Acute kidney injury (AKI) is a frequent complication following on-pump coronary artery bypass graft surgery (CABG). To better investigate the effect of CABG on kidney function and the pathological process of AKI during the operation, the urine metabolic and protein signatures of four time points in 55 postoperative AKI and 104 non-AKI patients after CABG were analyzed by using high-resolution tandem mass spectrometry combined with pattern recognition and functional annotation. In the longitudinal urinary metabolomics study, the protein catabolism pathway is prominent in AKI patients throughout the surgery and recovery process. The integration of metabolomic and proteomic data revealed that alterations in purine metabolism exhibited significant differences preoperatively between the AKI and the non-AKI cohorts. A panel of two proteins (ARFIP1 and SOD2) and two metabolites (tyrosyl-γ-glutamate and l-methionine) was discovered to have a good predicting performance (area under the curve, 0.92) in the preoperative urine. Our research suggests that the panel could play a significant role in distinguishing AKIs from non-AKIs prior to surgery. We propose targeting purine metabolism pathways that may help to identify potential renal protective approaches in acute kidney injury. This study helps to reveal changes in urinary metabolomics and proteomics after CABG and may provide diagnostic clues for patients with postoperative renal injury.

Objective: Acute kidney injury is a common complication after on-pump coronary artery bypass grafting. Prediction of acute kidney injury remains a challenge. Our study aims to identify a panel of urine metabolites for preoperative warning of acute kidney injury after on-pump coronary artery bypass grafting. Methods: A total of 159 patients undergoing isolated on-pump coronary artery bypass grafting were enrolled from July 7, 2017, to May 17, 2019. Preoperative urine samples were analyzed with the approach of liquid chromatography-mass spectrometry-based urine metabolomics. The study end point was the episode of acute kidney injury within 48 hours postoperatively. The predictive performance was determined by the area under the curve and calibration curve. The results were validated using bootstrap resampling. Results: The acute kidney injury (n = 55) and nonacute kidney injury (n = 104) groups showed significant different metabolic profiling. A total of 28 metabolites showed significant differences between the acute kidney injury and nonacute kid-ney injury groups. A metabolite panel of 5 metabolites (tyrosyl-gamma-glutamate, deoxycholic acid glycine conjugate, 5-acetylamino-6-amino-3-methyluracil, arginyl-arginine, and L-methionine) was discovered to have a good predicting performance (area under the curve, 0.89; 95% confidence interval, 0.82-0.93), which is higher than the clinical factor-based model (area under the curve, 0.63; 95% confidence interval, 0.53-0.72). Internal validation by bootstrap resampling showed an adjusted area under the curve of 0.88, and the calibration curve demonstrated good agree-ment between prediction and observation in the probability of postoperative acute kidney injury. Decision curve analysis revealed a superior net benefit of the metab-olite model over the traditional clinical factor-based model. Conclusions: We present 5 urine metabolites related to acute kidney injury after coronary artery bypass grafting. This metabolite model may serve as a preoperative warning of acute kidney injury after on-pump coronary artery bypass grafting. (J Thorac Cardiovasc Surg 2023;165:1165-75)

