Prediction model for the risk of postoperative death in patients with acute type A aortic dissection / 中华胸心血管外科杂志

Objective:Using different machine learning methods to construct and screen the best prediction model for predicting the risk of death within 30 days after surgery in patients with acute type A aortic dissection.Methods:Five hundred and twenty-one patients with acute type A aortic dissection who underwent surgery between 2015 and 2022 were included, after collecting their perioperative date and screening them, 329 patients were retained. two different groups of predictor variables were generated by using Lasso regression and principal component analysis, after that, logistic regression, support vector machine algorithm, random forest algorithm, gradient boosting algorithm, and super learning algorithm were used to develop prediction models for the risk of death within 30 days after surgery. Finally, we compare the models and select the best one. Results:The AUC values for all models rangrd from 0.791-0.959. The model using Lasso regression to determine the predictor variables and built by the super learning algorithm had the best prediction with an AUC value of 0.959. Conclusion:The super learning algorithm better than other algorithms in predicting death within 30 days after acute type A aortic dissection.

A nomogram prediction model for acute Stanford type A aortic dissection / 中华胸心血管外科杂志

Objective:This study was conducted to investigate the independent risk factors for predicting the occurrence of acute Stanford type A aortic dissection(TAAD), and to construct a nomogram model for predicting the occurrence of TAAD.Methods:The clinical data of patients meeting the diagnostic criteria for TAAD admitted to Tianjin Chest Hospital from June 2016 to December 2021 and healthy people examined by the physical examination center of Tianjin Chest Hospital during the same period were retrospectively collected, and the independent risk factors for TAAD were predicted by propensity matching analysis. Univariate and multivariate Logistic regression were used to analyze the variables with statistical differences, and a nomogram model was constructed to predict the occurrence of TAAD disease according to the screened risk factors. Results:A total of 148 patients in the TAAD group and 5 690 patients in the control group were collected. After bias matching analysis, 148 pairs were successfully matched. Multivariate Logistic regression analysis was performed on the matching results. The results showed that hypertension(HBP), diabetes mellitus(T2DM), Lp(a), very low density lipoprotein(VLDL) and apolipoprotein A1/B(ApoA1/B) were independent risk factors for the development of TAAD. HBP, Lp(a) and ApoA1/B were pathogenic factors( OR 7.267, 1.010 and 2.199, P<0.05, respectively), while T2DM and VLDL were protective factors( OR 0.173 and 0.139, P<0.05). Based on the independent risk factors obtained by multi-factor Logistic regression analysis, a nomogram model of TAAD incidence was constructed. The area under ROC curve( AUC) for predicting the onset of TAAD was 81.6%(95% CI: 0.766-0.863), and the internal calibration curve was close to the standard curve. Conclusion:This model has a good degree of differentiation and calibration, which is helpful for clinicians to guide healthy people to prevent the occurrence of TAAD and provide a theoretical basis for the prevention of TAAD.

Efficacy of low-dose inhaled nitric oxide in the treatment of severe hypoxemia after Sun’soperation: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective To investigate the efficacy of low-dose inhaled nitric oxide (iNO) in the treatment of severe hypoxemia after Sun’s operation. Methods The clinical data of patients undergoing Sun’s operation for acute Type A aortic dissection in our hospital from January 2020 to June 2022 were retrospectively analyzed. Patients who received conventional treatment before November 2021 were enrolled as a control group. After November 2021, iNO was used in our hospital, and the patients who received iNO as an iNO group. The preoperative clinical baseline data, perioperative clinical data and oxygenation index were compared between the two groups. Results A total of 54 patients were included in the control group, including 45 males and 9 females, with an average age of 53.0±10.9 years. A total of 27 patients were included in the iNO group, including 21 males and 6 females, with an average age of 52.0±10.6 years. The preoperative body mass index of the two groups was greater than 25 kg/m2, white blood cell count, C-reactive protein were significantly higher than normal level, but there was no statistical difference between the groups (P＞0.05). There were no statistical differences in intraoperative data between the two groups (P＞0.05). The iNO group had significantly shorter duration of mechanical ventilation, postoperative ICU stay, and postoperative hospital stay than the control group (P<0.001). After 12 h of iNO treatment, hypoxic condition improved obviously, oxygenation indices in 12 h, 24 h, 36 h,48 h, 60 h and 72 h in the iNO group were significantly higher than those in the control group (P<0.05). Conclusion The treatment of severe hypoxemia after Sun’s surgery with low-dose of iNO is safe and effective, can significantly improve oxygenation function, and has significant advantages in shortening ventilator use time, postoperative ICU stay and postoperative hospital stay, but it is not significant in changing postoperative mortality.

