Objective To investigate the influence of T helpers 17 (Th17) cells, regulatory T (Treg) cells and their related cytokines on postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG). Methods A total of 132 consecutive patients undergoing CABG between May 2013 and July 2016 were recruited. There were 82 males and 50 females with the age ranging from 39-76 years. Venous blood samples were collected within 2 hours after surgery. The expression of Th17 cells, Treg cells and their related cytokines in the peripheral blood was determined. Results POAF occurred in 35 patients (a POAF group) and 97 patients did not develop POAF (a No POAF group). Compared to the No POAF group, the proportion of Th17 cells and Th17/Treg ratio in the peripheral blood significantly increased in the POAF group (P>0.05) while proportion of Treg cells remained no significant change (P>0.05). The expression of Th17-related cytokines (IL-6, IL-8 and IL-17) all obviously increased in the POAF group (P>0.05). However, no significant difference was found in the expression of Treg-related cytokines (IL-10 and TGF-β) between the two groups (P>0.05). Conclusion Th17/Treg is unbanlanced in POAF patients and regulation of this imbalance may decrease the occurrence of POAF.
Objective To evaluate the safety and efficacy of biatrial Cox Maze Ⅳ cryoablation for concomitant atrial fibrillation (AF) during minimally invasive valve surgery. Methods A total of 47 patients (26 males, 21 females, age of 42-69 years) with mitral valve disease and long-standing persistent AF received minimally invasive biatrial Cox Maze Ⅳ cryoablation procedure combined with mitral valve surgery through right minithoracotomy from January 2014 to September 2015. The etiology of mitral valve disease was rheumatic (n=31) and degenerative (n=16). AF duration ranged from 2 to 11 years. Diameter of the left atrium ranged from 43 to 60 mm. Concomitant biatrial Cox Maze Ⅳ cryoablation procedure was performed through right lateral minithoracotomy. Results All 47 patients successfully underwent this minimally invasive concomitant biatrial Cox Maze Ⅳ cryoablation procedure and valve surgery. No patient needed conversion to sternotomy during the surgery. The mean cardiopulmonary bypass time, aortic cross-clamp time and cryoablation time was 95-146 (120.3±12.3) min, 82-115 (93.3±7.7) min and 32-48 (38.6±4.5) min, respectively. There was no death perioperatively. The average postoperative length of hospital stay was 5-16 (7.9±1.9) d. At discharge, 44 patients (44/47, 93.6%) maintained sinus rhythm. At a mean follow-up of 6-26 (14.4±5.4) months, sinus rhythm was maintained in 41 patients (41/47, 87.2%). Cumulative maintenance rate of normal sinus rhythm without AF recurrence at one year postoperatively was 86.3%±5.8%. Conclusion Biatrial Cox Maze Ⅳ cryoablation procedure is safe, feasible and effective for AF during concomitant minimally invasive valve surgery.
ObjectiveTo study the clinical results of Mini Maze procedure in atrial fibrillation patients with impaired left ventricular systolic function.MethodsFrom June 2010 to December 2017, 86 atrial fibrillation patients with impaired left ventricular systolic function received Mini Maze procedure including 54 males and 32 females, with an average age of 60.7±5.9 years. Among them, 12 were with paroxysmal, 27 were with persistent and 47 were with long-standing persistent atrial fibrillation. The mean atrial fibrillation duration was 6.5±4.8 years. CHA2DS2-VASc score was 2.2±1.1. The mean diameter of left atrium was 46.9±3.8 mm. The mean diameter of left ventricle was 51.7±4.6 mm. The preoperative ejection fraction was 42.2%±4.7%. All patients received Mini Maze procedure after general anesthesia. The ablation included 3 annular ablations and 3 linear ablations. The left atrial appendage was excised by Endo-Gia. Ablation of Marshall ligament and epicardial autonomic ganglions were made by an ablation pen.ResultsEighty-six patients successfully completed the procedure without transition to thoracotomy. There was no death during the perioperative period. Seventy-seven patients (89.5%) maintained sinus rhythm at discharge. Eighty patients were followed up for 27.2±12.1 months and 72 patients maintained sinus rhythm. The overall postoperative left ventricular ejection fraction was 47.1%±6.2%. The ejection fraction of the postoperative sinus rhythm group was 48.2%±5.8%, and the ejection fraction of the non-sinus group was 41.6%±5.8% (P<0.05). Multivariate regression analysis showed a left atrial diameter (HR=1.485, 95%CI 1.157-1.906, P<0.05) and an increase in ejection fraction over 10% (HR=18.800, 95%CI 1.674-189.289, P<0.05) were closely related to postoperative recurrence. Kaplan-Meier curve analysis showed that the recurrence rate of atrial fibrillation was significantly lower in patients with an increase in postoperative ejection fraction over 10% (P<0.05).ConclusionMini Maze procedure is safe and effective in the treatment of atrial fibrillation patients with left ventricular systolic dysfunction, which helps to improve left ventricular function to prevent the vicious circle of atrial fibrillation and heart failure.
