Abstract： Objective To explore the association between transforming growth factor-β receptor typeⅡ (TGFBR2) gene rs6785358 and rs764522 polymorphisms and rheumatic heart disease (RHD) in Chinese Han People. Methods The research design was a case-control study. A total of 207 patients who were hospitalized in Nanjing First Hospital Affiliated to Nanjing Medical University between October 2008 and January 2011 with RHD served as RHD group while 225 age and gender matched healthy adults as control group. Polymerase chain reaction-restriction length polymorphism (PCR-RFLP) technique was used to determine TGFBR2 gene rs6785358 and rs764522 polymorphisms. Results The frequencies of genotype AA, AG and GG of rs6785358 in RHD group and control group were 72.0%, 25.1%, 2.9% and 68.9％, 28.0％, 3.1％,respectively. There was no significant difference in the distribution of genotype frequencies for rs6785358 between RHD group and control group（χ2=0.50，P=0.78）. The frequencies of allele A and G of rs6785358 in RHD group and control group were 84.5％, 15.5％ and 82.9％, 17.1％,respectively. There was no significant difference in the distribution of allele frequencies for rs6785358 between RHD group and control group（χ2=0.43，P=0.51）. The frequencies of genotype CC, CG and GG of rs764522 in RHD group and control group were 77.3%, 21.3%, 1.4% and 75.6％, 21.3％, 3.1％, respectively. There was no significant difference in the distribution of genotype frequencies for rs764522 between RHD group and control group（χ2=1.33，P=0.51）. The frequencies of allele C and G of rs764522 in RHD group and control group were 87.9％, 12.1％ and 86.2％, 13.8％,respectively. There was no significant difference in the distribution of allele frequencies for rs764522 between RHD group and control group（χ2=0.55，P=0.46）. Further analysis by sex stratification showed that no statistical significance was detected in the distribution of genotype and allele frequencies for rs6785358 or rs764522 between RHD patients and controls. Conclusion TGFBR2 gene rs6785358 and rs764522 polymorphisms are not associated with RHD in Chinese Han people.
ObjectiveTo summarize clinical outcomes of different end-to-end anastomotic methods for surgical treatment of acute Stanford type A aortic dissection (AD). MethodsBetween January 2012 and May 2013, 95 patients with acute Stanford type A AD received surgical treatment in Nanjing Hospital Affiliated to Nanjing Medical University. According to different end-to-end anastomotic methods, 72 patients were divided into 3 groups (23 patients undergoing Bentall procedure were excluded from this study). In group A, there were 23 patients including 18 males and 5 females with their age of 48.67±9.23 years, who received 'sandwich' anastomotic technique strengthening both the inner and outer layers of the aortic wall. In group B, there were 11 patients including 8 males and 3 females with their age of 48.00±9.17 years, who received pericardium strengthening only inner layer of the aortic wall. In group C, there were 38 patients including 29 males and 9 females with their age of 49.20±8.57 years, who received artificial graft that was anastomosed directly to the aortic wall without any reinforcement. Postoperative outcomes were compared among the 3 groups. ResultsEight patients (11.11%)died postoperatively including 1 patient in group A (1/23, 4.35%)and 7 patients in group C (7/38, 18.42%). One patient in group A died of persistent wound errhysis and later disseminated intravascular coagulation. Three patients in group C died of persistent anastomotic incision errhysis and circulatory failure. Four patients in group C died of postopera-tive severe tricuspid regurgitation, secondary severe low cardiac output syndrome and multiple organ dysfunction syndrome. Severe postoperative complications included renal failure in 5 patients, respiratory failure in 7 patients, severe cerebral infarction and paralysis in 1 patient, paresis in 3 patients, delayed recovery of consciousness in 2 patients, and ischemic necrosis of the lower limb in 1 patient. Postoperative thoracic drainage amount in group C was significantly larger than that of the other 2 groups, and there was no statistical difference in thoracic drainage amount between group A and group B. Sixty-four patients were followed up for 1 to 6 months, and there was no late death during follow-up. Among the 5 patients with postoperative renal failure, only 1 patient needed regular hemodialysis, and renal function of the other 4 patients returned to normal. One patient with cerebral infarction recovered partial limb function and was able to walk with crutches. All the 3 patients with paresis recovered their limb function. ConclusionsAnastomotic quality of end-to-end anastomosis is of crucial importance for surgical treatment of acute Stanford type A AD. Appropriate reinforcement methods can be chosen according to individual intraoperative findings. 'sandwich' anastomotic technique can significantly reduce incision errhysis, prevent acute myocardial infarction caused by aortic anastomotic tear, and decrease postoperative mortality. If coronary ostia are involved in AD, concomitant coronary artery bypass grafting is needed.
