Lei Yu

ShenJing Hospital of China Medical University, Feng-t’ien, Liaoning, China

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Publications (29)50.09 Total impact

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    ABSTRACT: To explore if there is phenotypic switching in the vascular smooth muscle cells (vSMCs) of rat thoracic aortic aneurysms and the role it plays in the process of aneurysm formation. Male SD white rats were assigned randomly to the aneurysm group (AG) and control group (CG). The animal aneurysm model was obtained by soaking the peri-adventitia with porcine pancreatic elastase (PPE). The rats in the CG were given saline to provide contrast. A vascular ultrasound was used to monitor the diameter of the aneurysm. Specimens were stained with haematoxylin and eosin (HE), and α-SMA, SM-MHC, matrix metalloproteinase (MMP)-2 and MMP-9 were detected with immunohistochemistry staining. α-SMA, SM-MHC, MMP-2 and MMP-9 were conducted with western blot. vSMCs taken from the descending aorta of both of the CG and AG were separated and cultured until Passage 3. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method were used to analyse cell proliferation. Western blot was used to evaluate MMP-2, MMP-9 expression and flow cytometry was employed to assess cell apoptosis. Vascular ultrasound showed obvious dilatation of soaked descending aorta. HE staining showed thickening of thoracic aorta and disarrangement of cells after soaking with PPE. Immunohistochemistry staining showed high expression of MMP-2 and MMP-9 but low expression of SM-MHC and α-SMA in the AG. Tissue western blot analysis of the AG showed that the protein gray value was high in MMP-2 and MMP-9, but low in α-SMA and SM-MHC, which had statistical differences compared with CG with a P-value of <0.05. MTT analysis showed vSMC proliferation activity was higher in the AG than in the CG. Flow cytometry analysis revealed that cell apoptosis between the control and aneurysm groups had significant statistical differences. There is vSMC phenotypic switching in animal models as seen through the rat thoracic aortic aneurysms. This may play an important role in the formation of aneurysms. Our findings are relevant to human aneurysms and may be conducive in the research of aortic aneurysm pathology and treatment. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    Interactive Cardiovascular and Thoracic Surgery 03/2015; DOI:10.1093/icvts/ivv074 · 1.11 Impact Factor
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    ABSTRACT: Intraoperative conversion, especially under emergent circumstances during off-pump coronary artery bypass (OPCAB), is associated with a significantly higher rate of hospital mortality. This study compared the clinical early outcomes of patients emergently converting to cardiopulmonary bypass (CPB) with or without cardioplegic arrest and evaluated the efficacy of an on-pump beating heart technique for these critically ill patients. A retrospective study of patients treated at The First Affiliated Hospital of China Medical University over an 8-year period (2005 to 2013). Between January 2005 and September 2013, 104 patients were emergently converted to CPB during OPCAB. In the first 55 patients (53%), the cardioplegic arrest was performed. In the most recent 49 patients (47%), the on-pump beating heart procedure was used without cardioplegic arrest. There were no significant differences in their baseline clinical characteristics, number of anastomoses performed per patient, and reasons for conversions (P > .05). A significant reduction occurred in the observed mortality between the cardioplegic arrest group and the on-pump beating heart group (25.6% vs 6.1%, P=.008). A statistical difference was found between the cardioplegic arrest group and the on-pump beating heart group in the time of CPB, peak cardiac troponin I, duration of inotropic support, time to extubation, intensive care unit stay, postoperative hospital stay, incidence of new intra-aortic balloon pump support, and pulmonary complications (P < .05). The incidence of blood requirements, postoperative myocardial infarction, new-onset atrial fibrillation, hemodialysis, stroke, infective complications, and resurgery for bleeding were lower in on-pump beating heart group, but the difference did not reach statistical significance (P > .05). The on-pump beating heart technique is the preferred method of emergency conversion to CPB during OPCAB. It has lower postoperative mortality and morbidity than the cardioplegic arrest.
