目的 比较停跳冠状动脉旁路移植术(On-Pump CABG)与不停跳冠状动脉旁路移植术(Off-Pump CABG)对平均70岁以上患者随访1月内的临床疗效.方法 检索万方、维普、中国知网、PubMed、Web of Science、Science Direct和Cochrane Library等中英文数据库中关于Off-Pump CABG(试验组)与On-Pump CABG(对照组)临床随机对照试验,对两组患者的病死率及心肌梗死、脑卒中、肾功能衰竭4项指标进行Meta分析.结果 共有13项随机对照试验16966例患者纳入本次Meta分析.试验组患者病死率、心肌梗死、脑卒中和肾功能衰竭的发生率均明显低于对照组(P<0.05).病死率的OR值为0.76,95％CI=0.65～0.90;心肌梗塞发生率的OR值为0.77,95％CI=0.62～0.96;脑卒中的发生率的OR值为0.64,95％CI=0.45～0.89;肾功能衰竭的发生率的OR值为0.59,95％CI=0.47～0.73.结论 Off-Pump CABG对平均70岁以上患者随访1月内的疗效优于On-Pump CABG.

Objective To investigate the complications of anticoagulant embolism induced by Warfarin after cardiac valve replace-ment,and analyze the effects of different valve replacement and atrial fibrillation(AF).Methods A retrospective study was performed on 888 cases of patients who underwent cardiac valve replacement from January 1st,2012 to December 31th,2014.Anticoagulant drug use,complications of embolismand mortalitywere recorded.According to types of valve prostheses and AF status,patients were divided into the mechanical valve group(mechanical valve with AF group,mechanical valve without AF group),bioprosthesis valve group(bio-prosthesis valve with AF group,bioprosthesis valve without AF group),AF group and non-AF group,the incidence of thromboembolism was calculated and compared with the patients in each group(%/year).Results Follow-up was completed in 803 cases,with a fol-low-up rate 90.43%.Thirty-one patients who died during post-operative hospitalization were excluded and the remaining 772 patients were included.There were a total of 2 590.59 person-years(0.18~5.00 person-years) of follow-up.The number of embolism compli-cations was 26 person-times(1.00%/year).There were 13 person-times(1.08%/year) of embolism in the mechanical valve group, 13 person-times(0.94%/year) of embolism in the bioprosthesis valve group,and there was no statistically significant difference be-tween the two groups(P >0.05).There were 8 person-times(1.57%/year) of embolism in the mechanical valve with AF group, 10 person-times(2.12%/year) of embolism in the bioprosthesis valve with AF group,and there was no statistically significant differ-ence between the two groups(P >0.05). There were 18 person-times(1.83%/year) of embolism in AF group,8 person-times (0.50%/year) of embolism in non-AF group,and there was statistically significant difference between the two groups(P<0.01). There were 8 person-times(1.57%/year) of embolism in mechanical valve with AF group,5 person-times(0.72%/year) of embolism in mechanical valve without AF group,and there was no statistically significant difference between the two groups(P>0.05).There were 10 person-times(2.12%/year) of embolism in the bioprosthesis valve with AF group,3 person-times(0.33%/year) of embolism in the bioprosthesis valve without AF group,and there was statistically significant difference between the two groups(P <0.01). Conclusion There is no significant difference of embolism complications between the mechanical valve replacement and bioprosthesis valve replacement,while for the patients with AF,the incidence of embolism is higher.

体外膜肺氧合( extracorporeal membrane oxygenation,EC-MO)是指通过胸腔外血管插管进行的长时间体外心肺支持。ECMO可以对呼吸功能衰竭或心功能衰竭的危重患者进行有效的呼吸或循环支持。1972年,Hill等[1]首先报道了此技术的临床应用。 ECMO技术不仅应用于心胸外科的心肺支持、心肺移植过渡、呼吸窘迫综合征的救治,还用于新生儿胎粪吸入,气管内异物吸入、婴幼儿的室上性心动过速、重症心脏介入手术、先天性膈疝、严重心肺外伤、烧伤科患者的吸入性肺损伤、不同原因的严重肺炎及多器官功能衰竭等多种病症,并逐渐成为一个跨学科的新技术。在我国,ECMO仍处在起步阶段,对有关装置的认识及使用、临床适应证的选择、各种参数的控制及撤离ECMO的指征等,均是目前体外循环及心外科值得探讨的问题[2]。现结合青岛大学医学院附属医院心血管外科收治的l例缺血性心肌病患者,行冠脉搭桥加室壁瘤切除术后顽固性心力衰竭,应用ECMO 技术心肺辅助成功救治,对有关应用ECMO的情况进行回顾性分析。现报道如下。

