Objective:To study the ischem ia/reperfusion- induced dynamic changes of phospholipids on m yocardial mem brane during cardiopulm onary bypass(CPB) ,and to evaluate the protective effects of4 kinds of cardioplegia.Methods: One hundred and forty felines were randomized into6 groups:Group A,control;Group B,receiving no cardioplegia during ACC;Group C,D,E,F,receiving antegrade interm ittent cold crystalloid,intermittent cold blood,continuous cold blood and continuous warm blood cardioplegia,respectively.The quantities of total phospholipids,phosphatidylcholine and phosphatidylethanolamine were calculated on basis of thin layer chromatography.Results:For group C,D,E,F,a decrease in the quantities of total phospholipids,phosphatidylcholine and phosphatidylethanolamine was seen during early reperfusion, and a maximum decrease at30 - 6 0 m in reperfusion.After further reperfusion,total phospholipids,phosphatidylcholine and phosphatidylethanolamine for group C,D,E,F began to increase.The decrease of total phospholipids,phosphatidylcholine and phosphatidylethanolamine for group F was the smallest and the increase of it was the largest.Conclusion:At30 - 6 0 min reperfusion,the most significant injury of myocardial m em brane occurs.Further im provements of warm blood cardioplegia are still warrant despite of its greater m yocardial protection effects than others. [

Many esophageal diseases need esophageal replacement. Replacement with autograft leads to great damage and complications. The existing artificial esophagus, however, cannot match the demands of esophageal replacement. The study of tissue-engineered esophagus is the hope to solve these problems. This article reviews the progression of tissue-engineered esophagus.

To study the ischemia/reperfusion-induced dynamic changes in PLA 2 in cardiomyocytes and its effect on phospholipids of cardiomyocyte membrane during cardiopulmonary bypass (CPB), and to evaluate the protective effects of two kinds of cardioplegia. The results showed that there was an increase in PLA 2 activity during CPB followed by decreases in the contents of total phospholipids, phosphatidylcholine and phosphatidylethanolamine. During the 6o-min aorta occlusion beriod,there were no obvious changes in the activity of PLA 2 and the contents of total phospholipids, phosphatidylethanolamine and phosphatidylcholine when cardioplegia was used. During early reperfusion, there were a rapid increase in PLA 2 activity accompanied by a rapid decrease in contents of phospholipids.However,after 30~60min reperfusion, the contents of phospholipids for group C, D began to increase and the PLA 2 activity began to decrease. The changes in the contents of phospholipids and the PLA 2 activity in extracorporeal circulation with warm blood cardioplegia group were smaller in magnitude. These results suggested that the myocardial membrane injury was dependent on PLA 2 activation. Warm blood cardioplegia could provide better myocardial protection, and warrant further improvements.

Objective To investigate the effects of A3 adenosine receptor ( A3AR) agonist on lung injury after cardiopulmonary bypass ( CPB) in rabbits. Methods Twenty-four rabbits were randomly divided into 3 groups, with 8 in each group. Rabbits in control group only received CPB, those in agonist group were given selective A3AR agonist IB-MECA intravenously 15 min before aorta clamp, and those in agonist + antagonist group were managed with selective A3AR receptor antagonist MRS-1191 intravenously before IB-MECA infusion. After CPB, serum concentrations of tumor necrosis factor-α ( TNF-α) and interleukin-8 ( IL-8), concentrations of malondialdehyde ( MDA) and myeloperoxidase ( MPO) in lung tissues, lung wet/dry weight ratio ( W/D), lung function related indexes of PaO_2/FiO_2, airway pressure (AWP) and pulmonary vascular resistance ( PVR), and histological changes of lung tissues were observed. Results Concentrations of serum TNF-a and IL-8 were significantly lower in agonist group than in control group and agonist + antagonist group (P <0.05). Compared with control group and agonist + antagonist group, W/D was much smaller, and concentrations of MDA and MPO were significantly lower in agonist group after CPB (P <0.05). PaO_2/FiO_2 was significantly higher, while AWP and PVR were significantly lower in agonist group than in control group and agonist + antagonist group (P <0.05). It was revealed by histological examinations that the pathological changes were less severe in agonist group than in control group and agonist + antagonist group. Conclusion A3AR agonist IB-MECA can reduce lung injury after CPB.

