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1.
J Clin Lab Anal ; : e23773, 2021 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-34767671

RESUMO

BACKGROUND: miR-145 is closely related to vascular smooth muscle cells (VSMC) phenotype transformation; however, the regulatory mechanisms through which miR-145 regulates the VSMC phenotype transformation under mechanical stretching are unclear. In this study, we evaluated the roles of miR-145 in VSMCs subjected to mechanical stretching in aortic dissection (AD). METHODS: The expression of miR-145 in the aortic vessel wall of model animals and patients with AD was analyzed by quantitative polymerase chain reaction. miR-145-related protein-protein interaction networks and Wikipathways were used to analyze VSMC phenotypic transformation pathways regulated by miR-145. We used gain- and loss-of-function studies to evaluate the effects of miR-145 on VSMC differentiation under mechanical stretch induction and assessed whether Krüppel-like factor 4 (KLF4) was regulated by miR-145 in the aorta under mechanical stretch conditions. RESULTS: miR-145 was abundantly expressed in the walls of the normal human aorta, but was significantly downregulated in animal models and the walls of patients with dissection. We found that contractile phenotype-related proteins were downregulated in VSMCs subjected to mechanical stretching, whereas the expression of secreted phenotype-related proteins increased. miR-145 overexpression also downregulated contractile phenotype-related proteins in VSMCs and suppressed upregulation of phenotype-related proteins. Finally, under mechanical stretching, KLF4 expression was significantly increased in VSMCs, and overexpression of miR-145 blocked this effect. CONCLUSION: Our results confirmed that mechanical stretch-induced phenotypic transformation of VSMCs to promote AD via upregulation of KLF4; this mechanism was regulated by miR-145, which directly modulated KLF4 expression and VSMC differentiation.

2.
J Cardiothorac Surg ; 16(1): 297, 2021 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-34645494

RESUMO

OBJECTIVE: To compare the effects of modified triple-branched stent implantation and frozen elephant trunk technique on the quality of life (QoL) of acute Stanford Type A aortic dissection (AAAD) patients at different follow-up times. METHODS: Data from 175 AAAD survivors was collected which were divided into two groups according to different surgical techniques: (group A): modified triple-branched stent graft implantation; (group B): frozen elephant trunk. The SF-36 were used to assess the QoL at discharge (AD), the third postoperative month (POM3), and the twelfth postoperative month (POM12). RESULTS: (1) The total scores at each time of both groups showed lower than the normal level; Group A scored higher than group B at some time points in terms of some items (role physical, role emotion and mental health; all P = 0.000), and some items at POM3 or POM12 scored higher than at discharge (role physical, social function; both P = 0.000). (2) There were less patients with heavy self-perceived burden in group A than group B at discharge (P = 0.032) and patients with heavy self-perceived burden decreased over time. (3) Young postoperative AAD patients (P = 0.002) in group B (P = 0.005) with heavy self-perceived burden (P = 0.000), acute renal failure (P = 0.008), long LOS (P = 0.026) and blood loss (> 1000 mL/24 h) (P = 0.039) seemed to get a worse QoL. CONCLUSION: The impact on QoL of the modified triple-branched stent graft implantation technique seemed to be better than those of frozen elephant trunk surgery in role physical, role emotion and mental health.


Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular , Humanos , Qualidade de Vida , Stents , Resultado do Tratamento
3.
J Cardiothorac Surg ; 16(1): 252, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496919

RESUMO

OBJECTIVE: To investigate the effects of seasonal and climatic changes on postoperative in-hospital mortality and length of stay (LOS) in patients with type A acute aortic dissection (AAD). METHODS: Patients undergoing implantation of the modified triple-branched stent graft to replace the descending aorta in addition to aortic root reconstruction for type A AAD in our hospital from January 2016 to December 2019 were included. Relevant data were retrospectively collected and analyzed. RESULTS: A total of 404 patients were included in our analyses. The multivariate unconditional logistic regression analysis showed that patients admitted in autumn (OR 4.027, 95% CI 1.023-17.301, P = 0.039) or with coronary heart disease (OR 8.938, 95% CI 1.991-29.560, P = 0.049) were independently associated with an increased risk of postoperative in-hospital mortality. Furthermore, patients admitted in autumn (OR 5.956, 95% CI 2.719-7.921, P = 0.041) or with hypertension (OR 3.486, 95% CI 1.192-5.106, P = 0.035) were independently associated with an increased risk of longer LOS. CONCLUSION: Patients admitted in autumn or with coronary heart disease are at higher risk of in-hospital mortality following surgery for type A AAD. Also, patients admitted in autumn or with hypertension have a longer hospital LOS. In the autumn of the temperature transition, we may need to strengthen the management of medical quality after surgery for type A AAD.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Resultado do Tratamento
4.
J Cardiothorac Surg ; 16(1): 199, 2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34294106

