OBJECTIVETo investigate the correlation between Angle's class III patients' occlusion plane and anterior overbite by controlling the changes in occlusion plane during orthodontic treatment.

METHODSIn total, 90 Angle's class III adult orthodontic patients were selected as the experimental group, and 30 normal adults were selected as the control group. According to the overbite, the class III patients were divided into three groups, and 14 indicators were measured. ANOVA and multiple comparison analysis were used to analyze the difference between class III patients, and linear analysis was used to analyze the correlation between anterior overbite and anterior-posterior occlusion plane.

RESULTSIn class Ill patients, posterior occlusion plane and anterior overbite size were negatively correlated (r = -0.24, P < 0.05), whereas anterior occlusal plane and anterior overbite size were positive correlated (r = 0.23, P < 0.05).

CONCLUSIONThe shape of the occlusion plane varies in different anterior overbite patients. During orthodontic treatment in different overbite class III patients, the vertical height of the posterior teeth and the rotation of the occlusion plane should be controlled.

Adult ; Dental Occlusion ; Humans ; Malocclusion, Angle Class III ; Overbite ; Tooth

OBJECTIVETo evaluate the safety and efficacy of robotic mitral valve surgery using da Vinci S system.

METHODSWe conducted a retrospective review of 60 robotic mitral surgeries from March 2007 to December 2010. Of the 60 patients, 44 underwent mitral valve repair and 16 received mitral valve replacement. The surgical approach was through 4 right chest ports with femoral and internal jugular vein cannulations. Transesophageal echocardiography was used intraoperatively to estimate the surgical results.

RESULTSNone of the cases required a conversion to a median sternotomy. The mean cardiopulmonary bypass and cardiac arrest time was 132.2∓29.6 min and 88.1∓22.3 min for robotic mitral valve repair, and was 137.1∓21.9 min and 99.3∓17.4 min for robotic mitral valve replacement. Echocardiographic follow-up of all the patients revealed 3 cases of slight regurgitation in mitral valve repair group.

CONCLUSIONIn selected patients with mitral valve disease, robotic mitral surgery can be performed safely.

Adolescent ; Adult ; Aged ; Female ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Mitral Valve ; surgery ; Mitral Valve Annuloplasty ; methods ; Mitral Valve Insufficiency ; surgery ; Retrospective Studies ; Robotics ; methods ; Surgery, Computer-Assisted ; methods ; Young Adult

OBJECTIVETo determine the impact of prior percutaneous coronary intervention (PCI) on outcome of coronary artery bypass graft (CABG) surgery.

METHODSPerioperative data were collected from 1306 patients undergoing CABG from January 2002 to November 2010, including 117 patients with prior PCI and 1 189 patients without prior PCI. Among 117 patients with prior PCI, 99 patients had a single PCI procedure and 18 had multiple PCI procedures. The surgical outcomes including in-hospital mortality and major adverse cardiac events were compared between two groups.

RESULTSPatients with prior PCI were younger, less likely to have triple vessel and left main stem disease, and less recent myocardial infarction. Interval time between PCI and CABG was (13.39 ± 13.81) months. There were no significant difference in in-hospital mortality (1.7% compared with 0.5 % P=0.156) and major adverse cardiac events (including postoperative myocardial infarction, stroke, and in-hospital death,2.6% compared with 1.1% P=0.167) between two groups.

CONCLUSIONThere was no association between prior PCI and isolated CABG. Good outcomes can be obtained in the group of patients undergoing CABG who have had previous PCI.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; mortality ; Female ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the long-term outcomes of off-pump coronary artery bypass grafting (OPCAB) in patients aged over 75 years and analyze the risk factors affecting the outcomes of the procedure.

METHODSClinical data were reviewed for 97 consecutive patients aged 75 years or above receiving OPCAB at our center between November, 2000 and November, 2013. The perioperative data including length of ICU stay, duration of mechanical ventilation, incidence of postoperative complications and mortality rate of the patients were analyzed. The follow-up data of the patients were also analyzed including all-cause mortality rate and major adverse cardiac and cerebral events (MACCE, including myocardial infarction, cerebrovascular event, and repeated revascularization).