Efficacy and safety of extended dual antiplatelet therapy beyond 12 months after coronary artery bypass grafting / 中华胸心血管外科杂志

Objective:To investigate the efficacy and safety of prolonged dual antiplatelet therapy (DAPT) (aspirin + clopidogrel) after coronary artery bypass grafting (CABG) for more than 12 months.Methods:1 900 patients who received CABG treatment in Tianjin Chest Hospital from January 2019 to October 2020 were continuously included, and 1 528 patients were finally identified according to the inclusion and exclusion criteria. According to whether the patients continued to take DAPT treatment 12 months after discharge, they were divided into the extended DAPT group and the standard DAPT group. Cox multivariate regression and propensity score matching (PSM) analysis were performed on major cardiovascular and cerebrovascular adverse events (MACCE) and clinically related bleeding events in the two groups during 12-24 months after discharge to evaluate the efficacy and safety of extended DAPT treatment for more than 12 months. Results:Of the 1 528 patients, 624 (40.8%) continued to take DAPT 12 months after discharge. Compared with patients receiving standard DAPT, patients receiving extended DAPT had a lower incidence of MACCE within 12 to 24 months ( HR=0.597, 95% CI: 0.399-0.892, P=0.012); ( HR=0.519, 95% CI: 0.338-0.798, P=0.003), and there was no significant increase in clinically relevant bleeding risk ( HR=1.209, 95% CI: 0.522-2.798, P=0.658), ( HR=1.112, 95% CI: 0.452-2.737, P=0.817). At the same time, prolonged DAPT treatment also brought a good net benefit. Conclusion:Prolonged DAPT treatment after CABG for more than 12 months significantly reduced the risk of ischemia at 12-24 months after surgery, and did not significantly increase the risk of bleeding at 12-24 months after surgery. It may be beneficial for patients treated with CABG to continue DAPT (aspirin+ clopidogrel) on the basis of intensive DAPT therapy for 1 year.

Risk factors for continuous renal replacement therapy after total arch replacement of Stanford type A aortic dissection under moderate hypothermia circulatory arrest / 中华胸心血管外科杂志

Objective:To investigate the risk factors of acute kidney injury(AKI) combined with continuous renal replacement therapy(CRRT) after Stanford type A dissection under moderate hypothermia circulatory arrest(MHCA).Methods:From October 2017 to March 2020, all patients with Stanford type A dissection and total arch replacement surgery under MHCA were enrolled. According to whether receiving CRRT treatment, the patients were divided into CRRT group(49 cases) and control group(72 cases). Both tow groups chose the brain protection strategy of moderate hypothermia, the left common carotid artery and the innominate artery were perfused anteriorly. Relevant medical data was collected.Results:There was no statistical difference in age, sex, smoking history, and drinking history between the two groups of patients( P>0.10). There were statistical differences between the two groups in the diameter of the aortic sinus and whether Bentall surgery was performed at the same time( P≤0.05). On the 1st postoperative day, the serum creatinine(sCr) of the CRRT group was significantly higher than that of the control group[(214.04±79.51) μmol/L vs.(127.32±58.08) μmol/L]. The change trend of sCr was not obvious within 2 to 4 days after operation. The sCr of the control group was significantly lower than that of the CRRT group within 4 days after surgery[(264.20±111.76) μmol/L vs.(104.24±76.00) μmol/L]. The diameter of aortic sinus, combined with Bentall surgery, intraoperative red blood cell transfusion, intraoperative platelet transfusion, intraoperative autologous blood transfusion, intraoperative bleeding were positively correlated with whether CRRT was performed after surgery( P<0.10), while intraoperative plasma The amount of blood transfusion was negatively correlated with postoperative CRRT( P<0.05). Conclusion:The diameter of the aortic sinus before surgery, combined Bentall surgery, intraoperative blood transfusion products and intraoperative bleeding are risk factors for postoperative CRRT.

