Objective:To evaluate the clinical efficacy of total thoracoscopic mitral valve surgery combined with beating-heart tricuspid valvuloplasty under the concept of enhanced recovery after surgery (ERAS).Methods:Clinical data from the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2012 to January 2024 were collected and analyzed retrospectively. Patients were divided into the non-ERAS group (total thoracoscopic mitral valve surgery combined with beating-heart tricuspid annuloplasty without ERAS intervention) and the ERAS group (the same surgical procedures under the concept of ERAS). Propensity score matching (PSM) was used to reduce selection bias. Differences in perioperative blood transfusion, 24-hour postoperative drainage volume, incidence of severe postoperative complications [such as low cardiac output syndrome, liver failure, renal failure, stroke (ischemic/hemorrhagic), perivalvular leakage, re-thoracotomy during hospitalization, etc.], surgery and hospitalization-related indicators (operation time, cardiopulmonary bypass time, aortic cross-clamp time, length of hospital stay, etc.), and echocardiographic results at 1 month after surgery [mitral valve peak pressure difference, mitral valve peak flow velocity, mitral valve pressure half-time (PHT), tricuspid regurgitation area, right ventricular diameter, right atrial diameter] were compared between the two matched groups.Results:After PSM, the selection bias of covariates in the two groups was corrected. There were no statistically significant differences in operation time, cardiopulmonary bypass time, or aortic cross-clamp time between the two groups (all P>0.05). The ICU monitoring time, ventilator use time, and postoperative hospital stay in the ERAS group were significantly shorter than those in the non-ERAS group, with statistically significant differences (all P<0.05). There were no statistically significant differences in 24-hour postoperative drainage volume, perioperative red blood cell transfusion volume, plasma transfusion volume, or total hospitalization cost between the two groups (all P>0.05). Both the ERAS group and the non-ERAS group had 1 case of re-thoracotomy for hemostasis, and the non-ERAS group had 1 case of perivalvular leakage, with no statistically significant differences between the groups ( P>0.05). Echocardiographic results at 1 month after surgery showed that in the ERAS group, tricuspid regurgitation area, right atrial diameter, and right ventricular diameter were significantly improved compared with those before surgery (all P<0.05); in the non-ERAS group, tricuspid regurgitation area was improved compared with that before surgery, with a statistically significant difference ( P<0.05). There were statistically significant differences in the right ventricular diameter and right atrial diameter between the two groups one month after surgery (all P<0.05). Conclusions:Total thoracoscopic mitral valve surgery combined with beating-heart tricuspid valvuloplasty under the intervention of the ERAS concept is safe and effective, but further confirmation from more large-sample clinical studies is needed.

Objective:To investigate the association between estimated cumulative low-density lipoprotein cholesterol (LDL-C) exposure and the severity of coronary artery disease and long-term adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS).Methods:The subjects were from the PROMISE study. This study was a prospective cohort study led by Fuwai Hospital, Chinese Academy of Medical Sciences, with participation from eight regional tertiary hospitals as sub-centers, and enrolled 18 701 patients with confirmed coronary heart disease between January 2015 and May 2019. Among them, 8 429 patients with ACS were included in this study. The estimated cumulative LDL-C exposure was calculated by multiplying LDL-C by age. Participants were then divided into four groups based on quartiles. Baseline data and coronary angiography data were collected, and participants were followed for 2 years. The primary endpoint was MACCE, which was composed of all-cause death, cardiac death, myocardial infarction, revascularization, and stroke. Spearman correlation analysis was used to estimate the correlation between cumulative LDL-C exposure and the severity of coronary artery disease. The differences in MACCE among the four groups were compared, and multivariate Cox regression was used to divide the estimated cumulative exposure LDL-C into two groups, three groups, and four groups to analyze its relationship with MACCE.Results:The 8 429 ACS patients included in the study had an age of (60.9±11.4) years, with 1 951(23.1%) females. Spearman correlation analysis revealed that estimated cumulative LDL-C exposure was positively associated with the preoperative SYNTAX score, three-vessel lesions disease, left main disease, and the number of target lesions (correlation coefficients r=0.14, 0.10, 0.04 and 0.03, respectively, with all P<0.05). The 2-year follow-up results indicated that the incidence rates of MACCE, all-cause death, cardiac death, myocardial infarction, and stroke in ACS patients grouped by different levels of estimated cumulative LDL-C exposure were statistically significant (all P<0.05). The results of the Cox multivariate regression analysis showed that when the estimated cumulative LDL-C exposure was treated as a continuous variable and analyzed in two, three, and four groups, with the lowest group as the reference, the risk of MACCE occurrence in the high-value group increased by 21% (95% CI 1.08-1.37, P=0.002), 24% (95% CI 1.07-1.43, P=0.004), and 21% (95% CI 1.02-1.43, P=0.025) respectively. Conclusions:A positive correlation was found between estimated cumulative LDL-C exposure and severity of coronary artery disease. High estimated cumulative LDL-C exposure level is a risk factor for MACCE in ACS patients within 2 years.

