If one word is used to describe the development of congenital heart disease surgery in China, "hardship" would be the most appropriate. Generations of pioneers have used their ingenuity to overcome obstacles and promoted the development of the discipline. Seventy years of efforts have established the world's largest congenital heart disease treatment system. However, the huge number of potential patients, low early diagnosis rate and over-screening as well as the uneven developed diagnosis and treatment capabilities hinder the future development. The overall improvement of treatment of congenital heart disease in China lies on more efforts from our fellow experts. The publication of the "Chinese expert consensus on surgical treatment of congenital heart diseases" undoubtedly provides theoretical and practical guidance for the improvement of treatment.
Hybrid coronary revascularization (HCR) combining with coronary artery bypass grafting (CABG) has a long-term patency of left internal mammary artery to left anterior descending artery (LIMA-LAD) grafting, and the percutaneous coronary intervention (PCI) has a minimal invasiveness. It provides an alternative revascularization for patients with coronary heart disease. For patients who meet the HCR indications, most studies suggest that HCR can significantly reduce perioperative trauma, and offer favorable mid- and long-term prognosis, which is comparable with traditional revascularization strategies. Based on the major research results in this field in the past 10 years, we review the current application status and discuss the potential future direction of HCR in this paper.
Objective To introduce a modified REV procedure of complicated transposition of the great arteries （TGA） or double outlet right ventricle （DORV） which was combined with ventrieular septal defect （VSD） and pulmonary valve stenosis（PS）. Methods From Sep. 2005 to Feb. 2006, 3 children with complicated transposition of the great arteries underwent a modified REV operation. This modified REV operation was designed on the basis of classical REV procedure to preserve the native pulmonary artery valve and its function. Results Two patients recovered uneventfully but one died after extraeorporeal membrane oxygenator （ECMO） treatment. After 4 and 1 months follow-up respectively, the discharged 2 patients were asymptomatie and the eehoeardiography revealed that the pressure gradient between left ventrieular-main pulmonary were estimated to be 15 and 5mmHg. Conclusion This modified REV operation for preservation of pulmonary artery valve is an ideal procedure to complicated transposition of the great arteries. Advantages and disadvantages of this modified REV procedure were discussed.
Objective To investigate the surgical indications and the mid and long term results of morphologic tricuspid valve replacement for corrected transposition of the great arteries（cTGA）. Methods From September 1997 to September 2007, 18 cases with cTGA were treated in Fu Wai Hospital. There were 15 male and 3 female, aged from 16 to 51 years（33.3±12.8 years）, and weighed from 47 to 90 kg(60.9±14.7 kg). There were 10 cases with isolated morphologic tricuspid valve insufficiency, 3 complicated with ventricular septal defect, 2 complicated with ventricular septal defect and pulmonary valve stenosis, 2 with morphologic tricuspid valve insufficiency after septal defect repair, and 1 with mechanical valve dysfunction after morphologic tricuspid valve replacement. The preoperative mean morphologic right ventricle ejection fraction was 562%±11.6%. Of the 18 cases, 12 were in grade Ⅱ and 6 were in grade Ⅲ according to New York Heart classification（NYHA）.All the cases had undergone morphologic tricuspid valve replacement. Postoperative indices such as cardiac function and morphological right ventricle ejection fraction were followed up. Results One patient died of postoperative low cardiac output syndrome. Two had pervavlvular leak, which were cured by pervavlvular leak repair at 7th and 30th day after operation, respectively. Sixteen were followed up with a followup time of 57.0±407 months. There was no statistical significance between preoperative and postoperative mean morphologic right ventricle ejection fraction（52.8%±9.2% vs.56.2%±11.6%; t=2.062, Pgt;0.05）. The followup showed that 12 were in NYHA grade Ⅰ or Ⅱ, and 4 were in NYHA grade Ⅲ. There was no statistical significance between preoperative and postoperative percentage of cases in NYHA grade Ⅲ（χ2=1.532，Pgt;0.05）. Conclusion Morphologic tricuspid valve replacement can prevent the further damage to morphologic right ventricular function caused by morphologic tricuspid valve insufficiency. The mid and long term results were satisfying. During the followup, the morphologic right ventricle can function appropriately.
