Therapeutic and Prognostic Significance of Arachidonic Acid in Heart Failure.

BACKGROUND: Accurate prediction of death is an unmet need in patients with acute decompensated heart failure (HF). Arachidonic acid (AA) metabolites play an important role in the multiple pathophysiological processes. We aimed to develop an AA score to accurately predict mortality in patients with acute decompensated HF and explore the causal relationship between the AA predictors and HF. METHODS: The serum AA metabolites was measured in patients with acute decompensated HF (discovery cohort n=419; validation cohort n=386) by mass spectroscopy. We assessed the prognostic importance of AA metabolites for 1-year death using Cox regression and machine learning approaches. A machine learning-based AA score for predicting 1-year death was created and validated. We explored the mechanisms using transcriptome and functional experiments in a mouse model of early ischemic cardiomyopathy. RESULTS: Among the 27 AA metabolites, elevated 14,15-DHET/14,15-EET ratio was the strongest predictor of 1-year death (hazard ratio, 2.10, P=3.1×10-6). Machine learning-based AA score using a combination of the 14,15-DHET/14,15-EET ratio, 14,15-DHET, PGD2, and 9-HETE performed best (area under the curve [AUC]: 0.85). The machine learning-based AA score provided incremental information to predict mortality beyond BNP (B-type natriuretic peptide; ΔAUC: 0.19), clinical score (ΔAUC: 0.09), and preexisting Acute Decompensated Heart Failure National Registry, Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure, and Get With The Guidelines Heart Failure scores (ΔAUC: 0.17, 0.17, 0.15, respectively). In the validation cohort, the AA score accurately predicted mortality (AUC:0.81). False-negative and false-positive findings, as classified by the BNP threshold, were correctly reclassified by the AA score (46.2% of false-negative and 84.5% of false-positive). In a murine model, the expression and enzymatic activity of sEH (soluble epoxide hydrolase) increased after myocardial infarction. Genetic deletion of sEH improved HF and the blockade of 14,15-EET abolished this cardioprotection. We mechanistically revealed the beneficial effect of 14,15-EET by impairing the activation of monocytes/macrophages. CONCLUSIONS: Our studies propose that the AA score predicts death in patients with acute decompensated HF and inhibiting sEH serves as a therapeutic target for treating HF. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT04108182.

Prevalence of Coronary Artery Disease in Patients Undergoing Valvular Heart Surgery.

BACKGROUND: The risk of coronary artery disease (CAD) in different valve dysfunction has been unclear. METHODS: We reviewed patients, who underwent valve heart surgery and coronary angiography from 2008 to 2021, at our center. RESULTS: A total of 7,932 patients were included in the present study, and 1,332 (16.8%) had CAD. The mean age of the study cohort was 60.5±7.9 years, and 4,206 (53.0%) were male. CAD was 21.4% in aortic disease, 16.2% in mitral valve disease, 11.8% in isolated tricuspid valve disease, and 13.0% in combined aortic and mitral valve disease. Patients with aortic stenosis were older than those with regurgitation (63.6±7.4 years vs. 59.5±8.2 years, P < 0.001), and the CAD risks also were higher (28.0% vs. 19.2%, P < 0.001). The age difference was minimal (60.6±8.2 years vs. 59.5±6.7 years, P = 0.002) between patients with mitral valve regurgitation and stenosis, but the risks of CAD were twice high in regurgitation (20.2% vs. 10.5%, P < 0.001). When the type of valve impairment was not considered, non-rheumatic etiology, advanced age, male sex, hypertension, and diabetes were independent predictors of CAD. CONCLUSION: In patients undergoing valve surgery, the prevalence of CAD was influenced by conventional risk factors. Importantly, CAD also was associated with the type and etiology of valve diseases.

Recurrent prosthetic valve dysfunction in a patient with idiopathic hypereosinophilic syndrome: A case report and literature review.

