Objective: To retrospectively summarize the clinical experience of one-stage repair and surgical management in patients with interrupted aortic arch (IAA) combining aortopulmonary window (APW). Methods: A total of 8 patients with IAA combining APW received surgical repair in our hospital from 2009-01 to 2016-08 were enrolled including 4 male, the age at operation was between 3 months to 4.5 years. There were 6 patients<1 year at the mean age of (5.2±2.7) months with the mean body weight at (5.7±1.6) kg; 2 patients>1 year at the mean age of (4.1±0.6) years with the mean body weight at (14.6±0.9) kg. All patients had the history of repeated respiratory infection before the operation. The IAA morphology included type A in 6 patients and type B in 2; APW morphology included type II in 6 patients and type III in 2. All patients received median sternotomy with deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. The malformation of IAA combining APW was corrected by one-stage operation. Results: The mean pre-operative pulmonary artery systolic pressure (PASP) was (83.1±8.3) mmHg, mean cardiopulmonary bypass time was (127.0±18.5) min, aortic cross-clamp time was (78.0±14.1) min; the mean post-operative PASP was (43.6±8.5) mmHg, no operative death occurred. The patients were followed-up for (19.8±13.9) months and the mean aortic arch pressure gradient was (11.2±4.7) mmHg, all patients were well recovered. Conclusion: Primary anatomical IAA combining APW can be thoroughly corrected by one-stage operation; median sternotomy was simple method with good effect.

Objective: To explore the safety and efficacy of two modeling methods of CARTO3 system for radiofrequency catheter ablation (RFCA) in paroxysmal atrial fibrillation (PAF) patients. Methods: A total of 150 PAF patients with RFCA were randomly divided into 3 groups: Group A: using conventional point-to-point mapping to guide circumferential pulmonary vein isolation; Group B, using fast anatomical modeling to guide circumferential pulmonary vein RFCA; Group C, using combined application of 2 mapping methods to guide circumferential pulmonary vein RFCA. n=50 in each group and the rest operative procedures were the same in 3 groups. The operative time, X-ray exposure time, success rate and complication rates were recorded in 3 groups; the size of left atrium and systolic function of left ventricle at pre- and 6 months post-operation were compared. Results: Compared with Group A and Group B, Group C had the shorter operative time and X-ray exposure time, P<0.05;the success rates were similar among 3 groups. No serious complication occurred in all 3 groups. Echocardiography presented that compared with pre-operative condition, the size of left atrium and LVEF were similar at 6 months post-operation. Conclusion: Combined using of two modeling methods of CARTO3 system was safe and effective for RFCA in PAF patients; it may reduce the operative time and X-ray exposure time, improve the accuracy of circumferential pulmonary vein locating and help guiding RFCA of PAF at certain degree.

Objective: To establish an echocardiography parameter scoring system for assessing the risk of 1 year re-admission in patients with left ventricular systolic dysfunction (LVSD). Methods: A total of 412 chronic LVSD patients treated in our hospital from 2007-01 to 2016-01 were studied and the end point event was 1 year re-admission. The data included in 280 patients from 2007-01 to 2014-12 for establishing the scoring system and 132 patients from 2015-01 to 2016-01 for verifying the system. Based on 7 echocardiography parameters, the patients were divided into 7 sets of groups: ① Left ventricular diameter (LVD): Group0, n=290 and Group1, n=122;② Mitrial regurgitation (MR): Group0, n=203, Group1, n=138 and Group2, n=71; ③ Tricuspid regurgitation (TR): Group0, n=302, Group1, n=90 and Group2, n=20; ④ LVEF: Group0, n=272 and Group1, n=140; ⑤ Pulmonary artery systolic pressure: Group0, n=282 and Group1, n=130; ⑥ Hydropericardium: Group0, n=347 and Group1, n=65; ⑦ Hydrothorax:Group 0, n=261, Group1, n=86 and Group2, n=65. The parameters were identified by COX regression analysis, weighted value of scoring system was calculate by hazard ratio (HR), predictive value for1 year re-admission was assess by ROC curve and finally, scoring integration was verified by validation data group. Results: The integration score was calculated as follows: LVD>60mm=1 point; TR: Group1=1 point and Group2=3 points; MR: Group1=2 points and Group2=4 points; Hydrothorax: Group1=2 points and Group2=3 points;Hydropericardium=1 point. COX regression analysis indicated that for 1 year re-admission: HR=1.552 in Group1 vs Group0, HR=3.374 in Group2 vs Group0 and HR=4.562 in Group3 vs Group0, all P<0.05. The AUC of ROC for establishing the data was 70.0% (95% CI 0.640-0.761) and for verifying the data was 70.4% (95% CI 0.616-0.792); the best integration score was 4 points. Conclusion: Echocardiography parameter scoring system may better predict the risk of 1 year re-admission in LVSD patients which is superior to single echocardiography parameter.