ObjectiveTo summarize clinical experience and outcomes of modified Bentall procedure for the treatment of Stanford type A3 aortic dissection (AD). MethodsFifty-four patients with Stanford type A3 AD underwent aortic root replacement in Nanjing Hospital Affiliated to Nanjing Medical University from January 2004 to June 2013. There were 41 male and 13 female patients with their age of 21-73 years. According to different surgical methods, all the 54 patients were divided into 2 groups. In group A, there were 36 patients who received conventional Bentall procedure. In group B, there were 18 patients who received modified Bentall procedure ('gate' anastomosis of the coronary ostia for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia). Postoperative outcomes were compared between the 2 groups. ResultsThere was no statistical difference in age or gender between the 2 groups. Mean diameter of the aortic root of group A was significantly larger than that of group B (52.11±3.62 mm vs. 40.72±2.67 mm, P=0.000). There was no statistical difference in operation time, cardiopulmonary bypass time, intraoperative circulation arrest time, postoperative thoracic drainage or length of ICU stay between the 2 groups (P > 0.05). Four patients died postoperatively including 2 patients with uncontrollable bleeding, 1 patient with abdominal AD rupture and 1 patient with acute pulmonary embolism. There was no statistical difference in in-hospital mortality between group A and group B[5.56% (2/36)vs. 11.11% (2/18), P=0.462]. Forty-eight patients were followed up for 3 months, and 2 patients were lost during follow-up. Forty-eight patients received computed tomography angiography without false aneurysm formation in the aortic root, coronary ostial aneurysm or stenosis. ConclusionModified Bentall procedure ('gate' anastomosis of the coronary ostia)is simple and effective for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia.
ObjectiveTo compare the recent and mid-term results of two different treatments in bicuspid aortic valve (BAV) patients with dilated ascending aorta. MethodsFrom march 2007 to April 2014, there were totally 70 BAV patients received surgical treatment in Nanjing Cardiovascular Disease Hospital. According to the procedure of the ascending aorta, they were divided into two groups. As for group A which repaired the ascending aorta, there were 28 males and 9 females with an average age of 58.68±8.01 years. As for group B which replaced the ascending aorta, there were 25 males and 8 females with an average age of 54.18±11.97 years. And we compared perioperative clinical data and follow-up results of these two groups. ResultsThere were statistical differences between the two groups in cardiopulmonary bypass time, aortic cross clamping time, and ICU stay time (105.19±11.17 min vs. 180.94±32.10 min, P=0.000; 78.65±13.18 min vs. 110.24±29.64 min, P=0.000; 1.62±1.09 d vs. 3.58±2.89 d, P=0.001). And the time of the group A is shorter than that in the group B. Two patients in the group B died postoperatively, and the other 68 patients discharged. There was no significant difference in cumulative survival rate between the two groups (P=0.582). Postoperative following-up results showed that the ascending aortic diameter of both groups was smaller than that during the preoperative period. And at the latest time of the following-up, ascending aortic diameter was increased compared with pre-discharge in the group A (38.50±1.77 mm vs. 34.85±1.53 mm, P=0.007). But there was no increase in the group B. ConclusionWe suggests simultaneous treatment to dilated ascending aorta for BAV patients. Both the repair and replacement procedure could achieve satisfactory recent and mid-term results.
