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ABSTRACT: To assess the clinical outcomes of transaortic extended septal myectomy on early and midterm survival of patients with hypertrophic obstructive cardiomyopathy (HOCM).
From October 2009 to April 2012, 118 consecutive patients underwent extended Morrow's procedure for HOCM. There were 69 males and 49 females with an average age of (46 ± 13) years. Their clinical data were analyzed retrospectively. Preoperative transthoracic, intraoperative transoesophageal and postoperative transthoracic echocardiography was performed to assess septal thickness, left ventricular outflow tract (LVOT) gradient, mitral valve function and systolic anterior motion (SAM) of anterior mitral valve leaflet, etc. Concomitant surgical procedures were performed if other cardiac diseases required surgical interventions. Follow-up study was carried out during subsequent clinic visits at outpatient department and through telephone interviews with patients and their relatives.
The septal thickness was (25 ± 7) mm. SAM was detected in all. The in-hospital mortality was 0.8% (1/118) since one patient died of multiple organs failure one week later. Postoperative echocardiography demonstrated marked reduction in LVOT gradient (92 ± 22 vs 13 ± 10 mm Hg (1 mm Hg = 0.133 kPa), P = 0.000), New York Heart Association (NYHA) class (2.9 ± 0.6 vs 1.2 ± 0.4, P = 0.000) and significant improvement in mitral regurgitation. Concomitant surgical procedures were performed in 45 cases (38.1%, all for preexisting conditions). Complications included complete atrioventricular block (n = 3), first degree atrioventricular block (n = 6), complete left bundle branch block (n = 51), intraventricular conduction delay or left anterior division block (n = 26), transient renal dysfunction (n = 2) and intra-aortic-balloon-pumping (n = 2). No other severe complication was observed. During a follow-up period of 1 - 27 (7 ± 6) months, there was no readmission or death. All patients reported significant increase in physical ability and obvious decrease in limiting symptoms. At the latest follow-up, the NYHA functional class maintained grade I-II in all. And mitral regurgitation remained absent or mild.
Surgical procedure for HOCM patients is both safe and efficacious. It provides an excellent relief of LVOT obstruction.
Zhonghua yi xue za zhi 01/2013; 93(2):110-3.
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ABSTRACT: Right coronary to left ventricular fistulas are rare. We report a patient who presented with unstable angina and was found to have a large right coronary to left ventricular fistula.
Journal of Cardiac Surgery 02/2012; 27(3):311-3. · 0.87 Impact Factor
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ABSTRACT: We investigated whether the expression of transforming growth factor β-1 in the left atrial appendage affected the outcome of the radiofrequency modified maze procedure in patients with rheumatic valve disease and long-standing persistent atrial fibrillation.Messenger RNA and protein expression of transforming growth factor β-1 and volume fractions of collagen types I and III were measured in 80 patients with rheumatic valve atrial fibrillation who underwent valve surgery with the radiofrequency modified maze procedure; the same was done in a control group of 20 patients with rheumatic valve disease and sinus rhythm who underwent valve surgery alone.At 6 months' follow-up, atrial fibrillation recurred in 24 of the 80 patients in the study group. The messenger RNA and protein expressions of transforming growth factor β-1, collagen type I volume fraction, and left atrial dimension had increased gradually in the control group and in the study subgroups that maintained sinus rhythm or relapsed into atrial fibrillation (P <0.05). The messenger RNA and protein expressions of transforming growth factor β-1 correlated positively with collagen type I volume fraction (r=0.723, P <0.001 and r=0.745, P <0.001, respectively) and left atrial dimension (r=0.762, P <0.001 and r=0.765, P <0.001, respectively). In the sinus rhythm-maintained subgroup, the patients who regained functional atrial contraction had lower messenger RNA and protein expression of transforming growth factor β-1 than did the patients who failed to retain such function (P <0.05).We conclude that the expression of transforming growth factor β-1 in the resected left atrial appendage affects the recurrence of atrial fibrillation and restoration of functional left atrial contraction after the radiofrequency modified maze procedure.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2012; 39(1):17-23. · 0.65 Impact Factor
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Shengshou Hu,
Sheng Liu,
Zhe Zheng,
Xin Yuan,
Lihuan Li,
Minjie Lu,
Rui Shen,
Fujian Duan,
Xiaoling Zhang,
Jun Li,
Xuewen Liu,
Yunhu Song,
Wei Wang,
Shihua Zhao,
Zuoxiang He,
Hao Zhang,
Keming Yang,
Wei Feng, Xin Wang
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ABSTRACT: This study aimed at examining the efficacy of bone marrow mononuclear cell (BMMNC) delivery through graft vessel for patients with a previous myocardial infarction (MI) and chronic heart failure during coronary artery bypass graft (CABG).
