Four-corners traction combined with continuous everting suture technique as a modification in bicaval anastomosis for orthotopic heart transplantation.

BACKGROUND: Although standard bicaval techniques has become popular in orthotopic heart transplantation, distortion, bleeding, thrombosis and arrhythmia were still causes for concern. This study was designed to compare the standard bicaval techniques and modified bicaval techniques in our institution. MATERIALS AND METHODS: A total of 70 recipients underwent orthotopic heart transplantation at our center from June 2015 to April 2019 (standard group = 24 cases, modified group = 46 cases). The average follow-up period was 46.4 ± 17.4 months. Atrioventricular cavity diameter was measured by ultrasonography and left atrial morphology was evaluated by CT-angiography and three-dimensional reconstruction. RESULTS: Recipients in both groups were similar with pre-operative characteristics. Total ischemic, cardiopulmonary bypass and cross-clamp times were similar. The modified bicaval techniques group has a significantly fewer blood transfusion, lower post-transplant tricuspid regurgitation grade and the incidence of post-operative atrial arrhythmia than standard bicaval techniques group. CT-angiography and three-dimensional reconstruction illustrated ideal and physiologic left atrial morphological structure. Short-term survival differed significantly and the cumulative proportion of survival was significantly higher in the modified bicaval techniques group than that in the standard bicaval techniques group. CONCLUSIONS: This study showed that modified bicaval techniques offers a better early outcome than standard bicaval techniques. The significant reduction of intraoperative blood transfusion and post-transplant tricuspid regurgitation grade in the modified bicaval techniques group may has a major impact on the short-term survival.

Epidemiologic and clinical characteristics of heart transplant recipients during the 2019 coronavirus outbreak in Wuhan, China: A descriptive survey report.

BACKGROUND: The epidemiologic and clinical characteristics of heart transplant (HTx) recipients during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic remains unclear. We studied the characteristics of HTx recipients from December 20, 2019, to February 25, 2020, in an effort to understand their risk and outcomes. METHODS: All accessible HTx recipients were included in this single-center retrospective study. We collected information on the recipients using a web-based questionnaire as well as the hospital database. RESULTS: We followed 87 HTx recipients (72.4% were men, and the average age was 51 years). A total of 79 recipients resided in Hubei, and 57 recipients had a Wuhan-related history of travel or contact. Most took precautionary measures while in contact with suspicious crowds, and 96.6% of the families and communities undertook prevention and quarantine procedures. Four upper airway infections were reported, and 3 of them tested negative for SARS-CoV-2 (the fourth recovered and was not tested). All cases were mild and successfully recovered after proper treatment. Laboratory results of 47 HTx cases within the last 2 months were extracted. Of these, 21.3% of recipients had pre-existing lymphopenia, and 87.2% of recipients had a therapeutic concentration of tacrolimus (5-12 ng/ml). Liver and kidney insufficiency was seen in 5 and 6 recipients, respectively. CONCLUSION: HTx recipients who practiced appropriate prevention measures had a low rate of infection with SARS-CoV-2 and transition to the associated disease COVID-19. These early data will require confirmation as the pandemic establishes around the world.

Avß3 Single-Stranded DNA Aptamer Attenuates Vascular Smooth Muscle Cell Proliferation and Migration via Ras-PI3K/MAPK Pathway.

OBJECTIVES: To observe the effect of avß3 single-stranded (ss) DNA on proliferation and migration of vascular smooth muscle cells (VSMCs) and its potential mechanism. BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) is currently the preferred method for the treatment of coronary heart disease. However, vascular restenosis still occurs after PTCA treatment, severely affecting the clinical efficacy of PTCA. Integrin avß3 single-stranded (ss) DNA on proliferation and migration of vascular smooth muscle cells (VSMCs) and its potential mechanism. METHODS: In this experiment, we used systematic evolution of ligands by exponential enrichment (SELEX) to screen out avß3 single-stranded (ss) DNA on proliferation and migration of vascular smooth muscle cells (VSMCs) and its potential mechanism. ß3 single-stranded (ss) DNA on proliferation and migration of vascular smooth muscle cells (VSMCs) and its potential mechanism. ß3 single-stranded (ss) DNA on proliferation and migration of vascular smooth muscle cells (VSMCs) and its potential mechanism. ß3 single-stranded (ss) DNA on proliferation and migration of vascular smooth muscle cells (VSMCs) and its potential mechanism. RESULTS: In the present study, we found that avß3 single-stranded (ss) DNA on proliferation and migration of vascular smooth muscle cells (VSMCs) and its potential mechanism. P < 0.05). Avß3 single-stranded (ss) DNA on proliferation and migration of vascular smooth muscle cells (VSMCs) and its potential mechanism. P < 0.05). AvP < 0.05). Av. CONCLUSIONS: The findings suggest that avß3 ssDNA inhibited the proliferation and migration of VSMCs by suppressing the activation of Ras-PI3K/MAPK signaling.ß3 single-stranded (ss) DNA on proliferation and migration of vascular smooth muscle cells (VSMCs) and its potential mechanism.