Idiopathic hypereosinophilic syndrome with cardiac involvement is characterized by endocardial fibrosis and thrombosis. Here, we report a case of mitral valve prosthetic dysfunction in a patient with idiopathic hypereosinophilic syndrome and review related cases in the literature. Valve replacement with a 27-mm St. Jude bioprosthetic mitral valve improved his symptoms and hypereosinophilia. A 4-year follow-up revealed that the prosthetic valve was intact without thrombosis. Because mechanical prosthesis implantation yields poor surgical outcomes, bioprosthesis is the preferred choice for patients with idiopathic hypereosinophilic syndrome. Medications for controlling eosinophilia may improve the long-term outcomes of valve replacement surgeries.

Impact of type 2 diabetes mellitus on mid-term mortality for hypertrophic cardiomyopathy patients who underwent septal myectomy.

BACKGROUND: Type 2 diabetes mellitus is common in cardiovascular disease. It is associated with adverse clinical outcomes for patients who had undergone coronary artery bypass and valve operations. The aim of this study was to evaluate the impact of type 2 diabetes mellitus on the midterm outcomes of patients with hypertrophic cardiomyopathy who underwent septal myectomy. METHODS: We retrospectively analyzed the data of 67 hypertrophic cardiomyopathy patients with type 2 diabetes mellitus who underwent septal myectomy from two medical centers in China from 2011 to 2018. A propensity score-matched cohort of 134 patients without type 2 diabetes mellitus was also analyzed. RESULTS: During a median follow-up of 28.0 (interquartile range: 13.0-3.0) months, 9 patients died. The cause of death of all of these patients was cardiovascular, particularly sudden cardiac death in 3 patients. Patients with type 2 diabetes mellitus had a higher rate of sudden cardiac death (4.5% vs. 0.0%, p = 0.04). The Kaplan-Meier survival analysis revealed that the rates of predicted 3-year survival free from cardiovascular death (98.1% vs. 95.1%, p = 0.14) were similar between the two groups. However, the rates of predicted 3-year survival free from sudden cardiac death (100% vs. 96.7%, p = 0.01) were significantly higher in hypertrophic cardiomyopathy patients without type 2 diabetes mellitus than in those with type 2 diabetes mellitus. Furthermore, after adjustment for age and sex, only N-terminal pro-brain natriuretic peptide (hazards ratio: 1.002, 95% confidence interval: 1.000-1.005, p = 0.02) and glomerular filtration rate ≤ 80 ml/min (hazards ratio: 3.23, 95% confidence interval: 1.34-7.24, p = 0.047) were independent risk factors for hypertrophic cardiomyopathy patients with type 2 diabetes mellitus. CONCLUSIONS: Hypertrophic cardiomyopathy patients with and without type 2 diabetes mellitus have similar 3-year cardiovascular mortality after septal myectomy. However, type 2 diabetes mellitus is associated with higher sudden cardiac death rate in these patients. In addition, N-terminal pro-brain natriuretic peptide and glomerular filtration rate ≤ 80 ml/min were independent risk factors among hypertrophic cardiomyopathy patients with type 2 diabetes mellitus.

Effectiveness of a patient-specific 3-dimensional printed model in Septal Myectomy of hypertrophic cardiomyopathy.