Objective:To evaluate the clinical efficacy of total thoracoscopic mitral valve surgery combined with beating-heart tricuspid valvuloplasty under the concept of enhanced recovery after surgery (ERAS).Methods:Clinical data from the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2012 to January 2024 were collected and analyzed retrospectively. Patients were divided into the non-ERAS group (total thoracoscopic mitral valve surgery combined with beating-heart tricuspid annuloplasty without ERAS intervention) and the ERAS group (the same surgical procedures under the concept of ERAS). Propensity score matching (PSM) was used to reduce selection bias. Differences in perioperative blood transfusion, 24-hour postoperative drainage volume, incidence of severe postoperative complications [such as low cardiac output syndrome, liver failure, renal failure, stroke (ischemic/hemorrhagic), perivalvular leakage, re-thoracotomy during hospitalization, etc.], surgery and hospitalization-related indicators (operation time, cardiopulmonary bypass time, aortic cross-clamp time, length of hospital stay, etc.), and echocardiographic results at 1 month after surgery [mitral valve peak pressure difference, mitral valve peak flow velocity, mitral valve pressure half-time (PHT), tricuspid regurgitation area, right ventricular diameter, right atrial diameter] were compared between the two matched groups.Results:After PSM, the selection bias of covariates in the two groups was corrected. There were no statistically significant differences in operation time, cardiopulmonary bypass time, or aortic cross-clamp time between the two groups (all P>0.05). The ICU monitoring time, ventilator use time, and postoperative hospital stay in the ERAS group were significantly shorter than those in the non-ERAS group, with statistically significant differences (all P<0.05). There were no statistically significant differences in 24-hour postoperative drainage volume, perioperative red blood cell transfusion volume, plasma transfusion volume, or total hospitalization cost between the two groups (all P>0.05). Both the ERAS group and the non-ERAS group had 1 case of re-thoracotomy for hemostasis, and the non-ERAS group had 1 case of perivalvular leakage, with no statistically significant differences between the groups ( P>0.05). Echocardiographic results at 1 month after surgery showed that in the ERAS group, tricuspid regurgitation area, right atrial diameter, and right ventricular diameter were significantly improved compared with those before surgery (all P<0.05); in the non-ERAS group, tricuspid regurgitation area was improved compared with that before surgery, with a statistically significant difference ( P<0.05). There were statistically significant differences in the right ventricular diameter and right atrial diameter between the two groups one month after surgery (all P<0.05). Conclusions:Total thoracoscopic mitral valve surgery combined with beating-heart tricuspid valvuloplasty under the intervention of the ERAS concept is safe and effective, but further confirmation from more large-sample clinical studies is needed.

Objective:To investigate the association between estimated cumulative low-density lipoprotein cholesterol (LDL-C) exposure and the severity of coronary artery disease and long-term adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome (ACS).Methods:The subjects were from the PROMISE study. This study was a prospective cohort study led by Fuwai Hospital, Chinese Academy of Medical Sciences, with participation from eight regional tertiary hospitals as sub-centers, and enrolled 18 701 patients with confirmed coronary heart disease between January 2015 and May 2019. Among them, 8 429 patients with ACS were included in this study. The estimated cumulative LDL-C exposure was calculated by multiplying LDL-C by age. Participants were then divided into four groups based on quartiles. Baseline data and coronary angiography data were collected, and participants were followed for 2 years. The primary endpoint was MACCE, which was composed of all-cause death, cardiac death, myocardial infarction, revascularization, and stroke. Spearman correlation analysis was used to estimate the correlation between cumulative LDL-C exposure and the severity of coronary artery disease. The differences in MACCE among the four groups were compared, and multivariate Cox regression was used to divide the estimated cumulative exposure LDL-C into two groups, three groups, and four groups to analyze its relationship with MACCE.Results:The 8 429 ACS patients included in the study had an age of (60.9±11.4) years, with 1 951(23.1%) females. Spearman correlation analysis revealed that estimated cumulative LDL-C exposure was positively associated with the preoperative SYNTAX score, three-vessel lesions disease, left main disease, and the number of target lesions (correlation coefficients r=0.14, 0.10, 0.04 and 0.03, respectively, with all P<0.05). The 2-year follow-up results indicated that the incidence rates of MACCE, all-cause death, cardiac death, myocardial infarction, and stroke in ACS patients grouped by different levels of estimated cumulative LDL-C exposure were statistically significant (all P<0.05). The results of the Cox multivariate regression analysis showed that when the estimated cumulative LDL-C exposure was treated as a continuous variable and analyzed in two, three, and four groups, with the lowest group as the reference, the risk of MACCE occurrence in the high-value group increased by 21% (95% CI 1.08-1.37, P=0.002), 24% (95% CI 1.07-1.43, P=0.004), and 21% (95% CI 1.02-1.43, P=0.025) respectively. Conclusions:A positive correlation was found between estimated cumulative LDL-C exposure and severity of coronary artery disease. High estimated cumulative LDL-C exposure level is a risk factor for MACCE in ACS patients within 2 years.

