This study was aimed to evaluate the efficiency and effectiveness of platelet-rich plasma(PRP) prepared by acute plateletpheresis in patients undergoing open heart surgery, and to analyze the quality of prepared platelet-rich plasma. Whole blood from 20 patients with ASAII-III was collected and PRP was harvested by machine after induction of anesthesia. Platelet count (Plt), mean platelet volume (MPV), platelet distribution width (PDW), plasma pH, plasma lactic acid (LA) concentration, and lactic dehydrogenase (LDH) concentration, germiculture result, CD62p and PAC-1 positive rate of inactivated and activated platelets by ADP in the whole blood before plateletpheresis (T1) , in the PRP after plateletpheresis (T2) and PRP before back-transfusion (T3) were determinated. The results showed that as compared with whole blood the platelet count in the PRP at T2 was (783 ± 184) ×10(9)/L, MPV, PDW and pH significantly decreased (P < 0.01) , while the plasma LDH, LA concentration, CD62p and PAC-1 positive rate of inactivated platelets were not significantly different from the whole blood at T1. In the PRP at T3, the platelet count, MPV, PDW and pH significantly decreased (P < 0.01) , while plasma LDH concentration, CD62p and PAC-1 positive rate of inactivated platelet significantly increased (P < 0.05 or P < 0.01) compared with the whole blood at T1. There were no significant difference among the CD62p and PAC-1 positive rate of activated platelets in the whole blood and PRP. It is concluded that PRP can be efficiently obtained from the patients undergoing open heart surgery by acute plateletpheresis, and the platelets in PRP are not activated during the preparing process. Some platelets in PRP are activated during the preserving process, but the whole activating function of platelets keeps normal.
Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Humans ; Middle Aged ; Platelet-Rich Plasma ; Plateletpheresis ; methods

Certain congenital heart defects, which present at birth as complex morphologic defects, are actually the result of a relatively simple primary lesion and the subsequent acquired development of a complex secondary lesion during gestation. Moreover, fetal heart approach during gestation can prevent simple cardiac lesions from such development. Specific structural lesions can be diagnosed before 12 weeks of gestation by transvaginal fetal echocardiography, and animal experiments have shown that direct or indirect fetal cardiac approach and fetal cardiac bypass are technically feasible. A number of fetal bypass models have resulted in long-term survivors, with for example, the delivery of normal lambs at full-term gestation. Also, successful full-term delivery has been obtained after fetal cardiac intervention. The success of fetal cardiac bypass was accomplished by the use of total spinal anesthesia and the administration of indomethacin. Moreover, a 42 % long-term survival after fetal cardiopulmonary bypass in a fetal lamb model has been reported. Maternal risk related to fetal bypass should be considered carefully alongside fetal risks and benefits. Most fetal malformations do not directly threaten maternal health, yet the procedures required to address fetal malformations can produce significant maternal risk and discomfort and subsequent pregnancies may be jeopardized. Further investigation of maternal outcome is required. Deep exploration of fetal and maternal pathophysiologic responses to intervention and comprehensive investigation is required to overcome current limitations, and should precede clinical trials as many problems remain to be solved before these techniques can be applied to human beings.
Animal ; Cardiac Surgical Procedures ; Female ; Fetoscopy ; Fetus/*surgery ; Heart Defects, Congenital/*surgery ; Human ; Pediatrics/methods ; Pregnancy

Cardiac Surgical Procedures ; adverse effects ; Humans ; Positive-Pressure Respiration ; methods ; Respiratory Insufficiency ; therapy

Cardiac Surgical Procedures ; Extracorporeal Membrane Oxygenation ; methods ; Heart Failure ; therapy ; Humans ; Infant, Newborn ; Male

OBJECTIVETo design a device for direct vision intracardiac operation without cardiopulmonary bypass, and assess its applicability preliminarily.

METHODSThe device was designed according to the clinical needs of intracardiac operation and used in operations for repairing atrial septal defect in 5 ex vivo porcine heart models. The practical applicability of this device was thoroughly tested and the results of the operations were evaluated.

