Abstract： Arginine vasopressin （AVP） is closely related to the pathogenesis of a variety of cardiovascular diseases and kidney diseases. Currently it is often used for the treatment of severe peripheral vasodilatory shock， and particularly beneficial for patients with refractory catecholamine-resistant vasodilatory shock. For some patients who do not have adequate AVP level in plasma after cardiovascular surgery， external low-dose AVP infusion is helpful to decrease the heart rate, and the dosage and duration of catecholamine use. Early initiation of low-dose AVP infusion may be beneficial for postoperative patients’ hemodynamic recovery without adverse complications. More randomized control trials are needed to provide evidence for rational usage， dosage and duration of AVP administration.
Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 （57.6±13.2） years. They were put on dialysis 3-98 （25.2±30.6） months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure，two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was （125.8±33.5）minutes, aortic clamp time was（77.2±25.5） minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.
Patients with heparin-induced thrombocytopenia have a poor prognosis and high mortality, thus surgical risk under extracorporeal circulation increased. Early diagnosis, safe and effective alternative anticoagulation strategy are crucial for these patients to receive extracorporeal circulation surgery. This review focuses on the pathophysiology, laboratory examination, diagnosis and alternative anticoagulation strategy of extracorporeal circulation for patients with heparin-induced thrombocytopenia.
Objective To investigate the surgical therapy for chronic total occlusion (CTO) of coronary artery with offpump coronary artery bypass grafting (OPCAB). Methods From Aug. 1999 to Oct. 2007, 696 patients with 853 totally occluded coronary arteries (127 coronary arteries lack of opacification while the other 726 arteries with reverse flow showed by coronary angiography) underwent OPCAB. A total of 2 231 grafts were constructed including 136 placed to coronary endarterectomy (CE) targets and 28 arterialized middle cardiac veins. Blood flow was detected during operation in 26 coronary arteries with no opacification in preoperative angiography, while no blood flow was detected in 63 coronary arteries with opacification in preoperative angiography. Cardiopulmonary bypass was applied in 15 cases because of a poor hemodynamics and 6 of which were assisted with intraaortic balloon pump(IABP). Results All patients survived the operation. 6 died in hospital because of low cardiac output (2 cases), renal failure (2 cases), perioperative cardiac infarction (1 case) or cerebrovascular accident (1 case). Stress ulceration occurred in one case, mediastinal infection occurred in another case after operation. Both were treated medically and recovered. 692 patients were followed up and the rate of flup was 99.42%(685/686)， with 4 withdrawal. Freedom from cardiac angina was 99.85%(685/686) and cardiac functional grading (NYHA) was Ⅰ-Ⅱ. Conclusion OPCAB can be well performed in patients with chronic total occlusion of coronary arteries. The ralue of coronary angiography for evaluating totally occluded coronary artery is limited, and endoscope or intravascular ultrasound techniques may be helpful.
Objective\ To test whether off pump coronary artery bypass grafting(OPCAB) has advantages over conventional coronary artery bypass grafting(CCABG).\ Methods\ Between January 1999 and February 2000, 170 patients with multivessel coronary disease underwent only coronary artery bypass grafting by one surgeon. They were divided into two groups, OPCAB group:88 cases underwent CABG with off pump and beating heart via sternotomy; CCABG group: 82 cases underwent conventional CABG with extracorporeal circulation....
ObjectiveTo observe the effect of preoperative hyperbaric oxygen (HBO) pretreatment on systemic inflammatory response after extracorporeal circulation. MethodsA total of 30 patients who were going to receive mitral or aortic valve replacement were randomly allocated into a control group (group C, n=15) and a pretreatment group (group P, n=15).Three sessions of HBO pretreatments were given to the patients in the group P before operation. The changes of serum concentration of inflammatory factors including tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-10, P-selectin, intercellular adhesion molecule (ICAM)-1, heat shock protein (HSP)-70 between the two groups were compared at four time points:before incision of skin (T1), 30 min after ECC(T2), 1 h (T3) and 24 h (T4) after the end of ECC. ResultsThere was no statistical difference in the serum concentration of IL-6,TNF-α, P-selectin, ICAM-1, IL-10, and HSP-70 at T1 between the two groups (P>0.05). The level of all inflammatory factors ascended in first and descended at last in both groups, which reached a peak at T3 and descended at T4. But the serum concentration at T4 was still higher than the level at T1 (P<0.05). There was a statistical difference in serum level of HSP-70 between T4 and T1 (373.3±96.7 pg/ml vs. 316.3±55.5 pg/ml, P<0.05). There were statistical differences in serum concentration of IL-6 (141.5±25.9 pg/ml vs. 119.2±31.8 pg/ml), HSP-70 (449.8±48.3 pg/ml vs. 373.3±96.7 pg/ml), and IL-10 (64.2±8.2 pg/ml vs. 90.3±14.2 pg/ml) between the group C and the group P at T4 (P<0.05). There was no statistical difference between the two groups in postoperative ICU stay time and thoracic drainage. While time of postoperative ventilation in the group P was shorter than that in the group C with a statistical difference (11.4±5.6 days vs. 15.8±5.1 days, P<0.05). ConclusionHyperbaric oxygen pretreatment before operation can abate the bad inflammatory response after heart valve replacement surgery to some extent and strengthen the anti-inflammatory protection, thereby favoring the reduction in postoperative complications.