    Annals of Saudi medicine 07/2014; 34(4):314-319. DOI:10.5144/0256-4947.2014.314 · 0.71 Impact Factor
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    ABSTRACT: Off-pump coronary artery bypass grafting (OPCAB) is a popular treatment for patients with ischemic heart disease, especially for high-risk patients. However, whether OPCAB can lead to better clinical outcomes than on-pump coronary artery bypass grafting (ONCAB) in patients with enlarged ventricles remains controversial. This prospective randomized study was designed to characterize comparison of early clinical outcome and mid-term follow-up following ONCAB versus OPCAB in patients with triple-vessel disease and enlarged ventricles.
    Annals of Saudi medicine 05/2014; 34(3):222-8. DOI:10.5144/0256-4947.2014.222 · 0.71 Impact Factor
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    ABSTRACT: The literature on primary malignant cardiac tumors is relatively limited because of their rare incidence. This study aimed to provide a proposed treatment strategy for primary malignant cardiac tumors. The follow-up outcomes of 29 patients with primary malignant cardiac tumors operated, and 8 primary malignant cardiac tumors considered not operable from 1985 to 2013 in the First Affiliated Hospital of China Medical University were retrospectively analyzed. Of operation receivers, ten patients had positive surgical margins and nineteen patients had negative surgical margins. Eleven patients received a post-operative neoadjuvant chemotherapy. Patients rejected to surgery had a lower survival compared with operation receivers (15 vs 23 months, P = 0.011). However, there were no significant differences in survival in patients rejected to surgery than in patients who had positive surgical margins (15 vs 16 months, P = 0.874). Patients who had positive surgical margins had a median overall survival duration of only 16 months, whereas patients with negative surgical margins had a median overall survival duration of 27 months (P = 0.002). There were no significant differences in survival in patients with receiving a post-operative adjuvant chemotherapy than in the rest of the population (20 vs 25 months, P = 0.150). The prognosis for patients with primary malignant cardiac tumors remains very poor. Each patient should be managed on an individual basis, and variety of treatment strategy should be performed. Maximizing the possibility of obtaining negative surgical margins may prolong survival.
    Journal of Cancer Research and Clinical Oncology 03/2014; 140(6). DOI:10.1007/s00432-014-1651-1 · 3.01 Impact Factor
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    ABSTRACT: A novel technique for total arch repair was developed, and the safety and feasibility of this simplified technique were compared with those of total arch replacement. With the use of a self-designed stented graft, of which the proximal 10 cm is free of stent, 54 patients with acute type I dissection underwent ascending aorta replacement combined with total arch repair (simplified group). The stented part was implanted into the descending aorta as an elephant trunk, and the part free of stent was sutured inside the arch with exposure of the orifices of 3 arch vessels. A total of 41 patients with acute type I dissection undergoing ascending aorta and total arch replacement with stented elephant trunk (total arch group) were enrolled as controls. There was no permanent neurologic dysfunction or paraplegia in both groups. The incidence of postoperative transient neurologic dysfunction and prolonged ventilation was lower in the simplified group (P < .05). The hospital mortality was 3.7% (2/54) in the simplified group and 7.3% (3/41) in the total arch group (P = .44). No significant difference was detected in survival between the 2 groups (P = .78). Complete thrombosis in the false lumen of the residual arch was found in all patients undergoing simplified aortic repair. The rate of complete thrombosis in the false lumen of the distal aorta was similar between the 2 groups (P > .05). The risks of aortic event were comparable for both groups (P = .84). The simplified technique of total arch repair is an easy and effective surgical strategy for acute type I dissections.
