Objective To compare the effects of hypothermic arrest circulation ( HAC) with moderate or deep hypothermic antegrade selective cerebral perfusion ( ASCP) technique in patients with DeBake type Ⅰ aortic dissection or aortic arch aneurysm undergoing total aortic arch replacement. Methods Between Feb. 2007 and Aug. 2009, 60 patients who underwent aortic arch replacement using HAC + SCP technique. Patients were divided into two groups according to the lowest nasopharyngeal temperature: moderate hypothermia (18 - 20℃) (group MH, n = 28), and deep hypothermia (23 -25 ℃) (group DH,n=32). The clinical and neurological outcomes were observed. Results The overall in-hospital mortality was 3. 33% (2/60) ; In-hospital mortality was 3. 6% in the MH group, while3.1% in the DH group. There were no significant differences regarding to preoperative the patients' character parameters in both groups. At the beginning of ASCP, the nasopharyngeal and rectal temperatures were significantly higher in group MH[MH group (23.8 ± 1. 9 ) ℃ ( 26. 6 ± 2. 4 ) ℃ vs. DH group group (29.4 ±9.3) min vs. DH group(32.9 ± 13.4) min]. The rewarming time and CPB time were significantly shorter in MH group[(65.0±13.9) min vs. (90.3 ±27.2) min; (142.8 ±34.2) min vs. (194.1 ±42.0) min, P <0. 05]. Temporary neurologic deficits occurred in four patients (6. 67% ) without significant differences between two groups ( MH group 7.14% vs. DH group 6. 25% ). No patient suffered from permanent neurologic dysfunction. There were no significant differences between two groups in other parameters including intubation time, kidney insufficiency, the stay times in ICU and hospital. Conclusion Our results demonstrate that moderate HCA + ASCP technique is a safe strategy for the treatment of patients who require conventional total arch replacement with individual arch-vessel reconstruction. Shorter CPB time in patients with moderate HCA + ASCP did not increase any other postoperative adverse effects.

0.05). The LDL-C and apoB concentrations in fasting serum in men with 54T allele were significantly higher than those with 54A allele (2.38?0.63 vs 2.21?0.57mmol/L, P

Objective To summarize the timing, procedure and early and late outcomes of Surgical treatment of traumatic tricuspid insufficiency. Methods From May 1984 through September 2004, eight patients with traumatic tricuspid insufficiency were treated surgically. All were male, and the ages ranged from 7 to 67 years (median 38 years). Seven patients were blunt chest trauma (including traffic accidents in three). The median duration between trauma and operation was 19 months (range 1 month to 20 years). At operation, the heart functions of patients were in class II to IV (NYHA). Diagnoses were conformed by echocardiogram. The anterior leaflet was prolapsed because of the rupture of chord or anterior papillary muscle in all the patients, combined with chordal rupture of septal leaflet in one. In all the patients, right ventricular was enlarged in various degrees, as well as tricuspid annulus. In three patients, the tricuspid valve was repaired. Five cases received valve replacement, after repair failed. Results All the patients were recovered well without complication after operation. Only one of the three patients after tricuspid valve repair was detected mild tricuspid regurgitation by echocardiogram. The mean postoperative hospital stay was (16.6?6.5) days (7 to 24 days). The median follow-up period was 39 months (range 7 to 129 months). The heart functions were improved to class I (NYHA) in all patients. Conclusion The outcome of surgical treatment of traumatic tricuspid valve insufficiency is good. Surgical intervention should be done as early as possible once diagnosis was made to increase the feasibility of tricuspid valve repair. Tricuspid valve repair is the procedure of choice, while tricuspid valve replacement is also acceptable according to the long-term result of this report.