Little evidence exists supporting the practice of BMMNC delivery through graft vessel for patients with a previous MI and chronic heart failure during CABG.
From November 2006 to June 2009, a randomized, placebo-controlled trial was conducted to test the efficacy and safety of CABG for multivessel coronary artery disease combined with autologous BMMNCs in patients with congestive heart failure due to severe ischemic cardiomyopathy. Sixty-five patients were recruited, and 60 patients remained in the final trial and were randomized to a CABG + BMMNC group (n = 31) and a placebo-control group (i.e., CABG-only group, n = 29). All patients discharged received a 6-month follow-up. Changes in left ventricular ejection fraction from baseline to 6-month follow-up, as examined by magnetic resonance imaging, were of primary interest.
The overall baseline age was 59.5 ± 9.2 years, and 6.7% were women. After a 6-month follow-up, compared with the placebo-control group, the CABG + BMMNC group had significant changes in left ventricular ejection fraction (p = 0.029), left ventricular end-systolic volume index (p = 0.017), and wall motion index score (p = 0.011). Also, the changes in the distance on the 6-min walking test as well as B-type natriuretic peptide were significantly greater in the CABG + BMMNC group than in the control group.
In summary, patients with a previous MI and chronic heart failure could potentially benefit from isolated CABG (i.e., those who received CABG only) combined with BMMNCs delivered through a graft vessel. (Stem Cell Therapy to Improve Myocardial Function in Patients Undergoing Coronary Artery Bypass Grafting [CABG]; NCT00395811).
Journal of the American College of Cardiology 06/2011; 57(24):2409-15. · 14.16 Impact Factor
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ABSTRACT: Refinements in extracorporeal membrane oxygenation (ECMO) equipment, including heparin-coated surfaces, centrifugal pump, membrane oxygenator, and more biocompatible pump-oxygenator circuits, have reduced procedure-related complications and have made ECMO a safe and effective therapy for critical patients. The aim of this study was to evaluate the performance of two different ECMO circuit systems in a clinical setting and compare their outcomes. From December 2004 to December 2009, 121 patients required ECMO for primary or postcardiotomy cardiogenic shock at our heart center. We used the Medtronic circuit system in our earlier series (Group M, n = 64), and from July 2007, ECMO was carried out mainly with the Quadrox D PLS circuit system (Group Q, n = 56). We retrospectively summarized and analyzed the data of these patients. The evaluation was based on the comparison between properties of the membrane oxygenators and pumps, anticoagulation therapy, circuit-related complications, and clinical outcomes. Support pump flow rates, platelet counts, and trans-membrane pressure drops (TMPDs) of preoxygenator and postoxygenator pressures were compared between two groups at the time of support established (T1) and support established for 24 h (T2). There were no significant differences between the two groups with regard to patient characteristics and pre-ECMO data. The support pump flow rates and platelet counts at different times were comparable in the two groups. The cannulation technique, ECMO duration, and mean heparin dosage were similar in both groups. There were also no significant differences between the groups in mortality or complications related to bleeding and organ dysfunction. Compared with the M group, the Q group experienced less mechanical failure of the ECMO circuit. The Quadrox PLS circuit system showed less circuit thrombus formation (P < 0.045), less plasma leakage (P < 0.001), and less need for replacement of oxygenators (P < 0.001). Furthermore, frequency of hemolysis during ECMO was significantly lower (P < 0.045). In addition, at T1 and T2, TMPDs were significantly lower in the Q group. Our results suggest that both ECMO circuit systems provide similar effects for safe clinical application, but the Quadrox PLS ECMO circuit system demonstrated partially improved biocompatibility in terms of improved cell preservation, lower TMPDs, less plasma leakage, and thrombus formation.
