The first aortic valve repair was performed in 1958, but the clinical outcome was limited. Since the invention of prosthetic valves, aortic valve replacement has become and still maintained the dominated surgical treatment option. As the impact of the prosthetic valve-related event to quality of life of the patients and the studies of the mechanism of aortic regurgitation and the functional anatomy of aortic root grow, the application of aortic valve repair gets more popular, and the short- and mid-term outcomes are good.
Objective To measure the rate of changes of the cardiac troponin T (cTnT) and serum urea nitrogen (N), serum creatinine (Cr), estimated glomerular filtration rate (eGFR) of acute type A aortic dissection (AAAD) patients before and after surgery, and to explore the prognostic significance of the rate of changes. Methods We retrospectively analyzed 77 AAAD patients' clinical data between August 2015 and March 2016 from the department of the cardiothoracic surgery in Nanjing Drum Tower Hospital. There were 57 males and 20 females with an average age of 51.1±13.1 years. The test results of cTnT, N, Cr, eGFR were recorded. Patients were divided into three groups based on the duration of ventilation: less than 48 hours, 48 hours to 7 days, longer than 7 days, and divided into two groups based on whether postoperative dialysis was performed: dialysis group and non-dialysis group. Results In the groups with different duration of ventilation, the rate of cTnT change differed significantly. The rate of Cr and eGFR change in the group with the duration of ventilation longer than 7 days showed significantly different compared to other two groups. We found that the rate of Cr and eGFR change were statistically significant between the dialysis group and the non-dialysis group. In the receiver operating characteristic curve (ROC), the optimal cut-off value of the Cr growth rate for predicting postoperative dialysis therapy was 58.1%, and the optimal cut-off value of the eGFR decline rate was 45.5%. Conclusion The rate of changes in cTnT, N, Cr and eGFR can be used as a reliable mean to evaluate respiratory and renal function for AAAD patients in the early stage, which will facilitate an early assessment of the prognosis of AAAD patients.
ObjectiveTo investigate whether there is a protecting effect of remote ischemic preconditioning (RIPC) on patients underwent cardiac valvular surgery. MethodWe retrospectively analyzed the clinical data of 72 adult patients underwent cardiac valvular surgery in our hospital from Febuary 2014 through April 2015 year. There were 26 males and 46 females with an age ranging from 23-68 years. We devided 72 patients into a RIPC group and a control group. There were 14 males and 28 females with a mean age of 48.87±12.28 years in the RIPC group. After the induction of anesthesia, the RIPC group was induced by three cycles of right upper limb ischemia and reperfusion using a blood pressure cuff. The blood pressure cuff was inflated to 200 mm Hg and we held it on for 5 minutes, deflated to 0 mm Hg and maintained for 5 minutes, which was defined as one cycle. There were 10 males and 20 females with a mean age of 47.70±8.07 years in the control group. We placed a standard blood pressure gasbag on the right upper limb for 30 minutes without inflation in the control group. We recorded the clinical data including cardiopulmonary bypass (CPB) time, the cross-clamping time of ascending aorta, preoperative ejection fraction (EF), EF after discharging, postoperative complica-tion and mortality. Blood were sampled preoperatively (T0), 30 minutes after RIPC (T1), 30 minutes aftr the cardiopul-monary bypass finished (T2), 24 hours (T3), 48 hours (T4) and 72 hours (T5) after surgery to detect the concentration of troponin T (cTnT) and creatine kinase-MB (CK-MB). We counted the person-time used dopamine and norepinephrine. ResultThere was no death in both groups. The mechanical ventilation time, the time of ICU stay, the time of hospital stay, the number of person used vasoactive agent, and the EF when discharging showed no statistical difference between the two groups. Levels of cTNT in the RIPC group were statistically lower than those in the control group at T2 and T3 (P=0.001, P=0.001). Levels of CK-MB in the RIPC group were statistically lower than those in the control group at T2, T3, and T4 (P=0.011, P=0.010, P=0.033). ConclusionRIPC may have protective effect on myocardium for patients underwent cardiac valvular surgery.
Objective To evaluate the mid-long term results of application research of artificial Gore-Tex chordate in mitral valvuloplasty in patients with mitral insufficiency caused by endocarditis. Methods We retrospectively analyzed the clinical data of 28 consecutive infective endocarditis(IE) patients who received mitral valve repair with Gore-Tex in our hospital between January 2012 and December 2015. There were 17 males and 11 females. The age of these patients ranged from 18 to 69 (52.0±15.4) years. Echocardiography before operation showed the degree of mitral regurgitation (MR) was severe in 19 patients, moderate in 9 patients. Six patients were in New York Heart Association (NYHA) class Ⅱ, 14 in class Ⅲ, 8 in class Ⅳ. There were 26 selective surgeries and 2 emergent surgeries. One patient had concomitant coronary artery bypass graft. Six patients had aortic valve replacement. Five patients had aortic valve repair. Twenty patients had tricuspid valve repair. Five patients had Maze procedure. Results Follow-up was done to all the patients for 6 months to 55 (30.5±6.4) months. During the follow-up, the echocardiography showed that postoperative left atrium diameter (36.64±8.50 mm vs. 51.78±17.50 mm, P<0.05) and left ventricular end-diastolic dimension (49.30±5.05 mmvs. 57.70±7.49 mm, P<0.05) were significantly smaller than those before operation. The left ventricular ejection fraction (EF) increased from 53.86%±8.16% to 59.14%±4.23% (P<0.05). No MR was found in 16 patients, mild MR in 8 patients, mild to moderate MR in 2 patients, moderate MR in 1 patient. One patient required reoperation for recurrent infection. No death or complications related to thrombosis and embolism occurred after operation. Conclusion Application research of artificial Gore-Tex chordate in mitral valve repair is feasible for treating mitral valve lesions caused by endocarditis, and may provide a long-term outcome to the patients.
ObjectiveTo analyze long-term outcomes of aortic valve replacement (AVR) for patients with severe aortic regurgitation (AR) and left ventricular dysfunction (LVD). MethodsWe retrospectively analyzed clinical data of 44 patients with severe AR and LVD who received AVR in Drum Tower Hospital from January 2002 to December 2012. Left ventricular ejection fraction (LVEF) of all the patients was lower than 35%. There were 29 male and 15 female patients with their age of 23-78 (44±6) years and LVEF of 22%-34% (29%±3%). ResultsTwo patients died because of heart failure postoperatively. Cardiopulmonary bypass time was 57-92 (73±8) minutes, aortic cross-clamping time was 33-61 (48±6)minutes, and length of ICU stay was 2-15 (8±3) days. All the patients were followed up for 1-11 (4.3±2.9) years. Two patients died during follow-up because of heart failure and stroke respectively. One-year survival rate was 93% and five-year survival rate was 91%. ConclusionAVR can significantly increase long-time survival of patients with severe AR and LVD.
Object ive To summar ize recent advance in the appl icat ion and research of ar t i f icial chordae tendineae. Methods The cl inical and experimental research l iterature was extensively reviewed and analyzed. Results The follow-up results showed that artificial chordae tendineae replacement was superior to other operation methods in valve repair. But, it was compl icated and difficult-to-learn. In recent years with the development of many surgical skills and new techniques, good cl inical results were achieved. Conclusion With the development of surgical equi pment, chordae material, and implanting skills, artificial chordae tendineae implanting will be easier and the scope of appl ication will be larger.