Abstract: Objective To explore the surgical procedures and cerebral protection and improve surgical results by summarizing the experiences of surgical treatment of 68 patients of De Bakey Ⅰ aortic dissection. Methods We retrospectively analyzed the clinical data of 68 patients (including 45 males and 23 females aged 29 to 72 years with an age of 44.5±17.2 years) with De Bakey Ⅰ aortic dissection who were treated in the General Hospital of Shenyang Command between May 2004 and April 2010. Acute aortic dissection (occurring within 2 weeks) was present in 57 patients and chronic aortic dissection in 11. The intimal tear was located in the ascending aorta in 45 patients, in the aortic arch in 12 and in the descending part of the aortic arch in 11. Thirtyfive patients underwent emergency operation and 33 underwent selected or limited operation. The operations were performed under hypothermic circulation arrest plus selective antegrade cerebral perfusion or right vena cave retrograde cerebral perfusion to protect the brain. Total arch replacement and stented elephant trunk were performed in 25 patients, Bentall operation with concomitant total arch replacement and stented elephant trunk in 16 patients, pure right semi aortic arch replacement and stented elephant trunk in 15 patients, total aortic arch replacement in 7 patients, right semi aortic arch replacement and stented elephant trunk in 3 patients, and Cabrol operation with concomitant aortic conduit with valve and total arch replacement and stented elephant trunk in 2 patients. Results Five patients (4 with acute aortic dissection and 1 with chronic aortic dissection) died with an operative mortality of 7.4%(5/68). The causes of death were anastomotic bleeding during surgery in 1 patient, postoperative low cardiac output syndrome and malignant arrhythmia in 2, acute renal failure in 1 and cerebral complications in 1. During perioperative period, psychotic symptoms occurred in 5 patients, pericardial effusion in 2 patients, hoarseness in 6 patients and poor wound healing in 1 patient. All of them were cured before dehospitalization. Sixty patients (95.2%, 60/63) were followed up for 2 months to 6 years with the other 3 patients lost. During the ollow-up, sudden death occurred to 1 patient with unknown reasons, and 1 patient had pericardial effusion and symptoms improved with relevant treatment. All the other patients followed up had a good quality of life with significant improvement of heart function. Fiftyfour patients had a heart function of New York Heart Association class Ⅰ and 5 had a function of class Ⅱ. Conclusion The surgical treatment for De Bakey Ⅰ aortic dissection should be active. The beneficial results can be obtained with best choice of operative procedures, methods of cerebral protection, and adequate treatment of complications of operation.
Abstract:Objective To investigate clinical characteristics of patients with aortic valve disease and coronary artery disease （CAD）， and improve the pertinence of clinical management. Methods Clinical data of 78 patients who were older than 50 years and underwent isolated aortic valve replacement （AVR） in General Hospital of Shenyang Command from January to October 2010. All the patients were divided into two groups according to whether they had CAD：20 patients with CAD in the CAD group， including 19 males and 1 female with their average age of 64.6±8.3 years， and 58 patients without CAD in the control group， including 28 males and 30 females with their average age of 58.7±6.2 years. Clinical characteristics of AVR patients with CAD were analyzed by one-way analysis of variance and multiple factor analysis. Results One-way analysis showed that the incidence of old age （P=0.000）， male patients （P=0.004）， diabetes （P=0.004）， aortic regurgitation （P=0.034）， valvular lesion （P=0.028）， and postoperative mechanical ventilation time （P=0.008）of CAD group patients were significantly higher or longer than those of control group patients. Multiple factor analysis showed that independent clinical characteristics of AVR patients with CAD included male patients， old age， prolonged postoperative mechanical ventilation time， significantly decreased pulmonary arterial systolic pressure （PASP） at 6th postoperative month， and significant preoperative right ventricular diastolic dysfunction. Conclusion The screening age for possible CAD should be reasonably lowered if male patients with aortic valve disease have concomitant preoperative right ventricular diastolic dysfunction and/or tricuspid aortic valve degeneration. Patients undergoing isolated AVR need to take medications to reverse left ventricular remodeling for a long time to avoid severe arrhythmia.