Artificial Organs 03/2011; 35(7):733-7. · 2.00 Impact Factor
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ABSTRACT: Intravenous administration of bone marrow mesenchymal stromal cells (MSCs) is an attractive option for the treatment of myocardial infarction (MI). Previous studies revealed that MSC infusion could limit the deterioration of cardiac function following acute MI; however, little is known regarding the safety and efficacy of MSC infusion for chronic MI. In this study, we address cell retention after intravenous injection in a chronic MI model, and the fate and impact of distributed MSCs in the lung and heart.
MI model was created by coronary ligation in female rats. A total of 3 weeks later, 5 × 10(6) bromodeoxyuridine-labeled male MSCs in 300 µl phosphate-buffered solution (PBS) were infused intravenously (cell transplantation group, n = 37). The same volume of PBS was infused and served as the control group (n = 37). A total of 20 healthy rats received intravenous PBS injections and served as the sham group. 1 day and 4 weeks after cell or PBS infusion, echocardiography was performed and cell retention was evaluated by quantitative real-time PCR. The fate of the migrated cells was detected through immunohistochemistry and the expression of inflammatory and anti-inflammatory protein was evaluated in lung and heart. The lung and heart function was also assessed.
1 day after cell implantation, the percentage of retained cells relative to the initial number of injected cells in heart and lung was 0.54 ± 0.19% and 51.69 ± 12.96%, respectively. After 4 weeks, it decreased to 0.24 ± 0.09% and 0.22 ± 0.17%. The entrapped MSCs did not differentiate into alveolar epithelial-like cells. Likewise, the left ventricular function was not improved. No adverse effects on lung function were observed after cell infusion. The expression of pro-inflammatory factors, including TNF-α, IL-1β, malondialdehyde and myeloperoxidase, and anti-inflammatory factors, including TNF-α-induced protein 6, in the lung and heart was not significantly regulated after cell transplantation.
Although the majority of intravenous infused cells were harbored in the lung, they did not cause deterioration of lung function. However, they did not activate the release of inflammatory/anti-inflammatory proteins, or stimulate angiogenesis or myogenesis in the old infarcted myocardium. Thus, intravenous administration of MSCs for chronic MI needs further experimental study.
Regenerative Medicine 03/2011; 6(2):179-90. · 3.72 Impact Factor
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ABSTRACT: Low-level laser irradiation (LLLI) has the potential of exerting cardioprotective effect following myocardial infarction (MI). The authors hypothesized that LLLI could influence the expression of cardiac cytokines and contribute to the reversal of ventricular remodeling.
LLLI regulates the expression of cytokines after tissue damage. However, little is known concerning the alteration of the cardiac cytokine expression profile after LLLI.
MI was created by coronary ligation. The surviving rats were divided randomly into laser and control groups. 33 rats were exposed to a diode laser (635 nm, 5 mW, CW, laser, beam spot size 0.8 cm(2), 6 mW/cm(2), 150 sec, 0.8 J, 1J/cm(2)) as laser group. Another 33 rats received only coronary ligation and served as control group. 28 rats received a thoracotomy without coronary ligation (sham group). One day after laser irradiation, 5 rats from each group were sacrificed and the heart tissues were analyzed by cytokine antibody arrays. Enzyme-linked immunosorbent assay (ELISA) was performed to confirm its reliability. Two weeks after MI, cardiac function and structure were evaluated by echocardiography and histological study.
Cytokine antibody array indicated 4 cytokines were significantly changed after laser therapy. ELISA confirmed that granulocyte-macrophage colony stimulating factor and fractalkine were the cytokines involved in the response to therapeutic laser irradiation. However, there was no difference in cytokine release between various groups at 2 weeks after MI. Although LLLI did not improve the damaged heart function, it did reduce the infarct area expansion.
The antibody-based protein array technology was applied for screening the cytokine expression profile following MI, with or without laser irradiation. The expression of multiple cytokines was regulated in the acute phase after LLLI. Our results revealed a potential novel mechanism for applying laser therapy to the treatment of heart disease.
Photomedicine and laser surgery 02/2011; 29(6):391-8. · 1.76 Impact Factor
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ABSTRACT: Few studies have evaluated late clinical outcome of no-patch technique in patients with large left ventricular aneurysms. The objectives of this study were to evaluate a no-patch surgical technique to reconstruct the left ventricle in patients with left ventricular aneurysm and to assess early and late clinical outcomes.
