The end of the COVID-19 infection peak in 2022 prompts a backlog of cardiovascular surgical patients to gradually return to the hospital, resulting in a surge in cardiovascular surgeries. However, against the backdrop of the COVID-19 pandemic, the clinical practice of cardiovascular surgery faces many problems. Therefore, organized by Beijing Anzhen Hospital, experts in cardiovascular surgery and related fields have formulated hospital expert experience on perioperative treatment principles of cardiovascular surgery for patients infected with COVID-19. This article summarizes the clinical decision-making of patients requiring cardiovascular surgery after COVID-19 infection, and advises on the corresponding recommendations according to the existing evidence-based medical evidence as well as the actual clinical practice experience of relevant experts. The main content of the article includes special requirements for cardiovascular surgical treatment indications in patients with COVID-19 infection, selection of surgical timing, special requirements of preoperative, intraoperative and postoperative management, etc., which aims to provide COVID-19-infected patients with guidance on rational decision-making when receiving cardiovascular surgery.

Objective:To explore the value of critical ultrasound in evaluating the fluid responsiveness of small dose volume challenge in patients with septic shock.Methods:Thirty-six patients with septic shock admitted to the Third People's Hospital of Datong from January 2021 to December 2021 were enrolled, and the patients were randomly divided into control group and observation group, with 18 patients in each group. The control group was treated with traditional fluid challenge (500 mL of crystalloid injected within 30 minutes); the observation group received a small dose fluid challenge (100 mL of crystalloid injected within 1 minute). The hemodynamic indexes [central venous pressure (CVP), invasive mean arterial pressure (MAP), velocity-time integra (VTI)] and bilateral lung ultrasound scores were measured by critical ultrasound in both groups. The outcome related indicators of patients in the two groups were observed. The correlation between the above indexes and the fluid challenge was evaluated.Results:Compared with the control group, the heart rate (HR) and CVP of patients in the observation group after the challenge were significantly lower than those in the control group [HR (times/min): 99.74±3.22 vs. 107.65±3.14, CVP (mmHg, 1 mmHg ≈ 0.133 kPa): 7.55±0.22 vs. 10.26±0.52, both P < 0.05], invasive MAP and VTI were significantly higher than those in the control group [invasive MAP (mmHg): 77.36±2.14 vs. 69.81±2.56, VTI (cm/s): 68.85±1.26 vs. 44.71±1.28, both P < 0.05]. The ultrasonic score of the observation group was significantly better than those of the control group (all P < 0.05). In terms of outcome, the length of intensive care unit (ICU) stay, mechanical ventilation time and the time for urine volume more than 0.5 mL·kg -1·h -1 of the observation group were significantly shorter than those in the control group [the length of ICU stay (hours): 138.26±1.25 vs. 205.73±1.26, mechanical ventilation time (hours): 36.80±0.25 vs. 47.65±0.36, time to reach urine volume more than 0.5 mL·kg -1·h -1 (hours): 27.38±1.25 vs. 38.61±1.30, all P < 0.05], The dosage of norepinephrine was significantly decreased in the observation group compared with the control group (mg: 45.26±1.85 vs. 53.73±1.92, P < 0.05), and the amount of resuscitation crystalloid was significantly reduced compared with the control group (mL: 1 532.62±12.38 vs. 1 755.52 ± 12.30, P < 0.05). Correlation analysis showed that the volume of crystalloid was highly consistent with M-BLUE pulmonary ultrasound (zone 2, 4 and 5), mechanical ventilation time, norepinephrine dose, time to reach the standard of urine volume and ΔVTI (all P < 0.05). Conclusions:Small dose fluid challenge evaluated by critical ultrasound in septic shock patients has a high value for fluid responsiveness, which can better reduce the risk of obvious tissue edema caused by fluid overload, organ damage and even life-threatening, make fluid challenge more reasonable and appropriate, thereby improving the success of treatment.

