Objective Aortic dissection (AD) is a fatal cardiovascular emergency that is predominantly induced by long-term uncontrolled hypertension.Materials and methods The mouse AD model was established by combining β-aminopropionitrile with angiotensin II. The incidence rate, rupture rate, and survival status of the mice were evaluated. The structural damage of the aorta was observed using tissue staining technology, the extracellular matrix status, and macrophage pyroptosis were evaluated by immunofluorescence staining, the infiltration of inflammatory cells was detected by immunohistochemistry, the expression of pyroptosis-related molecules, and inflammatory factors was analyzed by Western blotting and enzyme-linked immunosorbent assay (ELISA). Cell proliferation was detected by EdU staining, and cell apoptosis was detected by flow cytometry.Results In the aortic tissues of AD model mice, the expression of APN, and the content of APN in the serum were significantly decreased. APN intervention can alleviate the thickening of the aortic media, rupture of elastic fibers, and degradation of the extracellular matrix. APN inhibits the proliferation, apoptosis, and phenotypic transformation of vascular smooth muscle cells (VSMCs). At the same time, it can inhibit the infiltration of neutrophils and macrophages and the inflammatory response. Underlying mechanism, it was found that APN inhibited NLRP3-mediated pyroptosis by reducing the release of inflammatory factors; this effect was dependent on the phosphorylation activation of AMPKα and APN receptor.Conclusion APN plays a protective role in AD. Its underlying mechanism is related to the activation of the AMPK pathway, which in turn inhibits macrophage pyroptosis and vascular inflammation. This study offers a new perspective for the pathological mechanism of AD.

The potential protective effect of basic fibroblast growth factor (BFGF) on the cardiovascular system has been proposed previously, however, its effect on calcific aortic valve disease (CAVD) and underlying mechanisms have not been elucidated. The valvular interstitial cell (VIC) were isolated from porcine aortic valve leaflets. To investigate the effect of BFGF on osteogenic differentiation of VIC, the osteogenic induced medium (OIM) and BFGF were added. The protein expression level was detected by Western blot, and apoptosis was determined by flow cytometry. The effect of BFGF on CAVD process in vivo was assessed by a rat CAVD model, which was identified by echocardiography and Alizarin red staining. The expression level of BFGF in the aortic valve and serum were significantly upregulated in CAVD patients compared to control group. In addition, exogenous BFGF injection attenuates CAVD process in vivo. The protein markers of osteogenic differentiation, endoplasmic reticulum stress (ERS), and apoptosis were significantly upregulated by culture with OIM. On the contrary, the aforementioned proteins were suppressed after adding 100 ng/mL of BFGF. Inhibition of PI3K/Akt and ERK1/2 pathways by specific inhibitors abolished the protective effect of BFGF. In conclusion, BFGF could alleviate the VIC calcification by inhibiting ERS-mediated apoptosis, which is partly regulated by activation of the PI3K/Akt and ERK1/2 signaling pathways. BFGF may provide a potential avenue for CAVD therapy.