In 1995, we began using a no-patch technique in patients with dyskinetic left ventricular aneurysms. A total of 145 patients underwent left ventricular reconstruction with this technique and were followed up for (59 ± 29) months (range, 1 - 127 months). Risk factors for early mortality were analyzed by bivariate analyses. Cox's proportional hazards model was used to calculate risk factors for all-cause mortality and hospital readmission. Kaplan-Meier methodology was used to analyze late survival.
One week after operation, left ventricular end-diastolic diameter had decreased from (61 ± 8) mm to (55 ± 8) mm, and geometry of the left ventricle was restored to a more normal conical shape. Early mortality was 3% and late mortality 11%. Over a 5-year follow-up period, hospital readmission was 28%. One-, 5-, and 10-year survival estimates were 95% (95% confidence interval (CI) 91% - 99%), 86% (95%CI 78% - 94%), and 74% (95%CI 60% - 88%). Readmission-free survival at 1 and 5 years after operation was 87% (95%CI 81% - 93%) and 60% (95%CI 50% - 70%), respectively.
The no-patch technique for left ventricular reconstruction is an effective and simple procedure that can achieve satisfactory early and late clinical outcomes in patients with left ventricular aneurysms.
Chinese medical journal 12/2010; 123(23):3412-6. · 0.86 Impact Factor
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ABSTRACT: Upper gastrointestinal (GI) hemorrhage is a serious complication of coronary artery bypass grafting (CABG). The aim of this study was to retrospectively investigate the risk factors and prevention of upper GI bleeding after CABG.
This study followed 6316 coronary patients who underwent CABG from 1998 to 2005. The perioperative parameters were recorded. Data from patients who experienced major gastrointestinal complications were analyzed retrospectively by univariate and multivariate analyses.
The rate of upper GI bleeding was 0.3%. The overall mortality for patients complicated by upper GI bleeding was 47.6%. The risk factors for upper GI bleeding were age (odds ratio [OR] = 3.18, 95% confidence interval [CI] = 1.73-5.87, P < 0.01), extracorporeal circulation time (OR = 1.30, 95% CI = 1.11-1.52, P < 0.01) and the prophylactic use of omeprazole (OR = 0.19, 95% CI = 0.04-0.89, P < 0.05). The long-term mortality was significantly different between the upper GI bleeding group and the controls (P < 0.01).
Advanced age and extracorporeal circulation time were risk factors for upper GI bleeding after CABG, and the prophylactic use of omeprazole decreased the rate of upper GI bleeding.
Surgery Today 10/2010; 40(10):931-5. · 1.22 Impact Factor
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ABSTRACT: Neural remodeling after myocardial infarction (MI) may cause fatal ventricular arrhythmia. Schwann cells (SCs), which are important for neurogenesis, are dramatically reduced after MI. We investigated the feasibility of modifying nervous system regeneration after MI and the efficacy by which it may prevent ventricular arrhythmia following SC transplantation.
Immediately after creation of MI, syngenic Lewis rats were randomized into cell transplantation (n=80) and control groups (n=72). SCs were isolated from sciatic nerves, and 5×10(6) cells were intramyocardially injected into the infarct region. Expression levels of myocardial nerve growth factor, vascular endothelial growth factor, growth-associated protein 43, connexin 43, and laminin in the SC group were significantly higher than control at 7 and 14 days after cell transplantation. Immunohistochemical staining illustrated increases in sympathetic and parasympathetic nerves in both groups. However, SC transplantation significantly increased the parasympathetic/sympathetic ratio at 14 days after cell injection. Dynamic electrocardiography and programmed electric stimulation were also performed. The SCs significantly decreased the low-/high-frequency ratio and arrhythmia score of programmed electric stimulation-induced ventricular arrhythmia at 2 weeks after cell injection. However, SCs did not restore heart function.
Transplanted SCs in the infarcted myocardium secrete multiple biological molecules, which alter the ratio of parasympathetic/sympathetic nerve density to normalize irritable myocardium. SC transplantation might be a novel cell-based antiarrhythmic therapy following MI.
Circulation 09/2010; 122(11 Suppl):S193-200. · 14.74 Impact Factor
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ABSTRACT: To evaluate the diagnostic value of NT-proBNP in patients with aortic stenosis (AS), analyze the relation of NT-proBNP to NYHA functional class and echocardiographic findings.
