Hui Xiong

Beijing Fuwai Hospital, Peping, Beijing, China

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Publications (12)35.63 Total impact

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    ABSTRACT: Although 1-stop hybrid coronary revascularization offers potential benefits for selected patients with multivessel coronary artery disease, the exposure to contrast dye and potent antiplatelet drugs could increase the risk of postoperative acute kidney injury and coagulopathy. The goal of the present study was to compare the measures of renal function, postoperative bleeding, and transfusion requirements in patients undergoing hybrid revascularization compared with off-pump coronary artery bypass grafting (CABG). We retrospectively analyzed the data from 141 consecutive patients who had undergone 1-stop hybrid coronary revascularization from June 2007 to January 2011. Propensity score matching with 141 off-pump CABG patients from our surgical database was performed for comparison. The change in renal function, cumulative chest tube drainage, and clinical outcome parameters were compared between the 2 groups. Compared with off-pump CABG, patients undergoing hybrid revascularization had significantly less chest tube drainage at 12 hours after surgery (P = .04) and for the total amount during the postoperative period (P < .001) and required fewer blood transfusions (P = .001). The hybrid group had a higher incidence of acute kidney injury, but this did not reach statistical significance (25.2% vs 17.6%, P = .13). The hybrid group required less inotropic and vasoactive support, had fewer respiratory complications, required a shorter time of mechanical support, and had a decreased length of intensive care unit stay. Compared with off-pump CABG, 1-stop hybrid coronary revascularization was associated with benefits such as less postoperative bleeding and blood transfusion requirements without significantly increasing the additional risk of acute kidney injury.
    The Journal of thoracic and cardiovascular surgery 07/2013; · 3.41 Impact Factor
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    ABSTRACT: OBJECTIVES: This study sought to compare midterm clinical outcomes of one-stop hybrid coronary revascularization (HCR) with coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) for the treatment of multivessel coronary artery disease. BACKGROUND: One-stop HCR has emerged to be a feasible and attractive alternative to CABG and PCI in selected patients with multivessel coronary artery disease. METHODS: From June 2007 to December 2010, 141 consecutive patients underwent one-stop HCR at Fuwai Hospital. Using propensity score methodology, these patients were matched with two separate groups of 141 patients who underwent isolated CABG or PCI during the same period. All patients were stratified by the European System for Cardiac Operative Risk Evaluation Score (EuroSCORE) and the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score (SYNTAX score) respectively. Cutoffs for EuroSCORE (low, ≤ 2; medium, > 2 and < 6; high, ≥ 6) and SYNTAX score (low, ≤ 24; medium, > 24 and < 30; high, ≥ 30) were identified by tertiles. Three groups' cumulative major adverse cardiac or cerebrovascular events (MACCE) rate in each risk tertile were compared. RESULTS: One-stop HCR incurred lower MACCE rate than PCI (p < 0.001), but similar with CABG (p = 0.140). After stratification by EuroSCORE or SYNTAX score respectively, the cumulative MACCE rate was similar among three groups in low and medium tertiles. But in high EuroSCORE tertile, patients who underwent one-stop HCR had lower MACCE rate than CABG (p = 0.030) and PCI (p = 0.006). Meanwhile, patients with high SYNTAX score who underwent one-stop HCR had lower MACCE rate than PCI (p = 0.002), but similar rate with CABG (p = 0.362). CONCLUSIONS: One-stop HCR provides favorable midterm outcomes for selected patients with multivessel coronary artery disease in each risk tertile. For patients with high EuroSCORE or SYNTAX score, it might provide a promising alternative to CABG and PCI.
    Journal of the American College of Cardiology 04/2013; · 14.09 Impact Factor
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    ABSTRACT: The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events (MACCE) in patients with multivessel disease undergoing hybrid coronary revascularization. The data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification (GRC) calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization. During a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power (area under curve (AUC)) of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 (95% confidence interval 0.42 - 0.77), 0.65 (0.47 - 0.82), 0.57 (0.39 - 0.75) and 0.65 (0.46 - 0.83), respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 (P = 0.86), 5.39 (P = 0.37), 13.81 (P = 0.32) and 0.02 (P = 0.89), respectively. In patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.
