Hypothermic Circulatory Arrest in Median Sternotomy Hemorrhage During Redo Aortic Surgery.

INTRODUCTION: This study summarizes the clinical data of patients who developed sternotomy hemorrhage during redo aortic surgery and analyzes the clinical experience of using hypothermic circulatory arrest. METHODS: We retrospectively analyzed the medical records of patients who developed sternotomy hemorrhage during redo aortic surgery from May 2018 to August 2021. General anesthesia with single-lumen tracheal intubation was used. Femoral artery, vein, and superior vena cava cannulation were used if cardiopulmonary bypass was required according to the situation, and right superior vein or apical cannulation was selected for left heart drainage. RESULTS: A total of 11 patients were enrolled in this study, comprising nine males and two females, with an average age of 44.3±16.7 years. All cases were successfully completed without cerebrovascular complications or paraplegia. Two patients died during hospitalization, two patients died during the follow-up after discharge, and the remaining patients are recovering well. CONCLUSION: The femoral-femoral bypass with hypothermic circulatory arrest technique is a safe and reliable method to use in cases of sternotomy hemorrhage during redo aortic surgery.

Hypothermic Circulatory Arrest in Median Sternotomy Hemorrhage During Redo Aortic Surgery

ABSTRACT Introduction: This study summarizes the clinical data of patients who developed sternotomy hemorrhage during redo aortic surgery and analyzes the clinical experience of using hypothermic circulatory arrest. Methods: We retrospectively analyzed the medical records of patients who developed sternotomy hemorrhage during redo aortic surgery from May 2018 to August 2021. General anesthesia with single-lumen tracheal intubation was used. Femoral artery, vein, and superior vena cava cannulation were used if cardiopulmonary bypass was required according to the situation, and right superior vein or apical cannulation was selected for left heart drainage. Results: A total of 11 patients were enrolled in this study, comprising nine males and two females, with an average age of 44.3±16.7 years. All cases were successfully completed without cerebrovascular complications or paraplegia. Two patients died during hospitalization, two patients died during the follow-up after discharge, and the remaining patients are recovering well. Conclusion: The femoral-femoral bypass with hypothermic circulatory arrest technique is a safe and reliable method to use in cases of sternotomy hemorrhage during redo aortic surgery.

Impact of unintentional coronary angiography on outcomes of emergency surgery in acute type A aortic dissection: a retrospective study.

BACKGROUND: This study investigated the impact of coronary angiography on outcomes of emergency operation in acute type A aortic dissection (ATAAD) patients who were initially misdiagnosed as an acute coronary syndrome. METHODS: From October 2016 to April 2019, 129 patients underwent emergency operation for ATAAD in our institution, including 21 patients (16.3%, coronary angiography group) who received preoperative coronary angiography without knowledge of the ATAAD, and the rest 108 did not (Non-coronary angiography group). Preoperative clinical characteristics, 30-day mortality and postoperative complications were compared. Multivariable logistic regression was performed to confirm the independent prognostic factors for short-term and long-term outcomes. RESULTS: Patients undergoing coronary angiography had higher prevalence of preoperative hypotension or shock (61.9% vs 35.2%, P = 0.022), ischemic changes on electrocardiogram (66.7% vs 37.0%, P = 0.012), platelet inhibition (ADP-induced inhibition 92.0% vs 46.0%, P = 0.001), and coronary involvement (66.7% vs 30.6%, P = 0.002). 30-day mortality was 4.8% versus 9.3% (P = 0.84). Coronary angiography group had more intraoperative bleeding (1900 ml vs 1500 ml, P = 0.013) and chest-tube drainage on the first postoperative day (1040 ml vs 595 ml, P = 0.028). However, preoperative coronary angiography was not independent risk factors for 30-day mortality (OR 0.171, 95%CI 0.013-2.174, P = 0.173) and overall survival (HR 0.407; 95%CI 0.080-2.057; P = 0.277). CONCLUSION: Patients undergoing coronary angiography carried a higher risk of preoperative hemodynamic instability, myocardial ischemia, and perioperative bleeding. However, unintentional coronary angiography did not have a significant impact on short-term and long-term outcomes of emergency surgery in ATAAD.

