Abstract: Objective To study the integration of transplanted cells and host cells by detection of the cellcell junction after transplantation of the myocardiumlike cell derived from the canine umbilical cord blood. Methods The mesenchymal stem cell(MSCs) was transfected by Laz-Z after harvest, culture, induced by 5-azacytidine(5-aza). Thirty-six adult hybrid dogs were randomly divided into cell transplantation group and control group. The canine of myocardium infarction was established. 107 MSCs were transplanted into dogs with acute myocardium infarction by coronary artery infusion and local injection in cell transplantation group and physiologic saline was used in the control group. The specimens were harvested and detected by immunofluorescence for 2, 4 and 8 weeks respectively. Results The umbilical cord blood MSCs were fusiform or spindleshaped. They presented clonal and knittinglike growth.The MSCs could differentiate into myocardium-like cell by the induction of 5-aza and express α-actin, desmin, connexin43.The transplanted cells could survive more than 8 weeks after transplantation. Cadherin and connexin 43 were found in the position of cellcell junction of transplanted cells group and between transplanted cells and host cells. Cadherin and connexin 43 were found in the hose cells of the control group. Conclusion The umbilical cord blood MSCs is able to differentiate into myocardiumlike cell in vitro and form cellcell junction in vivo to communicate with surrounding cells.
Objective To observe the plastic changes of sensory nerve in terms of structure and function when targetorgan changed through making the rat model of nerve regeneration by anastomosing the proximal end of sensory nerve and the distal end of motor nerve. Methods Thirty adult SD rats (male or female), weighing 200-250 g, were randomized into three groups (n=10 per group). The left upper l imb of the each rat was used as the experimental side, while the right upper l imb as the control side. In group A, the medial antebrachial cutaneous nerve was cut 5 mm away from its origin and its proximal end was anastomozed end-to-end to the distal end of musculocutaneous nerve. In group B, the musculocutaneous nerve was cut 5 mm away from its nerve entry point and the proximal end of medial antebrachial cutaneous nerve were anastomozed end-to-end to the distal end of musculocutaneous nerve. In group C, medial antebrachial cutaneous nerve and musculocutaneous nerve were cut, without further anastomosis. Twenty-four weeks after operation, the general condition and the motion of the elbow joint of rats, the wet weight and muscle fiber cross-section area of the biceps brachii as well as the latent period and the ampl itude of the evoked potential were observed and the acetylchol inesterase (AchE) staining of nerve of proximal end of anastomosis was conducted. Results All the rats survived for 24 weeks with good general condition and without wound infection. The rats in groups A, B and C were lost the active flexion of left elbow joint after operation. The rats in groups A and B got recovered to some degree at 24 weeks. The behavioral evaluation showed that there were 7 l imbs in group A and 5 l imbs in group B scoredas 4-5 points, there was a significant difference when compared with group C (P lt; 0.05), but there was no significant difference between group A and group B (P gt; 0.05). Group A and group B were superior to group C in terms of the wet weight and the muscle fiber cross-section area of the biceps brachii (P lt; 0.05), but no significant difference between group A and group B was detected (P gt; 0.05). The evoked potential of the biceps brachii and motor nerve fibers in proximal end of anastomosis could be detected in both group A and group B. But there was no significant difference between group A and group B with respects of function recovery of elbow joint, the latent period and the ampl itude of the evoked potential of the biceps brachii and the quantity of motor nerve fiber in proximal end of anastomosis (P gt; 0.05). Conclusion The change of target organ leads to the sensory nerve plasticity structurally and functionally, which may provide a new approach for peripheral nerve repair.
Objective To summarize the efficacy of aortic arch 1 zone clamping technique in the procedure of ascending aortic aneurysm involving the proximal aortic arch. Methods The clinical data of patients with ascending aortic aneurysm involving the proximal aortic arch who underwent surgical treatment with aortic arch 1 zone clamping technique in our hospital from 2017 to 2019 were retrospectively analyzed. ResultsA total of 35 patients were enrolled, including 21 males and 14 females, with an average age of 63.9±10.8 years. According to different lesions, the proximal aorta underwent Bentall/Carbrol procedure in 8 patients, Wheat in 4 patients, David in 3 patients, and ascending aorta replacement in 20 patients. Distal lesions were completely resected under aortic arch 1 zone clamping technique, and anastomotic reconstruction was performed under hypothermic cardiopulmonary bypass. Distal anastomosis was performed with interrupted suture in 7 patients, and continuous suture with intermittent reinforcement of the posterior wall in 28 patients. All patients successfully completed the procedure. The average cardiopulmonary bypass time was 121.5±28.2 min, the aortic clamping time was 78.1±21.3 min, and the distal anastomosis time was 15.2±3.6 min. One patient underwent a second thoracotomy for hemostasis, and the remaining patients were drained 330.6±108.1 mL on the first day following the procedure. The postoperative mechanical ventilation time of 2 patients exceeded 24 hours, and the main complications were pulmonary infection in 1 patient and acute renal injury in 2 patients. Transient delirium occurred in 2 patients and no transient or permanent neurological dysfunction occurred. The average follow-up time was 2.6±1.1 years. The maximum diameter of the ascending aorta after operation was 30.4±0.9 mm, the diameter of zone 1 aortic arch was 39.8±3.1 mm, and the diameter of the distal aortic arch was 32.3±4.3 mm. There was no lesion in the artificial blood vessels of all patients, and no aneurysms occurred at the proximal or distal anastomosis. No reoperation or intervention was needed for the aorta. ConclusionThe aortic arch 1 zone clamping technique can simplify the procedure of ascending aortic aneurysm involving the proximal aortic arch, reduce or avoid the use of deep hypothermic circulatory arrest, reduce the surgical trauma, and has good short-term and medium-term efficacy.