    The Journal of thoracic and cardiovascular surgery 03/2014; 148(5). DOI:10.1016/j.jtcvs.2014.02.077 · 3.99 Impact Factor
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    ABSTRACT: For patients with acute DeBakey type I aortic dissection without an intimal tear in the arch, the early and midterm outcomes of hemiarch replacement with stented elephant trunk were compared with those of total arch replacement. From January 2006 to December 2011, 197 patients with acute type I aortic dissection were identified without an intimal tear in the arch. Of the 197 patients, 71 underwent hemiarch replacement with stented elephant trunk implantation (hemiarch group) and 84 underwent ascending aorta and total arch replacement with stented elephant trunk implantation (total arch group). The incidence of postoperative transient neurologic dysfunction, low cardiac output syndrome, and prolonged ventilation was lower in the hemiarch group (P < .05 for all). The hospital mortality was 4.2% and 5.9% for the hemiarch and total arch groups, respectively (P = .91). No difference was detected in survival between the 2 groups (P = .56). Complete thrombosis in the false lumen of the residual arch was found in 92.1% of those undergoing hemiarch replacement. The rate of complete thrombosis in the false lumen of the distal aorta was similar between the 2 groups (P > .05). The risk of an aortic event was similar for both groups (P = .62). For patients with acute DeBakey type I dissection without an intimal tear in the arch, hemiarch replacement with stented elephant trunk implantation was easily performed, with satisfactory early and midterm outcomes. For these selective patients, total arch replacement with the stented elephant trunk technique did not improve the late surgical results further.
    The Journal of thoracic and cardiovascular surgery 11/2013; 148(5). DOI:10.1016/j.jtcvs.2013.10.058 · 3.99 Impact Factor
  • The Annals of thoracic surgery 10/2013; 96(4):1484. DOI:10.1016/j.athoracsur.2013.01.060 · 3.65 Impact Factor
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    ABSTRACT: Coronary artery fistula (CAF) is rare in patients undergoing coronary angiography. Coronary artery ectasia (CAE) is found in 1.2% to 4.9% of patients at autopsy or during angiographic studies. CAF combined with CAE is a extremely rare clinical condition. This study aimed to summarize a treatment strategy for this complex disorder. Ten consecutive patients who underwent surgical repair of CAF combined with CAE between 2000 and 2012 are reported. The main outcome measure was death. Secondary outcome measures included surgical technique, the extracorporeal circulation time, intubation duration, the intensive care unit stay period and discharge period. The mean extracorporeal circulation period was 103.8 W 25.7 minutes. The mean intubation duration was 10.5 W 3.2 hours. The mean intensive care unit stay period was 2.0 W 0.8 days and the mean discharge period was 11.4 W 2.6 days two patients were lost to follow-up. The other eight patients were asymptomatic and there were no deaths during the follow-up period. Surgical repair for CAF combined with CAE is effective with satisfactory results in adults.Objectives: Coronary artery fistula (CAF) is rare in patients undergoing coronary angiography. Coronary artery ectasia (CAE) is found in 1.2% to 4.9% of patients at autopsy or during angiographic studies. CAF combined with CAE is a extremely rare clinical condition. This study aimed to summarize a treatment strategy for this complex disorder. Methods: Ten consecutive patients who underwent surgical repair of CAF combined with CAE between 2000 and 2012 are reported. The main outcome measure was death. Secondary outcome measures included surgical technique, the extracorporeal circulation time, intubation duration, the intensive care unit stay period and discharge period. Results: The mean extracorporeal circulation period was 103.8 W 25.7 minutes. The mean intubation duration was 10.5 W 3.2 hours. The mean intensive care unit stay period was 2.0 W 0.8 days and the mean discharge period was 11.4 W 2.6 days two patients were lost to follow-up. The other eight patients were asymptomatic and there were no deaths during the follow-up period. Conclusions: Surgical repair for CAF combined with CAE is effective with satisfactory results in adults. doi: 10.1111/jocs.12109 (J Card Surg 2013;28:222-227).