Measured the whole venous blood of NT-proBNP with enzyme linked immuno sorbent assay in 40 aortic stenosis patients (AS group) and 76 normal subjects (control group). We assessed the diagnostic value of NT-proBNP for aortic stenosis, and related NT-proBNP to clinical NYHA functional class and echocardiographic findings.
Compared to controls, NT-proBNP levels had significantly higher in patients with aortic stenosis (P < 0.01). The level of NT-proBNP was gradually and significantly increased with the NYHA functional II, III and IV class compared to controls (all P < 0.01). NT-proBNP was significantly (3.5 times) higher in mild/moderate stenosis group than that in control group (2.95 ± 0.48 vs 2.63 ± 0.10, P < 0.05), and was significantly (6.0 times) higher in severe stenosis group than that in control group (3.16 ± 0.50 vs 2.63 ± 0.10, P < 0.01). LVMI was significantly (1.7 times) higher in mild/moderate stenosis group than that in control group (169 ± 51 vs 100 ± 22, P < 0.01), and was significantly (2.1 times) higher in severe stenosis group than that in control group (212 ± 86 vs 100 ± 22, P < 0.01). The NT-proBNP values of 1150 ng/L and 1356 ng/L were determined as the best cutoff values for the diagnosis of patients with mild/moderate (AUC = 0.657, P < 0.05) and severe aortic stenosis (AUC = 0.848, P < 0.01), the sensitivity, specificity and accuracy were 61.11% and 77.30%, 69.74% and 96.10%, 68.09% and 91.80%. Log (NT-proBNP) was significantly positively related with LVEDD, LVMI and mean transvalvular pressure gradient (MTPG) (all P < 0.05), and negatively related with LVEF (P = 0.01) in univariate analysis. In multiple regression analyses, NYHA functional class, LVEF and Log (MTPG) was independently associated with NT-proBNP.
NT-proBNP is valuable for the diagnosis of patients with aortic stenosis. NT-proBNP has correlation with the heart function and severity of the aortic stenosis.
Zhonghua yi xue za zhi 08/2010; 90(32):2233-6.
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ABSTRACT: To evaluate the diagnostic value of NT-proBNP in aortic stenosis (AS) patients with heart failure.
We measured the whole venous blood of NT-proBNP with enzyme linked immuno sorbent assay (Biomedica, Vienna, Austria) in 40 AS patients with heart failure and 76 normal subjects and assessed the diagnostic value of NT-proBNP for heart failure.
NT-proBNP levels were significantly higher in AS patients with heart failure compared to controls (P < 0.01). The level of NT-proBNP increased in proportion to the increase of NYHA functional classes (all P < 0.01). The level of NT-proBNP was similar between compensated heart failure group and control group (P > 0.05) and significantly (8 times) increased in decompensated heart failure group (P < 0.01 vs. control group). NT-proBNP level was also significantly higher in LVEDD > 50 mm group than that in LVEDD ≤ 50 mm group (P < 0.05) and in LVEF ≤ 60% group than that in LVEF > 60% group (P < 0.01). Patients with atrial fibrillation also had higher NT-proBNP levels compared to those with sinus rhythm (P < 0.05). The NT-proBNP value of 1360 ng/L was determined as the best cutoff value for the diagnosis of AS patients with heart failure (AUC = 0.762, P < 0.01) and decompensated heart failure (AUC = 0.997, P < 0.01), the sensitivity, specificity and accuracy were 67.50% and 100.00%, 96.05% and 96.05% and 86.21% and 95.83%, respectively. Log (NT-proBNP) was positively related with NYHA functional class and negatively related with LVEF in univariate analysis and multiple regression analyses (P < 0.05). NT-proBNP was independent correlative with NYHA functional class and LVEF.
NT-proBNP has a fairly good diagnostic potential for the identification of AS patients with heart failure. The accuracy is 86.21% for the diagnosis of AS patients with heart failure and 95.83% for decompensated heart failure with the diagnostic cutoff value of 1360 ng/L.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 07/2010; 38(7):579-83.
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ABSTRACT: To investigate the relationship of the transforming growth factor beta1 (TGF-β1) mRNA expression in atrial myocardium and the effectiveness of radiofrequency Maze procedure in patients with rheumatic valvular disease (RHD) and permanent atrial fibrillation (AF).