RESULTSThe perioperative mortality rate was 3.09% (3/97) in these patients. Of the 97 patients analyzed, 91 (93%) were available for follow-up for 29-192 months (with a median of 95.61∓34.07 months). The 10-year survival rate of the patients was 62% with a 10-year MACCE-free survival rate of 47.4%. During the follow-up, 6 (6.8%) patients underwent repeated revascularization procedures, 12 (12.37%) had cerebrovascular accidents and 5 (5.15%) had myocardial infarction. Logistic regression analysis showed that hypertension (OR=1.388, P=0.043) and diabetes (OR=1.692, P=0.017) were independent predictors of MACCE, and incomplete revascularization did not increase the risk of postoperative MACCE.

CONCLUSIONOPCAB is safe and effective in elderly patients with good long-term outcomes. Hypertension and diabetes are independent risk factors of MACCE, and adequate control of blood pressure and blood glucose can reduce the incidence of postoperative MACCE. Incomplete revascularization is not detrimental to the long-term outcomes of OPCAB in elderly patients.

OBJECTIVETo compare the grafts' blood flow after on-pump and off-pump coronary artery bypass graftings.

METHODSFive hundred and forty-seven cases were studied, including four hundred and three cases undergoing off-pump coronary artery bypass (OPCAB, off-pump group) and one hundred and forty-four cases undergoing on-pump coronary artery bypass (CCABG, on-pump group). In all cases left internal mammary artery (LIMA) was routinely anastomosed to left anterior descending artery (LAD), and saphenous vein (SV) to the other target vessels in sequential mode when there were more than two anastomoses. After all anastomoses were completed and hemodynamic status was stable, transit time flow-meter was utilized to measure and record the grafts' flow wave, pulsatility index (PI), value of mean flow, diastolic and systolic peak flow, vascular resistance, insufficiency ratio and mean blood pressure.

RESULTSPI, insufficiency ratio and diastolic peak flow of LIMA in off-pump group were 2.7 +/- 1.8, (2.2 +/- 4.3)%, (46.8 +/- 2.7) ml/min respectively; those in on-pump group were 2.8 +/- 2.0, (3.4 +/- 3.1)% and (52.8 +/- 3.7) ml/min respectively. And those of SV in off-pump group were 2.8 +/- 0.1, (1.8 +/- 0.3)% and (85.8 +/- 3.2) ml/min respectively and those in on-pump group were 2.6 +/- 0.2, (1.3 +/- 0.2)% and (93.9 +/- 5.6) ml/min respectively. For both LIMA and SV grafts' blood flow there was no significant difference in PI, insufficiency ratio, diastolic peak flow and mean blood pressure in both groups (P > 0.05). The mean flow and systolic peak flow in off-pump group were significantly less than those in on-pump, while the vascular resistance in off-pump group was significantly greater than that in on-pump group (P < 0.01).

CONCLUSIONThere is no significant difference in grafts' patency between OPCAB and CCABG.

Adult ; Aged ; Aged, 80 and over ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Female ; Humans ; Male ; Mammary Arteries ; physiology ; transplantation ; Middle Aged ; Monitoring, Intraoperative ; Regional Blood Flow ; Saphenous Vein ; physiology ; transplantation ; Vascular Patency ; Vascular Resistance

BACKGROUNDAmong various treatments preventing vein graft restenosis, external stent is receiving more and more attention. This study aimed to investigate the effect of non-restrictive external stent on the prevention of vein graft restenosis and the potential mechanisms of platelet-derived growth factor (PDGF) in the process of restenosis.

METHODSThirty-six "New Zealand white rabbits" were randomly divided into two groups, stented group (group S) and control group (non-stented group, group NS). Each rabbit underwent a reversed autologous external jugular vein into common carotid artery bypass grafting. In group S, the vein grafts were surrounded by a non restrictive stent which was 6 mm in diameter (a kind of Dacron vascular prosthesis); and in group NS, there was no stent to support the vein grafts. The grafts were harvested at the first week (1W), second week (2W) and fourth week (4W) after surgery respectively. The dimensions (including the thickness and area of the intima and media, luminal area) were measured by computer-aided image analysis system, and the intimal hyperplasia ratio was defined as the percentage of the area enclosed by the internal elastic lamina occupied by the intima.

