ObjectiveTo detect the expression of PITX2 and KCNQ1 in the left atrial appendage of patients with atrial fibrillation after modified mini-maze procedure, and to detect the clinical risk factors of different types of atrial fibrillation.MethodsWe collected left atrial appendage tissue of 59 atrial fibrillation patients who received modified mini-maze procedure and left atrial appendectomy from February 2017 to August 2018. The expression levels of PITX2 and KCNQ1 of left atrial appendage tissue were quantitatively analyzed by western blotting assay between paroxysmal attial fibrillation and persistent atrial fibrillation groups. The correlation between protein expression and prognosis after surgery was also analyzed based on clinical data.ResultsBinary-logistic regression analysis showed that KCNQ1 expression level was an independent risk factor for the progression from paroxysmal atrial fibrillation to persistent atrial fibrillation. Receiver operating characteristic (ROC) curve confirmed that KCNQ1 expression level (the ratio of KCNQ1 to actin in the analysis) was 0.60, which was the best cut-off point for the progression of paroxysmal atrial fibrillation to persistent atrial fibrillation.ConclusionHigh expression of KCNQ1 in left atrial appendage is a risk factor for progression from paroxysmal atrial fibrillation to persistent atrial fibrillation.
ObjectiveTo investigate the factors influencing myocardial recovery after left ventricular assist device (LVAD) implantation, aiming to identify patient characteristics associated with a higher potential for cardiac recovery and to inform clinical decision-making. MethodsThis retrospective study included consecutive patients with end-stage heart failure who underwent LVAD implantation at our institution between 2021 and June, 2025. Patients were categorized into three groups including a myocardial recovery group, an ongoing LVAD support group, and death group. Based on their postoperative outcomes, demographic, laboratory, and imaging data were compared among the groups. Multivariate logistic regression analysis was performed to identify independent predictors of myocardial recovery. Results A total of 57 patients who received an LVAD were included. Among them, 9 (15.8%) achieved myocardial recovery, 39 (68.4%) remained on LVAD support, and 9 (15.8%) died. Multivariate analysis identified younger age (OR=0.875, P=0.004) and a smaller preoperative left ventricular end-systolic diameter (LVESD) (OR=0.866, P=0.047) as independent predictors of myocardial recovery. Notably, all patients in the recovery group were male and had no prior implantation of an implantable cardioverter-defibrillator/cardiac resynchronization therapy defibrillator. Furthermore, a higher preoperative prealbumin level was significantly associated with survival (OR=1.018, P=0.024). ConclusionYounger age and a smaller preoperative LVESD are key predictors for myocardial recovery following LVAD implantation. Younger patients with a smaller LVESD exhibit a greater potential for functional recovery. Preoperative nutritional status, as indicated by prealbumin levels, may be a predictor of mortality.
According to the "Regulations on clinical application management of medical technologies", physicians intending to carry out restricted technologies must undergo standardized training and pass assessments in accordance with the clinical application management standards for the respective technology. As ventricular assist technology is classified as a nationally restricted technology, standardized training is one of the essential conditions for its application. This paper primarily explores the standardized training for the clinical application of ventricular assist technology in Shanghai, in light of its background, clinical application, and current training status. It proposes the training requirements for ventricular assist technology, animal training assessment standards, and clinical practice assessment standards in Shanghai, aiming to promote the standardized development and high-quality advancement of ventricular assist technology in Shanghai.
Standardizing the emergency assessment and management process for patients with implantable continuous-flow left ventricular assist device (LVAD) in emergency and intensive care settings is of great significance for reducing delays in diagnosis and treatment, lowering the mortality associated with LVAD-related emergencies, and improving overall prognosis and long-term survival. To this end, a multidisciplinary expert committee was convened to develop this consensus, integrating international evidence-based findings with clinical practice experience in China, with an emphasis on highlighting the characteristics of domestically manufactured devices. The aim is to establish an actionable standardized emergency management protocol to enhance clinical identification and response efficiency, reduce the risk of LVAD-related emergencies, and improve patient outcomes. Using a modified Delphi method, this consensus proposes a structured decision-making pathway that integrates an "ABC" rapid assessment with parallel device troubleshooting, prioritizing the use of point-of-care echocardiography for hemodynamic evaluation and complication assessment. Key emergency scenarios covered include low-flow alarms, pump thrombosis, right heart dysfunction, bleeding and anticoagulation imbalance, arrhythmias, and cardiac arrest. This consensus applies to implantable continuous-flow LVADs commonly used in China, including domestically manufactured devices such as Corheart 6, CH-VAD, EVAHEART, and HeartCon, as well as the imported device HeartMate 3.
