Objective     To summarize the clinical characteristics and surgical treatment experience of 1 106 patients with cardiac myxoma. Methods     Clinical data of 1 106 patients with cardiac myxoma who underwent surgical treatment in Beijing Anzhen Hospital from 2002 to 2018 were retrospectively analyzed. There were 749 (67.7%) females and 357 (32.3%) males. Results     The highest incidence rate was at the age of 51-70 years. The location of the disease was: left atrium in 987 (89.2%) patients, right atrium in 99 (9.0%) patients, left ventricle in 10 (0.9%) patients, right ventricle in 8 (0.7%) patients. There were 1 013 patients of heart classification (NYHA) Ⅰ-Ⅱ and 93 patients of Ⅲ-Ⅳ. There were 301 patients with cerebral infarction and 57 patients with peripheral arterial embolism. Tumor size was closely related to hemodynamic symptoms (P≤0.05), but not to peripheral vascular embolism (P>0.05). Two (0.2%) patients died in hospital and 306 patients were followed up, with a follow-up rate of 27.7%. The median follow-up time was 7 years (range, 1-18 years). One patient died of all causes, and 23 patients recurred, with a recurrence rate of 2.1%. Among 23 recurrent patients, 15 (65.2%) patients were atypical myxoma and 8 (34.8%) patients were typical myxoma. There was no statistical difference in aortic clamping time, ICU stay time, ventilator-assisted breathing time, postoperative hospital stay time, postoperative mortality, or cardiac ejection fraction at discharge between the reoperation in 23 recurrent patients and the first operation in 1 083 non-recurrentpatients. Conclusion     Cardiac myxoma is more common in middle-aged and elderly women, and it often occurs in the left atrium. The size of cardiac myxoma can affect the hemodynamic changes. Surgical treatment is effective. Atypical myxoma is more common in recurrent patients, and the effect is still satisfactory through surgical treatment.

Objective:To examine the short-term and long-term outcomes of tricuspid valve replacement (TVR) in patients with left ventricular dysfunction.Methods:The clinical data of 24 patients with left ventricular dysfunction who received TVR at Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University from November 1993 to August 2018 were consecutively enrolled. There were 14 males and 10 females, aged (41.9±13.2) years old (range: 19 to 66 years old). The preoperative ejection fraction was (42.9±6.4)% (range: 21% to 49%), while less than 35% in 3 patients. The scores of Charlson comorbidity index were as follows: 5 patients for 0, 6 patients for 1, 7 patients for 2, 1 patient for 3 and 5 patients for 4. The European system for cardiac operative risk evaluation (EuroSCORE) Ⅰ was 3.6±2.1 (range: 1 to 9). The EuroSCORE Ⅱ was (4.91±2.40)% (range: 1.58% to 11.60%). The model for end-staged liver disease score was 1.8±1.2 (range: 0.2 to 7.1). The simplified model for end-staged liver disease score was 5.6±2.5 (range: 1.5 to 13.4). Follow-up was conducted by clinic. The long-term survival rate was calculated by Kaplan-Meier method.Results:In-hospital mortality was 16.7% (4/24), including 1 patient for multiple organ failure and 3 patients for low cardiac output syndrome (LCOS). One patient needed continuous renal replacement therapy and 6 patients suffered from LCOS. The follow-up time was 1 to 19 years, with a median of 8 years. During the follow-up period, 4 patients died, including 2 deaths for cardiogenic cause, 1 death for anticoagulant complications, and 1 death for lung cancer. The 1, 5 and 10-year survival rates were 76.2%, 71.4% and 64.9%, respectively.Conclusion:The short-term and long-term clinical outcomes of TVR in patients with left ventricular dysfunction are acceptable, but the mortality and morbidity are still high.

