Zhi-yun Xu

Second Military Medical University, Shanghai, Shanghai, Shanghai Shi, China

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Publications (64)62.23 Total impact

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    ABSTRACT: The Society of Thoracic Surgeons 2008 cardiac surgery risk models have been developed for heart valve surgery with and without coronary artery bypass grafting. The aim of our study was to evaluate the performance of Society of Thoracic Surgeons 2008 cardiac risk models in Chinese patients undergoing single valve surgery and the predicted mortality rates of those undergoing multiple valve surgery derived from the Society of Thoracic Surgeons 2008 risk models.
    The Journal of thoracic and cardiovascular surgery. 07/2014;
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    ABSTRACT: Inconsistent results regarding the relations between consumption of dairy products and the risk of esophageal squamous cell carcinoma (ESCC) have been reported. In this report, we summarized the evidence by a meta-analysis of observational studies. Eligible studies published up to January 31, 2013 were retrieved via both computer searches and a manual review of references. Random-effects models were used to calculate the summary relative risk (SRR) based on high versus low and dose-response analysis. A total of 19 studies with 4315 ESCC cases were included in this meta-analysis. Overall, there were no significant associations between intakes of total dairy products, milk, cheese and butter and ESCC for the highest versus lowest intake categories (total dairy products: SRR 1.03, 95% confidence interval [CI]: 0.60-1.77; milk: SRR 0.93, 95% CI: 0.74-1.16; cheese: SRR 0.84, 95% CI: 0.61-1.15; butter: SRR 1.77, 95% CI 0.85-3.75). A significant inverse association was found for yogurt consumption (SRR 0.73, 95% CI: 0.54-0.98). There was high heterogeneity among studies on total dairy products, milk and butter; however, little or no heterogeneity was observed among studies on cheese and yogurt. No associations between consumption of milk, dairy products, butter or cheese and risk of ESCC were found, while yogurt consumption may have a protective effect. However, these associations may be subject to high levels of heterogeneity or confounding, and further efforts should be made to confirm these findings.
    Asia-Pacific Journal of Clinical Oncology 03/2014; · 0.91 Impact Factor
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    ABSTRACT: Valve calcification involves transdifferentiation of valve interstitial cells (VICs) into osteoblasts. Twist-related protein 1 (TWIST1) has been established as a negative regulator of osteoblast differentiation in both mouse and human mesenchymal stem cells, but its function in human aortic VICs is unknown. In our study, we determined the mechanism of TWIST1 action in regulating osteoblastic transdifferentiation of human aortic VICs. Human calcified and noncalcified aortic valves were examined for TWIST1 expression. Human aortic VICs were isolated and cultured. The data showed that calcified aortic valves express lower levels of TWIST1. In vitro experiments showed that TWIST1 overexpression inhibited the transdifferentiation of VICs into osteoblasts by decreasing the expression of runt-related transcription factor 2 (RUNX2) and its downstream osteoblastic markers. Through chromatin immunoprecipitation and dual luciferase assays, we found that TWIST1 repressed the expression of RUNX2 by directly binding to an E-box located at -820 bp of the RUNX2 P2 promoter region and inhibiting its activity. Our study results suggest that TWIST1 could play an important role in preventing human aortic valve calcification by negatively regulating osteoblastic transdifferentiation of human aortic VICs through direct inhibition of RUNX2.
    The Journal of thoracic and cardiovascular surgery 03/2014; · 3.41 Impact Factor
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    ABSTRACT: Since 2000, transcatheter pulmonary valve replacement has steadily advanced. However, the available prosthetic valves are restricted to bioprosthesis which have defects like poor durability. Polymeric heart valve is thought as a promising alternative to bioprosthesis. In this study, we introduced a novel polymeric transcatheter pulmonary valve and evaluated its feasibility and safety in sheep by a hybrid approach.
