Objective To analyze the characteristics of sternal Mycobacterium tuberculosis (Mtb) infection after cardiac surgery. Methods An electronic search was conducted for publicly available cases of sternal Mtb infection after cardiac surgery in PubMed, Web of Science, Wanfang database, and CNKI since their inception up to 18 July 2023, and 2 researchers analyzed the characteristics of the included cases and extracted relevant data. Results A total of 26 patients were included in 15 studies, 16 males and 10 females, aged 5-80 (61.9±15.6) years. Previous surgical history included coronary artery bypass grafting in 14 cases (53.8%), valve surgery in 8 cases (30.8%), congenital heart surgery in 3 cases (11.5%), and aortic surgery in 2 cases (7.7%). The main symptoms and signs were incisional abscesses, poor healing, mostly with pain, with or without erythema, and usually without systemic symptoms such as low-grade fever, night sweats, and weight loss. 13 cases reported a postoperative time to discovery of infection with a mean of 11.8 (0.5-60) months, and 9 cases reported an interval between discovery of infection and diagnosis with a mean of 12.1 (1.5-62) months. Confirmation of the diagnosis was mainly by Mtb culture of cleared bone tissue or pus, pathology and antacid staining. One case died of cardiac arrest before diagnosis. After the diagnosis of 25 cases, 13 cases received only anti-tuberculosis treatment, of which 11 cases received surgical treatment before diagnosis; 12 cases received anti-tuberculosis and surgical treatment, and all 25 cases were successfully cured. The duration of anti-tuberculosis treatment ranged from 6 to 12 months. Conclusion Sternal Mtb infection after cardiac surgery has a long incubation period, early diagnosis is difficult, the rate of missed diagnosis and misdiagnosis is extremely high, and timely diagnosis and treatment can significantly improve the prognosis.
目的探讨冠状动脉心肌桥（myocardial bridge，MB）的诊断、手术适应证、手术方式及手术效果。 方法回顾性分析2010年6月至2014年12月我院13例冠状动脉心肌桥患者行外科手术治疗的临床资料，其中男9例、女4例，年龄42～68岁。单纯MB 8例，合并冠心病2例，合并瓣膜病2例，合并先天性房间隔缺损1例，单纯8例MB均在非体外循环下行心肌桥松解术，2例合并冠心病患者在非体外循环下行心肌桥松解+冠状动脉旁路移植术，其余3例均在体外循环心脏停跳下行心肌桥松解+心内畸形矫治术。 结果13例外科手术均获成功，无并发症发生，患者心绞痛症状缓解，心电图提示心肌缺血明显改善，超声心动图检查提示心功能较术前明显提高，术后随访3～48个月，1例单纯MB患者行松解术后仍有心绞痛，应用药物控制，其余术后无不适症状，冠状动脉CT显示无心肌桥。 结论对冠状动脉心肌桥行外科手术治疗，能取得较满意的近、中期效果。
Objective To compare the early outcomes of domestic third-generation magnetically levitated left ventricular assist device (LVAD) with or without concomitant mitral valvuloplasty (MVP). Methods The clinical data of 17 end-stage heart failure patients who underwent LVAD implantation combined with preoperative moderate to severe mitral regurgitation in Fuwai Central China Cardiovascular Hospital from May 2018 to March 2023 were retrospectively analyzed. The patients were divided into a LVAD group and a LVAD+MVP group based on whether MVP was performed simultaneously, and early outcomes were compared between the two groups. Results There were 4 patients in the LVAD group, all males, aged (43.5±5.9) years, and 13 patients in the LVAD+MVP group, including 10 males and 3 females, aged (46.8±16.7) years. Compared with the LVAD group, the LVAD+MVP group had a lower pulmonary artery systolic pressure and pulmonary artery mean pressure 72 h after operation, but the difference was not statistically different (P>0.05). Pulmonary artery systolic pressure was significantly lower 1 week after operation, as well as pulmonary artery systolic blood pressure and pulmonary artery mean pressure at 1 month after operation (P<0.01). There was no statistically significant difference in blood loss, operation time, cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time, and ICU stay time between the two groups (P>0.05). The differences in 1-month postoperative mortality, acute kidney injury, reoperation, gastrointestinal bleeding, and thrombosis and other complications between the two groups were not statistically significant (P>0.05). Conclusion Concomitant MVP with implantation of domestic third-generation magnetically levitated LVAD is safe and feasible, and concomitant MVP may improve postoperative hemodynamics without significantly increasing perioperative mortality and complication rates.
Objective To compare and analyze the early- to mid-term outcomes of transcatheter aortic valve replacement (TAVR) combined with percutaneous coronary intervention (PCI) versus surgical aortic valve replacement (SAVR) combined with coronary artery bypass grafting (CABG) for the treatment of significant aortic stenosis (AS) and coronary artery disease (CAD). Methods The data of patients with significant AS and CAD who underwent surgical treatment at Central China Fuwai Hospital of Zhengzhou University from January 2018 to July 2023 were collected. These patients were divided into a TAVR+PCI group and a SAVR+CABG group according to the operation method. Propensity score matching (PSM) was used to select patients with close clinical baseline characteristics, and the early- to mid-term outcomes of the two groups were compared. Results A total of 272 patients were enrolled, including 208 males and 64 females, with a mean age of 64.16±8.24 years. There were 47 patients in the TAVR+PCI group and 225 patients in the SAVR+CABG group. After 1∶1 PSM, 32 pairs were selected. There was no statistical difference in baseline data between the two groups (P>0.05). Compared with the SAVR+CABG group, the TAVR+PCI group had significantly shorter operative time, mechanical ventilation time, ICU stay, postoperative hospital stay, and less intraoperative bleeding, and significantly lower postoperative transfusion and complete revascularization rates (P<0.05). The differences in the rates of postoperative in-hospital death, myocardial infarction, stroke, and other complications between the two groups were not statistically significant (P>0.05), and the differences in the rates of severe perivalvular leakage, death, or readmission in the mid-term follow-up were not statistically significant (P>0.05). Conclusion In patients with significant AS and CAD, the early- and mid-term rates of death and complications were similar between those treated with TAVR+PCI and SAVR+CABG, and TAVR+PCI is a safe alternative to SAVR+CABG.