Minimally invasive direct coronary artery bypass after percutaneous coronary intervention.

OBJECTIVES: Minimally invasive direct coronary artery bypass (MIDCAB) with the left internal thoracic artery (LITA) provides excellent long-term results for isolated left anterior descending coronary artery (LAD) disease. We tried to evaluate the impact of the previous percutaneous coronary intervention (p-PCI) for LAD on the clinical outcomes of MIDCAB in this study. METHODS: A total of 197 patients with isolated LAD disease underwent MIDCAB in our center from February 2009 to May 2020. 51 patients had the p-PCI for LAD and 146 patients did not. The primary outcome was the major adverse cardiovascular event (MACE). RESULTS: The incidences of the perioperative outcomes were comparable between the two groups (p > .05). The median follow-up time was 48.0 months (interquartile range, 25.9-85.5 months). The incidences of MACE (p < .001) and myocardial infarction or recurrent angina (p < .001) were significantly higher in the p-PCI group than those in the non-PCI group. The estimated 5-year freedom from MACE in the p-PCI group was significantly lower (56.1%, 95% confidence interval [CI]: 41.2%-71.0% vs. 83.4%, 95% CI: 76.7%-90.1%, p < .001). The previous LAD-PCI (hazard ratio [HR]: 2.664, 95% CI: 1.471-4.822, p = .001) and the history of peripheral arterial disease (HR: 3.145, 95% CI: 1.085-9.113, p = .035) were the independent predictors of MACE. The p-PCI group had a higher diseased graft rate than the non-PCI group (10.9% vs. 2.3%, p = .046). CONCLUSIONS: The previous LAD-PCI may deteriorate the outcomes of MIDCAB in patients with isolated LAD disease.

One-stage surgical correction of congenital tracheal stenosis complicated with congenital heart disease in infants and young children.

OBJECTIVES: Although the outcome of surgical treatment of congenital tracheal stenosis (CTS) has improved, surgical intervention for these patients, especially for those with associated congenital heart disease (CHD) remains challenging. In this report, we summarized our experience with these defects. METHODS: Clinical data were collected for children undergoing tracheoplasty and CHD surgery from January 2001 to March 2013. Bivariate and multiple regression analyses were used to determine the correlation between the variables. RESULTS: Forty-three patients underwent simultaneous repair of CTS and CHD. Their ages ranged from two months to nine years (mean 23.16 months) and weights from 3.5 to 46.1 kg (mean 10.71 kg). Associated CHD included pulmonary artery sling (n = 31), tetralogy of Fallot (n = 5), ventricular septal defect (n = 4), atrial septal defect (n = 4), double aortic arch (n = 2), and pulmonary atresia with ventricular septal defect (n = 1). Five patients underwent simple tracheal resection, eight patients underwent tracheal autograft, and 30 patients received slide tracheoplasty. There were seven deaths, five early and two late; the most common cause was the growth of granulation tissue. In bivariate analysis, the length of tracheal stenosis (p < 0.01), age (p < 0.01), and complications (p < 0.01) were associated with mortality. Shorter duration of postoperative mechanical ventilation (p < 0.05) and less serious complications (p < 0.05) were associated with slide tracheoplasty. The percentage of slide tracheoplasty was higher in long-segmental and diffuse tracheal stenosis (p < 0.01). CONCLUSIONS: Slide tracheoplasty is the best option for surgical treatment of long-segmental and diffuse tracheal stenosis. Simultaneous repair of associated CHD did not increase the complication rate and is the procedure of choice for patients with combined CTS and CHD.

Minimally invasive valve surgery including patients of combined simultaneous surgery: a retrospective study.