Objective:To examine the short-term and long-term outcomes of tricuspid valve replacement (TVR) in patients with left ventricular dysfunction.Methods:The clinical data of 24 patients with left ventricular dysfunction who received TVR at Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University from November 1993 to August 2018 were consecutively enrolled. There were 14 males and 10 females, aged (41.9±13.2) years old (range: 19 to 66 years old). The preoperative ejection fraction was (42.9±6.4)% (range: 21% to 49%), while less than 35% in 3 patients. The scores of Charlson comorbidity index were as follows: 5 patients for 0, 6 patients for 1, 7 patients for 2, 1 patient for 3 and 5 patients for 4. The European system for cardiac operative risk evaluation (EuroSCORE) Ⅰ was 3.6±2.1 (range: 1 to 9). The EuroSCORE Ⅱ was (4.91±2.40)% (range: 1.58% to 11.60%). The model for end-staged liver disease score was 1.8±1.2 (range: 0.2 to 7.1). The simplified model for end-staged liver disease score was 5.6±2.5 (range: 1.5 to 13.4). Follow-up was conducted by clinic. The long-term survival rate was calculated by Kaplan-Meier method.Results:In-hospital mortality was 16.7% (4/24), including 1 patient for multiple organ failure and 3 patients for low cardiac output syndrome (LCOS). One patient needed continuous renal replacement therapy and 6 patients suffered from LCOS. The follow-up time was 1 to 19 years, with a median of 8 years. During the follow-up period, 4 patients died, including 2 deaths for cardiogenic cause, 1 death for anticoagulant complications, and 1 death for lung cancer. The 1, 5 and 10-year survival rates were 76.2%, 71.4% and 64.9%, respectively.Conclusion:The short-term and long-term clinical outcomes of TVR in patients with left ventricular dysfunction are acceptable, but the mortality and morbidity are still high.

Objective:To construct preliminarily the malignant risk classification system for the cervical lymph node.Methods:A total of 301 patients with cervical lymphadenopathy were collected in this prospective study from Union Hospital, Fujian Medical University from July 2018 to December 2019. The ultrasonographic features(including the short diameter, ratio of long to short diameters(L/S), margin, border, matting, echogenic hilum, echogenicity, gross necrosis, microcalcification, hyperechoic area, flow type, vascular distribution), history of malignancy, inflammation performance of the neck and history of tuberculosis were analyzed. A score was assigned for each significant index related to benign/malignant lymph nodes by a Logistic regression analysis. The classification of the malignant risk was determined on the basis of the scores.Results:The factors significantly associated with the malignant lymph nodes were enlargement of the short diameter, L/S<2, microcalcification, hyperechoic area, irregular margin, matting, abnormal flow pattern, malignancy history. While the factors related to the benign were the inflammation performance and the fuzzy boundary. The risk of malignancy increased as the score of lymph node increased. The malignant risk of lymph node according to the classification system was as follows: category 1, 7.30%; category 2a, 35.00%; category 2b, 69.30%; category 2c, 91.50%; and category 3, 99.05%. The area under the ROC curve of the system was 0.913.Conclusions:The system has great potential of clinical application to assess the risk of malignancy in cervical lymph nodes.

Objective:To summarize the experience of reoperation for 23 cases of cardiac myxoma recurrence.Methods:From January 2002 to December 2018, 1106 patients with cardiac myxoma underwent surgical treatment. Among them, 23 patients underwent reoperation after recurrence. 10 males and 13 females with an average age of (50.5±10.8) years old. There were 22 patients with secondary operation and 1 patient with four operations. 3 cases with mitral insufficiency and 1 case with tricuspid insufficiency. There were 20 patients with NYHA Ⅰ-Ⅱ and 3 patients with Ⅲ-Ⅳ. A total of 1 083 patients with cardiac myxoma undergoing primary operation were selected as the control group. The operation time, cardiopulmonary bypass time, aortic clamping time, ICU monitoring time, ventilator assisted breathing time, postoperative hospital stay, in-hospital mortality and cardiac ejection fraction at discharge were compared between the two groups.Results:8 cases (34.8%) had the first onset in the left atrial septum, and 15 cases (65.2%) in other parts. Recurrence site: left atrium in 17 cases(73.9%), left ventricle in 2 cases (8.7%), right atrium in 3 cases (13.0%), right ventricle in 1 case (4.3%). Reoperation accounted for 2.1% of cardiac myxoma surgery in the same period. The median recurrence time of 13 patients was 24 months. During the same period, mitral valve replacement was performed in 2 cases, mitral valvuloplasty in 1 case and tricuspid valve plasty in 1 case. The average operation time was (3.9±2.8) h, cardiopulmonary bypass time was (107.6±33.8) min, aortic clamping time was (64.9±23.8) min, ICU monitoring time was (20.1±16.0) h, ventilator assisted breathing time was (16.9±8.5) h, cardiac ejection fraction at discharge was 0.51±0.10, postoperative hospital stay was (8.3±1.5) days. The median follow-up time was 5 (1-18) years. One case (4.3%) died of all causes. There was no significant difference in ICU monitoring time, ventilator assisted breathing time, discharge cardiac ejection fraction, postoperative hospital stay and hospital mortality between reoperation patients and one operation ( P>0.05). Conclusion:Atypical cardiac myxoma has a high recurrence tendency after operation. Regular follow-up after the first operation of cardiac myxoma is a necessary means to early detect recurrence and avoid complications. Reoperation after recurrence can still achieve satisfactory results.