PRIM2 Promotes Cell Cycle and Tumor Progression in p53-Mutant Lung Cancer.

p53 is a common tumor suppressor, and its mutation drives tumorigenesis. What is more, p53 mutations have also been reported to be indicative of poor prognosis in lung cancer, but the detailed mechanism has not been elucidated. In this study, we found that DNA primase subunit 2 (PRIM2) had a high expression level and associated with poor prognosis in lung cancer. Furthermore, we found that PRIM2 expression was abnormally increased in lung cancer cells with p53 mutation or altered the p53/RB pathway based on database. We also verified that PRIM2 expression was elevated by mutation or deletion of p53 in lung cancer cell lines. Lastly, silence p53 increased the expression of RPIM2. Thus, these data suggest that PRIM2 is a cancer-promoting factor which is regulated by the p53/RB pathway. The p53 tumor-suppressor gene integrates numerous signals that control cell proliferation, cell cycle, and cell death; and the p53/RB pathway determines the cellular localization of transcription factor E2F, which regulates the expression of downstream targets. Next, we explored the role of PRIM2 in lung cancer and found that knockdown of PRIM2 induced cell cycle arrest, increased DNA damage, and increased cell senescence, leading to decreased lung cancer cell proliferation. Lastly, the positive correlation between PRIM2 and E2F/CDK also indicated that PRIM2 was involved in promoting cell cycle mediated by p53/RB pathway. These results confirmed that the expression of PRIM2 is regulated by the p53/RB pathway in lung cancer cells, promotes DNA replication and mismatch repair, and activates the cell cycle. Overall, we found that frequent p53 mutations increased PRIM2 expression, activated the cell cycle, and promoted lung cancer progression.

The Control Index for the Construction of Sponge City in the Residential Area: A Case Study of Nanjing Jiangbei New District.

The construction of sponge cities is a crucial measure for the development of an ecologically sensitive urban civilization in China, but a systematic and comprehensive construction control target has not yet been established. Considering the Nanjing Jiangbei New District as an example, this article explores how to decompose the control objectives of stormwater management in urban regions into four levels, namely, urban areas, control planning units, implementation plots, and individual technical measures, which will form the basis for the design of sponge cities. The findings of this study are expected to serve as a reference for other regions of China in the design of rainwater management systems, which form the structural backbone of the sponge cities.

Construction and a preliminary study of paracrine effect of bone marrow-derived endothelial progenitor cell sheet.

The release of paracrine factors from endothelial progenitor cell (EPC) sheet is a central mechanism of tissue repair. The purpose of this study was to constuct the rat bone marrow derived-endothelial progenitor cell (BM-EPCs) sheet and investigate invest the role of stromal cell-derived factor-1α (SDF-1α)/CXCR4 axis in the biological function of BM-EPCs sheet. BM-EPC cells were identified by the cell-surface markers-CD34/CD133/VE-cadherin/KDR using flow cytometry and dual affinity for acLDL and UEA-1. After 7 days of incubation, the BM-EPC single-cell suspensions were seeded on thermo-sensitive plate to harvest the BM-EPC cell sheets. The expression levels of SDF-1α/CXCR4 axis-associated genes and proteins were examined using RT-qPCR and western blot analysis, and enzyme-linked immunosorbent assay (ELISA) was applied to determine the concentration of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and SDF-1α in the cell culture medium. The BM-EPC cell sheets were successfully harvested. Moreover, BM-EPC cell sheets have superior migration and tube formation activity when compared with single cell suspension. When capillary-like tube were formed from EPCs sheets, the releasing of paracrine factors such as VEGF, EGF and SDF-1α were increased. To reveal the mechanism of tube formation of BM-EPCs sheets, our research showed that the activation of PI3K/AKT/eNOS pathway was involved in the process, because the phosphorylation of CXCR, PI3K, AKT and eNOS were increased. BM-EPC cell sheets have superior paracrine and tube formation activity than the BM-EPC single-cell. The strong ability to secrete paracrine factors was be potentially related to the SDF-1α/CXCR4 axis through PI3K/AKT/eNOS pathway.