RESUMO

BACKGROUND: The cannulation technique used in totally endoscopic cardiac surgery has a significant impact on the overall prognosis of patients. However, there are no large cohort studies to discuss it. Here we report on our research of using open Seldinger-guided technique to establish femoro-femoral cardiopulmonary bypass during totally endoscopic cardiac surgery and evaluate its safety and efficacy. METHODS: The institutional database from 2017 to 2020 was retrospectively reviewed to find cases in which totally endoscopic cardiac surgery was performed. We identified 214 consecutive patients who underwent totally endoscopic cardiac surgery with peripheral femoro-femoral cannulation. All patients underwent femoral artery cannulation. Of these, 201 were cannulated in the femoral vein and 13 were cannulated in the femoral vein combined with internal jugular cannulation. The technique involves surgically exposing the femoral vessel, setting up purse-string over the vessels and then inserting a guidewire into the femoral vessel without a vascular incision, followed by exchange of the guidewire with a cannula. RESULTS: Surgery indications included mitral valve disease in 82.71% (177/214), atrial septal defect in 11.68% (25/214) and tricuspid regurgitation in the remaining 5.61% (12/214). Hospital survival was 98.60% (211/214). There were no cases of stroke and postoperative limb ischaemia. No femoral vessel injuries or wound infections was observed. No late pseudoaneurysms were evident. CONCLUSION: The open Seldinger-guided femoro-femoral cannulation technique is effective and safe. We highly recommend this technique, given its safety, simplicity and speed under direct vision. The limited manipulation of the vessels under direct vision minimizes the risk of local complications.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Adulto , Ponte Cardiopulmonar , Cateterismo , Feminino , Artéria Femoral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
J Cardiothorac Surg ; 16(1): 165, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099026

RESUMO

BACKGROUND: To analyze the clinical effect of two different ways of minimally invasive transthoracic closure in children with ventricular septal defect (VSD). METHODS: From January 2015 to July 2019, 294 children with VSD were enrolled in the Fujian Medical University Union Hospital. Patients were divided into two groups - those who underwent VSD closure through the left sternal fourth intercostal incision (group A: n = 95) and the lower sternal incision (group B: n = 129). RESULTS: The operation time, bleeding volume, postoperative mechanical ventilation time, postoperative intensive care unit (ICU) monitoring time, postoperative hospitalization time and complication rate in group A were significantly lower than those in group B (P < 0.05). There was no significant difference between the two groups in the operation success rate, mechanical ventilation time and total hospitalization cost (P > 0.05). CONCLUSION: The transthoracic closure of ventricular septal defect through the left sternal fourth intercostal incision is feasible, safe, cosmetic, and worth popularizing.


Assuntos
Comunicação Interventricular/cirurgia , Músculos Intercostais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esternotomia/métodos , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
6.
J Thorac Dis ; 13(5): 3042-3050, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34164195

