Objective Background and objective The Cox maze Ⅲ procedure has been considered the gold standard for the surgical treatment of atrial fibrillation (AF) and the modified Cox maze use bipolar radiofrequency ablation instead of the cut-and-sew technique,while also reducing the connecting lines in left atrium.This study was to understand whether completely isolation the posterior left atrium by increasing left atrium ablation lines can enhance the survival after modified Cox maze procedure.Methods From Jan 2009 to Dec 2009,all the patients underwent the Cox maze procedure,following the same examination,were divided into two groups (case-control): box lesion group (n =60),which is means the right and lefi pulmonary vein lesions were connected inferiorly by adding ablation lines,thereby completely isolating the posterior left atrium and the non-box lesion group (n =60).Similar interventions were given during the perioperative periods.Comparing the risk factors before surgeries,then follow-up was 100％ complete,and the mean follow-up was 9 ± 8.4 months.Results Except the box lesion had long time of extracorporeal circulation,the characteristics of the 2 groups were similar because there were no differences in age,AF duration,left atrial diameter,left ventricular ejection fraction or homochronous operation between the groups and there was no operative death.No patient was lost to follow-up.In the mean follow-up duration,a patient was died of intracerebral hemorrhage at 2 months postoperationly in the box lesion group and a patient suffered from stroke at 12 months postoperationly in the non-box lesion.The overall freedom from AF recurrence was higher in the box lesion group at 1 (70％ vs 51.2％,P =0.039) and 3 (78.3％ vs 60％,P =0.030) months.While it was 80％ vs 71.7％ (P =0.286) at 6 months.Eight patients wrere readmitted because of the recurrence of AF,4 and 2 patients underwent catheter ablation in box and non-box group respectively,one patient in each group underwent electrical conversion.After treatment,all of the patients were recovered to sinus rhythm and continued to take cordarone.Conclusion Compared to the single connecting between right and left pulmonary vein,isolating the entire posterior left atrium by creating a box lesion showed higher freedom from AF in the earlier months (1-3months).However,half a year after the surgery,there were no significant differences between the two groups.

Objective To observe the pathophysiological change of right heart remodeling model of beagle dogs caused by tricuspid regurgitation. Methods Six beagle dogs were separated to TR group and sham operation group randomly and equally. The anterior and posterior leaflets of tricuspid valve of beagle dogs from TR group were cut off under direct vision on the beating heart. The echocardiography data were measured pre-operation and post-operation 3, 6, 12 months respectively and autopsy results were acquired after the sacrifice of two animals who had been raised for 18 months. Results The operation was successful and survival 100%. The weight of TR group increased, and the echocardiography showed right atrium and ventricle enlargement and right heart dysfunction. The autopsy of TR group found myocardial fibrosis , liver cirrhosis and ascites. All of the results indicated the occurrence of right heart remodeling and right heart failure. There is no significant difference in sham operation group before or after operation. Conclusion The myocardial fibrosis is one of the pathological basis of right heart remodeling.

Objective To compare the surgical outcome and long-term follow-up after mitral valve replacement through either minimally invasive(MI) or traditional median stemotomy(ST) surgery.Methods All 1 096 patients who received either MI or ST mitral valve replacement surgery,between January 1,2012 and July 30,2015 were analyzed for outcome differences due to surgical approach using propensity score matching(MI group n =405,ST group n =691).Find out the best matched with the 202 cases of the two groups.The clinical data of patients were collected including operativedata,postoperativecomplications,and follow-up.Results MI Group was longer in CPB time [(145.97 ±34.65)min vs.(92.24 ±25.58)min,(P ＜ 0.001)],aortic clamping time [(93.89 ± 25.25) min vs.(56.42 ± 18.09) min,(P ＜ 0.001)],and operating time[(237.49 ± 47.48) min vs.(217.31 ± 55.95) min,(P ＜ 0.001)].The MI group was associated with more less in transfusion(24.26％ vs 33.66％ P=0.037),mechanical ventilation[(15.29 ±11.45)h vs.(21.34 ±40.36)h,(P=0.041)],ICU stay[(44.12 ±39.51)h vs.(61.15 ± 106.01) h,(P =0.033)],volume of thoracic drainag[(404.11 ±485.84)ml vs.(674.82 ±585.37)ml,(P＜0.001)],postoperative drainage time[(2.59 ±1.75)d vs.(4.25 ±1.91)d,(P ＜0.001)],hospital stay [(5.64 ± 3.07) d vs.(1 1.44 ± 6.71) d,(P ＜ 0.001)].There were no significant difference in the complications of follow-up(P ＞ 0.05).SF-36 score had no significant difference either(P ＞ 0.05).Conclusion The minimally invasive thoracoseopic has longer in CBP time and cross-clamp time,;but it didnot increase the risk of mortality and complications.What's more,havingless trauma,fewer transfusions,lcss wound infection,faster rccovcry,and high satisfaction with the incision in long-term follow up and other advantages.Minimally invasive thoracoscopic cardiac surgery is safe,effective and feasible.