Superior blood-saving effect and postoperative recovery of comprehensive blood-saving strategy in infants undergoing open heart surgery under cardiopulmonary bypass.

BACKGROUND: Optimization of blood-saving strategies during open heart surgery in infants is still required. This study aimed to study a comprehensive blood-saving strategy during cardiopulmonary bypass (CPB) on postoperative recovery in low-weight infants undergoing open heart surgery. METHODS: This was a prospective study of 86 consecutive infants (weighing <5 kg) with acyanotic congenital heart disease treated at the Tianjin Chest Hospital between March and December 2016, and randomized to the control (traditional routine CPB) and comprehensive blood-saving strategy groups. The primary endpoints were blood saving and clinical prognosis. The secondary endpoints were safety and laboratory indicators, prior to CPB (T1), after 30 minutes of CPB (T2), after modified ultrafiltration (T3), and postoperative 12 (T4), 24 (T5), 48 (T6), and 72 h (T7). RESULTS: The total priming volume and banked red blood cells in the comprehensive strategy group were significantly lower than in the control group (P = .009 and P = .04, respectively). In the comprehensive strategy group, immediately after CPB, the amount of salvaged red blood cells exceeded the priming red blood cells by 40 ±â€Š11 mL. Postoperatively, the comprehensive strategy group showed a significant decrease in the inotrope score (P = .03), ventilation time (P = .03), intensive care unit stay (P = .04), and hospital stay (P = .03) in comparison with the control group. CONCLUSION: The comprehensive blood-saving strategies for CPB were associated with less blood use and favorable postoperative recovery in low-weight infants with congenital heart disease undergoing open heart surgery.

Preliminary study of the application of transthoracic echocardiography-guided three-dimensional printing for the assessment of structural heart disease.

OBJECTIVE: To investigate the feasibility and diagnostic value of a preoperative transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) for the assessment of structural heart disease (SHD). METHODS: Fourty-four patients underwent cardiac surgery at Tianjin Chest Hospital. The patients were preoperatively assessed using TTE-guided 3DPM, which was compared to conventional three-dimensional transthoracic echocardiography (3DTTE) along with direct intraoperative findings, which were considered the "gold standard." Twelve patients had SHD, including four with mitral prolapse, two with partial endocardial cushion defects, two with secondary atrial septal defects, two with rheumatic mitral stenosis, one with tetralogy of Fallot, and one with a ventricular septal defect (VSD). Thirty-two patients who did not have SHDs were designated as the negative control group. RESULTS: The sensitivity and specificity of the TTE-guided 3DPM were greater than or equal to those of the 3DTTE. The P-value of the McNemar test of 3DTTE was >.05, which indicates that the difference was not statistically significant (Kappa = 0.745, P < .001). The P-value of the McNemar test of TTE-guided 3DPM was >.05, which indicates that the difference was not statistically significant (Kappa = 0.955, P < .001). A comparison of 3DTTE and TTE-guided 3DPM resulted in a P-value >.05, which indicates that the difference was not statistically significant (Kappa = 0.879, P < .001). TTE-guided 3DPM displayed the 3D structure of SHDs and cardiac lesions clearly and was consistent with the intra-operative findings. CONCLUSION: Transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) provides essential information for preoperative evaluation and decision making for patients with SHDs.

Performance of EuroSCORE II and SinoSCORE in Chinese patients undergoing coronary artery bypass grafting.