OBJECTIVE:To assess the effect of different antiplatelet strategies on clinical outcomes after coronary artery bypass grafting.DESIGN:Five year follow-up of randomised Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Grafting (DACAB) trial.SETTING:Six tertiary hospitals in China; enrolment between July 2014 and November 2015; completion of five year follow-up from August 2019 to June 2021.PARTICIPANTS:500 patients aged 18-80 years (including 91 (18.2%) women) who had elective coronary artery bypass grafting surgery and completed the DACAB trial.INTERVENTIONS:Patients were randomised 1:1:1 to ticagrelor 90 mg twice daily plus aspirin 100 mg once daily (dual antiplatelet therapy; n=168), ticagrelor monotherapy 90 mg twice daily (n=166), or aspirin monotherapy 100 mg once daily (n=166) for one year after surgery. After the first year, antiplatelet therapy was prescribed according to standard of care by treating physicians.MAIN OUTCOME MEASURES:The primary outcome was major adverse cardiovascular events (a composite of all cause death, myocardial infarction, stroke, and coronary revascularisation), analysed using the intention-to-treat principle. Time-to-event analysis was used to compare the risk between treatment groups. Multiple post hoc sensitivity analyses examined the robustness of the findings.RESULTS:Follow-up at five years for major adverse cardiovascular events was completed for 477 (95.4%) of 500 patients; 148 patients had major adverse cardiovascular events, including 39 in the dual antiplatelet therapy group, 54 in the ticagrelor monotherapy group, and 55 in the aspirin monotherapy group. Risk of major adverse cardiovascular events at five years was significantly lower with dual antiplatelet therapy versus aspirin monotherapy (22.6% v 29.9%; hazard ratio 0.65, 95% confidence interval 0.43 to 0.99; P=0.04) and versus ticagrelor monotherapy (22.6% v 32.9%; 0.66, 0.44 to 1.00; P=0.05). Results were consistent in all sensitivity analyses.CONCLUSIONS:Treatment with ticagrelor dual antiplatelet therapy for one year after surgery reduced the risk of major adverse cardiovascular events at five years after coronary artery bypass grafting compared with aspirin monotherapy or ticagrelor monotherapy.TRIAL REGISTRATION:NCT03987373ClinicalTrials.gov NCT03987373.

PurposeThe objective was to evaluate the influence of low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) [Lp(a)] on clinical outcomes in patients undergoing coronary artery bypass grafting (CABG).MethodsThis is a secondary analysis of a 5-year follow-up of the DACAB trial (NCT02201771), in which 500 patients who underwent primary isolated CABG were randomized to three-antiplatelet therapy for 1 year after surgery. Of them, 459 patients were recruited in this secondary analysis. Baseline LDL-C and Lp(a) levels were collected, and repeated measurement of LDL-C levels during the follow-up were recorded. Cut-off values for LDL-C were set at 1.8 and 2.6 mmol/L; thus, the patients were stratified into LDL-C <1.8, 1.8–<2.6, and ≥2.6 mmol/L subgroups. Cut-off value for Lp(a) was 30 mg/dL; thus, the patients were divided into Lp(a) <30 and ≥30 mg/dL subgroups. The primary outcome was 4-point major adverse cardiovascular events (MACE-4), a composite of all-cause death, myocardial infarction, stroke, and repeated revascularization. Median follow-up time was 5.2 (interquartile range, 4.2–6.1) years.ResultsDuring the follow-up, 129 (28.1%) patients achieved the attainment of LDL-C <1.8 mmol/L, 186 (40.5%) achieved LDL-C 1.8–<2.6 mmol/L, and 144 (31.4%) remained LDL-C ≥2.6 mmol/L. Compared with the postoperative LDL-C <1.8 mmol/L group, the risk of MACE-4 was significantly higher in the LDL-C 1.8–<2.6 mmol/L group [adjusted hazard ratio (aHR) = 1.92, 95% CI, 1.12–3.29; P = 0.019] and LDL-C ≥2.6 mmol/L group (aHR = 3.90, 95% CI, 2.29–6.64; P < 0.001). Baseline Lp(a) ≥30 mg/dL was identified in 131 (28.5%) patients and was associated with an increased risk of MACE-4 (aHR = 1.52, 95% CI, 1.06–2.18; P = 0.022).ConclusionsFor CABG patients, exposure to increased levels of postoperative LDL-C or baseline Lp(a) was associated with worse mid-term clinical outcomes. Our findings suggested the necessity of achieving LDL-C target and potential benefit of adding Lp(a) targeted lipid-lowering therapy in CABG population.

Achondroplastic dwarfism is a rare hereditary metabolic disorder associated with a higher incidence of cardiovascular disease.There are few epidemiological data and surgical experience of rheumatic valvular disease in this population.This report is the only one to date on mitral replacement in an achondroplastic dwarfism.In addition, our approach involves placing the mechanical aortic valve prosthesis upside down in the mitral position.The 10-year results show benefits, but intraoperative management, valve type, and anticoagulation regimen are real challenges.

