Integrated analysis of the lncRNA-miRNA-mRNA network based on competing endogenous RNA in atrial fibrillation.

Objective: Long non-coding RNAs (lncRNAs) play pivotal roles in the transcriptional regulation of atrial fibrillation (AF) by acting as competing endogenous RNAs (ceRNAs). In the present study, the expression levels of lncRNAs of sinus rhythm (SR) patients and AF patients were investigated with transcriptomics technology, and the lncRNA-miRNA-mRNA network based on the ceRNA theory in AF was elaborated. Methods: Left atrial appendage (LAA) tissues were obtained from patients with valvular heart disease during cardiac surgery, and they were divided into SR and AF groups. The expression characterizations of differentially expressed (DE) lncRNAs in the two groups were revealed by high-throughput sequencing methods. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed, and the lncRNA-miRNA-mRNA-mediated ceRNA network was constructed. Results: A total of differentially expressed 82 lncRNAs, 18 miRNAs, and 495 mRNAs in human atrial appendage tissues were targeted. Compared to SR patients, the following changes were found in AF patients: 32 upregulated and 50 downregulated lncRNAs; 7 upregulated and 11 downregulated miRNAs; and 408 upregulated and 87 downregulated mRNAs. A lncRNA-miRNA-mRNA network was constructed, which included 44 lncRNAs, 18 miRNAs, and 347 mRNAs. qRT-PCR was performed to verify these findings. GO and KEGG analyses suggested that inflammatory response, chemokine signaling pathway, and other biological processes play important roles in the pathogenesis of AF. Network analysis based on the ceRNA theory identified that lncRNA XR_001750763.2 and Toll-like receptor 2 (TLR2) compete for binding to miR-302b-3p. In AF patients, lncRNA XR_001750763.2 and TLR2 were upregulated, and miR-302b-3p was downregulated. Conclusion: We identified a lncRNA XR_001750763.2/miR-302b-3p/TLR2 network based on the ceRNA theory in AF. The present study shed light on the physiological functions of lncRNAs and provided information for exploring potential treatments for AF.

Early and mid-term outcomes of total repair of tetralogy of Fallot through a right subaxillary thoracotomy.

OBJECTIVES: We aimed to investigate the safety, feasibility and early and mid-term outcomes of total repair of elective tetralogy of Fallot through a right subaxillary thoracotomy. METHODS: Between May 2010 and September 2015, a retrospective review of patients with elective tetralogy of Fallot undergoing primary repair through a right subaxillary thoracotomy was performed. This study included 47 patients [27 males, 20 females; the mean age of 1.7 ± 1.5 years (ranging from 3 to 106 months); body weight of 9.7 ± 2.8 kg (ranging from 5 to 16 kg); McGoon ratio ≥1.5]. The ventricular septal defects were approached through a right atriotomy in 30 patients, a right ventriculotomy in 8 patients and the combination of a right atriotomy and ventriculotomy in 9 patients. Transannular and non-transannular patches were used in 20 and 27 patients, respectively. RESULTS: There was 1 operative death (2.1%), and the others recovered uneventfully. The median cardiopulmonary bypass and aortic cross-clamping times was 79 ± 20.8 (45-136) and 50 ± 15.7 (25-94) min, respectively. The mechanical ventilation time, length of intensive care unit and postoperative hospital stay were 0.9 ± 0.6, 2.6 ± 1.1 and 10.7 ± 2.7 days, respectively. The main complications involved low cardiac output syndrome in 5 patients, arrhythmia in 6 patients, pulmonary infection in 4 patients, small residual shunt in 2 patients, mild residual right ventricular outflow tract obstruction in 2 patients, mild tricuspid regurgitation in 3 patients and atelectasis in 1 patient. The mean follow-up time was 82 ± 22.0 months, and no late deaths occurred during the follow-up. One (2.1%) patient received reintervention for residual significant pulmonary artery stenosis. That was in addition to 2 (4.3%) patients having mild residual right ventricular outflow tract, 1 (2.1%) patient with moderate tricuspid regurgitation and 3 (6.4%) patients with moderate pulmonary valve regurgitation to be followed up. CONCLUSIONS: The right subaxillary thoracotomy, providing a safe and feasible alternative, can be performed with a low mortality rate and satisfactory early and mid-term outcomes for total repair of elective tetralogy of Fallot.