Objective To compare the short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B aortic dissection (AD). Methods A total of 45 patients (37 acute AD and 8 chronic AD) with complex type B AD were admitted to Nanjing First Hospital from January 2012 to June 2016, including 37 males and 8 females. All patients were confirmed by computed tomography angiography (CTA), and ultrasonic cardiogram (UCG) to rule out valvular diseases, aortic root and ascending aorta lesion, and pericardial effusion. According to different treatments, patients were divided into two groups: the open surgery group (OS group) with a total of 25 patients (20 males, 5 females, a mean age of 50.16±10.87 years); the hybrid technique group (HT group) with a total 20 patients (18 males, 2 females, mean age of 51.31±8.11 years). The short and mid-term outcomes of open surgery and hybrid technique for the treatment of complex type B AD were compared. Results All the patients were discharged successfully. There was no death, cognitive impairment, cerebral infarction, hemiplegia, paraplegia, coma and other neurological complications in both groups. In the OS group, one patient suffered acute kidney injury and received renal replacement therapy (RRT), whose renal function was returned to normal prior to discharge; one patient was transferred to ICU again owing to pericardial effusion, respiratory failure and lung infection; one patient underwent debridement surgery because of postoprative sternal dehiscence. In the HT group, one patient with recurrent chest pain five days after endovascular aortic repair, whose CTA showed hematoma of aortic arch and ascending aorta caused by reverse tear, underwent Sun’s procedure immediately. All patients received CTA examination three months after operation in outpatient room. In the OS Group, the tear of AD was closed well by stent-graft and no leakage or shunt was detected in CTA. The rate of thrombosis formation in thoracic aortic false lumen was 100.0%. Meanwhile, in the HT Group, there was one patient with type Ⅱ leakage and the rate of thrombosis formation in thoracic aortic false lumen was 94.7%. Conclusion For complex type B AD without optimal "landing zone" in descending aorta, open surgery is recommended as the first choice for experienced team because of its less costs and perfect results; hybrid technique which can achieve quicker recovery with less surgical trauma still has serious complications such as leakage, reverse tear, and so on.
Objective To summarize and analyze the surgical approach and early prognosis of repairing adult aortic closure insufficiency with the Florida sleeve procedure. Methods The patients with aortic insufficiency who underwent Florida sleeve repair in the First Hospital of Nanjing Medical University between August 2020 and May 2024 were selected. Their general data, perioperative conditions, and echocardiographic data before, during, and after the procedure and at follow-up were analyzed. Result Fifteen patients were included, consisting of 12 males and 3 females, aged 33-71 (53.5±12.4) years. Preoperative echocardiography indicated that there was 1 patient of rheumatic disease, 7 patients of degenerative disease, 4 patients secondary to aortic aneurysm, and 3 patients of bicuspid aortic valve. The severity distribution included 2 patients of severe insufficiency, 4 patients of moderate-to-severe insufficiency, 5 patients of moderate insufficiency, and 4 patients of mild-to-moderate insufficiency. The mean cardiopulmonary bypass time was (135.0±40.0) minutes, the aortic cross-clamp time was (109.9±38.6) minutes, and the median ICU stay was 1 day. No mortality was recorded within 30 days postoperatively. Follow-up echocardiography showed that the valve regurgitation, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and sinus diameter all achieved the desired outcomes. Conclusion Florida sleeve repair for aortic valve in patients with a sinus diameter less than 50 mm not only effectively improves hemodynamics in adults with aortic insufficiency, but also has the advantages of low surgical risk and rapid postoperative recovery, making it a promising procedure for clinical application.
Objective To compare surgical outcomes of Stanford type A acute aortic dissection between operations at midnight and daytime. Methods From January 2004 to March 2013，195 patients with Stanford type A acute aortic dissection received surgical treatment in Nanjing Hospital Affiliated to Nanjing Medical University （Nanjing Cardiovascular Disease Hospital）. Patients with identical or similar propensity scores were matched from 127 patients who underwent emergency operation at daytime and 68 patients who underwent emergency operation at midnight. A total of 58 pairs of matched patients which had the same or similar propensity score were selected in daytime surgery group （n=58，43 males and 15 females，47.7±14.6 years） and midnight surgery group （n=58，45 males and 13 females，48.3±14.6 years）. Operation time，postoperative chest drainage，mechanical ventilation time，postoperative incidence of dialysis and tracheostomy，length of ICU stay and in-hospital mortality were compared between the daytime group and midnight group. Results A total of 58 pair of patients were matched in this study. There was no statistical difference in postoperative incidence of tracheostomy ［19.0% （11/58） vs. 6.9% （4/58），P=0.053］ or in-hospital mortality ［8.6% （5/58） vs. 6.9%（4/58），P=0.729］ between the midnight group and daytime group. Operation time （485.7±93.5 minutes vs. 428.5±123.3 minutes，P=0.048），postoperative chest drainage （979.5±235.7 ml vs. 756.6±185.9 ml，P=0.031），mechanical ventilation time （67.9±13.8 hours vs. 55.7±11.9 hours，P=0.025），postoperative incidence of dialysis ［17.2% （10/58） vs. 5.2%（3/58），P=0.039］ and length of ICU stay （89.4±16.2 hours vs. 74.8±12.5 hours，P=0.023） of the midnight group weresignificantly longer or higher than those of the daytime group. A total of 107 patients were followed up for 4-6 months after discharge. During follow-up，there was no late death. Among the 13 patients who required postoperative dialysis，12 patientsno longer needed regular dialysis. Conclusion Emergency operation at midnight does not increase in-hospital mortalitybut increase some postoperative morbidity in patients with Stanford type A acute aortic dissection. Whether at midnight or daytime，better preoperative preparation and surgeons’ vigor are needed for timely surgical treatment for patients with Stanford type A acute aortic dissection.