OBJECTIVES: To evaluate the response to cardiac resynchronization therapy (CRT) and the correlation between CRT and pulmonary artery hemodynamic parameters. METHODS: The patients with chronic heart failure indicator for CRT were enrolled. The left ventricular end-systolic volume (LVESV) was measured by echocardiography and New York Heart Association (NYHA) classification was evaluated between one week before and six months after CRT. Mean pulmonary artery pressure (mPAP), pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR) were measured by right heart catheterization. Left ventricular reverse remodeling (LVRR) is defined as a decrease of 15% or more in LVESV at the 6th month after CRT; Clinical response is defined as a decrease of NYHA classification at or above grade 1 at the 6th month after CRT. Pulmonary hypertension (PH) was defined as mPAP≥25 mmHg. According to the response, patients were divided into 3 groups: group A (LVRR+clinical response), group B (no LVRR+clinical response) and group C (no LVRR+no clinical response). The changes of NYHA classification, echocardiographic and pulmonary hemodynamic parameters were observed in the 3 groups. The Kaplan-Meier survival curve was used to analyze the differences in all-cause mortality, combined end-point events of death or re-hospitalization due to heart failure among different groups. RESULTS: A total of 45 patients with CRT implantation [aged (63.27±9.55) years, 36 males] were included. The average follow-up period was (33.76±11.50) months. Thirty-one patients (68.89%) were in group A, 9 of whom with PH. Eight patients (17.78%) were in group B, 7 of whom with PH. Six patients were in group C, all with PH. Cardiac function including NYHA classification, echocardiographic and pulmonary hemodynamic parameters had been significantly improved in group A after CRT implantation (<0.05). In group B, NYHA classification and pulmonary hemodynamic parameters were decreased significantly (<0.05), but echocardiographic parameters did not change obviously (>0.05). There were no significant changes in NYHA classification, echocardiographic and pulmonary hemodynamic parameters in group C (>0.05). Compared with group C, group A and group B had lower all-cause mortality (=0.005) and lower incidence of composite endpoint events (=0.001). CONCLUSIONS Patients with LVRR and clinical response after CRT have a good prognosis. Patients with clinical response but without LVRR have a better prognosis than those without clinical response and LVRR, which may be related to the decrease of pulmonary hemodynamic parameters such as mPAP and TPG.
Aged ; Cardiac Resynchronization Therapy ; Heart Failure ; therapy ; Hemodynamics ; Humans ; Male ; Middle Aged ; Pulmonary Artery ; Treatment Outcome ; Ventricular Remodeling

Objective To explore a method to generate regulatory dendritic cells (DCregs) from murine bone marrow induced by 5-Aminolevulinic acid combined with ferrous iron (ALA/SFC).Methods Bone marrow cells were obtained from male C57BL/6 mice.To generate conventional DCs (BM-DCcons),the ceils were cultured in RPMI-1640 medium supplemented with 10％ FCS,10 ng/mL GM-CSF,10 ng/mL IL-4 for 7 days.The cells were collected for the analysis.To generate DCregs by ALA/SFC,the cells were cultured in RPMI-1640 medium supplemented with 10％ FCS,20 ng/mL GM-CSF,5-ALA 1 mmol/L + SFC 0.5 mmol/L for 7 days.The morphology of ALA-DCregs was observed by microscope and eytospin with May-Grunwal&Giemsa stain.The surface markers of ALA-DCregs were observed by FACS.The function of ALA-DCregs was detected by in vitro mixed lymphocyte reaction (MLR) and in vivo lymphocyte proliferation assay.Results The generated ALA-DCregs displayed an irregular shape with areas of protrusion and demonstrated higher CD11b/CD11c and higher MHC-II but lower CD40,CD80,CD86 expression levels than DCcons.They also had immune regulation effects in both in vitro and in vivo lymphocyte proliferation assay.Conclusion This study illustrated a feasible approach for generating functional DCregs from murine bone marrow induced by ALA/SFC.These cells can be useful for research and application of DC immunotherapy in the future.