    PLoS ONE 01/2014; 9(6):e100065. · 3.53 Impact Factor
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    ABSTRACT: Objective Valve calcification involves transdifferentiation of valve interstitial cells (VICs) into osteoblasts. Twist1 has been established as a negative regulator of osteoblast differentiation in both mouse and human mesenchymal stem cells, but its function in human aortic VICs is unknown. In this study, we aimed to determine the mechanism of TWIST1 action in regulating osteoblastic transdifferentiation of human aortic VICs. Methods and Results Human calcified and non-calcified aortic valves were examined for the expression of TWIST1. Data showed that calcified aortic valves expressed lower levels of TWIST1. Human aortic VICs were isolated and cultured. In vitro experiments showed that TWIST1 overexpression inhibited the transdifferentiation of VICs into osteoblasts by decreasing the expression of RUNX2 and its downstream osteoblastic markers. Through chromatin immunoprecipitation and dual luciferase assays, we found that TWIST1 repressed the expression of RUNX2 by directly binding to an E-box located at -820bp of the RUNX2 P2 promoter region and inhibiting its activity. Conclusion Our study suggests that TWIST1 may play an important role in preventing human aortic valve calcification by negatively regulating osteoblastic transdifferentiation of human aortic VICs through direct inhibition of RUNX2.
    The Journal of Thoracic and Cardiovascular Surgery. 01/2014;
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    ABSTRACT: There are debates regarding the optimal approach for AAAD involving the aortic root. We described a modified reinforced aortic root reconstruction approach for treating AAAD involving the aortic root. A total of 161 patients with AAAD involving the aortic root were treated by our modified reinforced aortic root reconstruction approach from January 1998 to December 2008. Key features of our modified approach were placement of an autologous pericardial patch in the false lumen, lining of the sinotubular junction lumen with a polyester vascular ring, and wrapping of the vessel with Teflon strips. Outcome measures included post-operative mortality, survival, complications, and level of aortic regurgitation. A total of 161 patients were included in the study (mean age: 43.3 1 15.5 years). The mean duration of follow-up was 5.1 1 2.96 years (2-12 years). A total of 10 (6.2%) and 11 (6.8%) patients died during hospitalization and during follow-up, respectively. Thirty-one (19.3%) patients experienced postoperative complications. The 1-, 3-, 5-, and 10-year survival rates were 99.3%, 98%, 93.8%, and 75.5%, respectively. There were no instances of recurrent aortic dissection, aortic aneurysm, or pseudoaneurysm during the entire study period. The severity of aortic regurgitation dramatically decreased immediately after surgery (from 28.6% to 0% grade 3-4) and thereafter slightly increased (from 0% to 7.2% at 5 years and 9.1% at 10 years). This modified reinforced aortic root reconstruction was feasible, safe and durable/effective, as indicated by its low mortality, low postoperative complications and high survival rate.
    Brazilian Journal of Cardiovascular Surgery 06/2013; 28(2):190-9.
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    ABSTRACT: OBJECTIVES: The EuroSCORE II is an updated version of the EuroSCORE. This multicentre study validated the EuroSCORE II and logistic EuroSCORE in Chinese patients who underwent heart valve surgery. METHODS: A total of 11 170 adult patients underwent heart valve surgery from January 2008 to December 2011. Model discrimination and calibration were assessed for both EuroSCORE II and logistic EuroSCORE. The patients were divided into three subgroups according to the weight of the procedures, and the performance of EuroSCORE II for each group was assessed. A correlation analysis was performed for operative complications and EuroSCORE II. RESULTS: The in-hospital mortality of this series was 2.02% (226 of 11 170), and the predicted mortality rate was 2.62 ± 5.75% by EuroSCORE II and 2.55 ± 6.51% by logistic EuroSCORE (LES). The C-statistics of EuroSCORE II and LES were 0.72 [95% confidence interval (CI) 0.69-0.75] and 0.67 (95% CI 0.63-0.70), respectively. Both models failed the Hosmer-Lemeshow goodness-of-fit test, with a P < 0.05. According to the weight of the procedure, the isolated non-CABG subgroup had the best discrimination (C-statistics: 0.76 in the non-CABG group, 0.67 in the 2 procedures group and 0.73 in the 3+ procedures group). The complication ratio was strongly related to the EuroSCORE II-predicted mortality (Pearson correlation coefficient: 0.90 for ARDS, 0.97 for acute renal failure, 0.97 for prolonged ventilation and 0.94 for a prolonged ICU stay). CONCLUSIONS: EuroSCORE II was an improvement upon its original logistic model for Chinese patients who underwent heart valve surgery, particularly for a single-valve procedure. The EuroSCORE II-predicted mortality correlated with the operative complications.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2013; · 2.40 Impact Factor
