李源
中国医学科学院阜外医院 心内科
Background:More elderly patients undergo coronary artery bypass surgery (CABG) than younger patients. Whether tranexamic acid (TA) is still effective and safe in elderly patients undergoing CABG surgeries is still unclear.Methods:In this study, a cohort of 7,224 patients ≥70 years undergoing CABG surgery were included. Patients were categorized into the no TA group, TA group, high-dose group, and low-dose group according whether TA was administered and the dose administered. The primary endpoint was blood loss and blood transfusion after CABG. The secondary endpoints were thromboembolic events and in-hospital death.Results:The blood loss at 24 and 48 h and the total blood loss after surgery in patients in the TA group were 90, 90, and 190 ml less than those in the no-TA group, respectively (p < 0.0001). The total blood transfusion was reduced 0.38-fold with TA administration compared to that without TA (OR = 0.62, 95% CI 0.56-0.68, p < 0.0001). Blood component transfusion was also reduced. High-dose TA administration reduced the blood loss by 20 ml 24 h after surgery (p = 0.032) but had no relationship with the blood transfusion. TA increased the risk of perioperative myocardial infarction (PMI) by 1.62-fold [p = 0.003, OR = 1.62, 95% CI (1.18-2.22)] but reduced the hospital stay time in patients who were administered TA compared to that of patients who did not receive TA (p = 0.026).Conclusion:We revealed that elderly patients undergoing CABG surgeries had better hemostasis after TA administration but increased the risk of PMI. High-dose TA was effective and safe compared with low-dose TA administration in elderly patients undergoing CABG surgery.
Frontiers in surgery 2023
BACKGROUND:Exploring the mechanisms of valvular heart disease at the cellular level may be useful to identify new therapeutic targets; however, the comprehensive cellular landscape of nondiseased human cardiac valve leaflets remains unclear.METHODS:The cellular landscapes of nondiseased human cardiac valve leaflets (5 aortic valves, 5 pulmonary valves, 5 tricuspid valves, and 3 mitral valves) from end-stage heart failure patients undergoing heart transplantation were explored using single-cell RNA sequencing. Bioinformatics was used to identify the cell types, describe the cell functions, and investigate cellular developmental trajectories and interactions. Differences among the 4 types of cardiac valves at the cellular level were summarized. Pathological staining was performed to validate the key findings of single-cell RNA sequencing. An integrative analysis of our single-cell data and published genome-wide association study-based and bulk RNA sequencing-based data provided insights into the cell-specific contributions to calcific aortic valve diseases.RESULTS:Six cell types were identified among 128 412 cells from nondiseased human cardiac valve leaflets. Valvular interstitial cells were the largest population, followed by myeloid cells, lymphocytes, valvular endothelial cells, mast cells, and myofibroblasts. The 4 types of cardiac valve had distinct cellular compositions. The intercellular communication analysis revealed that valvular interstitial cells were at the center of the communication network. The integrative analysis of our single-cell RNA sequencing data revealed key cellular subpopulations involved in the pathogenesis of calcific aortic valve diseases.CONCLUSIONS:The cellular landscape differed among the 4 types of nondiseased cardiac valve, which might explain their differences in susceptibility to pathological remodeling and valvular heart disease.
Arteriosclerosis, thrombosis, and vascular biology 2022
We report a case of a 21-year-old man with a cardiac pheochromocytoma involving the right atrium and extending to the right ventricular inflow tract, which was diagnosed by somatostatin receptor scintigraphy. For the preoperative evaluation, we chose multiple methods of imaging to accurately describe the anatomic extent and location of the tumor and its surrounding tissues, which showed that no major coronary artery ran through the tumor. The tumor was resected with disease-free margins effectively and safely with the use of cardiopulmonary bypass and with cardiac arrest. The patient remained asymptomatic at the 3-month follow-up.