OBJECTIVE: Advanced cardiovascular surgery in structural heart disease require accurate pre-operative evaluation. Most of non-invasive imaging technologies remain limited in two-dimensional and show insufficiency of visualization for procedural planning. The aim of this study was to discuss the value of patient-specific 3-dimensional (3D) printing in treatment of hypertrophic cardiomyopathy (HCM). METHODS: Patient-specific 3D-printed models were constructed preoperatively in 12 consecutive HOCM patients which come to Beijing Anzhen Hospital for surgical treatment from October 2016 to March 2017. Image files were extracted from multi-slice computed tomography images, 3D models were constructed by the Mimics 19.0 software and generated by Objet350 Connex3 3D printer. The 3D-printed models were made with soft material that can be surgically performed. The modified Morrow myectomy of the model was performed before the operation. Clinical characters and echocardiographic parameters were recorded. RESULTS: There was no significant difference in tissue volume between the models and specimens. Preoperative and postoperative echocardiography showed the septal thickness was reduced from 18.8±4.5 mm to 12.7±3.3 mm (p<0.001), the left ventricular outflow tract obstruction was adequately relieved (83.0±27.73 mm Hg to 8.7±6.5 mm Hg, p<0.001), and the SAM disappeared completely after the operation. Cardiac function was improved in all patients (New York Heart Association functional class III to class I/II). CONCLUSIONS: The proposed optimal 3D-modelled septal myectomy allows intraoperative monitoring of the shape and volume of the myocardium resection to achieve the 'ideal' interventricular septum. It eliminates obstruction in the LVOT and SAM, resulting in LV remodeling with an increase in LV end-diastolic volume and diameter at early follow-up.

Biomechanical and Performance Evaluation of Magnetic Elliptical-Ring Compressive Anastomoses.

BACKGROUND: After magnetic compressive anastomosis, anastomat passage through the narrow channels of the digestive tract is difficult owing to the device's large volume. Such passage can lead to mechanical damage to the digestive tract or anastomat's unstable excretion time. This article presents a new magnetic compressive anastomotic approach. METHODS: A magnetic elliptical-ring compressive anastomat was designed and evaluated for placement and passage in vitro. Nine young adult dogs underwent laparotomy with intestinal tissue side-to-side anastomosis. Four different groups of magnetic compressive anastomats of two different magnetic force levels (20 N or 30 N) and shapes (round or elliptical) were implanted into each dog simultaneously. Three dogs were euthanized on each of postoperative day 1, day 4, and day 7. Anastomoses were then compared with respect to histology and tensile fracture force. RESULTS: The magnetic elliptical-ring compressive anastomat was functional but produced less obstruction compared to its round counterpart during passage through the esophagus and intestine. Nine dogs underwent successful surgery and harvesting of 30 total anastomoses. Histology of anastomotic tissue showed that, along the newly formed tunnel connecting the two sides of anastomotic tissues, compressed tissues became thinner and fell off, and initial anastomoses formed on the seventh postoperative day. There were large differences in tensile fracture force among the anastomoses formed by magnets with different magnetic forces of the same structure. However, the magnetic compressive anastomat structure did not affect anastomotic repair during magnetic compression anastomosis. CONCLUSIONS: The magnetic elliptical-ring compressive anastomat is an efficient anastomotic device that can be used easily and with good passage. The device has good biomechanical properties and can be used with endoscopy to reduce operative time.

One-Stage Hybrid Procedure for Patent Ductus Arteriosus Combined with Other Cardiac Anomalies in Adults.

Patients with patent ductus arteriosus (PDA) are usually detected and treated during childhood, however, some are not detected until adulthood. In addition, heart failure, severe pulmonary hypertension, and calcification of the ductus may also exist. Transcatheter occlusion has become a widely used technique for the closure of small to moderate sized PDAs since Cambier first reported use of Gianturco coils for transcatheter closure of PDA in 1992 [Cambier 1992]. In the case studies reported here, the one-stage hybrid procedure for PDA combined with other cardiac anomalies in adults was applied with satisfactory results.

Splenorenal shunt via magnetic compression technique: a feasibility study in canine and cadaver.

