Objectives:This study aims to investigate the association between intraoperative hypotension(IOH)and postoperative stroke within 7 days following off-pump coronary artery bypass grafting(OPCABG).Methods:A retrospective analysis was conducted on 1 006 patients who underwent elective OPCABG at our hospital between April 2023 and April 2024.According to whether the mean arterial pressure(MAP)decreased to 55 mmHg during the operation and the corresponding time,the patients were divided into three groups:non-hypotension group(n=632),short-term hypotension group(MAP<55 mmHg cumulative time<15 minutes,n=279)and long-term hypotension group(MAP<55 mmHg cumulative time≥15 minutes,n=95).To study the effect of the cumulative duration of hypotension on cerebral perfusion when MAP<55 mmHg was used as the critical value of hypotension.The primary outcome measure was early ischemic stroke within 7 days after surgery.Results:The incidence of early postoperative ischemic stroke was 0.6%,3.6%and 1.1%in the non-hypotension group,short-term hypotension group and long-term hypotension group,respectively.Compared with the non-hypotension group,the incidence of early postoperative ischemic stroke in the short-term hypotension group was significantly higher(P<0.0167).Multivariate logistic regression analysis showed that compared with the non-hypotension group,short-term IOH(OR=6.535,95%CI:1.980-21.574,P=0.002)and preoperative serum creatinine level(OR=1.023,95%CI:1.008-1.039,P=0.002)were associated with the occurrence of ischemic stroke within 7 days after operation,long-term IOH was not associated with ischemic stroke within 7 days after operation(OR=1.691,95%CI:0.178-16.029,P=0.647).Conclusions:The occurrence of ischemic stroke after off-pump coronary artery bypass grafting is related to short-term IOH,but not to long-term IOH.

Objective To investigate the levels of serum soluble CD14 subtype(Presepsin)and serum amyloid protein A(SAA)in patients with colorectal cancer after laparoscopic surgery,and their predictive value for early anastomotic leakage.Methods From October 2021 to April 2024,126 patients with laparoscopic colorectal cancer were divided into the non-anastomotic leakage group(control group,n=103)and the anastomotic leakage group(observation group,n=23)based on whether anastomotic leakage occurred within 3 days after the operation.Clinical information was collected from both groups and compared between groups.Enzyme linked immunosorbent assay(ELISA)was applied to detect the postoperative serum levels of Presepsin and SAA in two groups.Pearson method was applied to investigate the correlation between postoperative serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery.The multivariate Logistic regression model was applied to analyze the key factors influencing the occurrence of anastomotic leakage in the early postoperative period in patients with colorectal cancer after laparoscopic surgery.The receiver operating characteristic curve(ROC curve)was applied to evaluate the predictive value of serum Presepsin and SAA levels for early anastomotic leakage in colorectal cancer patients after laparoscopic surgery.Results Compared with the control group,the proportion of patients with tumours≥7 cm from the anus was significantly reduced and intraoperative bleeding was significantly increased in the observation group,the differences were statistically significant(P<0.05).The postoperative levels of serum Presepsin and SAA in the observation group were obviously higher than those in the control group,the differences were statistically significant(P<0.05).There was an obvious positive correlation between serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery(r=0.749,P=0.016).Serum Presepsin levels higher than 389.23 pg/mL and SAA expression levels higher than 25.10 mg/L were independent risk factors for the occurrence of early anastomotic leakage after surgery in patients with colorectal cancer after laparoscopic surgery.A tumor distance from the anus of≥7 cm was a protective factor.The area under the curve(AUC)of serum Presepsin and SAA alone and in combination for detecting early anastomotic leakage in patients with colorectal cancer after laparoscopic surgery was 0.834(95%CI:0.757～0.894),0.801(95%CI:0.720～0.866),and 0.897(95%CI:0.830～0.944).The combined detection was superior to the separate detection of Presepsin and SAA(Zcombination-Presepsin=2.085,Zcombination-SAA=2.010,both P<0.05).Conclusion Serum levels of Presepsin and SAA are elevated in patients with colorectal cancer after laparoscopic surgery,and their combined detection has high predictive value for early anastomotic leakage.

