Objective Tricuspid regurgitation (TR) is a common valvular heart disease with unsatisfactory medical therapeutics and high surgical mortality. The present study aims to evaluate the safety and effectiveness of transcatheter tricuspid valve replacement (TTVR) in high-risk patients with severe TR. Methods This was a compassionate multicentre study. Between September 2018 and November 2019, 46 patients with TR who were not suitable for surgery received compassionate TTVR under general anaesthesia and the guidance of trans-oesophageal echocardiography and fluoroscopy in four institutions. Access to the tricuspid valve was obtained via a minimally invasive thoracotomy and transatrial approach. Patients’ data at baseline, before discharge, 30 days and 6 months after the procedure were collected. Results All patients had severe TR with vena contracta width of 12.6 (11.0, 14.5) mm. Procedural success (97.8%) was achieved in all but one case with right ventricle perforation. The procedural time was 150.0 (118.8, 180.0) min. Intensive care unit time was 2.0 (1.0, 4.0) days. 6-month mortality was 17.4%. Device migration occurred in one patient (2.4%) during follow-up. Transthoracic echocardiography at 6 months after operation showed TR was significantly reduced (none/trivial in 33, mild in 4 and moderate in 1) and the primary safety end point was achieved in 38 cases (82.6%). Patients suffered from peripheral oedema and ascites decreased from 100.0% and 47.8% at baseline to 2.6% and 0.0% at 6 months. Conclusions The present study showed TTVR was feasible, safe and with low complication rates in patients with severe TR.

Objectives: To evaluate the safety and efficacy of LuX-Valve on the treatment of severe tricuspid regurgitation (TR). Methods: This is a prospective observational study. From September 2018 to March 2019, 12 patients with severe TR, who were not suitable for surgery, received LuX-Valve implantation in Changhai Hospital. LuX-Valve was implanted under general anesthesia and the guidance of transesophageal echocardiography and X-ray fluoroscopy. Access to the tricuspid valve was achieved via a minimally invasive thoracotomy and transatrial approach. Main endpoints were surgery success and device success. Surgery success was defined as successful implanting the device and withdrawing the delivery system, positioning the valve correctly and stably without severe or life-threatening adverse events. Device success was defined as satisfied valve function (TR severity reduction ≥ 2 grades, tricuspid gradient ≤ 6 mmHg (1 mmHg=0.133 kPa)), absence of malposition, valve failure and reintervention, major adverse events including device related mortality, embolization, conduction system disturbances and new onset shunt across ventricular septum at day 30 post implantation. Results: A total of 12 patients with severe to torrential TR were included in this study. The age was (68.5±6.9) years and 7 were female. All patients had typical right heart failure symptoms. Procedural success was achieved in all cases, there was no intraprocedural mortality or transfer to open surgery. TR significantly improved after LuX-Valve implantation (none/trivial in 8 patients, mild in 3 patients and moderate in 1 patient). The average device time was (9.2±4.2) minutes. Intensive care unit duration was 3.0 (2.0, 4.8) days. One patient died at postoperative day 18 due to non-surgery and device reasons. Transthoracic echocardiography at 30 days after operation showed that TR was significantly reduced (none/trivial in 8 patients, mild in 2 patients and moderate in 1 patient) and device success was achieved in 11 cases. All survived patients experienced a significant improvement in life quality with significantly improvement in New York Heart Association (NYHA) classification (Ⅰ and Ⅱ: 6/11 post operation vs. 0/11 before operation, P=0.012) and there were no device related complications in this patient cohort. Conclusions: LuX-Valve implantation is feasible, safe and effective for the treatment of patients with severe TR.