Objective To evaluate the outcome of valvular surgery in the elderly. Methods Between 1993 and 2004, 4546 patients underwent cardiac valve operation at our hospital. 252 patients (5.5%)(147 males, 105 females) were 65 or older [mean age (67.9?2.9) years]. Rheumatic valvular disease presented in 201(79.8%) patients and non-rheumatic valvular disease in 51 (20.2%). 56.0% of patients were in New York Heart Association (NYHA) functional class Ⅲ-Ⅳ.63 (25%) patients had aortic valve replacement (AYR), 93 (36.9%) had mitral valve replacement (MVR), 42 (16.7%) had mitral valve repair (MVP), 47 (18.7%) had AVR + MVR/MVP, and 7 (2.8%) had isolated tricuspid repair or replacement.34 (13.5 % ) had concomitant coronary artery bypass grafting (CABG) . Results Results The operative mortality was 9.1%, and the tendency of decline was observed in recent 3 years. As compared with the patients aged 16 to 64 years, the duration of mechanical ventilation, stay in ICU and in hospital postoperatively was longer [(30.6?42.8)h vs. (24.1?45.0) h,P = 0.02, (60.1?101.2) h vs. (43.0?70.6) h, P = 0.00, (25.7?41.3) days vs. (19.6?14.4) days,P=0.00]. In this group, the morbidity of postoperative complications was significant higher than that of the patients aged 16 to 64 years (10.6% vs.6.4% , P = 0.01). Preoperative NYHA function class was an important factor for postoperative mortality. Multivariate logistic regression showed that concomitant coronary artery bypass grafting (CABG) , AVR+ MVR/MVP, and prolonged cardiopulmonary bypass time, prolonged aortic cross-clamping time, postoperative acute renal failure demanding dialysis were significant independent predictors of operative mortality. Conclusion The mortality of cardiac valvular surgery in the elderly is acceptable. It is characterized by higher morbidity of postoperative complications and prolonged duration of stay in hospital. Concomitant CABG, AVR + MVR/MVP, prolonged cardiopulmonary bypass time, prolonged aortic crossclamping time and postoperative acute renal failure were significant independent predictors of operative mortality.

Objective To evaluate the efficacy and safety of helmet delivered continuous positive airway pressure (Helmet-CPAP)for hypoxemia in airway extubated patients after cardiac surgery.Methods 120 adult patients in ICU from March 2014 to July 2015,who were after cardiac surgery,were enrolled.These patients who suffered hypoxemia within 48 hours after extubation,defined as that PaO2/FiO2 with oxygen mask could not reach 200,were divided into two groups.In the control group high concentration oxygen therapy with mask was delivered,while helmet-CPAP was delivered in the experimental group.Treatment duration was 6 hours.Results Helmet-CPAP significantly improved PaO2/FiO2 (144.35 ± 24.43 vs.201.35 ± 52.97,P ＜ 0.05) and left ventricular ejection fractions(0.5383 ± 0.0844 vs.0.5540 ± 0.0844,P ＜ 0.05).Breathing rate (22.60±5.08 vs.18.53 ±4.13,P＜0.05),heart rate(102.72±17.9 vs.95.15 ±13.79,P＜0.05)and shock index (0.85 ± 0.35 vs.0.75 ± 0.15,P ＜ 0.05) were significantly lower.The rate of using mechanical ventilation (6.67％ vs.28.33％,P ＜ 0.05) and length of ICU stay[41.0(25.0,67.5) hours vs.49.5 (32.5,90.8) hours,P ＜ 0.05] was significantly less than control group.Conclusion Helmet delivered continuous positive airway pressure is an effective and safe treatment for hypoxemia in airway extubated patients after cardiac surgery.

