目的:探讨左心室重构对低射血分数(LVEF＜40％)冠状动脉旁路移植术(CABG)患者围手术期风险及近期生存率的影响.方法:收集首都医科大学大兴教学医院心脏中心心外科2020年1月至2021年12月入院,LVEF＜40％,冠心病行CABG术患者76例,其中男52例,女24例,年龄(63±8)岁.住院期间行经胸超声心动图检查测定LVEF和左心室收缩末期容积指数(LVESVI),患者 LVESVI(98±16)mL/m2,以 LVESVI 100 mL/m2为界值分为两组:轻度左心室重构组(44例)定义为LVESVI,重度左心室重构组(32例)定义为LVESVI≥100 mL/m2.术后随访6个月,比较两组患者手术死亡率、围手术期并发症及近期生存率.结果:围手术期死亡率5.3％(4/76).重度左心室重构组患者围手术期死亡率高于轻度左心室重构组(9.4％vs.2.3％,P=0.03),同时重度左心室重构组患者术后应用主动脉内球囊反搏(IABP)比例较高(56.3％vs.29.5％,P＜0.01),术后心房颤动发生率较高(28.1％vs.9.1％,P--0.03).术后随访结果显示,轻度左心室重构组患者与重度左心室重构组患者相比,1、3及6个月无不良心血管事件生存率差异无统计学意义(100％vs.100％,97.7％vs.93.8％,95.5％vs.87.5％,P=0.23).结论:左心室重构增加患者CABG围手术期并发症及死亡率,但对患者近期生存率无明显影响.

目的:总结88例完整迷宫Ⅳ手术治疗心脏疾病合并心房颤动的近中期临床疗效.方法:2017年6月至2021年12月期间,应用双极射频钳+单极射频笔在进行心外科手术同时完成迷宫Ⅳ手术88例合并心房颤动的患者.所有手术均在体外循环下完成,并行循环下先完成右心房的射频消融,心脏停跳后再完成左心房的射频消融,对于双极消融不能达到的二尖瓣峡部及冠状静脉窦等部位应用单极笔进行"补消",术后3、6、12、18及24个月分别进行随访,随访终点事件为死亡,终点时间为术后24个月或2021年12月31日.随访内容为主要心脑血管事件、24h动态心电图(Holter),以Holter出现超过15s的心房颤动或心房扑动判定为心房颤动复发.结果:全组88例患者,2例死亡,1例为术后严重低心排,1例出现感染性休克;术后3、6、12、18及24个月的心房颤动免除率分别为93.0％、87.2％、79.4％、74.1％及72.0％.结论:迷宫Ⅳ手术作为一种外科治疗心房颤动的手段,在消除心房颤动,恢复窦性心律方面具有良好的近中期疗效,而手术成功的关键是标准的消融线路,特别是峡部和冠状静脉窦的消融.

要:目的探讨采用不接触(No-Touch)技术获取大隐静脉应用于冠状动脉旁路移植手术的临床效果.方法 选取2019年1月至2021年5月在首都医科大学大兴教学医院行非体外循环下冠状动脉旁路移植手术的患者61例,其中41例采用传统方法获取大隐静脉(常规组),20例采用不接触技术获取大隐静脉(No-Touch组).比较两组患者的大隐静脉获取时间、总手术时间、术中出血量、术中桥血管流量,术后总引流量、术后呼吸机辅助时间、重症监护室时间、术后24h肌钙蛋白I水平、血管活性药物应用时间以及桥血管病理情况,术后1年随访时行冠脉造影了解桥血管通畅情况.结果 两组患者总手术时间、术后呼吸机辅助时间、重症监护室时间、术后总引流量、术后24h肌钙蛋白I水平、术后血管活性药物应用时间等比较差异无显著性(P>0.05).No-Touch组获取大隐静脉时间长于常规组,差异有显著性(P<0.05).病理学观察显示,与常规组比较,No-Touch组获取的大隐静脉血管壁结构损伤较轻.术后1年随访时冠脉造影检查结果显示,常规组静脉桥血管闭塞25根,其中静脉桥-对角支2根、钝缘支3根、回旋支主干11支、左室后支6根、后降支3根,桥血管通畅率为81.6％(111/136),而No-Touch组静脉桥血管闭塞1根,为钝缘支闭塞,桥血管通畅率为97.6％(41/42).No-Touch组桥血管通畅率明显高于常规组(P<0.05).结论 与传统方法相比,在冠状动脉旁路移植手术中采用不接触技术获取大隐静脉不增加手术风险,且对静脉结构的损伤较轻,术后1年后桥血管通畅率较高.