Liriodendrininhibits cardiomyocyte apoptosis in acute myocardial infarction rats / 中华老年医学杂志

Objective:To investigate the protective effect of liriodendrin on acute myocardial infarction in rats and to explore the related mechanisms.Methods:From January to December 2019, 30 SPF male Wistar rats with a body weight of(200±10)g were randomly divided into a sham operation group, a control group, and a liriodendringroupwith 10 rats in each group using the numerical sampling method.The liriodendron group was intragastrically administered with a liriodendrinsolution(10 ml/kg)once a day from 5 days before myocardial infarction model construction to 3 days after surgery.The control group and the sham surgery group were intragastrically administered with 10 ml/kg normal saline.After surgery, high-sensitivity troponin T levels were measured in the three groups.Cardiac function of the rats was assessed using echocardiography on the 3rd day post-surgery.Then, the rats were sacrificed, followed by hematoxylin-eosin(HE)staining and TdT-mediated dUTP nick-end labeling(TUNEL)staining of cardiac tissues and measurement of interleukin(IL)-1β and tumor necrosis factor(TNF-α)levels.Western blot and real-time polymerase chain reaction(PCR)were used to detect the expression of apoptosis-related proteins and transcriptional activity.Results:High-sensitivity troponin T levels in the liriodendrin group[(1.74±0.63)μg/L]were lower than in the myocardial infarction group[(3.54±1.60)μg/L]at 2 hours after surgery( t=2.69, P<0.05). Echocardiography showed that, compared with the myocardial infarction group, the ejection fraction was higher in the liriodendrin group, and the left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume were lower in the liriodendrin group( P<0.05). Histological staining showed that the myocardial tissue of the control group was severely damaged, with infiltration of a large number of in flammatory cells.The number of TUNEL-positive cells in the liriodendrin group(56.66±2.414)was statistically significantly reduced, compared with in the myocardial infarction group(76.55±1.843)( t=6.55, P<0.05). The levels of IL-1β and TNF-α in the myocardial infarction group were higher than those in the liriodendrin group( P<0.05). The expression of apoptosis-related proteins in the liriodendrin group was lower( P<0.05)and the transcriptional activity of mRNA was also lower( P<0.05)than in the myocardial infarction group. Conclusions:Liriodendrin may protect cardiomyocytes after myocardial infarction in rats by inhibiting local inflammation and cell apoptosis.

Effects of different doses of ulinastatin on pulmonary function in patients undergoing total aortic arch replacement / 中华麻醉学杂志

Objective:To evaluate the effects of different doses of ulinastatin on lung function in patients undergoing total aortic arch replacement.Methods:One hundred and thirty five patients with acute Stanford type A aortic dissection of both sexes, aged 20-70 yr, with body mass index of 16.2-33.3 kg/m 2, of American Society of Anesthesiologist physical status Ⅳ, were divided into 3 groups ( n=45 each) using a random number table method: high-dose ulinastatin group (group H with total dose of 30 000 U/kg), low-dose ulinastatin group (group L with total dose of 20 000 U/kg) and control group (group C). In group H and group L, half of the total dose of ulinastatin was given after induction of anesthesia, the rest of the total dose was primed after being added to cardiopulmonary bypass (CPB) circuit, while normal saline 100 ml was given at the same time point in group C. After induction of anesthesia (T 0), and at 3, 6, 12, 24 and 48 h after the beginning of CPB (T 1-5), blood samples from the central vein were collected for determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). The oxygenation index (OI) and alveolar-arterial partial pressure of oxygen difference (P A-aO 2) at T 0 and T 2-T 5, intraoperative blood loss and blood transfusion, postoperative mechanical ventilation time, length of intensive care unit (ICU) stay and the incidence of complications within 30 days after surgery were collected. Results:Compared with group C, the plasma concentrations of TNF-α and IL-6 were significantly at T 1-T 5, OI was increased, and P A-aO 2 was decreased at T 2, 3 in H and L groups ( P<0.05). There was no significant difference in the mechanical ventilation time, length of ICU stay and incidence of complications within 30 days after surgery among the 3 groups ( P>0.05). Conclusion:Ulinastatin can inhibit inflammatory responses and improve lung function in patients undergoing total aortic arch replacement, but it has no value for clinical outcomes.