Objective: To evaluate the predictive value of 3 different risk stratification models including the risk adjustment in congenital heart surgery-1 (RACHS-1), Aristotle basic complexity (ABC), and Society of Thoracic Surgeons-European Association for cardiothoracic surgery congenital heart surgery mortality score (STAT) risk scoring system for death and major complications in patients after congenital heart surgeries. Methods: A total of 3 578 patients (age<18 years old) received surgery for congenital heart diseases from January to December 2015 in Fuwai hospital were enrolled, and the clinical data were retrospectively analyzed. The congenital heart disease patients were 1.7 (0.8, 4.5) years old, and the male accounted for 54.3% (1 943 cases).Death after surgery and major complications including use of extracorporeal membrane oxygenation, bedside thoracotomy, peritoneal dialysis for renal failure, bedside hemofiltration for renal failure, tracheotomy, reoperation for mediastinum infection, reoperation for heart in hospital were observed. The area under the receiver operating characteristic (ROC) curve was calculated to evaluate the predictive value for mortality after surgery and major complications with RACHS-1, ABC, and STAT risk scoring systems. Results: The mortality after surgery was 0.4% (14/3 578) , and the rate of major complications was 3.2% (113/3 578) . For mortality after surgery, areas under the ROC curve were 0.682 (95%CI 0.570-0.795, P=0.002), 0.722 (95%CI 0.612-0.832, P<0.001), and 0.753 (95%CI 0.659-0.847, P<0.001) with RACHS-1, ABC and STAT risk scoring systems, respectively. For major complications, areas under the ROC curve were 0.709 (95%CI 0.667-0.751, P<0.001), 0.743 (95%CI 0.702-0.784, P<0.001), and 0.731 (95%CI 0.693-0.770, P<0.001) with RACHS-1, ABC and STAT risk scoring systems, respectively. Conclusion: STAT risk scoring system is superior to RACHS-1 and ABC risk scoring systems on predicting death after surgery, and ABC risk scoring system is superior to RACHS-1 and STAT risk scoring systems on predicting major complications in Chinese patients with congenital heart disease in the single center.

目的 评价新型Pul-Stent支架在姑息性右心室-肺动脉连接术(Sano分流术)后肺动脉狭窄中的临床应用价值.方法 纳入2014年8月至2015年6月阜外医院9例肺动脉闭锁合并室间隔缺损行姑息性Sano分流术后肺动脉狭窄的患儿行新型Pul-Stent支架置入术.男5例,女4例;年龄4(1,9)岁;体重9～25(15.1±4.9)kg.结果 9例患儿共成功置入9枚支架,其中3例置入左肺动脉,6例置入右肺动脉.支架置入后,肺动脉狭窄处内径由术前(3.0±1.4)mm增加至(8.8±1.4)mm(P<0.001),跨狭窄处压力阶差由术前(73.2±21.4)mmHg(1 mmHg=0.133 kPa)降至(36.1±18.8)mmHg(P<0.001),右心室收缩压/主动脉收缩压比值由术前(0.7±0.2)降为(0.4±0.2)(P<0.001),差异均有统计学意义.术中1例球囊破裂,于外科术中置入肺动脉支架,无其他并发症发生.随访3(3,4)年,肺动脉支架无再狭窄、移位或断裂等,8例(8/9)接受了Ⅱ期根治术.结论 新型Pul-Stent支架作为一种专门设计用于肺动脉狭窄的支架,应用于Sano分流术后肺动脉狭窄安全且有效.

目的 :评价新型Pul-Stent支架治疗肺动脉分支狭窄的安全性和有效性.方法 :2014年9月至2016年12月期间,我院收治的先天性心脏病外科术后的肺动脉分支狭窄行新型Pul-Stent支架置入术的患者16例,男性10例,年龄18个月 ～33岁(112.1±101.7个月);体重9.2～78.0(29.0±20.4)kg.其中法乐四联症术后6例,肺动脉闭锁术后7例,右心室双出口术后2例,完全性大动脉转位术后1例.结果:16例患者共成功置入16枚支架,其中8例置入左肺动脉,8例置入右肺动脉.支架置入后,狭窄处血管内径由术前(3.7±1.7)mm增加至(9.5±1.8)mm(P<0.01);跨狭窄压力阶差由术前(58.6±28.1)mmHg(1 mmHg=0.133 kPa)降至(9.9±18.3)mmHg(P<0.01);右心室收缩压/主动脉收缩压比值由术前0.91±0.22降为0.72±0.18(P<0.01).术中1例气管内出血,1例支架脱载重新放置成功.术后随访12个月,2例支架内血管再狭窄,再次球囊扩张成功,1例支架阻塞对侧肺动脉血流行外科肺动脉成形术,其余无并发症发生.结论:新型Pul-Stent支架置入术成功率高、扩张效果良好、并且可再次进一步扩张.初步临床实践表明,Pul-Stent支架置入术治疗先天性心脏病外科术后的肺动脉分支狭窄安全、有效.

