ObjectiveTo analyze the early changes of gene expression levels and signaling pathways in 661W cell line under hypoxic conditions and to find potential functional target genes.MethodsThe cultured mouse 661W cells were divided into hypoxia treatment group and normoxia control group. Cells in the hypoxia treatment group were cultured in a three-gas incubator with volume fraction of 1% and 5% CO2 at 37 ℃. Cells in the normoxia control group were cultured in an incubator at 37 ℃ with volume fraction of 5% CO2. High-throughput sequencing technology was used to sequence the transcriptome of 661W cell treated with hypoxia and normoxia for 4 hours to screen for differentially expressed genes (DEG). Clustering heat map analysis, gene ontology (GO) functional enrichment analysis, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis and protein-protein interaction network (PPI) analysis were performed. The reverse transcription-polymerase chain reaction (RT-PCR) was used to verify the accuracy of the sequencing results.ResultsA total of 506 differentially expressed genes were screened, including 459 up-regulated genes and 47 down-regulated genes. GO functional enrichment analysis showed that the main biological processes of DEG were the cell's response to hypoxia, glycolysis, negative regulation of cell proliferation and apoptosis. hypoxia inducible factor (HIF)-1α pathway, glycolysis, Forkhead box O (FoxO) pathway, Insulin signaling pathway and Adenosine 5'-monophosphate-activated protein kinase (AMPK) pathway were involved in the above process. PPI analysis results showed that hub genes related to hypoxia were Aldoa, Aldoc, Gpi1, Hk2, Hk1, Pfkl, Pfkp, Vhl, Fbxo10 and Fbxo27. The RT-PCR results showed that the relative expression levels of 15 DEG mRNA in the hypoxic treatment group were higher than that of the normoxic control group, and the difference was statistically significant (P＜0.05). The mRNA expression levels of N-myc downstream-regulated gene-1 (Ndrg1), Mt1, and vascular endothelial growth factor A (VEGFA) were time-dependent on hypoxia.ConclusionsUnder hypoxia, DEG is mainly related to glucose metabolism, cell response to hypoxia, regulation of proliferation and apoptosis. HIF-1α pathway, glycolysis, FoxO pathway and AMPK pathway are involved in the early changes of 661W cells under hypoxia. Aldoa, Aldoc, Gpi1, Hk2, Hk1, Pfkl, Pfkp, Vhl, Fbxo10, Fbxo27 may play key roles in the response of 661W cells to hypoxia. Ndrg1, Mt1 and VEGFA could be potential functional target genes for the study of ischemia and hypoxia-related fundus diseases.
ObjectiveTo analyze clinical experience and outcomes of bileaflet preservation in mitral valve replace-ment (MVR) for patients with severe mitral regurgitation (MR). MethodsWe retrospectively analyzed clinical data of 17 patients with severe MR who underwent MVR with bileaflet preservation in the Department of Cardiovascular surgery of Guangdong General Hospital from June 2011 to January 2013. There were 14 males and 3 females with mean age of 63.41±11.82 years (range, 38 to 82 years). There were 13 patients with atrial fibrillation. Preoperatively, 5 patients were in New York Heart Association (NYHA) functional class Ⅲ, and 12 patients were in NYHA class Ⅳ. There were 7 patients with ischemic MR, 9 patients with degenerative MR, and 1 patient with rheumatic MR. ResultsMVR with bileaflet preservation was performed for all the patients. Concomitant coronary artery bypass grafting was performed for 4 patients. Eleven patients received bioprosthetic MVR, and 6 patients received mechanical MVR. There was no in-hospital death, postoperative low cardiac output syndrome or left ventricular rupture. All the 17 patients were followed up for a mean duration of 16.44±5.02 months (range, 2 to 25 months). During follow-up, 1 patient died of severe paravalvular leak 2 months after surgery. All the other patients had good mitral valve function. None of the patients had anticoagulation or prosthetic valve related complication. Patient's heart function was significantly improved. Eleven patients were in NYHA functional class Ⅰ, 4 patients were in NYHA class Ⅱ, and 1 patient was in NYHA class Ⅲ. Cardiothoracic ratio, left atrial dimension, left ventricular end-diastolic dimension and left ventricular end-systole dimension postoperatively and during follow-up were significantly smaller than preoperative values. Postoperative left ventricular ejection fraction (LVEF) was significantly lower than preoperative LVEF(50.94%±8.78% vs. 55.31%±10.44%, P=0.04), but LVEF during follow-up was not statistically different from preoperative LVEF(55.31%±10.44% vs. 56.13%±9.67%, P=0.73), and LVEF during follow-up was significantly higher than postoperative LVEF(56.13%±9.67% vs. 50.94%±8.78%, P=0.02). There was no statistical difference between postoperative mitral pressure half-time (PHT)and PHT during follow-up (95.06±19.00 ms vs. 94.56±19.19 ms, P=0.91). ConclusionMVR with bileaflet preservation is a safe and effective surgical technique for patients with severe MR, and can significantly improve postoperative left ventricular remodeling and function.
