Objective To investigate the protective effects of antitumor necrosis factor-α antibody （TNF-αAb） on lung injury after cardiopulmonary bypass （CPB） and their mechanisms. Methods Forty healthy New Zealand white rabbits，weighting 2.0-2.5 kg，male or female，were randomly divided into 4 groups with 10 rabbits in each group. In groupⅠ，the rabbits received CPB and pulmonary arterial perfusion. In group Ⅱ，the rabbits received CPB and pulmonary arterial perfusion with TNF-αAb. In group Ⅲ，the rabbits received CPB only. In group Ⅳ，the rabbits only received sham surgery. Neutrophils count，TNF-α and malondialdehyde （MDA） concentrations of the blood samples from the left and right atrium as well as oxygenation index were examined before and after CPB in the 4 groups. Pathological and ultrastructural changes of the lung tissues were observed under light and electron microscopes. Lung water content，TNF-α mRNA and apoptoticindex of the lung tissues were measured at different time points. Results Compared with group Ⅳ，after CPB，the rabbitsin group Ⅰ to group Ⅲ showed significantly higher blood levels of neutrophils count，TNF-α and MDA（P＜0.05），higherTNF-α mRNA expression，apoptosis index and water content of the lung tissues （P＜0.05），and significantly lower oxyg-enation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with group Ⅱ，after CPB，the rabbits in groups Ⅰ and Ⅲ had significantly higher blood concentrations of TNF-α （5 minutes after aortic declamping，220.43±16.44 pg/ml vs.185.27±11.78 pg/ml，P＜0.05；249.99±14.09 pg/ml vs.185.27±11.78 pg/ml，P＜0.05），significantly higher apoptosis index （at the time of CPB termination，60.7‰±13.09‰ vs. 37.9‰±7.78‰，P＜0.05；59.6‰±7.74‰ vs. 37.9‰±7.78‰，P＜0.05），significantly higher blood levels of neutrophils count and MDA （P＜0.05），significantly higher TNF-α mRNA expression and water content of the lung tissues （P＜0.05），and significantly loweroxygenation index （P＜0.05） as well as considerable pathomorphological changes in the lung tissues. Compared with groupⅠ，rabbits in group Ⅲ had significantly higher above parameters （P＜0.05） but lower oxygenation index （P＜0.05） only at 30 minutes after the start of CPB. Conclusion Pulmonary artery perfusion with TNF-αAb can significantly attenuate inflammatory lung injury and apoptosis of the lung tissues during CPB.
Abstract: Objective To explore the inhospital mortalityrelated risk factors in the patients undergoing offpump coronary artery bypass grafting (OPCAB). Methods We retrospectively analyzed the clinical data of 215 patients undergoing OPCAB in our hospital from November 2007 to November 2008. There were 171 males and 44 females aged between 40 and 85 years old. Among them, there were 47 patients older than 70 years old. All of them were coronary artery disease (CAD) patients with triple vessel disease. We adopted univarialble analysis and logistic multivariable regression analysis to screen the risk factors for the mortality of OPCAB. Results Six patients died in hospital after OPCAB with a mortality rate of 2.79% (6/215). No renal dysfunction or respiratory failure occurred. The rate of reoperation for bleeding was 4.65% (10/215) and all the 10 patients having undergone reoperation were alive. A total of 209 patients were all alive after 1year follow-up. The results of logistic multivariable regression analysis showed that New York Heart Association (NYHA) Ⅲ and Ⅳ heart function (OR=42.116，95% CI 3.319 to 534.465，P=0.004) and mechanical ventilation duration (OR=1.007，95%CI 1.001 to 1.013，P=0.028) were independent risk factors for inhospital mortality of OPCAB. Conclusion OPCAB is an effective and safe treatment for CAD with triple vessel disease. NYHA Ⅲ and Ⅳ heart function and mechanical ventilation time after OPCAB are the risk factors for OPCAB inhospital mortality, yet, needs further study with large sample.
ObjectiveTo determine the predictive value of the preoperative prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after non-coronary artery bypass grafting (CABG) cardiac surgery.MethodsThe clinical data of 584 patients who underwent elective non-CABG cardiac surgery with cardiopulmonary bypass (CPB) in our hospital from May to September 2019 were reviewed. There were 268 (45.9%) males and 316 (54.1%) females, with a mean age of 52.1±11.6 years. The mean cardiopulmonary time and aortic-clamp time was 124.8±50.1 min and 86.4±38.9 min, respectively. Totally 449 (76.9%) patients received isolate valve surgery. We developed the risk prediction model of AKI using multivariable logistic regression. The predictive values of preoperative PNI, Cleveland Clinic Score (CCS) and risk prediction model were estimated by the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. The improvement of preoperative PNI to predictive values of CCS or AKI risk prediction models were defined by the net reclassification index (NRI) and variation of AUC.ResultsThe preoperative PNI could neither effectively predict the occurrence of AKI following non-CABG cardiac surgery (AUC=0.553, 95%CI 0.489-0.617, P=0.095) nor improve the predictive effect of other AKI predictive models. The risk prediction model of AKI structured by our study had high predictive value on AKI or severe AKI (stage 2-3) (AUC=0.741, 95%CI 0.686-0.796, P<0.001) and superior to CCS (AUC=0.512, 95%CI 0.449-0.576, P=0.703).ConclusionThe preoperative PNI can neither predict the occurrence of AKI following elective non-CABG cardiac surgery nor improve the prediction values of other AKI prediction models.
Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. ResultsA total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.
Objective To investigate the protective effects of liposome prostaglandin E1（Lipo-PGE1） on myocardial ischemia-reperfusion injury （MIRI） during cardiopulmonary bypass （CPB）. Methods Thirty-two patients with clearly diagnosed heart valve disease and congenital heart disease such as atria septal defect （ASD） and ventricular septal defect （VSD） were selected in our hospital. The patients were randomly divided into two groups （16 patients in each group）, Lipo-PGE1 group： Lipo-PGE1（2ng/kg·min） was continuously pumped before starting of CPB until 2 h after ascending aortic off-clamping; control group： using the same volume of normal saline, arterial blood samples were taken before CPB, at 1, 2, 6 and 24 h after the ascending aortic off-clamping. The value of cardiac troponin I （cTnI）, creatine kinase MBmass （CK-MB）, interleukin-6 （IL-6）, tumour necrosis factor-α （TNF-α）, intercellular adhesion molecule-l（sICAM-1） were measured. Results cTnI, CK-MB, IL-6, TNF-α and sICAM-1 showed no significant difference in the two groups before CPB （P〉0. 05）. At 1,2, 6 and 24h after ascending aortic off-clamping, those values rose significantly than before CPB（P〈0. 01）, but Lipo-PGE1 group＇s values were lower than those in the control group （P〈0. 05）. Conclusions Lipo-PGE1 （2ng/kg·min） continuously pumped from before CPB to 2h after ascending aortic off-clamping can inhibit effectively the production of IL-6, TNF-α, and reduce the expression of sICAM-1, attenuate the process of inflammation, lighten the injuries of myocardial cells, and effectively protect the MIRI during CPB open heart surgeries.