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Objectives:To establish a comprehensive system of Cardiovascular Academic Performance Evaluation(CAPE)and rank global TOP100 medical institutions in the fields of cardiovascular diseases(CVD). Methods:CVD-related terms were extracted from Medical Subject Headings(MeSH),Embase thesaurus(EMtrees)and International Classification of Diseases(ICD)by CVD-related professionals,as well as by librarians and information professionals.Terminology databases(named as Fuwai Subject Headings)were established,and nine sub-disciplines were proposed,including ischemic heart diseases,hypertension,vascular diseases,arrhythmia,pulmonary vascular diseases,heart failure,congenital heart diseases,cardiomyopathy,and valvular heart diseases.The mapping patterns of sub-discipline,cardiovascular terminology and entry terms were pre-defined.The CVD-related research literature published from January 1,2016 to December 31,2022 were retrieved from Web of Science,PubMed and Scopus.Based on this,metadata were fused and duplicates were excluded.Fuwai Subject Headings were searched and matched into four respects for each literature,including subject words,titles,keywords,and abstracts,which was used to generate an information table of"Position—CVD terminology—Frequency",and to calculate CVD correlation scores and sub-discipline scores.We standardized the names of medical institutions and scholars,and make a ranking system for CAPE based on original articles with strong cardiovascular correlation(correlation score≥4).When evaluating the science and technological performance for Chinese hospitals in cardiovascular diseases,National Natural Science Foundation Projects,authorized invention patents,prize achievements,research platforms,and registered data of drug clinical trials in Center for Drug Evaluation(CDE)were considered besides research papers. Results:During 2016 and 2022,1 545 103 CVD research literatures were found worldwide.After excluding meeting abstracts,books,biographies,news,videos,audio texts,retracted publications,and corrections,1 178 019 CVD research literatures were further evaluated.518 058 literatures were indexed as"strongly correlated to CVD"using Fuwai Subject Headings.Besides papers,other data sources were also collected,including 11 143 CVD-related Natural Science Foundation Projects,19 382 CVD-related effective authorized invention patents,103 CVD-related national prize achievements,24 CVD-related national research platforms,and 2 084 CDE registered data of CVD-related drug clinical trials.Research teams from nine sub-disciplines reviewed and validated research literature in respective fields,and classification rules of corresponding sub-disciplines were created and improved based on their opinions.Finally,eleven individual indexes were chosen to construct CAPE system for ranking global TOP100 medical institutions in overall CVD field and TOP30 in nine sub-disciplines.From 2016 to 2022,the number of cardiovascular disease research papers published by Chinese institutes has increased by 123.5%,with a total of approximately 76.8 thousands papers published(about 30 papers per day on average),ranked the second under the United States(approximately 114.1 thousands papers).However,the proportion of papers published by the Chinese Journal Citation Reports(JCR)and the Chinese Academy of Sciences only ranked eighth in the world.In the comprehensive academic performance of original cardiovascular research papers in global hospitals from 2020 to 2022,only two Chinese medical institutions ranked in the TOP20 as evaluated by CAPE system. Conclusions:Based on multi-source data from 2016 to 2022,CAPE initiated to establish a cardiovascular academic performance evaluation system.
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Recent decades have seen the remarkable development of China in medical accessibility and quality index, and the application of a number of new advanced cardiovascular technologies benefits more patients. However, according to the Annual Report on Cardiovascular Health and Diseases in China published in this article, which was organized and summarized by National Center for Cardiovascular Diseases, there is still a huge population living with risk factors of cardiovascular diseases (CVD), and the morbidity and mortality of CVD are increasing. It is estimated that there are around 330 million patients suffering from CVD currently, including 245 million of hypertension, 13 million of stroke, 45.3 million of peripheral artery disease, 11.39 million of coronary heart disease (CHD), 8.9 million of heart failure, 5 million of pulmonary heart disease, 4.87 million of atrial fibrillation, 2.5 million of rheumatic heart disease, and 2 million of congenital heart disease. Tobacco use, diet and nutrition factors, physical activity, overweight and obesity, and psychological factors are what affect cardiovascular health, while hypertension, dyslipidemia, diabetes, chronic kidney disease, metabolic syndrome, and air pollution are the risk factors for CVD. In this article, in addition to risk factors for CVD, we also report the epidemiological trends of CVD, including CHD, cerebrovascular disease, arrhythmias, valvular heart disease, congenital heart disease, cardiomyopathy, heart failure, pulmonary vascular disease and venous thromboembolism, and aortic and peripheral artery diseases, as well as the basic research and medical device development in CVD. In a word, China has entered a new stage of transforming from high-speed development focusing on scale growth to high-quality development emphasizing on strategic and key technological development to curb the trend of increasing incidence and mortality of CVD.