INTRODUCTION: The concept of magnetic compression technique (MCT) has been accepted by surgeons to solve a variety of surgical problems. In this study, we attempted to explore the feasibility of a splenorenal shunt using MCT in canine and cadaver. MATERIAL AND METHODS: The diameters of the splenic vein (SV), the left renal vein (LRV), and the vertical interval between them, were measured in computer tomography (CT) images obtained from 30 patients with portal hypertension and in 20 adult cadavers. The magnetic devices used for the splenorenal shunt were then manufactured based on the anatomic parameters measured above. The observation of the anatomical structure showed there were no special structural tissues or any important organs between SV and LRV. Then the magnetic compression splenorenal shunt procedure was performed in three dogs and five cadavers. Seven days later, the necrotic tissue between the two magnets was shed and the magnets were removed with the anchor wire. RESULTS: The feasibility of splenorenal shunt via MCT was successfully shown in both canine and cadaver, thus providing a theoretical support for future clinical application.

Effect of type 2 diabetes on cardiac arrhythmias in patients with obstructive hypertrophic cardiomyopathy.

AIMS: Type 2 diabetes (T2D), a prevalent cardiovascular disease, is linked with cardiac arrhythmias such as atrial fibrillation (AF) and ventricular arrhythmia. This study evaluated T2D's impact on these arrhythmias in patients with obstructive hypertrophic cardiomyopathy (OHCM). METHODS AND MATERIALS: We retrospectively analyzed the data of 75 patients with OHCM and T2D from two medical centers in China from 2011 to 2020. A propensity score-matched cohort of 150 patients without T2D was also analyzed. RESULTS: Altogether, 225 patients were included. The prevalence of supraventricular tachycardia (SVT), AF, and non-sustained ventricular tachycardia (NSVT) was higher in patients with HCM and T2D than in those without T2D. Multivariate logistic regression showed T2D as an independent risk factor for SVT (odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.01-3.58, P = 0.04), AF (OR = 2.68, 95% CI = 1.27-5.67, P = 0.01), and NSVT (OR = 2.18, 95% CI = 1.04-4.57, P = 0.04). Further analysis identified fasting glucose and glycosylated hemoglobin levels as independent risk factors for AF and NSVT in patients with T2D. CONCLUSIONS: T2D independently increases the risk of cardiac arrhythmias (SVT, AF, NSVT) in OHCM patients. Furthermore, fasting glucose and glycosylated hemoglobin levels independently heighten AF and NSVT risk in OHCM patients with T2D.

Obstructive sleep apnea is associated with postoperative dialysis in patients who underwent coronary artery bypass grafting.

BACKGROUND: The incidence of obstructive sleep apnea (OSA) is significantly higher in patients who undergo coronary artery bypass grafting (CABG). OSA is correlated with a higher incidence of postoperative complications in patients undergoing CABG. However, whether OSA is associated with a decrease in renal function and a higher incidence of dialysis after CABG remains unclear. METHODS: Data from 178 consecutive patients who underwent isolated CABG at Anzhen Hospital between June 2019 and June 2020 were analyzed. Polysomnography was performed in all the patients. RESULTS: A total of 142 (79.8%) patients were diagnosed with OSA, 78 with mild OSA, and 64 with moderate-to-severe OSA. Compared to patients without OSA, the level of creatinine was significantly increased, and the level of estimated glomerular filtration rate (eGFR) was decreased in patients with OSA. In addition, the percentage of patients undergoing dialysis during the perioperative period increased with the severity of OSA (0.0% vs. 2.6% vs. 18.8%, P=0.02). Multiple linear regression analysis showed that age (ß=-0.29, P<0.001), male sex (ß=-0.17, P=0.02), apnea-hypopnea index (AHI) (ß=-0.35, P<0.001), and creatinine (ß=-0.78, P<0.001) were independently associated with a decrease in eGFR (adjusted R2=0.376, P<0.001). However, in the multivariate logistic regression model, we found that the level of eGFR (OR =0.94, 95% CI: 0.89-0.99, P=0.02) and AHI (OR =1.07, 95% CI: 1.01-1.13, P=0.02) were independently associated with dialysis after CABG. CONCLUSIONS: OSA is associated with a decrease in renal function and is an independent risk factor for postoperative dialysis in patients who undergo CABG.