RESULTS AND CONCLUSIONDirect vision operation for repairing atrial septal defect was successfully performed using this device, which can be a well applicable in some intracardiac operations, but its clinical effects need further evaluation.

Animals ; Cardiac Surgical Procedures ; instrumentation ; methods ; Cardiopulmonary Bypass ; Heart Septal Defects, Atrial ; surgery ; In Vitro Techniques ; Swine

The cardiovascular patch, served as artificial graft materials to replace heart or vascular tissue defect, is still playing a key role in cardiovascular surgeries. The defects of traditional cardiovascular patch materials may determine its unsatisfactory long-term effect or fatal complications after surgery. Recent studies on many new materials (such as tissue engineered materials, three-dimensional printed materials, etc) are being developed. Patch materials have been widely used in clinical procedures of cardiovascular surgeries such as angioplasty, cardiac atrioventricular wall or atrioventricular septum repair, and valve replacement. The clinical demand for better cardiovascular patch materials is still urgent. However, the cardiovascular patch materials need to adapt to normal coagulation mechanism and durability, promote short-term endothelialization after surgery, and inhibit long-term postoperative intimal hyperplasia, its research and development process is relatively complicated. Understanding the characteristics of various cardiovascular patch materials and their application in cardiovascular surgeries is important for the selection of new clinical surgical materials and the development of cardiovascular patch materials.
Cardiac Surgical Procedures/methods* ; Tissue Engineering ; Heart Ventricles ; Heart Atria ; Treatment Outcome

Objective: To observe the association between clinical phenotypes of hypertrophic cardiomyopathy (HCM) patients and a rare calcium channel and regulatory gene variation (Ca²⁺ gene variation) and to compare clinical phenotypes of HCM patients with Ca²⁺ gene variation, a single sarcomere gene variation and without gene variation and to explore the influence of rare Ca²⁺ gene variation on the clinical phenotypes of HCM. Methods: Eight hundred forty-two non-related adult HCM patients diagnosed for the first time in Xijing Hospital from 2013 to 2019 were enrolled in this study. All patients underwent exon analyses of 96 hereditary cardiac disease-related genes. Patients with diabetes mellitus, coronary artery disease, post alcohol septal ablation or septal myectomy, and patients who carried sarcomere gene variation of uncertain significance or carried>1 sarcomere gene variation or carried>1 Ca²⁺ gene variation, with HCM pseudophenotype or carrier of ion channel gene variations other than Ca²⁺ based on the genetic test results were excluded. Patients were divided into gene negative group (no sarcomere or Ca²⁺ gene variants), sarcomere gene variation group (only 1 sarcomere gene variant) and Ca²⁺ gene variant group (only 1 Ca²⁺ gene variant). Baseline data, echocardiography and electrocardiogram data were collected for analysis. Results: A total of 346 patients were enrolled, including 170 patients without gene variation (gene negative group), 154 patients with a single sarcomere gene variation (sarcomere gene variation group) and 22 patients with a single rare Ca²⁺ gene variation (Ca²⁺ gene variation group). Compared with gene negative group, patients in Ca²⁺ gene variation group had higher blood pressure and higher percentage of family history of HCM and sudden cardiac death (P<0.05); echocardiographic results showed that patients in Ca²⁺ gene variation group had thicker ventricular septum ((23.5±5.8) mm vs. (22.3±5.7) mm, P<0.05); electrocardiographic results showed that patients in Ca²⁺ gene variation group had prolonged QT interval ((416.6±23.1) ms vs. (400.6±47.2) ms, P<0.05) and higher RV5+SV1 ((4.51±2.26) mv vs. (3.50±1.65) mv, P<0.05). Compared with sarcomere gene variation group, patients in Ca²⁺ gene variation group had later onset age and higher blood pressure (P<0.05); echocardiographic results showed that there was no significant difference in ventricular septal thickness between two groups; patients in Ca²⁺ gene variation group had lower percentage of left ventricular outflow tract pressure gradient>30 mmHg (1 mmHg=0.133 kPa, 22.8% vs. 48.1%, P<0.05) and the lower early diastolic peak velocity of the mitral valve inflow/early diastolic peak velocity of the mitral valve annulus (E/e') ratio ((13.0±2.5) vs. (15.9±4.2), P<0.05); patients in Ca²⁺ gene variation group had prolonged QT interval ((416.6±23.1) ms vs. (399.0±43.0) ms, P<0.05) and lower percentage of ST segment depression (9.1% vs. 40.3%, P<0.05). Conclusion: Compared with gene negative group, the clinical phenotype of HCM is more severe in patients with rare Ca²⁺ gene variation; compared with patients with sarcomere gene variation, the clinical phenotype of HCM is milder in patients with rare Ca²⁺ gene variation.
Humans ; Cardiac Surgical Procedures/methods* ; Cardiomyopathy, Hypertrophic/genetics* ; Echocardiography ; Electrocardiography ; Phenotype ; Sarcomeres/genetics* ; Adult