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Humanos , Enfermedades Cardiovasculares/etiología , Hipertensión/complicaciones , Factores de Riesgo , Cardiomiopatías , Insuficiencia Cardíaca/complicaciones , Cardiopatías Congénitas/complicaciones , Enfermedad Coronaria , Fibrilación Atrial/complicacionesRESUMEN
Objective:To analyze the case characteristics and outcomes of 12 idiopathic giant cell myocarditis(IGCM)cases after heart transplantation(HT).Methods:From June 2004 to May 2022, clinical data were retrospectively reviewed for 12 cases with pathologically confirm IGCM after HT at Fuwai Hospital.General characteristics, clinical manifestations, pathological examinations and postoperative follow-ups are recorded.Results:From June 2004 to May 2022, a total of 1 143 HT operations are performed at Fuwai Hospital and 12 cases of IGCM(1.05%)are confirmed by postoperative pathology.The age is(47.6±7.3)years.There are 5 boys and 7 girls.Initial presenting manifestations are congestive heart failure(7 cases, 58.3%)and arrhythmia(4 cases, 33.3%). Median time from symptom onset to HT is 6 months.All of them are undiagnosed pre-operation.And dilated cardiomyopathy(5 cases, 41.7%)and arrhythmogenic right ventricular cardiomyopathy(3 cases, 25%)are confirmed.The follow-up period is(4~142)months post-HT.One death occurred during perioperative period and another is due to heart failure at 68 months post-HT.Only 1 case of grade 1R transplant heart rejection occurrs at 9 years post-HT and there is no case of recurrence.According to Kaplan-Meier survival analysis, cumulative survival rates of 1/5/10 years post-HT in IGCM patients are 91.7%, 91.7% and 73.3% respectively.No significant difference exist in survival rate for other etiologies post-HT(Log-rank P=0.265). Conclusions:HT is efficacious for end-stage IGCM.Regular and sufficient postoperative immunosuppression is vital for preventing heart transplant rejection and recurrent IGCM.Most IGCM patients have a decent prognosis post-HT.
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@#Objective To explore the value of transthoracic echocardiography (TTE) to monitor and evaluate aortic insufficiency (AI) within one year after the implantation of the left ventricular assist device (LVAD). Methods We retrospectively collected and analyzed the TTE data of 12 patients who received LVAD implantation from 2018 to 2020 in our hospital. All patients were males, with an average age of 43.3±8.6 years. We analyzed temporal changes in the aortic annulus (AA), aortic sinus (AoS), ascending aorta (AAo), the severity of AI and the opening of aortic valve before operation and 1 month, 3 months, 6 months and 12 months after LVAD implantation. Results All 12 patients survived within 1 year after LVAD implantation. One patient was bridged to heart transplantation 6 months after implantation, and two patients did not receive TTE after 3 and 6 months. Compared to pre-implantation, AoS increased at 1 month after implantation (31.58±5.09 mm vs. 33.83±4.69 mm). The inner diameters of AA, AoS and AAo increased at 3, 6 and 12 months after LVAD implantation compared to pre-implantation (P<0.05), but all were within the normal range except for one patient whose AoS slightly increased before operation. After LVAD pump speed was adjusted, the opening of aortic valve improved. The severity of AI increased at 6 and 12 months after LVAD implantation compared to pre-implantation, and increased at 12 months compared to 6 months after LVAD implantation (P<0.05). Conclusion TTE can evaluate aortic regurgitation before and after LVAD implantation and monitor the optimization and adjustment of LVAD pump function, which has a positive impact on the prognosis after LVAD implantation.