RESUMO

Background: This study aimed to determine how concomitant tricuspid annuloplasty (TAP) affects the clinical outcomes of patients undergoing totally endoscopic mitral valve surgery. Methods: This was a single-centre, retrospective study. Between January 2019 and June 2020, 143 patients who underwent totally endoscopic mitral valve surgery in our institution were enrolled. Ninety-two patients who underwent isolated mitral valve surgery were categorized into the minimally invasive mitral valve surgery (MIMVS) group (n=92), and patients who underwent mitral valve surgery with concomitant TAP were categorized into the MIMVS-TAP (n=51) group. Clinical data were collected from all patients, including demographic and perioperative data. We conducted propensity score matching (PSM) by using one-to-one ratio nearest-neighbour matching for baseline demographic data and tricuspid valve-related parameters. Forty patients in each group were matched in this way. Parametric and nonparametric tests were performed for data analysis. Results: Statistically, postoperative mortality within 30 days was not significantly different between the two groups (P=1). No differences were found in serious adverse events, such as stroke or third-degree conduction block, between the two groups after 1:1 PSM (P=1 and P=0.480, respectively). The mean operation time for the MIMVS+TAP group was longer (232.13±36.05 min) than that for the MIMVS group (204.25±28.49 min; P<0.001). The same was true for the cardiopulmonary bypass (CPB) time (169.48±25.96 vs. 153.10±23.00 min; P=0.004) and aortic clamp time (110.80±17.37 vs. 101.00±14.38 min; P=0.005). The duration of the intensive care unit stay and the overall postoperative length of stay were not different between the two groups (P=0.734 and P=0.472, respectively). The postoperative systolic pulmonary artery pressure differed between the two groups [38.00±8.45 (MIMVS); 33.65±7.34 (MIMVS + TAP), P=0.022]. Conclusions: Our study showed that totally endoscopic mitral valve surgery with concomitant TAP is just as safe and effective as isolated totally endoscopic mitral valve surgery, even with a long surgery duration. Our study also suggested that totally endoscopic mitral valve surgery with concomitant TAP can improve tricuspid function in patients.

7.
Heart Surg Forum ; 24(3): E553-E559, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34173761

RESUMO

BACKGROUND: We aimed to evaluate the clinical outcomes of concomitant tricuspid annuloplasty (TAP) in patients undergoing totally endoscopic mitral valve surgery. METHODS: It is a single-center, retrospective study that enrolled a total of 173 patients who underwent mitral valve surgery combined with tricuspid annuloplasty between January 2019 and June 2020 in our institution. Patients who underwent totally endoscopic mitral valve surgery with concomitant tricuspid annuloplasty were categorized into the MIMVS-TAP group (N = 51), and patients who underwent mitral valve surgery with concomitant tricuspid annuloplasty through a median sternotomy were categorized into the MVS-TAP group (N = 122). The data collected included detailed demographic and perioperative data. Each patient in the MIMVS-TAP group was individually matched to a patient in the MVS-TAP group, using the propensity scores, and we obtained a matched sample of 51 patients in each group. Parametric and nonparametric tests were used to analyze outcomes. RESULTS: There were no differences in death rates or related major adverse events between the two groups after propensity score matched analysis. The total operation time was longer in the MIMVS + TAP group versus the MVS+TAP group, as were the mean duration of cardiopulmonary bypass time and the cross-clamp time. The mean duration of intensive care unit stay was longer in the MVS + TAP group compared with that of the MIMVS + TAP group, as was the duration of post-operative hospital stay. CONCLUSIONS: Totally endoscopic mitral valve surgery with concomitant tricuspid annuloplasty can improve a patient's prognosis, with comparable short-term outcomes to those of the open approaches.


Assuntos
Anuloplastia da Valva Cardíaca/métodos , Endoscopia/métodos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valva Mitral/cirurgia , Pontuação de Propensão , Valva Tricúspide/cirurgia , Ecocardiografia/métodos , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem
8.
J Cardiothorac Surg ; 16(1): 146, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044881

RESUMO

OBJECTIVES: The relationship between inflammatory cytokines and postoperative delirium (POD) remains to be further investigated, especially in patients undergoing acute type A aortic dissection (AAD). Interleukin-6 (IL-6) is involved in the inflammatory process and has recently been identified as a biomarker of cerebral dysfunction. We explored the hypothesis that IL-6 was one of the critical causes of POD after surgical repair of AAD. METHODS: Plasma IL-6 was measured using electrochemiluminescence technology in patients preoperatively and 24 h, 48 h, and 72 h after surgical repair of acute type A aortic dissection. After the first three postoperative days, delirium was evaluated twice daily using the Confusion Assessment Method. ROC curves were used to evaluate the ability of IL-6 measurements to distinguish POD. RESULTS: The incidence of POD was 14.03% (31 of 221 patients). The patients in the POD group were significantly older than the patients in the non-POD group (56.48 ± 11.68 years vs 52.22 ± 10.50 years, P = 0.040). Plasma IL-6 concentrations were significantly higher in the POD group than in the non-POD group at three time points: preoperatively, after 24 h, and after 48 h. The AUC values corresponding to IL-6 preoperatively and 24 h after surgery were 0.73 and 0.72, respectively. CONCLUSIONS: Cerebral dysfunction after the surgical repair of AAD shows elevated stress levels and inflammatory responses. Plasma IL-6 is a potential biomarker to predict the onset of POD in acute type A aortic dissection patients following surgical repair.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Delírio/sangue , Interleucina-6/sangue , Adulto , Idoso , Área Sob a Curva , Biomarcadores/sangue , Delírio/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Curva ROC , Estudos Retrospectivos
9.
J Cardiothorac Surg ; 16(1): 117, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933114