Objective: To evaluate the impact of mean platelet volume (MPV) on prognosis in patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 1012 consecutive STEMI patients received percutaneous coronary intervention (PCI) in our hospital from 2010-01-01 to 2014-10-31 were enrolled. Major adverse cardiovascular events (MACE) were recorded in 2015-10. Based on ROC curve measured optimal critical point of MPV in all-cause death, the patients were divided into Low MPV group and High MPV group. The incidence of MACE was compared between 2 groups, the impact of MPV on prognosis of PCI treated STEMI patients was studied by uni- and multivariate COX regression analysis. Results: By ROC curve, the optimal critical point of MPV in all-cause death was MPV≤9. 466 fl. MPV≤9. 466 fl in Low MPV group, n=549 and MPV>9. 466 fl in High MPV group, n=463. The patients were followed-up for 34 (12-69) months. Compared with Low MPV group, the patients in High MPV group had the higher incidences of all-cause death and cardiac death, P<0. 001 and P=0. 001. With adjusted multivariates, COX regression analysis showed that MPV was an independent risk factor of all-cause death (HR=1. 463, P<0. 001) and cardiac death (HR=1. 458, P<0. 001) in relevant patients. Conclusions: Increased MPV at admission had the predictive value for long-term prognosis in PCI treated STEMI patients.

Objective: To study the relationship betweenperipheral blood eosinophil(EOS) level and acute myocardial infarction(AMI) combining helicobacter pylori (Hp) infection, to compare EOS level in Hp(+) and Hp(-) AMI patients with the possible mechanism. Methods: A total of 662 patients with coronary heart disease(CHD) admitted in our hospital from 2015-09 to 2016-05 were retrospectively studied. The patients were divided into 2 groups: AMI group, n=269 and Stable angina pectoris(SAP) group, n=393; according to 13C breath test, the patients were divided into another set of 2 groups: Hp(+) group, Hp infection value≥4.0, n=276 and Hp(-) group, Hp infection value<4.0, n=386. Clinical data was collected, EOS levels were compared between Hp(+) and Hp(-) AMI patients; relationship between EOS level and high sensitivity C-reactive protein(hs-CRP) level was analyzed in Hp(+) AMI patients. Results: Compared with SAP group, AMI group had the higher rate of Hp(+) as 46.5%vs38.4%, P=0.024. In Hp(+) group, compared with SAP patients, AMI patients had the lower EOS level and higher hs-CRP level, all P<0.000. In Hp(+) AMI patients, EOS level was negatively related to hs-CRP(r=-0.202, P<0.05). Conclusion:Hp(+) AMI patients had decreased peripheral blood EOS and increased hs-CRP, it implied that Hp(+) may aggravate the inflammatory response in AMI patients and therefore, affect EOS which could play an important role in thrombus formation.