RESULTSAt 1W, the difference of the thickness and area of the intima between groups S and NS was not significant (P > 0.05); at 2W and 4W, the thickness and area of the intima and the intimal hyperplasia ratio in group S were less significant than those in group NS (P < 0.05); from 1W to 4W, the thickness and area of the media in group S were smaller than those in group NS (P < 0.05). Immunocytochemistry staining of PDGF-B showed that the percentage of positive cells of intima in both two groups was peaked at 2W, and a significantly smaller percentage was detected in group S compared with that in group NS at 2W and 4W (P < 0.05); the percentage of PDGF-B positive cells of media in both two groups was also peaked at 2W, and that in group S was smaller than that in group NS from 1W to 4W (P < 0.05); and the percentage of PDGF-B positive cells of adventitia in group S was peaked at 4W, whereas the percentage of adventitia in group NS peaked at 2W, and the percentage of adventitia in group S was greater than in group NS at 4W (P < 0.05).

CONCLUSIONSNon-restrictive external stenting inhibits the hyperplasia of the intima and media of the vein grafts and reduces the thickness and area of the intima and media; Non-restrictive external stenting inhibits the synthesis of PDGF and changes its distribution, and then inhibits the hyperplasia of the intima.

Animals ; Female ; Graft Occlusion, Vascular ; prevention & control ; Image Processing, Computer-Assisted ; Immunohistochemistry ; Jugular Veins ; transplantation ; Male ; Models, Animal ; Platelet-Derived Growth Factor ; physiology ; Proto-Oncogene Proteins c-sis ; Rabbits ; Stents

OBJECTIVETo introduce the experience in coronary artery bypass grafting (CABG) combined with concomitant valve operation.

METHODSFrom 1998 to 2002, forty-five patients (38 men and 7 women) with coronary artery lesion and valve diseases underwent myocardial revascularization combined with concomitant valve operation. The mean age of the patients was 59 years (42 to 75 years). Heart function was Class II (NYHA) in 7 patients, Class III in 30, Class IV in 8. The value of ejection fraction was 0.32 to 0.50. Thirty patients had mitral valve lesion, 7 aortic lesion, and 8 both lesions. Seventeen patients had single-vessel diseases, 20 double-vessel diseases, 8 triple -vessel diseases, and 8 left main artery lesion. After cardiac arrest by cold blood cardioplegia under moderate cardiopulmonary bypass (CPB), distal anastomosis of the saphenous vein (SV) to the target vessels were firstly performed and followed by valve replacement (32 patients) or plasty (2). The left internal mammary artery (LIMA) was grafted to the left anterior descending artery (LAD) before aortic unclamping. Proximal anastomosis of the SV to the aorta was finally finished on beating heart. The mean bypass time was 173.5 min and the mean duration of aortic cross-clamping time was 112.6 min.

RESULTSNo mortality occurred during hospitalization and all patients were discharged 9.2 days after operation. Cardiac function of all patients was improved to Class I-II and no patient died during follow-up.

CONCLUSIONSCABG combined with valve surgery can be safely performed with good results.

Adult ; Aged ; Coronary Artery Bypass ; Coronary Artery Disease ; complications ; surgery ; Female ; Follow-Up Studies ; Heart Valve Diseases ; complications ; surgery ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo describe the early experiences with rFVIIa in the management of bleeding after cardiovascular surgery.

METHODSFrom May 2006 through December 2007, 16 patients received rFVIIa during or after surgery despite conventional medical therapy and transfusion of blood products. There were 15 male patients and 1 female patients, aged from 36 to 77 years old with a mean of 52 years old. The surgical procedures include aortic procedures for 8 cases, valve replacement for 6 cases, pulmonary thromboendarterectomy for 1 case and atrial septal defect repair for 1 case. The data of these patients were reviewed and the safety and efficacy of rFVIIa after cardiovascular surgery were evaluated.

RESULTSrFVIIa was administered as a first dose of 27.6 to 54.5 microg/kg with a mean of 40.2 microg/kg. Six patients achieved hemostasis after the first dose. Nine patients received a second administration within 30 min, with a cumulative dose of 59.3 to 90.9 microg/kg, a mean of 80.3 microg/kg. Eight patients achieved hemostasis and 1 patient went to exploration. One patient received four doses of rFVIIa with a cumulative dose of 203.4 microg/kg and the bleeding stopped. Mean amount of chest drain loss and the amount of red blood cell, fresh frozen plasma, cryoprecipitate, and platelet transfusions decreased significantly after rFVIIa administration. The total amount of chest drain losses, transfusions of red blood cell and cryoprecipitate within 12 h postoperatively was positively correlated with the time from the end of bypass to administration of rFVIIa. No thromboembolic complications and other adverse reactions were noted.