INTRODUCTION:Left main coronary artery (LMCA) atresia is a quite rare congenital malformation, which may present with various symptoms. Past literatures were sporadic without recent summary of world-wide cases. We hereby report an adult case of LMCA atresia with concomitant mitral regurgitation and also summarize all cases found in published literatures.CASE PRESENTATION:A 48-year old female presented with sudden dyspnea. Preliminary impression was acute heart failure caused by mitral regurgitation. Preoperative coronary angiography demonstrated that there was no left coronary ostium and multiple collateral vessels arising from right coronary artery. The diagnosis of left main coronary atresia was made and the patient received successful valvuloplasty and coronary artery bypass grafting with left internal mammary artery anastomosed to the left anterior descending (LAD) artery. She recovered well and 3-month follow-up showed the graft was patent.CONCLUSION:This case highlights the importance of angiography for diagnosis of LMCA and performance of CABG once diagnosed.

Complex cardiac anomalies are sometimes channeled toward Fontan palliation for various reasons. Nevertheless, anatomical repair after bidirectional cavopulmonary shunt may be another option with theoretical benefits. In this study, we report our experience with anatomical repair conversion in challenging patients who had been palliated with bidirectional cavopulmonary shunt. Retrospective review was conducted in patients who underwent anatomical repair conversion from prior bidirectional cavopulmonary shunt palliation between January 2008 and March 2016. Patients who underwent a planned staged 1½-ventricular repair were excluded. Twenty-three patients underwent anatomical repair conversion at a median age of 6.5 years (range 2.7–20.0 years). The interval time between palliation and conversion was 4.6 ± 2.4 years (range 0.9–12.4). Indications for conversion were high-risk Fontan candidates (n = 11) and preference for biventricular anatomy (n = 12). In eight of the patients, bidirectional cavopulmonary shunts were taken down and superior vena cava was reconnected to the right atrium with Gore-Tex tube or bovine jugular venous tube. Mean cardiopulmonary bypass and aortic cross-clamp times were 225.6 ± 107.0 and 138.3 ± 76.6 min, respectively. After a mean follow-up of 2.7 ± 2.2 years, there was no mortality and reoperation. No patients presented sinoatrial node dysfunction and superior venous cave stenosis. All the patients were in the New York Heart Association functional class I or II. Patients with previous bidirectional cavopulmonary shunt should be re-evaluated before completion of Fontan and, if cardiac anatomy allows, anatomical repair conversion may be considered, especially in patients with high-risk Fontan completion. Initial bidirectional cavopulmonary shunt palliation should not be considered as a one-way path to Fontan. Although technically challenging, early- and mid-term clinical results of anatomical repair conversion were satisfactory.

目的:总结自制三瓣叶Goretex管道在先天性心脏病(先心病)患儿右心室流出道重建中的近期结果.方法:2016-12至2017-06期间采用自制三瓣叶Goretex管道重建右心室流出道患儿19例,平均年龄(5.9±3.6)岁,平均体重(20.2±8.2)kg.根据患者年龄和体重,制定右心室流出道的直径目标值,将0.1 mm Goretex膜剪裁三片相同大小的椭圆形作为瓣叶,6/0 prolene线单纯连续缝合至Goretex管道,自制成三瓣叶Goretex管道.采集患儿出院时超声心动图评价带瓣管道内瓣口狭窄和反流程度情况,出院后1个月门诊超声心动图复查随访观察.结果:右心室双出口6例,矫正型大动脉转位4例,肺动脉闭锁4例,大动脉转位2例,共同动脉干1例,双根部调转术后外管道狭窄1例,主动脉瓣狭窄1例.单纯Rastelli术8例,Rastelli+Senning术1例,Rastelli+半Mustard术2例,Rastelli+上腔静脉右心房连接术(Glenn take down)2例,Rastelli+双侧双向Glenn例1例,右心室肺动脉外管道置换术3例,Ross术1例,共同动脉干矫治术1例;其中二次手术12例(63.2％).手术均在体外循环下完成,术后常规阿司匹林(3 mg/kg口服QD)抗栓,全组患者无院内死亡和严重并发症发生,出院及随访时间1个月时超声心动图显示所有患者肺动脉瓣口均无狭窄,2例(10.5％)患者肺动脉瓣轻度反流,其余患者无反流.结论:自制三瓣叶Goretex管道重建先心病右心室流出道近期结果满意,但中远期结果需要进一步随访.