Between January 2008 and September 2008, 40 patients with RHD and AF underwent a radiofrequency Maze procedure with concomitant valvular surgery. The patients were assigned to normal sinus rhythm (SR) group (group A) and persistence AF group (group B) according to the results of the 6-month follow-up. Another 10 patients with SR and RHD undergone valvular surgery alone were assigned to control group (group C). Left atrial appendage were obtained in all patients. Expressions of TGF-β1 mRNA were detected by semiquantitative RT-PCR technique. CVF-I and CVF-III were observed by sirius red staining.
At 6-month follow-up, there were 28 patients in group A and 12 in group B. Patients in group A and group B had higher mRNA expressions of TGF-β1, CVF-I and CVF-I/CVF-III compared with group C (P < 0.05). Also, the group B had higher mRNA expressions of TGF-β1, CVF-I and CVF-I/CVF-III than group A (P < 0.05). The patients who had return of functional atrial contraction in group A had lower mRNA expression than the non-return patients (39 ± 12 vs. 60 ± 12, P < 0.05). The TGF-β1 mRNA expression had a correlation with both the contents of CVF-I and left atrial diameter (r = 0.786, P < 0.05; r = 0.858, P < 0.05). Multiple logistic regression analysis revealed that the risk factors which independently associated with the postoperative persistence of atrial fibrillation at 6-month follow-up includes mRNA expression levels of TGF-β1 (OR = 1.13, 95%CI 1.05 - 1.18, P = 0.031), CVF-I (OR = 1.07, 95%CI 1.00 - 1.13, P = 0.037) and lett atrial diameter (OR = 2.23, 95%CI 1.08 - 4.59, P = 0.042).
The atrial TGF-β1 mRNA expression level could predict the persistence of AF and the return of the functional atrial contraction at 6-month follow-up in patients who underwent rheumatic valvular surgery and concomitant radiofrequency Maze procedure.
Zhonghua wai ke za zhi [Chinese journal of surgery] 06/2010; 48(11):820-4.
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Shou-jun Li, Wei Wang,
Zhe Zheng,
Sheng-shou Hu,
Ying-long Liu,
Xiang-dong Shen,
Jun Yan,
Xu Wang,
Fu-xia Yan,
Jin-ping Liu,
Ju Zhao
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ABSTRACT: To review the efficacy of total anomalous pulmonary venous connection (TAPVC) repair and to conclude the factors impacting the peri-operative death rate.
The clinical data of 145 infants under 1 year old who underwent the TAPVC repair from January 2001 to July 2008 was analyzed. There were 94 male and 51 female patients. The mean age when the repair was performed was (7 ± 3) months, and the average weight was (6.3 ± 1.6) kg. As to the pulmonary connection type, 77 patients were supracardiac (53.1%), 47 patients were cardiac (32.4%), 9 patients were intracardiac (6.2%), and the remaining 12 patients were mixed (8.3%). Pre-surgery echocardiography showed that 21 patients had pulmonary venous obstruction (12 patients were supracardiac type, 3 patients were cardiac type, 3 patients were intracardiac type, and 3 patients were mixed type).
All patients underwent two-ventricle anatomy correction (the cases of complex malformations had been excluded). Peri-operative mortality was 11.7% (17/145). Because of the significant improvement in the surgical techniques, anesthesiology, cardiopulmonary bypass and the management of ICU in January 2006, the population was divided into two groups: A (before January 2006) and B (after January 2006). Peri-operative mortality decreased from 19.0% in group A to 6.2% in group B(P = 0.020). After analysis, it was determined that the factors impacting mortality were which group the patient belongs to, whether he/she had preoperative pulmonary vein obstruction and how big the atril septel connection was. The operative technique to keep the anastomotic aperture adequate and prophylaxis pulmonary hypertensive episodes contributed to the improvement on the mortality rate. There had been no case of repeating the surgery because of pulmonary venous obstruction during peri-operative care period.
Improvements of the surgical technique as well as the treatment in preoperative and postoperative have led to the reduction of the mortality. Preoperative pulmonary vein obstruction is still an important factor that contributes to early mortality.
Zhonghua wai ke za zhi [Chinese journal of surgery] 05/2010; 48(10):731-3.
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ABSTRACT: A hybrid approach to support cell survival and decrease cell escape Cell transplantation has become an attractive option for cardiac regenerative therapy. However, poor cell survival and extensive redistribution throughout the body can drastically affect the outcome and safety of cell therapy. Although various approaches have been attempted to support the survival and engraftment of implanted cells, we need to apply a new comprehensive strategy by melding the in vitro and in vivo approaches to recondition the cells and infarcted myocardium. Here we summarize our understanding of cell survival and migration after transplantation into the damaged heart.