The Annals of thoracic surgery 2021
Background Cardiac surgery-associated acute kidney injury (CSA-AKI) is a common postoperative complication following cardiac surgery. Currently, there are no reliable methods for the early prediction of CSA-AKI in hospitalized patients. This study developed and evaluated the diagnostic use of metabolomics-based biomarkers in patients with CSA-AKI. Methods and Results A total of 214 individuals (122 patients with acute kidney injury [AKI], 92 patients without AKI as controls) were enrolled in this study. Plasma samples were analyzed by liquid chromatography tandem mass spectrometry using untargeted and targeted metabolomic approaches. Time-dependent effects of selected metabolites were investigated in an AKI swine model. Multiple machine learning algorithms were used to identify plasma metabolites positively associated with CSA-AKI. Metabolomic analyses from plasma samples taken within 24 hours following cardiac surgery were useful for distinguishing patients with AKI from controls without AKI. Gluconic acid, fumaric acid, and pseudouridine were significantly upregulated in patients with AKI. A random forest model constructed with selected clinical parameters and metabolites exhibited excellent discriminative ability (area under curve, 0.939; 95% CI, 0.879-0.998). In the AKI swine model, plasma levels of the 3 discriminating metabolites increased in a time-dependent manner (R2, 0.480-0.945). Use of this AKI predictive model was then confirmed in the validation cohort (area under curve, 0.972; 95% CI, 0.947-0.996). The predictive model remained robust when tested in a subset of patients with early-stage AKI in the validation cohort (area under curve, 0.943; 95% CI, 0.883-1.000). Conclusions High-resolution metabolomics is sufficiently powerful for developing novel biomarkers. Plasma levels of 3 metabolites were useful for the early identification of CSA-AKI.
Journal of the American Heart Association 2021
BACKGROUND:To compare the clinical outcomes, quality of saphenous vein (SV) grafts, and wound complications between endoscopic vein harvesting (EVH) technique and open vein harvesting (OVH) technique in patients with coronary artery bypass graft (CABG) surgery.METHODS:We reviewed one hundred patients with multi-vessel coronary artery disease who underwent elective CABG and agreed to preserve their SV specimens for study. Fifty patients (OVH group) underwent OVH, and the remaining (EVH group) underwent EVH. The median follow-up time was 12 months. Clinical outcomes, 1-year graft patency rates, endothelium integrity of SV grafts and wound complications were assessed.RESULTS:The follow-up time was 12 [12-13] months. Recurrence of angina was observed in 5 patients, with 3 (6.1%) in EVH group and 2 (4%) in OVH group (P=0.68). The endothelium integrity of specimens before distension was similar in both the groups (EVH: 81.1%±6.11% vs. OVH: 80.8%±6.58%, P=0.83). After distension, the endothelium integrity was still similar (EVH: 70.7%±9.73%; OVH: 68.3%±9.60%; P=0.22). Grafts of 5 (11.6%) patients in EVH group were classified as occluded, and 4 (9.8%) patients in OVH group showed occlusion of SV grafts (P=1.0). After day 7, the postoperative leg pain was significantly milder in EVH group than OVH group (1.16±0.76 vs. 2.50±0.91, P<0.01).CONCLUSIONS:These findings suggest that EVH is not associated with worse clinical outcomes or conduit quality. However, it may have advantage in wound healing.
Journal of thoracic disease 2020
Pseudoaneurysms arising from the left ventricular outflow tract are rarely reported. We report a 26-year-old man who was admitted with paroxysmal chest pain and dyspnoea on exertion. Computed tomography revealed the presence of a pseudoaneurysm (93 × 77 mm), and the communication was below the aortic annulus. Through median sternotomy, a huge pulsatile pseudoaneurysm was exposed, and an 8-mm-diameter communication of the pseudoaneurysm in the left ventricular outflow tract wall was visualized. The defect was successfully repaired, and the postoperative course was uneventful.
Interactive cardiovascular and thoracic surgery 2018
BACKGROUND AND OBJECTIVE:Our study aimed to elucidate the potential clinical and molecular issues in recurrent atrial fibrillation (AF) following a radiofrequency modified maze procedure in patients with rheumatic valvular disease and persistent AF.METHODS AND RESULTS:Eighty patients with rheumatic valvular disease and persistent AF (lasting more than 6 months) who had undergone a radiofrequency modified maze procedure and mitral valve replacement were enrolled into this single-center pilot study and were followed up for another 6 months. Their clinical characteristics were analyzed and the expression of matrix metalloproteinase (MMP)-2 including its specific inhibitor and collagen volume fraction (CVF) was also assessed. During the 6-month follow-up, 24 subjects had recurrent AF. Among them, the left atrial diameter was larger compared to that achieved in sinus rhythm (SR). The mRNA and protein expression of MMP-2 was significantly increased in recurrent AF patients, while its specific inhibitor did not show a significant difference (p > 0.05). The CVF of type I collagen increased significantly in the recurrent AF patients compared to SR patients (18.16 ± 3.22 vs. 11.66 ± 3.38, p < 0.001), whereas the CVF of type III collagen showed no significant difference (8.33 ± 3.44 vs. 9.55 ± 3.67, p > 0.05).CONCLUSION:This study suggests that the overexpression of MMP-2 is associated with CVF-I in the left atrial appendage which potentially leads to the recurrence of AF following a radiofrequency modified maze procedure in patients with rheumatic valve disease.
Cardiology 2013
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 2012