Objective To identify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following lower extremity fracture surgery in elderly patients. Methods Four hundred and thirty patients, aged ≥ 65 yr, undergoing elective lower extremity fracture surgery from January 2010 to December 2014, were selected. Age, gender, American Society of Anesthesiologists (ASA) physical sta-tus, preoperative comorbidities (diabetes mellitus, cardio-cerebrovascular events and hemiplegia), preop-erative anemia, surgical site (hip and femur, knee joint and the site below the knee), anesthesia method (general anesthesia, neuraxial anesthesia), surgery time, intraoperative hypertension and hypotension, intraoperative blood loss, postoperative Hb≤90 g∕L in hospital and volume of postoperative drainage, post-operative pneumonia and admission to the intensive care unit after operation were recorded. The patients were divided into either cardio-cerebrovascular event group or non-cardio-cerebrovascular event group ac-cording to whether the patients developed cardio-cerebrovascular events after surgery in hospital. The pa-tients were divided into either survival group or dead group according to the living status 1 yr after surgery. The risk factors of which P values were less than 0. 05 would enter the multi-factor logistic regression analy-sis to stratify the risk factors for in-hospital cardio-cerebrovascular events and 1-year mortality following low-er extremity fracture surgery. Results Three hundred and seventy-two patients completed the study. A-mong the 372 patients, 35 patients developed postoperative cardio-cerebrovascular events in hospital, and the incidence was 9. 4％, logistic regression analysis showed that the preoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ were risk factors for in-hospital postoperative cardio-cerebrovascular events. Thirty-three patients died within 1 yr after surgery, the mortality rate was 8. 9％, and logistic re-gression analysis showed that age≥75 yr, preoperative hemiplegia and development of cardio-cerebrovascu-lar events after surgery in hospital were postoperative 1-year mortality-related risk factors. Conclusion Preoperative cardio-cerebrovascular diseases and ASA physical status ≥ Ⅲ are the independent risk factors for in-hospital cardio-cerebrovascular events following lower extremity fracture surgery in elderly patients;age≥75 yr, preoperative hemiplegia and in-hospital postoperative cardio-cerebrovascular events are the in-dependent risk factors for 1-year mortality after surgery.

To explore the safety and efficacy for radiofrequency ablation of paroxysmal supraventricular tachycardia (PSVT) guided by Carto Univu three-dimensional mapping system.
 Methods: A total of 99 patients with PSVT underwent radiofrequency catheter ablation (RFCA) were assigned to a Carto Univu group (51 patients) and a two-dimensional X-ray group (48 patients) according to the mapping method. The operation time, X-ray exposure time, X-ray exposure dose, dose area product (DAP), operation success rate and complication rate were compared between the two groups.
 Results: The Carto Univu group and the two-dimensional X-ray group were not significant difference in the operation time, the X-ray exposure time of placing catheter, the X-ray DAP of placing catheter, the number of discharge, the discharge power, and the total discharge time (P>0.05). The mapping and ablation time, total exposure time, mapping and ablation DAP and total DAP in the Carto Univu group were significantly lower than those in the two-dimensional X-ray group (P<0.01). In the right accessory pathway cases, the mapping and ablation DAP and the total DAP in the Carto Univu group decreased compared with X-ray group (P<0.05), but it decreased more profound (P<0.01) in the left accessory pathway cases and the dual atrioventricular nodal pathways cases. Seven cases in the Carto Univu group achieved "zero X-ray", including 5 cases of the dual atrioventricular nodal pathways and 2 cases of the left accessory pathway. The immediate success rate for the two groups was 100%. After 3-12 months of follow-up, there was no recurrence in the Carto Univu group but 3 suspected recurrences in the two-dimensional X-ray group. In addition, no complications occurred in the two groups. 
 Conclusion: Carto Univu electroanatomic mapping system can guide PSVT safely and effectively during radiofrequency ablation and reduce radiation exposure to both doctors and patients. It is especially suitable for dual atrioventricular nodal pathways, which may even achieve "zero X-ray". Perhaps Carto Univu will be the first choice for RFCA of dual atrioventricular nodal pathways.
Catheter Ablation ; instrumentation ; methods ; Humans ; Imaging, Three-Dimensional ; instrumentation ; methods ; Operative Time ; Radiation Exposure ; prevention & control ; statistics & numerical data ; Radiography ; statistics & numerical data ; Recurrence ; Tachycardia, Supraventricular ; diagnostic imaging ; surgery ; Treatment Outcome

Objective Various factors may affect the effects of cardiac resynchronization therapy or cardiac resynchronization and implantable cardioverter-defibrilator ( CRT/CRTD) in chronic heart failure patients ( CHF) .The aim of our study was to explore the correlation of age and gender with the effects of CRT/CRTD in chronic heart failure patients. Methods This study included 136 CHF patients, 92 males and 44 females, treated by CRT/CRTD from January 2005 to March 2015.We divided the patients into three age groups:≥70 yr (n=29), 50-70 yr (n=77), and <50 yr (n=30), and compared the baseline characteristics, CRT respon-ding rate and all-cause mortality among different groups.The CRT response was defined as the decrease of NYHA cardiac function≥1 grade and left ventricular ejection fraction ( LVEF) improvement ≥5%. Results In the 136 CHF patients, there were 72 CRT responders (53%), 52%in the≥70 yr group, 55%in the 50-70 yr group, and 50%in the <50 yr group, with no statistically sig-nificant differences among the three groups (P>0.05).However, the CRT responding rate was remarkably higher in the female than in the male patients (66%vs 47%, P=0.027).Cox multivariate and Kaplan-Meier analyses revealed no significant differences in all-cause mortality between different genders or age groups.Multivariate logistic regression analysis showed that the left ventricular diastolic diameter and base QRS duration were independent factors of the CRT response. Conclusion Age does not affect the CRT response in chronic heart failure patients, while female patients have a higher CRT respon-ding rate than male patients.