Objective Construct the lentiviral AQP1 vector and explore whether it can transfect the myocyte or not,then test the law of the AQP1 expression and the edema in the successfully transducted myocytes after cardiopulmonary bypass in sheeps.Methods Design cleavage primer according to ovine AQP1mRNA,clone it into expressing vector and transducated into the 293T cells with other packing vectors to produce the lentiviral AQP1 vector,then test the virus titer.36 adult healthy sheeps are randomly divided into blank or AQP1-lentiviral transfected group,blank or AQP1-lentiviral vector suspension was injected in the ventricle tissue of healthy adult sheeps during cardiopulmonary bypass and take specimen in different time points (2,6,12,24,48,72 h)after extracorporeal circulation,3 in each group.Realtime-PCR WesternBlot ELISA FACS immumofluorescent and Dry/Wet methods are emploied to detect the expression of AQP1 and the according degree of edema.Results lentiviral AQP1 vector was successfully construced and transducated into the myocytes.The tranducated groups have the same trend of AQP1 of expression and cardiac edema after cardiopulmonary bypass compared to the blank vector group,but the degree is heavier(P ＜ 0.05).Conclusion Lentivral AQP1 vector can successfully transfect the myoctyes,and the overexpressed myocardial tissue have the same trend of AQP1 expression and edema after cardiopulmonary bypass,but with a heaver degree.The expression of aquaporins was positively relevant to the edema.

Objective To evaluate the effect of keeping atrial septal fenestration in correction of total anomalous pulmonary venous connection (TAPVC) with left ventricular hypoplasia.Methods We reviewed 44 TAPVC patients between June,2006 and June,2013 in Shanghai Xinhua Hospital.According to whether keeping atrial septal fenestration during operation,patients were divided into group A(keeping fenestration,25 cases) and group B(no fenestration,19 cases).Retrospective statistical analysis was carried on the in-patient data and follow-up outcomes.Results No statistically significant differences between the two group on age,weight,left ventricular volume and crossclamp time (P ＞ 0.05).While cardiopulmonary bypass time,ventilation time,dosage of positive inotropic drugs,and ICU stay time of group A were shorter compares with group B (P ＜ 0.05).4 patients in group A (16.00％) suffered from low cardiac output syndrome (LCOS) postoperatively,and 6 in group B(31.58％).Pulmonary edema occurred in 3 patients,1 in group A(4.00％),and 2 in group B(10.53％).Total post-operative mortality was 6.82％ (3/44).2 cases died of serious LCOS(1 from group A,and the other from group B),1 cases died of infection and multiple organ dysfunction syndrome(group B).No significant difference of mortality was observed between two groups.Follow-up data showed some fenestrations can close naturally.Conclusion Keeping atrial septal fenestration can be done as a feasibility tactic in correction of TAPVC with left ventricular hypoplasia.