RESUMO

BACKGROUND: To compare postoperative sexual dysfunction (SD) and quality of life (QOL) in Type A Aortic Dissection (AAD) Patients of Different Ages. METHODS: From January 2018 to December 2019, 204 AAD postoperative survivors in Union Hospital of Fujian Medical University were selected and were divided into young group (less than 50 years old) and elderly group (more than 50 years old). We evaluated SD according to the male International Erectile Dysfunction Index (IIEF-5) and female sexual function index (FSFI). The Short Form 12 Health Survey Questionnaire (SF-12) and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) were used to investigate the QOL, Quick Inventory Depressive Symptomatology-Self Report (QIDS-SR) and the Beck Depression Inventory-II (BDI-II) to investigate depressive symptoms. RESULTS: One hundred seventy-five patients completed all the questionnaire (85.8%). The total SD prevalence rate was 38.9% (68 cases), with 27.4% of the young (20 cases) and 47.1% of the elderly (48 cases). The age of non-SD and SD patients was 49.0 ± 11.5 and 56.9 ± 10.8 years, respectively (P = 0.03). Compared with non-SD patients, the total physical health of SD patients was significantly worse (P = 0.04), however, the mental health was not significantly worse (P = 0.77); the depressive symptoms did not expressed a significant difference between the SD and non-SD groups (QIDS-SR P = 0.15, BDI-II P = 0.06). Total physical health scores in the young SD group did not show significant better than elderly SD group (P = 0.24), however, total mental health scores showed significantly worse (P = 0.04), depressive symptoms scores were significantly higher (QIDS-SR P = 0.03, BDI-II P = 0.04). CONCLUSION: The postoperative AAD SD prevalence of elderly is higher than that of young, and the total physical health of SD patients is poorer than those without SD patients. The young SD patients did not show a significant higher physical health scores than the elderly SD patients, instead, the young SD patients were more psychologically affected than the elderly SD patients, whose mental health was worse, and depression symptoms were more obvious, suggesting that the factors affecting the QOL of postoperative SD patients are related to physical factors, but the young postoperative SD patients mainly affected by psychological factors.


Assuntos
Aneurisma Dissecante , Aorta/cirurgia , Disfunção Erétil/etiologia , Disfunção Erétil/psicologia , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/psicologia , Adolescente , Adulto , Idoso , Disfunção Erétil/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Qualidade de Vida/psicologia , Estudos Retrospectivos , Tamanho da Amostra , Índice de Gravidade de Doença , Disfunções Sexuais Fisiológicas/diagnóstico , Inquéritos e Questionários , Adulto Jovem
10.
Cardiol Young ; : 1-5, 2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34024301

RESUMO

OBJECTIVES: To investigate the safety and feasibility of midazolam for conscious sedation in transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography. METHODS: A retrospective analysis was performed on 55 patients who underwent transcatheter device closure of atrial septal defects from October, 2019 to May, 2020. All patients received intravenous midazolam and local anesthesia with lidocaine to maintain sedation. A group of previous patients with unpublished data who underwent the same procedure with general anesthesia was set as the control group. The relevant clinical parameters, the Ramsay sedation scores, the numerical rating scale, and the post-operative satisfaction questionnaire were recorded and analyzed. RESULTS: In the midazolam group, the success rate of atrial septal defect closure was 98.2%. Hemodynamic stability was observed during the procedure. None of the patients needed additional endotracheal intubation for general anesthesia. Compared with the control group, the midazolam group had no statistically significant differences in the Ramsay sedation score and numerical rating scale scores. Patients in the midazolam group experienced more post-operative satisfaction than those in the control group. CONCLUSIONS: Conscious sedation using midazolam is a safe and effective anesthetic technique for transcatheter device closure of atrial septal defects guided solely by transthoracic echocardiography.