Objective [WTBZ]To assess the impact of dual antiplatelet therapy using aspirin and clopidogrel on postoperative bleeding and blood transfusion early after coronary artery bypass grafting (CABG). Methods [WTBZ]In this randomized controlled trial, 249 patients were randomly assigned to 2 groups after coronary artery bypass grafting from December 2007 to December 2008. Daily clopidogrel (75 mg) and aspirin (100 mg) were initiated in 124 patients (group AC) while aspirin (100 mg) alone was administered to 125 patients (group A). Antiplatelet therapy was initiated within 48h postoperatively. Demographic, operative, and postoperative data were compared between the two groups. Chest tube drainage and quantity of blood products used in both groups were recorded. The effects of the antiplatelet regimen on chest tube drainage were compared using a linear regression model. Results [WTBZ]No statistical difference of demographic, operative, and preoperative data was observed between the two groups （Pgt;0.05）. Chest tube drainage after patients received ntiplatelet agents was not significantly different between group A and group AC（495.00±270.89 ml vs. 489.25±316.68ml，t=0.146, P=0.884）. No statistical difference of cases of transfusion(81 cases vs. 91 cases，χ2=1.937, P=0.164) or quantity of red cells (2.51±2.88 U vs. 2.25±2.87 U, t=0.690, P=0.491) and plasma (195.45±300.88 ml vs. 223.01±238.68 ml,t=0.759, P=0.449) transfused was found between group A and group AC. No perioperative mortality, reexploration or extrathoracic bleeding occurred in either group. Early postoperative use of dual antiplatelet therapy was not associated with increased bleeding after coronary artery bypass grafting on multivariable analysis（r=2.297，95%CI:-64.526,69.121，P=0.946）. Conclusionpresent study suggests that according to a predefined administration protocol, dual antiplatelet therapy of aspirin and clopidogrel can safely be administered in the early postoperative period in CABG patients, without increasing the risk of bleeding complications.
Objective To evaluate the longterm results of coronary artery bypass grafting (CABG) in treating cardiac diseases with heart insufficiency by analyzing the longterm survival rate and heart failure exemption rate of the patients. Methods A total of 239 patients who had coronary heart disease with left heart dysfunction (LVEFlt;40%) were enrolled in our study. Among the patients, there were 215 males and 24 females aged from 32 to 78 years old with an average age of 59.1. Before operation, 193 patients had a past history of myocardial infarction and 31 had angina. According to the New York heart function assessment (NYHA), 26 patients were categorized as class Ⅰ, 106 as class Ⅱ, 73 as class Ⅲ and 34 as class Ⅳ. Coronary angiography showed 10 cases (4.2%) of single vessel disease, 35 cases (14.6%) of double vessel disease and 194 cases (81.2%) of triple vessel disease. The result of preoperative ultrasound cardiogram showed that LVEF was 35.7%±4.6%. All patients received CABG, including 153 (64.0%) onpump surgeries and 86 (35.9%) offpump surgeries. Selective operation was done on 237 patients and there were 2 emergency cases. Valve repair or replacement, ventricular aneurysmectomy or aneurysm plication were not carried out during the operation. Results There were 1 to 6 (3.4±1.1) bypass grafting vessels in each case. Five (2.09%) patients died during the hospital stay, among which 2 died of low cardiac output and circulation failure, 1 died of malignant arrhythmia, 1 died of renal failure, and 1 died of coma with multiorgan failure. The followup period was 512±1.79 years. During the followup, 18 patients (7.7%) were lost and 29 patients died. Among them, there were 24 cardiac deaths and the cardiac death rate at the first year and the fifth year was 2.8% and 9.4% respectively. There were 40 cases of heart failure during the followup period. The exemption rate of heart failure was 93.7% and 81.8% at the first year and the fifth year respectively. The survival rate was 97.2% at the first year and 89.3% at the fifth year. Conclusion The longterm result of CABG in treating patients with ischemic heart insufficiency is satisfying.
