristics of patients undergoing isolated CABG between June 2005 and June 2008 at the Tongji Hospital were retrospectively analyzed. Elapsed time between CABG and extubation of more than 8hours was defined as late extubation. RESULTS The incidence of late extubation after CABG was 69.23% (288/416). Through univariate and logistic regression analysis, the independent risk factors for late extubation after CABG were older age (odds ratio [OR]=4.804), duration of cardiopulmonary bypass (OR=2.426), perioperative use of intra-aortic balloon pump (OR=1.451), preoperative arterial oxygen partial pressure (OR=.204), and postoperative hemoglobin level (OR=.793). CONCLUSION Older age, prolonged cardiopulmonary bypass time, perioperative intra-aortic balloon pump requirement, low preoperative arterial oxygen partial pressure, and low postoperative hemoglobin level were identified as the 5 independent risk factors for late extubation after CABG.

PI3K/AKT Mediated P53 Down-Regulation Participates in CpG DNA Inhibition of Spontaneous B Cell Apoptosis

The unmethylated CpG DNA can prevent spontaneous apoptosis of B cells. However, the precise mechanisms by which CpG DNA blocks apoptosis remain unclear. In this study, we showed B cell apoptosis was significantly inhibited by addition of CpG DNA. Treatment of CpG DNA could reduce the expression of caspase 3, increase IAP and Bcl-xL expressions, and inhibit p53 protein expression which level was increased in B cell spontaneous apoptosis at 24 h. AKT kinase activity was increased with the incubation of CpG DNA. The wortmannin and Ly294002 could abrogate the protection of B cell from apoptosis by CpG DNA. The up-regulations of Bcl-xL and IAP by CpG DNA were not inhibited when blocking PI3K by specific inhibitor Ly294002, while the inhibition of p53 by CpG DNA could be blocked by Ly294002. These results demonstrated that the inhibition of spontaneous B cell apoptosis by CpG DNA was correlated to up-regulation of Bcl-xL, IAP and down-regulation of p53 and caspase 3. CpG DNA inhibition of p53 is mediated through PI3K/AKT signaling.

Transcatheter Closure of Adult Patent Ductus Arteriosus with Severe Pulmonary Hypertension

The purpose of this study was to investigate the application of trial balloon occlusion for permanent closure of patent ductus arteriosus (PDA) with severe pulmonary hypertension (PH) in adults, and to assess its immediate and short-term results. From September 1999 to September 2005, a total of ten adults (two males, ages ranging from 20 to 54 years) with PDA who met the criterion for severe PH (basal pulmonary vascular resistance > 8 Wood units) received trial balloon occlusion via an embolectomy balloon catheter. Post-occlusion hemodynamics, along with an overall clinical and hemodynamic assessment, was used to consider the indication of closure of PDA. Nine of the patients underwent successful transcatheter closure of PDA and subsequently used Amplatzer occluder devices. Chest X-ray, cardiography and echocardiography were used for follow-up evaluation of the treatment within 6 months after successful closure of PDA. No patient had a detectable residual shunt by color flow mapping or any other complications (device migration, hemolysis, endocarditis, etc.) at follow-up. In conclusion, trial balloon occlusion helps to determine anticipated hemodynamics after closure of PDA, so it is conducive to indicating permanent closure of adult PDA with reversible but severe PH. Furthermore, satisfactory immediate and short-term outcomes have proven this method to be safe and valid.

Early results after surgical treatment of left ventricular aneurysm.

BackgroundLeft ventricular aneurysm (LVA) is a serious complication of myocardial infarction and reduces the chances of survival. Controversy still exists regarding the optimal surgical technique for LVA repair. We analyze the efficacy of two techniques, linear vs. endoventricular circular patch plasty, for repair of LVA and the efficacy of surgical ventricular restoration (SVR) on beating heart.MethodsThis study included 62 patients who underwent SVR from 1086 consecutive patients were subjected to coronary artery bypass grafting (CABG) between 2000 and 2009. All selected patients were divided either into group liner or patch according to the choice of the repair technique depended on factors such as localization, size and dimension of the scar. The patients also were divided either into group beating heart or cardioplegia. The pre-, intra- and postoperative relevant data of all selected patients were analyzed.ResultsThe mortality was not significantly different between linear and patch repair groups, also the actuarial survival rates within 24 months (p= 0.529). Postoperative echocardiographic findings showed significant improvements in left ventricular function in both groups. The beating heart technique reduced postoperative peak release by 27% for Cardiac troponin I (cTnI) compared with the cardioplegia group (0.46 ± 0.06 ng/mL versus 0.63 ± 0.09 ng/mL, p= 0.004), and increased the perioperative survival by 9% (97.2% versus 88.5%), but the actuarial survival rates were not significantly different between the groups from 2 to 24 months (p= 0.151).ConclusionsBoth techniques (linear and patch) achieved good results with respect to mortality, functional status and survival. The choice of surgical technique should be adapted in each patient. The beating heart technique may to some extent relieve myocardial injury in patients undergoing SVR.

