Abstract：?Objective?To analyze surgical procedures and clinical outcomes for patients with hypertrophic obstructive cardiomyopathy （HOCM） complicated by infective endocarditis.?Methods?We retrospectively analyzed clinical data of 7 patients with HOCM complicated by infective endocarditis who underwent modified Morrow procedure，removal of intracardiac vegetation，and valve replacement in Fu Wai Hospital from Sep. 2006 to Feb. 2012. There were 5 male patients and 2 female patients with their mean age of 39.80±13.60 years（ranging 21-55）. Postoperative clinical outcomes were observed. Preoperative and postoperative left ventricular outflow tract （LVOT） gradients， left atrium （LA） diameter，left ventricular ejection fraction （LVEF） and heart function were compared.?Results?There was no in-hospital death and perioperative survival rate was 100% in this group. Bacteria vegetations were multiply detected on the mitral valve leaflet （7 cases）， aortic valve leaflet （4 cases） and ventricular septum （1 case） with their diameter of 2-19 mm. Blood culture showed Staphylococcus aureus （3 cases），Squirrel aureus （1 case） . Postoperatively， first-degree atrioventricular block occurred in 2 patients， complete left bundle branch block in 1 patient， left anterior division block in 2 patients， and all these complications were not treated. Postoperative LVOT gradient and LA diameter were significantly lower than preoperative values （P＜0.05）， and cardiac function was significantly improved in these patients. All the patients underwent transthoracic echocardiography at a mean follow-up of 13.00±17.19 （1-49） months in outpatient service. The clinical symptoms of all these patients were diminished or significantly ameliorated and their quality of life was considerably improved. All the patients had NYHA classⅠorⅡ without any reintervention or death during follow-up.?Conclusion?Modified Morrow procedure and valve replacement is a good surgical strategy for patients with HOCM complicated by infective endocarditis with satisfactory early and mid-term clinical outcomes.
ObjectiveTo summarize the perioperative management strategies and early results of modified Morrow expanded operation and coronary artery bypass grafting (CABG) in patients with hypertrophic obstructive cardiomyopathy (HOCM) and coronary atherosclerotic heart disease.MethodsBetween January 2012 and December 2017, in the Second Inpatient Department of Fuwai Hospital, 32 patients (20 females and 12 males) underwent modified expanded Morrow operation and CABG. The median age was 53.7±8.7 years (interquartile range 37 to 67 years). Preoperative chest distress symptom was found in 24 patients, chest pain symptom was found in 14 patients, history of syncope in 6 patients. Cardiac echocardiography, electrocardiogram, chest X-ray, magnectic resonance imaging (MRI) were performed routinely after operation and follow-up to analyze structure and function of heart and mitral valve.ResultsAll patients underwent modified and expanded Morrow combined with CABG. The preoperative left ventricular outflow tract peak pressure difference (LVOTG) was 40 to 152 (79.6±28.7) mm Hg. Four patients underwent myocardial bridge releasing in the same period, mitral valve replacement in 2 patients, mitral valve angioplasty in 3 patients, Maze operation in 2 patients and tricuspid valveoplasty in 3 patients. There was no hospital mortality. CABG surgery in patients with branches included anterior descending artery in 26 patients, diagonal branch in 16 patients, left circumflex in 8 patients, right coronary artery in 11 patients. There were 15 patients with one coronary artery (CA) bypass graft, 5 patients with two CA bypass grafts, and 12 patients with 3 CA bypass grafts. The average of CA bypass grafts was 1.9±0.6. The postoperative ICU time ranged from 1–13 (4.1±2.8) days and postoperative hospital stay ranged from 7 to 30 (12.6±5.5) days. No severe postoperative complications were found and 1 patient had postoperative incision healing. The postoperative new arrhythmia included left bundle branch block in 6 patients. Compared with the preoperative values, postoperative left ventricular outflow tract peak pressure (79.6±28.7 mm Hg vs. 10.8±5.9 mm Hg, P<0.001), interventricular septum thickness (1.9±0.4 cm vs. 1.3±0.5 cm, P<0.001) were decreased obviously. Mitral valve closure is good or only mild reflux, mitral valve forward movement (SAM sign) disappeared. The patients were followed up for 6-68 months, with an average of 38.8±20.6 months. All patients were followed up with symptoms disappeared or only mild symptoms. NYHA classification decreased Ⅰ to Ⅱ grade after surgery, without long-term mortality, complications or reoperation.ConclusionFor patients with hypertrophic obstructive cardiomyopathy with coronary atherosclerotic heart disease, the application of improved expand morrow operation at the same time undergoing coronary artery bypass grafting is safe. It can significantly improve patients' survival and reduce symptoms, play a synergistic effect, and do not increase the patient's surgical complications.
