[Experience of Sun's procedure for chronic type B dissection with aortic arch involvement].

Objective: To study the surgical treatment of chronic type B dissection with aortic arch involvement using Sun's procedure. Methods: Between February 2009 and December 2015, 29 patients [20 males, 9 females, with a mean age of (41±12) years, range 24-64 years] with type B dissection with aortic arch involvement underwent Sun's procedure. Sixteen patient had a history of hypertension. Marfan syndrome was observed in 9 cases, coronary artery disease in 3 cases, mitral regurgitation in 3 patients, cerebrovascular disease in one patient. Twenty-two patients suffered proximal aortic arch disease, 4 cases experienced history of aortic root procedure and 2 subjects had history of pregnancy. Four patients had aortic arch malformation. Results: One case suffered from massive cerebral infarction after surgery and died in another hospital. Concomitant procedures included mitral valve replacement in 3 cases, coronary artery bypass grafting in 3 patients, reconstruction of the right aberrant subclavian artery in one patient. Ventilator support exceeding 24 hours obseved in 2 patients. One of them recieved continuous renal replacement therapy and recovered before discharge. Spinal cord injury was obseved in one case, brain infarction in one patient and pericardial drainage in one case. Two patients required tracheotomy. During 12-94 (43±23) months' follow-up, thoracoabdominal aortic replacment was performed in 4 patients, thoracic endovascular aortic repair (TEVAR) in 2 subjects and repair of perivalvular leakage in one patient. Conclusions: Sun's procedure obtained satisfactory results in patients with chronic type B dissection with aortic arch involvement. Concomitant repair of proximal aortic arch lesions and distal type B dissection can be adopted using Sun's procedure.

Study of molecular mechanism of Prostaglandin E1 in inhibiting coronary heart disease.

Prostaglandin E1 has been used clinically for improving heart diseases. In this study, we examined the effect of Prostaglandin E1 on blood lipid levels, heart protein and genes expression in coronary heart disease (CHD) rats. Female rats were fed either a control diet or hypercholesterolemic diet for 14 weeks. The feeding of a hypercholesterolemic diet (HCD) increased the serum TC, TG, and LDL-c levels, decreased the serum HDL-c, E2, P, FSH, LH and PRL levels in CHD rats. In addition, The feeding of a HCD diet markedly increased the content of serum TXA2, TXB2, and decreased the content of serum PGI2, and PGI2/TXA2, 6-Keto PGF1a. Furthermore, the feeding of a hypercholesterolemic diet markedly increased expression levels of myocardium Fas and Caspase-3 protein and mRNA levels, vascular endothelial growth factor and basic fibroblast growth factor mRNA, and decreased RyR2 mRNA in CHD rats. The feeding of Prostaglandin E1 for 14 weeks significantly reversed these abnormal biochemical indexes in rats. These findings suggest that Prostaglandin E1 play a obvious heart protective effect. The mechanisms may be related to restraining the excessive activation of Fas and Caspase-3 protein and modulating some gene expressions associated with CHD.

Meta-analysis of the long term effects of different interventions on chronic total coronary occlusions.

BACKGROUND: Coronary chronic total occlusion (CTO) is the end stage of coronary artery atherosclerosis. CTO revascularization can be performed by percutaneous transluminal coronary angioplasty (PTCA), bare metal stent (BMS) or drug-eluting stent (DES). It is important to scientifically evaluate the effectiveness of CTO interventional treatments. METHODS: Relevant studies of long term outcomes for several kinds of CTO treatments were examined. Data were extracted and assessed by two independent clinical experts, pooled and analyzed using meta-analysis. RESULTS: (1) Totally 8 articles comparing outcomes between PTCA and BMS treatment were analyzed. Follow-up variables such as mortality, subsequent coronary artery bypass graft surgery (CABG), re-occlusion, re-stenosis and target lesion revascularization (TLR) were analyzed by meta-analysis. Compared with BMS intervention, PTCA was associated with significant higher rate of re-occlusion, re-stenosis, subsequent PTCA and TLR. (2) Totally 12 articles compared long term outcomes between BMS groups and DES groups, encompassed 3605 CTO patients. During the long-term follow-up, six variables as major adverse cardiac events (MACE), myocardial infarction, all-cause death, subsequent CABG, accumulated MACE-free survival rate, re-stenosis/re-occlusion rate were analyzed by meta-analysis. Compared with patients in DES groups, patients in BMS groups had significant higher MACE, subsequent CABG, re-stenosis/re-occlusion rate, TLR, target vessel revascularization, while lower MACE-free survival rate. CONCLUSIONS: Incidence of re-occlusion, re-stenosis, subsequent PTCA and TLR were significantly lower for BMS implantation than for PTCA procedure. Variables, including MACE, subsequent CABG, re-stenosis/re-occlusion rate were higher while accumulated MACE-free survival rate was lower in BMS groups than in DES groups.

Efficacy of drug-eluting stent for chronic total coronary occlusions at different follow-up duration: a systematic review and meta-analysis.

OBJECTIVE: DESs have been proved to be beneficial for patients with chronic total coronary occlusions (CTO) in terms of cardiac function and other prognosis. We aim to compare the efficacy and safety of drug-eluting stent (DES) and bare-metal stent (BMS) in CTO recanalization at different follow-up duration. METHODS: Articles comparing outcomes between DES and BMS implantation in patients with CTO was searched. A fixed-effect (inverse-variance weighted) and random-effect (DerSimonian and Laird) model were used to analyze the pooling results. RESULTS: A total of 29 comparative studies including 24 cohort studies and 5 randomized controlled studies were identified with a total of 9140 patients (5008 received BMS and 4132 received DES). The risk of all cause death for DES was higher at 6 months and lower at 12 months than BMS, and no significant difference was shown at 24, 36 and 60 months. DES group had lower risk of MI after 12 months implantation, and no difference was shown at 6, 24, 36 and 60 months. Major adverse cardiovascular event (MACE)-free survival was clinically and significantly improved by 73%, 68%, 49%, 40% and 37% respectively in DES group at 6,12, 24, 36, and 60 months. CONCLUSIONS: DES is superior to BMS in binary restenosis, reocclusion and MACE-free survival during long-term follow up. The occurrences of all-cause death and MI show that the risk rate of BMS is higher than that of DES at 12 months. The frequency of all-cause death of DES is higher than BMS at 6 months. DES has higher risk of in-stent thrombosis than BMS at 36 months of implantation.