Objective: To investigate the impact of discontinued dual antiplatelet therapy(DAPT) of aspirin combining clopidogrel within 5 days on peri-operative bleeding in patients with coronary artery bypass grafting (CABG). Methods: A total of 2012 patients with off-pump CABG were retrospectively enrolled in our study including 1506 male and the mean age was at 61.92 years. All patients received regular DAPT previously and discontinued the medication≤5 days due to emergency or prior limited CABG. Based on the days from discontinued DAPT to operation, the patients were divided into 6 groups: 0-day group, n=220, 1-day group, n=240, 2-day group, n=360, 3-day group, n=332, 4-day group, n=428 and 5-day group, n=432. Relationships between risk factors of bleeding and discontinued DAPT time were studied. Results: Bleeding was defined by BARC (bleeding academic research consortium) standard. The incidences of bleeding events in 0-day group, 1-day group, 2-day group, 3-day group, 4-day group and 5-day group showed a decreasing trend as 29.1%, 24.6%,19.4%, 13.0%, 14.5% and 13.0% respectively, P<0.01. Post-operative chest drainage volume≥2L within 24h (P=0.13) and intracranial bleeding (P=0.60) had no obvious tendency changes; occurrence rates of 48h peri-operative transfusion≥5 U whole blood or red blood cells (P<0.01) and re-operation(P<0.01) had a decreasing trend by prolonged time of discontinued medication. The minor endpoint events were similar. Compared to (3-5) days discontinued medication, the patients with (0-2) days discontinued DAPT were with the higher incidences of overall bleeding, re-operation and 5U transfusion, the differences had statistical meaning. Conclusion: The incidence of bleeding presented a decreasing trend by prolonged time of discontinued DAPT before CABG;transfusion and re-operation had the statistical meaning for bleeding. Discontinued medication less than 3 days may increase bleeding events and therefore, in high risk patients, prior CABG discontinued medication should be more than 3 days.

Objective: To assess the quality of isolated coronary artery bypass grafting (CABG) in order to provide the decision support for medical quality management. Methods: Clinical information for adult patients who received CABG in our hospital during 2014 was collected. End point events were defined by major complications and mortality within 30 days after the operation. Taking SinoSCORE as risk variables, hierarchical Logistic regression model was conducted to make risk adjustment, Bootstrap method was used for simulation, we obtained RSMCR (risk-standardized major complication rate) and 95%CI. Results: There were 138/3785 (3.65%) patients with single CABG suffered from end point events.The range of un-adjusted end point events was (2.53%-6.09%) among 9 surgical teams (units), pre-operative risk condition was different among 9 units, SinoSCORE showed P<0.05 and with risk adjustment,the range of RSMCRs was(3.12%-4.82%); after Bootstrap simulation, one unit had the upper limit of RSMCR 95%CI(2.85%-3.61%) which was lower than the average and another unit had the lower limit of RSMCR 95%CI (3.81%-5.40%) which was higher than the average, RSMCR in the rest 7 units was similar. Conclusion: We made an objective evaluation for surgery quality in 9 adult care units by risk adjustment method andprovided a decision-making basis for improving medical quality management.

Objective: To explore GRACE (global registry of acute coronary events)score on short term prognosis of ST-segment elevation myocardial infarction (STEMI)in patients elder than 75 years with primary percutaneous coronary intervention(PCI). Methods: A total of 104 STEMI patients elder than 75 years with primary PCI in our hospital from 2011-11 to 2014-01 were studied. Based on GRACEscore at admission, the patients were divided into 2 groups: Lower/mid risk group, n=72 patients with GRACEscore at 112-154 (136.5±10.6) and High risk group, n=32 patients with GRACE score at 155-202(167.8±12.3). The baseline condition and outcomes were compared between 2 groups and the primary endpoint was 1 year mortality. Predictive value of GRACEscore on 1 year mortality was evaluated by ROC curve, the relationships between Lower/mid risk group, High risk group and clinical outcomes were assessed by log-ranksurvive curve andunivariate Cox regression analysis. Results: The area under ROC curve for GRACEscore predicting 1 year mortality was 0.788 with the sensitivity at 70.0%and specificity at 84.0 %.Univariate Cox regression analysis indicated that compared with Lower/mid risk group, High risk group had the higher risk of 1-year death (HR=5.75, 95% CI 1.486-22.256, P=0.0113); log-rank survive curve presented that High risk group had the higher 1 year mortality (21.9% vs 4.2%, P=0.0039). Conclusion: GRACE score may further distinguish the lower/mid risk and high risk populations in elder STEMI patients; it may also predict 1 year clinical prognosis.