Mid-term Outcomes of Common Congenital Heart Defects Corrected Through a Right Subaxillary Thoracotomy.

OBJECTIVE: To evaluate the mid-term outcomes of the correction of various congenital heart defects through a right subaxillary thoracotomy. METHODS: Between June 2004 and April 2014, all eligible patients were those with a common congenital heart defect corrected via an approach through a right subaxillary thoracotomy. There were 836 patients (male 417, female 419; median age, 3.5 years; median weight 13.6kg) with ventricular septal defect (VSD) closure (523 patients), atrial septal defect (ASD) closure (235 patients), partial atrioventricular canal (PAVC) correction (55 patients), mild tetralogy of Fallot (TOF) (23 patients). Additional procedures involved tricuspid valvuloplasty (TVP) (68 patients), repair of partial anomalous pulmonary venous connection (PAPVC) (54 patients), mitral annuloplasty (42 patients), closure of patent ductus arteriosus (PDA) (35 patients), correction of cor triatriatum (eight patients). The median cardiopulmonary bypass (CPB) and aortic cross-clamp times were 67 (28∼217) and 23 (3∼116) min, respectively. RESULTS: The procedures were performed successfully in all patients, and no in-hospital mortality occurred. There was no need for conversion to another approach in all procedures. The main complications involved arrhythmia in 21 patients, atelectasis in 18, pneumothorax in 17, subcutaneous emphysema in 15, pulmonary infection in 14, low cardiac output syndrome in eight, transient cerebral dysfunction in two. The patients were all in excellent condition after a mean follow-up of 34 months. The cardiac defect was repaired with no residual defect in 820 patients and with trivial to mild residual defect in 16 patients (10 with small VSD residual shunt, four with mild mitral regurgitation, two with mild residual right ventricular outflow tract obstruction). The incision healed properly in all, and the thorax showed no deformity. CONCLUSIONS: Right subaxillary thoracotomy, providing an advantageous alternative, can be performed with favourable cosmetic and satisfactory clinical results for the correction of a wide range of common congenital heart defects.

Minimally invasive surgical closure for doubly committed subarterial ventricular septal defects through a right subaxillary thoracotomy.

OBJECTIVES: To investigate the feasibility and cosmetic results of a right subaxillary thoracotomy for closure of doubly committed subarterial ventricular septal defects. METHODS: From October 2009 to September 2015, 78 patients [50 boys, 28 girls, mean age 4.7 ± 2.9 years (range, 0.5-15 years) and mean body weight 16.3 ± 9.6 kg (range, 7-42 kg)] with doubly committed subarterial ventricular septal defects were treated with minimally invasive surgical closure through a right subaxillary thoracotomy. All procedures were performed through an oblique 5- to 8-cm subaxillary mini-incision and the fourth intercostal space. The defect was approached through the main pulmonary artery or the right ventricular outflow tract. The defect was closed with a piece of Dacron patch or directly with one to two pledgetted polypropylene sutures. Additional procedures involved closure of atrial septal defects, closure of patent foramen ovale, mitral annuloplasty, tricuspid annuloplasty and relief of right ventricular outflow tract obstruction. RESULTS: The median cardiopulmonary bypass and aortic cross-clamp times were 51 ± 26.5 (33-78) and 27 ± 13.6 (15-46) min, respectively. The incision length was 6.7 ± 1.5 cm (range, 5.0-8.0 cm). The follow-up period was 37 ± 27.5 months (range, 6-72 months). The cardiac defect was repaired with a trivial to mild residual defect in 3 patients (2 patients with a small residual shunt and 1 with mild mitral regurgitation). No chest deformity or asymmetrical development of the breast was found. CONCLUSIONS: A right subaxillary thoracotomy, providing a feasible alternative to median sternotomy, can be performed with favourable cosmetic and satisfactory clinical results for closure of doubly committed subarterial ventricular septal defects.