BACKGROUND:Cardiac paragangliomas (PGLs) are clinically rare, with hypertension and metabolic changes as the main symptoms. The tumor is highly related to gene mutation, and surgery is presently the effective treatment. Medical history and clinical manifestations of the patient, routine laboratory examinations and imaging examinations, and pathological examination can help the final diagnosis.CASE PRESENTATION:The present study presents a 31-year-old male patient with a left atrial mass. The initial symptom was cough. Cardiac enlargement was found during the chest X-ray. The follow-up imaging examination revealed a left atrial occupying lesion, and the possibility of malignant occupying lesions was not ruled out. The patient underwent surgical resection of the mass. The final pathological result revealed paraganglioma. The thoracic computed tomography review two months after the operation revealed that the original occupying lesion disappeared, and no new lesion was found.CONCLUSIONS:Pheochromocytomas and paragangliomas (PPGLs) are a kind of neuroendocrine tumors. PPGLs can cause secondary hypertension, and lead to a series of clinical syndromes, including myocardial injury, metabolic changes, and so on. The occurrence of PPGIs is related to gene mutation. Biochemical detection, imaging examination, and genetic testing can help diagnose. The tumor should be surgically removed as soon as possible after the diagnosis. As a functional tumor, PPGLs should be fully prepared before surgery to avoid anesthesia and huge fluctuations in blood pressure during and after surgery, or the occurrence of fatal hypertensive crisis and intractable hypotension after tumor resection. Adequate preoperative preparation directly affects the prognosis of patients after surgery. Therefore, multidisciplinary cooperation before, during, and after the operation is extremely important.

Objective: It remains unclear whether aggressive low-density lipoprotein cholesterol (LDL-C) management (<1.8 mmol/L) can slow the process of vein graft stenosis. This study aimed to explore the impact of baseline LDL-C levels on vein graft patency in patients on ticagrelor with or without aspirin 1 year after coronary artery bypass grafting (CABG). Methods: This was a post hoc analysis of the DACAB (Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery) trial (NCT02201771), a randomized controlled trial (ticagrelor thorn aspirin or ticagrelor vs aspirin) of patients undergoing CABG in China. The study subjects were stratified as LDL-low (baseline LDL-C<1.8 mmol/L, 148 patients with 430 vein grafts) versus LDL-high (baseline LDL-C >= 1.8 mmol/L, 352 patients with 1030 vein grafts). The primary outcome was the 1-year vein graft patency (Fitzgibbon grade A) assessed by coronary computed tomographic angiography or coronary angiography. Results: Baseline/1-year LDL-C were 1.4/1.6 and 2.6/2.4 mmol/L in the LDL-low and LDL-high subgroups, respectively. Regardless of antiplatelet regimen, no significant inter-subgroup difference was observed for 1-year graft patency (LDL-low: 83.8% [359/430 grafts]; LDL-high: 82.3% [848/1030 grafts]; adjusted OR for non-patency [ORadj], 0.96; 95% confidence interval [CI], 0.62-1.50, P = .857). For both subgroups, the 1-year graft patency rates were greater with ticagrelor thorn aspirin versus aspirin (LDL-low: ORadj, 0.41; 95% CI, 0.17-0.97; LDL-high: ORadj, 0.38; 95% CI, 0.20-0.71; inter P = .679). Conclusions: In general, baseline LDL-C is not associated with 1-year vein graft patency after CABG. Regardless of the baseline LDL-C levels, ticagrelor thorn aspirin was superior to aspirin alone in maintaining vein graft patency. The primary factor causing early vein graft disease might not be atherosclerosis but thrombosis.