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Objective:To retrospectively analyze the data of patients undergoing extracorporeal membrane oxygenation (ECMO) during perioperative period of cardiac transplantation and provide objective and reliable evidence for further clinical promotion.Methods:Collect the clinical data of patients undergoing heart transplantation and ECMO support in Fuwai Hospital, analyze the duration of ECMO support, combined use of aortic balloon counterpulsation (IABP), and complications during the supporting period. All statistical analyses were processed by SPSS 23.0 software. Independent sample Student's test was employed for normal distribution and Mann-Whitney U test for abormal distribution. χ2 or Fisher exact test was utilized for comparinge the classification data between groups. Results:All ECMO support models were intravenous-arterial ECMO (V-A ECMO). Eight patients successfully bridging heart transplantation through VA-ECMO. Sixty-one patients (89.7%) who had undergone cardiac transplantation were successfully weaned from ECMO while 48 patients (70.5%) survived and discharged. The most common complications during circulation support are bleeding, acute renal insufficiency, and pulmonary infection. Patients with ECMO support in the operating room had a better rate of survival and weaning off(95.6%, 84.4%) than those with ECMO at the bedside of ICU(72.2%, 27.8%).Conclusions:ECMO can provide adequate circulation and respiratory function support for heart transplant patients, and it is an indispensable treatment for patients to go through the perioperative period of heart transplant surgery smoothly. It is advocated to use IABP combined with ECMO in the early stage and at the same time to increase the perfusion of vital organs, improve the prognosis of patients and obtain good outcomes.
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Congenital heart disease; surgery; consensus; overall improvement@#If one word is used to describe the development of congenital heart disease surgery in China, "hardship" would be the most appropriate. Generations of pioneers have used their ingenuity to overcome obstacles and promoted the development of the discipline. Seventy years of efforts have established the world's largest congenital heart disease treatment system. However, the huge number of potential patients, low early diagnosis rate and over-screening as well as the uneven developed diagnosis and treatment capabilities hinder the future development. The overall improvement of treatment of congenital heart disease in China lies on more efforts from our fellow experts. The publication of the "Chinese expert consensus on surgical treatment of congenital heart diseases" undoubtedly provides theoretical and practical guidance for the improvement of treatment.
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@#Hybrid coronary revascularization (HCR) combining with coronary artery bypass grafting (CABG) has a long-term patency of left internal mammary artery to left anterior descending artery (LIMA-LAD) grafting, and the percutaneous coronary intervention (PCI) has a minimal invasiveness. It provides an alternative revascularization for patients with coronary heart disease. For patients who meet the HCR indications, most studies suggest that HCR can significantly reduce perioperative trauma, and offer favorable mid- and long-term prognosis, which is comparable with traditional revascularization strategies. Based on the major research results in this field in the past 10 years, we review the current application status and discuss the potential future direction of HCR in this paper.
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An implantable axial blood pump was designed according to the circulation assist requirement of severe heart failure patients of China. The design point was chosen at 3 L/min flow rate with 100 mm Hg pressure rise when the blood pump can provide flow rates of 2-7 L/min. The blood pump with good hemolytic and anti-thrombogenic property at widely operating range was designed by developing a structure that including the spindly rotor impeller structure and the diffuser with splitter blades and cantilevered main blades. Numerical simulation and particle image velocimetry (PIV) experiment were conducted to analyze the hydraulic, flow fields and hemolytic performance of the blood pump. The results showed that the blood pump could provide flow rates of 2-7 L/min with pressure rise of 60.0-151.3 mm Hg when the blood pump rotating from 7 000 to 11 000 r/min. After adding the splitter blades, the separation flow at the suction surface of the diffuser has been reduced efficiently. The cantilever structure changed the blade gap from shroud to hub that reduced the tangential velocity from 6.2 m/s to 4.3-1.1 m/s in blade gap. Moreover, the maximum scalar shear stress of the blood pump was 897.3 Pa, and the averaged scalar shear stress was 37.7 Pa. The hemolysis index of the blood pump was 0.168% calculated with Heuser's hemolysis model. The PIV and simulated results showed the overall agreement of flow field distribution in diffuser region. The blood damage caused by higher shear stress would be reduced by adopting the spindle rotor impeller and diffuser with splitter blades and cantilevered main blades. The blood could flow smoothly through the axial blood pump with satisfactory hydraulics performance and without separation flow.
