Objective To evaluate the safety and early outcomes of hybrid coronary and peripheral artery revascularization.Methods From January 2008 to July 2008,peripheral artery stenting followed by off-pump coronary artery bypass grafting was performed on five patients under general anesthesia.Results The symptoms caused by the coronary artery disease and peripheral vascular artery disease were cured by the hybrid surgery in all the cases.No early complications occurred.The serum ALT and AST were(38.4?6.9) U/L and(28.0?8.2) U/L respectively after the surgery without significant difference comparing with those determined before the operation [ALT:(36.6?7.5) U/L,t=0.88,P=0.43;AST(26.4?7.2) U/L,t=1.73,P=0.16].Of the 5 patients,3 showed normal renal function before the surgery,and 2 had stenosis of the renal arteries;these two patients showed the postoperative level of BUN 7.3 and 6.8 mmol/L,and Scr value 61 and 82 ?mol/L respectively.In this series,the mean 24-hour chest drainage volume was(842?180) ml,mean ICU stay was(75.4?25.2) h,mean respirator time was(24.2?17.4) h,and mean postoperative hospital stay was(9.8?2.9) days.The patients were followed up for 2 to 9 months,none of them showed complications during the period.Conclusions For patients with both coronary heart disease and peripheral artery disease,hybrid surgery is a minimally invasive,safe,effective,and economic method.The method does not influence the liver and renal functions of the patients.Moreover,no significant difference exists in volume of chest drainage,ICU stay,respirator time,and postoperative stay between standard bypass grafting and this procedure.However,its long-term efficacy should be further investigated.

Objective To review our clinical experience with 41 reoperatioas of prosthetic heart valve dysfunction be-tween October 1996 and October2008. Methods There were 16 malas and 25 females with an average age of (44.5±12.6)years. All 41 patients underwent reoperation under hypothermic cardiopulmonary bypass, including 38 heart valve replace-ments, 2 disc rotations and cut of the excessive knot in 1 case. There were 13 emergency and 28 elective procedures. Results The median time for extubation was 15.3 hours and tracheostomy was needed in 5 cases. There were 6 deaths, all of which occurred in emergency cases, with a mortality rate of 15.4%. No death occurred in patients implanted with a bioprosthetic valve previously. Postoperative complications included 1 infective endocarditis, 1 intractable hiccup and 1 wound infection. Conclusion Prosthetic heart valve dysfunction is catastrophic. Early diagnosis and reoperation is mandatory.

Objective To study the relationship between fibroblast growth factor 21 (FGF21) and blood glucose (BG) after cardiac surgical operation.Methods Eighty-six coronary atherosclerotic heart disease patients without DM were divided into postoperative normal BG group (n=46) and postoperative elevated BG group (n =40).Their preoperative baseline data were recorded,their plasma FGF21 level was measured before and after operation.The relationship between FGF21 and BG was analyzed by dual regression analysis.Results The serum FGF21 level was signifycantly higher in two groups after operation than before operation (7.49±0.53 μg/L vs 3.04±0.26 μg/L,P＜0.01) and in postoperative normal BG group than in postoperative elevated BG group (5.84±0.72 μg/L vs 2.84±0.46 μg/L,P＜0.01).The circulating FGF21 level was related with the postoperative elevated BG level (OR =10.67,95％CI:2.34-48.63,P＜0.01).Conclusion BG is closely related with FGF21 after coronary bypass,which is of great importance for the management of BG after cardiac surgical operation.

Objective To analyze the midterm outcome of patients with congenital aortic stenosis undergoing percutaneous balloon aortic valvuloplasty (PBAV) by single echocardiographic guidance. Methods The clinical data of 12 patients with congenital aortic stenosis who underwent PBAV by single echocardiographic guidance at Fuwai Hospital from January 2016 to November 2017 were retrospectively analyzed. There were 7 males and 5 females with an average age of 18.27±15.30 years. The preoperative peak pressure gradient was 61.8–110.0 (80.30±24.50) mm Hg, and 50% of patients had aortic regurgitation. Results All patients successfully underwent PBAV. Aortic annulus diameter was 18.65±3.17 mm and balloon diameter was 17.62±3.77 mm, with balloon diameter to annulus diameter ratio of 0.92±0.07. The peak transaortic gradient was 16-51 (36.72±12.33) mm Hg immediately after procedure, which was significantly different from the preoperation (P=0.000). During the follow-up period, the peak transaortic gradient was 21-58 (37.06±13.52) mm Hg, and there was no significant difference between the follow-up and immediate postoperation (P=0.310). Immediately after procedure and during follow-up, 58% of patients had aortic regurgitation, which was not statistically different from the preoperation (P=0.682). Conclusion Systematic use of Doppler echocardiographic guidance for PBAV is feasible, and that it is associated with a high success rate and a very low complication rate.