Oral anticoagulation and antiplatelet therapy after transcatheter aortic valve replacement: A systematic review and Meta-analysis / 中华老年医学杂志

Objective:To assess the efficacy and safety of different antithrombotic strategies in patients following transcatheter aortic valve replacement(TAVR).Methods:A computerized search was performed to identify all relevant publications from PubMed, EMbase, CNKI and Wangfang databases.Non-randomized controlled trials of oral anticoagulant(OAC) vs. antiplatelet therapy(APT)and vitamin K antagonists(VKAs) vs. non-vitamin K antagonist oral anticoagulants(NOACs)after TAVR were collected, and the effects on postoperative bleeding, cerebrovascular events and all-cause mortality were analyzed.A meta-analysis was performed using RevMan 5.2 software provided by the Cochrane Collaboration. Results:A total of 9 studies were included.Compared with APT, the incidence of bleeding events caused by OAC increased(20.3% vs. 26.3%, OR=1.20, 95% CI: 1.04-1.39, P=0.01), while the incidence of cardiovascular events and all-cause mortality had no statistical difference.In the OAC group, all-cause mortality was lower in the VKAs group than in the NOACs group(9.8% vs. OR=0.73, 95% CI: 0.55-0.97, P=0.03). However, there was no statistical significance in cardiovascular and bleeding events( P>0.05). Conclusions:Compared with patients receiving APT, the incidence of bleeding events is higher in patients taking OAC.In patients taking OAC, VKAs can significantly decrease the mortality compared with NOACs.

To evaluate the effect of SYNTAX score on in-hospital mortality of CABG patients / 中华胸心血管外科杂志

Objective:To evaluate the effect of coronary artery anatomical score(SYNTAX score) on in-hospital mortality of CABG patients.Methods:The clinical data of patients who were performed with a CABG surgery alone in the Department of Cardiovascular Surgery, Tianjin Chest Hospital from July 2017 to December 2018 were collected. The clinical end point was all-cause in-hospital death or against-advice discharge after surgery. Univariate analysis and multivariate logistic regression analysis were performed on the clinical data of the patients to obtain the risk factors affecting the in-hospital death of CABG in our center, to evaluate the influence of SYNTAX score on the in-hospital death of CABG. Results:Univariate logistic analysis showed that age, critical condition, creatinine level, serum albumin level, NT-proBNP level, NYHA grade, internal mammary artery use, SYNTAX score were correlated with in-hospital mortality. Multivariate analysis showed that age(≥75 years old), history of diabetes mellitus, critical state, creatinine clearance rate < 85 ml/min, albumin <35 g/L, NYHA Ⅲ-Ⅳ, SYNTAX score(≥29) were independent risk factors for in-hospital mortality after CABG. Conclusion:Coronary artery anatomy score - SYNTAX score(≥29) was an independent risk factor for in-hospital mortality in CABG patients in our hospital.

Effect of Sun’s procedure on acute Stanford type A aortic dissection in patients over 60 years old compared with debranching hybrid procedure / 中华胸心血管外科杂志

Objective:To investigate the clinical efficacy of Sun's procedure and debranching hybrid procedure in the treatment of elderly acute Stanford type A aortic dissection.Methods:53 elderly patients(aged over 60 years old) with acute Stanford type A aortic dissection admitted to Tianjin Chest hospital from January 2017 to June 2018 were selected and divided into Sun's procedure group of 35 patients and debranching hybrid procedure group of 18 patients. The history of cerebral infarction before operation was more in the hybridization operation group than in the Sun's operation group, and the difference of other preoperative data was not statistically significant. The brain protection strategy was adopted in both groups. During Sun's procedure, bilateral anterograde cerebral perfusion and descending aorta balloon occlusion were performed to maintain the blood supply of lower limbs.And the total aortic arch and branch blood vessels were closed by stent-graft in debranching hybrid procedure.The basic data and perioperative conditions of the patients were statistically analyzed, and the postoperative results and short-term prognosis were compared between the two groups after 1 year of follow-up.Results:The hybrid group avoided circulatory arrest, and the lowest intraoperative nasopharyngeal temperature was slightly higher than that of the Sun' s group[(25.1±0.4)℃ ratio(27.7±0.6)℃)]. However, there were no significant difference in the operation time[(178.9±43.5)min ratio(166.9±95.4)min] and intraoperative blood loss[(1 724.9±1 394.2)ml ratio(1 590.7±920.5)ml] between the two groups, and no significant difference in postoperative renal failure(20% ratio 11.1%), cerebrovascular accident(cerebral infarction/cerebral hemorrhage)(11.4% ratio 5.6%), cognitive dysfunction(17.1% ratio 11.1%), ventilator assistance time[84.0(25.0, 160.0) hours ratio 61.7(17.3, 90.5) hours], ICU stay time[6.5(2.9, 14.3) days ratio 4.4(2.0, 6.1) days] and so on. There were 3 perioperative deaths in Sun's group and 2 perioperative deaths in hybrid group.The mean follow-up time of the two groups was 14.8 months. During the follow-up period of Sun's group, no new cerebrovascular event and 1 case of distal false lumen of the descending thoracic aorta active blood flow occurred and 1 case died 2 months after the operation.There was 1 case of new cerebrovascular events in hybrid group and no death. The 1-year survival rate was similar between the two groups.Conclusion:For patients over 60 years old with acute Stanford type A aortic dissection, Sun's procedure and hybrid procedure are safe and effective.