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Humanos , China , Simulación por Computador , Diseño de Equipo , Insuficiencia Cardíaca , Terapéutica , Corazón Auxiliar , Hemólisis , Modelos CardiovascularesRESUMEN
Objective To study the effect of possible factors pre-operativly on recipient survival after heart transplantation among the dilated cardiomyopathy (DCM) patients.Methods 394 DCM recipients went through heart transplantation from June 2004 to October 2017 in our center,and the pre-operative NT-proBNP levels and risk factors influencing the post-operational survival reported by ISHLT retrospectively were analyzed.Kaplan Meier method was used to calculate the 1-10 years survival rate of the DCM patients and analyze the clinical data of the recipients and the donors,and the ROC method was applied to find the cutoff point of every pre-operation event.The recipients were divided into two groups according to the cutoff point:<4 000 ng/L group (n =296) and ≥4 000 ng/ L group (n=73).COX regression curve was used to decide the hazard ratio and the Kaplan Meier curve was drawn.The result was verified by Log-rank.Results The cutoff point of the preoperative NT-proBNP level was 4000 ng/L.By analyzing the NT-proBNP levels between 2 groups,the relationship between them and the survival rate was acknowledged and the NT-proBNP level ≥4 000 ng/L was a risk factor (P =0.029,Kaplan Meier method).In the recipients whose pulmonary arterial systolic pressure (PASP) was more than 40 mmHg,the survival rate between <4 000 ng/L group (n =190) and ≥4 000 ng/L group (n =58)] showed significant difference (P =0.027),and there was no significant difference in the recipients whose PASP was less than 40 mmHg (P>0.05).Conclusion The 1-,3-,5-,7-,and 10-year survival rate in our patients was 97.2%,94.5%,91.9%,88.0% and 83.1 % respectively,which shows advantage over other international reports.The pre-operative NT-proBNP level ≥ 4 000 ng/L is a risk factor in the DCM patients who have pulmonary hypertension,so determination and dynamic monitoring of the pre-operative NT-proBNP level may be beneficial to the survival of cardiac transplantation,especially among the patients who have higher PASP level.
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Objective The aim of this study was to summarize the characteristics of rheumatic tricuspid valve disease ( RTVD) and to evaluate the mid-term outcomes in patients undergoing tricuspid valve repair with RTVD. Methods Between January 2009 and June 2016, 251 consecutive patients with rheumatic heart disease( RHD) underwent left-sided valvular re-placement by a single surgeon. We analyzed 39 patients with RTVD which was diagnosed during the operation. Among them, 32 patients, with moderate or higher tricuspid regurgitation( TR) , were compared with other 59 patients of functional tricuspid regurgitation( FTR) for a better understanding of the features of the RTVD. A total of 39 patients were categorized into 2 groups:Ring annuloplasty group(n=33) and non-Ring annuloplasty group(n=6) which consisted of modified De Vega annu-loplasty for 4 patients and edge-to-edge repair for 2. Meanwhile, 13 of them underwent concomitant tricuspid commissurotomy and 1 patient had a tricuspid leaflet augmentation procedure. We analyzed the mid-term outcomes of 22 patients( follow-up du-ration>1 year)with a mean follow-up duration of(45.5 ±25.1) months. Results Compared with FTR, patients with RTVD had higher preoperative TR grade(3.1 ±0.8 vs. 2.6 ±0.7, P=0.004) but with lower preoperative PASP[(53.8 ±19.4) mmHgvs.(63.6±21.5)mmHg,P=0.037)](1mmHg=0.133kPa) andtricuspidannulusdiameter(TAD) thatobserved bothinpreoperativeechocardiogramtests[(37.0±5.7)mmvs.(41.9±6.7)mm,P=0.018)]andintraoperativedetection [(35.6±4.1)mmvs.(39.9±6.5)mm,P=0.000)] . TherewasnoearlymortalityandresidualmoderateorhigherTR grades in either group. Compared with patients in non-ring annuloplasty group, patients in ring annuloplasty group showed low-er postoperative TR grade(0. 2 ± 0. 4 vs. 0. 7 ± 0. 5, P=0. 039) and acceptable TR grade(0. 8 ± 0. 5 vs. 1. 3 ± 1. 9, P>0. 050) during the mid-term follow-up. PASP, the peak diastolic velocity and pressure gradient across tricuspid valve were not different between groups in preoperative, postoperative and follow-up. Conclusion Compared with FTR, Patients with RTVD had lower preoperative PASP and TAD, but with a higher preoperative TR grade. In our study, ring annuloplasty showed simi-lar mid-term outcomes compared with other procedures.