    Journal of Cardiac Surgery 05/2013; 28(3):222-7. DOI:10.1111/jocs.12109 · 0.89 Impact Factor
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    ABSTRACT: Epithelioid haemangioendothelioma (EH) is a rare malignant tumor of vascular origin that usually arises in bone, liver, soft tissue, or lung. EH originating in the pleura has been less frequently described. We describe an uncommon case of pleural EH compressing the myocardium in a 39-year-old woman. The patient was diagnosed with pleural EH confirmed by surgery and immunohistochemistry. She sustained stable disease 14 months after the diagnosis and her symptoms improved after systemic chemotherapy with carboplatine and etoposide. Complete surgical excision of pleural EH followed chemotherapy may prolong survival.
    Journal of Cardiac Surgery 04/2013; 28(3). DOI:10.1111/jocs.12094 · 0.89 Impact Factor
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    ABSTRACT: To evaluate the effectiveness of mild hypothermia on low cardiac output in patients after cardiac surgery. Twelve patients manifesting low cardiac output after cardiac surgery despite of the use of massive doses of catecholamine and intra-aortic balloon pump (IABP) underwent mild hypothermia during May 2009 to February 2011. Changes in hemodynamic parameters of the patients were measured, including cardiac index (CI),mixed venous oxygen saturation [SvO(2)] and urine volume. In the process of mild hypothermia treatment, bladder temperature of patients was lowered to 33-35 centigrade in order to reduce the body oxygen demand. The CI [ml·s(-1)·m(-2)]of patients after mild hypothermia treatment was increased obviously (38.34 ± 5.00 vs. 30.01 ± 5.00), the same as SvO(2) (0.64 ± 0.07 vs. 0.54 ± 0.08) and urine output [ml·kg(-1)·h(-1): 3.0 ± 2.1 vs. 1.5 ± 1.1, all P < 0.05]. However, there was no significant change in heart rate, mean arterial pressure and blood oxygen pressure. Mild hypothermia is an effective and simple procedure to improve the cardiac function in patients after cardiac surgery complicated with low cardiac output.
    Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 04/2012; 24(4):219-21.
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    ABSTRACT: The purpose of this study was to evaluate the hemostatic efficacy and feasibility of direct injection of fibrin sealant into the sternal marrow cavity in senior patients undergoing on-pump coronary artery bypass grafting (CABG). A total of 82 senior patients undergoing on-pump CABG were randomized to the bone wax group (n=40) or the fibrin sealant group (n=42) for the period July 2010 to January 2011. The fibrin sealant-treated group had less chest drainage in the first 24 hours (186.67±49.53 versus 333.75±60.49 mL), less total chest drainage (326.19±67.24 versus 516±88.46 mL), less packed red blood cell (PRBC) administration (3.6±1.25 versus 7.4±2.13 U), less fresh frozen plasma (FFP) administration (5.52±1.64 versus 8.95±1.77 U), shorter intubation time (40.36±8.62 versus 46.25±10.46 hours), and shorter hospital stay (10.45±1.17 versus 11.03±1.37 days) compared with the bone wax group. No significant difference in the incidence of postoperative complications was found. Direct injection of fibrin sealant into the sternal marrow cavity significantly reduces the amount of postoperative blood loss and offers an attractive new treatment alternative for senior patients undergoing on-pump CABG.