Background Despite advances in treatment strategies, acute respiratory distress syndrome (ARDS) after cardiac surgery remains associated with high morbidity and mortality. A method of screening patients for risk of ARDS after cardiac surgery is needed. Objectives To develop and validate an ARDS prediction score designed to identify patients at high risk of ARDS after cardiac or aortic surgery. Methods An ARDS prediction score was derived from a retrospective derivation cohort and validated in a prospective cohort. Discrimination and calibration of the score were assessed with area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test, respectively. A sensitivity analysis was conducted to assess model performance at different cutoff points. Results The retrospective derivation cohort consisted of 201 patients with and 602 patients without ARDS who had undergone cardiac or aortic surgery. Nine routinely available clinical variables were included in the ARDS prediction score. In the derivation cohort, the score distinguished patients with versus without ARDS with area under the curve of 0.84 (95% CI, 0.81-0.88; Hosmer-Lemeshow P = .55). In the validation cohort, 46 of 1834 patients (2.5%) had ARDS develop within 7 days after cardiac or aortic surgery. Area under the curve was 0.78 (95% CI, 0.71-0.85), and the score was well calibrated (Hosmer-Lemeshow P = .53). Conclusions The ARDS prediction score can be used to identify high-risk patients from the first day after cardiac or aortic surgery. Patients with a score of 3 or greater should be closely monitored. The score requires external validation before clinical use.

目的:总结Cox迷宫Ⅳ手术治疗心脏疾病合并心房颤动的近期临床效果.方法:2017年6月至2018年9月期间,本治疗小组连续26例心脏疾病合并心房颤动患者实施心脏手术同期行Cox迷宫Ⅳ手术治疗心房颤动.手术经正中开胸,在体外循环下进行,在完成心内手术之前实施右心房及左心房的射频消融术,右心房射频在升主动脉阻断前、心脏跳动下进行,左心房射频则在心脏停跳下,经房间沟入路进行,所有患者均进行左心耳干预(包括结扎、缝扎、切除缝合及内部缝合).结果:全组26例患者术后院内死亡1例(3.8％),出院时心房颤动复发4例(16.0％).体外循环时间(174.4±39.5)min,主动脉阻断时间(122.7±33.3)min.术后合并哮喘1例,三尖瓣重度反流1例,反复胸腔积液1例,电复律1例.超声心动图结果显示,26例患者术后的左心房内径、左心室舒张末期内径及左心室射血分数较术前均有下降(P均<0.01).以术后3个月作为术后首次随访时间节点,25例患者进行24小时动态心电图随访,其中4例(16.0％)心房颤动复发,其余21例(84.0％)为窦性心律,偶发房性早搏及室性早搏.结论:Cox迷宫Ⅳ手术作为外科治疗心房颤动的一种术式,心房颤动转复率高,近期疗效肯定,安全可行,值得推广.