Journal of Cellular and Molecular Medicine 05/2010; 14(5):1078-82. · 4.13 Impact Factor
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ABSTRACT: Despite its widespread use and short-term efficacy, substantial uncertainty remains about the long-term outcomes and cost-effectiveness of off-pump coronary artery bypass (OPCAB).
A retrospective review of prospectively collected data was conducted of 6665 consecutive patients undergoing isolated coronary artery bypass graft (CABG) at our institution during 1999 to 2006. All patients were followed up until September 30, 2008. Short- and long-term outcomes were compared between OPCAB and conventional CABG. The 2 main long-term outcome measures were repeat revascularization and the composite outcome of major vascular events. Cost comparison at 2 years in a propensity-matched sample during follow-up was also a study interest. The overall mean baseline age was 60.3+/-8.6 years, and 17.0% were women. Compared with conventional CABG, patients who underwent OPCAB had lower rates of atrial fibrillation (P=0.003) and requirements for blood transfusion (P=0.03) and ventilation time >24 hours (P<0.001). After an average of 4.5 years of follow-up, the rates of repeat revascularization (adjusted hazard ratio, 1.40; 95% confidence interval, 1.03 to 1.89) and major vascular events (adjusted hazard ratio, 1.23; 95% confidence interval, 1.09 to 1.39) were significantly higher in the OPCAB than the conventional CABG group. At 2 years, OPCAB was associated with increased additional direct costs per patient compared with conventional CABG and had a similar survival rate.
Compared with conventional CABG, OPCAB is associated with small short-term gain but increased long-term risks of repeat revascularization and major vascular events, especially among high-risk patients. Moreover, OPCAB consumes more resources and is less cost-effective in the long run.
Circulation 04/2010; 121(16):1800-8. · 14.74 Impact Factor
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ABSTRACT: To review the experience of extracorporeal cardiopulmonary resuscitation (E-CPR) for cardiac arrest in adults.
From July 2005 to July 2009, extracorporeal life-support (ECLS) was performed for 10-15 minutes failed in CPR in 11 patients (male 7, female 4, age 24-71 years) with cardiac arrest. In 7 patients after cardiac operation, regular cardiopulmonary bypass was urgently established through re-opening of sternotomy incision, followed by extracorporeal membrane oxygenation (ECMO) for continuous support. In other 4 patients, ECMO implantation was directly performed through the femoral vessels during the CPR.
With E-CPR support, although the average CPR duration prolonged to (51+/-14) minutes (30-90 minutes), successful resuscitation was achieved in 10 patients with restoration of spontaneous heart beat. Median support duration of ECMO was 126 hours, ranged from 2 to 223 hours. Six patients could be successfully weaned from ECMO. However, the final discharge rate was 36.4% (4/11). Additional intra-aortic balloon pump was used in 2 patients, with 1 patient survived. Continuous renal replacement therapy (CRRT) was necessary in 3 patients because of acute renal failure.
The use of E-CPR can rescue some adult patients who fail to survive with conventional in-hospital CPR. Further studies are warranted to evaluate in order to better define patients who may benefit from E-CPR.
Zhongguo wei zhong bing ji jiu yi xue = Chinese critical care medicine = Zhongguo weizhongbing jijiuyixue 02/2010; 22(2):82-4.
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ABSTRACT: To compare the predictive value of glomerular filtration rate (GFR) estimated by the Cockcroft-Gault formula or the modification of diet in renal disease (MDRD) equation and serum creatinine for in-hospital and long-term mortality post coronary artery bypass graft surgery (CABG).
Clinical data of 5559 consecutive patients undergoing isolated CABG were retrospectively analyzed. The main outcomes were in-hospital mortality and long-term mortality. Estimated GFR was calculated by the Cockcroft-Gault formula and MDRD equation respectively. Receiver-operating characteristic curves and Cox's analysis were used for the comparison.
