In recent years, the field of cardiovascular surgery has undergone revolutionary changes and made rapid progress in various aspects, bringing more hope and possibilities for the health and well-being of patients. As in every era full of change, opportunities and challenges always coexist. The constant emergence of new technologies brings new opportunities and hope, as well as constant challenges to past concepts. This article aims to comprehensively summarize the latest developments in cardiovascular surgery, especially since 2023, introduce cutting-edge knowledge and technologies in the field of cardiovascular surgery, and deeply analyze and explore future development directions, in order to provide useful references and inspirations for cardiovascular doctors and jointly promote the continuous progress of cardiovascular surgery in China.
ObjectiveTo study the effect of endothelin receptor antagonist on recent outcome of patients undergoing Fontan surgery. MethodsThirty nine patients who received Fontan procedure from January 2009 to December 2010 in Wuhan Asia Heart Hospital were recruited in the study. There were 25 males and 14 females with mean age of 8.02±4.98 years (ranged from 2.5 to 18.0 years). According to the admission number, the patients were randomly divided into an endothelin receptor antagonists group (bosentan group, n=16) and a control group (n=23). The bosentan group received bosentan treatment by gastric fill or oral according to the recommended dose in three days after surgery for over 7 days. The control group did not receive any pulmonary hypertension targeted therapy. On the 10th day after surgery, indexes including mortality etc in the two groups were compared. ResultsNo death occurred in the bosentan group. One patient died on the 5th day after operation in the control group. There was no significant difference in the postoperative mortality. The patients in the bosentan group got significantly better results than the control group in cardiac function, incidence of pleural effusion, vasoactive drugs score, and serum B-type natriuretic peptide, albumin, alanine aminotransferase on the 10th day (P < 0.05); while the 6-minute walk distance, transcutaneous oxygen saturation, white blood cell count, C-reactive protein, cardiac troponin I, and creatinine of the two groups showed no statistical difference (P > 0.05). ConclusionEndothelin receptor antagonists can improve the short-term outcome of patients after Fontan surgery.
Implantable left ventricular assist device (LVAD) has become an essential treatment for end-stage heart failure, and its effect has been continuously improved. In the world, magnetic levitation LVAD has become mainstream and is increasingly used as a destination treatment. China has also entered the era of ventricular assist device. The continuous improvement of the ventricular assist device will further improve the treatment effect. This article reviews the current situation and development trend of LVAD treatment in China and abroad.
Pulmonary arterial hypertension (PAH) is a severe, progressive disease leading to right ventricular failure and finally death. Lung transplantation is recommended for PAH patients who do not respond to targeted drug combination therapy or World Health Organization functional class (WHO FC) Ⅲ or Ⅳ. However, only 3% of PAH patients can recieve the lung transplantation. A novel implantable interatrial shunt device (ISD) can create a relatively fixed right-to-left shunt established by balloon atrial septostomy (BAS). The device may decompress the right sided chambers, facilitate left heart filling, improve organ perfusion and reduce the likelihood of syncope, acute pulmonary hypertensive crisis and death. The systemic oxygen transport improves despite hypoxemia. Implantation is simple, feasible and safe, and the X-ray time and operation time are short. There is no severe complication or thrombosis during the mid-term follow-up of the clinical studies and the device remained patent. The syncope symptoms, six-minute walk distance, cardiac index and systemic oxygen transport improve significantly in the patients. ISD may be currently the last alternative treatment to improve symptoms and prolong survival in currently drug-resistant patients with severe PAH.
Objective To explore the clinical effects of emergency transcatheter aortic replacement (TAVR) on the treatment of patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis during hospitalization. Methods The study selected 44 patients from 8 heart valve centers from January 2018 to January 2021. All patients received emergency TAVR treatment. The patients’ baseline clinical data, cardiac ultrasound indicators, and postoperative hospital stay were collected. Paired t-test and McNemar test were used to compare and analyze the preoperative and postoperative cardiac ultrasound indexes, moderate to severe aortic stenosis, and cardiac function. Results The average age of the patients was (72.0±7.9) years. Valve displacement occurred in one patient during the operation, and the surgical success rate was 97.7%. Four cases died during hospitalization, and the mortality rate was 9.1%. The median length of hospital stay was 11.5 d. The postoperative aortic valve area was significantly higher than that before surgery [(0.5±0.2) vs. (3.8±1.6) mm2, P<0.05], the mean transvalvular pressure of the aortic valve was significantly lower than that before operation [(64.0±24.9) vs. (11.3±4.6) mm Hg (1 mm Hg=0.133 kPa), P<0.05], the peak aortic flow velocity was significantly lower than that before operation [(4.5±0.7) vs. (1.9±0.7) m/s, P<0.05], the left ventricular end diastolic inner diameter was lower than that before operation [(59.0±7.2) vs. (56.1±7.3) mm, P<0.05], the left ventricular ejection fraction increased significantly compared with that before operation [(30.1±10.4)% vs. (40.9±11.0)%, P<0.05], and the cardiac function improved significantly compared with that before operation (P<0.05). During the operation, 2 cases (4.5%) underwent valve-in-valve implantation, 11 cases (25.0%) underwent percutaneous coronary intervention during the same period. During the postoperative hospital stay, 1 case (2.3%) developed stroke, 3 cases (6.8%) experienced severe bleeding, 5 cases (11.4%) had severe vascular complications, 2 cases (4.5%) experienced acute myocardial infarction, 30 cases (68.2%) had small or trace paravalvular regurgitation, 3 cases (6.8%) received permanent pacemaker implantation, and 5 cases (11.4%) developed acute kidney injury. Conclustion Emergency TAVR is an effective and feasible treatment plan for patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis.
Percutaneous ventricular assist device (PVAD) is a minimally invasive treatment which can replace the function of the failing heart. It provides circulatory support for patients with severe emergent cardiovascular diseases such as complex coronary artery disease, acute myocardial infarction complicated by cardiogenic shock, and acute decompensated chronic heart failure. PVAD has been developed since the rise of the Hemopump, to the prosperity of the Impella, and increasingly been used as a haemodynamic support to improve prognosis. This article will review the evolution and clinical application of PVAD.