Background:The influence of baseline HbA1c levels on vein graft outcomes post coronary artery bypass grafting (CABG) remains unclear. Objective:The purpose of this study was to assess the association between baseline HbA1c and 1-year vein graft patency, and the effects of antiplatelet therapy on the 1-year vein graft patency after CABG in patients with baseline HbA1c <6.5% vs ≥6.5%. Methods:We examined the subgroups with baseline HbA1c <6.5% vs ≥6.5% from the DACAB trial (NCT02201771), in which 500 patients were randomly allocated to receive ticagrelor plus aspirin (T+A), ticagrelor alone (T), or aspirin alone (A) for 1 year after CABG. The primary outcome was the vein graft patency (FitzGibbon grade A) at 1 year. Results:A total of 405 patients with available baseline HbA1c data were included in this subgroup analysis. Of them, there were 233 patients (678 vein grafts) with baseline HbA1c <6.5% and 172 patients (512 vein grafts) with baseline HbA1c ≥6.5%. Compared with the HbA1c <6.5% subgroup, the HbA1c ≥6.5% subgroup showed worse 1-year vein graft patency (adjusted odds ratio [OR] for nonpatency: 1.69, 95% confidence interval [CI]: 1.08-2.64). T+A showed higher vein graft patency than A in both HbA1c <6.5% (adjusted OR for nonpatency: 0.34, 95% CI: 0.15-0.75) and HbA1c ≥6.5% subgroups (adjusted OR for nonpatency: 0.45, 95% CI: 0.19-1.09), without an interaction effect (P for interaction = 0.335), whereas T did not show more significant improvement than A in both subgroups. Conclusions:In the DACAB trial, lower baseline HbA1c was associated with higher vein graft patency 1 year after CABG. T+A improved 1-year vein graft patency vs A, irrespective of baseline HbA1c.

Calcific aortic valve disease (CAVD) is an active pathological process mediated by abnormal activation and transdifferentiation of valvular interstitial cells (VICs). The present study aims to investigate the function and underlying mechanism of the basic fibroblast growth factor (BFGF) on osteogenic differentiation of VICs. Porcine VICs cultured with osteogenic induction medium are supplemented with or without BFGF. Morphology of VICs is identified by fluorescein isothiocyanate-labeled phalloidin, the cell viability is assessed by the cell counting kit-8 method, and protein and mRNA expression level of osteogenic differentiation markers, including Runx2, osteopontin, and Sp7, are verified by western blot analysis and quantitative real-time PCR, respectively. RNA sequencing is used to identify changes in gene profiles. Alizarin Red S staining is used to measure calcium deposition. The results demonstrate that the content of calcium deposition and the expression level of osteogenic markers are downregulated by supplementing BFGF. Notch1 signaling pathway is extracted as a candidate target after bioinformatics analysis by RNA sequencing. The transfection of si-Notch1 abolishes the calcification inhibitory effect of BFGF. Taken together, our findings shed the light on the mechanism and potential therapeutics of BFGF for CAVD.

Objective:To summarize the results and methods of surgical treatment for type A aortic dissection with small true lumen of the descending aorta.Methods:9 patients underwent surgical treatment for type A aortic dissection with small true lumen of the descending aorta between January 2017 and December 2019 were analyzed retrospectively. There were 7 males and 2 females, mean age of (41.6±9.2) years. Acute dissection were 2 cases, and chronic dissection were 7 cases. Preoerative computed tomography was used to diagnose the dissection and evaluate the true lumen of the descending aorta. This procedure was done in all patients via a median sternotomy under hypothermic CPB with SCP. 4-branched prosthetic graft was used to replace the ascending aorta and aortic arch. The procedures involving the descending aorta: Hybrid surgery using TEVAR. Distal intimal flap fenestration. Implanting the intraoperative stent-graft or prosthetic graft at false lumen for second-step operation.Results:There was no in-hospital mortality. Stroke, Spinal cord, visceral ischemia and lower limbs malfunction were not observed. Reintervention was not found in case with acute dissection during follow-up. One patient who reveived fenestration underwent TEVAR, others with chronic dissection underwent thoracoabdominal aortic replacement 3 months after surgery.Conclusion:Hybrid or staged procedures was a suitable alternative to patients with type A aortic dissection with small true lumen of the descending aorta.