    The Annals of thoracic surgery 02/2012; 93(2):641-4. DOI:10.1016/j.athoracsur.2011.08.087 · 3.65 Impact Factor
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    ABSTRACT: Chronic total occlusion of the left main coronary artery (LMCA) is a rare condition, and the information on surgical experiences is limited. Although total occlusion of the LMCA is accompanied by well-developed collateral circulation, the condition of circulation is unstable during manipulation of the heart. We report our experience with revascularization in cases with total occlusion of the LMCA using the on-pump beating-heart (OnP-BH) technique. Retrospective case review of patients treated at The First Affiliated Hospital of China Medical University over a 10-year period (1999 to 2009). The on-pump coronary artery bypass grafting with the beating heart was applied to 8 patients with chronic total occlusion of the LMCA. The extracorporeal circulation period, intubation duration, intensive care unit stay period, discharge period, preoperative and postoperative treatments, and follow-up were observed. The mean extracorporeal circulation period was 80.4 (19.7) minutes. The mean intubation duration was 13.0 (4.6) hours. The mean intensive care unit stay period was 3.2 (0.7) days, and the mean discharge period was 16.8 (3.3) days. No perioperative myocardial infarction occurred. The mean follow-up period was 50.9 (34.8) months. All patients were asymptomatic, and no deaths were recorded during the follow-up period. The results of echocardiography showed improvement in the left ventricular function. The OnP-BH myocardial revascularization seems to be a valid alternative for chronic total occlusion of the LMCA.
    Annals of Saudi medicine 01/2012; 32(2):156-61. · 0.71 Impact Factor
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    ABSTRACT: Selective retrograde coronary venous bypass (SRCVB) may be a promising treatment for patients with advanced coronary artery disease (CAD). The aim of this study is to investigate the effect of SRCVB on plasma endothelial factor levels in dog myocardial ischemic model, and explore the possible mechanisms. 24 crossbreed dogs were randomly divided into three groups: (1) control group; (2) SRCVB group with 60 mmHg perfusion pressure; (3) SRCVB group with 90 mmHg perfusion pressure. The posterior descending coronary artery (PDA) was ligated in all groups, and SRCVB was performed in the last two groups. The levels of plasma nitric oxide (NO) and endothelin (ET) at different time points were determined in each group. In SRCVB groups, ink and imaging agent were injected to the heart through SVG graft for assessment of vein perfusion. At the acute period, there were significant increase in the plasma levels of NO and decrease in ET in SRCVB 90 mmHg group compared with the control (P < 0. 01), and a further improvement were found in SRCVB 60 mmHg group (P < 0. 01). The ink or imaging agent was found in the myocardial tissue and flowed back to right atrium through contralateral coronary vein. SRCVB with low level of perfusion pressure could provide effective perfusion for ischemic myocardium and alleviate the myocardial endothelial cell injury. It may be a new therapeutic strategy for severe CAD.
    Scandinavian cardiovascular journal: SCJ 12/2011; 45(6):369-73. DOI:10.3109/14017431.2011.616219 · 1.10 Impact Factor
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    ABSTRACT: Interrupted aortic arch is a rare congenital cardiac defect. There are extremely few cases in adults that are reported in the pertinent medical literature. However, single-stage repair of interrupted aortic arch combined with coronary artery disease has been rarely reported. We describe the management of interrupted aortic arch associated with coronary artery disease through single-stage surgical procedure without cardiopulmonary bypass in a 56-year-old woman. The vascular prosthesis was anastomosed between the aortic arch just distal to the origin of the left subclavian artery and the descending thoracic aorta. Then a venous bypass was subsequently formed between the left anterior descending coronary artery, the circumflex artery, and the descending aorta.
    The Annals of thoracic surgery 09/2011; 92(3):1110-3. DOI:10.1016/j.athoracsur.2011.03.043 · 3.65 Impact Factor
  • The Journal of thoracic and cardiovascular surgery 07/2011; 142(4):937-9. DOI:10.1016/j.jtcvs.2011.05.020 · 3.99 Impact Factor
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    ABSTRACT: Aortobronchial fistula (ABF) presenting as massive hemoptysis is a rapidly fatal process that is extremely difficult to diagnose and manage. ABF following ligation of patent ductus arteriosus (PDA) is extremely rare. We now report a case of an ABF developing 14 years after ligation of a PDA.