OBJECTIVE: This study investigated the perioperative safety and advantages of performing a minimally invasive valve surgery (MIVS) and conducting a preliminary examination of the combined simultaneous surgery (CSS). METHODS: A total of 29 patients (16 men and 13 women; mean age, 58.41 ± 13.08 years) who underwent MIVS at our center from July 2021 to March 2022 were selected. Among them, 16 patients underwent aortic valve surgery (AVS), 13 patients underwent mitral valve surgery (MVS), and four patients additionally underwent CSS. RESULTS: The MIVS time ranged from 165 to 420 min, with a mean of 230.54 ± 54.61 min; the cardiopulmonary bypass (CPB) time ranged from 54 to 164 min, with a mean of 120.24 ± 25.98 min; the aortic cross-clamp (ACC) time ranged from 36 to 118 min, with a mean of 78.66 ± 21.01 min and an automatic heart resuscitating rate was 89.66%; the mean tracheal intubation time was 6.30 ± 3.87 h, and the median total postoperative drainage was 317.5 (35, 1470) ml. No difference was observed between preoperative and postoperative left ventricular ejection fraction (LVEF) (61.90% ± 6.28% vs. 60.21% ± 5.52%, P = 0.281). The difference in postoperative drainage (419.20 ml ± 377.20 ml vs. 588.75 ml ± 673.63 ml, P = .461), tracheal intubation time (6.66 h ± 4.27 h vs. 4.63 h ± 1.11 h, P = .359), intensive care unit (ICU) stay (3.96 ± 8.62 days vs. 2.00 ± 0.816 days, P = .658), and postoperative hospital stay (9.96 ± 8.45 days vs. 8.25 ± 1.26 days, P = .694) between MIVS and CSS was not significant. CONCLUSION: MIVS in our center may be safe and effective. Additionally, CSS may be a feasible option that could be performed after a thorough preoperative evaluation and multidisciplinary discussion.

A pilot study of a novel biodegradable magnesium alloy airway stent in a rabbit model.

OBJECTIVE: To preliminarily investigate the feasibility of bioabsorption tracheal stenting for the therapeutic application of congenital tracheal stenosis (CTS). STUDY DESIGN: Experimental research. SETTING: Shanghai Children Medical Center, National Children's Medical Center. SUBJECTS AND METHODS: Five kinds of magnesium alloys with different compositions were studied in this paper, a patented Mg-Nd-Zn-Zr alloy series namely JDBM (JiaoDa BioMg) and four Mg-Ca-Zn alloys. The cytotoxicity of alloys was evaluated by the MTS ([3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium) assay in rabbit tracheal epithelial cells. Specific magnesium alloys had been immersed in the cell culture medium for 24 h. The tracheal stents that were made of magnesium alloy were implanted into the trachea of New Zealand rabbits and the ablation of the stent was monitored by fiber bronchoscopy. The routine blood examination was conducted prior to and following the stent placement. The rabbits were euthanized following 2-3 months of stenting. H&E staining of the main organs was conducted and the induction of apoptosis of the tracheal tissues was monitored. RESULTS: The cytotoxicity of the JDBM magnesium alloy was mild and lower than the remaining 4 alloys. The stents were placed successfully in five animals. The tracheal stents were successfully placed and gradually biodegradated as monitored by fiber bronchoscopy; no significant systemic inflammatory response was noted. No significant differences in the liver and/or kidney function prior to and following stent placement were noted. H&E staining indicated the absence of pathological changes in the trachea, liver, heart and/or kidney tissues. The apoptotic assay indicated that the apoptosis ratio of the tracheal tissues was comparable between rabbits with and without tracheal stenting. CONCLUSION: The results suggested the feasibility of bioabsorption stents made of biodegradable magnesium alloys using in patients with tracheal stenosis, especially in infants.

[The Expression of hTERT mRNA and p16 Protein in Non-small Cell Lung Cancer.].

BACKGROUND: hTERT and p16 are involved in oncogenesis and development of tumor. The aim of this study is to investigate the expression of human telomerase reverse transcriptase (hTERT) and p16 in non-small cell lung cancer (NSCLC). METHODS: The quantitative reverse transcription-polymerase chain reaction (RT-qPCR) and immunohistochemistry were applied to detect the hTERT and p16 in tissue of 21 cases of lung benign diseases and 117 of non-small cell lung cancer and adjacent tissues, respectively. RESULTS: hTERT mRNA levels from NSCLC in 117 patients and normal lung tissue in 21 normal controls were 2.937+/-0.836 and 2.042+/-0.378, respectively (t=-5.242, P<0.01). Expression of p16 protein was observed in 85.7% of normal tissues, while 47.9% of lung cancer tissues showed p16 protein expression (P=0.004). The expression of hTERT mRNA was significantly correlated with the histology (P<0.05); the expression of p16 protein was significantly correlated with the clinical stage, degree of differentiation and lymph node metastasis (P<0.05). The significant correlation between the expression of hTERT and p16 (P<0.05). CONCLUSIONS: The hTERT may be useful in clinical diagnosis of NSCLC. Expression of hTERT and p16 is related to the carcinogenesis and development of NSCLC.