Objective    To explore the appropriate method of biventricular repair and analyze the risk factors for reoperation, by summarizing the 15-year treatment experience of biventricular repair for double outlet right ventricle with non-committed ventricular septal defect (DORVncVSD). Methods    Clinical data of 162 consecutive patients with DORVncVSD who had biventricular repair from 2005 to 2019 in our center were retrospectively analyzed. The children were divided into two groups according to the path of intracardiac tunnel: 110 patients with ventricular septal defect rerouted to the aorta were recruited into a group A (75 males and 35 females aged 3.6±3.2 years); 52 patients with ventricular septal defect rerouted to the pulmonary artery were into a group B (30 males and 22 females aged 2.8±2.7 years). In order to establish a smooth intracardiac tunnel, enlargement of VSD, the resection of conus muscle and the transfer of tricuspid tendon or papillary muscle, etc were performed at the same time. Results    In the patients with biventricular repair, there were 9 (5.6%) early deaths and 6 (3.7%) early intracardiac baffle obstructions. During the follow-up of 7.5±7.0 years, and 8 (4.9%) late deaths occurred. The 1-year, 5-year, 10-year and 15-year survival rates of the group A were 92.7%, 91.1%, 91.1%, 85.4%, respectively and those of the group B were 92.2%, 85.2%, 85.2%, 85.2%, respectively. The difference between the two groups was not statistically significant (P=0.560). The follow-up results showed that 10 (6.2%) patients had late-onset intracardiac tunnel obstruction, and 8 patients underwent reoperation. There were more late-onset intracardiac tunnel obstruction patients and overall intracardiac tunnel obstruction patients in the group A than those in the group B (9 patients vs. 1 patient, P=0.017; 15 patients vs. 1 patient, P=0.001). No significant difference of early mortality and late mortality was noted for the group A (P=0.386) and the group B (P=0.223). Also it was noted that performing tricuspid valve operation at the same time in the group A had a significant impact to reduce the occurrence rate of intracardiac obstruction (1/46 vs. 15/64, P=0.004), without any tricuspid regurgitation or stenosis. The reoperation rate of patients with Rastelli after right ventricular outflow tract lesions was significantly higher than that of REV surgery and double root replacement surgery (5/14 vs. 0/38, P<0.001). Conclusion    The effect of biventricular repair for DORVncVSD is satisfactory. And concomitant tricuspid procedures can help reduce the occurrence of intracardiac obstructions. Reconstruction of right ventricular outflow tract with biological valved conduit is a risk factor for reoperation.

Objective     To analyze the safety and effectiveness of ultrasound-guided thoracoscopic atrial septal defect (ASD) closure. Methods     We prospectively collected the clinical data of 12 patients with ASD treated by ultrasound-guided thoracoscopic ASD closure in Fuwai Hospital from January to September 2017. The characteristics of the patients' ASD and operation, operation safety and effectiveness, postoperative complications and follow-up results were analyzed. Results     Among the 12 patients, 10 were successfully treated with ultrasound-guided thoracoscopic ASD closure. Two patients switched to ASD repair under thoracoscopy-assisted cardiopulmonary bypass. The size of the ASD was 17-40 (27.22±8.97) mm and the size of the occluder was 36 (30-42) mm. The average postoperative length of hospital stay was 6 days. There were no complications such as arrhythmia, bleeding and pericardial effusion after operation. The average follow-up was 6 (3-10) months after the operation. During the follow-up, no Ⅲ-degree conduction block, occluder dislocation, residual shunt or cardiac pericardial effusion was found. Conclusion     Ultrasound-guided thoracoscopic ASD closure is a minimally invasive, safe and effective treatment. This technique provides a new minimally invasive surgical option for patients with large defect diameter and poor edge condition.

Objective    To analyze the results of surgical treatment of severe aortic stenosis in infants. Methods    From August 2012 to December 2019, 28 infants undergoing aortic valvuloplasty in our hospital were selected, including 22 males and 6 females, aged 62.00 (47.00, 82.50) d. The baseline characteristics of the patients, postoperative complications and follow-up results were analyzed. Results    Twenty (71.43%) patients had bicuspid aortic valves. Five (17.86%) patients had heart failure and two (7.14%) patients used prostaglandin before surgeries. Postoperative mechanical ventilation time was 25.00 (17.00, 62.75) h, ICU stay was 3.50 (2.00, 8.50) d and postoperative hospital stay was 10.00 (7.00, 16.50) d. Four (14.29%) patients got delayed recovery (ICU stay>14 d). One (3.57%) perioperative death was observed. The follow-up time was 55.00 (43.25, 82.25) months. No death was found during follow-up. Four (14.81%) patients underwent a second operation, including three (11.11%) patients with severe aortic stenosis, and one (3.70%) patient with severe regurgitation. Conclusion    Infants with severe aortic stenosis are seriously ill and have a long postoperative recovery time, requiring early surgery. The postoperative follow-up results are satisfactory.