    Chinese medical journal 02/2013; 126(3):450-6. · 0.90 Impact Factor
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    ABSTRACT: OBJECTIVES: The classification system of Sakakibara and Konno for sinus of Valsalva aneurysm (SVA) is highly complex and seldom utilized in clinical practice. In this study, we propose a new and simple classification system; we suggest a novel approach that utilizes four distinct types of SVAs. METHODS: We retrospectively studied 257 cases of SVAs in which surgical repair was performed between October 1996 and December 2009 and divided these cases into four types: I, rupture or protrusion into the right atrium; II, rupture or protrusion into the right atrium or right ventricle near or at the tricuspid annulus; III, rupture or protrusion into the right ventricular outflow tract under pulmonary valve and IV, others. The surgical results of the different approaches in each respective type were compared as follows: cardiopulmonary bypass time, clamp aorta time, mechanical ventilation time, intensive care unit time and postoperative stay time. RESULTS: In all the patients, there was no early postoperative death; all the patients recovered and were discharged as expected. There were no significant differences in intensive care unit time and postoperative stay time among different approaches in each type (P > 0.05). Two hundred and thirty-eight (92.61%) patients were followed up. CONCLUSIONS: Surgical repair of SVAs exhibited good long-term results. Our classification of SVA could be potentially helpful for surgical practice. For Type I, the right atrium approach is advised; for Type II, the transaortic approach with a right atrium incision is advised; for Type III, the transaortic approach with pulmonary incision is advised while for Type IV, repair according to the respective situation is advisable.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2013; · 2.40 Impact Factor
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    ABSTRACT: Abstract  A coronary sinus approach using a Gore-Tex Patch was used to repair an intracardiac left ventricular pseudoaneurysm after a previous bioprosthetic mitral valve replacement. At follow-up six months after surgery, echocardiography and a computed tomographic scan revealed almost complete obliteration of the pseudoaneurysm cavity. (J Card Surg 2012;27:692-695).
    Journal of Cardiac Surgery 11/2012; 27(6):692-5. · 1.35 Impact Factor
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    ABSTRACT: The purpose of this study was to evaluate the feasibility, safety, and midterm outcomes of a simultaneous hybrid revascularization strategy for left main coronary artery disease (LMCAD), compared with conventional off-pump coronary artery bypass grafting (OPCAB). We compared the in-hospital and midterm outcomes of a simultaneous hybrid revascularization strategy (minimally invasive direct coronary bypass grafting of the left anterior descending coronary artery [LAD] and percutaneous intervention to non-LAD lesions) in 20 patients with LMCAD in an enhanced operating room. These patients were matched by propensity score to a group of 20 control patients who underwent standard OPCAB between September 2007 and December 2009. All baseline clinical characteristics of the 2 groups were similar. All of the patients in the 2 groups underwent surgery uneventfully without conversion to on-pump coronary artery bypass grafting. Compared with OPCAB, the patients in the hybrid group had shorter lengths of stay in the intensive care unit (34.8 ± 37.6 hours versus 50.7 ± 34.5 hours, P = .01). Transfusion requirements were reduced in the hybrid patients compared with the OPCAB patients (5% versus 40%, P = .01). The 2 groups did not differ with respect to the occurrence of other important morbidities. During the mean (±SD) follow-up of 18.5 ± 9.8 months, the group of patients who underwent the simultaneous hybrid procedure experienced an incidence of major adverse cardiac or cerebrovascular events that was similar to that of the OPCAB control group (100% versus 90%, respectively; P = .31). The midterm follow-up indicated that the simultaneous hybrid revascularization procedure for LMCAD is feasible, safe, and effective. These promising early findings warrant further prospective investigations.
