Objective To systematically evaluate the effectiveness and accuracy of brain natriuretic peptide (BNP) for predicting postoperative cardiovascular events of non-cardiac surgery. Methods Databases including The Cochrane Library, PubMed, Ovid, EMbase, WanFang Data and CNKI were searched electrically to collect literature published from 2000 to 2011, and relevant periodicals and references of the included studies were also manually retrieved. According to the inclusion and exclusion criteria, related cohort studies were selected, data were extracted, and quality of the included studies was evaluated by two reviewers independently. Then meta-analysis was conducted using RevMan 5.0 software. Results A total of 11 studies involving 3 649 patients were included. The results of meta-analysis showed that, compared with patients with lower BNP levels than the cut-off point before surgery, patients with higher BNP levels than the cut-off point before surgery suffered from a higher incidence of cardiovascular events, with a significant difference (OR=27.54, 95%CI 17.49 to 43.35, Plt;0.000 01), while the result of N-terminal pro-brain natriuretic peptide (NT-proBNP) was similar to that of BNP (OR=19.53, 95%CI 13.54 to 28.17, Plt;0.000 01). Conclusion Postoperative higher levels of BNP and NT-BNP can be used to predict postoperative cardiovascular events of non-cardiac surgery patients. This conclusion needs to be further proved by more high quality studies due to the quality limitation of the included studies.
Objective To investigate clinical diagnosis，timing of surgery and perioperative therapeutic strategies for blood culture-negative infective endocarditis （IE）. Methods Clinical data of 240 IE patients who were admitted tWuhan Asia Heart Hospital between July 2008 and July 2012 were retrospectively analyzed. According to their blood cultureresults，all the patients were divided into blood culture-negative group and blood culture-positive group. In the blood culture-negative group，there were 158 patients including 88 male and 70 female patients with their age of 51.3±10.1 years. In the blood culture-positive group，there were 82 patients including 45 male and 37 female patients with their age of 48.9±9.8 years. All the patients underwent surgical treatment，and the surgical procedures included complete vegetations excision，debridement of infected valves，removal of necrotic tissue around the annulus，and concomitant heart valve replacement or intracardiac repair. Postoperatively，all the patients received routine monitoring in ICU，cardiac glycosides，diuretics，other symptomatic treatment and adequate dosages of antibiotics for 4-6 weeks. Results Four patients died postoperatively in this study including 1 patient for low cardiac output syndrome and 3 patients for multiple organ dysfunction syndrome，1 patient in the blood culture-positive group and 3 patients in the blood culture-negative group respectively. There was no statistical difference in surgical mortality between the 2 groups （χ2=0.15，P=0.70）. All the other patients were discharged successfully and followed up for 6 to 36 months with the median follow-up time of 22 months. During follow-up, 2 patients died including 1 patient for cerebral infarction 2 years after surgery and another patient for cerebral hemorrhage 3 yearsafter surgery. Conclusion Patients with blood culture-negative IE should receive adequate dosage and duration of broad-spectrum antibiotics to control the infection rapidly, and aggressive surgical therapy to decrease in-hospital mortality and improve their quality of life and prognosis.
This paper is aimed to assess the effects of red blood cell (RBC) transfusion on clinical outcomes in cardiac surgery. Trials were identified by computer searches of the Pubmed,MEDLINE,Cochrane Library (Issue10,2012),from January 1980 to October 2012. References in identified trials and review articles were checked and experts contacted to identify any additional trials. The homogeneous randomized controlled trials (RCTs) were analyzed with RevMan 5.1 software. Five trials involving a total of 1,203 patients were identified. The results of meta-analyses showed that restrictive transfusion strategies reduced the risk of receiving a RBC transfusion (MD=-1.46,95% CI -1.18--1.1) and the volume of RBCs transfusion (RR=0.69,95% CI 0.53-0.89). No significant difference was noted between the two strategies in terms of mortality,adverse events and hospital or intensive care length of stay. Based on the results mentioned above, one can draw a conclusion that restrictive transfusion strategies reduced the risk of receiving RBC transfusion and the volume of RBCs transfused. Restrictive transfusion strategies did not appear to impact on the rate of adverse events and hospital or intensive care length of stay, compared to liberal transfusion strategies.
