Objective To investigate the effect of coronary artery bypass grafting (CABG) on patients with coronary heart disease and giant left ventricular dimension but without aneurysm. Methods The clinic data of 51 consecutive patients with coronary heart disease accompanied by enlarged left ventricle dimension without aneurysm, including 50 males and 1 female, undergoing CABG between January 2004 and December 2006 in Nanjing First Hospital of Nanjing Medical University was retrospectively reviewed. The patients were at the age of 54-61 years with an age of 57.5±3.2 years. All patients received CABG, combined with aortic valve replacement in 7, mitral valve replacement in 16, mitral valvoplasty in 17 and tricuspid valvoplasty in 7. After surgery, perioperative complications and mortality were closely observed and followup for a period of 37 months was carried out. Results The number of distal anastomoses per patient was 2.0-4.0(3.8±1.1). Four patients died perioperatively (7.8%), among whom 2 died from malignant ventricular fibrillation, 1 from acute kidney failure and 1 from stroke caused by severe low cardiac output syndrome. All other patients were discharged from hospital with good recovery. After operation, 5 patients had atrial fibrillation and 11 had ventricular fibrillation, but all of those patients survived after proper treatment. The followup period for 47 patients was 37-49 months (43±11months), with a followup rate of 100%. No death occurred during the follow-up. Ultrasound cardiography in the followup period showed that there was a decreased left ventricular enddiastolic dimension (59±2 mm vs. 68±5 mm; t=7.320, Plt;0.05) and an improved left ventricular ejection fraction (45%±17% vs. 34%±15%; t=4.770, Plt;0.05) compared with those before operation with statistical significance. Conclusion CABG is an effective surgical procedure in the treatment of coronary heart disease with giant left ventricular dimension but without aneurysm.
Objective To study the manageable methods, effect of early use of enteral nutrition after operations on esophageal cancer patients. Methods By different way of nutritional support after operation, 209 cases of esophageal cancer were divided into two groups in which enteral nutrition（EN） group,146 cases, were managed with early use of nutritional support through intestine and parenteral nutrition（PN） group, 63 cases, were given nutrition by way of veins. Complications, general recovery and blood biochemical criteria after operation between those two groups were compared. Results No cases of anastomotic fistula occurred in the two groups. The incidence of complications in EN group was significantly lower than that in PN group（P〈0.01）, and the occurrence of diarrhea was higher in EN group （P=0. 000）. The time needed for recovery of bowel sounds, anal exsufflation, defecation and hospital stay was shorter and hospital fee lower in EN group than those in PN group（P=0. 000）. The total amount of gastrointestinal and closed thoracic drainages decreased more significantly in EN group （P= 0. 000） and the value of albumin, globulin and total protein was significantly higher also in EN group （P = 0. 000）. But the amount of BUN, creatinine and neutrophil was significantly lower in EN group （P = 0. 000）. Conclusion Early use of enteral nutrition after operation on esophageal cancer is safe, effective and practical, with more significant advantages than those of parenteral nutrition.
Objective To assess the efficiency and safety of pulsatile catheter (PUCA) pump support during acute ischemic heart failure in sheep. Methods After heart failure model was induced successfully in 10 sheep, PUCA pump was inserted through aorta and the aortic valve orifice with its tip located in the left ventricle. It was then activated to support the hemodynamics for 3 hours. Hemodynamic parameters were monitored and recorded before thoracotomy, heart failure, and every 60 min after the support. Platelet and plasma free hemoglobin were tested during the experiment. Thrombosis in kidney, membrane-pump, and catheter were examined at the end of study. Results PUCA pump support was successful in 7 sheep for 3 hours and failed in 3 due to technical problems. During support with the PUCA pump, mean arterial pressure(MAP), systolic blood pressure (SBP) and diastolic blood pressure(DBP) increased gradually and close to the baseline at the end of experiment. No significant change in platelet and plasma free hemoglobin were found during the whole period of the PUCA pump support. No thrombosis was found as well by means of examining kidney, membrane-pump and catheter. Conclusions PUCA pump can successfully maintain the hemodynamics in a sheep acute heart failure model associated with few blood destruction and thrombosis. It is thus suitable for clinical application to heart failure patients for the maintenance of hemodynamics.
Objective To observe whether Cyclo-RGDfK (Arg-Gly-Asp-D-Phe-Lys) could enhance the adhesion of myofibroblast to decellularized scaffolds and upregulate the expression of Integrin αVβ3 gene. Methods Myofibroblast from the rat thoracic aorta was acquired by primary cell culture. The expression of Vimentin and α-smooth muscle actin(α-SMA) has been detected by immunoflurescent labeling. Decellularized valves have been randomly divided into three groups (each n=7). Group A (blank control): valves do not receive any pretreatment; Group B: valves reacted with linking agent NEthylN(3dimethylaminopropyl)carbodiimide hydrochloride (EDC) for 36 hours before being seeded; Experimental group: Cyclo-RGD peptide has been covalently immobilized onto the surface of scaffolds by linking agent EDC. The fifth generation of myofibroblast has been planted on the scaffolds of each group. The adhesion of myofibroblast to the scaffolds was evaluated by HE staining and electron scanning microscope. The expression of Integrin αVβ3 was quantified by halfquantitative reverse transcriptionpolymerase china reaction (RT-PCR). Results We can see that myofibroblast has exhibited b positive staining for Vimentin and α-SMA. Besides, it has been shown that the expression of Integrin αVβ3 was much higher in the experimental group than that of the group A and group B(Plt;0.05). There was no statistically difference in group A and group B (P=0.900). Conclusion RGD pretreatment does enhance the adhesive efficiency of seeding cells to the scaffolds and this effect may be related to the upregulation of Integrin αVβ3.
