李岩
中国医学科学院阜外医院 心血管外科
In an injured neonatal myocardium, macrophages facilitate cardiomyocyte proliferation and angiogenesis and promote heart regeneration. The present study reveals that transplantation of neonatal cardiac macrophages recruited by injury promotes adult heart regeneration after myocardial infarction with improvement of cardiac function and cardiomyocyte proliferation. The results indicate that neonatal cardiac macrophage transplantation could be a promising strategy for cardiac injury treatment. Here, we provide the technical details, including the isolation of neonatal cardiac macrophages from apical resection-injured neonatal mouse hearts, the transplantation of macrophages into myocardial-infarcted adult mice, and the estimation of heart regeneration after a macrophage graft.
Journal of visualized experiments : JoVE 2021
OBJECTIVES:The purpose of this study was to assess the efficacy of the hybrid total arch procedure for the treatment of DeBakey type I dissection by analyzing mid-term results.METHODS:From November 2009 to September 2014, 56 patients with DeBakey type I dissection underwent hybrid total arch repair without deep hypothermic circulatory arrest. During the follow-up, computed tomographic imaging was performed to evaluate the aortic diameter, true lumen diameter, false lumen diameter and false patency at the following three levels: pulmonary bifurcation, diaphragm and superior mesenteric artery.RESULTS:The hospital mortality rate was 3.6% (2/56 patients). Three patients exhibited type Ia endoleak during the operation and 1 patient demonstrated type II endoleak 5 days after surgery. During the follow-up, false lumen complete thrombosis was observed at the level of the pulmonary bifurcation in 94% of patients (P < 0.001). At the level of the diaphragm and superior mesenteric artery, false lumen thrombosis was observed in 68% (P < 0.001) and 36% (P < 0.001) of patients, respectively. No patient had type I or III endoleak and no reoperation was related to residual dissected aorta. The actuarial 1-, 3- and 5-year survival rates were 96.4% [95% confidence interval (95% CI), 91.5-100], 92.3% (95% CI, 85-99.6) and 89.6% (95% CI, 80.8-98.4), respectively.CONCLUSIONS:For patients with DeBakey type I dissection, the hybrid total arch procedure can be safely adopted with good mid-term results and with low morbidity and mortality. Longer-term follow-up is required to confirm the viability of this technique.
Interactive cardiovascular and thoracic surgery 2016
Loeys-Dietz syndrome presents early in life with rapidly progressive aortic aneurysmal disease. Aortic emergency in young children with Loeys-Dietz syndrome is an extremely rare occurrence. In this communication we report on 2 young children whose diagnoses were missed and consequently underwent urgent aortic repair due to aortic emergencies. For personalized management of aortic disease in Loeys-Dietz syndrome patients, when and how do we intervene?
The Annals of thoracic surgery 2015
BACKGROUND AND AIM OF THE STUDY:The study aim was to investigate the mid-term risk factors for neo-aortic regurgitation in patients with transposition of the great arteries (TGA) and Taussig-Bing malformation after the arterial switch operation (ASO).METHODS:Between February 2001 and December 2007, a total of 202 patients with TGA or Taussig-Bing malformation underwent the ASO at the authors' institution. Subsequently, 185 surviving patients (140 males, 45 females; mean age 14 +/- 28 months) were followed up in the out-patient department, using echocardiography. A multiple logistic regression analysis was performed to identify the risk factors for postoperative neo-aortic regurgitation.RESULTS:The mean period of follow up was 35 +/- 22 months (range: 3 to 88 months). Postoperative neo-aortic regurgitation was present in 19 patients; this was mild in 16 cases (9%) and moderate in three (2%). During the follow up, freedom from aortic regurgitation was 90%; the overall rates of freedom from aortic regurgitation at one, three, and five years were 95%, 89%, and 83%, respectively. The mid-term risk factors for neo-aortic regurgitation were ventricular septal defect (VSD) (p = 0.02), operative age >6 months (p = 0.01), and a postoperative neo-aortic valve Z-score >1 (p <0.01).CONCLUSION:The ASO showed an acceptable midterm function of the aortic valve. The risk factors for postoperative neo-aortic regurgitation included VSD, operative age >6 months, and a postoperative neo-aortic valve Z-score >1.