ObjectiveTo evaluate clinical outcomes of de-airing technique in minimally invasive cardiac surgery (MICS). MethodsFifty-six patients undergoing MICS in Zhongshan Hospital of Fudan University between June 2011 and June 2013 were recruited as a MICS group, including 31 male and 25 female patients with their age of 33-71 (57.3±7.2)years. Fifty-six patients who underwent mitral valvuloplasty via routine median sternotomy during the same period were recruited as the control group, including 27 male and 29 female patients with their age of 51-69 (53.7±6.8)years. Postoperative residual air in the heart, abnormal ECG findings, time to recovery of consciousness, cognitive function and neurological complications were compared between the 2 groups. ResultsThere were 69.6% patients with mild residual air and 30.4% patients with moderate residual air in the heart of MICS group, and 73.2% patients with mild residual air and 26.8% patients with moderate residual air in the heart of the control group (P > 0.05). There was no statistical difference in the incidence of abnormal ECG findings between the 2 groups (32.1% vs. 26.8%, P > 0.05). Patients with better, good and bad postoperative cognitive function accounted for 85.7%, 12.5% and 1.8% in MICS group respectively, and 78.6%, 19.6% and 1.8% in the control group respectively (P > 0.05). There was no statistical difference in the incidence of neurological complications between the 2 groups (1.8% vs. 1.8%, P > 0.05). ConclusionWith appropriate de-airing techniques, postoperative incidence of air embolism of MICS is comparable with that of conventional cardiac surgery via median sternotomy, and the risk of air embolism of MICS is not higher.
ObjectiveTo summary the safety and efficiency of the minimally invasive direct cardiac surgery (MIDCS) approach in elderly patients with heart disease. MethodsWe retrospectively analyzed the clinical data of 60 patients underwent MIDCS in Beijng Anzhen Hospital between April 2010 and January 2013. There were 34 males and 26 females with mean age of 66.4±4.8 years and mean weight of 66.1±10.6 kg. ResultsMean cardiopulmonary bypass time and aortic cross-clamp time was 141.2±57.2 minutes and 99.8±37.6 minutes respectively. A total of 37 patients (90.2%) recovered to beat automatically after heart ceased operation. Median mechanical ventilation time was 17.1±9.1 hours. Mean intensive care unit stay was 22.1±12.2 hours. Mean post operative hospital stay was 7.0±2.5 days. Mean incision length was 5.3±0.9 cm. Mean pericardial draining volume was 466.6±412.1 ml in the first day after operation. No transfusion occurred in 27 (45.0%) patients. Early postoperative mortality was 3.3% (2/60). There were 2 patients of reexplorations for bleeding, 1 patient of the twice tracheal intubation, 1 patient of cardiac arrest after operation, 2 patients of poor healing of skin incision, and 1 patient of injury of right phrenic nerve. When leaving hospital, 47 patients were in heart functional class Ⅰ, 8 patients in class Ⅱ, and 3 patients in class Ⅲ. ConclusionMIDCS is associated with good operative effect in the near future with superior safety and broad application range in elderly patients with heart disease.
ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction in adult patients after receiving noncardiac surgery under general anesthesia. MethodsThe randomized controlled trials (RCTs) about the influence of dexmedetomidine on the early postoperative cognitive dysfunction of patients after receiving noncardiac surgery with general anesthesia was searched in PubMed, EBSCO, Springer, Ovid, The Cochrane Library (Issue 1, 2013), CNKI, VIP, WanFang Data and Google Scholar up to November 30th, 2013. The references of included literature were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 22 RCTs involving 1 356 patients were enrolled. The results of meta-analysis indicated that:a) dexmedetomidine reduced the incidence of postoperative cognitive dysfunction on the first day (RR=0.38, 95%CI 0.29 to 0.49, P < 0.001), on the seventh day (RR=0.55, 95%CI 0.23 to 1.29, P=0.17); improved postoperative MMSE scores after surgery (on the first day:MD=2.38, 95%CI 1.42 to 3.34, P < 0.001; on the seventh day:MD=0.92, 95%CI 0.16 to 1.68, P=0.02), and decreased the expression of inflammatory factor IL-6 (instant:MD=-11.96, 95%CI-18.45 to-5.46, P=0.000 3; after 24 h:MD=-7.50, 95%CI-13.73 to-1.27, P=0.02); and TNF-α (instant:MD=-4.09, 95%CI-7.02 to-1.16, P=0.006)) in patients. b) No significant difference was found between two groups (MD=-0.97, 95%CI-2.37 to 0.43, P=0.17). ConclusionDexmedetomidine can effectively reduce the early-stage postoperative cognitive dysfunction, improve MMSE scores after the operation, and reduce inflammatory reaction. In addition, due to the limited quantity and quality of studies included, larger sample, high quality RCTs are needed to verify the abovementioned conclusion.