Follow-up was complete in 5485 patients (97.6%). Analysis of receiver-operating characteristic curves showed that GFR estimated by the Cockcroft-Gault formula had a maximal accuracy for predicting in-hospital mortality (area under the curve: 0.755, P < 0.01). Multivariate logistic analysis and the Cox's analysis results indicated estimated GFR < 60 mlxmin(-1)x1.73 m(-2) base on the Cockcroft-Gault formula was an independent risk factor for in-hospital and long-term mortality (hazard ratio 4.51 for in-hospital mortality, P < 0.01; hazard ratio 1.54 for long-term mortality, P < 0.01), both Cockcroft-Gault formula and MDRD equation were superior to serum creatinine for predicting in-hospital and long-term mortality post CABG.
GFR estimated by the Cockcroft-Gault formula was superior to GFR estimated by the MDRD equation for predicting in-hospital mortality, and estimated GFR was superior to serum creatinine for predicting in-hospital and long-term mortality.
Zhonghua xin xue guan bing za zhi [Chinese journal of cardiovascular diseases] 02/2010; 38(2):99-102.
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ABSTRACT: To investigate the eGFR as a risk factor for long-term (4-year) outcome in Chinese renal insufficiency patients after isolated coronary artery bypass grafting (CABG) at our institution.
From January 1999 to September 2003, 3371 consecutive patients who underwent isolated CABG were retrospectively reviewed. Of these patients, 549 (16.29%) patients were female, 1979 (58.71%) patients with hypertension, 866 (25.69%) patients with diabetes, 1130 (33.52%) patients with hyperlipidemia, 1011 (29.99%) patients with left main stenosis > 50%, and 1150 (34.11%) patients undergoing off-pump procedures. The mean age was (60 +/- 9) years old. Estimated GFR was calculated using the Cockcroft-Gault formula. The main outcomes were in-hospital mortality, in-hospital morbidity and long-term mortality. COX analysis was used in this study.
There were 649 patients with glomerular filtration rate estimates < 60 ml/(min.1.73 m(2)) and 2722 patients with glomerular filtration rate estimates > 60 ml/(min.1.73 m(2)). The in-hospital mortality and follow-up mortality was higher in the estimated glomerular filtration rate < 60 ml/(min.1.73 m(2)) group (2.77% vs. 0.77%, P < 0.01), (6.81% vs. 2.63%, P < 0.01). The COX analysis result confirmed eGFR < 60 ml/(min.1.73 m(2)), derived using the Cockcroft-Gault formula (HR: 1.948, 95%CI: 1.357 to 2.797, P < 0.01) was an independent risk factor for long-term mortality in patients after coronary artery bypass grafting surgery.
The estimated glomerular filtration rate < 60 ml/(min.1.73 m(2)) derived using the Cockcroft-Gault formula is an independent risk factor for long-term mortality in patients after coronary artery bypass grafting surgery.
Zhonghua wai ke za zhi [Chinese journal of surgery] 01/2010; 48(1):39-41.
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ABSTRACT: Cell escape occurs after intramyocardial injection for treatment of myocardial infarction (MI) and then the migrated cells might be entrapped by extracardiac organs. We investigated the fate of migrated bone marrow-derived mesenchymal stromal cells (MSCs) and their impact on lung, liver, and spleen. MI model was created by coronary artery ligation in female Lewis rats. Three weeks after the ligation, bromodeoxyuridine (BrdU)-labeled male MSCs were directly injected into the infarcted area in the cell transplantation group (n = 22). The same volume of phosphate-buffered solution (PBS) was injected in the control group (n = 21). In the sham group (n = 10) intramyocardial injection of the same volume of PBS was performed in healthy rats. Four weeks later, echocardiography was performed and the cell retention was evaluated by quantitative real-time polymerase chain reaction (qRT-PCR). Immunohistochemistry study was performed to identify the migrated cells. Heart function was improved after the cell injection. qRT-PCR results showed the percentage of retained cells in heart, spleen, liver, and lung ranked 3.63 ± 0.48%, 0.77 ± 0.13%, 0.68 ± 0.10%, 0.62 ± 0.11%, respectively, after cell transplantation. The implanted MSCs that escaped to liver, spleen, and lung did not differentiate into fibroblast, myofibroblast, or alveolar epithelial cells. However, the migrated MSCs in liver expressed functional hepatocyte marker. In conclusion, cell migration after intramyocardial injection did not result in deterioration of lung, liver, and spleen function. Our study might pave the way for new safety investigation of emerging cell resources and their impact on target and untargeted organs.
Cell Transplantation 01/2010; 19(12):1599-607. · 5.13 Impact Factor