The treatment of heart failure is a common clinical problem faced by the medical community all over the world. It is also the only cardiovascular disease in the world that is on the rise. Although drug therapy for heart failure has made great progress in recent years, there are still many problems. Therefore, reversing ventricular remodeling, assisting or even replacing the function of the damaged heart and improving the prognosis and quality of life of patients with heart failure through surgical treatment will become the main battlefield for the future treatment of heart failure. As a transitional support therapy or permanent replacement therapy before heart transplantation, ventricular assist device can significantly improve the survival and quality of life of patients with heart failure, and is becoming an important treatment method for patients with end-stage heart failure. This paper aim to review the history and prospect of ventricular assist devices after heart failure.

Objective:To investigate the difference between the short-term and long-term survival rates of patients undergoing tricuspid valve replacement with biological and mechanical valves.Methods:273 patients who received tricuspid valve replacement were selected from our Hospital from November 1993 to August 2018. The mean follow-up time was(8.2±5.6) years. The total follow-up rate was 95%. Kaplan-Meier method was used to make survival curves of the two groups and log rank test was used to compare the differences between the two groups. In addition, this study made the comparison of preoperative, intraoperative and postoperative information and long-term survival rate between these two groups.Results:There was no significant difference in demographic characteristics and baseline between mechanical valve group and biological valve group. 16 patients died in the mechanical valve group and 22 in the biological valve group. In the mechanical valve group, 14 cases died of postoperative low cardiac output syndrome and 2 cases died of gastrointestinal hemorrhage. 22 patients were died of low cardiac output syndrome. The auxiliary time in the mechanical valve group was longer than that in the biological valve group[(151.76±70.30)min vs.(131.62±60.25)min, P=0.013)]. There was no significant difference in long-term survival rate between the two groups in Kaplan- Meier survival curve( P=0.234). Conclusion:There is no difference in short-term and long-term survival rate between mechanical valve and biological valve in tricuspid valve replacement.

Objective:To investigate short-term and long-term outcomes of off-pump coronary artery bypass grafting(OPCABG)in patients aged 80 years and over.Methods:In this retrospective study, clinical data were collected, from June 2005 to July 2014, of 31 patients aged 80 and over years with left ventricular dysfunction who had received OPCABG in Beijing Anzhen Hospital and a follow-up of 3-12 years after discharge.Results:Ages of the patients ranged from 80 to 88 years with a mean age of(82.0±2.1)years.There were 25 males(80.6%). The mean left ventricular ejection fraction(LVEF)of patients was(42.0±6.5)% before operation, and 15 patients had LVEF less than 35%(48.4%). The average operation time was 4 hours.Three patients died in hospital(9.7%), of whom, one died from acute respiratory failure and the two others from low cardiac output syndrome.Perioperative complications included myocardial infarction(1 case, 3.2%), acute cerebral infarction(2 cases, 6.5%), tracheal intubation(3 cases, 9.7%), secondary thoracotomy and hemostasis(1 case, 3.2%), continuous renal replacement therapy(3 cases, 9.7%)and perioperative intra-aortic balloon pump(IABP)(8 cases, 25.8%). Twenty-eight patients were followed up for 3-12 years(median, 8.0 years), and no one had withdrawn.There were 10 all-cause deaths(35.7%), including 5 cardiogenic deaths(17.9%), 2 lung cancer deaths(7.1%), 2 deaths due to sepsis from systemic infection(7.1%), and 1 death from unknown causes.Besides, 2 patients had re-admission(7.1%), 2 patients suffered angina(7.1%)and 1 patient(3.6%)had recurrent myocardial infarction(3.6%). No patient received re-revascularization.Coronary computed tomography angiography(CTA)was performed on all surviving patients 1 year after surgery, and the patency rate of vascular bridges was 100%.Conclusions:Both short-term and long-term clinical outcomes of OPCABG are fair in patients aged over 80 years with left ventricular dysfunction, but the mortality and risk of complications are still high, and comprehensive preoperative evaluation is needed for these patients.

