Objectives To determine themyocardium -protecting effect of medium hypothermalblood cardioplegia (MHBC); further demonstrates thatthe optimal temperature between these hypothermaland normothermic can overcome the disa...Objectives To determine themyocardium -protecting effect of medium hypothermalblood cardioplegia (MHBC); further demonstrates thatthe optimal temperature between these hypothermaland normothermic can overcome the disadvantages;and thus discovers a more effective myocardium pro-tecting method. Methods Section 1: 14 mongreldogs (15-20 kg) were randomly divided into twogroups: experimental group and control group; car-dialpulmonary bypass was conventionally instituted,moderate hypothermia blood cardioplegia was used inexperimental group, Blood samples from right atriumtaken for examination of lactate dehydrogenase (LDH)creatine kinase(CK-MB) and Topin Ⅰ(cTn-Ⅰ). speci-mens of left ventricular subendocardial myocardiumwere biopsied to observe changes of ultrastructure.Section 2: 24 patients were randomly divided into twogroups and both groups received two types of treat-ment (same as Section 1) after aorta cross-clamp(ACC). Biochemical index and Clinical observationwere caculated as the indicators. Results In the ex-perimental research, LDH, CK-MB, cTn-Ⅰ were foundincreased afer reperfusion in both groups, but the ex-tent of changes in experimental group is tiny (statisti-cal difference). Compared with control group the effectof MHBC on cardial function is litile; the ultrastruc-ture. of cardiac muscle has no obvious change. In theclinical research, compared the test results of venousblood drawn before CPB, after beating recovery andafter CPB, CBC perfused group (LDH, CK-MB leak-age and cTn-Ⅰ value increase.) compared with MHBCperfused group had no remarkable difference (P>0.05), but at the result of clinical observation: MHBCperfused group had red, soft hearts after cardiac arrestbut CBC perfused group had pale, spasmatic heartsafter cardiac arrest; 0 case in MHBC perfused groupand 3 cases in CBC perfused group had twitch-re-moving beat recovery; 11 cases in MHBC perfusedgroup and 3 cases in CBC perfused group recoveredsinus heart rhythm after surgery; average consumptionof lidocaine was 16.67 (±55.28) mg for MHBC per-fused group and 118.33(±82.65) mg for CBC perfusedgroup (P<0.01) afer surgery; 4 cases in MHBC per-fused group and 11 cases in CBC perfused group suf-fered arrhythmia after surgery. Conclusions As anew myocardium - protecting method, MHBC perfusionin combination with natural body temperature drop ofCPB is worth clinical dissemination and application.展开更多
Background Although the results of surgical treatment in cardiac valve disease continue to improve, the postoperative mortality rate and the rate of complications in patients with advanced valvular heart disease (AVH...Background Although the results of surgical treatment in cardiac valve disease continue to improve, the postoperative mortality rate and the rate of complications in patients with advanced valvular heart disease (AVHD) are still very high. We did this retrospective study to summarize the surgical experience of heart valve replacement for patients with AVHD and discuss effective ways to improve the surgical outcome.Methods From January 1994 to October 2003, surgical procedures of heart valve replacement were performed on 227 (136 men and 91 women) patients with AVHD in our Department of Cardiothoracic Surgery. The clinical data of all patients were collected and analysed. Patients’ age ranged from 10 years to 77 years. In preoperative cardiac function grading, 157 cases were NYHA III and 70 cases NYHA IV. Fifty-one patients had had cardiac operations. The ultrasonic cardiac graphs showed that 145 patients suffered from moderate or severe pulmonary hypertension and 73 had combined giant left ventricle. Mitral valve replacement was performed in 32 cases, aortic valve replacement in 90, tricuspid valve replacement in 1, combined mitral and aortic replacement in 103 and combined mitral and tricuspid replacement in 1. Nineteen patients also received surgical corrections for other minor abnormalities during the operations. A logistic model was established to evaluate the influence of perioperative factors on the mortality rate. Results The operative mortality rate was 13.2% (30/227). The main causes of death included multiple organ dysfunction syndrome (MODS), low cardiac output syndrome and ventricular fibrillation. From the results of the binary noncounterpart multivariate logistic regression, the following statistically significant factors were found to influence the operative mortality rate: redo operation, age ≥55 years, preoperative NYHA cardiac function grading, extracorporeal