Tricuspid valve regurgitation is one of the common valvular diseases ([1][1]). Severe tricuspid regurgitation (TR) is associated with a 5-year survival rate of <50% ([2][2]). Morbidity and mortality in TR surgery are relatively high, especially in the elderly ([3][3]). The LuX-Valve (Ningbo

ABSTRACT Purpose: To report the results of a hybrid approach to aortic arch repair using an innovative unibody double-branched stent graft in a canine model. Materials and methods: The stent-graft system consists of two parts: the main body and two branches for reconstruction of the supra-arch branches. There is a 2-cm-long suturing portion at the proximal end of the main body. Twenty adult German sheep dogs underwent a hybrid surgical treatment to place the stent-grafts into the proximal descending aorta and the supra-arch branches. Outcomes were assessed by operative mortality, complications, imaging studies, and histomorphometric analyses. Results: Placement of the stent-graft was performed successfully in all dogs without complications. One dog died of respiratory failure due to early extubation. The other dogs survived to 6 months without complications, at which time they were sacrificed. The mean cardiopulmonary bypass time was 80.3 ± 7.3 mins and hypothermic circulatory arrest time was 10.7 ± 1.9 min. The average blood loss was 373.5 mL. At 6 months, postoperative aortic imaging indicated that the main body and branches of the stent-graft were fully open and in satisfactory position. No migration, deformation, or endovascular leakage was observed. Histomorphometric results showed normal arrangement of medial and adventitial elastic fibers, moderately proliferated intima, with or without neo-microvessels, and microscopic morphological changes in internal elastic lamina. Conclusions: These results demonstrate that it is possible and safe to reconstruct the aortic arch with the novel open-branched stent-graft placement.

BACKGROUND:Aortic rupture is one of the main causes of early death in acute and subacute Stanford type A aortic dissection (ATAAD) patients. This study aimed to analyze potential risk factors for pre-operational aortic rupture in ATAAD patients. METHODS:We retrospectively reviewed aortic dissection cases treated between May 2013 and May 2016 in Changhai Hospital, Shanghai. A total of 329 patients with ATAAD were included in the final analysis, and 31 patients died of aortic rupture before surgery. Clinical data on basic characteristics, clinical presentation, and biochemical measurements for all 329 patients were analyzed. RESULTS:The in-hospital aortic rupture rate was 9.4% (31/329), and the rupture accounted for 47% (31/66) of all in-hospital deaths of ATAAD patients. Patients who experienced rupture were significantly older (P<0.001), had lower systolic blood pressure (P=0.040), had more painful manifestation (P<0.001), had more systematic complications [shock (P=0.001), coma (P<0.001), hypoxemia (P=0.006), kidney and liver dysfunctions, and myocardial injury (higher troponin, P=0.009)], and had worse blood coagulability [lower platelet count (P=0.012), longer prothrombin time (P<0.001), and higher D-dimer (P=0.003)]. Multivariable analysis identified the following independent risk factors: shock [odds ratio (OR): 8.12; 95% confidence interval (CI), 1.10-59.85, P=0.040], pain requiring medication (OR: 12.67; 95% CI, 2.43-66.09; P=0.003), troponin level >0.7 ng/mL (OR: 9.28; 95% CI, 1.72-50.06; P=0.010), and D-dimer level ≥10 µg/mL (OR: 13.37; 95% CI, 2.18-81.97; P=0.005). CONCLUSIONS:Aortic rupture accounted for 47% of all in-hospital deaths among patient with ATAAD. Shock, pain requiring medication, a troponin level >0.7 ng/mL and a D-dimer level ≥10 µg/mL are independent risk factors for aortic rupture in these patients.

OBJECTIVE:To investigate how the intra-cardiac activation was translates into the characterized flutter wave in patients with cavatricuspid isthmus-dependent counter-clockwise atrial flutter (CTI-AFL).METHODS:A total of 15 hospitalized CTI-AFL patients (mean age: (60 ± 14) years old, 1 female) from October 2012 to February 2014 were enrolled in the study. The activation map was re-constructed during AFL rhythm for left atrium and right atrium using 3-dimensional mapping system. The flutter wave in surface electrocardiogram was analyzed in combination with the intra-cardiac activation.RESULTS:The mean left ventricular ejection fraction was (60.8 ± 6.6)%, and the left atrial diameter was (39.0 ± 3.4) mm. The mean tachycardia cycle length was (220 ± 24) ms. The activation map was completed in all cases. In inferior leads, the flutter wave was divided into three parts: slowly downward part, sharp downward part and the terminal positive part. The three parts corresponded to the fixed activation part of the macro-reentry.CONCLUSION:The distinctive flutter wave of CTI-AFL was determined by the unique macro-reentry activation in the right atrium. The activation of left atrium contributes to the downward part of the wave.