BACKGROUND: There are few data comparing clinical outcomes of complex percutaneous coronary intervention (CPCI) when using biodegradable polymer drug-eluting stents (BP-DES) or second-generation durable polymer drug-eluting stents (DP-DES). The purpose of this study was to investigate the safety and efficacy of BP-DES and compare that with DP-DES in patients with and without CPCI during a 5-year follow-up. METHODS: Patients who exclusively underwent BP-DES or DP-DES implantation in 2013 at Fuwai Hospital were consecutively enrolled and stratified into two categories based on CPCI presence or absence. CPCI included at least one of the following features: unprotected left main lesion, ≥2 lesions treated, ≥2 stents implanted, total stent length >40 mm, moderate-to-severe calcified lesion, chronic total occlusion, or bifurcated target lesion. The primary endpoint was major adverse cardiac events (MACE) including all-cause death, recurrent myocardial infarction, and total coronary revascularization (target lesion revascularization, target vessel revascularization [TVR], and non-TVR) during the 5-year follow-up. The secondary endpoint was total coronary revascularization. RESULTS: Among the 7712 patients included, 4882 (63.3%) underwent CPCI. Compared with non-CPCI patients, CPCI patients had higher 2- and 5-year incidences of MACE and total coronary revascularization. Following multivariable adjustment including stent type, CPCI was an independent predictor of MACE (adjusted hazard ratio [aHR]: 1.151; 95% confidence interval [CI]: 1.017-1.303, P  = 0.026) and total coronary revascularization (aHR: 1.199; 95% CI: 1.037-1.388, P  = 0.014) at 5 years. The results were consistent at the 2-year endpoints. In patients with CPCI, BP-DES use was associated with significantly higher MACE rates at 5 years (aHR: 1.256; 95% CI: 1.078-1.462, P  = 0.003) and total coronary revascularization (aHR: 1.257; 95% CI: 1.052-1.502, P  = 0.012) compared with that of DP-DES, but there was a similar risk at 2 years. However, BP-DES had comparable safety and efficacy profiles including MACE and total coronary revascularization compared with DP-DES in patients with non-CPCI at 2 and 5 years. CONCLUSIONS Patients underwent CPCI remained at a higher risk of mid- to long-term adverse events regardless of the stent type. The effect of BP-DES compared with DP-DES on outcomes was similar in CPCI and non-CPCI patients at 2 years but had inconsistent effects at the 5-year clinical endpoints.
Humans ; Drug-Eluting Stents/adverse effects* ; Myocardial Infarction/complications* ; Polymers/therapeutic use* ; Treatment Outcome ; Coronary Artery Disease/complications* ; Percutaneous Coronary Intervention/adverse effects* ; Absorbable Implants ; Prosthesis Design

Objective:To explore the pathogenic genes, clinical characteristics and treatment follow-up of children with congenital long QT syndrome (LQTS).Methods:Clinical data of 20 cases diagnosed with congenital LQTS and underwent gene testing from April 15, 2011 to April 15, 2021 in Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong University were retrospectively collected and analyzed using independent sample t-test and Fisher′ s exact probability method. Results:LQTS-related gene mutations were detected in all the 20 cases, and pathogenic or suspected pathogenic mutations were identified in 18 cases (90.0%). Five LQTS mutation genes were discovered, including KCNQ1, KCNH2, SCN5A, CACNA1C and AKAP9.Eighteen cases (90.0%) had positive symptoms, and 13 cases (65.0%) had definite inducements.The inducement of symptoms in children with LQTS type 1(LQT1) was related to exercise, the causes of syncope in LQT1 and Jervell-Lange-Nielsen syndrome type 1 (JLNS1) with complex heterozygous mutations were exercise or emotional agitation; the causes of syncope in LQTS type 2 (LQT2) were unrelated to exercise; severe exercise in LQTS type 3 (LQT3) resulted in symptoms; and seizure in LQTS type 8 (LQT8) was non-induced.The corrected QT(QTc) interval of 20 cases was (553.1±66.6) ms, with a range of 460-707 ms, among which 17 cases showed QTc≥480 ms.The electrocardiogram(ECG) manifestations of children with various types of LQTS were different.There was no significant difference in QTc between different genders, or between children with syncope and those without syncope (all P>0.05). The follow-up time was (3.4±2.3) years, ranging from 0 to 8.3 years.Seventeen children received treatment[beta blockers and implantable cardiovertor-defibrillator(ICD)] and 3 cases did not.By the end of the follow-up, 1 child died, 19 cases survived, and 2 cases of the surviving children lost consciousness. Conclusions:There is a high consistency between genetic diagnosis and clinical diagnosis of congenital LQTS.The positive rate of gene detection is 90.0%.The clinical manifestations and ECG characteristics vary with genotypes.Beta blockers are protective.ICD therapy can prevent sudden cardiac death when oral medication does not respond.

