A mortality risk assessment model for cardiac valve replacement surgery and its application in the use of prophylactic extracorporeal membrane oxygenation.

This study was conducted to establish a quantitative model to predict the risk of in-hospital mortality for patients undergoing cardiac valve replacement and to decrease mortality in patients with predicted high risk using prophylactic extracorporeal membrane oxygenation (PECMO). We retrospectively reviewed the medical records of 4482 patients who underwent cardiac valve replacement from January 1994 to December 2004, at Anzhen Hospital, Beijing, China. A total of 158 patients were going to receive heart valve replacement. Associations between mortality and the demographic, clinical, and laboratory variables of patients were first assessed using univariate analysis. Six of 7 variables in the univariate analysis were statistically significant and were included in the multivariate analysis: renal function; age; left ventricular ejection fraction (EF); coronary artery disease (CAD); pulmonary artery pressure (PAP); and left ventricular end-diastolic diameter (LVEDD). The area under the receiver operating characteristic (ROC) curve (AUC) was 73.58%. Observed mortality in the group with PECMO (5.45%, 3/55) was significantly lower (Pearson Chi2 = 4.314, P = 0.038, P < 0.05) than in the group without PECMO (24.27%, 25/103). With the use of our scoring model, the risk of postoperative mortality in patients planning to undergo valve replacement can be predicted before the procedure is performed. For patients with predicted mortality greater than 10%, the use of PECMO during surgery, in addition to extracorporeal circulation, was found to decrease mortality.

The key role of apoptosis in the pathogenesis and treatment of pulmonary hypertension.

In recent years, the process of the programmed cell death has gained much interest because it has important pathophysiological consequences contributing to the deletion of unwanted cells in the vessel wall, loss of pulmonary smooth muscle cells and therefore in reversing the pulmonary pressure. For the reason that most patients with pulmonary hypertension present with limited reversibility with vasodilators, antiremodeling approach for treatment appears to be feasible. Induction or enhancement of vascular smooth muscle cells apoptosis may be targeted to develop novel therapeutic approaches for pulmonary vascular remodeling in patients with pulmonary hypertension. This review summarizes the current mechanisms, investigate the roles and provide novel insights into the potential therapeutic value of apoptosis in the pulmonary artery remodeling of pulmonary hypertension.

Video-assisted minimally invasive surgery for lone atrial fibrillation: a clinical report of 81 cases.

OBJECTIVE: We sought to evaluate the feasibility and efficacy of a new type of video-assisted minimally invasive surgery for patients with atrial fibrillation. METHODS: Between December 2006 and February 2008, 81 patients with lone atrial fibrillation (49 with paroxysmal, 17 with persistent, and 15 with long-standing persistent atrial fibrillation) underwent this therapy with a bipolar radiofrequency ablation system. The main surgical procedures included bilateral pulmonary vein antrum isolation, obliteration of the left atrial appendage, division of the ligament of Marshall, and intraoperative electrophysiologic testing. RESULTS: The mean operation duration was 2.5 hours. One (1.2%) case was confirmed of left atrial appendage thrombus during the procedure. One (1.2%) patient was converted to sternotomy during the operation. Reintubation occurred in 1 (1.2%) patient, and acute heart failure occurred in 1 (1.2%) patient. One (1.2%) patient died of cerebral infarction 1 month after the operation. Follow-up was done between 3 and 19 months (mean, 12.7 +/- 3.9 months) after the operation. At discharge, 72.5% (58/81) of all patients were in sinus rhythm (paroxysmal atrial fibrillation, 83.7%; persistent atrial fibrillation, 64.7%; and long-standing persistent atrial fibrillation, 40.0%). At 3 months, overall 78.5% (62/79) were in sinus rhythm (paroxysmal atrial fibrillation, 85.7%; persistent atrial fibrillation, 82.4%; and long-standing persistent atrial fibrillation, 46.2%). At 6 months, overall 78.5% (62/79) were in sinus rhythm (paroxysmal atrial fibrillation, 85.7%; persistent atrial fibrillation, 70.6%; and long-standing persistent atrial fibrillation, 61.5%). At 12 months, overall 79.6% (39/49) were in sinus rhythm (paroxysmal atrial fibrillation, 80.0%; persistent atrial fibrillation, 75.0%; and long-standing persistent atrial fibrillation, 66.7%). At 18 months, 88.9% (8/9) of the paroxysmal group were in sinus rhythm. CONCLUSIONS: This minimally invasive technique proves to be safe and less traumatic and presents optimistic early outcomes for patients with paroxysmal and persistent atrial fibrillation. It might find wider application if more ablation lesions could be enrolled for long-standing persistent atrial fibrillation.