Objective To evaluate the safety and efficacy of radiofrequecy ablation for atrial fibrillation during minimally invasive mitral valve surgery via right thoracotomy.Methods From Jan.2008 to Dec.2011,30 patients underwent radiofrequecy Maze Ⅲ procedure for atrial fibrillation during mini-invasive mitral valve surgery(study group).Another 30 patients with atrial fibrillation undergoing mitral valve surgery through median sternotomy without Maze procedure during the same period were taken as controls.The pre-treatment data of the patients were matchable between the two groups.The study group received mitral valve repair/replacement and radiofrequecy Maze Ⅲ procedure for atrial fibrillation.The operative outcome,postoperative complication and elimination rate of atrial fibrillation were compared between the two groups.Results No patient in the study group was transferred to median sternotomy during operation,and there was no reoperation,prolonged incubation,failure of important organs,hemoglobinuria or death.Compared with the control group,the study group had significantly longer mean circulation arrest time and cardiopulmonary bypass time,significantly reduced chest drainage and blood transfusion volume,and significantly shortened hospital study(P0.05).The elimination rates of atrial fibrillation at immediately after operation,discharge and 6 months after operation were 96.7%,66.7% and 73.3% in the study group,and 50%,23.3% and 16.7% in the control group,respectively,with significant difference found between the two groups(P0.01).Compared with the control group,better heart function recovery was achieved in the study group at 6 month after operation.Conclusion Radiofrequecy ablation for atrial fibrillation during minimally invasive mitral valve surgery via right thoracotomy is safe and effective.Importantly,it does not increase risks and complications of surgery.The early and middle term effects are satisfactory.

OBJECTIVE:For acute type A dissection without an intimal tear in the arch, the optimal surgical strategy is unknown. The present study was designed to clarify the issue by comparing the early and late outcomes of proximal (PR) and extensive repair (ER). METHODS:From January 2002 to June 2010, 331 patients with acute type A dissection were treated surgically at our institute. Of these 331 patients, 197 were identified without an arch tear on the preoperative imaging examination and by intraoperative inspection. Of these 197 patients, 74 underwent proximal repair, including the aortic root, ascending aortic, or hemiarch repair, and 88 underwent extensive repair, including proximal repair, total arch replacement and a stented elephant trunk technique. The perioperative variables and late results were statistically analyzed. RESULTS:No significant difference was found in the rates of early mortality and morbidity between the 2 groups, despite the shorter duration of circulatory arrest in the PR group. During long-term follow-up (mean, 55.7 ± 33.1 months; maximum, 129), the overall survival rate in the whole cohort was 100%, 90.8%, and 71.1% at 1, 5, and 8 years, respectively. No difference was found in survival between the 2 groups (P > .05). However, complete thrombosis of the false lumen in the proximal descending aorta was achieved in 100% of the ER group and 24.6% of the PR group (P < .001). For patients with a patent false lumen in the PR group, distal anastomosis leakage and unclosed small intimal tears were identified in 53.3% and 35.6% patients, respectively. The reintervention rate was also lower in the ER group than in the PR group (4.9% vs 15.9%, P < .05) during follow-up. Moreover, the reintervention rate for patients with Marfan syndrome was 9.5% in the ER group and 38.5% in the PR group (P < .05). CONCLUSIONS:For patients with acute type A dissection without an intimal tear in the arch, extensive repair could promote the occlusion of distal false lumen and decrease the reintervention rate without increasing the operative risk.