Objective: To establish a scoring system for predicting the risk of side branch occlusion(SBO) in coronary bifurcation intervention based on visual estimation of quantitative coronary angiography (QCA). Methods: RESOLVE scoring system was developed from QCA. A total of 1545 patients with 1601 bifurcation lesions by RESOLVE study were enrolled. Based on RESOLVE scoring system, visual estimation was conducted to compare the consistency. According to SBO occurrence after main branch stent implantation, our research was divided into 2 groups: SBO group, which was defined by coronary angiography confirmed TIMI grade decreasing, n=114 patients with 118 lesions and Non-SBO group, n=1431 patients with 1483 lesions. Using RESOLVE scoring method as reference,V-RESOLVE scoring system was established, the discrimination, goodness-of-fit and V-RESOLVE score for the incidence of SBO were assessed;the diagnostic value for predicting the risk of SBO in coronary bifurcation intervention was compared between 2 scoring systems. Results: The consistency between visual and QCA was from fair to moderate (weighted Kappa=0.22-0.44). Compared with Non-SBO group, SBO group had the higher degrees of pre-operative bifurcation stenosis and side branch stenosis before main branch stent implantation; larger bifurcation angle and vessel diameters in main/side branches, all P<0.01. The area of V-RESOLVE under ROC curve was 0.76(95%CI 0.71-0.81) which was similar to the area of RESOLVE under ROC curve:0.77 (95% CI 0.72-0.81), P=0.74, Hosmer-Lemeshow P=0.17. The patients were categorized into 2 conditions by V-RESOLVE: high risk (V-RESOLVE score≥12)and non-high risk (V-RESOLVE score<12), the incidence of SBO was higher in high risk patients (16.7% vs 4.3%), P<0.01. The incidences of SBO were similar in non-high risk patients by V-RESOLVE and RESOLVE (4.3% vs 3.4%), P=0.22 and in high risk patients (16.7% vs 18.0%), P=0.60. Conclusion: V-RESOLVE scoring system may predict the risk of SBO in patients with coronary bifurcation intervention.

Objective:To explore the relationship between single nucleotide polymorphism (SNP) rs4977574 in CDKN2B-AS1 gene and female premature coronary artery disease (pCAD) occurrence. Methods: Our research included 2 groups: pCAD group, n=226 consecutive patients≤65 years of age and Control group, n=79 subjects with matched age,without CAD. The genotype of CDKN2B-AS1 SNP rs4977574 was detected by SNaPshot. Blood levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), uric acid (UA), fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) were examined; relationships between rs4977574 polymorphism and the above parameters were assessed. Results: Compared to Control group, pCAD group had increased blood levels of TG, UA, FPG and HbA1c, P<0.05. With adjusted age, body mass index (BMI), relevant disease history and risk factors, elevated HbA1c (HbA1c>6.2%) obviously increased the risk of female pCAD occurrence (OR=3.35, 95%CI 1.41-8.00, P=0.006). The genotype and allele frequency of rs4977574 were different between pCAD group and Control group, P<0.05. Compared to Control group, pCAD group had the higher frequency of G allele(OR=1.24, 95%CI 1.05-1.48, P=0.019); further analysis found that rs4977574 polymorphism was related to high HbA1c. Compared to AA genotype, GG+GA genotype had the increased incidence of high HbA1c(OR=2.08, 95%CI 1.11-3.89, P=0.022). Conclusion: CDKN2B-AS1 SNP rs4977574 was related to female pCAD occurrence and it was also related to high HbA1c.