目的:探索肺动脉瓣置换术(PVR)治疗法乐四联症矫治术后合并重度肺动脉瓣反流的效果.方法:回顾性分析2014-01至2017-02在我院行外科PVR治疗法乐四联症术后合并肺动脉瓣大量反流的24例患者的临床结果.结果:24例患者PVR手术时年龄(24.4±12.6)岁,患者行PVR与行法乐四联症矫治手术的平均间隔时间为(14.6±7.3)年.(1)围手术期结果:平均体外循环时间(182.5±75.4)min,平均主动脉阻断时间为(109.8±44.6)min(n=18,75％);同期三尖瓣成形10例(41.7％),瓣膜置换包括12例同种瓣,12例生物瓣.(2)手术结果:无院内死亡,平均住院时间为(15.2±5.5)天.(3)随访:平均随访(1.1±0.8)年,出院后无死亡及再手术等重大并发症,1例肺动脉瓣功能衰竭.PVR后右心室容积显著减小[手术前后右心室舒张末期容积指数:(190.5±29.8)ml/m2 vs(109.2±19.0)ml/m2,P<0.001;右心室收缩末期容积指数:(135.3±28.5)ml/m2 vs(80.0±11.3)ml/m2,P<0.001],而左心室容积、左心室射血分数、峰值耗氧量、QRS间期等改变差异均无统计学意义.末次随访超声检查发现,三尖瓣中量反流4例,肺动脉瓣大量反流1例、中量反流4例.结论:PVR可有效缩小法乐四联症矫治术后患者扩张的右心室,提高最大运动负荷,远期仍需进一步随访.

Background Vein graft failure is a crucial challenge in coronary artery bypass graft (CABG) surgery. Previous studies have suggested a patency benefit of the No-Touch vein harvesting technique, but only with small sample sizes. Materials and methods This study is a prospective, multicenter randomized clinical trial with a large sample size, aiming to investigate the efficacy of the No-Touch technique compared with the conventional approach. All patients requiring isolated CABG with left internal mammary artery plus at least one saphenous vein graft will be considered for entry into the study. Two thousand cases (1000 in each arm) will be enrolled over 1 to 2 years in 7 hospitals in China. Participants will be randomized in equal proportions between two surgical strategies: the No-Touch or conventional technique. The primary endpoint is graft vessel occlusion at 3 months after CABG surgery by CT coronary angiography. Secondary outcomes are major adverse cardiac or cerebrovascular events at 3 and 12 months post-operation and graft vessel occlusion at 1 year. Discussion This study will define the role of the No-Touch vein harvesting technique in CABG surgery and provide strong evidence to answer whether this technique could reduce vein graft occlusion.

Objective This study was to investigate impact of massive bleeding on perioperative outcomes after cardiac surgery and to analyse the risk factors of massive bleeding. Method This was a retrospective study of 4,303 consecutive adult patients undergoing cardiac surgery or aortic surgery. All the patients were divided into massive bleeding group and control group. Massive postoperative bleeding was a composite outcome of bleeding from chest tubes that exceeded 1.5 liters during any 8-hour period or massive transfusion, which was defined as the administration of more than 10 units of red cells within 24 hours after surgery. We also included repeat surgery due to hemorrhage or cardiac tamponade starting within the first 24 hours after protamine administration and death from hemorrhage during the 30-day study period. Outcomes of the two groups were compared to study the impact of massive bleeding on perioperative mortality and major complications, and hospital stay and total costs. Multivariable logistic regression analysis was used to predict the risk factors of massive bleeding. Result In all, 4303 cases were enrolled, massive bleeding group (n=373, 8.7%) and control group (n=3930, 91.3%). The massive bleeding group had higher mortality (5.4% vs 0.3%, P=0.000) and renal, cardiac, neurological and pulmonary complications. The massive bleeding group also had a longer hospital stay and higher total hospitalization costs. Multivariable logistic regression analysis indicated that risk factors of massive bleeding included age, weight, LVEF, Creatinine, Emergency status, Repeat procedure, combined procedures , aortic surgery, CPB time and antifibrinolytic agent. Conclusion Postoperative massive bleeding could significantly increase perioperative mortality and major complications, and lead to longer hospital stay and higher hospitalization costs. Risk factor analysis may help to decrease postoperative bleeding and improve clinical outcomes.