Objective To study the relationship between heart rate and failure of biological valve,and whether reduce the heart rate could delay the failure of biological valve.Methods Retrospective analysis of 92 bioprosthetic valve replacement cases in our institution from April 1996 to March 2001.The follow-up was carried out through the outpatient service,telephone and letter.The patients were divided into two groups based on the heart rate:Group A:basic heart rate no more than 75 beats per minute;Group B:basic heart rate greater than 75 beats per minute.Blood pressure,heart function,echocardiogram and reoperation rate was collected.Results In group A,the average follow-up time and the longest follow-up time was better than the patients in group B but has no significant difference.Echocardiographic data showed that the proportion of valve leaflets stiffness and calcification in group A was significantly lower than group B(7.7％ vs.17.9％,P ＜0.05).Redo operation rate in group A was lower than those in group B (7.7％ vs.22.6％,P ＜ 0.05).There were only 1 case(1.5 ％) suffering from the tearing in all three valve leaflets in group A while it was 8 cases(8.7％) in group B (2.6％ vs.15.1％,P ＜ 0.05).Conclusion Basic heart rate has a significant effect on the failure of the mitral bioprosthesis.To decrease the basic heart rate can delay the failure of the mitral bioprosthesis and improve the durability.

Objective To evaluate risk factors of in-hospital mortality during extracorporeal membrane oxygenation(ECMO) support for those with refractory cardiogenic shock after aortic surgery.Methods Retrospective analyses were conducted for 35 patients using ECMO after aortic surgery at Beijing Anzhen Hospital,Capital Medical University from September 2009 to March 2016.Demographic characteristics,diagnosis,ECMO related data,including ECMO indication,operation,clinical parameters before and 24 hours during ECMO were collected to set up a database.The patients were divided into survival group and non-survival group according to the prognosis.The risk factors of mortality in hospital after ECMO were analyzed by multivariate logistic regression analysis regression.Results There were 35 adult patients who had received ECMO support with 32 male and 3female.All patients received veno-arterial ECMO (V-A ECMO).ECMO was successfully weaned in 22 patients (62.9％),and 18 patients(51.4％) survived.Multivariate logistic regression analysis revealed that high lactic acid levels at 12 hours after ECMO(OR =1.445;95％ CI:1.026-2.034) and multiple organ dysfunction syndrome(MODS,OR =10.412;95％ CI:2.246-70.798)(P ＜ 0.05) were independent risk factors of in-hospital mortality in adult patients undergoing ECMO after aortic surgery.Conclusion High lactic acid levels at 12 hours after ECMO and MODS were very important factors of patients undergoing ECMO after aortic surgery.The proper identification and management shall improve the prognosis of patients.

Objective This study aims to analyze if high sensitivity C Reactive Protein (hs-CRP) was a independent risk factor of acute kidney injury(AKI) after A type aortic dissection surgery.Methods Clinical data of the 169 patients who underwent A type acute aortic dissection surgery from February 2009 to October 2010 were collected.Patients without preoperative detection of hs-CRP,patients with preoperative infection and patients diagnosed infection before AKI were excluded.Enrolled patients were divided into AKI group and non-AKI group,and according to using RRT or not,the patients were divided into RRT group and non-RRT group.All the factors were evaluated by means of univariate and multivariate logistic regression analysis to identify relative risk factors of AKI.Results AKI occurred in 95 cases(56.2％),Using RRT in 8 cases (4.7％).hsCRP is an independent risk factor of AKI(OR =0.975,95％ CI 0.952-0.999,P =0.041).hs-CRP and aortic cross clamping time were the independent risk factors of using RRT,The in-hospital mortality was significant difference between RRT group and non-RRT group (P ＜ 0.05).The area under the ROC curve of hs-CRP on RRT diagnosis was 0.733,95％ CI 0.570-0.896,P =0.026.The sensitivity of CRP ＞ 30.42 mg/L warning AKI need RRT was 87.5％,the specificity was 53.4％.Conclusion AKI after A type aortic dissection surgery was a severe complication and RRT associated with in-hospital mortality,hs-CRP was higher in acute aortic dissection patients.The level of hs-CRP and aortic cross clamping time were independent risk factors of AKI and RRT.