Protective effect of autologous platelet-rich plasma in elderly patients with type A aortic dissection undergoing total arch replacement surgery / 中华老年医学杂志

Objective To assess the therapeutic effect and safety of autologous platelet-rich plasma(aPRP)in elderly patients undergoing total arch replacement surgery.Methods A total of 44 elderly patients aged 60 years and over undergoing total arch replacement surgery in our hospital from August 2015 to August 2018 were enrolled.Forty-four patients were divided into the control group without aPRP application(n=23)and the aPRP application group (n =21).Patients were followed up postoperatively,and preoperative and intraoperative data,postoperative mortality,the incidence of continuous renal replacement therapy (CRRT)and neurological complications were collected and statistically analyzed.Results Compared with the control group,the aPRP application group showed the transfusion volume of allogeneic red blood cell and fresh frozen plasma were significantly decreased in aPRP group[(69.1± 138.3) ml vs.(803.6 ± 433.6) ml,P ＜0.05].The main indicators of blood coagulation function,postoperative hemoglobin and platelet count had no significant difference at 1h after the operation between the two groups (P ＞ 0.05).Postoperative drainage volume,hospital mortality,the duration of ventilatory support and duration of intermational components for unicode (ICU)stay had no statistical difference between the two groups(P＞0.05).The average hospitalization days were shorter in the aPRP group than in the control group[(13.7±6.7)days vs.(16.9± 11.4)days,P＜0.05].There was no statistical significance in the incidences of postoperative complications such as acute kidney injury,temporary neurological injury,stroke/cerebral hemorrhage,etc.between the two groups (P ＞ 0.05).Conclusions Preoperative aPRP application can significantly reduce intraoperative allogeneic blood transfusion volume,but has no significant effect on postoperative function of blood coagulation,reducing perioperative bleeding and complications,and the improvement of prognosis in elderly patients with type A aortic dissection undergoing total arch replacement surgery.

Effects of autologous platelet-rich plasma on postoperative outcomes in patients undergoing Sun′s procedure / 中华麻醉学杂志

Objective@#To evaluate the effect of autologous platelet-rich plasma (aPRP) on postoperative outcomes in the patients undergoing Sun′s procedure.@*Methods@#One hundred and sixteen patients with acute Stanford type A aortic dissection of both sexes, aged 18-64 yr, with body mass index of 19-34 kg/m2, of American Society of Anesthesiologist physical status Ⅳ, were divided into aPRP group (group A) and control group (group C) by a random number table method, with 58 cases in each group.After anesthesia induction and intubation, aPRP preparation was completed before surgery in group A, and surgery began in group C. After heparin neutralization, group A received retransfusion of platelet-rich plasma, while group C received conventional fluid management.Thromboelastography was performed on all patients, and the results were recorded.The intraoperative amount of allogeneic blood products and blood loss were recorded in two groups.Plasma concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were recorded after anesthesia induction (T0), immediately after completion of aPRP preparation (T1), 3 h after heparin neutralization (T2), and at 24 and 48 h after surgery (T3, 4). The volume of postoperative chest drainage and amount of allogeneic blood products, mechanical ventilation time, lengths of intensive care unit and hospital stay, incidence of important complications and fatality rate within 30 days after surgery were also collected.@*Results@#Compared with group C, the intraoperative amount of allogeneic blood products and blood loss were significantly reduced, α angle and MA values of thromboelastograph were larger, plasma concentrations of TNF-α and IL-6 were reduced at T2, 3, postoperative chest drainage volume and allogeneic blood transfusion were reduced, the postoperative mechanical ventilation time and length of hospital stay were shortened, and the incidence of pulmonary complications was reduced in group A(P<0.05). There was no significant difference in the length of intensive care unit stay, incidence of other complications or fatality rate within 30 days after surgery between the two groups (P>0.05).@*Conclusion@#aPRP can improve postoperative outcomes in the patients undergoing Sun′s procedure.