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    ABSTRACT: BACKGROUND: To compare six risk scores with regard to their validity to predict in-hospital mortality after heart valve surgery in a single-centre patient population of China. METHODS: From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the EuroSCORE II, VA risk score, NNE risk score, Ambler risk score, NYC risk score, and STS risk score. Calibration of the six risk scores was assessed by the Hosmer-Lemeshow (H-L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. RESULTS: Observed mortality was 3.32% overall. The STS score showed good calibration in predicting in-hospital mortality (H-L: P=0.126). The EuroSCORE II, VA score, NNE score, and NYC score underpredicted observed mortality (H-L: P<0.0001, P<0.0001, P=0.001, and P<0.0001, respectively) and the Ambler score overpredicted observed mortality (H-L: P=0.005). The discriminative power (i.e. the area under the ROC curve) for in-hospital mortality was highest for the STS score (0.706), followed by the EuroSCORE II model (0.693), NNE score (0.684), NYC score (0.682), Ambler score (0.677) and VA score (0.643). CONCLUSION: Compared with the EuroSCORE II, VA score, NNE score, NYC score, and the Ambler score, the STS score gives an accurate prediction for individual operative risk in patients undergoing heart valve surgery at our centre. Therefore, the use of the STS score for risk evaluation maybe suitable in patients undergoing heart valve surgery at our centre in the future.
    Heart Lung &amp Circulation 04/2013; · 1.25 Impact Factor
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    ABSTRACT: BACKGROUND: To assess the performance of the The European System for Cardiac Operative. Risk Evaluation II (EuroSCORE II) in Chinese patients undergoing heart valve surgery at our centre. METHODS: From January 2006 to December 2011, 3479 consecutive patients who underwent heart valve surgery at our centre were collected and scored according to the original EuroSCORE and EuroSCORE II model. All patients were divided into single valve surgery and multiple valve surgery subgroup. The entire cohort and each subgroup were analysed. Calibration of the original EuroSCORE and EuroSCORE II model was assessed by the Hosmer-Lemeshow (H-L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. RESULTS: Observed mortality was 3.32% overall, compared to expected mortality 3.84% for the original additive EuroSCORE (H-L: P=0.013), 3.33% for the original logistic EuroSCORE (H-L: P=0.08), and 2.52% for the EuroSCORE II (H-L: P<0.0001). The EuroSCORE II model showed good calibration in predicting in-hospital mortality for patients undergoing single valve surgery (H-L: P=0.103) and poor calibration for patients undergoing multiple valve surgery (H-L: P<0.0001). The discriminative power of the original EuroSCORE model (area under the ROC curve of 0.684 and 0.673 for the additive and logistic model, respectively) and EuroSCORE II model (area under the ROC curve of 0.685) for the entire cohort was poor. The discriminative power of the EuroSCORE II model was good for the single valve surgery group (area under the ROC curve of 0.792) and was poor for the multiple valve surgery group (area under the ROC curve of 0.605). CONCLUSION: The EuroSCORE II model give an accurate prediction for individual operative risk in patients undergoing single valve surgery but an imprecise prediction in patients undergoing multiple valve surgery at our centre. Therefore, the use of the EuroSCORE II model for risk evaluation maybe suitable in patients undergoing single valve surgery, and creation of a new model which accurately predicts outcomes in patients undergoing multiple valve surgery is maybe required at our centre in the future.
    Heart Lung &amp Circulation 01/2013; · 1.25 Impact Factor
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    ABSTRACT: The cancer stem cell (CSC) model depicts that tumors are hierarchically organized and maintained by CSCs lying at the apex. CSCs have been "identified" in a variety of tumors through the tumor-forming assay, in which tumor cells distinguished by a certain cell surface marker (known as a CSC marker) were separately transplanted into immunodeficient mice. In such assays, tumor cells positive but not negative for the CSC marker (hereby defined as CSC(+) and CSC(-) cells, respectively) have the ability of tumor-forming and generating both progenies. However, here we show that CSC(+) and CSC(-) cells exhibit similar proliferation in the native states. Using a cell tracing method, we demonstrate that CSC(-) cells exhibit similar tumorigenesis and proliferation as CSC(+) cells when they were co-transplanted into immunodeficient mice. Through serial single-cell derived subline construction, we further demonstrated that CSC(+) and CSC(-) cells from CSC marker expressing tumors could invariably generate both progenies, and their characteristics are maintained among different generations irrespective of the origins (CSC(+)-derived or CSC(-)-derived). These findings demonstrate that tumorigenic cells cannot be distinguished by common CSC markers alone and we propose that cautions should be taken when using these markers independently to identify cancer stem cells due to the phenotypic plasticity of tumor cells.