OBJECTIVES: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) was developed to update EuroSCORE and incorporated refinement and modification of several risk factors. SinoSCORE was designed by Chinese scholars based on 9839 patients who underwent coronary artery bypass grafting (CABG) at 43 participating institutions. This study was designed to validate the EuroSCORE II and SinoSCORE in Chinese patients undergoing CABG and to compare their performance overall and per subgroup. METHODS: A total of 4507 adult receiving CABG at our institution between January 2010 and April 2014 were included in this retrospective study. Patients were stratified for cardiovascular risk using EuroSCORE II and SinoSCORE. The performance of EuroSCORE II and SinoSCORE was analysed with a focus on discrimination power and calibration. RESULTS: The in-hospital mortality rate for the entire cohort was 1.4%, while the mortality rate predicted by EuroSCORE II was 1.47 ± 1.2% (95% CI 1.43-1.50) and by SinoSCORE was 2.86 ± 3.5% (95% CI 2.76-2.96). The C-statistics of EuroSCORE II and SinoSCORE were 0.728 and 0.716, respectively. The Hosmer-Lemeshow test indicated that EuroSCORE II had poor goodness of fit while SinoSCORE performed slightly better. When patients were divided into quartiles based on predicted risk, respectively defined as group I, II, III and IV, EuroSCORE II underestimated mortality rates of patients scored IV, but overestimated mortality rates in all other groups; SinoSCORE underestimated mortality rates of patients scored I and overestimated mortality rates in all other groups. EuroSCORE II only achieved good discrimination for patients scored I (area under the receiver operating characteristic curve, AUC = 0.707 > 0.70), and SinoSCORE achieved poor discrimination for all subgroups except group II (AUC = 0.754 > 0.70). EuroSCORE II overestimated the mortality rate in the isolated CABG group and underestimated mortality rates in patients with other cardiac surgeries. SinoSCORE overestimated mortality rates in all pathology subgroups. The AUC values of EuroSCORE II and SinoSCORE were 0.694 and 0.687, respectively, for isolated CABG. The AUC values of EuroSCORE II and SinoSCORE were 0.772 and 0.669 for combined cardiac surgery CABG. CONCLUSIONS: EuroSCORE II could predict mortality in the entire group and in the low-middle risk group, but not in the high-risk group, in which it underestimated mortality. SinoSCORE overestimated mortality rates in the entire group and in all subgroups. Risk models should be targeted to different heart diseases, and the statistical methods of established risk systems should be improved.

The significance of natriuretic peptide in treatment of pulmonary hypertension after mitral valve replacement.

OBJECTIVES: To compare the therapeutic efficacy of recombinant human brain natriuretic peptide and prostaglandin E1 in the treatment of pulmonary hypertension after mitral valve replacement. METHODS: Sixty patients with postoperative pulmonary hypertension were divided randomly into 3 groups that received saline, prostaglandin E1, and natriuretic peptide infusions for 12 hours each. The hemodynamics data were monitored consecutively, and the levels of thromboxane A2 and cyclic guanosine monophosphate were detected pretreatment, after treatment, and 1 week after surgery. RESULTS: The arterial pressure, pulmonary arterial pressure, and pulmonary capillary wedge pressure decreased 1 hour after prostaglandin E1 treatment and rebounded after treatment discontinuation. The pulmonary arterial pressure and pulmonary capillary wedge pressure in the natriuretic peptide group decreased 3 hours after treatment; pulmonary arterial pressure decreased less than that of the prostaglandin group, and there was no evidence of hemodynamic rebound after treatment discontinuation. The natriuretic peptide had no significant effects on arterial pressure. In both the prostaglandin and natriuretic peptide groups, cyclic guanosine monophosphate increased after the treatment, which was even higher in the latter group. Prostaglandin E1 could lead to the decrease of thromboxane A2, which was not seen in the natriuretic peptide group. CONCLUSIONS: Both brain natriuretic peptide and prostaglandin E1 can effectively reduce pulmonary hypertension; however, natriuretic peptide has a slower and milder efficacy. The effects of these 2 drugs in reducing the pulmonary arterial pressure may be mediated through different pathways.

The -251A>T polymorphism of interleukin-8 is associated with longer mechanical ventilation and hospital staying after coronary surgery.

BACKGROUND: Cardiac surgery is associated with inflammatory responses that are known to affect its outcome. The present study was designed to define whether post-operative release of interleukin (IL)-6, 8 and tumor necrosis factor-alpha (TNF-alpha) is related to the presence of a certain allele in functional polymorphism and its relationship to clinical outcome after off-pump coronary artery bypass (OPCAB). METHODS: One hundred and forty-five patients undergoing first time elective OPCAB were genotyped for IL-6(-174G>C), IL-8(-251A>T) and TNF-alpha(-308G>A) polymorphisms using polymerase chain reaction (PCR) and gene sequencing. Cytokine levels were measured in plasma samples taken before the operation and 4, 24 and 72h postoperatively by suspension array system. RESULTS: Levels of IL-6 and IL-8 increased significantly after OPCAB. Patients with IL-6-174GG and IL-8-251AA genotypes had higher post-operative circulating levels of IL-6 and IL-8, respectively. Logistic regression showed that IL-8-251AA genotype was an independent risk factor of ventilation time more than 1day (OR=11.80, 95% CI: 1.87-74.48) and hospital staying more than 14days (OR=38.00, 95% CI: 4.15-347.87) after surgery. CONCLUSIONS: OPCAB results in post-operative inflammatory responses. Genetic backgrounds alter the extent of inflammatory response and might relate to clinical outcome of OPCAB.

