Objective:To compare the impact of preoperative pulmonary vascular resistance(PVR) levels on the prognosis of patients undergoing left ventricular assist device(LVAD)implantation.Methods:A retrospective analysis was conducted on the clinical data of 33 patients among September 2021 and June 2024, who underwent LVAD implantation at Zhongshan Hospital, Fudan University. 29 males and 4 females, with a mean age of(53.61±9.65)years old. The cohort included 30 cases of dilated cardiomyopathy, 2 cases of ischemic cardiomyopathy, and 1 case of noncompaction cardiomyopathy. Patients were grouped based on a preoperative PVR threshold of 3 WU, Preoperative data from Swan-Ganz catheterization, liver and renal function indicators, as well as other relevant clinical parameters were recorded. Patients were followed up to assess differences in survival outcomes.Results:Preoperative PVR was elevated in 18 cases(60%)of the patients, with a mean preoperative PVR of(3.16±1.71)WU. Immediate postoperative right heart catheterization was performed in 20 patients, showing a significant reduction in PVR from(3.85±1.72)WU preoperatively to(1.80±1.38)WU postoperatively( P<0.05). The cardiac index improved significantly from(1.95±0.63)L·min -1·m -2 preoperatively to(4.25±1.26)L·min -1·m -2 postoperatively( P<0.001). The mean follow-up duration was(14.78±12.06)months, no significant difference in postoperative survival was observed between the two groups(100% vs. 80%, P=0.667). Conclusion:Increased pulmonary resistance is often secondary to left heart dysfunction. After the implantation of a LVAD, pulmonary resistance can be improved. For patients with relatively normal right heart function before surgery, elevated pulmonary resistance does not affect the short-term outcomes of the implantation.

Objective To explore the valve regurgitation status of left heart after the implantation of left ventricular assist device (LVAD) and its effect on prognosis of patients with LVAD implantation. Methods A total of 35 patients with cardiomyopathy who underwent magnetic levitation LVAD implantation at Zhongshan Hospital, Fudan University from February 2021 to July 2024 were retrospectively selected. Clinical data during hospitalization were collected, including preoperative basic data and postoperative valve regurgitation status. Telephone follow-ups were conducted to monitor patients’ survival status and transthoracic echocardiography was used to assess left valve function. Kaplan-Meier survival curves and log-rank test were employed to compare the survival rate of patients with different levels of valve regurgitation. Results The 35 patients had a mean age of (53.9±11.1) years, with 85.7% male, and 3 patients (8.6%) died during hospitalization. Preoperatively, 17 patients (48.6%) had moderate or greater mitral regurgitation, while all 35 patients had less than moderate aortic regurgitation. One month postoperatively, thirty patients were followed up, among which 24 patients (80%) had less than moderate mitral regurgitation, including 11 cases with alleviated regurgitation compared to pre-surgery; 6 patients (20%) had moderate or greater mitral regurgitation, including 4 cases with stable regurgitation and 2 cases with progression of regurgitation compared to pre-surgery; 2 patients (6.7%) had progression of aortic regurgitation to moderate or greater. The follow-up time was 1.2 (1.0, 2.1) years, with 1-year survival rate of 91.4% and 3-year survival rate of 71.1%. Survival analysis showed that the 3-year survival rate of patients with moderate or greater mitral regurgitation one month postoperatively was significantly lower than that of patients with less than moderate regurgitation (66.7% vs 83.3%, P＝0.046). Conclusions After the implantation of magnetic levitation LVAD, most patients showed improvement in mitral regurgitation, while aortic regurgitation remained unchanged. The degree of mitral regurgitation one month postoperatively is associated with prognosis.

Objective:To compare the impact of preoperative pulmonary vascular resistance(PVR) levels on the prognosis of patients undergoing left ventricular assist device(LVAD)implantation.Methods:A retrospective analysis was conducted on the clinical data of 33 patients among September 2021 and June 2024, who underwent LVAD implantation at Zhongshan Hospital, Fudan University. 29 males and 4 females, with a mean age of(53.61±9.65)years old. The cohort included 30 cases of dilated cardiomyopathy, 2 cases of ischemic cardiomyopathy, and 1 case of noncompaction cardiomyopathy. Patients were grouped based on a preoperative PVR threshold of 3 WU, Preoperative data from Swan-Ganz catheterization, liver and renal function indicators, as well as other relevant clinical parameters were recorded. Patients were followed up to assess differences in survival outcomes.Results:Preoperative PVR was elevated in 18 cases(60%)of the patients, with a mean preoperative PVR of(3.16±1.71)WU. Immediate postoperative right heart catheterization was performed in 20 patients, showing a significant reduction in PVR from(3.85±1.72)WU preoperatively to(1.80±1.38)WU postoperatively( P<0.05). The cardiac index improved significantly from(1.95±0.63)L·min -1·m -2 preoperatively to(4.25±1.26)L·min -1·m -2 postoperatively( P<0.001). The mean follow-up duration was(14.78±12.06)months, no significant difference in postoperative survival was observed between the two groups(100% vs. 80%, P=0.667). Conclusion:Increased pulmonary resistance is often secondary to left heart dysfunction. After the implantation of a LVAD, pulmonary resistance can be improved. For patients with relatively normal right heart function before surgery, elevated pulmonary resistance does not affect the short-term outcomes of the implantation.