CONCLUSIONSThe use of rFVIIa is associated with reduced blood loss, rapid improvement of coagulation variables, and decreased need for blood products. rFVIIa is safe and efficacious in the management of refractory postcardiotomy bleeding.

Adult ; Aged ; Cardiovascular Surgical Procedures ; Coagulants ; administration & dosage ; therapeutic use ; Factor VIIa ; administration & dosage ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Postoperative Hemorrhage ; drug therapy ; Recombinant Proteins ; administration & dosage ; therapeutic use ; Retrospective Studies

OBJECTIVETo summarize the experience in performing left ventricular aneurysmectomy (LVA) with geometric reconstruction and concomitant coronary artery bypass grafting (CABG) without mortality.

METHODSForty-two patients underwent LVA with geometric reconstruction and concomitant CABG. Forty-one patients were male, one was female with mean age of (55.5 +/- 2.4) years (40 - 68 years). Preoperative cardiac function was NYHA class III in 32 patients and class IV in 10. Thirty-eight patients had unstable angina pectoris and 10 had the history of severe ventricular arrythmia. Eight patients had ventricular tachycardia. Preoperative left ventricular ejection fraction (LVEF) was 41% (17% - 63%), LVEF was less than 40% in 29 cases. Left ventricular anatomic aneurysms were confirmed by ventriculography. Thirty-three cases underwent Jatene technique; 8 cases, Dor technique, and 1 case, Cooley technique. Mural thrombi were found in 21 patients and were completely removed. CABG was concomitantly performed in all patients. All of the left anterior descending artery was bypassed with left internal mammary artery and the other target vessels with saphenous vein. Mean cardiopulmonary bypass time was (135 +/- 11) minutes and aortic clamping time was (78 +/- 10) minutes.

RESULTSNo hospital mortality occurred and all patients were discharged. Postoperative reexploration for bleeding in 1 patient. The diameter and end systolic and diastolic volume of left ventricle were significantly decreased to nearly normal after operation. Operative ejection fraction had a tendency to increase but without significance (P > 0.05).

CONCLUSIONSLVA with geometric reconstruction and concomitant CABG could not only improve heart function but also eliminate ventricular arrythmia. The clinical result was excellent.

Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Coronary Artery Bypass ; Female ; Heart Aneurysm ; complications ; physiopathology ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; Ventricular Function, Left

OBJECTIVETo compare the blood flow of left internal mammary artery (LIMA) anastomosed to left anterior descending artery (LAD) with variable degree of stenosis in off pump coronary artery bypass grafting (OPCAB).

METHODSFrom 2000.9 to 2002.12, 167 cases (from a total of 209 OPCAB) were involved in this study. According to the degree of stenosis of LAD, all the cases were divided into group A (< 75%), group B (75% approximately 95%) and group C (> 95%). Blood flow of LIMA, routinely anatomized to LAD was immediately measured after anastomosis with transit-time flowmeter (TTFM) and several parameters were recorded.

RESULTSThe mean blood pressure at measurement was not significantly different (P = 0.08). Mean blood flow of group A (11.1 +/- 1.2) ml/min, B (16.3 +/- 1.6) ml/min and C (28.3 +/- 3.2) ml/min and diastolic flow of group A (26.3 +/- 2.8) ml/min, group B (34.8 +/- 3.2) ml/min and group C (55.1 +/- 5.3) ml/min, were significantly different between every two groups (P < 0.01) and the latter was bigger than the former. Systolic blood flow among group A (5.3 +/- 0.7) ml/min, group B (4.3 +/- 1.4) ml/min and group C (4.6 +/- 1.3) ml/min were not different (P = 0.91). Pulsatility index (PI) of group C (2.75 +/- 0.14) was significantly smaller than that of group A (4.36 +/- 0.47) and group B (3.72 +/- 0.31) (P < 0.01), but PI between groups A and B was of no significant difference (P = 0.12).

CONCLUSIONMean and diastolic blood flow of LIMA were closely related to the degree of stenosis of LAD. The higher the degree, the bigger the blood flow, and the smaller the value of PI. However, systolic blood flow was not influenced by the degree of lesion.

Adult ; Aged ; Coronary Artery Bypass ; Coronary Circulation ; Coronary Stenosis ; physiopathology ; Female ; Flowmeters ; Humans ; Male ; Mammary Arteries ; physiopathology ; Middle Aged ; Regional Blood Flow