目的 探讨心脏术后再次行主动脉根部置换手术的病因、手术操作及临床疗效.方法 回顾性分析2013年12月至2019年12月30例心脏手术后于我院行再次主动脉根部置换手术患者的临床资料,其中男20例、女10例,年龄(50.4±12.7)岁.再次手术时间间隔(8.0±8.5)年,再次手术原因包括:主动脉窦部扩张及升主动脉瘤14例(47％),再发主动脉夹层5例(17％),假性动脉瘤3例(10％),人工瓣膜心内膜炎4例(13％),瓣周漏4例(13％),再次手术均为正中开胸,行Bentall手术.同期行二尖瓣置换手术2例,二尖瓣成形手术3例,三尖瓣成形手术6例,冠状动脉旁路移植手术3例,2例DebakeyⅠ型的主动脉夹层患者同期行主动脉全弓置换+降主动脉象鼻支架植入手术.结果 术中体外循环时间96～296(161.3±43.0)min,主动脉阻断时间48～117(85.7±20.4)min.术后住院期间死亡5例(17％),主要死因包括心力衰竭及感染性休克.术后随访3～75(33.5±21.1)个月,随访期间死亡3例,其中1例死于感染性休克,2例死于脑出血.结论 心脏术后再发主动脉根部病变处理较为棘手,手术风险较高.术前需进行充分评估,合适的手术入路、充分的心肌保护、完善的手术方案对保证手术成功至关重要.

目的 探讨经胸微创介入术治疗小儿先天性心脏病复合畸形的临床效果.方法 回顾性分析60例先天性心脏病复合畸形患儿的临床资料,根据治疗方法不同将患儿分为对照组与试验组,各30例.对照组采用常规开胸手术治疗,试验组采用经胸微创介入手术治疗.比较两组患者的临床治疗效果.结果 术后6个月,试验组的LVSV高于对照组,LVEF低于对照组(P<0.05).试验组的手术时间、术后住院时间均短于对照组,手术成功率高于对照组,术后并发症总发生率低于对照组(P<0.05).结论 经胸微创介入术治疗小儿先天性心脏病复合畸形的效果显著,可改善患儿的心功能,提高手术成功率,降低术后并发症发生率.

Background To analyze the risk factors of chronic left ventricular dysfunction (LVD) after cardiac valve surgery. Methods A retrospective analysis of 860 patients who underwent heart valve surgery in our center from January 2017 to December 2018, including 650 males and 210 females, aged 58±5.8 years. Inclusion criteria: (I) the patient was clinically diagnosed with heart valve disease and met the surgical indications for mitral valve replacement (MVR), mitral valve repair (MVP), aortic valve replacement (AVR) and double valve replacement (DVR); (II) if atrial fibrillation, coronary artery disease, and tricuspid regurgitation are combined before surgery, radiofrequency ablation, coronary bypass and tricuspid angioplasty were performed contemporarily. Exclusion criteria: (I) preoperative LVEF <50%; (II) aortic dissection underwent Bentall and right heart valve replacement procedures; (III) cardiopulmonary resuscitation and death during perioperative period and 6 months after operation; (IV) postoperative CRRT, IABP, or ECMO assistance; (V) postoperative cardiac dysfunction due to valvular dysfunction, perivalvular leak, or infective endocarditis. Patients were divided into LVD group (LVEF <40%) and control group (LVEF ≥40%) based on cardiac LVEF at 6 months after surgery. Logistic regression was used to analyze the risk factors of postoperative LVD. Results There were 126 cases in LVD group and 734 cases in control group. There were significant differences in preoperative coronary artery disease, atrial fibrillation, pulmonary hypertension, NYHA classification, left ventricular end diastolic diameter (LVEDD), and left ventricular end systolic diameter (LVESD) between the two groups (P<0.05). The differences in the changes of LVEDD and LVESD before and after operation between the two groups were statistically significant (P<0.05). Logistic regression analysis showed that preoperative LVEDD >55 mm, preoperative LVESD >40 mm, preoperative combined atrial fibrillation, preoperative combined pulmonary hypertension, preoperative NYHA III–IV, and preoperative combined coronary artery disease were the risks of postoperative chronic LVD. Conclusions The left ventricular diameter, preoperative coronary artery disease, NYHA III–IV, preoperative atrial fibrillation, and preoperative pulmonary hypertension are risk factors for chronic LVD after heart valve surgery.