目的:总结主动脉瓣环扩大联合环上型生物瓣膜替换策略,治疗老年小瓣环主动脉瓣狭窄的近中期结果,探讨老年小瓣环主动脉瓣狭窄的治疗策略.方法:2010年1月至2017年1月,28例老年小瓣环主动脉瓣狭窄患者应用主动脉瓣环扩大联合环上型生物瓣替换策略进行治疗,主动脉瓣关闭不全或多个瓣膜病变等排除在本研究之外.男性8例,女性20例,年龄65～ 77岁,平均(70.5±3.48)岁,体表面积1.55～ 1.72 m2,平均(1.63±0.05) m2.按病因分类,退行性主动脉瓣狭窄17例,先天性二叶畸形6例,风湿性改变4例,其他病变1例.患者术前心功能分级(NYHA分级):Ⅱ级6例,Ⅲ级20例,Ⅳ级2例.同时合并疾病包括冠心病5例,2型糖尿病8例,高血压病7例,慢性肾功能不全5例,慢性阻塞性肺疾病3例,心房颤动7例,既往卒中史6例.手术前超声心动图测主动脉瓣环径(17.5±1.02) mm,平均跨瓣压差(59.8± 10.2)mmHg(1 mmHg=0.133 kPa).结果:体外循环时间(105.O±18.8)min,心肌血运阻断时间(71.0±17.1)min.实测主动脉瓣环径(18.1±0.87)mm,应用Nick法扩环25例,Nu(n)ez法3例,扩环后主动脉瓣环径(22.2±0.93) mm,平均增加(4.13±0.78)mm,平均替换瓣膜尺寸(21.8±0.99)mm,预期有效瓣口面积指数(1.10±0.07) cm2/ m2.同期行冠状动脉旁路移植术5例,心房颤动射频消融术7例,左心耳切除术7例.围手术期死亡1例(3.6％),死因为低心排血量综合征.开胸止血术1例,急性肾衰竭1例,肺部感染2例,切口并发症1例,临时起搏治疗6例.出院时平均跨瓣压差(13.14±2.14)mmHg,超声实测有效瓣口面积指数(1.12±0.07) cm2/m2,仅1例发生轻度患者-人造瓣膜不匹配.手术后2年,常规超声心动图检查及临床评估.24例患者心功能Ⅰ级,3例Ⅱ级.患者平均跨瓣压差及左心室质量指数较术前明显改善[(59.8±10.18)vs.(13.8±1.93) mmHg,P＜0.01;(151.3±9.95)vs.(110.6±6.95)g/m2,P＜0.01].5例患者主动脉瓣听诊区可闻及2/6级收缩期杂音,19例患者左心室肥厚得到逆转,8例患者仍存在轻度左心室肥厚.随访时平均有效瓣口面积指数(1.09±0.09) cm2/m2,1例发生轻度患者-人造瓣膜不匹配.结论:主动脉瓣环扩大联合环上型生物瓣替换策略治疗老年小瓣环主动脉瓣狭窄近中期疗效良好,既有效避免患者-人造瓣膜不匹配现象,又避免了长期抗凝所致的血栓栓塞及出血风险.

Objective: To investigate the indication and midterm outcomes of surgical treatment of traumatic tricuspid insufficiency. Methods: Totally 19 patients with traumatic tricuspid insufficiency who underwent surgical treatment at Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University from January 2002 to January 2018 were included in this retrospective study. There were 12 male and 7 female patients, aged (43.1±12.9) years (range: 17-68 years). The main causes of traumatic tricuspid insufficiency included blunt chest trauma following high-speed vehicle accidents (17 patients) and high-fall trauma (2 patients). The preoperative New York Heart Association functional class was class Ⅱ in 5 patients, class Ⅲ in 12 patients, and class Ⅳ in 2 patients. The mechanism of tricuspid insufficiency included anterior chordal rupture in 9 patients, anterior papillary muscle rupture in 3 patients, anterior and posterior chordal or papillary muscle rupture in 4 patients, laceration of leaflet combined with chordal rupture in 2 patients and infection combined with anterior papillary muscle rupture in 1 patient. Anular dilation and enlargement of the right ventricle were observed in all the patients. Paired t test was used to evaluate the echocardiogratic results at preoperation, postoperation and follow-up. Independent sample rank sum test was used to evaluate the intervals between trauma and surgery in tricuspid valve repair group and tricuspid valve replacement group. Results: Tricuspid valve repair was successful in 8 patients, and 11 patients underwent valve replacement. Among the patients who underwent valve replacement, 6 patients received mechanical valve and 5 received bioprosthetic valve. The interval from trauma to surgery of the valve repair group and valve replacement group were 8.5(10.0) months (range: 0.1-13.0 months) and 72.0 (108.0) months (range: 2.0-228.0 months), respectively. Concomitant procedures included debridement in scalp trauma (1 patient), internal fixation of femoral fracture (1 patient). One patient died from liver failure 10 days after operation and the remaining patients survived. Eighteen patients were followed up for (94±50) months, 15 patients were in New York Heart Association functional class Ⅰ and 3 patients in class Ⅱ. One patient received redo-tricuspid valve replacement because of mechanical valve failure at the 11 years of follow-up. Conclusions: The midterm outcomes of surgical treatment of severe traumatic tricuspid insufficiency were satisfactory. Early diagnosis and surgical invention were recommended to achieve successful valve repair.

