Objective To analyze the incidence of valve prosthesis-patient mismatch (PPM) and ventricular remodeling of elderly patients after aortic valve replacement (AVR). Methods We retrospectively analyzed the clinical data of 134 patient aged over 65 years who underwent AVR for the aortic stenosis or regurgitation at our hospital between January 2016 and December 2016. There were 73 males and 61 females aged 69.7±3.6 years ranging from 65-79 years. The clinical and ultrasound cardiography data were evaluated. PPM was defined as an effective orifice area index (EOAI) of ≤0.85 cm2/m2. The incidence of PPM and the left ventricular remodeling after surgical AVR in the patients with aortic stenosis and aortic regurgitation was analyzed, and the outcomes of aortic valve mechanical prosthesis and aortic valve bioprosthesis were compared. Results The incidence of PPM was 32.5% in aortic stenosis and 13.0% in aortic regurgitation (P<0.05). One patient died in the early post-operation, and the incidence of severe PPM was 6.0%. Conclusion The incidence of PPM after AVR in the patients with aortic regurgitation is less than that in the patients with aortic stenosis.
Abstract： Replacement of the aortic valve and aortic root has been the standard surgical strategy for patients with aortic root aneurysm for many years. Along with the increasing knowledge about the aortic root anatomy and physiology, and complications after aortic valve replacement, the technique of valve-sparing aortic root replacement has developed greatly. We focus on the etiology and classification aortic valve insufficiency, the valve-sparing techniques and clinical outcomes of valve-sparing aortic root replacement in this review.
The study investigates the current status of corporate governance structures in medical insurance agencies in typical cities and provinces in China, highlighting the challenges faced by corporate governance in these institutions. It advocates for the continued comprehensive promotion of the nationwide establishment of a unified corporate governance framework for medical insurance agencies. Furthermore, it recommends enhancing the legislative support system for corporate governance in medical insurance agencies to ensure the effective implementation of decision-making powers within these organizations. Additionally, the study proposes actively establishing social evaluation and supervision mechanisms for corporate governance to further enhance the corporate governance structure of medical insurance agencies in China.
Objective To summarize the clinical experiences of venoarterial extracorporeal membrane oxygenation (ECMO) which provides temporary cardiopulmonary assist for critical patients, and preliminary analysis of the cause of failure. Methods From February 2005 to October 2008, 58 adult patients (male 42, female 16) undergoing cardiogenic shock required temporary ECMO support. Age was 44.8±17.6 years, and support duration of ECMO was 131.9±104.7 hours. There were 24 patients (41.4%) with coronary heart disease, 11 patients (19.0%) with cardiomyopathy, 10 patients (17.2%) with cardiac valve disease,and 9 patients (15.5%) with congenital heart disease. Results 22 patients died in hospital. 11 patients (50%) died of multisystem organ failure, 5 patients (22.7%) died of refractory heart failure despite the ECMO support. Another patients died of bleeding and severe pulmonary hypertension etc. The percentage for patients need cardiac resuscitation before ECMO support and patients with acute renal failure treated by continuous renal replacement therapy (CRRT) under ECMO support were obviously higher in dead patients than those in survivor patients (45.5% vs.19.4%, 40.9% vs. 5.6%; P=0.043，0.001). All of the discharged patients were reassessed, mean followup time were 15.6 months. Three patients died of refractory heart failure， 1 patient died of neurologic complications. The other 32 survivors were in good condition with cardiac symptom of New York Heart Association class Ⅰ or Ⅱ. Conclusion ECMO offers effective cardiopulmonary support in adults. Early intervention and control of complications could improve our results with increasing experience. Combining using CRRT during the ECMO support is associated with significantly higher mortality rate. Suffered cardiac arrest prior to ECMO also influences the survival.
Objective To assess the use of arterial revascularization and to compare the early outcomes with traditional coronary artery bypass grafting (CABG). Methods From January 1999 to January 2005, 123 patients (114 male, 9 females; age 52.2±10.1 years) underwent coronary artery surgery alone with disease of more than one coronary artery were considered for complete arterial revascularization (artery revascularization group). Internal mammary artery and radial artery was considered for artery grafts. At same period 115 patients (102 males, 13 females; age 60.3±9.1 years) underwent traditional revascularization using left internal mammary artery and veins (traditional group). The purpose was to compare the operative results between two groups. Results The patients in artery revascularization group were younger than that in traditional group, but there were more patients with three vessels disease in traditional group(54.5% vs. 86.1%, P=0.001). Off-pump CABG was choosed for more patients in artery revascularization group (26.0% vs. 57.4%, P=0.001). Patients in this group need more operative time if on-pump technique was used. The number of grafts were less in this group (2.6±0.7 vs. 3.4±0.9, P=0.001).There was no significant difference in hospital mortality and morbidity between two groups. Conclusion Proper patients using artery grafts appear to be safe in terms of in hospital mortality and morbidity.
Objective To evaluate the longterm results of coronary artery bypass grafting (CABG) in treating cardiac diseases with heart insufficiency by analyzing the longterm survival rate and heart failure exemption rate of the patients. Methods A total of 239 patients who had coronary heart disease with left heart dysfunction (LVEFlt;40%) were enrolled in our study. Among the patients, there were 215 males and 24 females aged from 32 to 78 years old with an average age of 59.1. Before operation, 193 patients had a past history of myocardial infarction and 31 had angina. According to the New York heart function assessment (NYHA), 26 patients were categorized as class Ⅰ, 106 as class Ⅱ, 73 as class Ⅲ and 34 as class Ⅳ. Coronary angiography showed 10 cases (4.2%) of single vessel disease, 35 cases (14.6%) of double vessel disease and 194 cases (81.2%) of triple vessel disease. The result of preoperative ultrasound cardiogram showed that LVEF was 35.7%±4.6%. All patients received CABG, including 153 (64.0%) onpump surgeries and 86 (35.9%) offpump surgeries. Selective operation was done on 237 patients and there were 2 emergency cases. Valve repair or replacement, ventricular aneurysmectomy or aneurysm plication were not carried out during the operation. Results There were 1 to 6 (3.4±1.1) bypass grafting vessels in each case. Five (2.09%) patients died during the hospital stay, among which 2 died of low cardiac output and circulation failure, 1 died of malignant arrhythmia, 1 died of renal failure, and 1 died of coma with multiorgan failure. The followup period was 512±1.79 years. During the followup, 18 patients (7.7%) were lost and 29 patients died. Among them, there were 24 cardiac deaths and the cardiac death rate at the first year and the fifth year was 2.8% and 9.4% respectively. There were 40 cases of heart failure during the followup period. The exemption rate of heart failure was 93.7% and 81.8% at the first year and the fifth year respectively. The survival rate was 97.2% at the first year and 89.3% at the fifth year. Conclusion The longterm result of CABG in treating patients with ischemic heart insufficiency is satisfying.