Objective:To explore the treatment strategy and prognosis of primary graft dysfunction(PGD)after heart transplantation.Methods:A retrospective review was performed for 74 consecutive patients undergoing orthotopic heart transplantation between March 2017 and September 2019. Basiliximab was prescribed as an immune induction therapy. Over that time period, 14 patients developed PGD and required extracorporeal membrane oxygenation(ECMO)and/or intra aortic balloon pump(IABP)support. They were 13 males and 1 female with a mean age of (51.1±9.5)(30~63)years. Donor age was(42.7±6.5)(29~53)years, weight ratio of donor/recipient(0.91±0.12)(0.73~1.27)and ischemic time(251.2±117.5)(62~370). Diagnosed by interoperative transesophageal echocardiography, PGD was defined as having a need for supporting of ECMO and/or IABP during immediate post-operation because of impossibility of weaning from cardiopulmonary bypass. The specific procedures included ECMO(2 cases), ECMO+ IABP(8 cases)and IABP(4 cases).Results:The incidence of PGD was 18.9%(14/74). And 80% patients were successfully weaned from ECMO, 100% stayed off from IABP and 5 patients died in-hospital. Duration of ECMO support was (154.2±46.5)(104~216)hours and IABP support time (176.2±64.5)(78~288)hours. The survivors were followed up for 1~24 months, Ultrasound cardiogram ohowed that cardiac contractile function was satisfied. There was no instance of transplant rejection or cardiovascular adverse event.Conclusions:As a life-threatening condition, PGD is a leading cause of early death after heart transplantation. ECMO and/or IABP support for PGD patients after heart transplantation may yield a satisfactory long-term prognosis.

Background Most Marfan syndrome (MFS) patients have thoracic aortic diseases which is the major cause of death. The aim of the study is to analyze the impact of different surgical procedures on prognosis of MFS patients. Methods We retrospectively analyzed the results of hospitalization and long-term follow-up of MFS patients who underwent surgical intervention in our center. Results Of the 135 MFS patients, 11 died during hospitalization (8.1%). There were no statistical differences in in-hospital mortality between the proximal surgery group and the distal surgery group (P=0.11). Compared to patients who underwent proximal aortic surgery, patients who underwent arch and distal surgery were more likely to have postoperative respiratory dysfunction (P=0.008). The type of surgical procedure was not associated with the incidence of complications during hospitalization. Pre-surgical New York Heart Association (NYHA) Functional Classification IV (P=0.047), EF <50% (P=0.047), pre-surgical atrial fibrillation (P=0.042), and the injury of dissection propagating onto coronary arteries (P=0.02) were independent risk factors for post-surgical mortality. After 15 years of follow-up, there were no deaths in the David group, while the 15-year survival rate for patients in the Bentall group was 73%±13.5%, and 71%±13.9% for patients in the arch surgery group (P=0.42). The probability of patients in the David group not requiring re-surgery after 15 years was 58.9%±20%, while it was 58.7%±12.1% for patients in the Bentall group, 71.5%±10.5% for patients in the Bentall + Arch group, and 12.5%±11.7% for patients in the Arch + Stent group (P=0.007). Conclusions The David procedure was the most beneficial and had the highest long-term patient survival rates.