ObjectiveTo summarize the efficacy of clips and staplers for left atrial appendage in the thoracoscopic treatment of atrial fibrillation. Methods The clinical data of patients with atrial fibrillation treated in Xinhua Hospital from 2015 to 2016 were retrospectively analyzed. All patients received Mei's minimally invasive surgery for atrial fibrillation. Among them, patients were recruited in a clip group by clipping the left atrial appendage. The other patients were recruited in a stapler group to resect the left atrial appendage by stapler. Follow-up was conducted by outpatient clinic and telephone. Postoperative heart rhythm was recorded by the patient's symptoms, electrocardiogram and 24 h holter. Cranial magnetic resonance, cardiac CT and echocardiography were performed at least once during follow-up. Results There were 30 patients in the clip group, including 20 males and 10 females, with an average age of 65.7±7.1 years. There were 30 patients in the stapler group, including 20 males and 10 females with an average age of 66.8±5.4 years. All patients successfully received the procedure, with no conversion to thoracotomy or perioperative death. Sinus rhythm was maintained at discharge in 56 (93.3%) patients. Till June 2020, 59 patients were followed up for 42-66 (54.1±7.3) months and 1 patient in the clip group was lost. The residual length of the left atrial appendage was 3.9±1.8 mm in the clip group and 3.9±2.8 mm in the stapler group, and there was no statistical difference between the two groups (P=0.910). Kaplan-Meier curve indicated that there was no statistical difference in the maintenance of sinus rhythm between the two groups (P=0.757). During the follow-up period, all patients had no cerebrovascular adverse events such as stroke or embolism. Conclusion Clipping and resection of the left atrial appendage in thoracoscopic atrial fibrillation surgery are both safe and effective methods, which effectively prevent stroke. The atrial appendage clip makes the minimally invasive surgical intervention of the left atrial appendage safer and more convenient.
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 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 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 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 investigate the technique and efficacy of left atrial appendage (LAA) occlusion during off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease (CAD) and atrial fibrillation (AF).MethodsFrom 2013 to 2018, 84 elderly patients with CAD and AF with reduced left ventricular ejection fraction (LVEF< 50%) underwent OPCABG in our department. There were 54 males and 30 females at age of 70-82 years. They were divided into a left atrial appendage (LAA) occlusion group (n=56) and a non-LAA occlusion group (n=28). Postoperative antithrombotic therapy: the LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic therapy” for 3 months after operation, then was changed to aspirin + clopidogrel “dual antiplatelet” for long-term antithrombotic; the non-LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic” for long-term antithrombotic after operation. The clinical effectiveness of the two groups was compared.ResultsAll patients underwent the surgery successfully. There were 56 patients in the LAA occlusion group, including 44 patients of LAA exclusion and 12 patients of LAA clip. The time of LAA occlusion was 3 to 8 minutes. There was no injury of graft vessels and anastomotic stoma. Early postoperative death occurred in 2 patients (2.4%). There was no statistical difference between the two groups in postoperative hospital stay (P=0.115). Postoperative LVEF of the two groups significantly improved compared with that before operation (P<0.05). There was no stroke or bleeding in important organs during hospitalization. During follow-up of 1 year, no cerebral infarction occurred in both groups, but the incidence of bleeding related complications in the LAA occlusion group was significantly lower than that in the non-LAA occlusion group (3.6% vs. 18.5%, P=0.036).ConclusionFor elderly patients with CAD and AF with reduced LVEF, LAA occlusion during OPCABG can effectively reduce the risk of stroke and bleeding related complications, and without increasing the risk of surgery.
ObjectiveTo explore the effect and safety of surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) with mitral regurgitation (MR) through right mini-thoracotomy.MethodsFrom January 2008 to June 2018, 54 patients with HOCM and moderate-to-severe MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy, including 31 males and 23 females, with an average age of 47.1±12.6 years. All patients had systolic anterior motion (SAM) phenomenon. Preoperative left ventricular outflow tract pressure gradient (LVOTPG) was 93.6±32.8 mm Hg, interventricular septum thickness (IVST) was 24.8±2.8 mm.ResultsSurgeries in all patients were completed successfully. No early death or interventricular septal perforation occurred. One (1.9%) patient received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG (18.1±6.2 mm Hg) and IVST (14.5±2.1 mm) were significantly decreased compared with the preoperative values (P<0.05). No MR or SAM was observed in all patients. The follow-up time was 6-132 months, and during this period, no death, MR or SAM occurred. The average LVOTPG was 19.4±5.7 mm Hg, and the average IVST was 14.2±1.5 mm.ConclusionMorrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy is a safe and effective method for treatment of HOCM with moderate-to-severe MR.