Objective To observe the surgical outcome and survival of patients with tricuspid valve mechanical prosthesis replacement.Methods Clinical data of 36 patients receiving tricuspid mechanical valve replacement in Beijing Anzhen Hospital,Capital Medical University between January 2010 and December 2017 was retrospectively reviewed.There were 14 females and 22 males,with a mean age of (52 ± 9) years (28-64 years old).Among the patients,22 cases were in New York Heart Association(NYHA) functional class Ⅱ,12 cases were in NYHA class Ⅲ[and 2 cases were in NYHA class Ⅳ.Tricuspid valvular lesion of all patients was confirmed by echocardiography and surgical findings.There were 28 cases of rheumatic heart disease,4 cases of tricuspid valvular hypoplasia,3 cases of congenital heart disease (Ebstein's anomaly) and 1 case of tetralogy of Fallot.Mechanical valve replacement of tricuspid valve or multi-valve replacement was implemented and 45 mechanical prostheses were used.Results Three patients died of right heart insufficiency,infection and multiple organ dysfunction,the postoperative in-hospital mortality was 8.3％ (3/36).One patient was discharged 97 days after surgery;32 patients were discharged in 8-21 days after surgery.The mean follow-up interval was 3-42 months in 33 patients(91.7％).During follow-up,1 patient developed paravalvular leakage 3 months after surgery and underwent reoperation of bioprosthetic valve replacement;other patients survived without any valve-related events.Conclusions Tricuspid valve replacement has high risks of mortality and morbidity and requires rigorous indications.Patients with no indication of tricuspid valve repair or failure in repair can have valve replacement and the surgical effect is valid.

目的:探讨不同时期置入主动脉内球囊反搏(IABP)对高危冠心病患者行非体外循环冠状动脉旁路移植术(OPCAB)的安全性、围手术期各指标的影响以及危险因素分析.方法:回顾本中心心脏外科自2015年1月至2018年8月,586例OPCAB患者中78例(13.3％)高危冠心病患者应用IABP辅助治疗的时机及临床效果.根据置入IABP的时机,将患者分为预防应用组、紧急置人组两组.预防应用组:42例(53.8％),术前对冠心病高危患者预防性用IABP辅助;紧急置人组:36例(46.2％),OPCAB术中或术后因循环不稳定紧急置入IABP.对比两组患者使用IABP时间、ICU时间、术后住院天数、并发症、死亡率等指标.结果:两组患者术中旁路移植的桥血管数目及并发症发生率差异无统计学意义(P＞0.05).预防应用组患者IABP应用时间、机械通气时间及ICU停留时间均明显短于紧急置入组(P＜0.05).术前预防应用组患者围手术期病死率(4.8％)较紧急置入IABP患者(13.9％)明显减低(P＜0.05).结论:对于高危冠心病患者术前预防性应用IABP能缩短IABP使用及ICU停留时间,降低术后30 d病死率,预防性应用IABP对高危OPCAB患者是安全有效的,再次置入IABP是高危OPCABG患者短期死亡的危险因素.