ObjectiveTo explore effectiveness and safety of bioabsorbable anti-adhesive pericardial substitute (GM042) to eliminate pericardial adhesion. MethodsEighty patients who were expected to undergo multistage cardiac surgery in three years were randomly divided into a trial group (40 patients) and a control group (40 patients). The mean age of the patients in the trial group was 1.79±1.72 years and 1.63±1.52 years in the control group. Finally, 73 patients were included with 36 patients (13 females and 23 males) in the trial group and 37 patients (20 males and 17 females) in the control group. The trial group used GM042 to fill the pericardium defect at the first surgery while the control group didn't. The manipuility, safety, and the anti-adhesive role of GM042 were evaluated. ResultsThere was no significant difference in clinical indexes between at first surgery and six months after surgery in the trial group. There was no significant adverse event correlated to GM042. GM042 presented fine maneuverability during surgery. The adhesive score of the trial group was significantly lower than that of the control group (P<0.05). Adhesion score, pericardiac thickening, calcification, and visibility of heart surface structures were better in the trial group than those in the control group (P<0.05). ConclusionGM042 presented anti-adhesion effect and safety in cardiac surgery. Therefore, it's applicable to patients requiring re-operation.
Totally thoracoscopic surgery is a branch of minimally invasive cardiac surgeries, and its operational indicators are expanding with the development of the medical and imaging devices compared with median sternotomy and other minimally invasive cardiac surgeries (such as thoracoscope-assisted small incision surgery and robotic surgery). The learning curve is significantly shortened through the professional technique training. Totally thoracoscopic cardiac surgery has many advantages, such as minor trauma, few serious complications, fast recovery, high patient acceptance and being suitable to our country's current situation. Therefore it will be one main direction of minimally invasive cardiac surgery. This article mainly introduced the current status of totally thoracoscopic technology in the field of cardiac surgery in China.
Objective To explore risk factors related to acute kidney injury (AKI) in children who underwent corrective surgery for tetralogy of Fallot (TOF). Methods We retrospectively analyzed the clinical data of 726 children with corrective procedures for TOF aged less than 3 years in our hospital from March 1st 2010 to March 1st 2013. Children with AKI were picked using Acute Kidney Injury Network criteria. Demographic and perioperative variables of the remaining patients were reviewed. Univariate analysis was performed to compare the AKI group (240 patients) with the non-AKI group (486 patients). Multivariable analysis was carried out to identify significant determinants of AKI. Results A total of 240 children were with AKI. The result of univariate analysis showed that there was a statistical difference in age, Nakata index, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), transannular right ventricular outflow tract (RVOT) patch, or fresh frozen plasma (FFP) in prime solution between the AKI group and the non-AKI group. Multivariable logistic regression showed that in older children (OR=1.425, 95% CI 1.071 to 1.983, P=0.011) with more transfusion of FFP in the priming solution (OR=1.486, 95% CI 1.325 to 2.674, P<0.001) led to higher morbidity of mild AKI. In addition, there was an increase in morbidity related to AKI when children had less Nakata index (OR=0.282, 95% CI 0.092 to 0.869, P=0.013). Conclusion Postoperative AKI increases in older children group. Infusion of more FFP in priming solution increases morbidity of AKI. The less Nakata index is significantly associated with severe AKI.
Objective To compare video-assisted thoracic surgical technique (VATS) and conventional surgical technique (CSM) in mitral valve replacement (MVR). Methods We retrospectively analyzed clinical data of 93 patients in our hospital with mitral valve replacement between January 2010 and January 2015. The patients were divided into two groups including a VATS group and a CSM group.There were 43 patients with 25 males and 18 females at age of 57.43±5.65 years in the VATS group, and 50 patients with 27 males and 23 females at age of 56.40±6.32 years in the CSM group.The clinical outcomes of the two groups were compared. Results There was no mortality. Echocardiography was normal in both groups during 1-year follow-up. There was no significant difference between the two groups in the operative time, aortic clamping time, cardiopulmonary bypass (CPB) time, or ventilation time. As compared with the CSM group, the patients in the VATS group had a significantly lower complication rate, shorter chest incision length (5.23±1.36 cm vs. 18.21±3.89 cm), less blood transfusion (1.75±0.25 U vs. 3.15±1.50 U), less chest drainage (202.34±12.12 ml vs. 412.32±21.56 ml) and lower pain score (1.26±0.86 vs. 3.01±1.13), shorter time of postoperative hospital stay (8.20±2.36 d vs. 12.10±3.26 d). Conclusion MVR under VATS is not only technically feasible, but also with excellent clinical results.