The increased morbidity and mortality following cardiopulmonary bypass （CPB） may be due to the development of systemic inflammatory response syndrome （SIRS）. Leukocyte, especially neutrophil, plays a crucial role in SIRS during and after CPB, so the leukocyte removal by filtrations appears to be a logical anti-inflammatory strategy. Many articles reported that leukocyte depletion filter can decrease the potential adverse effects during CPB and reduce the morbidity and mortality following CPB. But the protective effects of the filter varied greatly from paper to paper. This may be due to the different design and biocompatibility of the filter at present, But, because the leukocyte plays a central role in SIRS, leukocyte depletion filter would be an important apparatus in therapy of noninfectious inflammation induced by CPB after it was improved.
ObjectiveTo investigate the high risk factors for perioperative atrial fibrillation (AF) and its effect on the postoperative short term outcome in esophageal carcinoma patients. MethodsSixty three patients with AF after esophagectomy (AF group) and 126 patients without AF after esophagectomy in control group were analyzed by χ 2, and logistic regression, and compare with patient the postoperative mortality and duration hospitalization in two groups.ResultsThe rates of age above 65 (χ 2=7.02, P lt;0.01), male sex (χ 2=4.06, P lt;0.05), history of cardiac disease (χ 2=6 03, P lt;0.05), history of chronic obstructive pulmonary disease (COPD, χ 2=29.14, P lt;0 01), postoperative thoracic gastric dilatation ( P lt;0.01), and postoperative lower oxygen saturation ( P lt;0.01) in AF group were significantly higher than those in control group. No significant relevance was found between history of diabetes or hypertension, choice of operative approach, site of stoma and postoperative AF. 1 in 15 AF patients regain sinus rhythm after remove the pathological factors, and the others resumed after antiarrhythmic drug therapy. The postoperative hospitalization time was 10.65±0.87 d in patients developing AF group and 9.98±0.96 d in control group ( P gt;0.05). No difference was observed between two groups with regard to mortality ( P gt;0.05).ConclusionAF occurs more frequently after esophagectomy in aged and male sex. Other factors contributing to AF are history of cardiac disease, COPD and lower oxygen saturation. And in this study, early occurrence of AF after operation for esophageal carcinoma does not show any negative impact on mortality or on postoperative duration hospitalization.
Objective To introduce the procedure of thoracic outlet tumors removal through posterior thoracotomy and its efficacy. Methods Ten patients with thoracic outlet tumors underwent surgical treatment via posterior approach from June 2004 to June 2007. Five patients suffered from neurogenic tumors, 4 patients apical lung carcinomas, and 1 patient apicoposterior lung tumor. The skin incision was started superiorly lateral to the transverse process of 6th cervical vertebrae, carried downward a way between the medial border of the scapula and the posterior midline and was extended in a gentle arc below the inferior angle of the scapula to the posterior axillary line. The chest was entered and the tumor is removed through resecting the rib(2nd or 3rd rib) located at the lower edge of the tumor after the scapula had been pushed forward. Results There was no death in this group. Tumors in 9 patients were resected completely. Thoracotomy only was done in another patients as a result of tumor invading neighboring major organs. Shoulder and back pain in 3 of 4 patients was remitted postoperatively. Two patients with “dumbell” neurogenic tumors improved strength of lower limbs. Pain and abdominal wall reflex resumed in one patient and muscle strength of lower limbs increased to 4th grade from 2nd grade in another one. Two patients required thoracentesis because of complicating with pleural effusion. The mean followup period was 18 months (range 336). Seven of 10 patients still lead a normal life. Conclusion Posterior thoracotomy can provide an excellent approach to remove the thoracic outlet tumors safely and completely.