Objective To summarize the short and mid-term outcome of adult patient suffered with aortic stenosis and small aortic root treated by aortic root enlargement with supraannular prostheses replacement or supraannular prostheses replace-ment.Methods From January 2005 to January 2017, 223 patients with aortic stenosis and small aortic root who underwent i-solated aortic valve replacement(AVR) were included in this retrospective study cohort.Patients with aortic insufficiency who underwent isolated AVR or those who underwent combined valve replacement were excluded from the study cohort .Aortic root enlargement with supraannular prostheses replacement was performed in 98 patients(ARE), and supraannular prostheses re-placement was performed in the remaining 125 patients as a control group(SP).The mean age and other baseline characteristics were compared between the two group, except that body surface area(BSA) in ARE were higher than that in SP[(1.62 ± 0.04)m2 vs(1.61 ±0.04)m2, P=0.015].Results Operative mortality occurred in 6 patients(2.7%), the cause of death including low cardiac output syndrome(LCOS, 3 patients), multiple organ failure(MOF, 2 patients) and stroke(1 patient). Reoperation for bleeding occurred in 5 patients and acute renal failure in 9 patients, pneumonia in 5 patients.The other nonfa-tal operative complications included wound complication(8 patients), temporary pacing therapy(24 patients), and new onset of acute mitral regurgitation(1 patient).The operative mortality and nonfatal complication were not statistically different be-tween the two groups.Patients in ARE received more bioprotheses and iEOA was higher than those in SP .Transvalvular pres-sure gradients and incidence of patient-prostheses mismatch were lower in ARE.At the 2 years of follow-up, transvalvular pres-sure gradients and left ventricular mass index were statistically lower in ARE compared with SP .The iEOA of ARE was higher than that in SP(1.22 ±0.13 vs 0.87 ±0.13, P<0.01).However, during the mid-term follow up(mean duration of follow-up was 6.31years), the overall survival rate was not statistically different between the two groups.Conclusion The strategy of aortic root enlargement with supraannular prostheses to treat adult patients with aortic stenosis and small aortic root can provide more optimal hemodynamic effect , effectively avoid PPM and was not associated with increased risk of mortality or adverse event when compared with strategy of supraannular prostheses replacement.However, the mid-term survival rate was not statistically different between the two strategies.

目的:分析不停跳冠状动脉移植术(OPCABG)后,心房颤动发生的临床相关因素,为临床预防和治疗术后发生的心房颤动(AF)提供参考依据.方法:收集大兴区人民医院2013年1月至2016年12月期间,128例OPCABG患者,观察围术期的相关临床资料,按术后是否发生AF,分为AF组42例和非AF组86例.对比两组患者的临床资料,分析患者年龄、左心房内径(LAD)、左心室射血分数(LVEF)、术前动脉氧分压、右冠状动脉主干狭窄(≥70％)等因素与OPCABG术后AF发生的相关性.结果:OPCABG术后AF发生率为32.8％,多发生于术后1～3d.两组间比较显示:AF组年龄、左心室射血分数、左心房内径、动脉氧分压、右冠状动脉主干狭窄(≥70％)与非AF组比较,差异有统计学意义(P＜0.05).多因素Logistic分析结果提示:年龄、左心房内径、右冠状动脉主干狭窄(≥70％)是OP-CABG术后发生AF的危险因素.结论:OPCABG术后AF的发生与年龄、左心房内径、右冠状动脉主干狭窄(≥70％)密切相关.

目的 探讨在非体外循环下,应用胸骨下段小切口进行多支冠状动脉旁路移植术并完全再血管化的可行性及安全性.方法 2017年5～7月我科共实施胸骨下段小切口非体外循环冠状动脉旁路移植术患者18例,其中男16例、女2例,年龄60.9 (45～71) 岁,双支病变4例,三支病变14例,其中包含左主干病变3例.结果 全组18例患者无术中及术后死亡,手术时间195～360 (271.0±32.0) min,术中血流动力学不稳定行主动脉内球囊反搏 (IABP) 辅助2例,均于术后第2 d拔除,术后发生切口感染1例,经清创后痊愈,术后平均出血量为80～950 (270.5±209.7) ml,全部患者术中及术后无输血,搭桥总数61支,平均搭桥根数 (3.4±0.6) 支,其中乳内动脉桥11支,大隐静脉桥50支,前降支搭桥总数18支,其中左乳内动脉桥11支,静脉桥7支,对角支搭桥10支,钝缘支搭桥18支,左室后支搭桥1支,后降支搭桥12支,右冠状动脉主干搭桥2支,ICU住院时间9～19 (13.2±2.7) h,呼吸机使用时间6～17 (10.8±2.9) h,术后连续测定肌酸激酶同工酶 (CK-MB) 及肌钙蛋白I (CTnI) 变化,术后第1 d均有不同程度升高:CK-MB 8.8 (3.1～28.6) U/L,CTnI 1.5 (0.16～4.56) ng/dl;术后第5 d基本恢复正常水平:CK-MB 1.6 (0.6～3.3) U/L,CTnI 0.2 (0.08～0.57) ng/dl,术后平均住院时间4～7 (5.8±0.8) d.结论 胸骨下段小切口在多支冠状动脉病变的非体外循环冠状动脉旁路移植术可行、安全,同时切口美观、胸骨稳定性好、术后并发症少、易于掌握,并能在微创伤不借助特殊器械的情况下完全再血管化.

