If one word is used to describe the development of congenital heart disease surgery in China, "hardship" would be the most appropriate. Generations of pioneers have used their ingenuity to overcome obstacles and promoted the development of the discipline. Seventy years of efforts have established the world's largest congenital heart disease treatment system. However, the huge number of potential patients, low early diagnosis rate and over-screening as well as the uneven developed diagnosis and treatment capabilities hinder the future development. The overall improvement of treatment of congenital heart disease in China lies on more efforts from our fellow experts. The publication of the "Chinese expert consensus on surgical treatment of congenital heart diseases" undoubtedly provides theoretical and practical guidance for the improvement of treatment.
Objective To compare the clinical early results of on-pump and off-pump coronary artery bypass grafting re-operations (re-CABG)and introduce our experience. Methods From April 2000 to June 2006, 21 cases with coronary artery diease of re-CABG were performed in this hospital. 10 patients received off-pump CABG (off-pump group), and 11 underwent CABG re-operations with cardiopulmonary bypass CABG(on-pump group). There were no significant difference regarding gender, age, weight, diabetes, hypertension, left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) between two groups before operation. On-pump CABG procedures were performed on hypothermia cardiopulmonary bypass. Standard methods were used to finish off-pump CABG. Flow meters were utilized to measure the flow of grafts in both groups. Results No one in off-pump group needed to conver to on-pump CABG. There was no operative or late mortality. The operation time, respiratory support time, the volume of chest tube drainage, blood transfusion and postoperative hospital stay were less in off-pump group than those in on-pump group after operation. Early death occurred in 1 patient in on-pump group. The number of distal anastomosis were more in on-pump group than that in off-pump group. Conclusions Both off-pump CABG and on-pump CABG can be applied to CABG re-operations and achieved similar completeness of revascularization, similar early surgical results.
Atrial fibrillation （AF） is the most common cardiac arrhythmia and associated with incremental morbidity and mortality. It is implicated that multiple reentry circuits have been the dominant mechanism of AF. The classical surgical treatment for medically refractory AF is the maze procedure composed of aultiple cuts and sutures within the atrial walls to disrupt the abnormal reentry circuits. Although the maze procedure is recognized as the most effective treatment of AF, it is complicated, time consuming and much invasive. New surgical ablation therapy, applying alternate energy sources （cryothermy, radiofrequency, microwave） have evolved to simplify the maze procedure without cut and suture and demonstrated promising success rates. The optimal lesion set has not yet been defined, Modification of lesion sets and techniques that ensure continuous and transmural lesions may improve the outcomes of ablation therapy and recover rate of sinus rhythm.
Objective To study the development of a physiologic fixation method and investigate the effect of physiologic fixation method on porcine aortic root and aortic valve leaflets. Methods Physiological fixer of aortic root was manufactured in a factory. The fixers with different diameter were made of organic glass. Porcine aortic root with ascending aorta and anterior leaflet of mitral valve and partial ventricular septum were dissected out from the fresh heart. The roots were attached to appropriately sized inflow and outflow spigots. Physiologic fixation was utilized to maintain aortic root and leaflets natural anatomical shape, the aortic root was pressurized to the inflow and outflow portions simultaneously, and the leaflets floated freely at zero-pressure differential with in the pressurized root. Results The process of physiologic fixation retained the properties of a native valve. The leaflets were much softer and extensible than those from valves fixed under low pressure. The results of pulsatile flow testing indicated that the effective orifice areas of predilation at 80mmHg were significantly greater than those of predilation at 40 mmHg（P〈0.05）, while mean pressure differences were found to be lower comparatively（P〈0.05）. This difference translates into a mode of valve function that more closely approximates that of the native aortic valve. Conclusion Physiologic fixation process retains the valve＇s natural anatomical shape as well as the underlying structure of the leaflets, providing improved flow characteristics.