ObjectiveTo summarize the pathological characteristics of primary left ventricular tumors and their influence on surgical treatment.MethodsThe clinical data of 32 patients with primary left ventricular tumor in Fuwai Hospital from January 2008 to March 2019 were retrospectively analyzed, including 17 males and 15 females with an average age of 33.88±17.89 years. The impact of different types of left ventricular tumor pathology on the surgical outcome was analyzed.ResultsThirty-two patients with primary left ventricular tumors underwent surgery. Postoperative pathological biopsy results revealed benign tumor in 31 patients, including myxoma in 10 patients, lipomas in 7 patients, fibroma in 4 patients, hemangioma in 3 patients, rhabdomyoma in 2 patients, cyst in 2 patients, schwannoma in 1 patient, papillary fibroelastoma in 1 patient, cavernous hyperplasia of valvular lymphatic vessels in 1 patient. There was 1 patient of carcinoid (low-grade malignant tumor). Thirty patients underwent tumor resection surgery under hypothermic anesthesia and cardiopulmonary bypass followed by cardiac arrest while 2 patients without cardiopulmonary bypass. Nine patients received partial resection of the tumor, including lipomas in 6 patients, rhabdomyoma in 2 patients, schwannoma in 1 patient. Twenty-three patients received complete resection of the tumor. There were no in-hospital deaths, bleeding, secondary thoracotomy, low cardiac output, renal failure, postoperative embolism or other surgical complications. All the patients were normal before they were discharged out of the hospital. Their average postoperative hospital stay was 8.1±2.7 d. Within 6 months after the surgery, all 32 patients returned to the hospital for reexamination, and ultrasound results were all normal. Afterwards, the patients were followed up by telephone or in an outpatient clinic, and 3 patients were lost. The follow-up rate was 90.63%. During the follow-up of 3-120 (61.4±38.5) months, among the 9 patients whose tumors were partially resection, 2 patients recurred. One patient with schwannoma recurred 30 months after the surgery, and in the other patient lipomas grew 15 months later which resulted in massive regurgitation of the mitral valve.ConclusionSurgical resection is the first choice for the treatment of left ventricular benign tumors. For malignant left ventricular tumors, it is necessary to be cautious, and the surgical risk needs to be carefully evaluated. Most of the primary left ventricular tumors need to be operated as soon as possible. A surgeon should develop different surgical strategies according to different pathological types of tumors.
ObjectiveTo assess mid− and long−term outcomes of ascending aortic wrapping (AAW) in adult patients undergoing aortic valve replacement (AVR). MethodsWe retrospecctively analyzed clinical data of adult patients who underwent AVR and AAW in Fuwai Hospital from January 2010 to August 2019. Ascending aorta diameter (AAD) was measured by echocardiography or CT scan preoperatively and postoperatively. ResultsA total of 33 patients were enrolled, including 23 males and 10 females aged 22−73 (51.06±12.61) years. There was no perioperative death. The mean preoperative, postoperative and follow−up AAD of the patients were 46.06±3.54 mm, 34.55±5.17 mm, and 37.12±5.64 mm, respectively. The median follow−up time was 38.20 (18.80−140.30) months. The median increase rate of diameter was 0.63 (−0.11, 1.36) mm per year after the surgery. The increase rate was>5 mm per year in 1 patient, and>3 mm in another one. ConclusionMid−term outcomes of AAW in adult patients undergoing AVR are satisfied and encouraging.