目的:分析体外循环(CPB)心脏术后急性呼吸窘迫综合征(ARDS)患者的临床特点,预后情况及危险因素.方法:回顾性分析2005年1月至2015年12月,于首都医科大学附属北京安贞医院心脏外科行体外循环心脏手术后发生ARDS的144例患者.记录患者围术期相关资料和预后情况,二元Logistic回归分析影响预后的危险因素.结果:CPB心脏手术后ARDS患者144例平均年龄55.3岁,其中男性98例,占68.1％.CPB术后ARDS患者病死率27.8％ (40/144).CPB心脏手术后发生ARDS的主要手术类型是大血管手术,占28.5％,其次是CABG联合瓣膜手术占18.8％,多瓣膜手术占17.3％.不同手术类型对于ARDS患者的气管插管时间和住ICU时间,差异无统计学意义.二元Logistic回归分析示低BMI、术后应用ECMO和CRRT是患者院内死亡的危险因素(P均＜0.05).结论:CPB心脏术后ARDS患者病死率高,低BMI、术后应用ECMO或CRRT的ARDS患者院内死亡风险更高.

目的:探讨二尖瓣置换术中乳头肌悬吊固定技术重建瓣下连续性的方法,在二尖瓣关闭不全合并左心室功能严重受损的患者中临床应用效果.方法:回顾性分析2013年6月至2016年7月,在我院心外科,因二尖瓣关闭不全合并左心室功能严重受损,需行二尖瓣置换术且应用乳头肌悬吊固定技术,作为重建瓣下结构连续性的方法的患者临床资料22例,男性15例,女性7例;年龄36 ～75岁,平均年龄(59.18±11.5)岁;心功能(NYHA分级)Ⅲ级17例,Ⅳ级5例,心房颤动18例.病因包括感染性心内膜炎(4例)、退行性变(13例)、缺血性二尖瓣返流(3例)及风湿性改变(2例).结果:22例患者在二尖瓣置换术中,全部切除二尖瓣前叶及瓣下腱索、大部分后叶及腱索,保留后叶基底部及与之相连的基底部腱索,再将前后乳头肌分别悬吊固定于后瓣环相应的位置以重建瓣下结构的连续性,最后以间断或连续缝合法置入人造瓣膜.本组置入机械瓣12枚,生物瓣10枚,同期行左心耳缝闭及左心房折叠术17例,心房颤动射频消融术15例,冠状动脉旁路移植术3例,三尖瓣成形15例.1例死于术后严重肺部感染,其余均顺利出院,21例患者随访,随访时间12～40个月,平均(26.14±8.16)个月.随访期间1例发生感染性心内膜炎,其余患者心功能改善,人造瓣膜功能良好,无瓣膜功能障碍及抗凝治疗导致的出血或栓塞并发症.术后及随访期间心胸比、左心室舒张期末径及收缩期末径、球形指数较术前明显改善,左心室收缩功能在术后早期得到改善,表现为左心室射血分数明显提高,随访期进一步改善.结论:应用乳头肌悬吊固定技术重建二尖瓣下结构连续性的方法,在二尖瓣关闭不全合并左心室功能受损的二尖瓣置换术中安全有效,与传统的保留二尖瓣下结构的技术相比,简单易行,易于掌握,近中期疗效满意.