Impact of diabetes mellitus on patients over 70 years of age undergoing coronary artery bypass grafting

OBJECTIVE We evaluated in-hospital outcomes of diabetic and nondiabetic patients aged over 70 years after isolated coronary artery bypass grafting (CABG). PATIENTS AND SETTING All patients aged over 70 years at our center, who underwent CABG between January 2003 and December 2008, were entered into this study. Diabetes in this study was defined as the need for oral medication or insulin. METHODS The relevant preoperative, intraoperative, and postoperative characteristics of selected patients were investigated, compiled, and retrospectively analyzed. RESULTS One hundred and twenty-one diabetic patients aged over 70 years, accounting for 30.8% of the total population, were entered into this study. Diabetic patients aged over 70 years were more likely to present with left main trunk disease (P=.0194), and less likely to have undergone previous percutaneous coronary intervention (P=.0121), compared with their nondiabetic counterparts. Univariate and multivariate logistic regression analysis showed that diabetic patients aged over 70 years had a higher rate only of deep sternal wound infection (odds ratio, 2.28; 95% confidence interval, 1.29 to 6.84; P=.0028), while sharing similar rates for other morbidities and mortality compared with nondiabetic patients aged over 70 years. CONCLUSIONS Elderly diabetic patients are not at significantly increased risk from CABG, compared with their nondiabetic peers.

Risk Factors for Late Right Ventricular Systolic Dysfunction in Pediatric Patients With Repaired Tetralogy of Fallot

To evaluate independent risk factors for late right ventricular systolic dysfunction after correction of Tetralogy of Fallot (TOF) in a single-centre, retrospective and observational clinical trial.Patients less than 3 years of age who underwent correction of TOF and subsequently routine clinical follow-up of more than 36 months were included in this study and were divided either into an experimental group (right ventricular systolic dysfunction) or a control group (normal right ventricular systolic function) according to the tricuspid annular peak systolic velocity (TAPSV) value measured by pulsed wave-tissue Doppler imaging (pulsed wave-TDI). The relevant data of all selected patients were investigated and analyzed. From January 2012 to December 2012, a total of 113 consecutive eligible patients were enrolled in this study and were divided either into an experimental group (n = 41) or control group (n = 72). Through univariate analysis and subsequent logistic regression, low preoperative arterial oxygen saturation (OR = 1.66, 95%CI 1.22-4.58, P = 0.0163), age less than 6 months at the time of surgery (OR = 3.45, 95%CI 1.87-9.17, P = 0.0021), and transannular patch (OR = 2.15, 95%CI 1.31-5.38, P = 0.0015) were 3 independent risk factors for late right ventricular systolic dysfunction after correction of TOF.This clinical trial suggested low preoperative arterial oxygen saturation was associated with late right ventricular systolic dysfunction after correction of TOF, and appropriate age at the time of surgery and selection of a proper surgical method to reconstruct the right ventricular outflow tract contributed to improving late right ventricular systolic function in pediatric patients with repaired TOF.

Results of radiofrequency ablation for permanent atrial fibrillation in patients undergoing mitral valve surgery.

Objectives — The study aim was to evaluate the safety and feasibility of radiofrequency ablation for the surgical treatment of permanent atrial fibrillation in patients with degenerative mitral valve disease. Design — From August 2000 to August 2003, 40 consecutive patients (mean age 69.0 ± 9.3 years) with permanent atrial fibrillation and degenerative mitral valve disease underwent surgical radiofrequency ablation in conjunction with 22 mitral valve repairs and 18 mitral valve replacements. The mean duration of chronic AF was 5.1 ± 3.4 years.The completeness of follow-up was 100%.The mean follow-up time was 4.6 ± 2.0 years (range 0 to 7.8 years). Results — Thirty-day mortality was 2.5% (1 patient), the cause of death was cardiac failure. Cardiac failure and temporary A-V block were the most common postoperative complications. Both occurred in 10% (4 patients). No complication was related to the ablation procedure.At discharge, 65% (26/40) of the patients were in sinus rhythm. Overall incidence of sinus rhythm at the end of the follow-up was 56.4% (22/39). The 1-, 3- and 5-year survival was 97.5%, 91.8% and 85.9%, respectively. Conclusion — Mitral valve surgery combined with radiofrequency ablation is a safe and effective procedure in patients with permanent atrial fibrillation and degenerative mitral valve disease.The result is encouraging in restoring sinus rhythm, and an excellent postoperative survival rate can be achieved.

Identification of mutant genes with high‐frequency, high‐risk, and high‐expression in lung adenocarcinoma

To identify mutant genes with high‐frequency‐risk‐expression between lung adenocarcinoma and normal samples.