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Objective@#To investigate the technical method for harvesting and application of the descending branch of the lateral circumflex femoral artery (DBLCFA) in the coronary artery bypass grafting (CABG) operation.@*Methods@#Between December 2016 and April 2017, 19 patients were arranged to use DBLCFA and got CT angiography (CTA) of pelvic and femoral arteries pre-operative at Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Finally, DBLCFA was harvested in 16 patients (including 2 female patients, with a mean age of (47.4±8.5) years) through the anterior thigh incision (13 cases on the left side, 3 cases on the right side). The CABG operations were performed under the cardiopulmonary bypass support (in 10 cases) or under the beating heart condition (in 6 cases), and the DBLCFA conduit was used combining with bilateral internal thoracic artery (in 12 cases), radial artery (in 7 cases) and saphenpous vein (in 3 cases).@*Results@#Due to anatomical variations such as short length and anomalous branch, or due to silent atherosclerosis stenosis of femoral artery, DBLCFA in 3 patients was considered inappropriate for use and was not harvested after CTA examination. In another 16 patients, DBLCFA was safely and quickly harvested and successfully used. On average, 3.4±0.6 anastomosis was built up in CBAG, no adverse effects were exhibited. The length of the harvested DBLCFA was (10.3±1.8) cm, with average lumen diameter of (1.9±0.5) mm. DBLCFA was used as free graft in 15 patients (7 to the first diagonal branch, 6 to the ramus intermedius branch, 1 to the left anterior descending branch and 1 to the second obtuse marginal branch). In 1 patient, the DBLCFA was firstly implanted end-to-side to the internal thoracic artery as a "Y" type composite graft, and then anastomosed to the third obtuse marginal branch.@*Conclusions@#The descending branch of the lateral circumflex femoral artery is an option conduit in CABG. It can be harvested easily and safely. However, pre-operative CTA examination is necessary to exclude the variation and appropriate strategy for graft establishment should be considered during the operation.
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Objective To study the effect of de novo donor-specific antigen (DSA) on transplant heart function and recipient survival after heart transplantation.Methods 195 recipients went through heart transplantion from March 2013 to January 2016 in our center,13 patients with preoperative panel reactive antibody (PRA) and 10 patients suffered from in-hospital death were exclude from this study,and the actual number of patients enrolled in this study was 172.By detecting HLA typing and DSA,recipients were divided into DSA positive group,anti-HLA antigen positive but DSA negative group (DSA negative group) and anti-HLA negative group.Cardiac dysfunction,coronary heart disease and cardiovascular death were recorded as cardiac events during the follow-up period.By analyzing the cardiac events rate among 3 groups,the relationship between DSA and cardiac events was acknowledged.Results The mean follow-up period of all patients was (1.3 ± 0.8) years.Among 172 patients,6 were positive for DSA (3.4%).In the DSA positive group,66% of DSA were directed at HLA Ⅱ,mainly against HLA-DQ,1 developed only anti-HLA I antibody,1 developed both anti-HLA Ⅰ and Ⅱ antibody.The median developing time of DSA was (256 ± 125) days,and the distribution was centralized in the first half year.84% of patients in DSA positive group were witnessed cardiac events.One patient was diagnosed as coronary heart disease and received PCI at 145th days after DSA was developed.Four out of 6 patients experienced cardiac dysfunction with median developing time of (54 ± 13) days,and the cardiac function restored after treatment with immunosuppression modification,high-dose glucocorticoid and IVIG.In the DSA negative PRA positive group,the incidence of cardiac events was 13%.There was one cardiovascular death,and 2 cases of cardiac dysfunction.In the HLA antigen negative group,the incidence of cardiac events was 4%.Cox regression analysis revealed that DSA could be seen as an independent risk factor in leading to cardiac events and affecting mid-long term survival of recipients (P =0.02).Significant difference was observed in Kaplan-Meier analysis among 3 groups (P<0.001).Conclusion DSA has strong impact on outcome after heart transplantation.Routine surveillance and appropriate treatment should be attached to DSA.