11.
J Mol Cell Cardiol ; 157: 1-13, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33819456

RESUMO

AIM: Pulmonary hypertension (PH) is a pathophysiological syndrome with functional abnormalities of the pulmonary artery and heart, eventually becoming life threatening to the patients. Autophagy-related gene 7 (ATG)-7 is involved in many cardiovascular diseases, but little is known about the specific role of ATG-7 in the development of PH. We aimed to examine the expression of ATG-7 in PH patients and PH mice, specifically investigate pulmonary physiological responses in a mouse model with conditional deletion of ATG-7 in smooth muscle cells (SMCs) and further clarify the mechanism of PH caused by ATG-7 deficiency. METHODS AND RESULTS: SMC-ATG-7-/- mice underwent echocardiography and subsequent pulmonary arterial pressure (PAP) checks. The PAP was lower in wild-type (WT) mice (22.6 ± 2.0 mmHg) than knockout (KO) mice (34.0 ± 2.5 mmHg; p < 0.001). Pulmonary artery resistance was increased in KO (17.61 ± 2.03 mm2·s-1) versus WT mice (8.91 ± 1.62 mm2·s-1; p < 0.005). Combined with these statistics, SMC-ATG7-/- mice were diagnosed with PH. The increase of ATG-7 expression in vessels from PH patients and PH mice were assessed and the effects of ATG-7 on vascular remodeling were investigated in SMCs using relevant methods. We also identified silencing ATG-7 in SMCs induced the increased level of Ca2+ and abnormal proliferation through PP2A/ 4EBP-1/ elf-4E pathway. CONCLUSIONS: ATG-7 affects vascular remodeling and exerts a protective function during the pathogenesis of PH. Our study revealed a novel mechanism ATG-7 deficiency promotes cell proliferation via the interaction between PP2A, 4EBP-1 and elf-4E.

12.
J Cardiothorac Surg ; 16(1): 91, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865420

RESUMO

INTRODUCTION: Totally endoscopic technique has been widely used in cardiac surgery, and minimally invasive totally endoscopic mitral valve surgery has been developed as an alternative to median sternotomy for many patients with mitral valve disease. In this study, we describe our experience about a modified minimally invasive totally endoscopic mitral valve surgery and reported the preliminary results of totally endoscopic mitral valve surgery. The aim of this retrospective study is to evaluate the results of totally endoscopic technique in mitral valve surgery. MATERIAL AND METHODS: We retrospectively reviewed the profiles of 188 patients who were treated for mitral valve disease by modified totally endoscopic mitral valve surgery at our institution between January 2019 and December 2020. The procedure was performed under endoscopic right minithoracotomy and with femoro-femoral cannulation using the single two-stage venous cannula. RESULTS: A total of 188 patients underwent total endoscopic mitral valve surgery. Fifty-six patients had concomitant tricuspid valvuloplasty, 11 patients underwent concomitant ablation of atrial fibrillation and atrial septal defect repair was performed in three patients. Only one patient postoperatively died of multi-organ failure. Two patients were converted to median sternotomy. Except for one patient underwent operation to stop the bleeding from the incision site, no other serious complications nor reintervention occurred during the follow-up period. CONCLUSIONS: The modified totally endoscopic mitral valve surgery performed at our institution is technically feasible and safe with the same efficacy as reported studies.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Toracoscopia/métodos , Toracotomia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
J Cardiothorac Surg ; 16(1): 82, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858463