BACKGROUND:Functional tricuspid regurgitation often occurs in patients with concomitant left sided, valve disease. Several types of tricuspid valve annuloplasty have been described, but there is no consensus on the management of functional tricuspid regurgitation. We report a modified annuloplasty technique and compare its efficacy with the conventional Kay technique.METHODS:A retrospective review was made of 60 patients who received tricuspid valve annuloplasty (group A, modified method; group B, Kay technique) and the early and midterm outcomes of modified method and Kay technique were compared.RESULTS:Three patients underwent ring annuloplasty using a semirigid Carpentier-Edwards ring due to failing suture annuloplasty. All patients were completely cured when they left the hospital. The follow-up time was (32 ± 7) months in group A and (30 ± 7) months in group B. After three years, tricuspid regurgitation decreased by more than two grades in 13 patients in group A and 11 in group B. The mean postoperative regurgitation grade in group A was lower than group B at 12, 24 and 36 months but not significantly. Three of 28 patients developed recurrent tricuspid regurgitation in group A and five of 26 patients in group B during the follow-up period (three deaths and three ring annuloplasties excluded). Freedom from recurrent tricuspid regurgitation in group A was higher than that group B at all follow-up points. Postoperative right atrium diameter, right ventricle endodiastolic dimension and tricuspid regurgitation area decreased obviously in both groups. The right ventricle endodiastolic dimension and tricuspid regurgitation area improved more significantly in group A than group B over three years of follow-up,CONCLUSIONS:The modified annuloplasty technique achieved the same outcomes as the conventional Kay annuloplasty over the first three years postoperation. As this modified technique is simple and less expensive, it is another option for correction of functional tricuspid regurgitation.

输油泵房是油库的“心脏”，油库大量油料的收发和库内输转都要经输油泵房来实现，常用的有离心泵、水环式真空泵、滑片泵、齿轮泵、螺杆泵等，有的离心泵还是多级的。输油泵房设备多、噪声大，噪声不仅影响一线员工的身心健康，而且对油库的安全运行构成潜在威胁，影响到油库长远发展，值得高度关注和重视。

Through quality detection,petrographic analysis of coal and 40kg testing coke oven test,coal quality and coking property of Russian imported K9 coking coal have been researched.K9 coal,which has low ash and sulfur,stable quality,belongs to single coal seam.So it is beneficial to stabilize coke quality in coal blending and coke making.Coking property of K9 is a little better than that of domestic Zhonggang 2# coking coal used in our plant.

Based on the actual situation of high noise in oil transportation pump room,the main noise source in the pump room and hazard of noise were pointed out.The prevention measures were presented from the aspects of active noise control,strengthening noise monitoring,rephrasing personnel prevention.

Human atrial and ventricular myocardium has distinct structure and physiology. MicroRNAs (miRNAs) are the central players in the regulation of gene expression, participating in many physiological processes. A comprehensive knowledge of miRNA expression in the human heart is essential for the understanding of myocardial function. The aim of this study was to compare the miRNA signature in human right atrial and ventricular myocardium. Agilent human miRNA arrays were used to indicate the miRNA expression signatures of the right atrial (n = 8) and ventricular (n = 9) myocardium of healthy individuals. Quantitative reverse transcription-polymerase chain reactions (qRT-PCRs) were used to validate the array results. DIANA-mirPath was used to incorporate the miRNAs into pathways. MiRNA arrays showed that 169 miRNAs were expressed at different levels in human right atrial and ventricular myocardium. The unsupervised hierarchical clustering analysis based on the 169 dysregulated miRNAs showed that miRNA expression categorized two well-defined clusters that corresponded to human right atrial and ventricular myocardium. The qRT-PCR results correlated well with the microarray data. Bioinformatic analysis indicated the potential miRNA targets and molecular pathways. This study indicates that distinct miRNA expression signatures in human right atrial and ventricular myocardium. The findings provide a novel understanding of the molecular differences between human atrial and ventricular myocardium and may establish a framework for an anatomically detailed evaluation of cardiac function regulation.

Started from the function of technology appraisal in the oil depot equipment management,the problems in present oil depot equipment technology appraisal is pointed out,and the countermeasures for strengthening and improvement are proposed.

It is found through experiment that caking index are different if different making sample methods for caking index detection are applied,and it differs if coal species are different,the principle and requirement of making coal sample are pointed out.Scientific and reasonable making sample methods for caking index detection are found by experiment study,and it is suggested that national standards for making coal sample methods for caking index detection shall be formulated.

