Abstract： Objective To analyze clinical outcomes of intra-aortic balloon pump （IABP） application for high-risk patients before undergoing off-pump coronary artery bypass grafting （OPCAB）， and summarize our experience and weaning indications of IABP. Methods We retrospectively analyzed clinical data of 102 high-risk patients with coronary artery disease who underwent IABP implantation before OPCAB from January 2008 to July 2011 in Zhongshan Hospital of Fudan University. There were 71 male patients and 31 female patients with their average age of 63.0±8.2 years in this IABP group. We also chose another 100 patients without IABP implantation before undergoing OPCAB as the control group， including 55 male patients and 45 female patients with their average age of 64.1±9.5 years. Postoperative systolic arterial blood pressure （SABP）， mean arterial blood pressure （MABP）， mechanical ventilation time， length of intensive care unit（ICU） stay， morbidity， duration of IABP treatment and in-hospital mortality of two groups were compared. Left ventricular ejection fraction （LVEF） was evaluated with echocardiography 3 months after surgery. Results Postoperative SABP （95.3±12.2 mm Hg vs. 80.1±11.7 mm Hg；t=8.440， P=0.000） and MABP （78.9±13.5 mm Hg vs. 52.3±15.1 mm Hg； t=12.410， P=0.000） of the IABP group were significantly higher than those of the control group. Mechanical ventilation time， length of ICU stay and duration of inotropic support of the IABP group were significantly shorter than those of the control group. The incidence of ventricular arrhythmia， low cardiac output syndrome， perioperative myocardial infarction and dialysis-requiring acute kidney failure of the IABP group were significantly lower than those of the control group. In-hospital mortality of the IABP group was significantly lower than that of the control group ［5.9% （6/102） vs. 17.0% （17/100）， χ 2 =6.180， P=0.020］. Ninety-six patients in the IABP group and 83 patients in the control group were followed up for 3 months. Three months after surgery， echocardiography showed that LVEF of the IABP group was significantly higher than that of the control group（45.3%±12.0% vs. 39.1%±8.2%， t=3.950， P=0.000）. Conclusion Preoperative prophylactic IABP implantation and optimal timing of weaning from IABP support can not only significantly reduce surgical risk and improve surgical outcomes and postoperative recovery of high-risk patients undergoing OPCAB， but also considerably ameliorate patient heart function and reduce perioperative morbidity and mortality.
Abstract： Objective To investigate the extracellular matrix （ECM） gene expression profile of saphenous vein （SV） in end-stage renal disease （ESRD） patients undergoing coronary artery bypass grafting （CABG）. Methods Sixty-eight patients who were diagnosed as coronary artery disease by coronary angiography and admitted to Department of Cardiovascular Surgery，Zhongshan Hospital of Fudan University from July 2004 to December 2010 were enrolled in this study. According to whether or not they had preoperative ESRD history，all the 68 patients were divided into 2 groups，the ESRD group with 30 ESRD patients who needed maintenance hemodialysis，and the control group with 38 patients without preoperative renal disease. Preoperative clinical data of all the patients were collected in detail. SV samples were obtained at the time of CABG. Microarray，immunohistochemistry and Western blotting were used to investigate the expression profile of ECM genes of SV in ESRD patients undergoing CABG. Results There was no statistical difference in preoperative clinical variables between the 2 groups except the variables which were directly related to their kidney disease （P＞0.05）. There were 16 genes that were up-regulated at least 3-fold and 3 genes that were down-regulated at least 3-fold in the ECM gene expression profile of SV in the ESRD group patients before CABG. The expressions of matrix metalloproteinases-2 （MMP-2） and matrix metalloproteinases-9 （MMP-9） of the ESRD group were significantly higher than those of the control group （2.60±0.50 vs. 0.70±0.16，1.80±0.40 vs. 0.60±0.15，P＜0.01）. The expressions of tissue inhibitor of metalloproteinase-2 （TIMP-2） and tissue inhibitor of metalloproteinase-3 （TIMP-3） of the ESRD group were significantly lower than those of the control group （0.60±0.19 vs. 2.20±0.30，0.90±0.28 vs. 2.40±0.70，P＜ 0.05）. Conclusion A variety of ESRD-related risk factors of cardiovascular diseases may severely influence on the balance of ECM gene expression of SV before CABG，and the resulting imbalance is a risk factor to aggravate SV graft disease after CABG.