Transcatheter tricuspid valve intervention is the new frontier of interventional cardiology. The LuX-Valve is a radial force-independent orthotopic tricuspid valve replacement device developed in China. The LuX-Valve Plus transcatheter tricuspid valve replacement (TTVR) system is changed from the trans-atrial to the transjugular approach, which further reduces trauma and pulmonary complications compared with the first generation LuX-Valve. The first-in-human study has been completed at Zhongshan Hospital, Fudan University and an exploratory multicentre clinical study is underway. Echocardiography plays an important role in pre-TTVR screening, intraoperative guidance and postoperative evaluation and follow-up, especially two-dimensional transoesophageal echocardiography (2D-TEE) and three-dimensional transoesophageal echocardiography (3D-TEE). However, there is a lack of appropriate intraoperative guidance and assessment protocols. In this study, we briefly described the protocols and imaging considerations for intraoperative 2D-TEE and 3D-TEE to ensure the successful implantation of TTVR.

Tricuspid regurgitation (TR) interventions are under rapid development. The K-Clip? system is the first domestic transcatheter tricuspid annuloplasty system with unique clamping procedure to achieve annular reduction.Intraoperative echocardiographic monitoring procedures for transcatheter tricuspid annuloplasty have not been reported yet in China. Thus, this review aimed to propose the standard two-dimensional and three-dimensional transesophageal echocardiographic workplanes and procedures to guide and monitor the implantation of K-Clip system based on our experience in Zhongshan Hospital, Fudan University to provide a reference point for the intraoperative echocardiographic monitoring of future transcatheter tricuspid annuloplasty devices in China.

Objective? To anaLyze the infLuencing factors of stress hypergLycemia in patients undergoing surgery for non-diabetic Standard Type A aortic dissection and to expLore the methods of its monitoring and management. Methods? TotaLLy 100 patients with non-diabetic Standard Type A aortic dissection admitted in the Department of Cardiac Surgery, Zhongshan HospitaL were retrospectiveLy incLuded. Their generaL information incLuding age, gender, body mass index (BMI), pain score, operation time and time of circuLatory arrest as weLL as morning fasting bLood-gLucose (FBG) before operation, before extracorporeaL circuLation, before and after circuLatory arrest, after rewarming, after machine haLt, at ICU admission and on 1 - 6 day postoperativeLy was coLLected. Univariate anaLysis and Logistic regression anaLysis were used to expLore the factors affecting the peak bLood-gLucose perioperativeLy. ResuLts? The area under the ROC curve for perioperative bLood-gLucose and overaLL adverse outcome was 0.646 (95%CI 0.528-0.763,P=0.021), and the comparativeLy good cutoff vaLue of perioperative peak bLood-gLucose for the disease was 14.35. The patients' bLood-gLucose started to rise after extracorporeaL circuLation, and the tendency to rise was more significant after rewarming. Their bLood-gLucose remained at a reLativeLy high LeveL at ICU admission. It tended to decrease since 24 h postoperativeLy, and it returned to normaL LeveLs at 6 d post operation. Univariate anaLysis showed that there was statisticaL difference in BMI, white bLood ceLL, C-reactive protein (CRP), time of extracorporeaL circuLation, Acute PhysioLogy and Chronic HeaLth EvaLuation Scoring System (APACHEⅡ) and whether emergency surgery received between the patients with ≥14.35 mmoL/L or ＜14.35mmoL/L bLood-gLucose perioperativeLy (P＜0.05). According to Logistic regression anaLysis, BMI, CRP and time of extracorporeaL circuLation were independent risk factors of stress hypergLycemia in patients undergoing surgery for non-diabetic Standard Type A aortic dissection (OR＞1). ConcLusions? Severe infLammatory response and high BMI preoperativeLy indicate that stress hypergLycemia may occur in patients undergoing surgery for non-diabetic Standard Type A aortic dissection during the perioperative period. Perioperative hypergLycemia can be reduced by reducing the time of extracorporeaL circuLation. MedicaL and nursing workers need to enhance gLycemic monitoring in the process of extracorporeaL circuLation, after rewarming and post operation and deveLop targeted gLycemic management protocoLs for the patients.