ObjectiveTo investigate the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) level and in-hospital prognosis in patients with acute type A aortic dissection within 24 hours of admission.MethodsFortysix patients diagnosed with type A aortic dissection were included in our hospital and their Lp-PLA2 levels within 24 hours of admission were measured between January 2017 and June 2019. According to their Lp-PLA2 levels within 24 hours of admission, 23 patients were classified into a high Lp-PLA2 group (Lp-PLA2 > 200 μg/L, 16 males and 7 females at age of 52.0±14.0 years) and 23 patients were into a low Lp-PLA2 group (Lp-PLA2 ≤200 μg/L, 15 males and 8 females at age of 53.0±11.0 years). The relationship between Lp-PLA2 level and clinical outcome was analyzed.ResultsThe incidences of bleeding, hospital infection, multiple organ dysfunction and mortality in the high Lp-PLA2 group were higher than those in the low Lp-PLA2 group (P<0.05). Seven (15.2%) patients died during 3 months of follow-up. The 3-month survival rate of patients with an increase of Lp-PLA2 was significantly lower than that of the patients with normal Lp-PLA2 (P<0.01), which was an independent predictor of adverse outcomes at 3 months of onset (P<0.01).ConclusionLp-PLA2 may be a predictor of disease progression in the patients with acute type A aortic dissection, and the patients with significantly elevated Lp-PLA2 have a higher 3-month mortality than the patients with normal Lp-PLA2.
ObjectiveTo investigate the impact of deep hypothermic circulatory arrest (DHCA) with antegrade cerebral perfusion (ACP) on cognitive function of patients undergoing surgical therapy for acute Stanford type A aortic dissection (AD). MethodsBetween January 2009 and March 2012, 48 patients with acute Stanford type A AD underwent Sun's procedure (aortic arch replacement combined with stented elephant trunk implantation) under DHCA with ACP in Nanjing Hospital affiliated to Nanjing Medical University. There were 40 males and 8 females with their age of 51.3±13.6 years. Circulatory arrest time and time for postoperative consciousness recovery were recorded. Preoperative and postoperative cognitive functions of each patient were evaluated by mini-mental status examination (MMSE). ResultsMean cardiopulmonary bypass time of the 48 patients was 237.3±58.5 minutes, and mean circulatory arrest time was 37.3 ±6.9 minutes. Four patients died postoperatively with the causes of death including lung infection, multiple organ dysfunction syndrome, myocardial infarction and acute respiratory distress syndrome. Forty-one patients recovered their consciousness within 24 hours postoperatively, and the mean time for postoperative consciousness recovery was 15.3±6.5 hours. Preoperative MMSE score was 28.6±1.1 points, and MMSE score at 1 week postoperatively was 23.6±4.5 points. Thirty-one patients were followed up for 6 months with the follow-up rate of 70.45%. The average MMSE score of the 31 patients at 6 months after surgery was 27.6±2.1 points which was significantly higher than postoperative average MMSE score (P < 0.05), but not statistically different from preoperative average MMSE score (P > 0.05). ConclusionsDHCA with ACP can provide satisfactory cerebral protection for patients undergoing surgical therapy for acute Stanford type A AD, but patients' cognitive function may be adversely affected in the short term. As long as cerebral infarction or hemorrhage is excluded in CT scan of the brain, such adverse impact may generally disappear automatically within 6 months after surgery.
目的总结采用分期全主动脉置换治疗急性A型主动脉夹层合并胸腹主动脉瘤的手术方式和早期治疗效果。 方法自2013年2月至2014年2月，2例急性A型主动脉夹层合并Crawford Ⅱ型胸腹主动脉瘤的马方综合征患者进行了分期全主动脉置换手术。患者均为男性，年龄分别为41岁和26岁。一期在部分深低温停循环下行主动脉根部、全弓置换及支架象鼻植入术，二期在常温非体外循环下应用四分叉人工血管行全胸腹主动脉置换术。 结果手术结果满意，2例患者均康复出院，无任何并发症。 结论分期全主动脉置换术治疗急性A型主动脉夹层合并全胸腹主动脉瘤是一种安全、有效的方法。