Objective To evaluate the impact of cerebrospinal fluid drain(CSFD) on the incidence of acute spinal cord injury(SCI) following extensive TAAA repair.Methods From February 2009 to July 2016,153 patients underwent extensive TAAA repairs with a consistent strategy of normal thermia,non-circulatory bypass,sequential aortic cross clamping,aortic-lilac bypass,and intercostal artery reconstruction.The repairs were performed with preoperative CSFD (n =78) or without CSFD (n =75).In the former group,CSFD was inserted after the patient has been anaesthetized and continued for 72 hours after surgery.The target CSF pressure was 10 mmHg or less.Results The mean age of patients was (38 ± 10) years and 108 (70.6％) were male.There were 87 (53.8％) patients with previous aortic surgeries and 33 (22％) with Marfan syndrome.The two groups had similar risk factors for paraplegia.Aortic clamp time,operation time and number of reattached intercostal arteries were similar in both groups.In-hospital mortality rates were 1.3％ (one patient) and 6.7％ (five patients) for CSFD and the group without CSFD,respectively (P =0.086).Ten patients (13.3 ％) in the group without CSFD had paraplegia develop.In contrast,only two patients in the CSFD group(2.6％) had postoperative paraplegia(P =0.013).Stepwise logistic regression analysis identified CSFD had spinal cord protection,P =0.026;OR =0.171;95％ CI:0.036-0.809).No patients occurred CSF catheter related complications.Conclusion This randomized clinical trial showed that preoperative CSFD placement could be an effective strategy in preventing SCI following extensive aortic aneurysm repair.Care should be taken to prevent complications related to overdrainage.

BACKGROUND: Studies have shown that alanine (A) to threonine (T) substitution at codon 54 of intestinal fatty acid-binding protein (FABP2) in different populations is associated with dyslipidemia and other characteristics of metabolic syndrome.OBJECTIVE: To investigate the frequency of encoding 54Ala/Thr (A/T) single nucleotide polymorphism in the FABP2 in middle-aged and old people, and explore the association between 54T FABP2 and plasma lipids.DESIGN: A case-controlled analysis. SETTING: Department of Biochemistry, Hebei North University and Department of Clinical Laboratory, the 251 Hospital of Chinese PLA.PARTICIPANTS: 469 physical examinees were selected from the Medical Examination Center, the 251 Hospital of Chinese PLA between October 2003 and April 2005. The subjects included 217 males with mean age of (56±10) years, and 252 females with mean age of (55±13) years. Only people with normal liver and kidney function, and with no blood relation were recruited. The informed consent to this study was obtained from all subjects. The experiment was admitted by Hospital Ethics Committee. METHODS: ①After fasting for 12 hours, automatic analyzer (Olympus AU 6400) was adopted to measure plasma total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apoprotein A1(Apo A1) and Apo B levels. ②1 mL venous blood was extracted and immediately mixed with anti-coagulants containing citric acid, natrium citricum and glucose. White blood cells were separated and genomic DNA was isolated using standard methods with proteinase K digestion and phenol/chloroform purification. The genotype distribution frequency in each group was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). MAIN OUTCOME MEASURES: ①Plasma TC, TG, HDL-C, LDL-C, Apo A1and Apo B levels; ②Distributions of FABP2 genotypes at codon 54. RESULTS: ①The genotype frequencies of A/A, A/T, T/T were 0.48, 0.42, and 0.10 in males, and 0.44, 0.46, and 0.10 in females, respectively. The allelic frequency of point mutant 54Thr in FABP2 gene was 0.31 in males and 0.33 in females, respectively. There was no difference between males and females (χ2=0.47, P ＞ 0.05). ②The LDL-C and Apo B concentrations in fasting plasma of males with 54T allele were significantly higher than those with 54A allele (P ＜ 0.05). The TC and LDL-C concentrations in fasting plasma of females with 54T allele were significantly higher than those with 54A allele (P ＜ 0.05). CONCLUSION: In the middle-aged and old populations, the frequency of encoding 54Ala/Thr polymorphism in FABP2 gene is not correlated with gender, but with high lipoprotein profile.