目的 旨在探讨完全性大动脉转位(transposition of the great arteries,TGA)患者动脉调转术(arterial switch operation,ASO)后出现新主动脉瓣反流(neoaortic regurgitation,NAR)的危险因素.方法 回顾性分析2008～ 2013年1月阜外医院行ASO 229例TGA患者的临床资料,其中男173例、女56例,年龄3 d～93.9(7.8±15.9)个月(中位年龄47d),体质量4～18(6.3±4.2) kg(中位体质量2.4 kg).结果 平均随访(62.5±31.1)个月(最短随访36个月),ASO术后有28例(12.2％)患者出现了中重度的NAR.Kaplan-Meier生存曲线显示ASO术后1年、2年、3年、5年免除中重度NAR的概率分别为100.0％、100.0％、99.6％及95.3％.单因素分析结果显示出现中重度NAR的患者ASO时的体质量、术前伴有肺动脉高压的比例和前期肺动脉环缩术的比例均明显大于无或微少量NAR的患者[(8.3±5.6) kg vs.(5.8±4.3) kg,P=0.006;50.0％vs.20.4％,P=0.001;28.6％vs.10.4％,P=0.013)].多因素分析结果显示前期肺动脉环缩术(HR=3.8,P=0.005)以及术前伴有肺动脉高压(HR=16.5,P＜0.001)是术后中重度NAR的危险因素.结论 ASO术后的NAR发生率较为满意,术前伴有肺动脉高压以及前期肺动脉环缩术和NAR有关.

Objective:To summarize the surgical treatment result in patients with anomalous left coronary artery from pulmonary artery (ALCAPA) combining severe left ventricular dysfunction.Methods:A total of 24 ALCAPA patients combining severe left ventricular dysfunction received coronary reimplantation in our hospital from 2009-02 to 2016-04 were retrospectively studied.The patients' mean age was 7.0 (5.0,17.8)months including 13 male;mean left ventricular ejection fraction (LVEF)＜30％ and the median pre-operative LVEF was 21.0％ (17.3％,26.5％).Results:There were 2/24 (8.3％) in-hospital death,The median cardiopulmonary bypass time was 109 (95,128) min,aorta cross-clamp time 65 (48,87) min,mechanical ventilation time 94.5 (48.3,165.5) h and ICU stay time 176.5 (101.0,305.3) h;2 patients received ECMO support and weaned off successfully and 2 patients received re-intubation.In 22 survival patients,the median discharge LVEF was 26.0％ (20％,35％) which was similar to pre-operative condition,P＞0.05.The mean follow-up time was (15.3±14.9) months at the longest of 63 months,no re-admission,reoperation and death occurred.The patients had NYHA I and the last follow-up LVEF was 60％ (50％,69％) which was increased than discharge level,P＜0.05,4 patients had LVEF＜50％.Conclusion:Surgical treatment had satisfactory short-and mid-term outcomes in ALCAPA patients combining severe left ventricular dysfunction;comprehensive effort should be emphasized in surgery,anesthesia,cardiopulmonary bypass and ICU management at peri-operative period.

目的 复杂先天性心脏病因心内畸形复杂和外科技术局限等原因选择单心室矫治.然而,单心室矫治的中远期预后远差于双心室矫治.本文总结既往复杂先天性心脏病行单心室姑息术转双心室矫治的临床结果.方法 回顾性分析2013年10月至2016年3月单心室姑息术后转双心室矫治的8例复杂先天性心脏病患者的临床资料,其中男5例、女3例.患儿行Glenn姑息术时中位年龄2.6(1.0～5.9)岁,转双心室矫治手术时中位年龄6.6(4.5～11.1)岁.3例完全性大动脉转位合并室间隔缺损和左室流出道狭窄,3例室间隔缺损远离型右室双出口合并肺动脉狭窄或肺动脉闭锁,1例右室双出口合并完全性房室间隔缺损和肺动脉狭窄,1例法洛四联症.结果 8例Glenn姑息术后患者完成转双心室矫治并将上腔静脉与右房重新连接,平均体外循环时间(275.6±107.1) min,平均主动脉阻断时间(165.9±63.6) min,平均住院时间(33.6±23.0)d,平均住ICU时间(20.3±21.0)d.无手术死亡.平均随访(1.4±0.7)年,无随访死亡及再手术,随访未见窦房结功能异常、肺动脉狭窄及上腔静脉-右房吻合口狭窄.所有患儿心功能明显改善,纽约心脏学会心功能分级(NYHA)均为Ⅰ～Ⅱ级.结论 尽管技术相对困难,部分单心室姑息术后的患者仍可恢复双心室矫治,近中期临床结果满意,远期结果仍需进一步随访.