Impact of obstructive sleep apnea on new-set atrial fibrillation after septal myectomy in patients with hypertrophic obstructive cardiomyopathy.

BACKGROUND: Obstructive sleep apnea (OSA) is associated with a higher prevalence of postoperative atrial fibrillation in patients who underwent cardiac surgery. However, whether OSA is a risk factor for postoperative atrial fibrillation after septal myectomy remains unclear. We hypothesized that OSA was associated with postoperative atrial fibrillation after septal myectomy. METHODS: A total of 99 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were included in our manuscript. Polysomnography was performed in all patients, and the heart rhythm was continuously monitored during the perioperative period. RESULTS: In the present study, 25 (25.3%) patients developed postoperative atrial fibrillation after septal myectomy. The prevalence of postoperative atrial fibrillation was significantly higher in patients with OSA and increased with the worsening severity of OSA. Notably, the apnea-hypoxia index was significantly higher in patients with postoperative atrial fibrillation among the different OSA groups. In receiver operating characteristic analysis, the area under the curve for the apnea-hypopnea index was 0.785 (95% CI: 0.684-0.887, P<0.001); an apnea-hypopnea index of 10.4 was the optimal cutoff point to predict postoperative atrial fibrillation. In the multivariable analysis, apnea-hypopnea index ≥10.4 (odds ratio: 6.29, 95% CI: 2.18-18.14, P=0.001), moderate-to-severe OSA (odds ratio: 4.88, 95% CI: 1.42-16.86, P=0.01), and left atrium diameter (odds ratio: 1.12, 95% CI: 1.03-1.22, P=0.01) were independent risk factors associated with postoperative atrial fibrillation after adjusting for relevant variables. However, the association between the diagnosis of OSA and postoperative atrial fibrillation was no longer statistically significant. CONCLUSIONS: The severity of OSA reflected by the apnea-hypopnea index in patients with obstructive hypertrophic cardiomyopathy who underwent surgery is an independent risk factor for postoperative atrial fibrillation, which is associated with adverse clinical outcomes.

Effect of obstructive sleep apnea on right ventricular ejection fraction in patients with hypertrophic obstructive cardiomyopathy.

BACKGROUND: Obstructive sleep apnea (OSA) is a common disease associated with worse structural and functional impairment of the heart in patients with hypertrophic obstructive cardiomyopathy (HOCM). HYPOTHESIS: The presence and severity of OSA can decrease the right ventricular ejection fraction (RVEF) in patients with HOCM. METHODS: In total, 151 consecutive patients with a confirmed diagnosis of HOCM at Fuwai Hospital between September 2017 and September 2018 were included. Polysomnography and cardiac magnetic resonance imaging were performed in all patients. RESULTS: Overall, 84 (55.6%) patients were diagnosed with OSA. The RVEF significantly decreased with the severity of OSA (none, mild, moderate-severe: 46.1 ± 8.2 vs 42.9 ± 7.5 vs 41.4 ± 7.4, P = .009). The apnea-hypopnea index (AHI) was significantly high in patients with RVEF<40% among the different OSA groups (mild, moderate:7.7 ± 2.4 vs 9.6 ± 2.9, P = .03; 24.4 ± 9.0 vs 36.3 ± 18.0, P = .01). In the multiple linear regression model, the right ventricular end-systolic volume (ß = -0.28, P < .001), AHI (ß = -0.09, P = .02), and oxygen desaturation index (ß = -0.11, P = .04) were independently associated with a decrease in RVEF (adjusted R2 = 0.347, P < .001). Furthermore, the prevalence of RVEF<40% was high in patients with OSA. Compared with RVEF>40%, RVEF<40% was associated with more symptoms, mainly chest pain, chest distress, NYHA class III or IV, pulmonary hypertension, and moderate or severe mitral regurgitation. CONCLUSION: In patients with HOCM, the presence and severity of OSA is independently associated with a lower RVEF. In addition, compared with patients with RVEF>40%, those with RVEF<40% had more symptoms, including chest pain, chest distress, and NYHA class III or IV.