Objective To evaluate the role of transthoracic echocardiography ( T T E ) and transesophageal echocardiography( T EE) in the process of transapical mitral valve repair using a novel edge‐to‐edge device( ValveClamp) and this device′s efficacy and safety in a preliminary clinical trial . Methods Six patients with moderate to severe or severe degenerative mitral regurgitation ( DM R) confirmed by T T E and T EE were enrolled . T T E was performed pre and post procedure as well as 30 days post procedures . Related cardiac structure and hemodynamic parameters ,including mitral regurgitation area ( MRA‐max ) , vena contracta width ( VCW ) ,mitral valve effective orifice area ( M VEOA ) ,left ventricular end diastolic diameter ( LVEDD ) , left ventricular end systolic diameter ( LVESD ) , left ventricular ejection fraction ( LVEF) ,max and mean mitral valve pressure gradient ( M VPG‐max and M VPG‐mean) were recorded and evaluated in a central core laboratory . Results All the procedures were successfully performed .M RA‐max , VCW and M VEOA decreased significantly post procedures ( all P ＜ 0 .000 ) , and they remained no significant changes within 30 days post procedures ( all P ＞ 0 .05 ) . M eanwhile ,M VPG‐max and M VPG‐mean slightly increased ( all P ＜0 .01 ) and left atrial anterior‐posterior dimension attenuated 30 days post procedures( P ＜0 .05) ,but all M VPG‐mean were lower than 5 mm Hg ( 1 mm Hg＝0 .133 kPa) . T here were no significant changes in other hemodynamic parameters ( all P ＞ 0 .05) . Conclusions T ransapical mitral valve repair using ValveClamp can be performed safely and a significant reduction in mitral regurgitation can be achieved in patients with DM R . T EE and T T E facilitate the patient selection for ValveClamp procedures as well as perioperative navigation and assessment .

Objective To determine the risk factors for severe complications after total aortie areh replacement.Methods Patients with acute type A aortic dissection of both sexes,scheduled for elective total aortic areh replacement,were selected.According to whether or not postoperative severe complications occurred during hospitalization,the patients were divided into either postoperative severe complications group or non-postoperative severe complication group.Factors including age,gender,body mass index,preoperative complications (Marfan syndrome,hypertension and diabetes mellitus),preoperative left ventricular ejection fraetion,levels of serum N-terminal pro-brain natriuretic peptide,hemoglobin and serum alanine aminotransferase,aspartate aminotransferase and creatinine,international normalized ratio,operation time,cardiopulmonary bypass time,selective antegrade cerebral perfusion time,regional cerebral oxygen saturation (rSO2),etc.were recorded.The risk factors of which P values were less than 0.05 would enter the multivariate logistie regression analysis to stratify postoperative severe complications-related risk factors for this type of patients.Results A total of 98 patients were enrolled in this study.Of the 98 patients,28 patients developed posloperative severe complications,and the incidence was 29c％.The results of logistic regression analysis showed that age＞60 yr,△rSO2-min＜80％ throughout the surgery and △rSO2-min＜80％ during hemostasis were independent risk factors for severe complications after total aortie arch replacement.Conclusion Age ＞60 yr,△rSO2-min＜80％ throughout the surgery and △rSO2-min＜80％ during hemostasis are independent risk factors for severe complications after total aortic arch replacement.

Objective To construct the assessment index system for general nursing goals management based on the performance structure theory. Methods Expert interviews and Delphi expert enquiry were used to complete the construction of index system, and SPSS17.0 was used to do data statistics and reliability analysis. Results The assessment index system for general nursing goals management was constructed which contained 6 level-Ⅰindicators such as nursing quality, nursing safety, nursing service, teaching and training, the contribution of department and the communication skills and 22 level- Ⅱ indicators. The department monthly examination scores calculation method and feedback mechanism were also established. The expert positive coefficients were 97.6%and 98.8%respectively, the authority coefficients were 0.85 and 0.86, the importance and feasibility mean scores of every index were 3.86-4.98 and 3.98-4.88, and coefficients of variation were 0.03-0.27 and 0.05-0.25 in 2 rounds of enquiry. The importance of level-Ⅰor level-Ⅱ indicators and operability coordination coefficients were 0.10-0.36, the significance test showed P<0.05. Conclusions The design of each dimension of the index system gives full consideration to 3 dimensions of performance: task-adaptive-relationship. Representative of key indicators is strong. The Delphi method used in building is scientific and the results are reliable. The maneuverability of calculate Method is strong, easy to quantify. The feedback mechanism has a strong incentive by combining the assessment results closely with the individual interests. The establishment of the index system can provide scientific and objective basis for the full implementation of the general nursing goals management.

Nurses working in the department of infectious diseases are under tremendous physical and psychological pressure due to the particularity of the unit. The physical and mental status as well as working attitude of nurses are not optimistic. The nursing teams are widely unstable in hospitals. This paper reviewed studies about nurses working in department of infectious disease, aiming to better understand physical and mental health level of nurses as well as their influencing factors and intervention strategies. It can provide policy recommendations for nursing managers to further stabilize the nursing team. At the same time, this paper finds out the existing deficiencies and enlightenment in previous studies from the perspectives of research direction and research method, and provides references for further researches on flow factors of nurses in department of infectious diseases.