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Objective To evaluate the effect of CYP3A5 genetic polymorphisms on tacrolimus (Tac) concentration/dosing and other clinical outcomes in a pilot cohort of 113 Chinese HTx recipients.Methods Association between CYP3A5 genetic variants and blood dose-adjusted trough concentrations (C0/D) of Tac at 1st month at the beginning of the immunosuppressive therapy was evaluated in cohorts of 113 patients,then at 1st,3rd,6th,and 12th months after transplantation in 41 patients who received Tac-based immunosuppressive therapy and never changed within one year after transplantation,respectively.In addition,we also evaluated the association between CYP3A5 genetic variants and other clinical outcomes,such as the classifications of endomyocardial biopsy and longterm prognosis.Results The CYP3A5 wild homozygote (* 1/* 1),mutant homozygote (* 3/* 3),and mutant heterozygote (* 1/* 3) occurred in 5,34 and 74 recipients respectively.The gene mutation rate of CYP3A5 in this cohort of Chinese HTx recipients was 80.5 % and the homozygous proportion was 65.5%.Compared with CYP3A5 expressors (* 1/* 1 or * 1/* 3),CYP3A5 nonexpressors (* 3/* 3) had a higher Tac C0/D at 1st month (47.34 ± 11.40 vs.116.11 ± 42.40 vs.293.70 ± 171.20,P =0.000),as well as other studied time points (3rd month:98.32 ± 39.43 vs.292.07 ± 141.08,P=0.003;6th month:90.00 ± 21.31 vs.341.68 ± 165.02,P =0.002;and 12th month:96.02 ± 29.33 vs.339.23 ± 162.30,P =0.018);and might have a lower classification of endomyocardial biopsy at 1st month (1.43 ± 0.73 vs.1.50 ± 0.58,P =0.867),3rd month (1.55 ±1.00 vs.2.00 ± 1.73,P =0.512),and 6th month (1.36 ± 0.84 vs.2.33 ± 1.53,P =0.132);as well as a higher mortality due to acute organ rejection (10% vs.0,P =0.244) and all-cause mortality (20% vs.9.7%,P =0.580).Conclusion In Chinese HTx recipients,the frequency of this * 3 allele is lower than that has been reported in the white population.The determinations of CYP3A5 genetypes in heart transplant recipients are helpful to guide the individualized Tac regimens.
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Objective:To explore the effect of remote ischemic post-conditioning (RIPoC) on oxidation/reduction response, energy metabolism and inlfammatory reaction of ischemic myocardial tissue in rats with ischemic reperfusion (IR) injury. Methods:IR model was established by 30 min left anterior descending (LAD) artery occlusion followed by 120 min reperfusion, conditioning was defined as 3 cycles of 30 seconds ischemia followed by 30 seconds reperfusion in adult rats. The rats were divided into 5 groups:①ischemic pre-conditioning (IPC) group, the rats received the conditioning prior to IR treatment,②ischemic post-conditioning (IPoC) group, the rats received 30 min LAD occlusion followed by conditioning at the beginning of 120 min reperfusion, ③ remote ischemic post-conditioning(RIPoC) group, the rats received 30 min LAD occlusion, followed by femoral artery conditioning at the beginning of 120 min reperfusion, ④ IR group, ⑤ Sham group. n=8 in each group.Ischemic myocardial tissue was collected at the end of experiment, superoxide dismutase (SOD) activity was assayed by xanthine oxidase method,malondialdehyde (MDA) content was examined by thiobarbituric acid method, myeloperoxidase (MPO) activity was determined by chemistry colorimetric method, adenosine triphosphate(ATP)amount was measured by bioluminescence method;expressions of myocardial stromal cell derived factor-1 (SDF-1) and vascular endothelial growth factor (VEGF), mitochondrial function related genes Ndufa2, Ndufa4, Cox4il and Cox7a2 were evaluated by real time quantitative PCR. Results:In IPC, IPoC and RIPoC groups, the ischemic myocardial tissue had increased SOD activity and ATP amount, decreased MDA content and MPO activity; induced expressions of SDF-1, VEGF, mitochondrial function related genes Ndufa2, Ndufa4, Cox4il and Cox7a2. Conclusion:RIPoC may increase anti-oxidation/reduction response, protect energy metabolism and reduce inlfammatory reaction in ischemic myocardial tissue, the effect was similar to pre-conditioning and post-conditioningin rats with IR injury.