Objective To review our experience in the diagnosis and treatment for 98 cases with penetrating aortic ulcer(PAU) after thoracic aortic lumen repair(TEVAR) postoperative use of immunosuppressant adjuvant therapy. Methods A retrospective analysis was performed on 98 cases of PAU with histopathological from July 2002 to May 2012. After TEVAR,patients were treated with(treatment group) or without(control group) tripterygium glycosides and prednisone for about 7 to 12 days. The average of follow-up is 32.4±6.3 months and the recurrence rate was recorded. Serum levels of vascular cellular adhesion molecule-1(VCAM-1) and heat shock protein 60(HSP60) were determined by ELISA. Results The serum levels of VCAM-1 and HSP60 were significantly reduced one month after TEVAR in treatment group,but were only modestly reduced in control group. After about three years follow-up,the recurrence rate of patients in the treatment group(11.11%) was significantly lower than that in the control group(31.91%). Conclusion Adjuvant therapy with immunosuppressants can effectively attenuate the recurrence rate of PAU after TEVAR.

Objective To investigate the necessity of low-intensity anticoagulation standard in patients after heart valve replacement and the rationality of INR in our hospital.Methods 681 eligible candidates were anticoagulated under the current guidelines for postoperative anticoagulation therapy in our hospital(AVR 1.5-2.0,MVR 2.0-2.5,DVR 2.0-2.5,TVR 2.5-3.0).We monitored the patient 's PT regularly and analyzed the occurrence of anticoagulation-related complications,such as bleeding,thrombosis and embolism.Results 602 cases completed the follow-up.During the period of follow-up,66 patients had bleeding tendencies,the incidence of bleeding complications was 10.96％ (66/602).1 1 patients had embolism complications,the incidence of thrombotic complications was 1.83 ％ (11/602).The average of INR was 2.24± 0.68,the mean oral Warfarin dose was(3.12± 1.14) mg/d.Conclusion Our study suggest that the effect of low-intensity anticoagulation after heart valve replacement is reliable.Further more,the current anticoagulation standards of our hospital meet the requirements of postoperative clinical anticoagulant after heart valve replacement in our region.

Since the optimal management of patients with acute aortic dissection is unclear, this study analyzed total arch replacement combined with stented elephant trunk implantation in the treatment of acute type A aortic dissection.

Objective: To construct and identify lentiviral vector expressing hBax and Hhgf fusion protein labeled with enhanced green fluorescence protein.Methods: The attB1-K-hBAX/T2A/eGFP/P2A/hHGF-attB2 gene fragment was obtained by overlap PCR method.Gateway technology was used to construct the pLV.EX2d.null-EF1A>hBAX/T2A/eGFP/P2A/hHGF plasmid and pLV.EX2d.null-EF1A>eGFP plasmid.After sequencing,the lenti virus was packaged through co-transfecting above-mentioned construct into human embryonic kidney cell line-293FT with helper plasmids.Then the virus titer was examined by fluorescence microscope.Results: The re-combinant lentiviral transfer vector plasmids were constructed correctly,the titer of lentiviral-hBAX-eGFP-hHGF was 7.8×107 TU/mL,and the titer of lentiviral-eGFP was 9×107 TU/mL.Conclusions: The lentiviral vector was constructed and high titer of lentivirus particles were obtained successfully.

Fresh autologous pericardium is an alternative aortic valve substitute for children; however, the data were scarce and mixing. We presented a case of a 2-year-old boy who underwent right coronary leaflet replacement with fresh autologous pericardium and ventricular septal defect correction. At 17-year follow-up, the valve was in good condition and the patient remained asymptomatic without any medication.

Objective To construct enhanced green fluorecence protein(EGFP) labeled lentiviral vector carrying hBax and hHGF genes.To explore normal cell can be infected by the lentiviral vector and express interest proteins.Methods The attB1-K-hBAX /T2A /eGFP /P2A /hHGF-attB2 gene fragment was constructed by overlap PCR method.Gateway technology was used to construct the pLV.EX2d.null-EF1A > hBAX /T2A /eGFP /P2A /hHGF plasmid and pLV.EX2d.null-EF1A > eGFP plasmid.After sequencing,they were packaged through co-transfected into human embryonic kidney cell line-293T with helper plasmids.Then the virus titer was examined by fluorescence microscope.The cultured NIH3T3 cells were divided into 3 groups and treated with EGFP labeled lentiviral vector carrying hBax and hHGF genes(experimental group),lentiviral vector just carrying EGFP(negative control group) and nothing(blank group).The expressions of Bax and HGF were detected by RT-PCR and Western blot.Results The recombinant lentiviral transfer vector plasmids were constructed correctly:the titer of lentiviral-hBAXeGFP-hHGF was 7.8 × 10 7 TU /ml,and lentiviral-eGFP was 9 × 10 7 TU /ml.The expression levels of Bax and HGF in the experimental group were up-regulated significantly,which were much higher than those of the other two groups at 48 h after infection(P < 0.05).Conclusions The lentiviral vector was successfully constructed and efficient lentivirus particles with high titer were packaged.After the EGFP labeled lentiviral vectors carrying hBax and hHGF genes could successfully infected NIH3T3 cells,interest genes and proteins could be expressed successfully.This research provided the foundation for further study of the effects on vascular endothelial cells,smooth muscle cells,and fibrocytes of the EGFP labeled lentiviral vector carrying hBax and hHGF genes.