Objective To investigate the levels of serum soluble CD14 subtype(Presepsin)and serum amyloid protein A(SAA)in patients with colorectal cancer after laparoscopic surgery,and their predictive value for early anastomotic leakage.Methods From October 2021 to April 2024,126 patients with laparoscopic colorectal cancer were divided into the non-anastomotic leakage group(control group,n=103)and the anastomotic leakage group(observation group,n=23)based on whether anastomotic leakage occurred within 3 days after the operation.Clinical information was collected from both groups and compared between groups.Enzyme linked immunosorbent assay(ELISA)was applied to detect the postoperative serum levels of Presepsin and SAA in two groups.Pearson method was applied to investigate the correlation between postoperative serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery.The multivariate Logistic regression model was applied to analyze the key factors influencing the occurrence of anastomotic leakage in the early postoperative period in patients with colorectal cancer after laparoscopic surgery.The receiver operating characteristic curve(ROC curve)was applied to evaluate the predictive value of serum Presepsin and SAA levels for early anastomotic leakage in colorectal cancer patients after laparoscopic surgery.Results Compared with the control group,the proportion of patients with tumours≥7 cm from the anus was significantly reduced and intraoperative bleeding was significantly increased in the observation group,the differences were statistically significant(P<0.05).The postoperative levels of serum Presepsin and SAA in the observation group were obviously higher than those in the control group,the differences were statistically significant(P<0.05).There was an obvious positive correlation between serum levels of Presepsin and SAA in patients with colorectal cancer after laparoscopic surgery(r=0.749,P=0.016).Serum Presepsin levels higher than 389.23 pg/mL and SAA expression levels higher than 25.10 mg/L were independent risk factors for the occurrence of early anastomotic leakage after surgery in patients with colorectal cancer after laparoscopic surgery.A tumor distance from the anus of≥7 cm was a protective factor.The area under the curve(AUC)of serum Presepsin and SAA alone and in combination for detecting early anastomotic leakage in patients with colorectal cancer after laparoscopic surgery was 0.834(95%CI:0.757～0.894),0.801(95%CI:0.720～0.866),and 0.897(95%CI:0.830～0.944).The combined detection was superior to the separate detection of Presepsin and SAA(Zcombination-Presepsin=2.085,Zcombination-SAA=2.010,both P<0.05).Conclusion Serum levels of Presepsin and SAA are elevated in patients with colorectal cancer after laparoscopic surgery,and their combined detection has high predictive value for early anastomotic leakage.

Objectives:This study aims to investigate the association between intraoperative hypotension(IOH)and postoperative stroke within 7 days following off-pump coronary artery bypass grafting(OPCABG).Methods:A retrospective analysis was conducted on 1 006 patients who underwent elective OPCABG at our hospital between April 2023 and April 2024.According to whether the mean arterial pressure(MAP)decreased to 55 mmHg during the operation and the corresponding time,the patients were divided into three groups:non-hypotension group(n=632),short-term hypotension group(MAP<55 mmHg cumulative time<15 minutes,n=279)and long-term hypotension group(MAP<55 mmHg cumulative time≥15 minutes,n=95).To study the effect of the cumulative duration of hypotension on cerebral perfusion when MAP<55 mmHg was used as the critical value of hypotension.The primary outcome measure was early ischemic stroke within 7 days after surgery.Results:The incidence of early postoperative ischemic stroke was 0.6%,3.6%and 1.1%in the non-hypotension group,short-term hypotension group and long-term hypotension group,respectively.Compared with the non-hypotension group,the incidence of early postoperative ischemic stroke in the short-term hypotension group was significantly higher(P<0.0167).Multivariate logistic regression analysis showed that compared with the non-hypotension group,short-term IOH(OR=6.535,95%CI:1.980-21.574,P=0.002)and preoperative serum creatinine level(OR=1.023,95%CI:1.008-1.039,P=0.002)were associated with the occurrence of ischemic stroke within 7 days after operation,long-term IOH was not associated with ischemic stroke within 7 days after operation(OR=1.691,95%CI:0.178-16.029,P=0.647).Conclusions:The occurrence of ischemic stroke after off-pump coronary artery bypass grafting is related to short-term IOH,but not to long-term IOH.

Objective: To investigate the clinical outcomes of selective major aortopulmonary collaterals(MAPCAs) unifocalization and report histopathological findings in patients with pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals(PA/VSD/ MAPCAs). Methods: The study enrolled 6 MAPCAs/VSD/PA patients with age ranged from 6 to 96 months and body weight ranged from 5.0 to 23.0 kg. These patients underwent selective MAPCAs unifocalization and primary repairs. Preoperative cardiac catheter, selective arteriography, cardiac CTA and intraoperative pathology were performed to identify different function, anatomic distribution and histopathology of MAPCAs. Results: 6 MAPCAs/VSD/PA patients underwent selective MAPCAs unifocalization and primary repair. No death occurred after operation and at follow-up which lasted for 1 to 20 months. Preoperative cardiac catheter, selective arteriography and intraoperative histopathology demonstrated distribution of functional MAPCAs similar to native pulmonary artery arborization and participating in arterial gas exchange. Functional MAPCAs were classified into elastic arteries according to histopathology. Conclusion There are two histological type of MAPCAs which play different roles. Selective unifocalization to functional MAPCAs which are classified into elastic arteries like native pulmonary artery is a safe and effective treatment approach for PA/VSD/MAPCAs.

