Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St. Thomas crystalloid cardioplegia: A 12-year study from a single institution.

Cardioplegic reperfusion during a long-term ischemic period interrupts cardiac surgery and increases cellular edema due to repeated administration. The present clinical study compared the protective effects of histidine-ketoglutarate-tryptophan (HTK) solution and St. Thomas crystalloid cardioplegia. Clinical experiences of the myocardial protection induced by one single perfusion with HTK were reviewed in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease. This retrospective study included 88 high-risk patients (aortic cross-clamp time, >120 min) between March 2001 and July 2012. The cohort was divided into two groups according to the technique used. Either myocardial protection was performed with one single perfusion with HTK solution (HTK group) or with conventional St. Thomas crystalloid cardioplegia (St group). The duration of cardiopulmonary bypass did not differ between the two groups. The mortality, morbidity, intensive care unit (ICU) stay, postoperative hospitalization, and transfusions of HTK group are significantly lower than those of the St group (P<0.05). Univariate and multivariate analysis demonstrated that HTK is a statistically significant independent predictor of decreased early mortality and morbidity (P<0.05). In conclusion, the present findings suggested that HTK solution decreases mortality, morbidity, ICU stay, postoperative hospitalization, and transfusions in high-risk patients with severe pulmonary arterial hypertension associated with complex congenital heart disease.

Effect analysis of repeat sternotomy in pediatric cardiac operations.

BACKGROUND: Reoperation for congenital heart disease may be associated with cardiac or vascular injuries during repeat sternotomy, resulting in increased mortality and/or morbidity rates. The aim of this study was to determine the frequency of these cardiac injuries and the associated outcome. METHODS: Between January 2012 and December 2013, 4256 sternotomy procedures were performed at the Pediatric Cardiac Center in Fuwai Hospital, including 195 repeat sternotomy procedures (RS). We retrospectively studied the clinical data of 195 RS patients and 250 randomly selected primary sternotomy (PS) patients. Demographic and operative details, major injures (MI), and clinical outcomes were compared between the two groups. We also assessed the risk factors for major injury and in-hospital mortality and morbidity. RESULTS: Significant differences were observed between the RS and PS groups in terms of skin incision to cardiopulmonary bypass(CPB) time, overall CPB time, cross-clamp time and blood requirement, and ventilation time (p < 0.001). MI during RS occurred in 7 of the 195 patients (3.6 %), while operative mortality was 1.0 % (2/195). However, in the RS patients, mortality and morbidity rates were not significantly different between the MI subgroup and the non-MI subgroup (p = 1.000 and 0.556, respectively). Additionally, no significant difference was found between the RS and PS groups in terms of mortality (p = 1.000) and morbidity (p = 0.125). CONCLUSIONS: Both RS and MI are not associated with increased risk of operative mortality and morbidity. Outcomes for reoperative pediatric operations in contemporary practice are similar with those for primary operations.

[Aortic valve preservation and root reconstruction in Marfan syndrome].

OBJECTIVE: To explore the experiences of aortic valve preservation and root reconstruction in patients with Marfan syndrome. METHODS: From July 2003 to Dec 2007, 22 patients with Marfan syndrome were treated by aortic valve preservation and root reconstruction. There were 12 male and 10 female, the age ranged from 10 to 57 years old with a mean of (28 +/- 10) years. The operation procedures included reimplantation technique in 9 patients, remodeling technique in 8 patients, and patch technique in 2 patients. In addition, reimplantation technique + total aorta replacement in 1 patient, remodeling technique + "aortic arch replacement + stent-elephant trunk" in 1 patient, patch technique + "aortic arch replacement + stent-elephant trunk" in 1 patient. The patients were followed-up by 17 to 64 months with a mean of (46 +/- 16) months. RESULTS: No in-hospital and follow-up period death occurred. There was one reexploration for bleeding 1 d postoperative. No valve-related complication occurred during the follow-up. At the end of follow-up, no aortic regurgitation was demonstrate in 16 patients, but mild regurgitation in 4 patients, moderate regurgitation in 1 patient and severe regurgitation in 1 patient. Two patients with moderate and severe aortic regurgitation need reoperation 1 year postoperative. CONCLUSION: The early and mid-term results of aortic valve preservation and root reconstruction operations in Marfan syndrome were favorable.