ObjectiveTo investigate the clinical efficacy of unilateral antegrade selective cerebral perfusion (UASCP) compared to bilateral antegrade selective cerebral perfusion (BASCP) in aortic surgery.MethodsPubMed, EBSCO, Web of Science, Cochrane Library, CBM, CNKI, Wanfang Database were searched from establishment of each database to January 2019 to identify clinical studies on prognosis of UASCP versus BASCP in aortic surgery patients. The quality of randomized controlled trials was assessed by Cochrane risk assessement tool. The quality of non-randomized controlled trials was assessed by the Newcastle-Ottawa Scale ( NOS). Meta-analyses were presented in terms of odds ratio (OR) with 95% confidence interval (CI) by using RevMan 5.3 software.ResultsSixteen eligible studies including 3 randomized controlled trials, 2 propensity matching score studies, and 11 retrospective case control studies including4 490 patients were identified. The 3 randomized controlled trials were with high bias risk. The NOS score of the other 13 studies was more than 6 stars. Pooled analysis showed no significant difference between the UASCP and BASCP groups in terms of permanent neurological dysfunction (PND) (OR=0.93, 95%CI 0.74 to 1.18, P=0.57), temporary neurological dysfunction (TND) (OR=1.26, 95%CI 0.94 to 1.69, P=0.12), acute kidney injury rate (OR=1.11, 95%CI 0.79 to 1.55, P=0.55), 30-day mortality (OR=0.94, 95%CI 0.67 to 1.32, P=0.72), length of ICU stay (OR=–0.64, 95%CI –1.66 to 0.37, P=0.22) and hospital stay (OR=–0.35, 95%CI –2.38 to 1.68, P=0.74).ConclusionThis meta-analysis shows that UASCP and BASCP administration do not result in different mortality and neurologic morbidity rates. However, more studies with good methodologic quality and large sample are still needed to make further assessment.
ObjectiveTo summarize the clinical data and efficacy of surgical treatment of aortic periannular abscess.MethodsThe clinical data of 35 aortic periannular abscess patients admitted to our hospital from January 2009 to June 2019 were retrospectively analyzed, including 21 males and 14 females, aged 36 to 67 (53.0±12.3) years. Among them, there were 14 patients of native aortic valve endocarditis and 21 patients of prosthetic valve endocarditis (16 patients of mechanical valve and 5 patients of biological valve). Preoperative blood cultures were positive in 15 patients, including 8 patients of Staphylococcus aureus, 2 patients of Staphylococcus epidermidis, 3 patients of Streptococcus grass green, 1 patient of Pseudomonas aeruginosa, and 1 patient of Enterococcus.ResultsEleven patients underwent emergency or urgent surgery. Thirty patients underwent aortic valve replacement, and 5 patients underwent modified Cabrol surgery to replace the aortic root. Early postoperative complications included 1 patient of bleeding, 8 patients of low cardiac output syndrome, 5 patients of renal insufficiency, 10 patients of respiratory insufficiency, 3 patients of tracheotomy, 8 patients of pulmonary infection and 1 patient cerebrovascular accident. The postoperative follow-up period was 6 to 120 (53.6±20.8) months. During the follow-up, 4 patients died and 4 patients were lost. No infection recurred during the follow-up. Perivalval leakage occurred in 3 patients, and one patient underwent occlusion 12 months following the procedure. The survival curve indicated that the 1-year survival rate was 85.5%, and the 5-year survival rate was 67.3%.ConclusionAlthough the lesions of periannular abscesses are complicated and critical, effective perioperative antibiotic treatment, individualized surgical timing, and appropriate surgical strategies can significantly reduce mortality and achieve better results.