Avß3 single-stranded DNA aptamer attenuates vascular restenosis via Ras-PI3K/MAPK pathway in rats after percutaneous transluminal coronary angioplasty.

Our aim was to investigate the effect of avß3 single-stranded DNA aptamer (avß3 ssDNA) on vascular restenosis in rats after percutaneous transluminal coronary angioplasty (PTCA) via the Ras-PI3K/MAPK pathway. Sixty Sprague-Dawley rats were randomly divided into six groups: sham-operated, PTCA, PTCA+cilengitide (18 mg/kg, n = 8), and avß3 ssDNA treatment at 50, 100, and 200 µg/kg. Hematoxylin-eosin staining was performed to evaluate the successful establishment of the PTCA model and to assess the degree of intimal hyperplasia. Immunofluorescence and in situ hybridization were carried out to observe the level of avß3. Immunohistochemistry was used to detect the expression of E-cadherin, N-cadherin, α-smooth muscle actin (α-SMA), angiotensin 1 (ANG1), and ANG2. The expression of osteopontin (OPN), focal adhesion kinase (FAK), Ras, mitogen-activated protein kinase (MAPK), phosphatidylinositol-4,5-bisphosphate 3-kinase (PI3K), signal transducer and activator of transcription 1 (STAT1), and GTPase was observed by the western blot and quantitative reverse transcription polymerase chain reaction. Compared with rats subjected to PTCA only, those treated with avß3 ssDNA showed significantly decreased vascular occlusion rate (P < .05). The protein expression of avß3, OPN, p-FAK, ANG2, and E-cadherin was significantly increased by avß3 ssDNA (P < .05), while the levels of ANG1, α-SMA, N-cadherin Ras, MAPK, PI3K, STAT1, and GTPase were significantly decreased (P < .05). Avß3 ssDNA reduced the proliferation, migration, epithelial-mesenchymal transition, and vascular remodeling of vascular smooth muscle cells, and the mechanism may be related to the Ras-PI3K/MAPK pathway.

MDG­1 inhibits H2O2­induced apoptosis and inflammation in human umbilical vein endothelial cells.

MDG­1, a water­soluble polysaccharide extracted from Ophiopogon japonicus, has been reported to serve a role in antimyocardial ischemia by protecting cardiomyocytes from hypoxia/reoxygenation­induced damage. However, it remains unknown whether MDG­1 protects human umbilical vein endothelial cells (HUVECs) against oxidative stress­induced damage. In the present study, HUVECs were treated with hydrogen peroxide (H2O2) to establish an oxidative stress­induced cell injury model. Treatment of HUVECs with different concentrations of H2O2 significantly attenuated cell viability and increased cell apoptosis in a time and dose­dependent manner. Pretreatment with MDG­1 markedly reduced H2O2­induced cell death, ROS generation and inflammatory factor secretion. In addition, pretreatment with MDG­1 decreased the expression levels of proapoptotic proteins BCL2 associated X (Bax) and caspase­3, while it increased the expression levels of the antiapoptotic protein BCL2 apoptosis regulator (Bcl­2), compared with H2O2 treatment alone. Taken together, the present data suggest that MDG­1 protected HUVECs against H2O2­induced apoptosis and inflammation through inhibition of Bax/Bcl­2 protein ratio, caspase­3 expression, and inflammatory factor secretion. This study provides a potential application for MDG­1 in the treatment of cardiovascular disease.

Endoscopic radial artery harvesting does not compromise graft patency for coronary artery bypass graft: a meta analysis of 2782 patients.

BACKGROUND: Endoscopic radial artery harvesting is a favourable harvesting technique which provides excellent cosmetic result and low incidence of incision related complications, however the impact of this technique on graft quality is less well-explained. We sought to evaluate the impact of harvesting technique on graft patency and relevant clinical outcomes in patients undergoing coronary artery bypass graft (CABG). METHOD: A systematic literature search was conducted to identify publications containing comparisons between different sampling skills in CABG, data was extracted and analysed with Revman, Downs and Black score was applied to evaluate the methodological quality of included studies. RESULT: Ten studies containing 2782 patients were undertaken, the quality was generally acceptable. Pooled analysis results indicate endoscopic radial artery harvesting was associated with a lower incidence of wound infection and a similar incidence of haematoma formation compared with open harvesting. The difference in graft patency and all-cause mortality was insignificant between two cohorts. CONCLUSION: Endoscopic radial artery harvesting is a safe technique and provides equivalent graft patency as compared with open harvesting, further investigation is required to confirm the aforementioned conclusion and evaluate the impact of harvesting technique on hand sensory and motor function.