OBJECTIVETo summarize the method and experience of cardiopulmonary bypass (CPB) with vacuum-assisted venous drainage technology (VAVD) in the minimally invasive cardiac surgery (MICS).

METHODS35 cases of patients undergoing MICS were achieved femoral arterial cannula and femoral venous cannula. During the course of the CPB, we used the VAVD technology. At the same time, we selected 35 cases as control group.The time of the CPB, mechanical ventilation and ICU, and the amount of the urine, blood products, and chest drainage were recorded.

RESULTSThe time of mechanical ventilation and ICU staying, the volume of the blood products and the volume drainage within 48 h postoperatively in the MICS group were significantly shorter and less than that in control group (P < 0.05).

CONCLUSIONThe use of VAVD in the MICS can increase the vena cava drainage effectively, and ensure the surgery safe and successful.

Adolescent ; Adult ; Aged ; Cardiac Surgical Procedures ; methods ; Drainage ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Vacuum ; Veins ; Young Adult

Cardiac Catheterization ; Cardiac Surgical Procedures ; instrumentation ; methods ; Heart Septal Defects, Ventricular ; therapy ; Humans ; Male ; Thoracic Injuries ; complications

OBJECTIVEInfants are usually subjected to serious complications after cardiac surgery with cardiopulmonary bypass (CPB). This study was conducted to evaluate the effects of a modified ultrafiltration technique (MUF) on infants undergoing cardiac surgery with CPB.

METHODSA total of 261 infants less than 1 year old with congenital heart disease and who required CPB were randomized into receive MUF during CPB (n=205) or not (n=56, control group). Bypass duration, aortic cross-clamp duration, postoperative blood effluents and transfusions, mechanical ventilation duration following operation, and hematocrit and oxygenation index 24 hrs postoperatively were compared between the two groups.

RESULTSNo ultrafiltration-related complication was found in the MUF group. There were no significant differences in the duration of bypass and aortic cross-clamp between the two groups. Postoperative blood effluents and transfusions in the MFU group were significantly reduced (79.5+/-18.6 mL vs 57.3+/-15.4 mL and 78.1+/-32.5 mL vs 67.9+/-25.6 mL respectively) compared with the control group (P<0.05). The duration of mechanical ventilation following operation in the MFU group was shorter than that in the control group (28.6 +/- 9.1 hrs vs 32.3 +/- 8.7 hrs; P<0.05). MUF produced a significant improvement in hematocrit (34.6 +/- 3.7 min vs 29.8+/-2.8 min; P<0.01) and oxygenation index (275.2+/-39.1 vs 202.2+/-25.6; P<0.01) 24 hrs postoperatively when compared with the control group.

CONCLUSIONSMFU can reduce postoperative bleeding and blood transfusions, improve pulmonary function and shorten the duration of mechanical ventilation in infants undergoing cardiac surgery with CPB.

Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; methods ; Female ; Heart Defects, Congenital ; surgery ; Humans ; Infant, Newborn ; Male ; Ultrafiltration ; methods