ObjectiveTo evaluate the efficacy and safety of modified maze Ⅳ (Cox-maze Ⅳ) in hypertrophic obstructive cardiomyopathy (HOCM) patients.MethodsFrom June 2016 to June 2019, 30 HOCM and persistent atrial fibrillation (pAF) patients received Cox-maze Ⅳ operation with modified extended Morrow operation, including 21 males and 9 females. The average age was 51.36±10.27 years and the average weight was 72.48±11.29 kg. All patients underwent left atrial appendectomy. Recurrence of AF, improvement of symptoms, cardiac function (NYHA) were assessed during follow-up.ResultsThere was no death during the perioperative period. Postoperative left ventricular outflow tract gradient was significantly decreased compared with that before operation (P<0.01), and all systolic anterior motion (SAM) signs disappeared after operation. Thirty patients were all effectively followed up for 3-40 (16.24±8.26) months. During the follow-up period, there was no death, and the cardiac function (NYHA) of all patients recovered to gradeⅠ-Ⅱ. At the end of follow-up, twenty-four patients (80.00%) maintained sinus rhythm, and twenty-seven patients (90.00%) maintained sinus rhythm after amiodarone conversion. Univariate analysis showed that the smoking history (P=0.04), left atrial diameter≥55 mm before operation (P=0.03), left atrial diameter≥50 mm after operation (P=0.02), postoperative tricuspid regurgitation (P=0.02) were closely related to postoperative AF recurrence. The increase of left atrial diameter after operation was an independent risk factor for AF recurrence (P=0.02).ConclusionMorrow/Cox-maze Ⅳ procedure is safe and effective in treatment of patients with HOCM complicated with pAF, which helps to maintain postoperative sinus rhythm, and to improve the cardiac function. The increase of left atrial diameter after operation is an independent risk factor for AF recurrence.
ObjectiveTo summarize the age distribution of different pathological types of primary left ventricular tumor and its influence on preoperative diagnosis, surgical methods and therapeutic effect.Methods The clinical data of 35 patients with primary left ventricular tumor admitted to Fuwai Hospital of Chinese Academy of Medical Sciences from January 2008 to March 2019 were retrospectively analyzed. There were 19 males and 16 females with an average age of 33.81±17.56 years. According to the age, the patients were divided into an infant group (less than 7 years), an adolescent group (7-17 years), a young group (18-44 years), a middle-aged group (45-59 years) and an elderly group (over 60 years). The age distribution characteristics of different pathological types of tumor patients were analyzed, and the influence on surgical methods, short-term and long-term curative effect of surgery in different age groups was analyzed. Within 6 months after the operation, the patients returned to the hospital to review the echocardiography, and then were followed up by telephone.Results Of the 35 patients with primary left ventricular tumor, only 1 patient in the middle-aged group had low malignancy carcinoid tumor, and the others were benign tumors. Fibroma and rhabdomyoma accounted for the majority of the infant group and adolescent group. Myxoma was the common tumor in the young group, middle-aged group and elderly group, followed by lipoma. Thirty-three patients were operated under general anesthesia, hypothermia and cardiopulmonary bypass (CPB). Two patients with epicardial lipoma underwent normothermic surgery without CPB. Nine patients underwent partial resection of left ventricular tumors, and 26 patients received complete resection of left ventricular tumor. There was no hospital death, opening stanching, secondary thoracotomy, low cardiac output, embolism or other complications. The postoperative hospital stay was 7.97±2.56 days, and the postoperative reexamination was normal. Subsequently, 35 patients were followed up by telephone or outpatient service. The average follow-up time was 59.87±37.62 months. In the young group, 2 patients with partial resection recurred.Conclusion Surgical resection is the first choice for the treatment of left ventricular benign tumor, and it is safe. The principle of left ventricular tumor surgery is to protect the function of ventricle and valve, prevent damage to the conduction system, and remove the tumor as completely as possible.
The "2022 AHA/ACC/HFSA guideline for the management of heart failure" replaces the "2013 ACCF/AHA guideline for the management of heart failure" and the "2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure". The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose and manage patients with heart failure. Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to manage patients with heart failure, with the intent to improve quality of care and align with patients’ interests. New recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses. This article summarized and interpreted the new concept of heart failure in 2022 guidelines, especially the new evidence and suggestions related to cardiac surgery.
Enhanced recovery after surgery (ERAS) has been proven to reduce surgical injuries, promote recovery, and improve postoperative outcomes in different types of surgeries. A core principle of ERAS is to provide programmatic evidence-based perioperative interventions. An international multidisciplinary expert group provided a statement on clinical practice in each thematic area of ERAS by obtaining a list of potential ERAS elements, and reviewing literature. The "Version 2024 of the ERAS Joint Consensus Statement" is developed from the "Version 2019 of the ERAS Recommendations". The consensus statement group was composed of multidisciplinary experts such as cardiac surgeons, anesthesiologists, intensive care physicians, and nurses, based on ERAS's personal professional knowledge and experience. This article interprets the changes and new statements in the 2024 consensus, which can provide a foundation for the best perioperative practices for adult cardiac surgery patients.