Objective To investigate the surgical technique and outcomes of replacement of chordae tendineae in mitral valve repair, and evaluate the value of real-time three-dimensional transesophageal echocardiography in the perioperative period. Methods Thirty-one patients with mitral valve prolapse underwent mitral valve repair using chordae tendineae replacement concomitant with implantation of valveplasty ring. A 4-0 Goretex sutures was used for reconstruction of artificial chordae. Realtime three-dimensional transesophageal echocardiography was performed in all the patients during the preoperative, intraoperatire, and postoperative periods. The length of the chordae tendineae under the A1 section of the anterior leaflet and the P1 section of the posterior leaflet were measured and considered the normal length of chordae tendineae by real-time three-dimensional transesophageal echocardiography preoperatively. These pre-determined normal chordal lengths helped intraoperatively to approximate the length of the artificial chordae used and postoperatively to gauge the success of the procedures. The same values were used again postoperatively to gauge the success of intervention. Full flexible valveplasty rings were used in all the patients.Results There was no operative death. The mean cardiopulmonary bypass (CPB) and aortic cross clamp time were ( 142. 0 ±31.2 ) min and (98.0 ± 22.5 ) min, respectively. One patient' s intraoperative echocardiography upon termination of CPB showed persistent severe mitral regurgitation and was converted to mitral valve replacement. This patient was not included in the study group. The mean number of artificial chordae per patient was (2.0 ± 1.5 ) , range from 1 to 3. The mean preoperatively measured normal chordal length was ( 21.0 ± 2.5 ) mm, and the mean postoperative artificial chordal length was ( 20.0 ± 2.2 )mm. The difference was not significant. The follow-up interval was from 3 to 30 months and the follow-up rate was 98%. During the follow-up period, there was no late death. Trace mitral regurgitation (MR) was detected in 15 patients, mild and moderate MR were detected in 1 for each. No severe MR was detected. The freedom from reoperation was 100% during follow-up.There were no documented artificial chordae ruptures. Conclusion Conclusion Artificial chordal replacement with Gore-tex suture in mitral valve repair in this group of patients with mitral valve prolapse appears to have satisfactory early and mid-term results. Real-time three-dimensional transesophageal echocardiography plays a critical role in this technique. Real-time threedimensional transesophageal echocardiography can exactly predict the length of artificial chordae, which is helpful to improve the outcomes of mitral valve repair. However, longer term follow-up and larger series are required to validate our findings.