ObjectiveTo summarize the experience and efficacy of "one-stop" left atrial appendage clipping (LAAC) combined with transcatheter aortic valve replacement (TAVR) for patients with atrial fibrillation (AF) and aortic valve disease. Methods From April 2018 to March 2021, 16 patients with AF and severe aortic valve disease underwent "one-stop" LAAC and TAVR in our department. All patients had long-standing persistent AF. There were 10 males and 6 females with an average age of 77.2±6.2 years. CHA2DS2-VASc score was 4.4±0.8 points, and HAS-BLED score was 3.5±0.7 points. ResultsAll patients successfully underwent "one-stop" LAAC combined with TAVR. There was no death during perioperative and follow-up periods. The length of the left atrial appendage base measured during the operation was 37.8±3.5 mm. The types of atrial appendage clip were 35 mm (n=3), 40 mm (n=8) and 45 mm (n=5). The time required for clipping the left atrial appendage (from skin cutting to skin suturing) was 25.7±3.8 min. There was no stroke or bleeding of important organs during the perioperative period. The average hospital stay was 6.8±2.0 d. The follow-up time was 19.6±10.1 months, during which there was no patient of cerebral hemorrhage or cerebral infarction. During the administration of warfarin, 2 patients had subcutaneous ecchymosis and 1 patient had gingival bleeding. Conclusion"One-stop" LAAC combined with TAVR can be safely and effectively used to treat AF and aortic valve disease patients with high risk of thromboembolism and anticoagulant bleeding. The early and middle-term curative effect is satisfactory.
ObjectiveTo analyze the efficacy of one-stop carotid endarterectomy (CEA) and off-pump coronary artery bypass grafting (OPCABG) for patients with coronary artery disease (CAD) combined with carotid artery stenosis. MethodsThe clinical data of patients with CAD and severe carotid artery stenosis who underwent one-stop CEA and OPCABG in our department from March 2018 to June 2021 were retrospectively analyzed. Before the surgery, all patients routinely underwent coronary and carotid angiography to diagnose CAD and carotid artery stenosis. All patients underwent CEA first and then OPCABG in the simultaneous procedure. ResultsA total of 12 patients were enrolled, including 9 males and 3 females, aged 58-69 (63.7±3.4) years. All patients had unilateral severe carotid artery stenosis, and the degree of stenosis was 70%-90%. The lesions of carotid artery stenosis were located in the bifurcation of carotid artery or the beginning of internal carotid artery. All patients successfully underwent one-stop CEA combined with OPCABG. The number of bridging vessels was 2-4 (2.8±0.6). The operation time of CEA was 16-35 (25.7±5.6) min. There was no death during the perioperative or follow-up periods. No serious complications such as stroke and myocardial infarction occurred during the perioperative period. During the follow-up of 6-40 months, the patency rate of arterial bridge was 100.0% (12/12), and that of venous bridge was 95.5% (21/22). Cervical vascular ultrasound showed that the blood flow of carotid artery was satisfactory. ConclusionOne-stop CEA and OPCABG can be safely and effectively used to treat CAD and carotid artery stenosis. The early and middle-term curative effect is satisfactory.