    Heart Surgery Forum 02/2012; 15(1):E18-22. · 0.63 Impact Factor
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    ABSTRACT: Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, and SVA combined with right ventricular outflow tract stenosis is even rarer. We retrospectively analyzed 222 patients receiving surgical repair of SVA in our center over nine years, and report the incidence of right ventricular outflow tract stenosis in SVAs and the surgical results of 13 cases of SVA with right ventricular outflow tract stenosis. Between January 2000 and December 2009, 13 patients with SVA combined with right ventricular outflow tract stenosis underwent surgical repair of SVA and correction of right ventricular outflow tract stenosis. There were nine males and four females. The mean age was 29.69 ± 9.98 years (range 13 to 45 years). Associated cardiovascular lesions were ventricular septal defect (n = 12), aortic regurgitation (n = 9), mitral regurgitation (n = 2), and tricuspid regurgitation (n = 1). All 13 patients were followed from 35 to 126 months (mean 80.15 ± 32,14 months). There was neither early death after operation nor late death. All the patients recovered well uneventfully. The incidence of right ventricular outflow tract stenosis among 222 SVA patients was 5.86%. Surgical correction of SVA with right ventricular outflow tract stenosis results in good mid-term results. Longer follow-up is needed to determine the efficacy of this procedure as this cohort of patients ages.
    Journal of Cardiac Surgery 12/2011; 27(1):99-102. · 1.35 Impact Factor
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    ABSTRACT: We introduce a simple classification of the non-coronary sinus of Valsalva aneurysm, and suggest a different approach for the corresponding type of non-coronary sinus of Valsalva aneurysm. Between October 1996 and December 2009, 45 patients with non-coronary sinus of Valsalva aneurysm underwent surgical repair. Twenty-three were male and 22 female. The mean age was 32.80±11.77 years (range, 13-67 years). We divided them into two types, type I: rupture or protrusion into right atrium; and type II: rupture or protrusion into right atrium or right ventricle near or at the tricuspid annulus. For type I (n=32), the right atrium approach was chosen, using direct suture with patch repair. For type II (n=13), the transaortic approach with right atrium incision was chosen, with patch repair through an aortic incision and direct suture through a right atrium incision. Surgical results between types I and II were compared as regards cardiopulmonary bypass time, clamp aorta time, mechanical ventilation time, and intensive care unit time, and postoperative stay time. There was no early death after operation. There were no significant differences in cardiopulmonary bypass time, mechanical ventilation time, intensive care unit time, and postoperative stay time between two types (p>0.05). There was significant difference in clamp aorta time, with type II being longer than type I (p<0.05). Forty-three patients (93.33%) were followed up; one case of coronary artery disease using medication occurred, and there was no late death. Approach through the right atrium or right atrium with aortotomy showed the same early surgical results. Our classification of non-coronary SVA is simple and practical for clinical usage.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 03/2011; 40(5):1047-51. · 2.40 Impact Factor
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    ABSTRACT: This study sought to compare early and midterm clinical outcomes of a simultaneous hybrid coronary revascularization procedure with those in a propensity-matched subset of patients undergoing conventional off-pump coronary artery bypass grafting. From June 2007 through December 2009, 104 consecutive patients (mean age 61.8 ± 10.2 years) with multivessel coronary artery disease underwent elective simultaneous coronary revascularization at Fuwai Hospital. Using propensity score methodology, these patients were matched with 104 patients who had undergone off-pump coronary artery bypass grafting through median sternotomy during the same period. We compared these groups' in-hospital clinical outcomes and freedom from major adverse cardiac or cerebrovascular events at a mean follow-up of 18 ± 7.9 months. The hybrid procedure required longer operative time and incurred higher in-hospital costs, but had shorter median intubation time (11.6 ± 6.3 vs 13.8 ± 6.8 hours, p = 0.02), intensive care unit length of stay (34.5 ± 35.6 vs 55.3 ± 46.4 hours, p < 0.001), and postoperative in-hospital length of stay (8.2 ± 2.6 vs 9.5 ± 4.5 days, p = 0.01). The hybrid group had significantly less chest tube drainage (789 ± 389 vs 834 ± 285 mL, p = 0.005) and need for blood transfusion (28.8% vs 51.9%, p > 0.001). At a mean follow-up of 18 months, the freedom from major adverse cardiac or cerebrovascular events is in favor of the hybrid group (99.0% vs 90.4%; p = 0.03). Compared with conventional off-pump coronary artery bypass grafting, simultaneous hybrid coronary revascularization shortens recovery time and has superior outcomes at a mean follow-up of 18 months. Simultaneous hybrid coronary revascularization provides a safe and reproducible alternative for selected patients with multivessel coronary artery diseases.