Objective:To evaluate the accuracy of pRIFLE criterion and KDIGO criterion for the diagnosis of acute kidney injury (AKI) after radical operations for tetralogy of Fallot in children from the perspective of postoperative outcomes.Methods:A total of 375 children, aged<8 yr, undergoing radical operations for tetralogy of Fallot, were selected continuously and retrospectively. According to the pRIFLE and KDIGO diagnostic criteria, postoperative AKI was diagnosed, and the children were classified into different AKI grades. The prognostic parameters (postoperative mechanical ventilation time, duration of intensive care unit (ICU) stay, postoperative length of hospital stay, total costs of hospitalization, and in-hospital mortality, etc.) were collected, and the differences among different AKI grades were compared. Logistic regression method was used to analyze the risk factors for prolonged postoperative length of hospital stay (≥14 days) when two different criteria were used to diagnose AKI. The children diagnosed as non-AKI by KDIGO criterion were further confirmed using pRIFLE criterion, and the prognostic parameters in the children who were diagnosed as AKI and non-AKI were compared.Results:When two different criteria were used to diagnose AKI after radical resection for tetralogy of Fallot, the incidence was 56.8% (pRIFLE criterion) and 40.0% (KDIGO criterion). AKI diagnosed according to the two criteria was the independent risk factor for prolonged postoperative length of hospital stay, and the levels of all the prognostic parameters (postoperative mechanical ventilation time, duration of ICU stay, postoperative length of hospital stay, total costs of hospitalization, and in-hospital mortality) were significantly higher in AKI children than in non-AKI (AKI grade 0) children ( P<0.01). Among the 225 children diagnosed as non-AKI according to the KDIGO criterion, 63 cases were diagnosed as AKI and 162 cases as non-AKI according to the pRIFLE criterion, however, there was no significant difference in each prognostic parameter between children with AKI and non-AKI ( P>0.05). Conclusion:The pRIFLE criterion has a higher sensitivity, while the KDIGO criterion produces better accuracy when used to evaluate the diagnosis of AKI after radical operation for tetralogy of Fallot in children from the perspective of postoperative outcomes.

Objective:To evaluate the relationship between preoperative long-term sleep disorder and postoperative hyperalgesia in the patients undergoing cardiac surgery.Methods:One hundred and eighty-one adult patients of both sexes, aged 18 yr, undergoing elective cardiac valve surgery under cardiopulmonary bypass with general anesthesia, were enrolled in this study.On 1st day before surgery, the Pittsburgh Sleep Quality Index questionnaire was used to assess the patient′s sleep quality in the last month.When Pittsburgh Sleep Quality Index score was more than 5, the patient was considered to have long-term sleep disorder.Postoperative analgesia was performed with sufentanil.Patients were divided into 2 groups according to the numeric rating scale (NRS) score: non-hyperalgesia group (NHA group, NRS score <4) and hyperalgesia group (HA group, NRS score ≥4). A multivariate logistic regression was used to identify the risk factors associated with postoperative hyperalgesia.Results:The results of logistic regression analysis found that smoking and preoperative long-term sleep disorder were independent risk factors for postoperative hyperalgesia.Conclusion:Preoperative long-term sleep disorder may induce hyperalgesia after cardiac surgery in patients.

Objective     To compare the clinical characteristics and prognosis of patients who received two different intraventricular repair. Methods     We retrospectively analyzed the clinical data of 24 complete transposition of the great arteries (TGA)/left ventricular outflow tract obstruction (LVOTO) patients who all received intraventricular repair. The patients were allocated into two groups including a REV group and a Rastelli group. There were 13 patients with 9 males and 4 females at median age of 25.2 (6, 72) months in the REV group. There were 11 patients with 10 males and 1 female at median age of 47.9 (14, 144) months in the Rastelli group. Results     The age at operation (P=0.041), pulmonary valve Z value (P=0.002), and LVOT gradient (P=0.004), rate of multiphase operation between the REV group and the Rastelli group was statistically different. The mean follow-up time was 17.3 months. And during the follow-up, 1 patient had early mortality, 2 patients had early reintervention, 7 patients had postoperative RVOTO, and received Rastelli and larger VSD inner diameter were associated with postoperative RVOTO. Conclusion     As the traditional surgery for TGA/LVOTO patients, the intraventricular repair has a low early mortality and low early reintervention. Modified REV is associated with postoperative peripheral pulmonary vein isolation (PVIS). Patients who received Rastelli operation and with larger VSD inner diameter are more likely to have postoperative RVOTO, but the reintervention for PVI and   RVOTO during follow up is very low.