circulation time ≥120 minutes and postoperative usage of GIK (glucose, insulin and potassium) solution. All factors were risk ones except postoperative application of GIK. The Hosmer-Lemeshow goodness of fit coefficient of this model was 0.976. Conclusions The risk factors associated with postoperative mortality rate in the patients with AVHD were redo operation, age ≥55 years, preoperative NYHA cardiac function grading and extracorporeal circulation time ≥120 minutes. Postoperative usage of GIK acted as a kind of metabolic therapy and will improve the recovery for patients with AVHD. Active perioperative management and care will play a very important role in reducing the operative risk and improving the short term outcome of surgical treatment for the patients with AVHD.展开更多
Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved w...Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved with a modified linear closure of leftventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 toMay 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysmduring off-pump coronary artery bypass surgery. Repair was completed on the beating heart tominimize ischaemia and allow assessment of wall function and viability to guide closure. Allpatients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia.The majority (75% ) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejectionfraction was 26% ±9%. The mean left ventricular, end diastolic diameter was (57. 5 ±7. 1) mm. Theventricular preoperative and postoperative performances were compared. χ~2 test and Student' s ttest were used to analyse the outcomes. A P value less than 0. 05 was considered significant.Results Hospital mortality was 1. 3% (1/75). Coronary artery bypass was performed with an average of(3. 3 ±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. Themean NYHA class and ejection fraction increased significantly (P < 0.001 ) . The mean leftventricular, end diastolic diameter decreased significantly (P <0. 001). Conclusions Surgicalclosure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. Theoperation is associated with a low inhospital mortality and morbidity. A postoperative improvementin the early term cardiac functions and symptoms and quality of life was documented, increasing ourexpectations of an increased long-term survival.展开更多
文摘Objectives To determine themyocardium -protecting effect of medium hypothermalblood cardioplegia (MHBC); further demonstrates thatthe optimal temperature between these hypothermaland normothermic can overcome the disadvantages;and thus discovers a more effective myocardium pro-tecting method. Methods Section 1: 14 mongreldogs (15-20 kg) were randomly divided into twogroups: experimental group and control group; car-dialpulmonary bypass was conventionally instituted,moderate hypothermia blood cardioplegia was used inexperimental group, Blood samples from right atriumtaken for examination of lactate dehydrogenase (LDH)creatine kinase(CK-MB) and Topin Ⅰ(cTn-Ⅰ). speci-mens of left ventricular subendocardial myocardiumwere biopsied to observe changes of ultrastructure.Section 2: 24 patients were randomly divided into twogroups and both groups received two types of treat-ment (same as Section 1) after aorta cross-clamp(ACC). Biochemical index and Clinical observationwere caculated as the indicators. Results In the ex-perimental research, LDH, CK-MB, cTn-Ⅰ were foundincreased afer reperfusion in both groups, but the ex-tent of changes in experimental group is tiny (statisti-cal difference). Compared with control group the effectof MHBC on cardial function is litile; the ultrastruc-ture. of cardiac muscle has no obvious change. In theclinical research, compared the test results of venousblood drawn before CPB, after beating recovery andafter CPB, CBC perfused group (LDH, CK-MB leak-age and cTn-Ⅰ value increase.) compared with MHBCperfused group had no remarkable difference (P>0.05), but at the result of clinical observation: MHBCperfused group had red, soft hearts after cardiac arrestbut CBC perfused group had pale, spasmatic heartsafter cardiac arrest; 0 case in MHBC perfused groupand 3 cases in CBC perfused group had twitch-re-moving beat recovery; 11 cases in MHBC perfusedgroup and 3 cases in CBC perfused group recoveredsinus heart rhythm after surgery; average consumptionof lidocaine was 16.67 (±55.28) mg for MHBC per-fused group and 118.33(±82.65) mg for CBC perfusedgroup (P<0.01) afer surgery; 4 cases in MHBC per-fused group and 11 cases in CBC perfused group suf-fered arrhythmia after surgery. Conclusions As anew myocardium - protecting method, MHBC perfusionin combination with natural body temperature drop ofCPB is worth clinical dissemination and application.