    The Annals of thoracic surgery 02/2011; 91(2):432-8. · 3.45 Impact Factor
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    ABSTRACT: "One-stop" hybrid coronary revascularization has emerged to be a reliable and attractive alternative for selected patients with multivessel coronary artery disease. However, the optimal antiplatelet regimen of the one-stop hybrid procedure still remains controversial. We modified the antiplatelet protocol in order to reduce the risk of perioperative bleeding and maximally inhibit platelet activity. This study sought to investigate whether the inhibition of platelet activity by this modified antiplatelet protocol is comparable with the conventional protocol widely used and recommended in percutaneous coronary interventions (PCI). Twenty three patients undergoing one-stop hybrid procedure and 20 patients undergoing conventional PCI were enrolled in this prospective study. The modified antiplatelet protocol included perioperative use of aspirin; clopidogrel was administered immediately before PCI with a 300 mg loading dose, followed by a maintenance dose of 75 mg/day for 12 months. Blood samples were obtained before the operation and 2 hours, day 1 and day 3 after operation. Platelet aggregation was induced with: 1) arachidonic acid (AA) (final concentration 0.5 mmol/L) to assess the efficacy of aspirin; 2) adenosine diphosphate (ADP) (final concentration 10 micromol/L) to assess the specific efficacy of clopidogrel. Platelet counts were statistically lower in the hybrid group than in the PCI control group (p = 0.0018) on day 1 after operation. AA-induced platelet aggregation increased significantly in comparison with the preoperative baseline values (p = 0.0079) and the PCI control group (p = 0.0023) on day 1 after operation. ADP-induced platelet aggregation gradually decreased in the hybrid group, and achieved similar platelet inhibition with the PCI group on 2 hours and day 1 after operation. No major adverse clinical events such as death, perioperative myocardial infarction, stent thrombosis or reoperation for bleeding occurred in both groups within 30 days after procedure. These results demonstrate that our modified antiplatelet therapy can sufficiently inhibit platelet activity similarly as the conventional protocol for PCI early after operation. Thus, this modified protocol, with continuous use of aspirin and intraoperative administration of loading dose clopidogrel, might be a safe and effective antiplatelet strategy for the one-stop hybrid coronary revascularization.
    Platelets 03/2010; 21(3):183-90. · 2.24 Impact Factor
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    ABSTRACT: To evaluate the efficacy of one-stop hybrid coronary revascularization [simultaneous minimally invasive direct coronary artery bypass surgery (MIDCAB) and percutaneous coronary intervention (PCI) procedures performed in an enhanced (or called "hybrid") operative unit] for the treatment of unprotected left main coronary artery (ULMCA) disease. From June 2007 to April 2009, 14 patients [13 male, mean age: (60.4 +/- 15.4) years] underwent the one-stop hybrid approach in the "hybrid" operating room. Proximal lesions were evidenced in 5 patients and distal or bifurcation lesions in 11 patients. MIDCAB procedure for grafting of the left intramammary artery (LIMA) with the left anterior descending (LAD) artery was first performed via lower partial ministernotomy on the beating heart, followed by PCI on the LMCA disease and non-LAD coronary lesions. Operation was successful in all patients underwent the one-stop hybrid procedure. LIMA grafts were used in all 14 patients and confirmed to be patent by angiography. A total of 25 non-LAD coronary lesions were treated by PCI and 29 stents (27 drug-eluting stents and 2 bare-mental stents) were implanted to 23 lesions and coronary angioplasty was performed in the remaining lesions. There was no death, perioperative myocardial infarction, stroke or repeat revascularization during the procedure and the follow-up period. All the patients remained free from angina during the 7.9 months (range 1 - 15 months) follow-up period. LIMA grafts and stents were patent in 5 patients at 1-year follow-up. Our initial experience demonstrates that one-stop hybrid coronary revascularization provides a reasonable, feasible and safe alternative for selected patients with LMCA diseases.
    Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 01/2010; 38(1):23-6.
  • The Journal of thoracic and cardiovascular surgery 05/2007; 133(4):1090-2. · 3.41 Impact Factor