Objective To analyze related factors of death in patients with coronary artery bypass grafting (CABG).Methods Totally 12 200 cases of CABG were performed in Beijing Anzhen Hospital,Capital Medical University from January 2008 to January 2013,182 cases died.Clinical data of the death cases were retrospectively analyzed,including age,heart function,coexisting lesions and cause of death.Results The death rate in patients over 70 years old was 1.8％ (78/4 353),which was significantly higher than that in patients under 70 years old [1.3％ (104/7 847)] (P ＜ 0.01).Different coexisting lesions with death rates from high to low were acute myocardial infarction[12.1％ (34/281)],left ventricular dysfunction [6.3％ (78/1 238)],left main coronary lesion[4.5％ (40/887)],ischemic mitral regurgitation [3.6％ (19/528)] and ventricular aneurysm [2.0％ (5/250)].The death rate in patients with left ventricular ejection fraction (LVEF) ＜ 50％ was 6.3％ (78/1 238),which was significantly higher than that in patients with LVEF≥50％ [0.9％ (104/10 962)] (P ＜ 0.01).The common causes of death were heart failure [72.0％ (131/182)] and multiple organ failure [21.4％ (39/182)].Conclusions Death risk of CABG is associated with advanced age,acute myocardial infarction,left ventricular dysfunction,left main coronary disease and ischemic mitral regurgitation.The common causes of death are heart failure and multiple organ failure.

ObjectivesVascular calcification is a dysfunction of the vasculature. Recent findings indicate that fibroblast growth factor21 (FGF21), a protector of the cardiovascular system, is related to the mineral deposition of bone and enhances the osteogenic activity of bone morphogenic protein (BMP)-2. In this study, we explored whether FGF21 suppresses vascular calcification. MethodsA calcifying model was established by culturing primary rat vascular aortic smooth muscle cells (VSMCs) in a beta-glycerophosphate (BGP)-containing calcifying medium for 14days. In addition, recombinant human FGF21 was applied to protect against VSMC calcification. ResultsIn the presence of BGP, the expression levels of osteoblastic genes, including alkaline phosphatase (ALP), BMP-2 and runt-related transcription factor (RUNX)-2, were significantly upregulated on day 3, an effect that was maintained through day 14 (P<0.001). A concomitant increase in ALP protein expression was observed through day 9 (P<0.05). The incubation of VSMCs with calcifying medium for 14days increased ALP activity (P<0.05) and led to the formation of visible calcium nodules over the course of the protocol. -klotho expression was unaltered in BGP-induced VSMCs for the 14-day culture period. The culturing of VSMCs with calcifying medium led to opposing trends in the expression of FGFRs, namely, an increase in FGFR1 and FGFR4 mRNA levels (P<0.001) and a decrease in FGFR2 and FGFR3 mRNA levels (P<0.01). Reduced mineral deposition, in combination with decreased ALP activity (P<0.001) and ALP protein expression (P<0.001), was noted in VSMCs treated with varying doses of FGF21 and BGP in a dose-dependent manner. In addition, FGF21 downregulated osteoblastic-promoting gene expression, including ALP (P<0.001), BMP-2 (P<0.001) and RUNX-2 (P<0.001). Furthermore, FGF21 enhanced -klotho expression (P<0.05) and increased FGFR1 and FGFR3 mRNA levels (P<0.001). FGFR-1 inhibitor SU5402 blocked partial inhibition of FGF21 on the expression of BMP-2 (P<0.001) and RUNX-2 (P<0.05). Furthermore, FGF21 suppressed the phosphorylation of P38, while P38 inhibitor, SB203580, attenuated the downregulation of RUNX-2 (P<0.05). ConclusionsThese data demonstrate FGF21 attenuates VSMC calcification invitro via an FGF21/FGFR1/3/-klotho/P38MAPK/RUNX-2 signalling pathway.