RESUMO

BACKGROUND: Blood glucose variability is associated with poor prognosis after cardiac surgery, but the relationship between glucose variability and postoperative delirium in patients with acute aortic dissection is unclear. The study aims to investigate the association of blood glucose variability with postoperative delirium in acute aortic dissection patients. METHODS: We prospectively analyzed 257 patients including 103 patients with delirium. The patients were divided into two groups according to whether delirium was present. The outcome measures were postoperative delirium, the length of the Intensive Care Unit stay, and the duration of hospital stay. Multivariable Cox competing risk survival models was used to assess. RESULTS: A total of 257 subjects were enrolled, including 103 patients with delirium. There were statistically significant differences between the two groups in body mass index, history of cardiac surgery, first admission blood glucose, white blood cell counts, Acute Physiology and Chronic Health Evaluation II score, hypoxemia, mechanical ventilation duration, and the length of Intensive Care Unit stay(P < 0.05). The delirium group exhibited significantly higher values of the mean of blood glucose (MBG) and the standard deviation of blood glucose (SDBG) than in the non-delirium group(P < 0.05). In model 1, the adjusted hazard ratio (AHR) of the standard deviation of blood glucose was 1.436(P < 0.05). In Model 2, the standard deviation of blood glucose (AHR = 1.418, 95%CI = 1.195-1.681, P < 0.05) remained significant after adjusting for confounders. The area under the curve of the SDBG was 0.763(95%CI = 0.704-0.821, P < 0.01). The sensitivity was 81.6%, and the specificity was 57.8%. CONCLUSIONS: Glucose variability is associated with the risk of delirium in patients after aortic dissection surgery, and high glycemic variability increases the risk of postoperative delirium.


Assuntos
Aneurisma Dissecante/cirurgia , Glicemia/análise , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Delírio/sangue , Doença Aguda , Adulto , Aneurisma Dissecante/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Delírio/diagnóstico , Delírio/etiologia , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida
14.
J Cardiothorac Surg ; 16(1): 38, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743734

RESUMO

BACKGROUND: Clinical application of minimally invasive cardiac surgery has increased annually. Cardiopulmonary bypass is established by peripheral cannulation during minimally invasive cardiac surgery. The methodology of peripheral cannulation has unique characteristics, which have associated risks and complications. Few studies have been conducted on this topic. In this study, we focused on complications of peripheral cannulation in totally endoscopic cardiac surgery. METHODS: Patients who underwent totally endoscopic cardiac surgery with cardiopulmonary bypass established by peripheral cannulation at our institution between January 2019 and June 2020 were reviewed. Specific cannulation strategies and related cannulation complications were noted. RESULTS: One hundred forty-eight patients underwent totally endoscopic cardiac surgery. One hundred forty-eight cannulations were performed in the femoral artery and vein, and eleven were performed in the internal jugular vein (combined with the femoral vein). The median size of the femoral artery cannula was 22Fr, and that of the venous canula was 24Fr. One patient died of retroperitoneal haematoma due to femoral artery injury. Three patients had postoperative lower limb oedema. One patient had a postoperative diagnosis of femoral vein thrombosis. CONCLUSIONS: Different from cannulation in patients with aortic dissection and aneurysms, femoral artery cannulation is safe in totally endoscopic cardiac surgery. Venous cannulation is characterized by a large-bore venous cannula and a short period of use. There are few reports about complications of venous cannulation. The main complication in this study was mechanical injury, and the key to preventing this injury is meticulous manipulation during surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Cateterismo/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Doenças Vasculares Periféricas/etiologia , Adulto , Idoso , Cânula , Endoscopia , Feminino , Artéria Femoral , Veia Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório
15.
Pediatr Cardiol ; 42(5): 1002-1009, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33759021