Objective To provide a ventricular assist device for patients with heart failure, Fu Wai （FW） axial blood pump was developed for partly or totally to assist the left ventricular function. Vitro hemolysis and animals tests were also employed to test the hydromechanics and hemocompatibility of the FW left ventricular assist devices developed in Fu Wai hospital. Methods Using vitro test loop, FW axial blood pump has been used to evaluate the performance of hemolysis， the pump has also been tested for hemolysis characteristic through five sheep experiments. Results At 8 400 r/min, the pump generates 5 L/min flow against 100 mm Hg, the normalized index of hemolysis (NIH) was0.17±0.06 mg/L. The plasma free hemoglobin of in vivo tests was around 30 mg/dl. Conclusion The results obtained in vitro and in vivo testing indicate an acceptable design for the blood pump, further in vivo tests will be performed before clinical use.
Objective [WTBZ]To assess the impact of dual antiplatelet therapy using aspirin and clopidogrel on postoperative bleeding and blood transfusion early after coronary artery bypass grafting (CABG). Methods [WTBZ]In this randomized controlled trial, 249 patients were randomly assigned to 2 groups after coronary artery bypass grafting from December 2007 to December 2008. Daily clopidogrel (75 mg) and aspirin (100 mg) were initiated in 124 patients (group AC) while aspirin (100 mg) alone was administered to 125 patients (group A). Antiplatelet therapy was initiated within 48h postoperatively. Demographic, operative, and postoperative data were compared between the two groups. Chest tube drainage and quantity of blood products used in both groups were recorded. The effects of the antiplatelet regimen on chest tube drainage were compared using a linear regression model. Results [WTBZ]No statistical difference of demographic, operative, and preoperative data was observed between the two groups （Pgt;0.05）. Chest tube drainage after patients received ntiplatelet agents was not significantly different between group A and group AC（495.00±270.89 ml vs. 489.25±316.68ml，t=0.146, P=0.884）. No statistical difference of cases of transfusion(81 cases vs. 91 cases，χ2=1.937, P=0.164) or quantity of red cells (2.51±2.88 U vs. 2.25±2.87 U, t=0.690, P=0.491) and plasma (195.45±300.88 ml vs. 223.01±238.68 ml,t=0.759, P=0.449) transfused was found between group A and group AC. No perioperative mortality, reexploration or extrathoracic bleeding occurred in either group. Early postoperative use of dual antiplatelet therapy was not associated with increased bleeding after coronary artery bypass grafting on multivariable analysis（r=2.297，95%CI:-64.526,69.121，P=0.946）. Conclusionpresent study suggests that according to a predefined administration protocol, dual antiplatelet therapy of aspirin and clopidogrel can safely be administered in the early postoperative period in CABG patients, without increasing the risk of bleeding complications.
Abstract: Objective To investigate the clinical application of a novel modified aortic and pulmonic translocation in surgical repair of transposition of great arteries(TGA) with ventricular septal defect(VSD) and left ventricular outflow tract obstruction(LVOTO). Methods Five patients received surgical repair of the TGA with VSD and LVOTO at our heart center. The surgical technique used was a modification of the Nikaidoh procedure by which the native pulmonary root was preserved and translocated to reconstruct the right ventricular outflow tract. Two patients with atrioventricular discordance required a Senning procedure. Results All patients survived the operation and were discharged from the hospital. There were no major complications. At a median follow-up of 5.40 months, the echocardiography demonstrated normal ventricular function in all patients. No residual aortic stenosis or insufficiency was found in all the patients. Two patients had mild pulmonary insufficiency. Conclusions The novel modification of the Nikaidoh procedure may have excellent early results with minimal postoperative pulmonary insufficiency. The procedure may also allow growth of the pulmonary root and therefore decrease the need for reoperation. However, this has to be further investigated and long-term follow-up studies are warranted.