The Journal of heart valve disease 2010
BACKGROUND:Biventricular repair of double-outlet right ventricle (DORV) with noncommitted ventricular septal defect (VSD) or subpulmonary VSD, associated with pulmonary stenosis, remains controversial. The usual technique, Rastelli or réparation à l'étage ventriculaire (REV) procedure, may not meet a perfect biventricular outflow tract reconstruction in terms of hemodynamic performance and long-term outcome. Here we present an early result of an alternative solution for these anomalies by double-root translocation technique.METHODS:Between August 2006 and August 2009, a total of 10 consecutive patients underwent a double-root translocation procedure, at a median age of 48 +/- 55 months (range, 1 to 16 years). The VSD was repaired with a Dacron patch, and VSD enlargement was done in 3 patients. The aortic translocation was done with (n = 4) or without (n = 6) coronary reimplantation. The neopulmonary artery was reconstructed with a monocusp bovine jugular vein patch (n = 8) or a homograft patch (n = 2). The mean follow-up interval was 21.9 +/- 11 months (range, 2 to 36). Biventricular outflow tract function was assessed by echocardiography.RESULTS:There were no early or late deaths, and no required reoperations. Two patients required early support by extracorporeal membrane oxygenation. Postoperative echocardiography showed satisfactory hemodynamic effect of the reconstructed biventricular outflow tract and ventricular function. One patient had trivial aortic regurgitation and 4 patients had trivial or mild pulmonary insufficiency in follow-up.CONCLUSIONS:The early results showed an optimized solution for DORV with noncommitted VSD or DORV with subpulmonary VSD, associated with pulmonary stenosis. Long-term benefits need to be evaluated with a larger number of patients and longer follow-up.
The Annals of thoracic surgery 2010
BACKGROUND:Numerous studies have compared the outcomes of coronary artery bypass grafting (CABG) surgery and coronary stenting for the treatment of multivessel coronary disease. In 2003, drug-eluting stents were introduced with the hope of reducing restenosis. However, limited information exists on the comparison of drug-eluting stents and CABG surgery. The long-term outcome of drug-eluting stents compared with that of CABG surgery is also unclear.METHODS AND RESULTS:We identified 3720 consecutive patients with multivessel disease who underwent isolated CABG surgery or received drug-eluting stents between April 1, 2004, and December 31, 2005, and we compared safety (total mortality, myocardial infarction, and stroke) and efficacy (target-vessel revascularization) during a 3-year follow-up. These outcomes were compared after adjustment for differences in baseline risk factors. Patients who underwent CABG (n=1886) were older and had more comorbidities than patients who received drug-eluting stents (n=1834). Patients receiving drug-eluting stents had considerably higher 3-year rates of target-vessel revascularization. Drug-eluting stents were also associated with higher rates of death (adjusted hazard ratio, 1.62; 95% confidence interval, 1.07 to 2.47) and myocardial infarction (adjusted hazard ratio, 1.65; 95% confidence interval, 1.15 to 2.44). The risk adjusted rate of stroke was similar in the 2 groups (hazard ratio, 0.92; 95% confidence interval, 0.69 to 1.51).CONCLUSIONS:In a cohort of patients with multivessel disease, CABG was associated with lower rates of death, myocardial infarction, and target-vessel revascularization than drug-eluting stents.
Circulation 2009
OBJECTIVE:The European System for Cardiac Operative Risk Evaluation (EuroSCORE) model is a widely used risk prediction algorithm for cardiac surgery in China due to lack of a local model, although its validation has never been tested. The aim of this study was to assess the performance of the logistic EuroSCORE when applied in the Chinese Coronary Artery Bypass Grafting Registry database, which is representative of adult cardiac surgery in China.METHODS:The logistic EuroSCORE model was applied to all patients undergoing coronary artery bypass grafting (CABG) surgery at 35 centres in China between January 2004 and December 2005. The entire cohort and a subgroup of patients undergoing isolated CABG were analysed. The calibration of the EuroSCORE model was assessed by comparing observed and predicted in-hospital mortalities. Discrimination was tested by determining the area under the receiver operating characteristic (ROC) curve.RESULTS:The Chinese CABG Registry Study recruited 9248 patients. There were significant differences in the prevalence of risk factors between the Chinese population and European cardiac surgical populations. For the entire cohort, the predicted mortality was 5.51% and observed mortality was 3.27%. Of the isolated CABG subset of 8120 patients, the predicted mortality was 4.21% and the observed mortality was 2.22%. The logistic EuroSCORE overpredicted observed mortality for the entire cohort and the isolated CABG subset at all risk tertiles to different degrees. The discriminative power of EuroSCORE was acceptable but not very satisfactory, with an area under the ROC curve of 0.72 for the entire cohort and 0.71 for the isolated CABG subset.CONCLUSION:EuroSCORE model does not accurately predict outcomes in this group of Chinese CABG patients. Therefore, caution should be exercised when using it for risk prediction in China. Creation of a new model, which accurately predicts outcomes in Chinese CABG patients, is warranted.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2009
BACKGROUND:Preoperative renal dysfunction has been an important predictor for adverse cardiovascular events after coronary artery bypass grafting (CABG). In the past, serum creatinine was widely used to assess renal function. Until recently, estimated glomerular filtration rate (eGFR) was recommended in evaluating renal function. The Cockcroft-Gault formula and the Modification of Diet in Renal Disease (MDRD) equation are two widely used formulas in clinical practice. Which method best predicts long-term outcome after CABG is still unknown. This study compared the predictive effectiveness of the Cockcroft-Gault formula, the MDRD equation, and serum creatinine level for in-hospital and long-term mortality.METHODS:We retrospectively reviewed data collected from 5559 patients who underwent isolated CABG at Fuwai Hospital from January 1999 to December 2005. The main outcomes were in-hospital and long-term mortality. Receiver operating characteristic (ROC) curves and Cox analysis were used for the comparison.RESULTS:Mean follow-up was 56.5 +/- 24.6 months. ROC curve analysis showed that the Cockcroft-Gault formula had the greatest accuracy for predicting in-hospital mortality (area under the curve, 0.755; p < 0.001). Multivariate analysis confirmed that the eGFR based on the Cockcroft-Gault formula was an independent predictor of in-hospital (odds ratio, 4.51, p < 0.001) and long-term (hazard ratio, 1.54; p = 0.003) mortality. Both formulas were better than the serum creatinine level.CONCLUSIONS:Both formulas could provide a better measure of risk assessment than serum creatinine for in-hospital and long-term mortality. The Cockcroft-Gault formula was better than the MDRD equation for predicting in-hospital mortality.