RESUMO

The efficacy of primary sutureless repair for supracardiac total anomalous pulmonary venous connection (TAPVC) needs to be confirmed. This study aimed to compare the long-term outcomes between the conventional surgery and the sutureless technique with a modified approach in superior TAPVC. Between January 2008 and December 2018, 173 patients with supracardiac TAPVC underwent surgery either with the conventional procedure (n = 130) or the sutureless repair (n = 43). Multivariate analysis and competing-risk analysis were used to identify risk factors for early death and postoperative pulmonary venous obstruction (PVO), respectively. Among 173 patients who underwent repair of supracardiac TAPVC, 46 (28%) had preoperative PVO, and 22 (12.7%) had postoperative PVO. The sutureless group had a lower postoperative PVO rate compared with the conventional group (p = 0.027). The risk factors for death were age ≤ 28 days [odds ratio (OR), 11.56; 95% confidence interval (CI) 1.33-100.47, p = 0.015], weight ≤ 3 kg (OR 9.57; 95% CI 1.58-58.09, p = 0.009), emergency operation (OR 19.24; 95% CI 3.18-116.35, p = 0.002), cardiopulmonary bypass time (OR 2.16; 95% CI 1.36-3.43, p = 0.003), cross-clamp time (OR 1.73; 95% CI 1.20-2.50, p = 0.022), and duration of ventilation (OR 1.11; 95% CI 1.02-1.21, p = 0.027). Age ≤ 28 days [Hazard Ratio (HR) 1.92; 95% CI 1.92-11.02, p < 0.001] and preoperative PVO (HR 41.70; 95% CI 8.15-213.5, p < 0.001) were associated with postoperative PVO. The sutureless repair is a reliable technique for supracardiac TAPVC. Age ≤ 28 days is associated with 30-day mortality and postoperative PVO.


Assuntos
Complicações Pós-Operatórias/cirurgia , Pneumopatia Veno-Oclusiva/cirurgia , Síndrome de Cimitarra/cirurgia , Procedimentos Cirúrgicos sem Sutura/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Modelos de Riscos Proporcionais , Pneumopatia Veno-Oclusiva/etiologia , Pneumopatia Veno-Oclusiva/mortalidade , Reoperação/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos sem Sutura/efeitos adversos , Procedimentos Cirúrgicos sem Sutura/mortalidade
16.
J Card Surg ; 36(2): 637-642, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33410181

RESUMO

BACKGROUND: This study aimed to evaluate the analgesic and sedative effects of remifentanil-based fast-track cardiac anesthesia in children undergoing transthoracic device closure of ventricular septal defects (VSDs). METHODS: A retrospective analysis was conducted on 62 children who underwent transthoracic device closure of VSDs from May 2019 to August 2019. The patients were divided into two groups based on the anesthesia methods: group F was given remifentanil-based fast-track cardiac anesthesia, and Group C was given conventional anesthesia. Patient-related clinical data, postoperative analgesia scores, and sedation scores were collected and analyzed. RESULTS: There was no significant difference in intraoperative hemodynamic changes, bispectral index values, postoperative analgesia scores, sedation scores, or the incidence of adverse events between the two groups. Compared with Group C, the duration of mechanical ventilation and the length of intensive care unit (ICU) and hospital stay in group F were significantly lower. CONCLUSION: Remifentanil-based fast-track anesthesia can be safely applied in children undergoing transthoracic device closure of VSDs, with acceptable postoperative analgesia and sedation effects and shorter mechanical ventilation times and ICU and hospital stays compared with conventional anesthesia.


Assuntos
Anestesia , Comunicação Interventricular , Analgésicos , Criança , Comunicação Interventricular/cirurgia , Humanos , Hipnóticos e Sedativos , Remifentanil , Estudos Retrospectivos
17.
Ann Thorac Surg ; 112(1): 75-82, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33098877

RESUMO

BACKGROUND: The patch neointima technique is a modified valve-sparing aortic root repair surgery for acute type A aortic dissection and the short-term outcomes are satisfactory. The midterm outcomes have not been reported. METHODS: From January 2009 to December 2012, 147 patients underwent valve-sparing aortic root repair with the patch neointima technique for type A aortic dissection in our center. The midterm outcomes of the patients were evaluated by echocardiography and aortic computed tomography angiography. RESULTS: Of 147 patients, 32 patients (21.8%) underwent proximal arch repair, and 115 patients (78.2%) underwent proximal arch repair combined with triple-branched stent graft implantation. The perioperative mortality was 5.4%. Preoperative aortic insufficiency (AI) was observed in 94 patients (63.9%); 131 patients (89.1%) left the operating room with 0 AI; the remaining 16 patients (10.9%) had trace or less than 1+ AI. A total of 128 patients (87.1%) completed 7-year follow-up. The mean follow-up time was 5.7 ± 1.2 years. As many as 82% of patients (105) were 0 AI and 15.6% of patients (20) were 0.5+ trace or less than 1+ AI. No reoperation was performed for the aortic root. The diameters of sinotubular junction and sinus were reduced to the normal range (28.3 ± 4.2 mm and 30.5 ± 3.6 mm, respectively) and remained stable (28.9 ± 5.6 mm, P = .300, and 30.8 ± 4.2 mm, P = .540, respectively) during 7 years of follow-up. CONCLUSIONS: Valve-sparing aortic root repair with patch neointima technique was associated with stable function of the aortic valves and no expansion of the aortic root in the midterm.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Neointima/cirurgia , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico , Angiografia por Tomografia Computadorizada , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Neointima/diagnóstico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
18.
Ann Thorac Surg ; 111(3): e205-e207, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33121969