Objective: To identify the risk factors for early fluid overload(FO)following repair in the pediatric patients with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) complicated with moderate or severe left ventricular dysfunction (left ventricular ejection fraction [LVEF]<50%) and evaluate the effect on clinical outcomes. Methods: Forty-three pediatric patients with ALCAPA complicated with moderate or severe left ventricular dysfunction, aged 2-128 months, weighing 4.5-34.5 kg, with New York Heart Association Ⅲ or Ⅳ, undergoing ALCAPA repair, were enrolled in this study.The pediatric patients were divided into FO≥5% group (n=14) and FO<5% group (n=29) according to the FO developed within 24 h after operation. The pediatric Risk, Injury, Failure, Loss, and End-Stage Renal Disease criterion was used to diagnose acute kidney injury developed after operation. Factors including age, height, weight, preoperative LVEF, preoperative biomarkers, operative data, postoperative ventilation time, duration of intensive care unit(ICU)stay and related postoperative clinical outcome parameters were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistic regression analysis to stratify the risk factors for FO≥5% developed within 24 h after operation.The effect of FO≥5% on postoperative severe acute kidney injury (Injury and Failure), ventilation time, duration of ICU stay and etc. was assessed. Results: Fourteen cases developed early postoperative FO≥5%, and the incidence was 33%.The results of the logistic regression analysis showed that lower preoperative LVEF was an independent risk factor for early postoperative FO≥5% (P<0.05). Compared with FO<5% group, the postoperative ventilation time and duration of ICU stay were significantly prolonged, the number of pediatric patients who developed pulmonary infection and required reintubation was increased, the number of pediatric patients in whom duration of ICU stay was more than 14 days was increased (P<0.05), and no significant change was found in the other parameters of clinical outcomes in FO≥5% group (P>0.05). Conclusion Lower preoperative LVEF is a risk factor for early postoperative FO in pediatric patients with ALCAPA complicated with a moderate or severe left ventricular dysfunction undergoing repair, and it is not helpful for clinical outcomes in pediatric patients when postoperative early FO≥5% occurs.

Objective: To investigate the outcomes of coarctation resection and aortoplasty with autologous pulmonary artery patch for treating coarctation of the aorta combined with hypoplastic aortic arch in infants. Methods: Clinical data of 21 infants with coarctation of the aorta and hypoplastic aortic arch, who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch in Fuwai hospital from January 2009 to June 2016 were retrospectively analyzed. The age of the patients was 4 (2, 5) months,and the body weight of the patients was (5.3±1.6) kg. The patients were followed up to observe the surgery effect. Results: No perioperative death and serious complications occurred. When the patients were discharged,the systolic blood pressure of the right upper limb was lower than the preoperative systolic blood pressure ((85.7±5.9) mmHg(1 mmHg=0.133 kPa) vs. (100.7±16.6) mmHg, P<0.001),and the systolic blood pressure of the right lower limb was higher than the preoperative systolic blood pressure ((98.7±13.3) mmHg vs. (85.6±20.8) mmHg, P<0.001). The pressure gradient of aortic coarctation detected by echocardiography was lower than the preoperative pressure gradient ((13.1±3.8) mmHg vs. (46.2±17.1) mmHg, P<0.001). No restenosis was detected by echocardiography at discharge. Follow-up data were obtained in 19 patients, and the follow-up time was 18 (8, 45) months.The patients grew well, and no death occurred. Restenosis occurred in 3 cases, 1 patient underwent aortic balloon dilatation and the remaining 2 patients were under follow up observation. Computed tomography angiography showed that the morphology of aortic arch was normal without signs of aortic aneurysm. Conclusion Coarctation resection with autologous pulmonary artery patch aortoplastystrategy is considered as a safe and effective surgical method for management of infant coarctation with hypoplastic aortic arch, and this surgery method is related with satisfactory early and mid-term outcomes in this patient cohort.