    PLoS ONE 01/2013; 8(1):e54579. · 3.53 Impact Factor
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    ABSTRACT: BACKGROUNDAND AIMOFTHE STUDY: The aim of this study was to develop a logistic risk prediction model for prolonged ventilation after adult heart valve surgery. MATERIALSAND METHODS: This is a retrospective observational study of collected data on 3965 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n = 2400) and a validation dataset (n = 1565). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for prolonged ventilation (defined as ventilation greater than 72 h). Performance of the model was then assessed by observed and expected rates of prolonged ventilation on the development and validation dataset. Model calibration and discriminatory ability were analyzed by the Hosmer-Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. RESULTS: There were 303 patients that required prolonged ventilation (7.6%). Preoperative independent predictors of prolonged ventilation are shown with odds ratio and P value as follows: (1) age, 1.9, P < .0001; (2) hypercholesterolemia, 5.3, P = .001; (3) renal failure, 18.2, P = .004; (4) previous cardiac surgery, 2.4, P = .0002; (5) left bundle branch block, 4.2, P = .011; (6) ejection fraction, 1.4, P = .003; (7) left ventricle weight, 1.5, P = .007; (8) New York Heart Association class III-IV, 1.8, P = .021; (9) critical preoperative state, 4.5, P < .0001; (10) tricuspid insufficiency, 1.2, P = .031; (11) concurrent CABG, 2.2, P = .019; and (12) concurrent other cardiac surgery, 2.1, P = .001. The Hosmer-Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P = .202 vs P = .291). The ROC curve for the prediction of prolonged ventilation in development and validation dataset was .789 and .710, respectively. CONCLUSIONS: We developed and validated a local risk prediction model for prolonged ventilation after adult heart valve surgery. This model can be used to calculate patient-specific risk by the logistic equation with an equivalent predicted risk at our center in future clinical practice.
    Heart & lung: the journal of critical care 11/2012; · 1.04 Impact Factor
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    ABSTRACT: To investigate the effectiveness of surgical approaches, outcomes and prognosis of aortic root pathology due to Stanford A aortic dissection. Retrospective analysis the clinical data of 161 patients (122 male and 39 female, mean age of (44 ± 21) years) underwent surgical treatment for Stanford A aortic dissection between January 2001 and June 2011. There were 146 patients of acute aortic dissection and 15 patients of chronic aortic dissection. All the patients had aortic root pathologies that included commissural prolapsed in 140 cases, more than moderate aortic insufficiency in 75 cases, aortic sinus intima rupture in 15 cases, right and/or left coronary artery tearing in 8 cases, right and/or left coronary artery dissection in 16 cases, aortic root aneurysm in 31 cases. Aortic root replacement (Bentall procedures) were used in 72 cases, aortic root remodeling (including aortic valve replacement) in 80 cases, aortic root reimplantation (David procedure) in 9 cases. The cardiopulmonary bypass time was shorter in aortic root remodeling group ((193 ± 42) minutes) than the other two groups ((210 ± 61) minutes, (197 ± 34) minutes, F = 3.22, P = 0.04). The in-hospital mortality was 8.1% (13 cases), 5 cases (6.9%) in aortic root replacement group, 7 cases (8.8%) in aortic root remodeling group, 1 case in aortic root reimplantation. The cause of death included respiratory failure (4 cases), permanent neurological deficits (3 cases), multiple organ failure (4 cases), acute renal failure (2 cases). The survivors were followed up for 6 months to 6 years. There was no patient required reoperation for aortic root pathologies. There was no statistically significant difference between aortic root remodeling group and reimplantation group (P > 0.05). The surgical treatment for aortic root pathology due to Stanford A aortic dissection is challenging. Appropriate procedures according to the specialty of aortic root pathology can be performed with favorable functional results.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 11/2012; 50(11):991-4.