心脏移植已成为治疗儿童(<18岁)终末期心脏病的有效手段,随着外科手术技术的改进以及免疫抑制剂的发展,儿童心脏移植受者术后生存率令人满意.目前全球每年实施约500例儿童心脏移植手术,根据国际心肺移植学会报道,2009年至2016年儿童心脏移植受者占心脏移植总人数的12.7％[1].中国心脏移植注册系统数据显示,2015年至2018年,全国上报心脏移植手术共1 583例,其中儿童心脏移植受者93例(5.9％)[2].本文回顾性分析海军军医大学长海医院完成的1例先天性心脏病术后短期内行心脏移植儿童受者临床资料,探讨此类患儿心脏移植适应证、手术方式和术后排斥反应的防治等,现报道如下.

BACKGROUND:In the present post hoc analysis of the DACAB trial, we evaluated the effects of ticagrelor with or without aspirin on 1-year vein graft outcomes after coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (CPB) (on-pump and off-pump). METHODS:The DACAB trial was a multicenter, randomized, open-label, parallel control study enrolling 500 patients with 1,460 vein grafts undergoing CABG. For current post-hoc study, all patients in the DACAB study were included in the analysis to compare the effects of different antiplatelet regimens under on/off pump. Patients were randomly assigned to 1 of 3 antiplatelet treatment regimens (ticagrelor plus aspirin, T + A; ticagrelor alone, T; or aspirin alone, A) within 24 hours after CABG, and were stratified into on-pump and off-pump subgroups. The primary outcome was 1-year vein graft patency rate. RESULTS:Totally 121 patients underwent on-pump CABG (39 with 121 vein grafts in T + A, 36 with 101 vein grafts in T, and 46 with 137 vein grafts in A) and 379 patients underwent off-pump CABG (129 with 336 vein grafts in T + A, 130 with 387 vein grafts in T, and 120 with 348 vein grafts in A). Compared with A, T + A showed a higher 1-year vein graft patency rate in both on-pump (adjusted OR for non-patency =0.62, 95% CI: 0.16-2.45) and off-pump (adjusted OR for non-patency =0.35, 95% CI: 0.20-0.62) subgroups, P interaction =0.647; whereas T did not in either on-pump (adjusted OR for non-patency = 0.92, 95% CI: 0.31-2.76) or off-pump (adjusted OR for non-patency =0.58, 95% CI: 0.34-1.00) subgroups, P interaction =0.430. CONCLUSIONS:In the DACAB trial, for patients underwent either on-pump or off-pump CABG, ticagrelor plus aspirin showed consistent benefit for achieving 1-year vein graft patency, with particular benefit being seen in the off-pump.

BACKGROUND To evaluate the performance of Society of Thoracic Surgeons (STS) 2008 cardiac surgery risk scores for postoperative complications in Chinese patients undergoing single valve surgery at multicenter institutions. METHODS From January 2009 through December 2012, 4493 consecutive patients older than 16 years who underwent single valve surgery at 4 cardiac surgical centers were collected and scored according to the STS 2008 risk scores. The final research population included the following isolated heart valve surgery types: aortic valve replacement, mitral valve replacement, and mitral valve repair. Calibration of the risk scores was assessed by the Hosmer–Lemeshow (H-L) test. Discrimination was tested by calculating the area under the receiver operating characteristic (ROC) curve. RESULTS The observed incidence rate for cerebrovascular accident (CVA), renal failure (RF), prolonged ventilation (Vent), reoperation (Reop), prolonged postoperative length of stay (PLOS), and short postoperative LOS (SLOS) was 0.90%, 1.32%, 4.18%, 2.43%, 3.64%, and 1.65%, respectively. The predicted incidence rate for CVA, RF, Vent, Reop, PLOS, and SLOS was 0.76%, 1.55%, 4.94%, 6.69%, 3.92%, and 2.54%, respectively. The STS 2008 risk scores give an accurate calibration for individual postoperative risk in CVA, RF, Vent, and PLOS (Hosmer–Lemeshow: P = .052, P = .474, P = .468, and P = .712, respectively). The area under the ROC curve of the STS 2008 risk scores for the above 4 postoperative complications were 0.714, 0.724, 0.727%, and 0.713, respectively. CONCLUSION The STS 2008 risk scores were suitable for major postoperative complications in patients undergoing single valve surgery, except for Reop and SLOS.