    Journal of Cardiac Surgery 05/2011; 26(4):402-4. DOI:10.1111/j.1540-8191.2011.01258.x · 0.89 Impact Factor
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    ABSTRACT: To investigate the effects of exogenous basic fibroblast growth factor (bFGF) on myocardial regeneration after acute myocardial infarction (AMI). AMI models were established by ligating the mid-third of left anterior descending artery, thereafter, miniswines were randomly divided into control (none treatment, n = 6) and bFGF groups (n = 6). For the bFGF group, bFGF (100 μg) was injected with a sterile microinjection at five sites within the ischemic region. 5-Bromo-2-deoxyuridine (250 mg) was administrated intravenously twice a week after the operation, to label cells undergoing DNA replication. The expression of stromal cell-derived factor-1α (SDF-1α) and CXC chemokine receptor 4 (CXCR4), cardiac stem cell-mediated myocardial regeneration, myocardial apoptosis, histological and immunohistochemical analyses, and cardiac function were evaluated at different time points. Four weeks after bFGF therapy, it showed an increased vessel density and myocardial perfusion (P < 0.001), upregulative expression of SDF-1α and CXCR4 (P < 0.001), increased c-kit and 5-bromo-2-deoxyuridine-positive cells (P < 0.001), enhanced myocardial viability (P < 0.001), and improved left ventricular ejection fraction (P = 0.007), compared with the control. Exogenous bFGF was shown to have increased angiogenesis and myocardial perfusion, promoted myocardial regeneration by activating the SDF-1α/CXCR4 axis, and thereby improved the cardiac function, which may provide a new therapeutic strategy for AMI.
    Coronary artery disease 03/2011; 22(4):279-85. DOI:10.1097/MCA.0b013e32834523f8 · 1.30 Impact Factor
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    ABSTRACT: (J Card Surg 2011;26:302-303)
    Journal of Cardiac Surgery 03/2011; 26(3):302-3. DOI:10.1111/j.1540-8191.2011.01230.x · 0.89 Impact Factor
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    ABSTRACT: The objective was to report our experience with a simplified procedure of ascending aorta and hemiarch replacement with a stent-graft elephant trunk in type A dissections. The efficacy of innominate artery cannulation was investigated. From January 2007 to January 2010, 46 patients (35 men, 11 women; mean age, 52.7 ± 12.3 years) with acute type A dissection with 3 vessels of the arch free of lesions received ascending aorta and hemiarch replacement with implantation of a stent graft into the descending aorta under hypothermic circulatory arrest and selective antegrade cerebral perfusion. The innominate artery was used for artery cannulation. Cardiopulmonary bypass time was 107.9 ± 17.7 minutes, and the time of selective antegrade cerebral perfusion was 35.5 ± 7.1 minutes. The in-hospital mortality was 2.2% (1/46). No permanent neurologic dysfunction and paraplegia were observed. Three patients were lost to follow-up. The average follow-up time was 13.7 ± 7.4 months. Three months after the operation, the false lumen of the distal aorta decreased significantly with thrombosis around the stent graft in all the patients (42/42), at the level of the middle descending aorta in 81.1% (37/42) of the patients, and at the diaphragmatic level in 73.8% (31/42) of the patients. No reoperation related to residual dissected aorta was carried out. The simplified procedure of ascending aorta and hemiarch replacement with a stent-graft elephant trunk performed by using innominate artery cannulation is safe and effective in patients with acute type A dissection without involvement of 3 vessels of the arch.
    The Journal of thoracic and cardiovascular surgery 03/2011; 142(6):1458-63. DOI:10.1016/j.jtcvs.2011.02.027 · 3.99 Impact Factor
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    ABSTRACT: (J Card Surg 2011;26:217-218)
    Journal of Cardiac Surgery 02/2011; 26(2):217-8. DOI:10.1111/j.1540-8191.2011.01222.x · 0.89 Impact Factor

Publication Stats

43 Citations
50.09 Total Impact Points

Institutions

  • 2013
    • ShenJing Hospital of China Medical University
      Feng-t’ien, Liaoning, China
  • 2010–2013
    • China Medical University (PRC)
      Feng-t’ien, Liaoning, China