Objective:To analyze the indication and status of early use of analgesic, sedative and antiepileptic drugs of patients with traumatic brain injury (TBI) admitted to the neurological intensive care unit (NICU).Methods:A questionnaire covering hospital basic characteristics, prehospital and emergency care, inpatient treatment, neurocritical care and rehabilitation were used to survey NICU of 37 hospitals in 18 municipalities or provinces from the Chinese registry of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) by Web or Email. The indications for admission to the NICU, categories and frequency of early use of analgesic and sedative drugs, and categories, frequency and indications of early use of antiepileptic drugs were analyzed.Results:Glasgow coma scale (GCS)≤8 points in patients with TBI and post-operation of TBI were the main indications for admission in 30 NICU (81.1%) and 24 NICU (64.9%), respectively. When admitting patients with a GCS of 9-12 points or 13-15 points, most NICU gave more considerations to the combined other risk factors. In terms of the early use of analgesics and sedatives, fentanyl was routinely used for analgesia (i.e., use frequency for 70%-100%) in 13 NICU (35.1%), and midazolam and alpha-2 agonists were routinely used for sedation in 24 NICU (64.9%) and 18 NICU (48.6%), respectively. Regarding the early use of antiepileptic drugs, sodium valproate was routinely used in 35 NICU (94.6%). Moreover, seizures within 2 hours after injury, penetrating TBI and cortical contusion were indications for routine application of antiepileptic drugs in 35 NICU (94.6%), 21 NICU (56.8%) and 20 NICU (54.1%), respectively.Conclusions:Severe TBI and post-operation of TBI are the main indications for admission to the NICU, while the combination of other risk factors will be considered when admitting patients with moderate or mild TBI. For TBI patients admitted to NICU, fentanyl, midazolam and sodium valproate are the most commonly used analgesic, sedative, and antiepileptic drugs in the early stage. Seizures within 2 hours after injury, penetrating TBI and cortical contusion are the main indications for antiepileptic drug use.

Objective: To analyze the association between plasma high-density lipoprotein cholesterol (HDL-C) levels and the severity of coronary artery disease, and to evaluate the impact of HDL-C levels on long-term outcomes in patients underwent percutaneous coronary intervention (PCI). Methods: A total of 10 458 consecutive patients underwent PCI from January 2013 to December 2013 at Fuwai hospital were enrolled in this study. Patients were divided into three groups according to HDL-C tertiles: low HDL-C group (HDL-C≤0.89 mmol/L, n=3 525), median HDL-C group (HDL-C>0.89-1.11 mmol/L, n=3 570) and high HDL-C group (HDL-C>1.11 mmol/L, n=3 363). SYNTAX score was used to evaluate the severity of coronary artery disease, linear regression was used to analyze the relationship of HDL-C and SYNTAX score. Kaplan-Meier survival analysis was used to compare the outcomes among the three groups. Multivariate Cox regression was used to define the potential associations of HDL-C and outcomes. Results: The HDL-C level was (1.03±0.28) mmol/L and the SYNTAX score was 11.7±8.1. Patients were older, proportion of female, stable angina pectoris, successful PCI and left ventricular eject fraction value were higher, while incidence of diabetes mellitus was lower, hyperlipidemia, old myocardial infraction, smoking history and left main and three vessels disease were lower in high HDL-C group (all P<0.05). Patients in high HDL-C group also had the lowest SYNTAX score (12.2±8.4 vs. 11.7±8.1 vs. 11.2±7.8, P<0.001). Both univariate and multivariate linear regression analysis showed that HDL-C was negatively associated with SYNTAX score, e.g. Univariate analysis: β=-0.046, P<0.001; Multivariate analysis: β=-0.058, P=0.001. And 10 400 (99.4%) patients completed 2-year follow up. At 2-year follow-up, there were no difference in all-cause death, cardiac death, myocardial infarction, revascularization, stroke, major adverse cardiovascular and cerebral events (MACCE) and stent thrombosis among three groups (P for trend>0.05), while patient in high HDL-C group experienced the highest BARC type 2 bleeding events (P for trend=0.018). Multivariate Cox regression analysis showed that HDL-C level was not an independent risk factor of 2-year adverse ischemia events (P>0.05) and 2-year bleeding events (P>0.05). Conclusion In patients underwent PCI, plasma HDL-C level is negatively associated with SYNTAX score, but not an independent risk factor of ischemic and bleeding events post PCI.