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    ABSTRACT: BACKGROUND: The aim of this study was to develop a preoperative risk prediction model and an scorecard for prolonged intensive care unit length of stay (PrlICULOS) in adult patients undergoing heart valve surgery. METHODS: This is a retrospective observational study of collected data on 3925 consecutive patients older than 18 years, who had undergone heart valve surgery between January 2000 and December 2010. Data were randomly split into a development dataset (n=2401) and a validation dataset (n=1524). A multivariate logistic regression analysis was undertaken using the development dataset to identify independent risk factors for PrlICULOS. Performance of the model was then assessed by observed and expected rates of PrlICULOS on the development and validation dataset. Model calibration and discriminatory ability were analysed by the Hosmer-Lemeshow goodness-of-fit statistic and the area under the receiver operating characteristic (ROC) curve, respectively. RESULTS: There were 491 patients that required PrlICULOS (12.5%). Preoperative independent predictors of PrlICULOS are shown with odds ratio as follows: (1) age, 1.4; (2) chronic obstructive pulmonary disease (COPD), 1.8; (3) atrial fibrillation, 1.4; (4) left bundle branch block, 2.7; (5) ejection fraction, 1.4; (6) left ventricle weight, 1.5; (7) New York Heart Association class III-IV, 1.8; (8) critical preoperative state, 2.0; (9) perivalvular leakage, 6.4; (10) tricuspid valve replacement, 3.8; (11) concurrent CABG, 2.8; and (12) concurrent other cardiac surgery, 1.8. The Hosmer-Lemeshow goodness-of-fit statistic was not statistically significant in both development and validation dataset (P=0.365 vs P=0.310). The ROC curve for the prediction of PrlICULOS in development and validation dataset was 0.717 and 0.700, respectively. CONCLUSION: We developed and validated a local risk prediction model for PrlICULOS after adult heart valve surgery. This model can be used to calculate patient-specific risk with an equivalent predicted risk at our centre in future clinical practice.
    Heart Lung &amp Circulation 08/2012; · 1.25 Impact Factor
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    ABSTRACT: We sought to explore the pulmonary haemodynamic changes in rheumatic mitral stenosis patients with secondary pulmonary hypertension. The pulmonary artery resistance and compliance of 35 patients with rheumatic mitral stenosis and 12 controls without cardiopulmonary vascular disease were evaluated by using an improved method, which is based on making calculations with parameters obtained from right heart catheterisation. The results are as follows: (1) pulmonary artery compliance in patients with secondary pulmonary hypertension was significantly lower than that of the control group (P<0.01); (2) linear correlation analyses showed that preoperative mean pulmonary artery pressure (mPAP) closely correlated with zero-pressure compliance in the mitral stenosis group (r=-0.745, P<0.05); (3) PAP and pulmonary vascular resistance decreased significantly in both groups with mitral stenosis after infusing 0.5μgkg(-1)min(-1) of sodium nitroprusside (P<0.01). The pulmonary zero pressure compliance and mean pressure compliance increased significantly in the group with mild pulmonary hypertension; whereas in the severe group, the mean compliance changed with significance as the mPAP decreased (1.51±0.59 vs 1.81±0.77ml/mmHg), however no significant change occurred in the pulmonary zero pressure compliance (2.35±1.24ml/mmHg vs. 2.24±1.53ml/mmHg, P>0.05) The walls of pulmonary artery vessels in patients with pulmonary hypertension secondary to rheumatic mitral stenosis appeared to be remodelled by varying degrees as indicated by their haemodynamic properties. Structural remodelling may be a factor affecting preoperative pulmonary artery pressure. Mitral stenosis patients with severe pulmonary hypertension have significantly lower responses to sodium nitroprusside possibly due to aggradation and deposition of collagen in the artery walls, decreasing constriction and dilation, or atrophy of smooth muscle cells.