To compare the effects on hemodynamics of univentricular support with that of biventricular support on experimental ischemic biventricular dysfunction so as to provide experimental basis for clinical usage of the Luo-Ye pump. Eight canines were placed with a left ventricular assist device (LVAD; left atrial-aorta bypass) and a right ventricular assist device (RVAD; right atrial-pulmonary artery bypass). Left anterior descending coronary artery(LAD) was ligated, three minutes later, the proximal of right coronary artery (RCA) was ligated to establish animal madel of acute ischemic biventricular dysfunction. First start the LVAD, and then RVAD was started five minutes later. The hemodynamic data were recorded including central venous pressure(CVP), cardiac output (CO), mean artery pressure(MAP), and pulmonary artery pressure(PAP) and pulmonary capillary wedge pressure (PCWP). During biventricular assist devices (BVAD) the hemodynamics were improved remarkably, MAP increased from 37.4 +/- 8.8 mmHg to 84.2 +/- 9.7 mmHg (P < 0.01) (the normal level), CO increased from 0.82 +/- 0.1 L/min to 1.33 +/- 0.12 L/min (P < 0.01), CVP decreased from 14.6 +/- 2.3 cmH2O to 4.2 +/- 1.5 cmH2O (P < 0.01), PCWP decreased significantly from 14 +/- 3.9 mmHg to 1.6 +/- 0.9 mmHg. These data suggest that LVAD during biventricular dysfunction could not improve the hemodynamics to normal level. Howere BVAD could increase CO and MAP to normal level and decrease heart work and myocardial oxygen consumption, which could help to improve myocardial metabolism and myocardial function. Therefore, BVAD is the first choice in treating severe biventricular dysfunction which was not respond to drug therapy and intra-aortic balloon pump (IABP).
Animals ; Dogs ; Heart-Assist Devices ; Hemodynamics ; Myocardial Ischemia ; complications ; Ventricular Dysfunction ; etiology ; physiopathology ; surgery

BACKGROUND:The mechanical valves used in the adult Luo-Ye pump have a large size and great destruction to blood, which are not suitable for infant ventricular assist pump. Therefore, designing and producing a high molecular valve with smal size and low incidence of thrombosis is a research hotspot. OBJECTIVE:To design and produce a valve of 20 mL infant Luo-Ye pump, and to test its basic functions and fatigue properties. METHODS:The size and shape of valve was designed with MASTERCAM software, polyurethane valve was obtained through producing the valve model and plastic injection;the static leakage, pressure drop and fatigue resistance of polyurethane valve were tested according to the ISO5840 requirements. RESULTS AND CONCLUSION:The polyurethane trefoil valve was produced, but the failure rate of plastic injection was high;the basic function of the trefoil valve met the ISO5840 requirements bascial y;after continuously operated 1.0×107 times, stroke volume of 20 mL Luo-Ye pump was changed 5.2%, and two polyurethane valves and valve leaflets did not change and damage. Polyurethane trefoil valve was designed and produced successful y;polyurethane valves could meet the needs of 20 mL Luo-Ye pump, which already have the ability to clinical trials.

BACKGROUND:Calcium metaphosphate has excel ent biocompatibility, degradability, and cel affinity. Human bone marrow mesenchymal stem cel s can grow and proliferate in the pores of the porous calcium metaphosphate, but less is known about calcium metaphosphate nanoparticles.
OBJECTIVE:To prepare calcium metaphosphate nanoparticles, and to analyze the effect of calcium metaphosphate nanoparticles at different concentrations on apoptosis of human bone marrow mesenchymal stem cel s by flow cytometry.
METHODS:The calcium metaphosphate nanoparticles were prepared by wet bal mil ing. Scanning electron microscopy and transmission electron microscopy were used to observe the morphology of the calcium metaphosphate nanoparticles, and the crystal structure of nanoparticles was analyzed by X-ray diffraction. Calcium metaphosphate nanoparticles were mixed in the CYAGON Oricel TM basal medium, and the concentrations of calcium metaphosphate nanoparticles in the medium were 10, 1, 0.1 mg/L. Human bone marrow mesenchymal stem cel s were cultured for 7 days in the above-mentioned media, and apoptosis of human bone marrow mesenchymal stem cel s was analyzed by flow cytometry.
RESULTS AND CONCLUSION:Calcium metaphosphate nanoparticles were successful y prepared by wet bal mil ing, irregular in shape, and the mean diameter was 10-30 nm. X-ray diffraction results showed the crystal structure of nonaparticles was mainlyβ-Ca(PO3)2. The cel ratio of G0/G1 phase and G2/M phase in 10 mg/L group was obviously higher than that in 1, 0.1 mg/L groups (P<0.01). The cel apoptosis rates during the early, middle, late stages in 10 mg/L group were obviously higher than those in 1, 0.1 mg/L groups (P<0.01), and the total cel apoptosis was also significantly increased in 10 mg/L group (P<0.01). These findings indicate that human bone marrow mesenchymal stem cel s proliferation can be inhibited by calcium metaphosphate nanoparticles, and apoptosis rate is increased significantly when the concentration of calcium metaphosphate nanoparticles increases from 1 mg/L to 10 mg/L.