[Analysis of risk factors in elderly patients with renal dysfunction undergoing off-pump coronary artery bypass grafting].

OBJECTIVE: To analyze the risk factors in the patients over 65 years old undergoing off-pump coronary artery bypass grafting (OPCAG) as grouped by postoperative creatinine clearance rate (Ccr). METHODS: A total of 462 consecutive patients over 65 years old undergoing OPCAG from January 2007 to December 2008 were recruited. They were divided into 3 groups by renal functions: normal, minor injury and moderate-severe injury. The risk factors were analyzed by a comparison of postoperative complications, duration of intubation, stay of intensive care unit and mortality rate, et al. RESULTS: There was no significant difference between the parameters of preoperative complications, left ventricle ejection fraction (LVEF), left ventricle end diastolic diameter (LVEDD) and lipid level, et al. And the postoperative complications were closely related to the decrease of Ccr and the increases of B-type natriuretic peptide (BNP), CKMB, total bilirubin (TBIL) and LVEDD (P < 0.01 for each). CONCLUSIONS: The moderate-severe renal injury (Ccr < 50 ml/min) with the abnormal levels of TBIL, BNP and LVEDD are the risk factors for a worse prognosis in OPCAG patients over 65 years old. Because of the injury of OPCAG, we should pay attention to patients with abnormal renal function (Ccr < 80 ml/min) to prevent an onset of severe complications.

[Effect of pericardial suction blood re-transfusion in off-pump coronary artery bypass grafting on inflammatory cytokines, myocardial injury and pulmonary function].

OBJECTIVE: To investigate the effect of pericardial suction blood re-transfusion in off-pump coronary artery bypass grafting (CABG) on inflammatory cytokines, myocardial injury and lung function. METHODS: 31 patients of off-pump CABG were divided into two study groups (OPCABG1 group and OPCABG2 group) according to the amount of pericardial suction blood re-transfusion beyond or less than 600 ml. 13 patients of on-pump CABG were control group. Serum samples from vein were collected for measurement of IL-6, IL-8, IL-10 and TNF-alpha pre-operation and 1, 4, 24, 48 hours post-operation respectively. The results of CK-MB, TnI, AaDO2 and PaO2/FiO2 were recorded. RESULTS: Patients of the three groups had no significant difference in terms of gender, age, bodyweight, history of hypertension and cardiac infarction and diabetes, EF and left ventricular end diastolic of pre-operation, the amount of bypass graft and shed blood. Of the three groups, IL-6, IL-8 and IL-10 reached peak level one hour after the operation, and dropped to the pre-operation level 72 hours after the operation. One hour after the operation, the level of IL-6 and IL-8 in OPCABG1 group was higher than in OPCABG2 group (P < 0.05) and about the same in CABG group (P > 0.05). Four hours after the operation, the level of CK-MB in OPCABG1 group was lower than that of CABG group (P < 0.05) and about the same in OPCABG2 group (P >0.05). 4 and 24 hours after the operation, the level of TnI in OPCABG1 group was lower than that of CABG group (P < 0.05) and about the same in OPCABG2 group (P > 0.05). Among the three groups, there was no significant difference in AaDO2 and PaO2/FiO2. CONCLUSIONS: Re-transfusion of large amount of pericardial suction blood can increase serum level of IL-6, IL-8, but it can not cause myocardial injury and affect the gas exchange function of lung significantly.

Perioperative plasma brain natriuretic peptide and cardiotrophin-1 in off-pump coronary artery bypass.