Objective To evaluate the efficacy of a combination of beating-heart minimally invasive approach and leaflets augmentation technique treating severe tricuspid regurgitation (TR) after cardiac surgery. Methods From January 2015 to August 2017, patients undergoing reoperative tricuspid valve repair (TVP) with minimally invasive approach and leaflets augmentation were enrolled. Cardiopulmonary bypass (CPB) was established via femoral vessels and the procedures were performed on beating heart with normothermic CPB. A bovine pericardial patch was sutured to leaflets to augment the native anterior and posterior leaflets. Other repair techniques, such as ring implantation and leaflet mobilization, were also applied as needed. Results A total of 28 patients (mean age 55.6±10.1 years, 5 males, 23 females) were enrolled. One patient was converted to median sternotomy due to pleural cavity adhesion. Twenty-seven patients underwent totally endoscopic TVP with leaflets augmentation. No patients was transferred to tricuspid valve replacement. Two patients died in hospital. All patients were followed up for 7.4±5.0 months and there was no late death and reoperation. Regurgitation area was converted from 20.7±10.1 cm2 to 3.3±3.3 cm2 after TVP according to the latest echocardiography (P<0.001). Conclusion Minimally TVP with leaflets augmentation is effective in treating severe isolated TR after primary cardiac surgery. It can significantly increase success rate of tricuspid valvuloplasty and decrease the surgical trauma.
Objective To examine the effect and safety of thoracoscopic surgery for left atrium myxoma excision. Method Sixty-nine left atrial myxoma patients underwent excision of left atrial myxoma in our hospital between January 2012 and August 2014 year. The patients were divided into two groups according to the procedure. Thirty patients under-went thoracoscopic surgery, as a thoracoscopic group, with 8 males and 22 females, aged 47.36±13.02 years. Thirty-nine patients received median sternotomy surgery, as a median sternotomy group, with 10 males and 29 females, aged 49.17±13.09 years. The effect and safety between the two groups were compared. Results All patients survived after surgery without death and other serious complications. Compared with the median sternotomy surgery group, longer cardiopul- monary bypass and aortic cross clamp time, shorter ICU stay, ventilator support, and postoperative drainage time, shorter hospital stay time, less postoperative drainage, lower cost, and more higher rate of returning to work in 1 month after surgery were found in the thoracoscopic group with P value less than 0.05. There was no complication of stroke and other neurological complication in the two groups. All patients were followed up for 11 months to 4 years and 7 months, average age of 38.5±12.7 months. There was no recurrence in both groups. Conclusions The thoracoscopic left atrial myxoma excision cardiopulmonary is effective and safe. It can be used as a surgical treatment of left atrial myxoma preferred.