Objective To investigate the experience of operative technique of donor organ harvesting and lung transplantation in some unusual circumstance, and to improve surgical success ratio of lung transplantation. Methods Lung transplants were preformed in 65 cases, including 47 singlelung transplants and 18 double single lung transplants. All the recipients were suffered from intensive respiratory failure,and nine patients were longterm ventilatordependented of the total. The recipients included emphysema (n=23), pulmonary fibrosis (n=24), pneumosilicosis(n=5), pulmonary tuberculosis(n=2), lymphangioleiomyomatosis(n=1) and ventricular septal defect(VSD) or VSD with Eisenmenger’s syndrome(n=4),bronchiectasis (n=4), diffuse panbronchiolitis (n=1) and primary pulmonary hypertension(n=1). Retrospectively summarize clinical experience of lung transplant operation especially experience of dealing with special circumstances encountered in operation. Results 64 donor organ harvesting were achieved successfully. Inhospital death was 11cases (16.9%) after operation. Early death was due to primary lung graft dysfunction (n=3), severe infection(n=6), acute rejection(n=1), pulmonary vein embolism(n=1). Complications took place after operation in 9 cases, to exploratory thoracotomy to stop bleeding after transplantation in 3 cases, pulmonary artery anastomosis again because of stenosis in 1 case, bronchus stoma stenosis in 3 cases, pulmonary infarction in 2 cases, of which one patient accepted pulmonary lobectomy. Follow-up period was from 1.0 year to 5.6 years of 54 cases. 1year survival rate was 72.3%（47/65）.The pulmonary function was improved and the quality of life is well in most patients of the group. Conclusion To improve the technique of donor organ harvesting and lung transplantation is important to decrease the early mortality after transplantation.
Objective To evaluate midterm and longterm clinical outcome of bilateral internal mammary artery composited Y grafts for coronary artery bypass grafting (CABG)， analyze risk factors for late death ，and to improve surgical results. Methods Between January 2000 and May 2004, One hundred and sixtyfive patients underwent bilateral internal mammary artery grafts for CABG, The clinical data, postoperative complications and survival results were retrospectively reviewed and analyzed. The preoperative and postoperative cardiac function was compared. All factors that may have affected the survival were analyzed by logistic regression, to identify significant variables associated with late death. Results Total 561 anastomosis sites of internal mammary arteries were completed with each patient received an average of 3.4 grafts. There were no perioperative deaths. There were 16 patients with postoperative complications including recurrent angina, myocardial infarction, low cardiac output syndrome, sternal infection and so on. All patients were treated conservatively without reoperation. One hundred sixty patients（97%）were followed up of 5.6±1.2 years, there were 23 late deaths including 10 patients of cardiac related death in which 3 had recurrent myocardial infarction, 4 heart failure, and 3 arrhythmia; 13 patients of nocardiac related death in which 4 upper gastrointestinal hemorrhage, 3 cancer and 6 uncertain cause. 25 patients had major cardiac related events including recurrent angina 18, myocardial infarction 4, repeated revascularization 3. Left ventricular ejection fraction [CM(159mm]was significantly improved as compared with that before operation（54%±6% vs. 43%±12%, Plt;0.05）. The 1-, 3-, 5-year actuarial survival rates and eventfree rates were 98.2%±0.3%, 96.2%±0.5%, 90.5%±1.9% and 95.5%±1.2%, 91.3%±2.1%, 86.6%±1.5%, respectively. According to statistical analysis, univariate analyses had proved that advancing age＞65 years，diabetes，ejection fraction(EF) less than 30%，the New York Heart Association (NYHA) class Ⅲ/Ⅳ, and low cardiac output syndrome required placement of the intraaortic balloon pump were predictors associated with hospital major adverse cardiac events (Plt;0.05). Those variables entered into the logistic regression model and found to be independent predictors associated with increased late cardiac death included advancing age ＞65 years(OR=11.6), diabetes (OR=21.4), EF less than 30%(OR=37.5) and NYHA class Ⅲ/Ⅳ(OR=40.2). Conclusion Patients receiving bilateral internal mammary artery composited Y grafts have better longterm survival and reduced cardiac related events. Independent risk factors for late death are NYHA function class Ⅲ/Ⅳ, EF less than 30%, diabetes and advancing age ＞65 years.
Objective Choose polylactide-co-glycolide/hydroxyapatite (PLGA/HA) and porous phosphate calcium (PPC) as the object that we will study, compare their degradabality and choose one as a suitable scaffold for rib reconstruction. Methods All the experiments were divided into PLGA/HA group and CPC group. Degradabality experiment in exvivo: put the two scaffold which have the same size into 0.9% NaCl, keep sterile, then put the container into warm cage，get out and weigh them in 2, 4, 8, 12 and 24 weeks, compare the different speed of the two scaffold. Degradability experiment in vivo: put the two scaffold which have the same size under the skin of the rabbit, and weigh them in 2, 4, 8, 12 and 24 weeks, the tissue around the scaffold was examinzed by HE and the scaffold was examined by electron scanning microscope. Results Micro-CT and Scanning electron microscopy shows that CPC group had better structure （1101.2228±0.6184 mg/ccm vs. 1072.5523±0.7442 mg/ccm）and porosity（70.26％±0.45％ vs.72.82％±0.51％）than PLGA/HA group; The result of degradabality experiment in vitro shows that the speed of the two scaffolds was slow. It is at 24 weeks that the degradability is obvious,and the PLGA/HA group degraded a lot which was 60%. The result of degradabality experiment in vivo shows that the speed of degradabality of PLGA/HA group was faster than that is in the 0.9% Nacl, also was faster than that of CPC group which was 96%.The reponse of tissue around the PLGA/HA was more sever than that of CPC group which is in favour of the growth of cells. Conclusion As for the reconstruction of large defect of rib, CPC is more suitable than PLGA/HA.