Objective: To analyze the clinical efficacy of coronary artery bypass grafting(CABG)in patients of advanced age with left main coronary artery disease(LMCAD). Methods: From 2005 to 2014, 101 elderly patients(≥80 years)with LMCAD underwent off-pump CABG in our hospital.Among them, 82 were male and 19 were female, with an average age of(81.4±1.7)years.Seventy-six cases(75.2%)had significant left main stenosis(≥70%)and twenty-five cases had left main stenosis less than 70%.The average left ventricular end diastolic diameter was(48.2±8.3)cm; left ventricular ejection fraction was more than 50% in 89 cases and 30% to 50% in 12 cases.Fourteen cases had mitral insufficiency and one had ventricular aneurysm.In addition, 56 patients had New York Heart Association functional classification Ⅰ to Ⅱ, and 45 patients had classification Ⅲ to Ⅳ.Ninety-nine patients had Canadian Vascular Society(CCS)classification of angina pectoris Ⅰto Ⅲ, two had classification Ⅳ and thirteen had acute myocardial infarction.Six patients were implanted with intra-aortic balloon counterpulsation before CABG. Results: The average operation time was(3.9±0.8)h, the average number of bridging vessels were(3.0±1.0)roots, ICU monitoring time was(50.2±46.0)h, and ventilator assisted breathing time was(42.9±68.5)h.Six patients(5.9%)had secondary thoracotomy hemostasis, five(4.9%)had secondary tracheal intubation, and four(4.0%)had continuous dialysis.Intra-aortic balloon counterpulsation was implanted in 3cases(2.9%)during operation and in 11 cases(10.9%)after operation.Two cases(2.0%)had perioperative myocardial infarction and 8 cases(7.9%)died after operation during hospitalization.The median follow-up time was 6(1-11)years, and 17(16.8%)had all-cause mortality. Conclusions Although the two independent high-risk factors, old age and left main stenosis often coexist, off-pump CABG and perioperative management are still safe and effective treatments.

Objective:To examine the outcome of off-pump coronary artery bypass (OPCAB) in elderly patients with left ventricular dysfunction.Methods:From June 2008 to July 2016, 252 patients aged over 80 years underwent isolated OPCAB at Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, these patients′ data were collected. The left ventricular dysfunction group (ejection fraction (EF): 35% to 50%) was comprised of 31 patients aged (82.0±2.1) years (range: 80 to 88 years), including 25 males and 6 females. Through matching one-to-one on propensity scores, 31 patients (EF >50%) were included into the left ventricular normal group. Among them, there were 25 males and 6 females, aged (81.9±1.9) years (range: 80 to 89 years). Postoperative mortality and complications between the matched groups were compared using the t test, Wilcoxon rank-sum test, χ 2 test or Fisher exact test. Results:Between the dysfunction group and normal group, the preoperative serum creatinine was 144.6(66.0) μmol/L vs. 94.9(43.2) μmol/L ( M( Q R), Z=3.177, P=0.033), respectively, while the pre-discharge serum creatinine was 147.0(59.0) μmol/L vs. 92.0(24.0) μmol/L ( Z=-2.685, P=0.007), respectively. In dysfunction group, the perioperative intra-aortic balloon counterpulsation (IABP) utilization rate was higher (25.8%(8/31) vs. 3.2%(1/31), P=0.026), the total hospitalization day was longer (17(15) days vs. 14(8)days, Z=2.054, P=0.012), the preoperative hospitalization day was longer too (7(7) days vs. 5(4) days, Z=-2.457, P=0.014). However, there was no significant difference in the incidence of postoperative mortality (9.7%(3/31) vs. 3.2%(1/31), P=0.612) and other prognostic indicators between the two groups. Conclusions:The elderly patients, with light and moderate left ventricular insufficiency, are characterized by the abnormal increase in renal function and the rise of IABP utilization due to hemodynamic disorder in OPCAB perioperative period. Preoperative treatment for cardiac insufficiency may be the cause of prolonged preoperative and total hospital stay. However, there is no significant difference in the postoperative mortality and other complications compared with the patients of normal left ventricular function.