Objective To explore the technique of performing minimally invasive Cox Maze Ⅳ procedure by bipolar clamp through right lateral minithoracotomy for atrial septal defect (ASD) combined with atrial fibrillation (AF) in adults. Methods Thirty-five patients (21 males, 14 females with age ranging from 45 to 73 years) with ASD and persistent or long-standing persistent AF received minimally invasive Cox Maze Ⅳ procedure and ASD closure from August 2012 to April 2016 at Department of Cardiothoracic Surgery, Xinhua Hospital. Diameter of left atrium ranged from 39 to 60 mm and left ventricle ejection fraction (LVEF) ranged from 48% to 62%. Diameter of ASD ranged from 20 to 35 mm. Cox-maze Ⅳ procedure was performed through right minithoracotomy entirely by bipolar radiofrequency clamp. Then, mitral or tricuspid valvuloplasty and surgical ASD closure was performed through right minithoracotomy. Results All patients successfully underwent this minimally invasive surgery. No patient needed conversion to sternotomy. The mean cardiopulmonary bypass time was 120.1±14.1 min. The mean aortic cross-clamp time was 79.5±12.2 min. There was no early death or pacemaker implantation perioperatively. The average length of hospital stay was 10.1±2.7 d. At a mean follow-up of 22.8±12.2 months, sinus rhythm was restored in 32 patients (32/35, 91.4%). Cumulative maintenance of normal sinus rhythm without AF recurrence at 2 years postoperatively was 89.1%±6.0%. Conclusion The minimally invasive Cox Maze Ⅳprocedure performed by bipolar clamp through right minithoracotomy is safe, feasible, and effective for adult patients with ASD combined with AF.
ObjectiveTo determine the effects of resecting the lower half of left stellate ganglion (LSG) on fast ventricular rate (VR) in persistent atrial fibrillation (AF) and its mechanism. MethodsTwelve mature healthy male beagle dogs (15–25 kg) were studied. They were randomly divided into two groups (an experimental group and a control group, 6 dogs in each group). The control group were merely performed with rapid left atrial pacing to induce persistent AF. The experimental group were disposed with rapid left atrial pacing and received resection of the lower half of LSG after the persistent AF was documented. Simultaneously the ventricular rates were monitored separately before anesthesia, after anesthesia, 30 minutes and one month after LSG resection. The forward passing effective refractory period (ERP) of the canine atrioventricular node (AVN) was also measured. ResultsEach dog was documented with persistent AF after 3–6 weeks’ left atrial pacing. After resecting the lower half of LSG for 30 minutes (the control group was only observed for 30 minutes without LSG resection), the average VR of the control group attained 144.5±4.2 beats/min, while that of the experimental group was 121.5±8.7 beats/min (P<0.001). After resecting the lower half of LSG for one month (the control group was observed for one month without LSG resection), the average VR of the control group was 139.2±5.6 beats/min, while that of the experimental group was 106.5±4.9 beats/min (P<0.001). Meantime, the forward passing ERP of AVN of the experimental group was significantly prolonged than that of the control group (265.6±7.8 ms vs. 251.1±4.6 ms, P=0.003). ConclusionResection of the lower half of LSG is efficient in reducing VR in canines with persistent AF, one of the mechanisms of which may be prolonging the forward passing ERP of AVN.
ObjectiveTo summarize the application and clinical effect of left anterior minimally invasive thoracotomy to surgical repair of subarterial ventricular septal defect (VSD) in children.MethodsFrom October 2015 to April 2019, 21 children with subarterial VSD underwent surgical repair via left anterior minimally invasive thoracotomy. There were 13 males and 8 females, aged 5-13 (9.1±2.2) years, and weighing 22-55 (35.6±9.5) kg. The diameter of subarterial VSD was 4-15 (9.1±3.3) mm. Eight patients had right coronary valve prolapse, and 4 aortic valve regurgitation (3 mild and 1 mild-to-moderate). The minimally invasive surgery was performed via left parasternal thoracotomy through the second or third intercostal space. The peripheral perfusion was performed with femoral arterial and venous cannulation. After aortic cross-clamp (ACC), subarterial VSD was performed with direct suture of patch closure through an incision on the root of pulmonary artery.ResultsAll patients successfully underwent surgical repair (patch closure, n=15; direct suture, n=6) of subarterial VSD through left anterior minimally invasive thoracotomy. The cardiopulmonary bypass time was 45-68 (57.1±6.3) min. The ACC time was 23-40 (32.6±4.7) min. The postoperative ventilation time was 5-9 (6.3±1.3) h, postoperative in-hospital time was 5-8 (5.7±1.0) d and drainage volume was 33-105 (57.5±17.7) mL in postoperative 24 h. No death, residual VSD shunt, atrioventricular block, wound infection or thoracic deformity occurred during the perioperation or follow-up. Only one patient still had trivial aortic valve regurgitation.ConclusionLeft anterior minimally invasive thoracotomy could be safely and effectively applied to surgical repair of subarterial VSD in children, with satisfactory early- and mid-term outcomes.