文摘Background Although the results of surgical treatment in cardiac valve disease continue to improve, the postoperative mortality rate and the rate of complications in patients with advanced valvular heart disease (AVHD) are still very high. We did this retrospective study to summarize the surgical experience of heart valve replacement for patients with AVHD and discuss effective ways to improve the surgical outcome.Methods From January 1994 to October 2003, surgical procedures of heart valve replacement were performed on 227 (136 men and 91 women) patients with AVHD in our Department of Cardiothoracic Surgery. The clinical data of all patients were collected and analysed. Patients’ age ranged from 10 years to 77 years. In preoperative cardiac function grading, 157 cases were NYHA III and 70 cases NYHA IV. Fifty-one patients had had cardiac operations. The ultrasonic cardiac graphs showed that 145 patients suffered from moderate or severe pulmonary hypertension and 73 had combined giant left ventricle. Mitral valve replacement was performed in 32 cases, aortic valve replacement in 90, tricuspid valve replacement in 1, combined mitral and aortic replacement in 103 and combined mitral and tricuspid replacement in 1. Nineteen patients also received surgical corrections for other minor abnormalities during the operations. A logistic model was established to evaluate the influence of perioperative factors on the mortality rate. Results The operative mortality rate was 13.2% (30/227). The main causes of death included multiple organ dysfunction syndrome (MODS), low cardiac output syndrome and ventricular fibrillation. From the results of the binary noncounterpart multivariate logistic regression, the following statistically significant factors were found to influence the operative mortality rate: redo operation, age ≥55 years, preoperative NYHA cardiac function grading, extracorporeal circulation time ≥120 minutes and postoperative usage of GIK (glucose, insulin and potassium) solution. All factors were risk ones except postoperative application of GIK. The Hosmer-Lemeshow goodness of fit coefficient of this model was 0.976. Conclusions The risk factors associated with postoperative mortality rate in the patients with AVHD were redo operation, age ≥55 years, preoperative NYHA cardiac function grading and extracorporeal circulation time ≥120 minutes. Postoperative usage of GIK acted as a kind of metabolic therapy and will improve the recovery for patients with AVHD. Active perioperative management and care will play a very important role in reducing the operative risk and improving the short term outcome of surgical treatment for the patients with AVHD.
文摘Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved with a modified linear closure of leftventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 toMay 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysmduring off-pump coronary artery bypass surgery. Repair was completed on the beating heart tominimize ischaemia and allow assessment of wall function and viability to guide closure. Allpatients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia.The majority (75% ) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejectionfraction was 26% ±9%. The mean left ventricular, end diastolic diameter was (57. 5 ±7. 1) mm. Theventricular preoperative and postoperative performances were compared. χ~2 test and Student' s ttest were used to analyse the outcomes. A P value less than 0. 05 was considered significant.Results Hospital mortality was 1. 3% (1/75). Coronary artery bypass was performed with an average of(3. 3 ±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. Themean NYHA class and ejection fraction increased significantly (P < 0.001 ) . The mean leftventricular, end diastolic diameter decreased significantly (P <0. 001). Conclusions Surgicalclosure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. Theoperation is associated with a low inhospital mortality and morbidity. A postoperative improvementin the early term cardiac functions and symptoms and quality of life was documented, increasing ourexpectations of an increased long-term survival.