Surgical outcome for hypertrophic cardiomyopathy patients with extreme interventricular septal thickness: a propensity score matched study.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) with extreme interventricular septal thickness (IVST) is associated with a higher incidence of adverse cardiovascular events. However, the results of these patients who underwent septal myectomy are unclear. METHODS: We studied 47 HCM patients with IVST ≥30 mm who underwent septal myectomy between 2011 and 2018 in Anzhen Hospital. After a 2:1 propensity score matching, the study cohort included 141 patients and 94 patients with IVST <30 mm. RESULTS: Patients with IVST ≥30 mm had a longer clinical course of disease, high incidence of syncope, palpitation, and moderate or severe mitral regurgitation. After a mean follow-up of 34.0±21.3 months, 6 patients died, including 5 with IVST ≥30 mm and 1 with IVST <30 mm. The 5-year survival free of all-cause mortality was significantly higher in patients with IVST ≥30 mm than in those with IVST <30 mm (98.9% vs. 85.7%, P=0.03). Multivariable Cox analysis revealed that IVST ≥30 mm (HR: 1.12, 95% CI: 1.01-1.25, P=0.028) was an independent risk factor for all-cause mortality. Meanwhile, left ventricular end diastole diameter (HR: 0.72, 95% CI: 0.54-0.97, P=0.031) and age (HR: 0.91, 95% CI: 0.83-0.99, P=0.025) were also independent risk factors for all-cause mortality in this special cohort. Furthermore, the incidence of NYHA class III or IV was significantly higher in patients with IVST ≥30 mm. CONCLUSIONS: The surgical outcome was poor in a matched cohort of HCM patients with IVST ≥30 mm, which was mainly reflected by mortality and the incidence of NYHA class III or IV.

mir15a/mir16-1 cluster and its novel targeting molecules negatively regulate cardiac hypertrophy.

In response to pathological stimuli, the heart develops ventricular hypertrophy that progressively decompensates and leads to heart failure. miRNAs are increasingly recognized as pathogenic factors, clinically relevant biomarkers, and potential therapeutic targets. We identified that mir15a/mir16-1 cluster was negatively correlated with hypertrophic severity in patients with hypertrophic cardiomyopathy. The mir15a/mir16-1 expression was enriched in cardiomyocytes (CMs), decreased in hypertrophic human hearts, and decreased in mouse hearts after transverse aortic constriction (TAC). CM-specific mir15a/mir16-1 knockout promoted cardiac hypertrophy and dysfunction after TAC. CCAAT/enhancer binding protein (C/EBP)ß was responsible for the downregulation of mir15a/mir16-1 cluster transcription. Mechanistically, mir15a/mir16-1 cluster attenuated the insulin/IGF1 signal transduction cascade by inhibiting multiple targets, including INSR, IGF-1R, AKT3, and serum/glucocorticoid regulated kinase 1 (SGK1). Pro-hypertrophic response induced by mir15a/mir16-1 inhibition was abolished by knockdown of insulin receptor (INSR), insulin like growth factor 1 receptor (IGF1R), AKT3, or SGK1. In vivo systemic delivery of mir15a/mir16-1 by nanoparticles inhibited the hypertrophic phenotype induced by TAC. Importantly, decreased serum mir15a/mir16-1 levels predicted the occurrence of left ventricular hypertrophy in a cohort of patients with hypertension. Therefore, mir15a/mir16-1 cluster is a promising therapeutic target and biomarker for cardiac hypertrophy.

Application of 3D printing in the surgical planning of hypertrophic obstructive cardiomyopathy and physician-patient communication: a preliminary study.