ObjectiveTo analyze the short-term and long-term efficacy of staged coronary artery bypass grafting (CABG) and carotid artery stenting (CAS) compared with CABG alone in patients with coronary heart disease with preoperative history of stroke and carotid stenosis. MethodsWe reviewed the clinical data of 55 patients (48 males, 7 females, aged 67.62±7.06 years) with coronary heart disease and carotid stenosis who had a history of stroke and underwent CABG+CAS or CABG alone in Zhongshan Hospital from 2008 to 2017. There were 13 patients in the staged CABG+CAS group and 42 patients in the CABG alone group. The differences in the incidence of perioperative adverse events and long-term survival between the two groups were studied, and univariate and multivariate analyses were carried out to determine the independent risk factors of long-term adverse events. Results Perioperative adverse events occurred in 1 (7.69%) patient of the staged CABG+CAS group, and 4 (9.52%) patients of the CABG alone group (P=0.84). During the follow-up period (67.84±37.99 months), the long-term survival rate of patients in the staged CABG+CAS group was significantly higher than that in the CABG alone group (P=0.02). The risk of long-term adverse events in the staged CABG+CAS group was 0.22 times higher than that in the CABG alone group (95%CI 0.05-0.92, P=0.04). ConclusionStaged CABG+CAS can significantly improve the long-term survival prognosis without increasing the perioperative risk. It is a safe and effective treatment, but prospective randomized studies are still needed to further confirm this finding.
Objective To investigate the clinical efficacy of minimally invasive mitral valvuloplasty (MVP) in the treatment of infective endocarditis (IE) with mitral regurgitation (MR). Methods A retrospective analysis was conducted on the clinical data of patients who underwent MVP for IE with MR in the Department of Cardiovascular Surgery at Zhongshan Hospital, Fudan University from January 2016 to December 2020. Patients were divided into two groups based on the surgical incision: those with a right mini-thoracotomy were classified as a minimally invasive surgery (MIS) group, and those with a median sternotomy were classified as a median sternotomy (MS) group. All patients had isolated mitral valve involvement. Perioperative data were analyzed, and mid- to long-term outcomes were compared between the two groups. Results A total of 86 patients were included, with 40 in the MIS group (22 males and 18 females, with a mean age of 39±15 years ranging from 8 to 71 years) and 46 in the MS group (27 males and 19 females, with a mean age of 49±16 years ranging from 14 to 71 years). The patients in the MIS group were relatively younger (P=0.004) with better preoperative cardiac function (P=0.004). There was no statistical difference in preoperative fever, gender, or comorbidities between the two groups (P>0.05). The MIS group had shorter postoperative ventilation times, less postoperative 24-hour drainage, less blood transfusion, and shorter total hospital stays compared to the MS group (P=0.001, 0.018, 0.005, 0.005). There was no statistical difference in cardiopulmonary bypass times or ICU stays between the two groups (P>0.05). The perioperative complication rates and mortality rates were not significantly different between the two groups (P>0.05). Follow-up was conducted for 11-92 months, with a mean duration of 49±19 months and an overall follow-up rate of 91.6%. During the follow-up, 3 patients in each group required reoperation for mitral valve issues, with no statistical difference in incidence (7.5% vs. 6.5%, P=0.691). There were no warfarin-related complications, recurrences, or deaths in either group during follow-up. Multivariate regression analysis identified age, preoperative cardiac function, and surgeon experience as influencing factors for the choice of surgical approach. Conclusion Minimally invasive MVP for IE with MR is relatively safe in the perioperative period and shows significant efficacy, with clear mid- to long-term outcomes. It is recommended for younger patients with better preoperative cardiac function and when performed by surgeons with extensive experience in mitral valvuloplasty.