Objective To improve the operative effects of patients who had tetralogy of Fallot with aortopulmonary collateral arteries (TOF-APCAs) and evaluate the clinical effects of staging and onestop hybrid approach for TOFAPCAs. Methods From January 2003 to December 2007, thirty patients with TOF-APCAs had undergone combined therapy of APCAs embolization and complete surgical repair. Fifteen patients had APCAs embolization therapy before or after TOF radical operation(staging hybrid group ); Fifteen had onestop hybrid treatment(onestop hybrid group). Results Angiography revealed that there were 19 APCAs in staging hybrid group, and of which 15(78％) were embolized successfully. Five cases had complications and one died from respiratory circulating failure. The rest all recovered and discharged. And 22 APCAs were found in one-stop hybrid group, eighteen (82％) of them were embolized successfully. Only one case had pulmonary effusion. The time of hospitalization(median 37 d vs. 22 d, P=0.011),ICU staying（median 7.0 d vs. 4.7 d,P=0.029）and endotracheal intubation（median 131 h vs. 19 h,P=0.009） was obviously longer, and the hospitalization expenses（median 64 101 [CM(159mm]yuan vs. 48 021 yuan, P=0.033）were obviously higher in staging hybrid group than that in one-stop hybrid group.And there was no statistical significance in cardiopulmonary bypass time（P=0.126） and aortic clamping time（P=0.174） between two groups. Conclusion In comparison with traditional staging hybrid approach, one-stop hybrid approach can simplify the operative process for patients who have TOFAPCAs, improve the operative successful rate and cut down expenses.
Objective To study the development of a physiologic fixation method and investigate the effect of physiologic fixation method on porcine aortic root and aortic valve leaflets. Methods Physiological fixer of aortic root was manufactured in a factory. The fixers with different diameter were made of organic glass. Porcine aortic root with ascending aorta and anterior leaflet of mitral valve and partial ventricular septum were dissected out from the fresh heart. The roots were attached to appropriately sized inflow and outflow spigots. Physiologic fixation was utilized to maintain aortic root and leaflets natural anatomical shape, the aortic root was pressurized to the inflow and outflow portions simultaneously, and the leaflets floated freely at zero-pressure differential with in the pressurized root. Results The process of physiologic fixation retained the properties of a native valve. The leaflets were much softer and extensible than those from valves fixed under low pressure. The results of pulsatile flow testing indicated that the effective orifice areas of predilation at 80mmHg were significantly greater than those of predilation at 40 mmHg（P〈0.05）, while mean pressure differences were found to be lower comparatively（P〈0.05）. This difference translates into a mode of valve function that more closely approximates that of the native aortic valve. Conclusion Physiologic fixation process retains the valve＇s natural anatomical shape as well as the underlying structure of the leaflets, providing improved flow characteristics.
Atrial fibrillation （AF） is the most common cardiac arrhythmia and associated with incremental morbidity and mortality. It is implicated that multiple reentry circuits have been the dominant mechanism of AF. The classical surgical treatment for medically refractory AF is the maze procedure composed of aultiple cuts and sutures within the atrial walls to disrupt the abnormal reentry circuits. Although the maze procedure is recognized as the most effective treatment of AF, it is complicated, time consuming and much invasive. New surgical ablation therapy, applying alternate energy sources （cryothermy, radiofrequency, microwave） have evolved to simplify the maze procedure without cut and suture and demonstrated promising success rates. The optimal lesion set has not yet been defined, Modification of lesion sets and techniques that ensure continuous and transmural lesions may improve the outcomes of ablation therapy and recover rate of sinus rhythm.
Abstract： Objectives To evaluate the early and mid-term follow-up outcomes of “one-stop” hybrid coronary revascularization strategy for patients with multivessel coronary artery disease. Methods From June 2007 to December 2009, 104 consecutive patients underwent “one-stop”hybrid coronary revascularization in Fu Wai Hospital. There were 93 male patients and 11 female patients with mean age of （61.8±10.2）years（ranging from 35 to 81 years）. All the patients had multivessel coronary artery disease including left anterior descending （LAD）coronary artery stenosis, and underwent “one-stop”hybrid coronary revascularization. “One-stop”hybrid procedure was first performed through a lower partial sternotomy at the second left intercostal space. The distal anastomosis of in situ left internal mammary artery （LIMA）to LAD graft was completed. Angiography was performed immediately to confirm patency of the LIMA graft after closure of the thorax. A 300 mg loading dose of clopidogrel was administered through a nasogastric tube after confirmation of LIMA graft patency. Intravenous unfractionated heparin was administered to obtain an activated clotting time of greater than 250 s. Then percutaneous coronary intervention（PCI）was performed on the non-LAD lesions. Results All the patients underwent“one-stop”hybrid coronary revascularization including grafted LIMA to LAD，and one hundred and ninety one drug eluting stents and three bare metal stents were used for other non-LAD lesions. No death event occurred during surgery and in hospital. All the patients were followed up for a mean duration of 1.5 years. There was no myocardial infarction, neurologic event or death occurred during follow-up except one patient with stent stenosis who was treated by PCI. Conclusion “One-stop” hybrid coronary revascularization is a feasible and safe alternative for patients with multivessel coronary artery disease.