ObjectiveTo compare the efficacy and safety of mitral valvuloplasty via minimally invasive approach with those of mitral valvuloplasty via traditional median sternotomy.MethodsA total of 1 221 patients undergoing mitral valvuloplasty from January 2015 to August 2018 in Guangdong Provincial People's Hospital were analyzed retrospectively, including 721 males and 500 females, with an average age of 47.2±15.1 years. According to the different surgical methods, they were divided into a study group (n=654), who received mitral valvuloplasty via the totally thoracoscopic approach, and a control group (n=567), who received mitral valvuloplasty via traditional median sternotomy. Clinical data, surgical results, and perioperative outcomes of the two groups were compared.ResultsThere was no significant difference in preoperative general data between the two groups (P>0.05). Compared with the control group, the study group had longer cardiopulmonary bypass time and aortic cross-clamping time (146.7±42.4 min vs. 122.7±30.6 min, 96.2±32.7 min vs. 78.3±23.8 min, both P=0.000), and shorter total operation time (227.4±55.3 min vs. 238.1±56.4 min, P=0.001). There was no significant difference in the incidence of secondary cross-clamping and mitral valve replacement between the two groups (3.7% vs. 2.6%, P=0.312; 1.7% vs. 1.4%, P=0.690). The blood transfusion rate and the incidence of respiratory tract infection and postoperative poor wound healing were lower (13.0% vs. 24.5%, 2.1% vs. 18.0%, 1.5% vs. 5.3%, all P=0.000) and the postoperative hospital stay was shorter (6.2±4.4 d vs. 11.5±8.8 d, P=0.000) in the study group. There was no significant difference in hospitalization expense between the two groups (95 847.9±31 322.0 yuan vs. 99 673.1±47 930.3 yuan, P=0.149). Within 30 d after surgery, 1 patient died in the study group and 4 patients died in the control group. Before discharge, there were 4 and 5 patients with severe mitral valve regurgitation in the study group and the control group, respectively.ConclusionCompared with mitral valvuloplasty via traditional median sternotomy, minimally invasive mitral valvuloplasty is superior in shortening operation time and postoperative hospital stay, lowering blood transfusion rate, and reducing postoperative complications, which can achieve better clinical outcomes.
ObjectiveTo investigate long-term outcomes of patients without warfarin anticoagulation after isolated prosthetic aortic valve replacement (AVR) and evaluate the feasibility of short-term instead of lifelong anticoagulation therapy for low-risk AVR patients. MethodsSeven patients who underwent prosthetic AVR in Guangdong General Hospital between 1996 and 1999 but discontinued warfarin anticoagulation 3 years after surgery were regularly followed up. There were 6 male and 1 female patients with their age of 25-75 (40.0±11.4) years. These patients received warfarin anticoagulation during the first 3 years after surgery but discontinued oral anticoagulant 3 years after surgery (discontinued anticoagulation group). Fifteen patients who underwent prosthetic AVR during the same period and continued warfarin anticoagulation were enrolled as the control group (continuing anticoagulation group). International normalized ratio (INR) was set between 1.8 and 2.5 during warfarin anticoagulation period in both groups. Survival rate and the incidence of severe adverse events were compared between the 2 groups. ResultsIn the discontinued anticoagulation group,1 patient was lost during follow-up. No thromboembolic event,death or prosthetic valve thrombosis was observed. All the patients were in NYHA class Ⅰ. In the continuing anticoagulation group,3 patients were lost during follow-up. Eleven patients were in NYHA class Ⅰ and 2 patients were in NYHA class Ⅱ. Severe anticoagulation-related bleeding events occurred in 3 patients with gastrointestinal bleeding. One patient died of massive outbreak of vomiting blood,and another patient had sudden death. Ten-year survival rate was 100.0% and 86.7% in the discontinued anticoagulation group and continuing anticoagulation group, respectively. ConclusionFor low-risk patients after isolated prosthetic AVR,short-term warfarin anticoagulation may be acceptable, which means warfarin is administered only in the first 3 years after surgery and discontinued 3 years after surgery.
ObjectiveTo explore the therapeutic effects of different surgical strategies on women with mechanical valve dysfunction during pregnancy.MethodsA total of 11 patients with mechanical valve dysfunction during pregnancy who underwent surgeries in our hospital from 2007 to 2017 were retrospectively included. The average age was 27.5±3.7 years. The prognosis of patients was analyzed according to the gestational weeks, cardiac function and the severity of mechanical valve dysfunction.ResultsNo death occurred. Three of them suffered subtotal hysterectomy during the surgery because of uncontrolled bleeding, and the others recovered without complications. Among the 5 patients with pregnancies <28 weeks, 1 patient was found intrauterine death before hospital admission, 2 suffered fetal loss 5 days after the cardiac surgery, and the other 2 patients continued their gestations until deliveries. Among the other 6 patients with pregnancies >28 weeks, 1 fetus died because of intracranial hemorrhage, and the other 5 survived without embryopathy or foetopathy.ConclusionGestation week, cardiac function and severity of mechanical valve dysfunction may be taken into account when making a treatment regimen for women with dysfunctional valve prostheses during pregnancy.