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Objective To analyze the risk factors for in-hospital mortality in patients aged over 65 years undergoing heart valve surgery combined with coronary artery bypass grafting(CABG).Methods Between February 2002 and September 2014,540 patients aged over 65 years undergoing heart valve surgery combined with CABG in our institute were retrospectively studied.Univariate analyses and multivariate logistic regression analyses were performed to explore risk factors associated with in-hospital mortality.Results Overall in-hospital mortality was 4.26%.Univariate analysis depicted that chronic obstructive pulmonary disease (COPD) (P =0.001),last serum creatinine (P =0.043),unstable angina(P =0.046),Canadian Cardiovascular Society 111-ⅣV (P =0.005),number of diseased coronary vessels (P =0.043),cardiopulmonary bypass time-delayed (P =0.003),post-operative morbidity (P =0.000) had a significant impact on in-hospital mortality.Multivariate logistic regression analysis revealed that COPD (P =0.005,OR =5.598),CPB time-delayed (P < 0.001,OR =1.011),re-exploration (P <0.001,OR =15.813),malignant arrhythmia (P =0.014,OR =4.900) were independent risk factors of in-hospital mortality.Conclusion The present research demonstrates that COPD,CPB time-delayed,re-exploration and malignant arrhythmia dramatically impacted the in-hospital mortality of patients aged over 65 years undergoing combined heart valve surgery and CABG.
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Objective: To report the medium-long term survival rates of ventricular septal myectomy for treating the patients with hypertrophic obstructive cardiomyopathy and to analyze the predictive factors affecting the outcomes. Methods: A total of 655 consecutive patients who received ventricular septal myectomy in our hospital from 1984-10 to 2014-12 were retrospectively summarized. The cohort study was conducted with questionnaires by cardiovascular nurses. Result: The operative mortality was 1.4% (9/655). The mean follow-up time was (30.8 ± 30.9, from 3 to 213) months, there were 52/646 (7.9%) patients lost contact and 583 patients having NYHA classification at I or II during that period. The overall survival rates for 1 year, 5-year and 8-year were 98.3%, 90.5% and 88.3% respectively. There were 80 patients suffered from end point events including HCM-related death, heart transplantation, repeated myectomy, permanent pacemaker implantation and re-admission for ischemic stroke, tachyarrhythmia, myocardial ischemia or infarction, congestive heart failure. The end point events free survival rates for 1 year, 5-year and 8-year were 94.2%, 76.7% and 65.9% respectively. Multivariable Cox regression analysis presented that age>50 years (HR=2.16, 95% CI 1.36-3.46,P=0.001) and pre-operative atrial ifbrillation (FA) (HR=2.31, 95% CI 1.35-3.94,P=0.002) were the independent predictors for end point events occurrence. Conclusion: Ventricular septal myectomy may achieve good medium-long term survival rate with less adverse event in patients with hypertrophic obstructive cardiomyopathy. Elder than 50 years of age and with pre-operative FA were the independent predictors for adverse events occurrence.
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Objective: To establish a mice model of congenital heart disease transposition of great arteries in order to provide a research reference for the occurrence and development of transposition of great arteries. Methods: A total of 20 pregnant ICR mice at 8-10 weeks of age were divided into 2 groups: Control group, the mice received a single dose of DMSO 70 mg/kg at 8.5 days of gestation,n=5 and Experiment group, the mice received a single dose of all-trans retinoic acid 70 mg/kg at 8.5 days of gestation,n=15. All animals were treated for 18 days and then the embryos were taken to observe cardiac morphology under stereomicroscope. Results: Compared with Control group, Experiment group had obviously increased occurrence rates of premature delivery, abortion and embryo absorption, and 61.2% phenotype for transposition of great arteries; meanwhile, combining with non-heart defect phenotypeas exophthalmos and spinal malformation. Conclusion: All-trans retinoic acid may induce transposition of great arteries in mice embryos, which is a feasible animal model in experimental research.
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Objective Summarizing single clinical experience with extracorpomreal membrane oxygenation(ECMO) as a supplement to extracorporeal cardiopulmonary resuscitation(ECPR) in adult patients with cardiac arrest to explore new ideas.Methods We retrospectively analyzed the characteristics of 17 patients who underwent ECMO as part of ECPR from July 2005 to September 2014 at Fuwai Hospital,and analyzed the differences between the survival group(n =6) and the in-hospital death group.Results The mean CPR time was(44.53 ± 21.39) min.The support duration of ECMO was(106.38-± 70.43) h.12 patients of all were successfully weaned from ECMO,and 6 patients survived to hospital discharge.There were significant differences between the two groups in terms of the last serum creatinine and blood lactate acid level before ECMO,and the time to lactate normalization.11 patients died,7 patients developed bleeding,and 8 cases developed infection.Conclusion Single-center data showed that applying ECMO as a means of ECPR improved the survival rate in cardiac arrest patients.Additionally,creatinine and lactic acid were good indicators for assessing prognosis.Refractory circulatory dysfunction and neurologic complications have an adverse impact on the survival of cardiac arrest patients.