Protective effect of autologous platelet-rich plasma in elderly patients with type A aortic dissection undergoing total arch replacement surgery / 中华老年医学杂志

Objective@#To assess the therapeutic effect and safety of autologous platelet-rich plasma(aPRP)in elderly patients undergoing total arch replacement surgery.@*Methods@#A total of 44 elderly patients aged 60 years and over undergoing total arch replacement surgery in our hospital from August 2015 to August 2018 were enrolled.Forty-four patients were divided into the control group without aPRP application(n=23)and the aPRP application group(n=21). Patients were followed up postoperatively, and preoperative and intraoperative data, postoperative mortality, the incidence of continuous renal replacement therapy(CRRT)and neurological complications were collected and statistically analyzed.@*Results@#Compared with the control group, the aPRP application group showed the transfusion volume of allogeneic red blood cell and fresh frozen plasma were significantly decreased in aPRP group[(69.1±138.3)ml vs.(803.6±433.6)ml, P<0.05]. The main indicators of blood coagulation function, postoperative hemoglobin and platelet count had no significant difference at 1h after the operation between the two groups(P>0.05). Postoperative drainage volume, hospital mortality, the duration of ventilatory support and duration of intermational components for unicode(ICU)stay had no statistical difference between the two groups(P>0.05). The average hospitalization days were shorter in the aPRP group than in the control group[(13.7±6.7)days vs.(16.9±11.4)days, P<0.05]. There was no statistical significance in the incidences of postoperative complications such as acute kidney injury, temporary neurological injury, stroke/cerebral hemorrhage, etc.between the two groups(P>0.05).@*Conclusions@#Preoperative aPRP application can significantly reduce intraoperative allogeneic blood transfusion volume, but has no significant effect on postoperative function of blood coagulation, reducing perioperative bleeding and complications, and the improvement of prognosis in elderly patients with type A aortic dissection undergoing total arch replacement surgery.

Effects of autologous platelet-rich plasma on postoperative outcomes in patients undergoing Sun′s procedure / 中华麻醉学杂志

Objective To evaluate the effect of autologous platelet-rich plasma(aPRP)on postop-erative outcomes in the patients undergoing Sun's procedure.Methods One hundred and sixteen patients with acute Stanford type A aortic dissection of both sexes,aged 18-64 yr,with body mass index of 19-34 kg/m2,of American Society of Anesthesiologist physical status Ⅳ,were divided into aPRP group(group A)and control group(group C)by a random number table method,with 58 cases in each group.After an-esthesia induction and intubation,aPRP preparation was completed before surgery in group A,and surgery began in group C.After heparin neutralization,group A received retransfusion of platelet-rich plasma,while group C received conventional fluid management.Thromboelastography was performed on all patients,and the results were recorded.The intraoperative amount of allogeneic blood products and blood loss were recorded in two groups.Plasma concentrations of tumor necrosis factor-alpha(TNF-α)and interleukin-6(IL-6)were recorded after anesthesia induction(T0),immediately after completion of aPRP preparation(T1),3 h after heparin neutralization(T2),and at 24 and 48 h after surgery(T3,4).The volume of post-operative chest drainage and amount of allogeneic blood products,mechanical ventilation time,lengths of intensive care unit and hospital stay,incidence of important complications and fatality rate within 30 days after surgery were also collected.Results Compared with group C,the intraoperative amount of allogeneic blood products and blood loss were significantly reduced,α angle and MA values of thromboelastograph were larger,plasma concentrations of TNF-α and IL-6 were reduced at T2,3,postoperative chest drainage volume and allogeneic blood transfusion were reduced,the postoperative mechanical ventilation time and length of hospital stay were shortened,and the incidence of pulmonary complications was reduced in group A(P＜0.05).There was no significant difference in the length of intensive care unit stay,incidence of other complications or fatality rate within 30 days after surgery between the two groups(P>0.05).Conclu-sion aPRP can improve postoperative outcomes in the patients undergoing Sun's procedure.