ObjectiveTo analyze clinical experience and outcomes of video-assisted thoracoscopic surgery (VATS)for bioprosthetic mitral valve replacement (MVR). MethodsWe retrospectively analyzed 32 patients who underwent VATS bioprosthetic MVR in the Department of Cardiovascular Surgery of Guangdong General Hospital from March to December 2013. There were 14 males and 18 females with a mean age of 55.6±17.3 years (range, 19 to 80 years), mean body weight of 55.7±9.7 kg (range, 37 to 78 kg) and mean body surface area of 1.67±0.16 m2 (range, 1.30 to 1.95 m2). Five patients had atrial fibrillation. There were 20 patients in New York Heart Association (NYHA)functional class Ⅱ, 11 patients in class Ⅲ, and 1 patient in class Ⅳ. There were 16 patients with rheumatic mitral valve disease, 11 patients with degenerative mitral valve disease, 4 patients with infective endocarditis and 1 patient with associated congenital heart disease. ResultsVATS bioprosthetic MVR was successfully performed for all the patients, including 27 patients with Medtronic Hancock Ⅱ Bioprosthesis and 5 patients with Medtronic Mosaic Bioprosthesis. Concomitantly, tricuspid valvuloplasty was performed for 13 patients and atrial septal defect repair was performed for 1 patient. There was no in-hospital death, low cardiac output syndrome or left ventricular rupture. Postoperative echocardiography showed good bioprosthetic function in all the patients without paravalvular leakage. Postoperative cardiac function significantly improved compared with preoperative cardiac function. There were 9 patients in NYHA functional class Ⅰ, 17 patients in class Ⅱ, and 6 patients in class Ⅲ. Left atrial diameter and left ventricular end-diastolic diameter examined postoperatively and 3 months after surgery were significantly smaller than preoperative values. Left ventricular ejection fraction (LVEF)examined postoperatively and 3 months after surgery was significantly lower than preoperative LVEF. ConclusionsVATS bioprosthetic MVR is a minimally invasive, safe and feasible procedure with a low postoperative morbidity. Incision size can be significantly reduced with a special type of bioprosthesis.
ObjectiveTo study the effectiveness of simplified blood management in cardiovascular surgery, minimize the need for blood transfusions and decrease the medical care costs. MethodsFrom March 2010 to May 2013, the simplified blood management was applied in 655 patients who underwent cardiovascular surgery in the department of cardiac surgery, Guangdong General Hospital. There were 316 males and 339 females with their age of 13-78 (45.0±13.8) years. The techniques of simplified blood management consisted of preoperative strategies, intraoperative strategies, and postoperative strategies. ResultsThere were 437 patients (66.7%) avoiding red cell transfusion in cardiac surgery. Of the 437 patients, 403 (61.5%) without any blood products transfusion, 29 had transfusion of plasma transfusion, 3 of plasma and cryoprecipitation, one of plasma and platelet, and one of platelet only. Two patients died within 30 days postoperative with 0.5% mortality rate:one died of multiple organ failure, one died of cardiac arrest. The procedures and special etiologies of 437 patients avoiding red cell transfusion included mitral valve replacement in 86 patients, double valve (aortic and mitral) replacement in 75 patients, aortic valve replacement in 51 patients, mitral valve replacement plus modified Maze procedure in 41 patients, atrial septal defect repair in 41 patients, mitral valve repair in 38 patients, double valve replacement plus modified Maze procedure in 25 patients, re-do operation in 23 patients, ventricular septal defect repair in 18 patients, coronary artery bypass grafting plus valve replacement in 10 patients, myxoma excision in 8 patients, subacute bacterial endocarditis in 8 patients, pericardium dissection in 5 patients, off-pump coronary artery bypass grafting in 4 patients, Bentall procedure in 4 patients. Of 65 patients with cardiac surgery history, 23 (35.4%) were free from red cell transfusion in the second operation. ConclusionSimplified blood management is of benefit to reduce the blood transfusion safely and effectively, no using additional expensive medication and medical devices and therefore without increasing hospital costs. The technique is suitable to any institute and patient. It is worthwhile to be used widely in clinical practice. Cell salvage system is not necessary.