OBJECTIVE: It has been suggested that brain natriuretic peptide (BNP) and cardiotrophin-1 (CT-1) are associated with myocardial dysfunction. The present prospective study was designed to investigate perioperative changes of plasma levels of BNP and CT-1 in off-pump coronary artery bypass (OPCAB). METHOD: Forty-nine patients undergoing elective OPCAB were divided into three groups. Group I: no previous myocardial infarction; Group II: previous myocardial infarction more than 12 weeks; Group III: recent myocardial infarction within 4-8 weeks. Perioperative BNP and CT-1 levels were measured, and hematochemical parameters were also collected. RESULTS: Higher preoperative BNP and CT-1 levels were found in group III as compared to those in group I. BNP levels increased after operation, and reached peak value at 3-7 days after the operation. However, the postoperative changes of BNP levels were not different among groups in any time points. CT-1 levels did not change significantly after the operation as compared to baseline. CONCLUSION: Higher BNP and CT-1 levels were associated with recent myocardial infarction. BNP elevated after OPCAB, but CT-1 showed no significant postoperative changes. Postoperative changes of BNP and CT-1 do not associated with cardiac function in OPCAB.

Concomitant ablation of atrial fibrillation: are results associated with surgeon's experience?

BACKGROUND AND AIM OF THE STUDY: Atrial fibrillation (AF) ablation has become an effective concomitant procedure, which is increasingly used. We questioned whether results are related to surgeon's experience. METHODS: Patients (n = 141) with persistent AF (pAF) underwent concomitant left atrial (LA) endocardial ablation, performed by six surgeons. Follow-up (FU) was after 3, 6, and 12 months (mean 8 +/- 4.1 months). FU was 97% complete. Results were analyzed according to surgeon's volume: >20 (group A, n = 85) and

Ablation of atrial fibrillation in valvular heart surgery: are results determined by underlying valve disease?

BACKGROUND AND AIM OF THE STUDY: Although, in recent years, atrial fibrillation (AF) ablation has become an effective concomitant procedure in cardiac surgery, it is unclear whether the outcome of the procedure is determined by the underlying valve disease. METHODS: Between 2003 and 2005, 191 patients (100 females, 91 males; mean age 70+/-8.7 years) underwent concomitant left atrial (LA) ablation. Among these patients, those with permanent AF (pAF) and mitral (MVD; n = 64), aortic (AVD; n = 37), and combined valve disease (CVD; n = 23) were prospectively studied after three, six and 12 months, and annually thereafter. The predictive values of preoperative variables for postoperative AF were examined. RESULTS: AVD patients were older than MVD patients (74 +/-7.8 versus 66+/-8.6 years; p <0.001), and presented smaller atria (48+/- 5.7 versus 53+/-8.0 mm; p <0.05), but CVD patients were similar to MVD patients in terms of these parameters (age 70+/-9.3 years, LA diameter 54+/-9.6 mm). Ablation caused no injury or death in any of the patients. Within 30 days after surgery, three (4.7%), three (8.1%) and two (8.7%) of the MVD, AVD and CVD patients, respectively, had died (6.4% overall mortality). The sinus rhythm (SR) conversion rate was 76.8, 63.3 and 58.8% (p = NS) after a mean follow up (FU) of 10+/-4.0, 9+/-4.2 and 10+/-3.9 months (p = NS) in the MVD, AVD and CVD groups, respectively. FU was 97% complete. During FU, four (6.6%), two (5.9%) and four (19.0%) MVD, AVD and CVD patients died, respectively. Univariate analysis demonstrated a shorter AF duration (42+/-49.0 versus 85+/-67.2 months; p <0.05) and smaller LA diameter (50+/-8.1 versus 55+/-9.2 mm; p <0.05) in patients with SR versus non-SR. Multivariate analysis revealed AF duration (Odds ratio (OR) 1.01, 95% CI 1.00-1.02, p <0.05) and LA diameter (OR 1.08, 95% CI 1.01-1.15, p <0.05) as independent predictors of SR conversion. Overall, 86% of patients with two or less years' duration of pAF were in SR at FU. CONCLUSION: AF duration and LA diameter, but not the type of valve disease, predict SR conversion after concomitant ablation of pAF in valvular heart surgery.