Clinical efficacy of single center intracavitary isolation procedure for treatment of elderly Standford type B aortic dissection / 中华老年医学杂志

Objective To evaluate clinical efficacy of single center intracavitary isolation procedure for treating elderly Standford type B aortic dissection.Methods 46 consecutive patients aged ≥ 65 years with Standford B aortic dissection,who underwent membrane stent intracavitary isolation treatment,in Tianjin Chest Hospital between 2010-2015 were enrolled in this study.All enrolled patients received examinations of echocardiography,contrast-enhanced CT,hepatic and renal functions,and the blood and urine routine tests before the procedure.After the procedure,the contrastenhanced CT of whole aorta was annually rechecked for all patients in the four time points of predischarge,3,6,12 months after operation.Deadline date of the follow up was December 2015.The outcomes of whole aorta CT and survival rate were analyzed.Results Successful stent implantation was performed in all patients (100 ％).Two (4.3 ％) patients died in the perioperative period,and one died due to the new aortic dissection at the last 8 months after operation.Overall survival rate was 89.1％(41 cases)during the follow-up period(95％CI:52.5-63.6 and 32.6-38.9,all P＜0.05).Conclusions The short and long term outcomes of intracavitary isolation procedure for treating Standford B aortic dissection are satisfactory in elderly patients.Perioperative blood pressure control,strict image measure,and carefully selecting the appropriate scaffold model are the keys for successful operation.

The short term outcome after mitral valve replacement with the perimount bovine pericardial valve / 天津医药

Objective To evaluate the short term outcome after mitral valve replacement with the Perimount bovine pericardial valve. Methods Eighty-eight patients underwent mitral valve replacement with the bovine pericardial valve in hospital were included in this study. Postoperative general condition including mortality and cerebral hemorrhage was observed. The hemodynamic and New York heart disease association (NYHA) heart function classification were recorded by Doppler echocardiograms before operation, postoperative 1 week, 3 months and 1 year after mitral valve replacement. Values of the different time points of NYHA, left atrial diameter (LA), left ventricular end diastolic diameter (LVDD), left ventricular end systolic diameter (LVSD), left ventricular ejection fraction (LVEF) and pulmonary artery pressure (PAP) were compared. The hemodynamic parameters were also compared including the peak cross valve pressure (PG), mean cross valve pressure (MG), peak cross valve velocity (PV) and effective orifice area (EOA) 1 week, 3 months and 1 year after surgery. Results There were two cases (2.3%) dead in one year (one died of cerebral hemorrhage and another one died of thromboembolism). There was 1 perivalvular leakage (1.2%). There was no endocarditis or structural valve deterioration. NYHA cardiac function was improved at postoperative 3 months and 1 year (P < 0.05). The values of LA, LVDD and PAP were significantly decreased at postoperative 1 week, 3 months and 1 year compared with those before operation (P<0.05). Values of LVSD and LVEF were significantly decreased at postoperative 1 week compared with those before operation (P<0.05). The value of LVEF was significantly increased at postoperative 3 months and 1 year (P<0.05). Compared with postoperative 1 week, the values of LA and LVEF were significantly increased at postoperative 3 months and 1 year (P < 0.05). There were no significant differences in PG, MG, PV and EOA between postoperative 1 week, 3 months and 1 year. Conclusion With the excellent performance of cardiac function recovery, left ventricular restoration and hemodynamic, the Perimount bovine pericardial valve remains a reliable choice as a mitral tissue valve.

A comparison of Sun’s operation and ascending aorta replacement combined with open placement of triple-branched stent graft in treatment of type A aortic dissection / 天津医药

Objective To evaluate results of surgical treatment for patients with acute type A aortic dissection using Sun’s operation and triple-branched stent graft. Methods According to the operation mode, thirty-three patients with type A aortic dissection were divided into Sun’s operation group (n=22) and triple branches aortic arch stent-graft placement op?eration (triple-branched) group (n=11). Preoperative examinations included cardiac ultrasound, aortic CT angiography (CTA), hepatic and renal functions and blood routine test in all patients. Intraoperative monitoring included the index about cardiopulmonary bypass and blood loss. The perioperative hepatic and renal functions and complications were also recorded. Survival and recovery rates were evaluated by follow-up between two groups of patients. Results There were six periopera?tive death in Sun’s group, and three patients died in triple-branched group. In triple-branched group, the intraoperative blood loss was significantly increased than that in Sun’s group [(3 586.4±2 926.8) mL vs. (2 630.5±1 821.2) mL, P0.05). At 5 year after operation, there were no significant differences in the recurrence of new aortic dissection, the incidence of cerebral infarction and mortality between Sun’s group and triple-branched group (P>0.05). Conclusion Sun’s operation can significantly decrease patient’s intraoperative blood loss and improve cardiac function. But its survival rate and long term results need advanced observation.