Objective Objectives: To introduce the technique of performing minimally invasive concomitant Cox Maze Ⅳ ablation procedure entirely by bipolar clamp through right lateral minithoracotomy for patients with atrial fibrillation(AF) associated with mitral valve diseases.Methods Sixty nine patients with mitral valve disease and long-standing persistent AF received minimally invasive Cox Maze Ⅳ ablation procedure combined with mitral valve surgery from June 2012 to January 2015.The etiology of mitral valve disease was rheumatic(41 cases) and degenerative(28 cases).Age at operation ranged from 52 to 71 years.There were 43 males and 26 females.AF duration ranged from 1.5 years to 13 years.Diameter of the left atrium ranged from 42 to 60 mm.Diameter of the left ventricle ranged from 43 to 66 mm.Left ventricle ejection fraction (LVEF) ranged from 0.45 to 0.67.Concomitant Maze Ⅳ ablation procedure was performed through right lateral minithoracotomy entirely by bipolar radiofrequency clamp.Results All patients successfully underwent this minimally invasive concomitant Maze Ⅳ ablation procedure and mitral valve surgery.The mean cardiopulmonary bypass time was(130.3 ± 17.7) minutes.The mean aortic crossclamp time was(91.8 ± 12.7) minutes.No patient needed conversion to sternotomy during the surgery.There was no early death or pacemaker implantation in the perioperation.The average length of hospital stay was(9.8 ± 3.3) days.At discharge, 65 patients(65/69, 94.2％) maintained sinus rhythm.At a mean follow-up time of(21.0 ± 8.6) months, sinus rhythm was restored in 62 patients(62/69, 89.9％).Cumulative maintenance of normal sinus rhythm without AF recurrence at 2 years postoperatively was(85.1 ± 5.8)％.Conclusion The minimally invasive concomitant Maze Ⅳ ablation procedure performed entirely by bipolar clamp through right lateral minithoracotomy was a safe, feasible, and effective technique for patients with AF associated with mitral valve diseases.

Objective To summarize the experience of hybrid repair performed in high risk patients with dissection involving the aortic arch.Methods From Sep.2007 to Mar.2015,hybrid repair was performed in 33 high risk patients with dissection involving the aortic arch including acute (n =8),subacute (n =15),or chronic (n =10) cases.Descripitive statistics were computed for continuous and categorical variables.Results There were 22 male and 11 female patients with a mean age of(69 ± 10) years,and ASA Physical Status Ⅲ-Ⅳ.Simultaneous (n =27) and staged (n =5,mean interval 5.0 ± 1.3 days)endovascular repair were performed via femoral artery.The technical success rate was 100％.The average hospital stay was (16 ±6) days.One case died of cerebral infraction.There were two with strokes,one with pneumonia and two with renal failure as complications.Median follow-up was 47 months (3-66 months).There were four deaths with two were related to aortic artery.Endoleak was found in 3 during follow-up.One type Ⅰ endoleak was cured after remedy hybrid repair.Conclusions Hybrid repair performed in patients at high risk with dissection involving the aortic arch is less invasive with favorable medium and long-term outcomes.

Objective To evaluate the outcomes achieved by using left internal mammary artery(LIMA) to radial artery (RA) total arterial composite grafts in minimally invasive direct coronary artery bypass grafting (MIDCAB) for patients with multiple vessel disease.Methods From January 2009 to September 2015, 39 patients(24 males) with multiple vessel disease underwent MIDCAB with LIMA-RA total arterial composite grafts without cardiopulmonary bypass in our hospital .MIDCAB was performed through a left anterior minithoracotomy .Results All patients successfully underwent MIDCAB with LIMA-RA total arterial composite grafts.No patient required to convert to strenotomy during the surgery.Mean operation time was(176.1 ± 14.1)min.Revascularization was performed for 2 target vessels in 11 cases, 3 target vessels in 25 cases and 4 target vessels in 3 cases.Mean postoperative ventilation time was(21.9 ±27.9) h.Mean ICU time was(2.8 ±2.1) days, and mean postoper-ative inhosptial time was(11.2 ±3.3)days.There was no early death in perioperation.At a follow-up of 6 to 86 months[aver-age(27.5 ±18.0) months], one patient died.The overall survival at 2 years postoperatively was(96.0 ±3.9)%.The paten-cy rate of LIMA was 100%.The overall patency rate of RA grafts at 2 years postoperatively was(91.8 ±4.0)%.Conclusion MIDCAB with LIMA-RA total arterial composite grafts is a safe and effective procedure with favorable early and mid-term out-comes for patients with multiple vessel disease .