目的 对16例三瓣膜置换病例进行临床分析,以利提高对本病的手术疗效.方法 行三瓣膜置换术16例患者中男性6例,女性10例.其中风湿性心脏病14例,感染性心内膜炎2例.术前心功能Ⅱ级3例,Ⅲ级8例,Ⅳ级5例.结果 本组死亡1病,随访10 ～71个月,心功能Ⅰ～Ⅱ级12例,Ⅲ级3例.结论 对三瓣膜置换术要严格掌握手术适应症,并注意瓣膜选择.

Objective To observe the expression of caspase-3 on the trehalose as cryoprotectant for preserving aortic valve homograft in liquid nitrogen.Methods The aortic valve homograft was divided into 5groups,namely:0.1 mol/L DMSO(control group),0.1 mol/L trehalose(experimental group 1),0.1 mol/L trehalose+0.1 mol/L DMSO(experimental group 2),0.2 mol/L trehalose+0.1 mol/L DMSO(experimental group 3),0.3 mol/L trehalose+0.1 mol/L DMSO(experimental group4).At the time of 12 months,15 months and 18 months when preserved in liquid nitrogen,relative expression of caspase-3 of the aortic valve homograft was measured by RT-PCR and Western Blot.Fresh group was a negative control group.Results At the same time(P<0.05),the expression of caspase-3 of fresh aortic tissue was slightest.The experimental group 2 was in accord with the experiment group 3,which was of a sort compare with the fresh group.The experimental group 4,which was worse than the experimental group 2 and 3,ranked above the experimental group 1.The worst was the control group.Conclusions The joint use of trehalose and DMSO could well inhibit the expression of caspase-3.Moreover.0.1mol/L trehalose+0.1 mol/L DMSO and 0.2 mol/L trehalose +0.1 mol/L DMSO could maximize the inhibition of the expression of caspase-3.

Objective To study the fresh autologous pericardial valve in abdominal aorta as heart valve substitute.Methods Fresh and 2 g/L glutaraldehyde-treated autologous pericardial valve(each group,n=8) was implanted into swine abdominal aorta.When the pericardial valves were harvested at 3(T1) and 6(T2) months after the surgery(each time in each group,n=4),with macroscopic and histological inspection,as well as observation under electron microscope,we studied the valves' expansibility,biocompatibility and calcification.Results There is a single layer of endothelial-like cell on the surface of all the pericardial valves and thrombus inside the valves.The connection between fresh autologous valves and aortic tissue is tighter,with positive expansion in their length than when implanted(F=223.44;q=3.73,3.86;P<0.05).Moreover,the increase of calcification in fresh valves is lower than treated ones(t=14.969,19.204;P<0.05).Conclusion Fresh autologous pericardial valves have great potential as heart valve substitute,and will be especially useful in surgical treatment for heart valve disease in children.

BACKGROUND: It was very mature that protecting organs and tissues in liquid nitrogen at present, but the debates were different protective agents of that. OBJECTIVE: To observe the effect of apoptosis and metabolization of trehalose as cryoprotectant for preserving aortic valve homograft in liquid nitrogen on their tissues and cells, and to seek the best protective agents and their optimal concentrations. METHODS: The aortas and pulmonary arteries obtained from New Zealand white rabbits and frozen in liquid nitrogen to 12, 15, 18 months, 0.1 mol/L dimethyl sulfoxide (DMSO), 0.1 mol/L trehalose, 0.1mol/L trehalose +0.1 mol/L DMSO, 0.2 mol/L trehalose+0.1 mol/L DMSO, 0.3 mol/L trehalose+ 0.1 mol/L DMSO was used in liquid nitrogen, respectively. After specimens rewarming, the apoptosis of the specimens was detected by immunohistochemistry method, and the metabolism of tissue cells was detected by glucose consumption. RESULTS AND CONCLUSION: Immunohistochemistry and glucose consumption determination results showed that the freezing effects of 0.1mol/L trehalose + 0.1 mol/L DMSO and 0.2 mol/L trehalose+0.1 mol/L DMSO were the best. 0.3 mol/L trehalose+ 0.1 mol/L DMSO, which was worse than 0.1 mol/L trehalose + 0.1 mol/L DMSO and 0.2 mol/L trehalose+0.1 mol/L DMSO, ranked above 0.1 mol/L trehalose. The worst was 0.1 mol/L DMSO. The trehalose as the cryoprotectant for preserving aortic valve homograft in liquid nitrogen had a good protective effect. The separate use of trehalose was better than the separate use of DMSO. The joint use of trehalose and DMSO was better than the separate use of either one. The best concentrations of trehalose of the joint use were between 0.1 mol/L and 0.2 mol/L.