    Heart Lung &amp Circulation 08/2012; · 1.25 Impact Factor
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    ABSTRACT: Recurrence or metastasis of myxomas is not rare and can lead to malignancy. We aimed to analyze the risk factors for postoperative cardiac myxoma recurrence and to summarize its clinical characteristics, treatments and classification. The clinical data of 5 patients with recurrent cardiac myxoma were retrospectively analyzed and our clinical experience was summarized. Moreover, the relevant literatures were reviewed. All the five cases of primary myxomas were derived from atypical positions. One patient had early distant metastasis, one had family history, and two suffered malignant recurrence. The recurrence interval was (2.30 ± 2.16) years and the recurrent tumors were all found in different chambers from those of the corresponding primary tumors. Re-operation was performed after recurrence. One patient died of heart failure after malignant recurrence, and the other 4 cases had satisfactory therapeutic outcomes after re-operations. Our experience advocated a clinical classification of "typical" and "atypical" cardiac myxoma, the typical myxomas referred to the tumors locating at the left atria, with single pedicle, rooted at or around the fossa ovalis, involving no genetic causes, and the atypical myxomas included the familial tumors, tumors stemming from multiple chambers, rooted in abnormal positions of the left atrium, with evident genetic mutation, or with malignant tendency. Postoperative follow-up is of vital importance for patients with myxomas characterized by multi-chamber distribution, early distant metastasis, atypical origin, and family history. Once recurs, re-operation is necessary and should be performed immediately.
    Chinese medical journal 08/2012; 125(16):2914-8. · 0.90 Impact Factor
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    ABSTRACT: Background: We sought to develop and validate a logistic model and a simple score system for prediction of significant coronary artery disease (CAD) in patients undergoing operations for rheumatic aortic valve disease. Hypothesis: The simple score model we established based on the logistic model was efficient and practical. Methods: A total of 669 rheumatic patients (mean age 51 ± 9 years), who underwent routine coronary angiography (CAG) before aortic valve surgery between 1998 and 2010, were analyzed. A bootstrap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (≤5%) patients, from which an additive model was derived. Receiver operating characteristic (ROC) curves were used to compare discrimination, and precision was quantified by the Hosmer-Lemeshow statistic. Significant coronary atherosclerosis was defined as 50% or more luminal narrowing in 1 or more major epicardial vessels determined by means of coronary angiography. Results: Eighty-eight (13.2%) patients had significant coronary atherosclerosis. Independent predictors of CAD include age, angina, diabetes mellitus, and hypertension. A total of 325 patients were designated as low risk according to the bootstrap logistic regression and additive models. Of these patients, only 4 (1.2%) had single-vessel disease, and none had high-risk CAD (ie, left main trunk, proximal left anterior descending, or multivessel disease). The bootstrap logistic regression and additive models show good discrimination, with an area under the ROC curve of 0.948 and 0.942, respectively. Conclusions: Our logistic regression model can reliably estimate the prevalence of significant CAD in rheumatic patients undergoing aortic valve operation, while the additive simple score system could reliably identify the low-risk patients in whom routine preoperative angiography might be safely avoided. Clin. Cardiol. 2012 doi: 10.1002/clc.22033 The authors have no funding, financial relationships, or conflicts of interest to disclose. Dr. Guan-xin Zhang and Dr. Bai-ling Li have contributed equally to the work. Dr. Lin-han is co-corresponding author (sh_hanlin@hotmail.com).