Objective:To explore and discuss the anticoagulant therapy throughout pregnancy in patients with mechanical aortic valve replacement.Methods:120 pregnant patients after mechanical aortic valve replacement were randomly divided into 4 groups according to different anticoagulant therapy projects from January 2013 to January 2017.Patients in the group A were given oral domestic warfarin throughout pregnancy, and those in the group B were given the low molecular weight heparins calcium injection and then oral domestic warfarin after 12 weeks of pregnancy, and those in the group C were given oral imported warfarin throughout pregnancy, and those in the group D were given the low molecular weight heparins calcium injection and then oral imported warfarin after 12 weeks of pregnancy.The administration of warfarin was controlled aiming for an international normalized ratio of 1.5 to 2.0.Results: (1) There was significant difference on the warfarin dose between group C/D and group A/B. (2) There was no significant difference on the incidence of spontaneous abortion, premature delivery, postpartum hemorrhage, thrombotic complication and death between 4 groups. (3) There was no significant difference on the incidence of neonatal abnormality, intracranial hemorrhage and death between 4 groups.Conclusions:Oral warfarin throughout pregnancy in patients without high risk factors of thrombosis after mechanical aortic valve replacement is safe and effective.

Objective To investigate the impact of extracellular acidic or alkaline environment on aortic valve interstitial cells calcification and the underlying mechanism.Methods From January to June 2017,aortic valves were collected from patients underwent heart transplantation surgery in the Department of Cardiovascular Surgery Changhai Hospital Affiliated to the Second Military Medical University,secondary collagenase digestion method was used to isolate aortic valve interstitial cells,cell immunofluorescence method and flow cytometry were used to identify the aortic valve interstitial cells.Passaged aortic valve interstitial cells were randomly divided into A group,B group,C group and D group,thereinto cells in A group were cultivated in ordinary culture medium(pH was 7.4),cells in B group,C group and D group were cultivated in ordinary culture medium and calcification medium with different pH(7.1,7.4 and 7.7,respectively).Real-time fluorescence quantitative PCR was used to detect the mRNA expression of BMP-2,Runx2 and ALP,Western Blot method was used to detect the protein expression of BMP-2 and Runx2,colorimetric method was used to detect the activity of ALP,alizarin red staining method was used to observe the calcified nodules in cells.Results (1) Cell immunofluorescence test results showed that,positive rate of Vimentin was nearly 100%;flow cytometry results showed that,the positive rate of CD31 was 1.17%.(2) Taking A group as control,relative mRNA expression of BMP-2,Runx2 and ALP in C group and D group was statistically significantly higher than that in B group,respectively,meanwhile relative mRNA expression of BMP-2,Runx2 and ALP in D group was statistically significantly higher than that in C group,respectively(P<0.05).(3) Relative protein expression of BMP-2 and Runx2 in B group,C group and D group was statistically significantly higher than that in A group,respectively,relative protein expression of BMP-2 and Runx2 in C group and D group was statistically significantly higher than that in B group,respectively, meanwhile relative protein expression of BMP-2 and Runx2 in D group was statistically significantly higher than that in C group, respectively(P<0.05).(4) Activity of ALP in B group,C group and D group was statistically significantly higher than that in A group,respectively,activity of ALP in C group and D group was statistically significantly higher than that in B group, respectively,meanwhile activity of ALP in D group was statistically significantly higher than that in C group(P<0.05).(5) Alizarin red staining results showed that,calcified nodules in A group were little,while calcified nodules in B group,C group and D group gradually increased;compared with C group,calcified nodules in B group significantly reduced,while calcified nodules in D group significantly increased.Conclusion Extracellular acidic environment can inhibit the aortic valve interstitial cells calcification,while extracellular alkaline environment may promote the aortic valve interstitial cells calcification,the mechanism possibly correlated with influence on BMP-2 signaling pathway.