BACKGROUND: The aim of this study was to evaluate the effect of 3-dimensional (3D) printing in treatment of hypertrophic obstructive cardiomyopathy (HOCM) and its roles in doctor-patient communication. METHODS: 3D-printed models were constructed preoperatively and postoperatively in seven HOCM patients received surgical treatment. Based on multi-slice computed tomography (CT) images, regions of disorder were segmented using the Mimics 19.0 software (Materialise, Leuven, Belgium). After generating an STL-file (StereoLithography file) with patients' data, the 3D printer (Objet350 Connex3, Stratasys Ltd., USA) created a 3D model. The pre- and post-operative 3D-printed models were used to make the surgical plan preoperatively and evaluate the outcome postoperatively. Meanwhile, a questionnaire was designed for patients and their relatives to learn the effectiveness of the 3D-printed prototypes in the preoperative conversations. RESULTS: The heart anatomies were accurately printed with 3D technology. The 3D-printed prototypes were useful for preoperative evaluation, surgical planning, and practice. Preoperative and postoperative echocardiographic evaluation showed left ventricular outflow tract (LVOT) obstruction was adequately relieved (82.71±31.63 to 14.91±6.89 mmHg, P<0.001), the septal thickness was reduced from 21.57±4.65 to 17.42±5.88 mm (P<0.001), and the SAM disappeared completely after the operation. Patients highly appreciated the role of 3D model in preoperative conversations and the communication score was 9.11±0.38 points. CONCLUSIONS: A 3D-printed model is a useful tool in individualized planning for myectomies and represent a useful tool for physician-patient communication.

Comparison of Clinical Effects between Percutaneous Transluminal Septal Myocardial Ablation and Modified Morrow Septal Myectomy on Patients with Hypertrophic Cardiomyopathy.

BACKGROUND: Percutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy (HCM). This study aimed to determine the clinical outcome of these two strategies. METHODS: From January 2011 to January 2015, 226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, after operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher's exact tests. Quantitative variables were compared using the paired samples t-test. RESULTS: Interventricular septal thickness was significantly reduced in both groups (21.27 ± 4.43 mm vs. 18.72 ± 4.13 mm for PTSMA, t = 3.469, P < 0.001, and 21.83 ± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P < 0.001, respectively). The left ventricular outflow tract (LVOT) pressure gradient (PG) significantly decreased after the operations in two groups (70.30 ± 44.79 mmHg vs. 39.78 ± 22.07 mmHg for PTSMA, t = 5.041, P < 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P < 0.001, respectively). Seven patients (10.29%) in the PTSMA group required a repeat operation in the follow-up. Eight (11.76%) patients were evaluated for New York Heart Association (NYHA) III/IV in the PTSMA group, which was significantly more than the five (3.16%) in the same NYHA classes for the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. CONCLUSIONS: Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA.

Comparison of surgical results in patients with hypertrophic obstructive cardiomyopathy after classic or modified morrow septal myectomy.

The study was conducted to evaluate the surgical results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either classic Morrow septal myectomy or modified procedure.The modified Morrow septal myectomy has gained interest as a new treatment for patients with drug-refractory symptoms of HOCM; however, its benefits in comparison to the classic procedure are unknown.In all, 236 symptomatic HOCM patients underwent surgical treatment from January 2006 to January 2015. Among them, 86 patients were treated by the classic Morrow myectomy and 150 patients via the modified procedure. Septal thickness, maximal left ventricular outflow tract (LVOT) pressure gradient (PG), and the presence of a permanent pacemaker were recorded after operation and follow-upThe left ventricular septal thickness (22.1 ±â€Š11.9 vs 17.1 ±â€Š4.0 mm for classic procedure, and 22.3 ±â€Š4.4 vs 16.1 ±â€Š3.5 mm for modified procedure; P < .001), LVOT velocity (410.6 ±â€Š134.0 vs 210.5 ±â€Š81.4 mm/s for classic procedure, and 432.7 ±â€Š119.3 vs 167.7 ±â€Š50.1 mm/s for modified procedure; P < .001), LVOT PG (76.0 ±â€Š43.5 vs 19.8 ±â€Š16.7 mm Hg for classic procedure, and 80.8 ±â€Š40.7 vs 12.3 ±â€Š8.5 mm Hg for modified procedure; P < .001) were significantly decreased after the operation in both groups. The modified group, however, showed significantly greater reduction in these echocardiographic parameters than the classic group. PG was completely eliminated in 142 (94.7%) patients receiving the modified myectomy, and a resting PG over 30 mm Hg was demonstrated in 16 (18.6%) patients in the classic group at follow-up (P = .001). Thirty-two (37.2%) patients in the classic groups had a mitral valve replacement, which is significant more than 14 (9.3%) in the modified group (P < .001).Both the classic procedure and the modified procedure can reduce LVOT obstruction and alleviate symptoms in patients with HOCM. The modified Morrow septal myectomy is superior to the classic procedure in reducing the LVOT gradient with a lower incidence of mitral valve replacement.

