ABSTRACT
@#The "2022 AHA/ACC/HFSA guideline for the management of heart failure" replaces the "2013 ACCF/AHA guideline for the management of heart failure" and the "2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure". The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose and manage patients with heart failure. Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to manage patients with heart failure, with the intent to improve quality of care and align with patients’ interests. New recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses. This article summarized and interpreted the new concept of heart failure in 2022 guidelines, especially the new evidence and suggestions related to cardiac surgery.
ABSTRACT
@#Objective To explore the association between preoperative, perioperative parameters, especially estimated glomerular filtration rate (eGFR) and postoperative atrial fibrillation (POAF) after modified extended Morrow procedure. Methods A total of 300 hypertrophic obstructive cardiomyopathy (HOCM) patients who underwent modified extended Morrow procedure in our hospital from January 2012 to March 2018 were collected. There were 197 (65.67%) males and 103 (34.33%) females with an average age of 43.54±13.81 years. Heart rhythm was continuously monitored during hospitalization. The patients were divided into a POAF group (n=68) and a non-POAF group (n=232). The general data, perioperative parameters and echocardiographic results were collected by consulting medical records for statistical analysis. Univariate and multivariate logistic regression models were used to analyze the risk factors for POAF. Results Overall incidence of POAF during hospitalization was 22.67% (68/300). Compared with patients without POAF, patients with POAF were older, had higher incidence of chest pain and syncope, lower level of preoperative eGFR, higher body mass index and heart function classification (NYHA), larger preoperative left atrial diameter and left ventricular end diastolic diameter, and longer ventilator-assisted time, ICU stay and postoperative hospital stay. Age, heart function classification (NYHA)≥Ⅲ, hypertension, syncope history and eGFR were independent risk factors for POAF. Receiver operating characteristic curve analysis showed that the area under the curve of eGFR was 0.731 (95%CI 0.677-0.780, P<0.001), and the sensitivity and specificity were 82.4% and 57.8%, respectively. Conclusion Increased age, high preoperative heart function classification (NYHA), hypertension, preoperative syncope history and decreased eGFR are independent risk factors for POAF in HOCM patients who underwent surgical septal myectomy. Preoperative decreased eGFR can moderately predict the occurrence of POAF after modified extended Morrow procedure.
ABSTRACT
Objective:To evaluate the early effects of combined transaortic and transapical approach to septal myectomy in patients with complex hypertrophic obstructive cardiomyopathy(HOCM).Methods:We consecutively enrolled 20 complex HOCM patients who received transaortic and transapical myectomy in fuwai hospital from January 2019 to October 2019. Echocardiography was performed to compare left atrial size, left ventricular end diastolic diameter, peak left ventricular outflow gradient, ventricular septal thickness, mitral systolic anterior motion and mitral regurgitation grade before and after operation. Furthermore, pre-operative and post-operative electrocardiogram were also analyzed to determine the incidence of bundle branch block. Functional status was evaluated by New York Heart Association functional class.Results:Of the 20 complex hypertrophic cardiomyopathy patients, 7(35%) HOCM patients with long-segment septal hypertrophy more than 7cm, 4(20%) patients had both mid-ventricular obstruction and left ventricular outflow obstruction. Apical hypertrophic cardiomyopathy with LOVT obstruction was observed in 5 patients(25%) and aneurysm was found in 4(20%) HOCM patients. Postoperative thickness of ventricular septum was significantly decreased compared with that of preoperation[(21.1±3.6)mm vs.(13.4±3.1)mm]. Peak LOVT gradient or mid-ventricular gradient also significantly reduced after operation[(77.0±21.0) mmHg vs.(9.2±3.4) mmHg] or [(71.0±23.0) mmHg vs. 0 mmHg, 1 mmHg=0.133 kPa]; After surgery, mitral systolic anterior motion disappeared, mitral regurgitation degree reduced from (1.9±1.5) to (0.2±0.4); NYHA class improved from(2.1±0.2) to(1.3±0.5). New incidence of left bundle branch block occurred in 9 patients, and 1 patient developed complete bundle branch block and implanted permanent pacemaker. The 30-day survival was 100%.Conclusion:Combined transaortic and transapical septal myectomy is an effective and reasonably safe procedure for patients with complex hypertrophic obstructive cardiomyopathy.