RESUMO

Herein we described a novel repair approach for a left atrial esophageal fistula. Complete mediastinal debridement and simultaneous primary repairs of the left atrial posterior wall and the esophagus were completed under a median sternotomy, central cardiopulmonary bypass, left atrial circular incision around four pulmonary veins, inflamed left atrial posterior wall removal, and posterior pericardial opening.


Assuntos
Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ablação por Cateter/efeitos adversos , Fístula Esofágica/cirurgia , Esôfago/cirurgia , Fístula Esofágica/diagnóstico , Fístula Esofágica/etiologia , Fístula/diagnóstico , Fístula/etiologia , Fístula/cirurgia , Átrios do Coração , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/cirurgia , Humanos , Reoperação , Tomografia Computadorizada por Raios X
19.
Heart Lung ; 50(1): 159-164, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32690218

RESUMO

BACKGROUND: The prognostic nutritional index (PNI) has recently been reported to associate with the surgical prognosis of patients with some cardiovascular diseases. However, the prognosis significance of the preoperative PNI in patients with acute type A aortic dissection (AAAD) remains unclear. OBJECTIVES: The present study aimed to explore the relationship between PNI and postoperative in-hospital mortality in patients with AAAD. METHODS: Between June 2013 and December 2019, we retrospectively reviewed the clinical data of 651 patients undergoing AAAD surgery. Patients were divided into two groups according to the median PNI. The risk factors of postoperative in-hospital mortality were identified by univariate and multivariate logistic regression analysis. RESULTS: In-hospital mortality was significantly more common in the low group (24.8% vs 16.3%: P = .007). The percentage of prolonged mechanical ventilation (58.9% vs 49.8%: P = .020) and the median duration of intensive care unit stays (7.0 vs 6.0 days: P = .003) were also higher and longer in the low group. Multivariate logistic regression analysis showed that the PNI, age, hypertension, and operation time independently predicted in-hospital mortality. Besides, compared with patients with a history of hypertension, the low PNI affected in-hospital mortality more than those without (odds ratio [OR]: 2.07; 95% confidence interval [CI]: 1.20-3.56; P = .009). CONCLUSIONS: Lower PNI may be independently associated with in-hospital mortality of patients after AAAD surgery.


Assuntos
Aneurisma Dissecante , Avaliação Nutricional , Aneurisma Dissecante/diagnóstico , Mortalidade Hospitalar , Humanos , Estado Nutricional , Prognóstico , Estudos Retrospectivos
20.
J Invest Surg ; 34(4): 467-472, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31366250

RESUMO

BACKGROUND: Few comparative studies have focused on the advantages and disadvantages of transthoracic device closure, transcatheter device closure, and surgical repair via right submammary thoracotomy for restrictive ventricular septal defect (VSD). In this article, we compared the safety, efficacy, and clinical effects of these three treatments. Methods: The clinical data of 192 pediatric patients with a restrictive VSD in our hospital from January 2017 to May 2018 were retrospectively collected and analyzed. According to the different treatments, the patients were divided into three groups (the surgical and device groups). Results: There was no significant difference in the demographic characteristics, VSD size, mean pulmonary artery pressure, or cardiothoracic ratio. In addition, there were significant differences in the duration of mechanical ventilation, operation, hospitalization, and ICU stay between the two device groups and the surgical group, but there were no significant differences between the two device groups. Conclusions: Transthoracic device closure, transcatheter device closure, and surgical repair via right submammary thoracotomy for restrictive VSD repair are all safe and feasible. These three treatments have their own disadvantages and advantages and should be selected according to individual patients.

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