OBJECTIVE To review the process of supervision process of extracorporeal circulation clinical quality in Shanghai 2010.Analysis the final results,evaluate the general perfusion safety status in Shanghai as a model in China.METHODS Under the requests of Shanghai thoracic and cardiovascular surgery clinical quality control center,Shanghai Society of Extracorporeal Circulation(SSEC) have issued a standard perfusion record form and standards with common sense by all the participant hospitals.Supervision process had been finished by experts from SSEC.RESULTS Generally,all perfusionist from different hospitals match the criteria of personnel certification,and with good performance in on-site oral or operating test.The basic regulatory documents were available in most of the hospital,but documents for clinical perfusion protocol were not sufficient.Basic safety devices were not available in some hospitals.CONCLUSION The goal of clinical quality supervision is to benefit both perfusion safety and perfusion clinical results.The general perfusion safety status in Shanghai is good,but some problems are still existing and worth more attention.

目的:总结主动脉瓣病变合并升主动脉瘤或夹层行Wheat手术的治疗经验.方法:回顾自1998年1月至2007年6月45例主动脉瓣病变合并升主动脉瘤或夹层患者行主动脉瓣及升主动脉置换的手术及随访资料.结果:手术死亡2例,分别死于术后多脏器功能衰竭及败血症;随访1 ～ 9年,无晚期死亡,2例马凡综合征患者在术后2年和8年因主动脉瓣瓣周漏及人工瓣膜心内膜炎合并慢性升主动脉夹层而再次手术.结论:主动脉瓣病变合并升主动脉瘤行Wheat手术效果满意,但主动脉瓣病变同时合并主动脉根部扩张的病例,应同期行根部置换.

OBJECTIVE:To review the experience of reoperative valve replacement for 104 patients.METHODS:From January 2002 to December 2009, 104 patients underwent heart valve replacement in reoperations, accounting for 2.92% of the total patient population (3557 cases) who had valve replacement during this period. In this group, 53 male and 51 female patients were included with a median age of 46 years (ranged from 13 to 72 years). The reasons of reoperation included 28 cases suffered from another valve lesion after valve replacement, 10 cases suffered from valve lesion after mitral valvuloplasty, 19 cases suffered from perivalvular leakage after valve replacement, 18 cases suffered from valve lesion after previous correction of congenital heart defect, 7 cases suffered from bioprosthetic valve decline, 10 cases suffered from prosthetic valve endocarditis, 9 cases suffered from dysfunction of machine valve, and 3 cases suffered from other causes. The re-operations were mitral and aortic valve replacement in 2 cases, mitral valve replacement in 59 cases, aortic valve replacement in 24 cases, tricuspid valve replacement in 16 cases, and Bentall's operation in 3 cases. The interval from first operation to next operation was 1 month-19 years.RESULTS:There were 8 early deaths from heart failure, renal failure and multiple organ failure (early mortality 7.69%). Major complications were intraoperative hemorrhage in 2 cases, re-exploration for mediastinal bleeding in 2 cases and sternotomy surgical site infection in 1 case. Complete follow-up (3 months-7 years and 2 months) was available for all patients. Two patients died, one patient died of intracranial hemorrhage, and another cause was unknown.CONCLUSION:Satisfactory short-term and long-term results can be obtained in reoperative valve replacement with appropriate timing of operation control, satisfactory myocardial protection, accurate surgical procedure and suitable perioperative treatment.

OBJECTIVETo evaluate the surgical technique and indication on descending aortic aneurysms.METHODSFrom January 1996 to June 2006, 41 patients with descending aortic aneurysm underwent operation, including DeBakey type III dissection in 26, false aneurysm in 6, true aneurysm in 4, and residual or newly complicated type III dissection after the surgery of Marfan syndrome in 5. Operations were performed by left heart bypass in 9, femoral-femoral bypass in 7, pulmonary-femoral bypass in 2, and deep hypothermic circulatory arrest in 23. The whole thoracic descending aorta was replaced in 15, and intercostal arteries were reimplanted in 12.RESULTSOne patient died of acute renal failure with the hospital mortality 2.4%. Main complications: respiratory dysfunction in 6, renal dysfunction in 6, recurrent nerve injuries in 4, chylothorax in 2, and no paraplegia.CONCLUSIONSSurgical intervention of descending aortic aneurysm still has its unique advantages and indications; surgical safety is markedly improved by the use of deep hypothermic circulatory arrest.