Objective: To observe the safety and impact of short-term anticoagulant therapy on prognosis after selective percutaneous coronary intervention (PCI) in patients with coronary artery disease. Methods: From January 2013 to December 2013, 9 769 consecutive patients underwent selective PCI in Fuwai Hospital were retrospectively included in this study. Patients were divided into two groups, including non-post-PCI anticoagulant therapy group and low-dose and short-time post-PCI anticoagulant therapy group (enoxaparin 0.4 ml/12 h or fondaparinux 2.5 mg/day by subcutaneous injection for 2-3 days after PCI). All patients were evaluated at 30 days, 180 days and 12 months for major adverse coronary and cerebral events (MACCE) including all-cause death, myocardial infarction, revascularization and stroke as well as in-stent thrombosis and bleeding events. Data from 1 755 pairs of patients were analysis after propensity score matching. The clinical outcomes were compared between groups by using Kaplan-Meier survival analysis before and after propensity score matching. Multivariable Cox analysis was used to define the impact and determinants of post-PCI anticoagulation on clinical outcomes. Results: one thousand seven hundred and fifty-five (18.0%) patients didn′t receive post-PCI anticoagulation and 8 014 (82.0%) patients received post-PCI anticoagulation, 5 666 (58.0%) patients received enoxaparin and 2 348 (24.0%) patients received fondaparinux. Patients were younger and incidence of female patients was less, incidence of renal dysfunction and acute coronary syndrome were higher in low-dose and short-time post-PCI anticoagulant therapy group than in non-post-PCI anticoagulation group (all P<0.05). Similarly, patients with post-PCI anticoagulation were associated with more left main coronary artery lesion and branch lesion (P<0.05). Post-PCI anticoagulation patients were associated with less trans-femoral process, more drug-eluting stents implantation and less simple balloon dilatation (all P<0.05). Nine thousand seven hundred and seventeen (99.5%) patients completed 2 years follow up. Post-PCI anticoagulation patients had significantly lower 30-day all-cause death (0.05% (4 cases) vs. 0.46% (8 cases), P<0.001) and stroke (0 vs. 0.11% (2 cases), P=0.003), lower 180-day all-cause death (0.17% (14 cases) vs. 0.57% (10 cases), P=0.002), revascularization (2.07% (166 cases) vs. 3.71% (65 cases), P<0.001) and MACCE (3.49% (280 cases) vs. 5.47% (96 cases), P<0.001), lower 2-year revascularization (7.61% (610 cases) vs. 12.84% (225 cases), P<0.001) and MACCE (10.92 (875 cases) vs. 16.01% (281 cases), P<0.001). Multivariable Cox regression analysis showed that post-PCI anticoagulant therapy was an independent protective factor of 30-day (HR=0.17, 95%CI 0.05-0.62, P=0.007), 180-day all-cause death (HR=0.37, 95%CI 0.16-0.87, P=0.023) and MACCE (HR=0.74, 95%CI 0.58-0.94, P=0.013), 2-year MACCE (HR=0.71, 95%CI 0.62-0.81, P<0.001). After propensity score matching, post-PCI anticoagulation therapy remained as an independent protective factor of 30-day all-cause death (HR=0.11, 95%CI 0.01-0.92, P=0.042) and 2-year MACCE (HR=0.81, 95%CI 0.68-0.96, P=0.015). Conclusions Low-dose and short-time post-PCI anticoagulant therapy may decrease 30-day all-cause death, 180-day all-cause death and MACCE and 2-year MACCE, and meanwhile this option does not increase bleeding risk in patients underwent selective PCI.