ABSTRACT
Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, the orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of suspected or confirmed COVID-19 patients, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of OVCF patients diagnosed with COVID-19, the authors jointly develop this expert consensus to systematically recommend the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures.
ABSTRACT
@#Objective To evaluate the efficacy and safety of modified maze Ⅳ (Cox-maze Ⅳ) in hypertrophic obstructive cardiomyopathy (HOCM) patients. Methods From June 2016 to June 2019, 30 HOCM and persistent atrial fibrillation (pAF) patients received Cox-maze Ⅳ operation with modified extended Morrow operation, including 21 males and 9 females. The average age was 51.36±10.27 years and the average weight was 72.48±11.29 kg. All patients underwent left atrial appendectomy. Recurrence of AF, improvement of symptoms, cardiac function (NYHA) were assessed during follow-up. Results There was no death during the perioperative period. Postoperative left ventricular outflow tract gradient was significantly decreased compared with that before operation (P<0.01), and all systolic anterior motion (SAM) signs disappeared after operation. Thirty patients were all effectively followed up for 3-40 (16.24±8.26) months. During the follow-up period, there was no death, and the cardiac function (NYHA) of all patients recovered to gradeⅠ-Ⅱ. At the end of follow-up, twenty-four patients (80.00%) maintained sinus rhythm, and twenty-seven patients (90.00%) maintained sinus rhythm after amiodarone conversion. Univariate analysis showed that the smoking history (P=0.04), left atrial diameter≥55 mm before operation (P=0.03), left atrial diameter≥50 mm after operation (P=0.02), postoperative tricuspid regurgitation (P=0.02) were closely related to postoperative AF recurrence. The increase of left atrial diameter after operation was an independent risk factor for AF recurrence (P=0.02). Conclusion Morrow/Cox-maze Ⅳ procedure is safe and effective in treatment of patients with HOCM complicated with pAF, which helps to maintain postoperative sinus rhythm, and to improve the cardiac function. The increase of left atrial diameter after operation is an independent risk factor for AF recurrence.
ABSTRACT
Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.
ABSTRACT
The ischemic mitral regurgitation( IMR) is present in 20% to 30% of patients with old myocardial infarction. In patients with heart failure after myocardial infarction , the incidence of IMR is even as high as 50%.IMR has adverse effects on the prognosis of patients and is positively correlated with the degree of reflux , including increased risk of heart failure and mortality of cardiovascular disease.Patients with severe hemodynamic abnormalities, and in the case of have accepted the best drug treatment is still difficult to alleviate symptoms of heart failure , surgical treatment should be implemented.However, the surgical treatment strategy of IMR is still controversial, that is, for the moderate IMR, only the blood transport reconstruction is sufficient to restore the natural form of the valve, whether the valve operation needs to be performed simultaneously ; In the case of severe IMR, simultaneous valvular surgery has been agreed upon.The controversy is that the mitral valve repair(MVP) and mitral valve replacement(MVR) are both superior and inferior.The purpose of this paper is to review the literature on IMR sur-gery in order to help us understand this important question.
ABSTRACT
Objectives: To evaluate the predictor and risk factor of left ventricular (LV) free wall reverse remodeling in patients with obstructive hypertrophic cardiomyopathy (HCM) after modiifed Morrow procedure by three-layer speckle tracking of echocardiography. Methods: Our investigation included 2 groups: HCM group, n=60 patients who had successful modified Morrow procedure in our hospital from 2014-06 to 2014-12, there were 41 (68.3%) male with the average age of (39.1 ± 15.2) years. Control group, n=40 healthy subjects. Three-layer speckle tracking echocardiography was conducted to analyze pre-and post-operative LV free wall three-layer myocardium (endocardial, mid, and epicardial layers) changes at longitudinal strain (LS) and circumferential strain (CS). Clinical and echocardiography information were collected at pre-and (6-24) months post-operation. The impact factors for LV free wall reverse remodeling was identiifed by liner regression analysis and the segment’s thickness≥15mm was deifned as the hypertrophic LV free segment. Results: In HCM group, compared with pre-operative condition, the post-operative thickness of LV free wall including anterior, anterolateral and inferolateral were reduced;while both post-operative LS and CS elevated (-13.8 ± 4.8)%vs (-17.0 ± 5.2)%and (-23.7 ± 3.8)%vs (-25.4 ± 3.7)%, P Conclusion:①After modiifed Morrow procedure, LVOT obstruction disappeared which leaded LV free wall reverse remodeling in HCM patients, ②three-layer myocardium of LV free wall all had reverse remodeling, ③better improved LVOT gradient were with less number of hypertrophic segments;the elder patients usually had the better post-operative reverse remodeling.