Minimally invasive video-assisted double-valve replacement through right anterolateral Minithoracotomy.

OBJECTIVE: This study aimed to investigate feasibility and safety of minimally invasive video-assisted surgery for double-valve (mitral and aortic) replacement through right anterolateral minithoracotomy. METHODS: Between February 2011 and April 2013, 60 patients with combined valvular disease underwent double valve replacement, 26 of them by minimally invasive video-assisted surgery through right anterolateral minithoracotomy (study group) and 34 by median sternotomy (control group). Peripheral cardiopulmonary bypass (CPB) was established through right femoral artery and vein. The incision was made around the right breast approximately 5 cm in length. Pericardiotomy, bicaval occlusion, atriotomy and aortotomy, and double valve replacement were performed with thoracoscope. RESULTS: In the study group, times of CPB and aortic cross-clamp were 146.5 ± 40.5 min and 91.5 ± 23.4 min, respectively, which were significantly different from those in the control group, 115.4 ± 26.5 min and 75.4 ± 16.5 min (P<0.05). Thoracic drainage in the study group was significantly lower than the control group, 587 ± 245 ml (study group) versus 756 ± 267 ml (control group) (P<0.05). Length of ICU and postoperative hospital stay were shorter in the study group, 1.9 ± 0.8 and 8.7 ± 4.5 days versus 2.8 ± 1.3 and 11.2 ± 5.6 days in the control group (P<0.05), respectively. There was no statistical difference in the postoperative results of TTE (transthoracic echocardiography) (P>0.05). All patients recovered smoothly with follow-up of six months to two years, with no severe complications. CONCLUSIONS: Minimally invasive video-assisted procedure through right anterolateral minithoracotomy is a new promising approach for double valve replacement. Our study suggested that this approach was feasible, safe and had cosmetic effects.

A novel surgical procedure: scaffold-pulmonary autograft transplantation.

Mitral valve-related operations are easy to perform and show good results, but to prevent severe thromboembolism or a high ratio of prosthetic valve destruction by tissue, lifetime anticoagulant therapy is essential after the operation. Thus, identifying a new type of surgical procedure and prosthetic valve to cure mitral valve diseases is necessary. Pulmonary valve autograft transplantation (Ross II) with the "top hat" transplantation technique was first reported by Ross DN to cure mitral disease. Because the "top hat" procedure has some shortcomings, we designed the scaffold-pulmonary autograft transplantation procedure and performed animal experiments to confirm the feasibility and effectiveness of the procedure. A total of 13 minipigs, weighing 20-25 kg, were employed as experimental animals to undergo scaffold-pulmonary autograft valve transplantation in our surgical animal lab. The surgical procedure was performed under hypothermic general anaesthesia and extracorporeal circulation (or cardiopulmonary bypass, CPB). Briefly, the chest cave was opened through the left intercostal, the pulmonary valve autograft was harvested during on-pump beating heart, and the pulmonary valve autograft was mounted in a self-made pulmonary valve scaffold and transferred to the mitral valve annulus without removing the mitral instruments. Finally, the outflow tract of the right ventricle was re-established with a pig pulmonary homograft. After finishing data collection, all animals were executed 1 hour after removal from the CPB. For the 13 minipigs that underwent the operation, the CPB time was 182.4 ± 23.4 min. Two of the thirteen cases died of bleeding during the operation and of a post-operative pulmonary embolism, and the remaining eleven survived for one hour. The pressure of the left atrium did not increase significantly (P = 1.00), and the ultrasonic cardiograph (UCG) showed good function of the new mitral valves, with mean ejection fraction (EF) values of 63.6%. The mitral valve orifice areas were 1.10 ± 0.13 cm(2) (pre-operation) and 1.01 ± 0.08 cm(2) (post-operation) (P = 0.013). The function and structure of the new mitral valves were normal. We preliminarily consider scaffold-pulmonary autograft valve transplantation to be a new alternative to cure mitral valve disease, but advanced chronic animal experiments will be needed to confirm the long-term results of the operation. The results showed it could be a new alternative to cure mitral valve disease.