Surgery for acute aortic dissection using the Chinese CRONUS stented elephant trunk technique: experience with 252 patients.

OBJECTIVES: The elephant trunk method was introduced to treat aortic disease. There are a variety of modified elephant trunk methods, including the stented elephant trunk. We retrospectively reviewed our experience and evaluated the effectiveness of surgical treatment for acute aortic dissection using the Chinese CRONUS stented elephant trunk technique. METHODS: From August 2005 to December 2012, 252 patients with acute aortic dissection underwent surgical treatment using the Chinese CRONUS stented elephant trunk technique at the Renmin Hospital of Wuhan University. We review the characteristics of the patients, the surgical method, and the prognosis. Furthermore, we modified the stented elephant trunk technique to simplify the surgical procedure using stented elephant trunk fenestration in 81 patients. RESULTS: The procedure was technically successful in all patients. The mean duration of cardiopulmonary bypass, myocardial ischemia, and circulatory arrest was 158±34 minutes, 98±24 minutes, and 27±9 minutes, respectively. The mean stay in the intensive care unit was 74±11 hours. The in-hospital mortality rate was 3.2% (8/252). A 92.2% (225/244) follow-up rate was achieved. Five patients died during follow-up. The diameter of the descending aorta significantly decreased in 173 patients (78.6%), did not change 39 patients (17.7%), and dilated in 8 patients (3.7%). CONCLUSIONS: In surgery for acute aortic dissection, the Chinese CRONUS stented elephant trunk technique had a low prevalence of morbidity and mortality in our patients. The satisfactory effects demonstrated that the technique is safe and effective in closing the residual false lumen of the descending aorta. Stented elephant trunk fenestration could further simplify the surgical procedure with minimal invasion.

Outcomes of surgical versus balloon angioplasty treatment for native coarctation of the aorta: a meta-analysis.

BACKGROUND: Native coarctation of the aorta (COA) accounts for 5-7% of congenital heart disease. Open surgical treatment was the only choice until balloon angioplasty (BA) treatment was introduced as an alternative therapy for COA in the 1980s. BA treatment was thought to be a less invasive and potentially safer technique, and has been used on numerous patients. But as has been reported during the past 30 years, the risk of aneurysm formation and recoarctation existed in either of those 2 procedures. Unfortunately, follow-up for either type of treatment has been limited, making it difficult to draw any meaningful conclusions as to which treatment option is superior. Our objective was to compare results of 2 therapeutic modalities to treat native COA: BA without stent implantation and surgery. METHODS: We performed a meta-analysis of controlled trials of surgical versus BA treatment for native COA. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and the Chinese Biomedical Database of clinical trials were searched using PubMed and OVID. Controlled trials in which patients with COA were assigned to surgical repair or BA treatment were included. For each outcome, we evaluated the quality of the evidence with reference to the Grading of Recommendations Assessments, Development, and Evaluation criteria. We used RevMan 5.1 software (The Nordic Cochrane Centre, Copenhagen, Denmark) to analyze the data. RESULTS: A literature search yielded 9 comparable studies, for a total of 623 patients, of whom 378 and 245 were assigned to surgery and BA. Meta-analysis of these studies showed no significant difference in postintervention gradient (inverse variance fixed mean difference: 1.44 [95% CI: -1.16 to 4.04]), midterm recoarctation (Mantel-Haenszel [M-H] random odds ratio [OR]: 0.24 [95% CI: 0.04-1.58]), and long-term recoarctation (M-H fixed OR: 0.61 [95% CI: 0.34-1.11]). BA reduces the risk of severe complications (M-H fixed OR: 2.67 [95% CI: 1.37-5.21]; P < 0.001) but increases the risk of short-term recoarctation (M-H fixed OR: 0.25 [95% CI]: 0.12-0.54]; P < 0.001) and aortic aneurysm formation (M-H fixed OR: 0.12 [95% CI]: 0.04-0.34]; P < 0.001). CONCLUSIONS: BA provides immediate results comparable to surgery and reduces invasion, but it does not provide better results compared with surgery when considering medium- and long-term complications and even increases the incidence of aneurysm formation.

Transforming growth factor-ß1 induces matrix metalloproteinase-9 expression in rat vascular smooth muscle cells via ROS-dependent ERK-NF-κB pathways.