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Objective: To compare the long term prognosis between revascularization (REV) and medical therapy (MP) in patients with three-vessel disease (3VD) with or without left main (LM) lesion. Methods: A total of 4,875 consecutive patients with elective coronary angiography (CAG) diagnosed 3VD with or without LM lesion treated in our hospital from 2007-01 to 2008-12 were retrospectively studied. The patients were divided into 2 groups: MT group,n=705 (14.5%) and REV group,n=4170 (85.5%). The all cause mortality and the rate of revascularization during follow-up period were compared between 2 groups by inverse-probability-weighting approach with propensity score. Results: There were 3962/4875 (81.3%) patients with simple 3VD (right, left anterior descending and left circumlfex coronary arteries) and 913 (18.7%) with 3VD+LM lesion. The in-hospital mortality was similar between 2 groups (OR=0.7, 95% CI 0.3-1.4,P=0.30). With the longest 2-year follow-up study, the adjusted all cause mortality and the rate of revascularization in MT group were both higher than those in REV group (HR=8.3, 95% CI 6.7-11.1,P Conclusion: In real world, the long term prognosis by revascularization treatment was superior to medical treatment in patients with either simple 3 vessel coronary disease or 3 vessel combining LM disease.
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<p><b>OBJECTIVE</b>To assess the cardiopulmonary exercise testing (CPET) derived performance of oxygen uptake and ventilation efficiency parameters, including oxygen uptake efficiency plateau (OUEP) , oxygen uptake efficiency slope (OUES), V·E/V·CO2 slope and lowest V·E/V·CO2, in patients with end-stage chronic heart failure (CHF) and evaluate their clinical value on monitoring cardiac function and hemodynamic status.</p><p><b>METHODS</b>A total of 26 end-stage CHF patients considered for heart transplantation were enrolled in this study. CPET, echocardiography and invasive hemodynamic examinations with Swan-Ganz flowing balloon catheter were performed. Correlation analysis was made between oxygen uptake and ventilation efficiency parameters from CPET and echocardiographic and hemodynamic parameters.</p><p><b>RESULTS</b>OUEP and OUES showed good correlation with peak oxygen consumption (peak V·O2) (r = 0.535, P < 0.01;r = 0.840, P < 0.001). In end-stage CHF patients, the slope of OUEP with respect to peak V·O2 is about 32, but the slope of OUES with respect to peak V·O2 is only about 2. The difference was 16 times. The change of OUEP was more sensitive and significant than those of OUES and peak V·O2 (P < 0.05). OUEP, peak V·O2 (%pred), V·E/V·CO2 slope and lowest V·E/V·CO2 were all correlated well with non-invasive hemodynamic parameters peak cardiac output (r = 0.535, P < 0.01; r = 0.652, P < 0.001; r = -0.640, P < 0.001; r = -0.606, P = 0.001 respectively) and peak cardiac index (r = 0.556, P < 0.01;r = 0.772, P < 0.001; r = -0.641, P < 0.001; r = -0.620, P < 0.001 respectively) derived from CPET, but not correlated with invasive hemodynamic parameters cardiac output and cardiac index at rest (P > 0.05). Both peak V·O2 (%pred) and V·E/V·CO2 slope were significantly correlated with invasive hemodynamic parameters systolic pulmonary arterial pressure (r = -0.424, P < 0.05; r = 0.509, P < 0.01) and mean pulmonary arterial pressure (r = -0.479, P < 0.05; r = 0.405, P < 0.05). Peak V·O2 (%pred) was also significantly correlated with pulmonary capillary wedge pressure (r = -0.415, P < 0.05), and V·E/V·CO2 slope was significantly correlated with pulmonary vascular resistance (r = 0.429, P < 0.05).</p><p><b>CONCLUSIONS</b>The oxygen uptake and ventilation efficiency parameters derived from CPET, including peak V·O2, OUEP, lowest V·E/V·CO2 and V·E/V·CO2 slope etc, are objectively monitoring and evaluating cardiac function and hemodynamic status. And they are useful for optimizing clinical management of patients with end-stage CHF.</p>