Vascular calcification is prevalent and associated with adverse outcome without available therapy. The benefits of fibroblast growth factor (FGF)-21 on metabolism and atherosclerosis make it a promising therapeutic agent for vascular calcification. We investigated the effects of FGF21 on vascular smooth muscle cell (VSMC) calcification by culturing rat VSMCs in a calcifying medium for 9days. FGF21 markedly attenuated mineral deposition and apoptosis at the indicated time points. In the presence of FGF21, the expression levels of osteoblastic protein including bone morphogenic protein-2, alkaline phosphatase(ALP), runt-related transcription factor(RUNX)-2 and nuclear factor-kappa B ligand (RANKL) were down-regulated, whereas the expression of osteoprotegerin (OPG) increased. Knockdown of OPG significantly impaired inhibition of FGF21 on apoptosis and the expression of pro-apoptotic genes including caspase-3 and Bax and osteoblastic –promoting markers including ALP, RUNX-2 and RANKL. Furthermore, FGF21 facilitated the phosphoryl of AKT but suppressed P38, while OPG knockdown attenuated the effects. LY29400 (inhibitor of PI3K) abrogated the activation of PI3K/AKT and SB203580 (inhibitor of P38) abolished the inhibition of FGF21 on P38, while alteration was observed in the expression of RUNX-2. FGF21 inhibited VSMCs calcification via OPG/RANKL system, and through P38 andPI3K/AKT pathways.

目的:总结156例非体外循环冠状动脉旁路移植术(OPCAB),术中术式改为体外循环辅助下心脏跳动中冠状动脉旁路移植手术(CABG)的经验.方法:选取2006年1月至2016年1月,同一手术组实施的OPCAB术中术式改为体外循环辅助下CABG术病例156例,分析其中原因及危险因素.结果:156例患者中,左主干狭窄＞50％以上49例,术前左心室射血分数＜40％ 105例,手术方式改变原因依次为:低心排出量综合征、恶性心律失常难以控制、以及目标血管无法暴露充分.结论:CABG术中对于部分左主干狭窄病变,严重心功能不全、目标血管难以暴露的患者,体外循环辅助下手术是一种更为安全可靠的手术方法.

目的 总结双侧腋下小切口直视下肺静脉隔离及左心耳切除治疗孤立性心房颤动的临床经验.方法 对28例孤立性心房颤动患者通过腋下小切口径路,直视下用Atricure双极射频消融系统行双侧肺静脉隔离及左心耳切除、Marshall韧带切断.结果 无围术期死亡、Ⅲ度房室传导阻滞、脑卒中及大出血等严重并发症,气管插管时间(4.2±2.6)h,平均住院时间(5.8±3.2)d.24例患者术毕转复窦性心律,1例电复律后转复,3例5d内转复.平均随访16.5个月,1例心房颤动复发,2例出现阵发性房性早搏.结论 双侧腋下小切口直视下射频消融治疗孤立性心房颤动效果良好,无需特殊器械辅助,易于推广.

Objective To summarize surgical experience and explore the best treatment strategy for the management of complicated mediastinitis after cardiac surgery. Methods Clinical data of 18 patients who received vascularized muscle fl ap transposition combined with negative pressure wound therapy(NPWT) for the treatment of complicated mediastinitis after cardiac surgery in one stage in the Department of Cardiac Surgery of Beijing Anzhen Hospital,Capital Medical University between June 2006 and December 2012 were retrospective analyzed. There were 12 male and 6 female patients with their average age of 65.5±8.2 years. The average interval between cardiac surgery and vascularized muscle flap reconstruction was 12.5±5.8 days. Results Postoperatively,1 patient died of recurrent mediastinitis,sepsis and multiple organ dysfunction syndrome. Seventeen patients had an uneventful postoperative recovery and one-stage wound healing. Postoperative hospital stay was 18.6±7.2 days and wound healing time was 4.5±2.4 weeks. All the 17 patients were followed up for over 6 months, no recurrent mediastinitis was observed, and they had a good quality of life. Conclusion Vascularized muscle fl ap transposition combined with NPWT is a simple and effective surgical strategy for the treatment of complicated mediastinitis after cardiac surgery in one-stage.