Choledochojejunostomy with an innovative magnetic compressive anastomosis: How to determine optimal pressure?

AIM: To investigate the optimal magnetic pressure and provide a theoretical basis for choledochojejunostomy magnetic compressive anastomosis (magnamosis). METHODS: Four groups of neodymium-iron-boron magnets with different magnetic pressures of 0.1, 0.2, 0.3 and 0.4 MPa were used to complete the choledochojejunostomy magnamosis. Twenty-six young mongrel dogs were randomly divided into five groups: four groups with different magnetic pressures and 1 group with a hand-suture anastomosis. Serum bilirubin levels were measured in all groups before and 1 wk, 2 wk, 3 wk, 1 mo and 3 mo after surgery. Daily abdominal X-ray fluoroscopy was carried out postoperatively to detect the path and the excretion of the magnet. The animals were euthanized at 1 or 3 mo after the operation, the burst pressure was detected in each anastomosis, and the gross appearance and histology were compared according to the observation. RESULTS: The surgical procedures were all successfully performed in animals. However, animals of group D (magnetic pressure of 0.4 MPa) all experienced complications with bile leakage (4/4), whereas half of animals in group A (magnetic pressure of 0.1 MPa) experienced complications (3/6), 1 animal in the manual group E developed anastomotic stenosis, and animals in group B and group C (magnetic pressure of 0.2 MPa and 0.3 MPa, respectively) all healed well without complications. These results also suggested that the time required to form the stoma was inversely proportional to the magnetic pressure; however, the burst pressure of group A was smaller than those of the other groups at 1 mo (187.5 ± 17.7 vs 290 ± 10/296.7 ± 5.7/287.5 ± 3.5, P < 0.05); the remaining groups did not differ significantly. A histologic examination demonstrated obvious differences between the magnamosis groups and the hand-sewn group. CONCLUSION: We proved that the optimal range for choledochojejunostomy magnamosis is 0.2 MPa to 0.3 MPa, which will help to improve the clinical application of this technique in the future.

[research status and application of magnetic compression anastomosis in surgery].

OBJECTIVE: To summarize the recent development of the magnetic compression anastomosis in surgery. METHODS: The abroad and domestic relevant literature about magnetic compression anastomosis was extensively reviewed, and comprehensive analyzed. RESULTS: Magnetic compression anastomosis in the reconstruction of the body lumen is a simple and effective way; laparoscopy combined with magnetic compression anastomosis has the advantages of small wound and quick recovery. Magnetic compression anastomosis has been increasingly used in clinical practice. But its mechanism has not been fully revealed, and it is difficulty in expelling out of the magnet for the gastrointestinal and certain large-size lumen, so further research and optimization are still needed. CONCLUSION: Relative to the traditional manual suture, magnetic anastomosis has great advantage, especially a combination of magnetic compression anastomosis and minimally invasive surgery has bright prospects for development.