Abstract： Objective To analyze the influence of preoperative left atrial dimension （LAD） on the effectiveness of surgical radiofrequency ablation for the treatment of atrial fibrillation （AF） through a 5-year postoperative follow-up of AF patients after surgical radiofrequency ablation. Methods Clinical data of 433 patients with persistent or permanent AF who received bipolar radiofrequency ablation procedures during concomitant cardiac surgery in Beijing Anzhen Hospital from 2006 to 2009 were retrospectively analyzed. All the patients were divided into 4 groups according to their preoperative LAD：Group A， 75 patients with their LAD＜50 mm， including 22 males and 53 females with their average age of 56.50±10.05 years；Group B， 89 patients with their LAD ranging from 50 to 60 mm， including 32 males and 57 females with their average age of 55.63±10.28 years；Group C， 117 patients with their LAD ranging from 60 to 70 mm， including 41 males and 76 females with their average age of 55.13±10.96 years；and Group D， 152 patients with their LAD＞70 mm， including 68 males and 84 females with their average age of 53.22±11.49 years. Postoperative ECG records right after surgery， before discharge， at 6 months and 1，2，3，4 and 5 years during follow-up were collected. The relationship between preoperative LAD and postoperative sinus rhythm restoration rate was analyzed. Results There was statistical difference in sinus rhythm restoration rate right after surgery（P=0. 011）， before discharge（P=0. 002）， at 6 months（P＜ 0. 001） and 1 year （P＜0. 001）， 2 years（P＜0. 001）， 3 years（P＜0. 001）， 4 years（P＜0. 001） and 5 years（P= 0. 006） during follow-up among the 4 groups. Postoperative sinus rhythm restoration rates right at 6 months and 1，2，3， 4 and 5 years during follow-up was 90.4%， 89.9%， 90.3%， 91.3%， 89.1%， and 90.9% in Group A， 80.2%，79.0%，78.1%， 76.1%，72.5%，70.0% in Group B，74.7%，74.0%，71.2%，72.4%，70.0%， and 64.7% in Group C， and 61.8%，57.6%，56.8%，53.9%，50.7%，and 48.6% in Group D， respectively. Conclusion Patients with a larger preoperative LAD have a lower postoperative sinus rhythm restoration rate after surgical radiofrequency ablation for the treatment of AF.
ObjectiveTo assess the health effectiveness, cost and cost effectiveness of different oral anticoagulation (OAT) therapies in China, including warfarin plus international normalized ratio (INR) test in hospital labs (Lab test), warfarin plus patient self-management (PSM) with point of care device, and novel anticoagulant (Dabigatran) alone.
MethodsA Markov model containing four states (no complication, hemorrhagic event, thrombotic event and death) was developed to account for long-term cost and outcomes of warfarin/novel anticoagulant users including atrial fibrillation patients and deep venous thrombosis patients. Direct medical cost was taken into consideration, covering expenses of drugs, OAT monitoring and complication management. Both clinical and cost parameters were mainly derived from literatures.
ResultsCompared with hospital lab test, the PSM pattern obtained a prolonged 8.48 years and 5.08 QALYs with the larger amount of cost, CNY 47 482. The incremental cost-effectiveness ratio (ICER) of PSM versus hospital lab test came to CNY 19 240 per QALY gained, lower than GDP China per capita in 2014 (CNY 46 628). And the novel anticoagulant pattern was dominated by PSM pattern due to shortened QALYs while increased cost. The sensitivity analysis demonstrated the results were not sensitive to main indicators, including utility in different health status, complication probability, and disease management cost.
ConclusionPSM can generate more QALYs by reducing the risk of major thrombotic and bleeding events with acceptable incremental cost, which turns to be the most cost effective way among the 3 patterns and demonstrates promising future in OAT management.
Objective To summarize the experience and results of mitral annuloplasty with modified partial flexible artificial ring. Methods Two hundred and fifteennine patients were underwent partial flexible ring annuloplasty after mitral valve plasty surgery in our hospital from an. 1998 to Aug.2006. The etiology included rheumatic (16 cases), infective endocarditis of mitral (16 cases), ischemic (13 cases), ongenital (40 cases) and degeneration (174 cases). Echocardiogram test were performed in the perioperative periods to monitor the lefe atrium (LA), left ventricular enddiastolic dimension (LVEDD), left ventricular endsystolic dimension (LVESD), left ventricular ejection fraction(LVEF), left ventricular fractional shortening (LVFS) and mitral regurgitation grades. The perioperative mortality, morbidity, reoperation rate were recorded during the followup. Results Aortic cross clamping time was 74±30 min and cardiopulmonary bypass time was 105±37min. The perioperative survival rate was 96.5% (250/259) and free from complications rate was 93.4% （242/259）. No left ventricular out flow tract obstruction and coronary artery stenosis were occurred in this group. The 60 months survival rate was 938% (243/259) and 5 years nonreoperation rate was 96.1%(249/259). The perioperative echocardiogram results showed the LVEDD decreased from 62.60±10.19mm to 52.88±8.67mm and the LVEF increased from 57.91% to 61.00%（Plt;0.05）. During the followup the mitral regurgitation grades were improved significantly (Plt;0.05),there were 188 cases of trifle mitral regurgitation (72.6%), 62 cases of mild mitral regurgitation (23.9%), 8 cases of moderate mitral regurgitation(3.1%) and 1 case of serious mitral regurgitation(0.4%). Conclusion This simplified mitral annuloplasty technique is an easy handling and effective treatment for the mitral repair.