The Annals of thoracic surgery 2009
BACKGROUND:This research was aimed at validating a new risk model for in-hospital mortality in Chinese patients undergoing coronary artery bypass graft (CABG) surgery. This model (NYS), which was developed for isolated CABG surgery from data of New York's cardiac surgery reporting system in 2002, was proved effective, but its validation in Chinese patients has yet to be carried out.METHODS:The original model was recalibrated, and the fitness of the recalibrated model was tested in the Chinese Coronary Artery Bypass Graft Registry. From January 2004 to December 2005, 9248 patients undergoing CABG were enrolled in the Chinese CABG Registry, and 8120 patients who underwent isolated CABG were selected for the current study.RESULTS:The C statistic value for the original model was 0.74 (95% confidence interval [CI], 0.70-0.78), and the chi2 statistic was >26.13 (P < .001), indicating a necessity for recalibration. The fit of the recalibrated model was satisfactory (C statistic, 0.74 [95% CI, 0.70-0.78]; chi2 = 5.98; P = .65). Furthermore, translation of risk profiles into NYS scores revealed strong correlations between risk-score levels and different end points, including in-hospital mortality, major adverse cardiac events, and length of intensive care unit stay. Independent predictors were identified in the Chinese CABG Registry. Many predictors for the Chinese CABG Registry were the same as those in the NYS model.CONCLUSIONS:The original NYS system overestimates in-hospital mortalities in Chinese patients undergoing CABG, whereas the recalibrated model corrects such overestimations. This model can be a useful risk-predictive tool for Chinese patients undergoing isolated CABG.
The heart surgery forum 2008
OBJECTIVE:The aim of the present study was to investigate the influence of off-pump coronary artery bypass grafting on early and long-term mortality and morbidity in a consecutive series of elderly patients (aged > 65 years) compared with conventional coronary artery bypass grafting.METHODS:From January of 1999 to December of 2003, data were extracted for 1191 patients aged more than 65 years: a conventional coronary artery bypass grafting group (n = 744) and an off-pump coronary artery bypass grafting group (n = 447). Age-related early outcomes of interest were in-hospital mortality and postoperative morbidities. Long-term outcomes, including total mortality, repeated revascularization, Q-wave myocardial infarction, stroke, readmission, and the combination of death, Q-wave myocardial infarction, stroke, and repeated revascularization, were evaluated with Cox regression analysis.RESULTS:Univariate analysis for early outcomes showed significant benefits from off-pump coronary artery bypass grafting. After adjustment for baseline characteristics, there was still a benefit of off-pump coronary artery bypass grafting. Kaplan-Meier survival analyses (propensity matched cases) showed that stroke, major adverse cardiac and cerebrovascular events, and readmission occurred more frequently in the off-pump coronary artery bypass grafting group (P < .001). There was a nonsignificant trend to higher total mortality (P = .193) and higher repeated revascularization rates (P = .067) in the off-pump coronary artery bypass grafting group. Cox regression for long-term outcomes showed that patients in the off-pump coronary artery bypass grafting group had a higher incidence of stroke (hazard ratio 2.611, 95% confidence interval 2.152-3.070), readmission (hazard ratio 2.000, 95% confidence interval 1.747-2.253), and major adverse cardiac and cerebrovascular events (hazard ratio 1.764, 95% confidence interval 1.456-2.072).CONCLUSION:Our analysis shows that off-pump coronary artery bypass grafting compared with conventional coronary artery bypass grafting was associated with favorable early outcomes in the elderly population. However, the early benefits of off-pump coronary artery bypass grafting were not maintained in the long term, and off-pump coronary artery bypass grafting showed trends toward worse long-term results.
The Journal of thoracic and cardiovascular surgery 2008