Functional tricuspid regurgitation is referred to tricuspid regurgitation due to enlargement of right ventricular and dilation of tricuspid annulus. Patients with chronic progressive tricuspid regurgitation have poor prognosis, poor quality of life and heavy economic burden. This article provides a comprehensive review of functional tricuspid regurgitation in terms of anatomical basis, pathological stage, imaging assessment and surgical decision making.

Objective:To summarize the experience and early outcomes of transapical mitral valve-in-valve procedure with J-Valve in patients with bioprostheses degeneration.Methods:The clinical data of 29 patients who underwent mitral transcatheter valve-in-valve implantation with J-Valve from April 2020 to March 2021 were retrospectively analyzed. There were male 16 and female 13 patients with average age (72.0±11.6) years. Patients underwent previous mitral valve replacement with bioprostheses of Hancock Ⅱ in 17, Edwards SAV in 7, Edwards Perimount in 3, Balmedic in 1, Mosaic in 1. The size of mitral bioprostheses included 25 # for 8 patients, 27 # for 17 patients, and 29 # for other 4 patients. The operations were performed in the hybrid operation room. Under X-ray fluoroscopy and TEE monitoring, the retro-preseted J-valve was implanted into the mitral bioprosthetic valve via the intercostal space and apical puncture. Results:One patient was converted urgently to mediate sternotomy, and the transcatheter mitral valve was reset after opening left atrium on cardiopulmonary bypass due to the migration of transcatheter valve. twenty eight patients were successfully completed transcatheter mitral valve-in-valve procedure with technical success achieving in 96.6% . Among the 28 patients who successfully were completed valve-in-valve procedure, 1 died and 27 were discharged in well condition. The mean mitral transvalvular gradient was (7.6±2.2)mmHg(1 mmHg=0.133 kPa), no death or other major complications occurred during the follow-up.Conclusion:The application of J-Valve interventional valve in patients with bioprosthesis degeneration can achieve favourable early outcomes, even if the patient was replaced with a small bioprosthesis in the previous operation, the hemodynamic effect was still satisfactory.

Objective:To explore the efficacy and safety of open cardiac operation and interventional therapy in pregnant patients and describe the feto-neonatal and maternal outcomes.Methods:A retrospective study of 39 cases of women undergoing open cardiac operation or interventional therapy during pregnancy was conducted in Guangdong Provincial People′s Hospital from Jan. 2014 to Oct. 2019.Results:The age of 39 pregnant women with gestational heart disease was (30±6) years old (21-43 years old). Among them, 37 cases were single and 2 cases were twin pregnancy. Modified World Health Organization (mWHO) pregnancy risk classification were all level Ⅳ. There were 22 women receiving cardiac operation under cardiopulmonary bypass during pregnancy, 14 patients undergoing percutaneous balloon mitral valvuloplasty, 2 patients accepting percutaneous balloon pulmonary valvuloplasty, and 1 case receiving atrial septal defect occluder with ultrasound guidance. Three were no maternal deaths during and after the operation. One patient had an inevitable abortion. Four fetuses died in the uterine after open cardiac surgery. There patients chose termination of the pregnancy after cardiac operation. There were 31 live birth, in which 7 cases were preterm live birth and 24 patients were term live birth. The total number of newborns were 33. Two fetuses suffered neonatal intracranial hemorrhage and died after birth. Thirty-one fetuses were alive and born without any abnormity.Conclusion:For pregnant women with high risk of cardiovascular disease and classified as mWHO pregnancy risk level Ⅳ, cardiopulmonary bypass and interventional therapy during pregnancy could be used as an alternative for better materal and fetal outcomes.