马浩
中国医学科学院阜外医院 小儿心外科三病区
OBJECTIVES:Subclinical hypothyroidism (SCH) is characterized by an elevated thyroid-stimulating hormone and normal free thyroxine. This study aimed to evaluate the influence of SCH on mid-term outcomes of patients after coronary artery bypass grafting (CABG).METHODS:From January 2015 to December 2018, 548 SCH patients and 6718 euthyroid patients who underwent CABG were identified. Propensity score matching was used to create 2 cohorts with similar baseline characteristics (n = 544 in each group). The mid-term follow-up outcomes were compared. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models.RESULTS:The mean follow-up for all patients was 39.7 ± 17.3 months. The unadjusted Kaplan-Meier estimate for mortality at 5-year follow-up was higher in patients with SCH compared with euthyroid patients (5.3% vs 1.6%, log-rank P = 0.03). After adjusting for covariates, the risk of mortality was higher in patients with SCH compared with euthyroid patients [HR, 2.40; 95% confidence interval (CI), 1.03-5.58; P = 0.04]. The adjusted risk of major adverse cardiovascular and cerebral event (HR, 2.16; 95% CI, 1.51-3.08; P < 0.001) and angina (HR, 2.44; 95% CI, 1.41-4.24; P = 0.001) was higher in patients with SCH compared with euthyroid patients.CONCLUSIONS:SCH is associated with an increased risk of mortality, major adverse cardiovascular and cerebral event and angina compared with euthyroidism in patients undergoing CABG.
Interdisciplinary cardiovascular and thoracic surgery 2023
BACKGROUND:The prognosis of severe coronary artery disease (CAD) patients undergoing left ventricular restoration (LVR) and ineligible for concomitant coronary artery bypass grafting (CABG) is unclear. This study illustrates the clinical characteristics and the long-term survival of these patients in a retrospective cohort.METHODS:From January 1999 to March 2021, a total of 78 patients underwent surgical left ventricular restoration without concomitant CABG at our center. The primary endpoint was the major adverse cardiovascular and cerebrovascular events (MACCE). Kaplan-Meier analysis was performed to calculate survival, and compared by log-rank test, followed by multiple adjustments using Cox regression.RESULTS:The mean age was 55.3 ± 11.4 years. There were 76 (97.4%) true and 2 (2.6%) pseudo-aneurysms. Forty-six (59.0%) patients presented NYHA functional class III or IV. The mean EuroSCORE was 10.6 ± 3.2. Concomitant surgeries included mitral valve repair (N = 3), mitral valve replacement (N = 2), tricuspid valve repair (N = 2), ventricular septal defect closure (N = 18), maze procedure (N = 1), and appendage ligation (N = 1). Reoperation for bleeding was performed in one patient (1.3%). Prolonged ventilation was observed in 21 (26.9%) patients. Fourteen (17.9%) patients presented with low cardiac output and were supported with IABP. Operative death occurred in one (1.3%) patient. The median duration of echocardiographic follow-up was 53 months (interquartile range, 81.5) and was obtained in 46 (59.0%) patients. Left ventricular ejection fraction (LVEF) improved from 41.1% ± 10.5% to 45.6% ± 7.9% (P < 0.001), and the left ventricular end-diastolic dimension (LVEDD) fell from 57.8 ± 6.6 mm to 52.0 ± 6.2 mm (P < 0.001). The median patient follow-up time was 79.5 months (interquartile range, 53.5). Overall, 1-, 5-, and 10-year survival rates were 98.7%, 95.5% and 82.3%, respectively.CONCLUSIONS:Patients with severe CAD and ineligible for concomitant CABG are in critical condition, and LVR could be a reliable approach to improving cardiac function with satisfactory early and long-term outcomes.
The heart surgery forum 2022
OBJECTIVE:This study aims to compare the midterm outcomes of left ventricular reconstruction (LVR) added to coronary artery bypass grafting (CABG) with those of CABG alone in patients with left ventricular aneurysm (LVA) and mild or moderate mitral regurgitation (MR). We also assessed the impact of LVR on the degree of MR.METHODS:A total of 130 patients (77 who underwent CABG plus LVR and 53 who underwent CABG alone) with concomitant mild or moderate MR were included in the study population. All-cause mortality was considered the primary endpoint. Major adverse cardiovascular and cerebrovascular events (MACCEs), including death, myocardial infarction, stroke, and subsequent mitral valve surgery, were considered secondary endpoints. Kaplan-Meier analysis was performed to evaluate event-free survival. MR was graded 0 to 4+ by echocardiogram.RESULTS:The median follow-up time among all patients was 22 months. There was a significant difference between the CABG plus LVR and CABG alone groups with regard to all-cause mortality ( P = 0.019). However, the statistical difference was not observed in cardiogenic mortality ( P = 0.186) and MACCEs ( P = 0.107). In the grade of MR, the two groups both resulted in the decreased grade of MR, but the CABG plus LVR group had a significant number of patients improving to 0 or 1+ ( P = 0.030).CONCLUSION:The clinical outcomes of CABG alone are comparable with those of CABG plus LVR in patients with LVA and mild or moderate MR. However, CABG+LVR demonstrated greater reduction in MR severity after surgery than CABG alone.
Coronary artery disease 2022
Cardiac fibroma is a rare benign primary tumour of the heart. In the paediatric population, it has been reported as the second most common benign cardiac tumour following rhabdomyoma. However, the prevalence of cardiac fibroma is rarely reported in the adult population. Signs and symptoms are nonspecific, including palpitations, cardiac murmur, arrhythmias, dyspnoea, cyanosis, chest pain, and sudden mortality, whereas, a number of patients with cardiac fibroma are asymptomatic. Surgical resection should be considered as the best option in symptomatic patients. This study reported four surgical cases of adults with cardiac fibroma arising from the left ventricle and a literature review regarding the clinical and pathological features, diagnostic modalities, therapeutic aspects, and prognosis of this rare entity.
Cardiology in the young 2020