Objective To explore pathogenesis of rheumatic heart vascular diseases(RHVD) from direction of valve repair after mechanical stress injury through tenascin-C(TN-C) expression by culturing valve interstitial cells in vitro with designed strain-producing instrument under mechanical stress.Methods Aortic valves were obtained under aseptic condition,and the endothelial layer deprived.The valve interstitial cells were isolated by collagenase Ⅰ and then cultured in vitro.The equi-biaxial cyclic strain production device was developed.TN-C mRNA was measured by quantitative real-time RT-PCR after mechanical application.Signal transduction pathways induced by mechanical stress were assessed after using different protein kinase inhibitors.Results The equi-biaxial cyclic strain production device was developed successfully.Cyclic strain induced TN-C transcription through RhoA/ROCK signaling pathway other than p38 mitogen-activated protein kinase,PKC and ERK activation were found.Conclusion In the process of rheumatic valvulitis,the mechanical power plays a certain role in TN-C transcription and expression and thus inducing pathologic changes of the valve.

AIM:To identify the distribution of tenascin-C(TN-C)in sera and heart valves of patients with rheumatic heart diseases and its significance.METHODS:The sera of normal subjects,patients with congenital valves malformation and patients with rheumatic heart diseases were collected and the TN-C concentrations were measured with ELISA.The heart valves were obtained surgically from patients with congenital malformation or rheumatic heart diseases.The valves were embedded in paraffin and then TN-C distribution pattern was identified by immunohistochemistry.RESULTS:Compared with normal subjects or patients with congenital valves malformation,the sera concentration of larger variants TN-C was significantly higher than that in patients with rheumatic heart diseases.TN-C was mainly distributed on the basement membrane beneath the endothelial cells in the malformed valves,and universally distributed in the rheumatic valves.CONCLUSION:To some extents,TN-C could be taken as biomarker of rheumatic heart diseases and TN-C may be involved in pathogenesis of rheumatic heart valves diseases.

Objective To study the feasibility and reliability of autologous pericardium to be uesd as aortic valve replacement. Methods An abdominal aorta replacement by using pericardium was done under general anesthesia.A preliminary test was conducted to screen experimental animals.The vital signs and physiological index were monitored.Hemodynamics was evaluated by vascular ultrasonography.The survival of the animals was observed to judge if there was any embolisims so as to assess the biocompatibility. Results A pig was an ideal experimental animal.The operative mortality was 6.25%.No embolism was noted.Thrombogenesis in pericardial valve was seen on macroscopic observation. Conclusion Pericardial valve implantation done under abdominal aorta blocking is safe and easy.Post-operative anticoagulant therapy is advisable.

行非体外循环冠状动脉旁路移植术(OPCAB)168例。结果166例症状明显改善,随访3~43个月,均未再次发生心绞痛;围术期死亡2例,1例术后9d死于多器官功能衰竭,1例死于急性心肌梗死。认为OPCAB早期疗效满意,良好的暴露、麻醉和充分的体外循环准备是手术成功的保证。

病人女,27岁.高热15d,心悸、气促5d.病人孕20周淋雨后突发高热,发病后10d出现胸闷、憋气、不能平卧、咳白色泡沫样痰,急诊入院.既往有"脚气病"史.查体:体温39.8℃,贫血貌,口唇发绀,颈静脉怒张,肝-颈静脉回流征(+),双肺呼吸音粗,闻及少许干性罗音.

1993年2月至2003年12月,我们对226例冠状动脉粥样硬化性心脏病患者施行冠状动脉搭桥术,取得了良好效果.现报告如下.

主动脉缩窄(COA)是一种先天性主动脉狭窄,缩窄通常发生在弓降部动脉导管或动脉韧带附着处附近.1986年6月至2004年5月,我们共收治13例COA患者.现报告如下.