    Clinical Cardiology 07/2012; · 1.83 Impact Factor
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    ABSTRACT: OBJECTIVES: The prognostic significance of preoperative atrial fibrillation on mitral valve replacement remains unclear. The aim of this study was to explore the effects of the presence of preoperative atrial fibrillation on mortality and cardiovascular outcomes of mitral valve replacement for rheumatic valve disease. METHODS: A retrospective analysis was performed on a total of 793 patients who underwent mitral valve replacement with or without tricuspid valve repair in our hospital. The patients selected were divided into two groups according to preoperative rhythm status. Patients with preoperative atrial fibrillation were assigned to the AF group, while patients in preoperative sinus rhythm were assigned to the SR group. Postoperative follow-up was performed by outpatient visits, as well as by telephone and written correspondence. Data gathered included survivorship, postoperative complications, left ventricular function and tricuspid regurgitation. RESULTS: For patients with atrial fibrillation vs. those in sinus rhythm, there was no difference in postoperative mortality and morbidity. Follow-up was a mean of 8.6 ± 2.4 years. For patients with preoperative atrial fibrillation, 10-year survival from a Kaplan-Meier curve was 88.7%, compared with 96.6% in patients with preoperative sinus rhythm (P = 0.002). Multivariate analysis identified low left ventricular ejection fraction, older age, large left atrium and preoperative atrial fibrillation as significant adverse predictors for overall survival. Freedom from thromboembolism complications at 13 years was lower for patients with preoperative atrial fibrillation without maze procedure and left atrial appendage ligation, compared with that for patients with preoperative sinus rhythm without maze procedure and left atrial appendage ligation, and patients with concomitant maze procedure and left atrial appendage ligation (76.3 vs. 94.8 vs. 94.0%, respectively; P = 0.001). On echocardiography, the proportion of patients with significant tricuspid regurgitation was 38.7% (atrial fibrillation patients) vs. 25.4% (patients in sinus rhythm; P < 0.001). Left ventricular ejection fraction measured 5 years after surgery increased by an average of 1.2% in the AF group, while it increased by 5.3% in the SR group (P = 0.028). CONCLUSIONS: Preoperative atrial fibrillation is a risk factor for long-term mortality, thromboembolism complications and tricuspid regurgitation, and it also has an adverse effect on the degree of improvement when considering left ventricular function.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2012; · 2.40 Impact Factor
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    ABSTRACT: To explore the feature of the edge-to-edge technique and its effect for mitral regurgitation due to myxomatous degeneration. The in-patient data and follow-up outcomes of 58 patients after the edge-to-edge technique for mitral regurgitation due to myxomatous degeneration from January 2000 to January 2009 were analyzed retrospectively. Of the 58 patients, 32 patients were male and 26 patients were female, and the age range was from 43 years to 65 years with a mean of (56 ± 6) years, and moderate mitral regurgitation was observed in 18 patients and severe regurgitation in 40 patients, and the prolapse of the anterior leaflet was observed in 50 patients and the prolapse of the bileaflet in 8 patients. The edge-to-edge technique was performed in all patients and the annuloplasty was performed in 44 patients. There was no perioperative death and serious complication. Postoperative transthoracic echocardiography of all the survivors indicated that the dimensions of left atrial and left ventricular were obviously decreased (P < 0.05) and mitral insufficiency was obviously improved (no regurgitation was observed in 9 patients and trace regurgitation in 30 patients and mild regurgitation in 19 patients) and there was no mitral stenosis. Totally 58 patients were followed up from 24 months to 95 months with a mean of (58 ± 20) months. During the follow-up, there were 2 deaths for noncardiac factors. Freedom from recurrent moderate or severe mitral regurgitation at 5 years after operations was 91.9%. According to undergoing combined annuloplasty or not, 58 patients were divided into the edge-to-edge technique group (14 cases) and the edge-to-edge technique + annuloplasty group (44 cases), and the survival analysis shows there was significant difference on freedom from long-term recurrent moderate or severe mitral regurgitation after operations between two groups (χ(2) = 4.034, P = 0.045) and long-term effect of the latter group was better. The edge-to-edge technique can be conveniently used and bring about satisfactory perioperative and long-term effects for mitral regurgitation due to myxomatous degeneration. The combination of the edge-to-edge technique and the annuloplasty can improve the long-term effect significantly.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 01/2012; 50(1):32-4.
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    ABSTRACT: Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR). The diagnosis and treatment of the disease were reported in 11 cases. Eleven patients (nine men and two women, mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated. Medical records, echocardiograms and surgical treatment were reviewed. In accordance with the Hurwitz and Roberts classification, the patients were classified as type A (n = 2), type B (n = 7), type F (n = 1) and type G (n = 1). Three patients were associated with other heart diseases, including infective endocarditis and mitral prolaps, left superior vena cava, aortic aneurysm. All had aortic regurgitation (AR) except two with aortic stenosis (AS), detected by color-flow Doppler echocardiography. The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography. All patients underwent successful aortic valve replacement. Quadricuspid aortic valve is a rare cause of aortic insufficiency, while echocardiography plays an important role in diagnosing the disease. Aortic valve replacement is the major therapy for the disease.