Objective To improve the operative effects of patients who had tetralogy of Fallot with aortopulmonary collateral arteries (TOF-APCAs) and evaluate the clinical effects of staging and onestop hybrid approach for TOFAPCAs. Methods From January 2003 to December 2007, thirty patients with TOF-APCAs had undergone combined therapy of APCAs embolization and complete surgical repair. Fifteen patients had APCAs embolization therapy before or after TOF radical operation(staging hybrid group ); Fifteen had onestop hybrid treatment(onestop hybrid group). Results Angiography revealed that there were 19 APCAs in staging hybrid group, and of which 15(78％) were embolized successfully. Five cases had complications and one died from respiratory circulating failure. The rest all recovered and discharged. And 22 APCAs were found in one-stop hybrid group, eighteen (82％) of them were embolized successfully. Only one case had pulmonary effusion. The time of hospitalization(median 37 d vs. 22 d, P=0.011),ICU staying（median 7.0 d vs. 4.7 d,P=0.029）and endotracheal intubation（median 131 h vs. 19 h,P=0.009） was obviously longer, and the hospitalization expenses（median 64 101 [CM(159mm]yuan vs. 48 021 yuan, P=0.033）were obviously higher in staging hybrid group than that in one-stop hybrid group.And there was no statistical significance in cardiopulmonary bypass time（P=0.126） and aortic clamping time（P=0.174） between two groups. Conclusion In comparison with traditional staging hybrid approach, one-stop hybrid approach can simplify the operative process for patients who have TOFAPCAs, improve the operative successful rate and cut down expenses.
Abstract: Objective To investigate changes of left ventricularregional systolic function after surgical treatment of left ventricular aneurysm (LVA) by realtime threedimensional echocardiography (RT-3DE). Methods From February 2009 to February 2010, 14 consecutive patients who were diagnosed to have coronary artery diseases with LVA underwent surgical repair and coronary artery bypass grafting (LVA group) in our hospital. All patients of the LVA group were followed up for a mean period of 4 months. Twodimensional echocardiography (2DE) and RT-3DE were performed before operation and during the follow-up. Left ventricular regional ejection fraction (EF) was acquired by Qlab software analysis. At the same time, 12 healthy persons were included as controls (control group). Statistical analyses were carried out to compare left ventricular regional EF between the LVA group (before operation and 4 months after operation) and the control group. Results Contrary to the control group, preoperative regional EF of the LVA group increased from apex to base. In addition to the inferior basal segment, lateralinferior basal segment and anteriorinferior basal segment, regional EF in the remaining 14 segments were significantly lower than that of the control group (P＜0.05). At postoperative followup, regional EF recovered the increase from base to apex, and there was no significant difference between anteriorinferior segment and lateral segment regional EF of the LVA group and those of the control group (P＞0.05), while regional EF of other segments in the LVA group was lower than that in the control group (P＜0.05). Conclusion RT-3DE is an effective method to assess left ventricular regional systolic function in patients with LVA. After LVA repair and coronary artery bypass grafting, regional systolic function will restore to the normal direction of progressive increase, and some nonaneurysm segments systolic function will go back to normal.
Abstract: Objective To study the impact of different kinds of mechanical circulation support devices on plasma free hemoglobin(FHb). Methods From Mar. 2004 to Dec. 2005, 20 patients received mechanical circulation support in Fu Wai Hospital, who were divided into 4 groups according to the different type of supporting devices. 9 got extracorporeal membrane oxygenation (ECMO) treatment, 8 received BVS5000 left ventricular support, 2 got MEDOS left ventricular support and 1 received AB5000 left ventricular support. Random control group included 9 cardiotomy patients after CPB supporting and 9 patients with offpump coronary artery bypass grafting during the same period. Parameters such as FHb, Tbil, Dbil, Cr and BUN were monitored throughout the supporting term. The results were compared according to the different types of mechanical circulation support devices. Results The elevation of FHb caused by CPB could be decreased to normal within 1d. However, in BVS5000 group, the elevated FHb level decreased to normal till 2 days later. The others mechanical circulation support devices such as ECMO, MEDOS, AB5000 elevated the FHb throughout the whole supporting period. Compared with those in ECMO group, the patients in BVS5000 group had obviously lower level of FHb since the third day after the beginning of supporting. In patients who got ECMO treatment, there was a trend that the elevation degree of FHb was lower in those with support flow rate less than 2.5 L/min. For most patients got devices support, there was also an elevation of Tbil and BUN level during the supporting period. Conclusion Mechanical circulation support devices, such as ECMO, BVS5000, MEDOS and AB5000, can cause red cell destruction in acceptable level. BVS5000 has much smaller impact on cell destruction than others do in postoperative patients.