Objective: To introduce the construction idea and function for establishing China Cardiovascular Surgery Registry (CCSR)database and to provide a reference for domestic congener databases. Methods: Using peer database as reference, taking current status of cardiovascular surgery registry and hardware in our country with the necessity of international communication, we worked on a variables selection, metadata instruction, logic rules, case report form develpment and finally established a web-based, multi-functional database that enabled cross-database and international merging of data, forming a national intelligent data-exchanging platform for cardiovascular surgery. Results:CCSR database has over 300 variables of multiple topics including basic information, risk factors, medical procedures and endpoint events. Taking clinical and association data exchange standards as reference, it may conduct cross-discipline data connection, record important peri-operative information in relevant patients and meanwhile, it has the functions of automatic logic check, data report, statistical study, data export and importing the electronic medical records. Conclusion:CCSR database is a national platform accord with current status of Chinese cardiovascular surgery and characteristics, meanwhile it gives consideration to international communication and data exchange; which may play a important role in improving medical care and clinical investigation.

Objective:To investigate the impact of blood transfusion on the prognosis for patients with coronary artery bypass grafting(CABG).Methods A retrospective analysis of 1,420 consecutive CABG Cases was performed.The patients were divided into the blood transfusion group (n =464) and the control group (n =956)based on whether homologous red blood cells were transfused pre-operation.Treatment outcomes of the two groups were compared to study the impact of blood transfusion on perioperative mortality,major complications,hospitalization duration and total cost.Multivariable logistic regression analysis was used to predict if blood transfusion and the volume of RBCs transfused were independent risk factors for postoperative outcomes.Results There was no significant difference in mortality rates between the two groups at 1.08％ (5/464) vs 0.31％ (3/956)(P＞ 0.05).The blood transfusion group had higher morbidity ratio compared to the control group at 49.14％(228/464) vs 27.72％(265/956) (P＜0.05).The blood transfusion group also presents a longer hospitalization duration at 9.24±6.32 d vs 7.63±4.38 d(P＜0.01) and higher hospitalization costs at 102,300±49,000 vs 87,900±32,100 (P＜0.01).This analysis indicated that perioperative blood transfusion was an independent risk factor for postoperative morbidity and the volume of RBCs transfused was an independent risk factor for postoperative mortality and morbidity.Conclusion Perioperative blood transfusion can significantly increase perioperative major complications,and lead to prolonged hos-pitalization period with a higher cost.The increase of the RBCs transfused is related to higher mortality and morbidity.