ABSTRACT
Objective: To evaluate the efifcacy of modiifed extended Morrow procedure on hypertrophic obstructive cardiomyopathy (HOCM) in adolescent patients. Methods: We retrospectively studied 29 consecutive HOCM patients at the age≤21 years who received modiifed extended Morrow procedure in our hospital from 2011 to 2015 for their clinical conditions to assess surgical efifcacy. Echocardiography was performed to compare left atrial size, left ventricular end diastolic diameter, left ventricular ejection fraction, left ventricular outlfow tract peak pressure, ventricular septal thickness, mitral systolic anterior motion and mitral regurgitation grade before and after operation. Moreover, pre-operative and post-operative plasma NT-proBNP levels were determined. Cardiac function was evaluated by New York Heart Association functional class. Results: There were 17 (58.6%) patients received isolated modiifed extended Morrow procedure and 12 patients had concomitant operation including 8 (27.6%) with coronary artery bypass grafting. Compared with pre-operation, the post-operative thickness of ventricular septum decreased from (24.6 ± 6.8) mm to (16.9 ± 7.1) mm, left ventricular outlfow tract gradient decreased from (68.8 ± 15.7) mmHg to (10.7 ± 4.2) mmHg, bothP<0.001; mitral regurgitation degree reduced from (1.7 ± 1.3) to (0.2 ± 0.4),P<0.01; NYHA classification improved from (3.4 ± 0.8) to (1.4 ± 0.5),P<0.01; plasma level of NT-proBNP reduced from (1957.6 ± 392.5) ng/ml to (458.7 ± 161.0) ng/ml,P<0.01. There was no peri-operative death, the survival rates at 12, 24 and 36 months post-operation were 100%, 86.7% and 86.7% respectively. Conclusion: Modiifed extended Morrow procedure has been a safe and effective method for treating adolescent HOCM patients, adequate exposure is the key point to assure surgical efifcacy.
ABSTRACT
Systolic anterior motion of mitral valve ( SAM) is a relatively uncommon complication , but it can result in se-vere left ventricular outflow tract(LVOT) obstruction and/or mitral regurgitation(MR), even can be life-threating.Echocardio-graphy is still the first-line method of SAM diagnosis.Due to LVOT obstruction and MR reducing the long-term prognosis of pa-tients with SAM, it is necessary to carry out surgical treatment for patients with SAM for whom conservative treatment are not ef-fective.Then mitral valve repair(MVREP) is the first choice.Besides, surgical techniques for treatment and prevention of SAM have made great progress which have promoted the popularization of MVREP , and the rate of MVREP in mitral valve oper-ation has been greatly improved .
ABSTRACT
This paper introduced the development and application of a computer management system for nursing care knowledge,which could manage intra-and extra-nursing care knowledge respectively and realized information share,utilization and innovation. It motivated the nurses to study actively,helped them with knowledge accumulation and innovation,elevated nurses' job identification,optimized team culture construction and increased work efficiency.
ABSTRACT
OBJECTIVE:To improve the quality and efficiency of ADR monitoring in hospital for the convenience of reporters and ADR monitoring personnel.METHODS:Combined with the characteristics of hospital information system,computer technology such as network,ASP.NET programming language,SQL server 2005 database and data transformation were used to develop and apply ADR monitoring system based on hospital local area network.RESULTS:The ADR reporting quality has been improved and the quantity of ADR reports increased markedly and was kept stable.CONCLUSION:The system contributed to a informationalized and networking administration of ADR reporting,and it improved ADR reporting level thus deserving to be recommended.