ObjectiveTo analyze the protective mechanism of spinal cord ischemia-reperfusion injury mediated by N-methyl-D-aspartate (NMDA) receptor.MethodsA total of 42 SD rats were randomly assigned to 4 groups: a non-blocking group (n=6), a saline group (n=12), a NMDA receptor blocker K-1024 (25 mg/kg) group (n=12) and a voltage-gated Ca2+ channel blocker nimodipine (0.5 mg/kg) group (n=12). The medications were injected intraperitoneally 30 min before ischemia. The neural function was evaluated. The neuronal histologic change of spinal cord lumbar region, the release of neurotransmitter amino acids and expression of spinal cord neuronal nitric oxide synthase (nNOS) were compared.ResultsAt 8 h after reperfusion, the behavioral score of the K-1024 group was 2.00±0.00 points, which was statistically different from those of the saline group (5.83±0.41 points) and the nimodipine group (5.00±1.00 points, P<0.05). Compared with the saline group and nimodipine group, K-1024 group had more normal motor neurons (P<0.05). There was no significant difference in glutamic acid concentration in each group at 10 min after ischemia (P=0.731). The nNOS protein expression in the K-1024 group was significantly down-regulated compared with the saline group (P<0.01). After 8 h of reperfusion, the expression of nNOS protein in the K-1024 group was significantly up-regulated compared with the saline group (P<0.05).ConclusionK-1024 plays a protective role in spinal cord ischemia by inhibiting NMDA receptor and down-regulating nNOS protein expression; during the reperfusion, K-1024 has a satisfactory protective effect on spinal cord function, structure and biological activity of nerve cells.
ObjectiveTo evaluate the performance and safety of a novel device for left atrial appengdage (LAA) closure in dogs.
MethodsThrough the fourth left intercostal, the LAA clips were implanted at the base of LAA in six dogs. Macroscopic pathology, histopathology and biological detection were performed at 7 d, 60 d, 90 d, 180 d after implan-tation respectively.
ResultsThe devices were all successfully implanted at the base of LAA. There is no transposition of the LAA clips. Complete fibrosis and atrophy of LAA occurred at 60 d after implantation. LAA closure was completed with a new endothelial tissue layer developed on the occluded orifice of the left atrium after 60 d after implantation. The level of atrial natriuretic peptide did not decrease significantly after the device implantation (275.64±60.00 pg/ml vs. 248.34±56.10 pg/ml, P=0.529).
ConclusionThe novel device for LAA closure achieved easy, reliable and safe closure of the LAA in canine model.
ObjectiveTo explore the short-term follow-up clinical effect of transcatheter valve-in-valve implantation treatment for mitral bioprosthesis deterioration.MethodsThe single center data of elderly patients with mitral valve bioprosthetic dysfunction who received transapical J-Valve intervention between January 2019 and May 2020 were reviewed and summarized. After the informed consent was signed, single lumen endotracheal intubation was performed under general anesthesia in hybrid operating room. The left intercostal small incision was used to explore the apical area. Fluoroscopy and three-dimensional esophageal ultrasound were used to guide the puncture needle. Then the guide wire entered the left atrium through the mitral valve biological valve. The catheter was exchanged, and the rigid support wire was exchanged. The reverse loaded J-Valve system was guided and implanted into the biological mitral valve with beating heart. The appropriate implantation depth was adjusted, and stent valve was released under rapid pacing. Post balloon dilation of the valve was performed if necessary.ResultsFrom January 2019 to May 2020, transcatheter J-Valve implantation was completed in 20 patients with mitral valve dysfunction and high-risk evaluation of routine thoracotomy and cardiopulmonary bypass (the Society of Thoracic Surgeon score above 6). In terms of the type of the the mitral bioprosthesis, there were 6 cases of Hancock valves, 7 cases of Perimount valves, 6 cases of Epic valves, and 1 case of Baxiter valve. In terms of the size of the the mitral bioprosthesis, there were 2 cases of size 29 valves, 11 cases of size 27 valves, and 7 cases of size 25 valves. One valve fell into the left ventricle at early stage. One patient had mild valve displacement during operation, and a second valve was implanted at the same time. The success rate of valve-in-valve implantation was 95%. The length of stay in intensive care unit was less than 6 h in 5 cases, 6-24 h in 13 cases, 24-48 h in 1 case, and more than 48 h in 1 case. No patient’s postoperative mitral regurgitation was moderate or above. The mean mitral valve pressure gradient was (5.2±2.3) mm Hg (1 mm Hg=0.133 kPa). Patients recovered well after the valve-in-valve implantation treatment, with no death within postoperative one month. One patient died of infection and multiple organ failure during follow-up after one month. Other patients recovered smoothly without serious complications.ConclusionsThe clinical effect of J-Valve intervention in the treatment of mitral valve bioprosthetic dysfunction through apical approach is good. The implantation can be completed under beating heart, avoiding cardiopulmonary bypass and routine thoracotomy cardiac arrest, which is worthy of further observation and follow-up.