Both matrix metalloproteinase-9 (MMP9) and transforming growth factors-ß1 (TGF-ß1) are the important factors in the pathogenesis of the aortic aneurysm (AA) and aortic dissection (AD). Recent studies have shown that inhibition of reactive oxygen species (ROS) production, extracellular signal-regulated kinase 1/2(ERK1/2) or NF-κB pathways is able to suppress aneurysm formation. The median layers of arterial walls are mainly the vascular smooth muscle cells (VSMCs), while the pathogenesis of AA and AD is closely related to the changes in the median layer structure. Thus, we investigated the molecular mechanisms underlying TGF-ß1-induced MMP-9 expression in VSMC, the involvement of intracellular ROS and signaling molecules, including ERK1/2 and NF-κB. Rat vascular smooth muscle cells (A7r5) were used. MMP-9 expression was analyzed by gelatin zymography, western blot and RT-PCR. The involvement of intracellular ROS and signaling molecules including ERK1/2 and NF-κB in the responses was investigated using reactive oxygen scavenger N-acetylcysteine (NAC) and pharmacological inhibitors (U0126 and BAY11-7082), determined by ROS testing and western blot testing for their corresponding proteins. TGF-ß1 induces MMP-9 expression via ROS-dependent signaling pathway. ROS production leads to activation of ERK1/2 and then activation of the NF-κB transcription factor. Activated NF-κB turns on transcription of the MMP-9 gene. The process in which TGF-ß1 induces MMP9 expression involves the ROS-dependent ERK-NF-κB signal pathways in VSMC. This discovery raises a new regulation pathway in the VSMC, and it shows the potential to help to find a new solution to treating aortic aneurysm and aortic dissection.

[Simplified surgical procedure of stented elephant trunk fenestration in acute Stanford type A aortic dissection].

OBJECTIVE: To study the technical feasibility of simplified total arch replacement via stented elephant trunk fenestration in the treatment of acute Stanford type A aortic dissection. METHODS: A total of 42 consecutive patients with acute type A aortic dissection underwent total aortic arch replacement plus fenestrate stented elephant trunk implantation under hypothermic cardiopulmonary bypass and bilateral antegrade cerebral perfusion between August 2008 to February 2011. The aortic arch was accessed longitudinally. Transection of aortic arch was performed between left common carotid artery and left subclavian artery. A stented elephant trunk was inserted in descending aorta. Then the reconstruction of left subclavian artery was made by fenestration in stented elephant trunk. Finally 3-branched graft was used to complete the reconstruction of aortic arch. RESULTS: Operations were performed successfully. The mean cardiopulmonary bypass (CPB) time was (156 ± 42) min, mean aortic cross-clamp time (91 ± 18) min, mean circulatory arrest time (20 ± 5) min and mean antegrade cerebral perfusion (ACP) time (33 ± 7) min. No postoperative death occurred. The incidence of temporary neurological dysfunction was 4.8% (2/42). They underwent neither re-exploration for postoperative hemorrhage nor hoarseness due to recurrent nerve palsy. Left radial arterial pulses were palpable in all of them. None had sensory deficit and dyskinesia of left arm. All their angiographic findings showed complete patency of left subclavian artery. There was neither space nor blood flow around the stented elephant trunk. The false lumen of descending aorta around elephant trunk closed and obliterated in all cases. CONCLUSIONS: The above-mentioned technique of modified total aortic arch replacement provides a distinct operative field and may achieve simple but reliable anastomosis with less bleeding. Thus aortic arch replacement becomes easier and more effective.

[The clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment for patients with DeBakey I thoracic aortic dissection].

OBJECTIVE: To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey I thoracic aortic dissection. METHODS: From January 2006 to October 2010, 101 cases of DeBakey I aortic dissection were treated by modified total arch replacement and stent elephant trunk technique, in which emergency surgery for 73 cases. There were 76 male and 25 female patients, aged from 21 to 77 years with a mean of (49 ± 8) years. Intraoperative ascending aortic replacement in 31 cases, Bentall procedure in 29 cases, Wheat procedure in 7 cases, David procedure in 34 cases. At the same time stent elephant trunk in the left subclavian artery corresponding position was windowed to rebuild the blood supply. Deep hypothermic circulatory arrest cerebral protection was completed by bilateral antegrade cerebral perfusion. RESULTS: The mean cardiopulmonary bypass time was (212 ± 40) min, mean myocardial occlusion time was (95 ± 16) min, mean circulatory arrest time was (42 ± 8) min. Operative mortality was 1 case and hospital mortality was 5 case, which died of septicemia, acute renal failure and hemiplegia complicated with multiple organ failure. Compared with selective cerebral perfusion, the incidence of postoperative cerebral vascular accident and transient neurological dysfunction decreased. Seventy-six cases received aorta CTA before discharged, the closure rate of descending thoracic aortic dissection false lumen was 78.9%. Seventy-one patients were followed up for 5 to 49 months, 50 cases was reviewed by CTA, of which closure rate of descending thoracic aortic dissection false lumen was 88.0%, no late death and re-surgery. CONCLUSIONS: The modified total aortic arch replacement and stent elephant trunk technique treatment for patients with DeBakey I thoracic aortic dissection was safe and effective, with less postoperative complications.