    Chinese medical journal 09/2011; 124(17):2779-81. · 0.90 Impact Factor
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    ABSTRACT: To observe the trend of change in perioperative blood glucose level in patients undergoing deep hypothermic circulatory arrest (DHCA), in order to evaluate the influencing factors of inciting hyperglycemia and the clinical effects of insulin control. In the Department of Cardiothoracic Surgery of Changhai Hospital, 176 patients underwent aortic operation under DHCA from January 2000 to January 2010. Blood glucose, arterial blood gas and lactate levels were determined at four time points, including pre-cardiopulmonary bypass (CPB), pre-DHCA, post-DHCA, and at admission to intensive care unit (ICU). Hyperglycemia after surgery was controlled at the level of 6-8 mmol/L by intermittent subcutaneous injection or intravenous micropump injection of insulin. At the same time, the cumulative amount of insulin within 24 hours after surgery was recorded. The blood glucose (mmol/L) level at pre-DHCA time point was significantly higher than that of pre-CPB (9.62 ± 1.79 vs. 5.04 ± 1.401,P<0.05), and the blood glucose level was further elevated at the time point of post-DHCA (14.91 ± 2.36,P<0.01) and in-ICU (15.32 ± 2.47) compared with that of pre-CPB (P<0.01). The level of blood glucose elevation was positively correlated with blood lactate level. One hundred and thirty-four patients (76.1%) insulin was given with intravenous micropump due to poor effect of intermittent subcutaneous injection of insulin in controlling blood glucose. Among whom 30 patients (17.0%) developed the phenomenon of insulin resistance. Perioperative hyperglycemia during DHCA was associated with old age (≥ 50 years old), primary hypertension, serious aortic valve disease, diabetes or coronary heart disease, emergency operation, CPB time ≥ 3 hours and DHCA time ≥ 45 minutes. The cumulative amount of insulin within 24 hours after surgery was increased significantly. The results of blood glucose (mmol/L) in-ICU were as follows : age ≥ 50 years old or < 50 years old (18.66 ± 2.52 vs. 12.90 ± 2.27); hypertension with and without (18.98 ± 2.55 vs. 12.31 ± 2.34); serious aortic valve disease with and without (19.59 ± 2.95 vs. 12.13 ± 2.23); diabetes with and without (20.62 ± 1.76 vs. 11.75 ± 1.11); coronary heart disease with and without (19.77 ± 2.98 vs. 12.01 ± 2.02); emergency operation with and without (19.78 ± 1.97 vs. 12.23 ± 1.38); CPB time ≥ 3 hours or < 3 hours (19.86 ± 1.89 vs. 11.70 ± 1.15); DHCA time ≥ 45 minutes or < 45 minutes (19.92 ± 1.88 vs. 11.64 ± 1.12), and all of them should statistical difference (all P < 0.05). The cumulative amount of insulin (U) within 24 hours after surgery was as follows: age ≥ 50 years old or < 50 years old (169.5 ± 56.6 vs. 110.2 ± 38.5); hypertension with and without (171.6 ± 64.0 vs. 104.8 ± 34.3); aortic valve disease with and without (171.4 ± 36.8 vs. 109.4 ± 27.6); diabetes with and without (202.5 ± 46.7 vs. 100.4 ± 31.5); coronary heart disease with and without (178.5 ± 38.6 vs. 104.6 ± 26.4 ); emergency operation with and without (178.3 ± 35.7 vs. 102.7 ± 26.8); CPB time ≥ 3 hours or < 3 hours (168.6 ± 37.2 vs. 107.3 ± 27.5); DHCA time ≥ 45 minutes or < 45 minutes (172.5 ± 36.1 vs. 105.4 ± 28.7), and all of them showed significant statistical difference (all P < 0.05). and all of them showed significant statistical difference (all P < 0.05). DHCA may cause significant increase in perioperative blood glucose and lactate, and even may lead to insulin resistance. Patients often require continuous intravenous administration of large doses of insulin. Perioperative hyperglycemia during DHCA is related to many factors, which should be considered in control of blood glucose.
    Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 07/2011; 23(7):387-91.

Publication Stats

154 Citations
62.23 Total Impact Points

Institutions

  • 2006–2014
    • Second Military Medical University, Shanghai
      Shanghai, Shanghai Shi, China
  • 2003–2014
    • Changhai Hospital, Shanghai
      Shanghai, Shanghai Shi, China
  • 2013
    • Government of the People's Republic of China
      Peping, Beijing, China
  • 2011
    • Renji Hospital
      Shanghai, Shanghai Shi, China