Objective Arrhythmias are one of the main causes of postoperative morbidity after thoracic surgery.The aim of this study was to evaluate whether video-assisted thoracoscopic surgery decreases the risk of postoperative arrhythmias compared with traditional open lung lobectomy.Methods 138 consecutive patients were enrolled from January 2011 to February 2012,after five age and risk factors matched,68 patients undergoing video-assisted thoracic surgery and 70 patients undergoing traditional open lung lobectomy were eligible for analysis.The rhythm was documented preoperatively and postoperatively with standard electrocardiogram (ECG) recording and ECG monitoring.All patients followed 3 months after hospital admission.Results There was a 17.6％ incidence (12/68) of postoperative new-onset arrhythmias undergoing video-assisted thoracic surgery and 18.6％ of patients (13/70) undergoing thoracotomy,but the difference was not statistically significant.In both groups,atrial fibrillation was the most common arrhythmia (60％).There was no significant difference in the other morbidity (P ＞0.05) and mortality rate(P =0.57,1.5％ vs 2.9％) between the two groups.Conclusion New-onset arrhythmias,most frequently atrial fibrillation,are common after lung lobectomy.Regardless of surgical approach,postoperative arrhythmias after lobectomy occurred with equal frequency.New insights in the pathophysiology of postoperative thoracic arrhythmias and advances in prevention and therapy are need future study.

Objective To evaluate the feasibility,safety and efficacy of perventricular device closure of supracristal or intracristal ventricular septal defects (VSD) using a minimally invasive technique through a parasternal approach.Methods 49 patients,aged 4 months to 53 years [median 4.8 years],were enrolled in this study.A 1.5 to 3 cm parasternal incision was made in the left second or third intercostal space.The pericardium was incised and cradled without entering the pleural space.Two parallel pursestring sutures were placed at the right ventricular outflow tract.After puncture,the specially designed delivery sheath loaded with the device was inserted into the right ventricle.Under transesophageal echocardiographic guidance,the sheath was advanced through the defect into the left ventricle.Then the device was deployed to close the defect.Results Successful implantation of the device was achieved in 47 patients (96％),including 26 in intracristal group and 21 in supracristal group.The concentric,eccentric,and muscular occluders were used in 17,28 and 2 patients,respectively.The mean diameter of VSD was (4.4 ± 1.7)mm in the intracristal group and (2.7 ± 0.9) mm in the supracristal group.The mean device size was (7.0 ± 2.3) mm and (4.8 ± 1.1)mm in the intralcristal and supracristal group,respectively.The mean intracardiac manipulation time was (17 ± 16) min.During the follow-up period of 3 to 24 months,no device-related complications were found.Conclusion The perventricular device closure of small-sized supracristal or under medium-sized intracristal VSD is feasible,safe,and efficacious through a left parasternal approach.

Objective To investigate the association between CYP11 B2 gene polymo-rphism and left ventricle hypertrophy with meta analysis.Methods Literatures about the association of CYP11 B2 gene polymorphism and left ventricle hypertrophy from January 1992 to December 2011 were searched.The electronic databases retrieved from Pubmed,Embase,China national knowledge intemet,Chinese biological medicine disk,VIP fulltext database and Wanfang fulltext database.Odds ratio of CYP11 B2 genotype distributions in left ventricle hypertrophy patients comparing with healthy control were analyzed.RevMan5.1 software was applied for investigating hereogeneity among individual studies and summarizing effects with proper statistical methods.Six case control studies were enrolled.Results A total of 541 cases and 553 controls were enrolled for the study.The pooled OR of CC vs TT + TC genotype was 1.15 (95％ CI:0.74 ～ 1.80) (Z =0.63,P =0.53) in the subgroup of hypertension,and the pooled OR of CC vs TT + TC genotype was 1.15 (95 ％ CI:0.74 ～ 1.80) (Z =0.63,P =0.53) in the subgroup of race.The pooled OR of C vs T allele was 1.15 (95％ CI:0.76 ～ 1.74) vs 0.87 (95％ CI:0.58 ～ 1.31) (Z =0.67,P =O.50).Conclusion Whether the hypertension or the race,the genotype of CYP11 B2 polymorphism has no association with an increased risk of left ventricle hypertrophy.

So far,thoracoscopy(video-assisted thoracic surgery) has been maturely used in the field of thoracic and cardiovascular surgery,and already has achieved satisfactory results.In compare,the developing cardioscopy technique to perform intracardiac surgery,due to its own characteristics,was rarely applied as an supplementary clinical means over a long period of time.But more and more studies suggested that cardioscopy technique has it's own advantages in cardiovascular surgery,such as not extend the operation time and aortic clamping time,can provide a clearer operative field,and cause less tissue damage.Although there are a few cases reported completely cardioscopy technique treatment experience,it has not been widely used in clinical because of it's limitations.Even no such kind of research has been reported in China yet.This article aims to review the status of cardioscopy technique and its development prospects,to investigate the feasibility of its'widely clinical application in the future

Objective This study aims to analyze the independent risk factors associated with postoperative delirium of patients undergoing Stanford A aortic dissection surgery.Methods Clinical data of the patients who underwent Stanford A aortic dissection surgery from December 2014 to October 2015 were collected.All patients received surgery under deep hypothermic circulatory arrest(DHCA) and the nasal temperature goal was below 23℃.After surgery,patients were transferred to the cardiovascular ICU,where they received standard postoperative care.The delirium was diagnosed according to the criteria of the confusion assessment method for the intensive care unit(CAM-ICU).The possible risk factors of pre-operation,during operation or post-operation were analyzed via univariate analysis and multivariate logistic regression to determine the independent risk factorsof postoperative delirium.Results 148 patients underwent Stanford A aortic dissection surgery which the incidence of postoperative delirium was 31.1％ (46/148).Univariate analysis showed the associated risk factors were age,hypertension,cognitive impairment,emergency operation,operation time,aorta clamping time,DHCA time,fluctuation of blood pressure during operation,blood transfusion,quality of sleep,length of ICU stay and electrolyte disturbance(P ＜ 0.05).Multivariate logistic regression analysis revealed that hypertension,cognitive impairment,fluctuation of mean arterial blood pressure(MAP) ＞ 30 mmHg (1 mmHg =0.133 kPa),DHCA time ＞ 40 min,postoperative poor quality of sleep and electrolyte disturbance were independently associated with postoperative delirium after Stanford A aortic dissection surgery(P ＜ 0.05).Conclusion Delirium is a frequent complication.Factors independently associated with delirium are hypertension,cognitive impairment,DHCA time,postoperative poor quality of sleep and electrolyte disturbance.Prevent,assess and manage delirium should be paid more attention and reinforced.

Percutaneous pulmonary valve implantation (PPVI) is an exciting growing field in cardiovascular medicine.With the sophisticated improvement of biomedical engineering,development of PPVI offers people a new way of less invasive techniques to treat these groups of patients with pulmonary valvular regurgitation over the past several years.New stent designs and operative and interventional hybrid approaches are under investigation.This nonsurgical approach has been proven to be feasible and holdpromise,although many obstacles still exist.At the present time,PPVI has been widely used in clinical in the United States and European countries,but in our country,only a small number of cases reports have been published.With wider application and development of PPVI,cumulative experiences and long-term follow-up of PPVI therapies,better criteria will be established for patient election.Complications will be reduced and safer and more effective treatment results will be achieved.PPVI therapies will be applied to a larger subset of patients and become an important alternative to future conventional pulmonary valve replacement.