Interventional Treatment of Renal Artery Pseudoaneurysms / 中国微创外科杂志

Objective To evaluate the clinical value of percutaneous renal artery angiography and embolization of the renal artery pseudoaneurysms. Methods A retrospective analysis was made on 15 cases of postoperative urethral bleeding following urinary calculi surgery from January 2012 to February 2014, which were diagnosed of renal artery pseudoaneurysms via the renal artery angiography.Superselective catheter placement was carried out into the proximal of parent artery and the pseudoaneurysm was embolized by using a coil and gelatin sponge. Results Renal artery angiography clearly displayed pseudoaneurysms in the 15 cases, which were located in interlobular artery in 11 cases, arcuate artery in 3 cases, and minor interlobular artery in 1 case.Urethral bleeding was stopped after using gelatin sponge and spring coil embolization.Among them urethral bleeding recurred in 1 case after two days, and a second embolization was conducted.After the embolization, transient renal colic happened in 2 cases and a fever of 37.8-39.3 ℃lasting for 3-8 d was seen in 7 cases.Follow-ups for 3-24 months ( mean, 15 months) showed no renal dysfunction and urinary tract bleeding. Conclusion The transcatheter embolization and angiography can diagnose and treat renal artery pseudoaneurysms, with safe and effective outcomes.

Effects of preoperative aspirin therapy on early postoperative outcomes in elderly patients undergoing off-pump coronary artery bypass surgery / 中华老年医学杂志

Objective To analyze the benefits and risks of preoperative aspirin treatment in elderly patients undergoing off-pump coronary artery bypass (OPCAB) grafting.Methods From January 2010 to June 2014 in Tianjin Chest Hospital,1 501 consecutive patients aged ＞65 years with mean age (71.1 ± 4.2) years who underwent selective first-time isolated off-pump coronary artery bypass surgery were included in this research.They were divided into 2 groups:aspirin group (longterm use of entericcoated aspirin tablets within 5 days before operation,n =369) and aspirin withdrawal group (aspirin withdrawal for 5 days and over before operation,n=1 132).Univariate analysis and a logistic regression were used to compare the postoperative events between the two groups.To adjust for the remaining differences between groups,propensity score was enrolled into the logistic regression model.Results There were no significant differences between the two groups in all-cause in-hospital mortality,postoperative myocardial infarction,cerebrovascular events,postoperative renal failure,blood dialysis and reoperation for bleeding (all P＞＞ 0.05),but more frequency of red blood cell transfusions were found in aspirin group than in aspirin withdrawal group [74.0％(273/369)vs.62.5％(707/1 132),adjusted OR=1.50,95％CI:1.13-2.00,P＜0.01].Conclusions Preoperative aspirin treatment can increase the incidence of red blood cell transfusion,but cannot increase the incidence of reoperation for bleeding,and has no effect on the postoperative outcomes such as all-cause in-hospital mortality,cerebrovascular events,postoperative myocardial infarction,postoperative renal failure or blood dialysis in patients undergoing selective isolated OPCAB.

Therapeutic effect comparison between unipolar and bipolar radiofrequency ablation in treating atrial fibrillation in elderly patients / 中华老年医学杂志

Objective To compare clinical effect of unipolar versus bipolar radiofrequency ablation in treating atrial fibrillation (AF) in elderly patients and discuss the correlated risk factors.Methods From October 2008 to December 2013,a total of 50 elderly patients with organic heart disease and AF underwent radiofrequency ablation surgery.All patients were divided into 2 groups of unipolar (group A,n=20) and bipolar (group B,n=30 patients) radiofrequency ablations.The variations of electrocardiogram (ECG) and ultrasonic cardiogram (UCG) in patients were collected and the complications and the NYHA class of the patients were recorded at 3,6 and 12 months after surgery.The total 43 elderly patients were divided into sinus group and non-sinus group according to their ECG at 12 months after surgery.Results The recovery rates of sinus rhythm at 3,6 and 12 months after surgery were 73.7％(14/19),66.7％(12/18) and 61.1％ (11/18)respectively in group A and 82.8％(24/29),85.2％(23/27)and 88.0％(22/25) respectively in group B.Two groups of the recovery rate of sinus rhythm had a statistically significant difference between the two groups (P＜0.05) at 12 months after surgery.The complication rate in group A was higher than in group B [55.0％ (11 cases) vs.26.7％ (8 cases),P＜0.05].Preoperative history of AF and left atrial diameter were the influencing factors for the sinus rhythm recovery rates (P＜0.05).Conclusions Bipolar radiofrequency ablation for AF is safe and has less complications and high success rate of restoring sinus rhythm.The patients with long preoperative history of AF and left atrium distension have a low success rate of restoring sinus rhythm with a high recurrence rate.