OBJECTIVE: To study the effects of cardiac resynchronization therapy (CRT) with different pacing rates and modes on MTWA.
 METHODS: From March, 2012 to October, 2014, 43 patients who received CRT or CRT-D implantation in the first affiliated hospital, Nanjing Medical University were studied. Time-domain MTWA test were assessed following CRT implantation. MTWA was measured at 90 min(-1) and 110 min(-1) by treadmill exercise test with GE CASE 8000 during CRT-on (BIV biventricular) and CRT-off (RA right atrial) pacing modes. The comparsion of MTWA values between different pacing mode and pacing rates were analyzed. According to the heart function classification the patients were divided into 3 groups. The correlation between MTWA and cardiac function was analyzed.
 RESULTS: MTWA-AAI was significantly increased compared to MTWA-BIV at the pacing rate of 90 min(-1) [(11.27±9.94) µV vs (7.09±7.16) µV, P=0.001]. The value of MTWA at pacing rate of 110 min(-1) was nonsignificantly higher than MTWA during AAI pacing [(16.91±12.51) µV vs (15.58± 10.97) µV, P=0.517]. The value of MTWA at pacing rate of 110 min(-1) was higher than MTWA at pacing rate of 90 min(-1) during AAI or BIV (P<0.05). MTWA-AAI and MTWA-BIV in group of NYHA IV were higher than those in group of NYHA II (P<0.05).
 CONCLUSION Biventricular pacing mode at lower pacing rates can significantly attenuate MTWA. The value of MTWA is associated with the severity of CHF.
Arrhythmias, Cardiac ; therapy ; Cardiac Resynchronization Therapy ; Exercise Test ; Heart Failure ; therapy ; Humans

PURPOSE: Acute renal graft rejection can only be definitively diagnosed by renal biopsy. However, biopsies carry a risk of renal transplant injury and loss. Micro-CT is widely used in preclinical studies of small animals. Here, we propose micro-CT could noninvasively monitor and evaluate renal location and function in a mouse kidney transplant model. METHODS: Orthotopic kidney transplantation was performed in a BALB/c -to- C57BL/6j or C57BL/6j-to- C57BL/6j mouse model. After optimizing imaging techniques, five mice were imaged with micro-CT and the findings were verified histologically. RESULTS: Micro-CT can monitor and evaluate renal location and function after orthotopic kidney transplantation. There were no mice deaths while renal transplants were failure. CONCLUSION: We propose that graft micro-CT imaging is a new option that is noninvasive and specific, and can aid in early detection and follow-up of acute renal rejection. This method is potentially useful to improve posttransplant rejection monitoring.
Allografts* ; Animals ; Biopsy ; Follow-Up Studies ; Graft Rejection ; Kidney ; Kidney Transplantation ; Mice* ; Transplants

Objective Both kidneys of mice used To investigate the surgical procedures for establishment of murine kidney transplantation models by using bilaterial donor kidneys as grafts for two recipients.Method Using Balb/c male mice as donors/receptors,through careful dissection and trimming of donor renal vessels and abdominal great vessels,both right and left kidneys were harvested and separately transplanted into two recipients.The anastomosis between the aorta and vena cava of the graft and recipient mouse was made in end to-side manner using the 10-0 sutures.The artery and vein was anastomosed by dual point 180 continuous sutures.The technique of pulling the end of graft ureter into recipient's bladder and external fixation method were used for urethral reconstruction.Five days later the recipient's kidney was removed after transplantation.Result The kidneys in 30 mice were transplanted (15 left kidneys and 15 right kidneys) and model survival rate was 76.7％ (12/15 for the left and 11/15 for the right).The average operating time of donor was 339 min and that of recipient was 46 12 min.Cold ischemia time for the first and second transplantation was about 0.5 h and 1.5 h respectively.Conclusion Through careful microsurgical operation we establish the mouse kidney transplantation models using both donor kidneys as grafts,which reduces the costs of microsurgery experiments.