Perivenous application of fibrin glue prevents the early injury of jugular vein graft to arterial circulation in rabbits.

BACKGROUND: Placement of an external support has been reported to prevent intimal hyperplasia of vein grafts. However, it is limited by potential complications. In the present study, we investigated the effect of fibrin glue on preventing vein graft failure as perivenous application. METHODS: Twenty-four rabbits were divided into non-supported group (n = 12) and fibrin glue group (n = 12). All animals underwent unilateral jugular vein into common carotid artery interposition grafting and then fibrin glue was applied as perivenous support. Samples of tissues were harvested after 4 weeks. RESULTS: The vein grafts with fibrin glue demonstrated a statistically significant decrease in proliferating cell nuclear antigen in the medial/intimal region [13.38% (11.26% - 15.11%)] compared with non-supported vein grafts [31.22% (27.15% - 35.98%)] (P < 0.001). Light microscopy showed remarkable attenuation of endothelial cell loss and numerous microvessels in neoadventitia in the fibrin glue group compared with the non-supported group. The smooth muscle cells migrated into adventitia significantly in fibrin glue group, whereas the smooth muscle cells migrated into intima in non-supported group. Conclusion Perivenous support of vein graft with fibrin glue in vivo can attenuate the severe injury encountered in the non-supported vein grafts exposed to artery.

[Surgical treatment of giant coronary artery aneurysm].

OBJECTIVE: To discuss the clinical features and surgical treatments of giant coronary artery aneurysm (CAA). METHODS: From July 1996 to October 2004, 6 giant CAA patients were underwent surgery at Fuwai hospital. Three cases were underwent CAA resection, 2 concomitant coronary bypass, 3 reconstruction. The giant CAA was often combined with other cardiac diseases. Four cases underwent additional procedures of fistula closure, 3 aortic valve replacements, 2 aortoplasty and 1 thrombus cleaning at the same time. RESULTS: All patients recovered uneventfully. The mean of cardiopulmonary bypass time was (144 +/- 26) min (range 67 to 207 min). Aortic cross clamping time was (104 +/- 21) min (range 56 to 172 min). Patients follow-up time occurred from 8 to 87 months (mean of 48 months). All patients were free of symptoms during follow-up. None of the patients died during the follow-up period and none of the CAA recurred. CONCLUSIONS: The giant CAA is a serious cardiovascular disease, early diagnosis and surgical treatment are mandatory.

[Effect of the biodegradable chitosan external stent on the early changes in the rabbit vein grafts].

OBJECTIVES: To investigate the effect of chitosan biodegradable external stent (CES) on the early changes of rabbit vein graft (VG). METHODS: Rabbit vein grafting models were divided into S group (with perivenous CES) and NS group (without perivenous CES). The VG were harvested in 1 week, 2 weeks, 4 weeks after operation, respectively. The expression of proliferating cell nuclear antigen (PCNA) was used for evaluating the proliferation of the smooth muscle cell (SMC). The thickness, area of neointima and media of the VG were calculated by computer imaging analysis system. RESULTS: CES began to degrade in 2 weeks after operation. The thickness, area of both neointima and media of the VG in S group, increased mildly in 1 week after operation, and kept steady in 1 or 2 weeks after grafting, which was significantly less than NS group (both P < 0.01), then increased mildly in 4 weeks after grafting but still less than NS group (P < 0.05). The expression of PCNA of SMC decreased significantly in comparison with NS group though increasing mildly in four weeks after operation. Both neointimal formation and cell proliferation in the graft wall were significantly reduced by external stenting as compared to the results with unstented grafts. CONCLUSIONS: CES may reduce early intimal and medial hyperplasia, and may be beneficial in improving the long term patency of the VG. The biodegradable characteristics of the CES may influence its effect.