Objective To review the experience of the surgical treatment of child patients with anomalous left coronary artery from the pulmonary artery (ALCAPA).Methods We retrospectively analyzed the clinical data of 56 children patients with ALCAPA underwent coronary re-implantation in our hospital from April 2004 through February 2015.There were 35 males and 21 females at mean age of 25.5 (7.3-60.0) months.Nineteen patients (33.9％) were less than 1 year of age.The mean weight was 11.8 (7.8-19.8) kg.Results There was one death in-hospital.The mean cardiopulmonary bypass time and cross-clamp time was 131.8±61.2 min and 83.4±32.1min,respectively.The mean mechanical ventilation time and intensive care unit time was 12.5 (6.5-43.8) h and 49.0 (21.0-116.0) h,respectively.Three patients underwent extracorporeal membrane oxygenation (ECMO) support and weaned off successfully.The mean postoperative left ventricular ejection fraction (LVEF,63.4％±15.8％ vs.50.6％±18.7％) and left ventricular end diastolic diameter (LVEDD,36.4±32.5 mm vs.42.3±7.4 mm) significandy improved compared postoperative (P＜0.05).The mitral regurgitation (MR) distribution in the 15 patients underwent mitral valve repair was:moderate in 2 patients,mild in 8 patients,trivial in 2 patients and none in 3 patients.The MR in the other 41 patients improved or did not change.The survivors completed the follow-up for a mean time of 45.4±23.6 months.During the follow-up period,one patient died due to noncardiac reason.No patient required reoperation or readmission.All the patients survived with New York Heart Association heart function class Ⅰ or class Ⅱ.At the latest echocardiography,the mean LVEF (62.8％±5.0％) significantly improved compared with the LVEF of discharge.The MR distribution was moderate in 6 patients,mild in 24 patients,trivial in 4 patients and none in 21 patients.Conclusion The coronary re-implantation has a satisfactory mid-term result for patients with ALCAPA.Mitral valve repair is recommended for the patients with severe regurgitation and evident ischemic lesions of the papillary muscles.

目的 评估应用3D打印技术指导远离型右室双出口的手术决策、模拟和外科手术的效果.方法 我院2012年1月至2013年12月,在3D打印技术指导下12例远离型右室双出口的患者经历治疗决策、手术模拟并最终完成了外科手术矫治,其中男9例、女3例,年龄(2.9±2.2)岁.3D打印技术指导策略包括:超声诊断确诊为远离型右室双出口,CT检查,基于CT的3D格式文件生成,3D打印心脏模型,外科手术模拟,外科手术.在模拟手术时,外科医生根据模型设计补片形状,室间隔缺损扩大方法,肌束切除方案等.8例患者行双心室矫治,4例行单心室矫治.双心室矫治的患者中6例行单纯心内隧道矫治,1例行心内隧道加动脉调转,1例行双根部调转手术.心室内隧道修补均施行了室间隔缺损扩大术.行单心室矫治的原因主要是非常小的限制型室间隔缺损和三尖瓣主要腱索或者乳头肌跨越主动脉瓣下流出道.结果 全组患者手术中探查所见和术前3D打印模型相关性很好.无手术死亡,无重大并发症发生.1例患者术后有轻度的主动脉瓣下狭窄.没有随访期死亡和再次手术.参与手术的医生对于3D打印模型满意.结论 3D打印模型对于远离型右室双出口的手术决策能提供很好的帮助,并且通过提供外科手术模拟的术前评估从而减少手术并发症,改善手术结果.

BACKGROUND:In light of the burgeoning volume and certain variation of in-hospital outcomes of cardiac operations in China, a large patient-level registry was needed. We generated the Chinese Cardiac Surgery Registry (CCSR) database in 2013 to benchmark, continuously monitor, and provide feedback of the quality of adult cardiac operations. We report on the design of this database and provide an overview of participating sites and quality of data.METHODS:We established a network of participating sites with an adult cardiac surgery volume of more than 100 operations per year for continuous web-based registry of in-hospital and follow-up data of coronary artery bypass grafting (CABG) and valve operations. After a routine data quality audit, we report the performance and quality of care back to the participating sites.RESULTS:In total, 87 centers participated and submitted 46,303 surgical procedures from January 2013 to December 2014. The timeliness rates of the short-list and in-hospital data submitted were 73.6% and 70.2%, respectively. The completeness and accuracy rates of the in-hospital data were 97.6% and 95.1%, respectively. We have provided 2 reports for each site and 1 national report regarding the performance of isolated CABG and valve operations.CONCLUSIONS:The newly launched CCSR with a national representativeness network and good data quality has the potential to act as an important platform for monitoring and improving cardiac surgical care in mainland China, as well as facilitating research projects, establishing benchmarking standards, and identifying potential areas for quality improvements (ClinicalTrials.gov No. NCT02400125).

Objective This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus. Methods From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years). Results Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years). Thirty patients (60%) were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9) units.m2 and 64.3±17.9 (range, 38 to 101) mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28%) patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335–43.092; p = 0.022). Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II. Conclusions Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up.