Objective We probed how to predict left ventricular ejection fraction (LVEF) of the ischaemic cardiomyopathy (ICM) patients would be improved apparently after revascularization. Methods Between July 2010 and December 2015, 245 ICM patients (30%≤LVEF≤40%) with coronary bypass grafting (CABG) were retrospectively observed. Among them, 146 patients were accompanied by ischemic mitral regurgitation (IMR) (146/245, 59.6%), and 41 patients underwent mitral valvuloplasty or replacement because of more than moderate IMR. There were 13 patients early death, and other 232 patients who were followed up over 6 months were divided into two groups based on whether or not post-operative LVEF increased by 10%: a LVEF recovered group (group A, 124 patients) and a non-recovered group (group B, 108 patients). Results Preoperative NT-proBNP in the group A was significantly higher than that in the group B (P=0.036). There were less patients with myocardial infarction in the group A than that in the group B (P=0.047), and more with angina pectoris in the group A than that in the group B (P=0.024). There was no significant difference in the extent of mitral regurgitation or mitral surgery between the groups A and B (P>0.05). There were lower left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic volume (LVEDV) in the group A than those in the group B (P<0.05). Multivariate analysis revealed that preoperative LVEDD dilated apparently and no angina pectoris existed before surgery were independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. The LVEDD of 245 patients (including 13 early deaths) was 41-71 mm. We found that the ICM patients with LVEDD ≥60 mm were more likely to signify the unfavourable prognosis (χ2=8.63, P=0.003, OR=2.21, 95% confidence interval 1.25 to 3.91). Conclusion Preoperative LVEDD dilated and no angina pectoris before surgery are independent risk factors for LVEF with no recovery in the ICM patients (30%≤LVEF≤40%) after revascularization. LVEDD≥60 mm can be regarded as the preoperative forecasting factors for the unfavourable prognosis in the ICM patients (30%≤LVEF≤40%) after revascularization.
ObjectiveTo study the relationship between preoperative heart rate variability (HRV) and postoperative atrial fibrillation (POAF) after off-pump coronary artery bypass grafting (OPCAB). MethodsA retrospective analysis was performed on the clinical data of 290 patients who were admitted to the Department of Cardiovascular Surgery, General Hospital of Northern Theater Command from May to September 2020 and received OPCAB. There were 217 males and 73 females aged 36-80 years. According to the incidence of POAF, the patients were divided into two groups: a non-atrial fibrillation group (208 patients) and an atrial fibrillation group (82 patients). The time domain and frequency domain factors of mean HRV 7 days before operation were calculated: standard deviation of all normal-to-normal intervals (SDNN), root mean square of successive differences, percentage difference between adjacent normal-to-normal intervals that were greater than 50 ms, low frequency power (LF), high frequency power (HF), LF/HF. ResultsThe HRV value of patients without POAF was significantly lower than that of patients with POAF (P<0.05). The median SDNN of the two groups were 78.90 ms and 91.55 ms, respectively. Age (OR=3.630, 95%CI 2.015-6.542, P<0.001), left atrial diameter (OR=1.074, 95%CI 1.000-1.155, P=0.046), and SDNN (OR=1.017, 95%CI 1.002-1.032, P=0.024) were independently associated with the risk of POPAF after OPCAB. Conclusion SDNN may be an independent predictor of POAF after OPCAB.
Objective To investigate surgical treatment and evaluate the curative effect in patients with moderate to severe ischemic mitral regurgitation (IMR). Methods The clinical data of the patients with coronary heart disease complicated with moderate to severe IMR who agreed to receive surgical treatment from June 2014 to June 2019 in our hospital were analyzed retrospectively. The patients were divided into two groups: a coronary artery bypass grafting (CABG) group and a CABG+mitral valve surgery (MVS) group. The preoperative and postoperative clinical data between the two groups were compared. Results Finally 105 patients were collected, including 75 males and 30 females, aged 40-79 (62.70±7.90) years. There were 34 patients in the CABG group, and 71 patients in the CABG+MVS group including 2 patients of mitral valvuloplasty and 29 patients of mitral valve replacement. Among the 105 patients, 5 died during the perioperative period and 2 died in 3 months after operation, all of whom were from the CABG+MVS group. There was no statistical difference in perioperative and postoperative 3-month mortality rate between the two groups (P=0.14). Eighty-seven patients were followed up in the medium and long term. There was no statistical difference in the degree of preoperative mitral insufficiency (MI) (P=0.59) and left atrium diameter (P=0.51) between the two groups, but the degree of postoperative MI in the CABG group was significantly higher than that in the CABG+MVS group (P<0.01). However, the left atrium diameter in the CABG group was significantly smaller than that in the CABG+MVS group (P<0.01). Paired analysis showed that systolic pulmonary artery pressure, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular ejection fraction and MI were significantly improved after operation (P<0.01); left atrium diameter was significantly improved after operation in the CABG group (P<0.01), but there was no statistical difference before and after operation in the CABG+MVS group (P=0.10). Conclusion For patients with moderate to severe IMR, CABG with mitral valve treatment can improve left ventricular remodeling, but can not significantly improve left atrial remodeling. Whether performing mitral valve treatment during CABG should be cautious. CABG alone is a safe and effective scheme for elderly patients with poor physical condition and low life expectancy.