Objective To explore the safety and complications of repeated sternotomy after mitral valve repair and prevention strategies. Methods We retrospectively analyzed the clinical data of 88 consecutive patients of non-rheumatic mitral valve disease who underwent repeated sternotomy for failure of first-time mitral valve repair in our hospital from January 2009 through June 2015. There were 53 males and 35 females with a mean age of 36.1±17.5 years in the patients who underwent repeated sternotomy. Meanwhile 88 patients who underwent the first-time sternotomy for mitral valve repair simultaneously were randomly recruited as a control group, and there were 57 males and 31 females with a mean age of 39.9±12.6 years. The clinical outcomes were analyzed retrospectively and compared between the two groups. Results No major injury was observed in the patients who underwent repeated sternotomy. Eight patients (9.1%) in the repeated sternotomy group required femoral artery cannulation. Cardiopulmonary bypass (CPB) time was longer in the femoral artery cannulation group than that in the aortic cannulation group (155.5±59.0 minvs. 119.5±39.9 min,P=0.023). While there was no statistical difference in aortic cross-clamp time (P=0.786). Eight patients (9.1%) in the repeated sternotomy group used extra-pericardium approach. There was no significant difference in CPB time (P=0.255) or aortic cross-clamp time (P=0.360) between the patients who used extra-pericardium approach and those used routine approach. There was no statistical difference in post-operative complications between the patients who used different sternotomy strategies. Although CPB time (123.0±3.0 minvs. 95.4±37.1 min,P=0.000) or aortic cross-clamp time (79.0±36.3 minvs. 67.5±29.1 min,P=0.026) was longer in the repeated sternotmy group, the major outcomes were similar between the repeated sternotmy group and the first-time sternotmy group (P＞0.05). Conclusion Repeated sternotomy after mitral valve repair is relatively safe. With appropriate strategies, repeated sternotomy is not associated with increased risk of operative morbidity.
ObjectiveTo evaluate the clinical outcomes of pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF) after re-PVR surgery.MethodsPubMed, EMbase, the Cochrane Controlled Trials Register databases, CNKI, CBM disc and VIP datebases were searched, and study eligibility and data abstraction were determined independently and in duplicate. Literature searches from database establishment to December 2018. The heterogeneity and data were analyzed by the software of Stata 11.0.ResultsOf 4 831 studies identified, 26 studies met eligibility criteria, and invovled with a total of 3 613 patients. The combined 30-day mortality for PVR was 2.2% (95% CI 1.5%-3.1%) and follow-up mortality was 3.4% (95% CI 2.4%-4.9%), re-PVR rate was 6.8% (95% CI 5.1%-9.2%), and the rate of intervention was 11.4% (95% CI 8.0%-16.4%). Subgroup analysis showed that the patient's age range may be a heterogeneous source of mortality during the follow-up period, and there was no statistical heterogeneity for adult patients (P=0.63, I2=0%), with a lower incidence than those including adolescents patients. The type of valve was likely to be a source of retrospective PVR. There was no statistical heterogeneity in bioprosthetic valves and allograft lobes (P=0.24, I2=25%). And the incidence of re-PVR was lower than that of the mechanical valve patients. Heart function classification (NYHA) of patients with TOF after PVR was statistically improved (P<0.05). Electrocardiogram QRS change was not statistically differently (P>0.05). Postoperative MRI findings showed a decrease in RVEDV, an increase in RVEF, a decrease in RV/LV ratio, and a decrease in pulmonary valve (all P<0.05). Funnel map monitoring, Begg test and Egger's test both indicated that there was no publication bias.ConclusionsAccording to the results of the analysis, PVR after TOF surgery is a more mature surgery, the clinical effect was significant, with lower early and long-term mortality. The long-term mortality rate of adolescent patients undergoing PVR is higher than that of adult patients. Long-term outocme of re-PVR or re-intervention is still the main problem affecting the effect of the operation. Indications for surgery and choice of valve need further investigation.