Abstract： Objective To summarize surgical experiences and explore risk factors of patients undergoing repeated heart valve surgery. Methods Clinical records of 325 consecutive patients who underwent repeated heart valve surgery from January 1998 to December 2008 in Changhai Hospital of Second Military Medical University were retrospectively analyzed. There were 149 male patients and 176 female patients with their average age of （47.1±11.8） years. Following variables were collected: preoperative morbidity， heart function， indications and surgical strategies of repeated heart valve surgery， postoperative mortality and morbidity， which were compared with those clinical data of patients who underwent their first heart valve surgery during the same period. Multivariate logistic regression was used to determine risk factors of perioperative death of patients undergoing repeated heart valve surgery. Results The main reasons for repeated heart valve surgery were mitral valve restenosis after closed mitral commissurotomy and new other valvular diseases. Postoperatively， 28 patients died in the early-stage with the overall mortality of 8.6% （28/325）. The main reasons of in-hospital death included low cardiac output syndrome （LCOS）and acute renal failure. Compared with patients undergoing their first heart valve surgery， patients who underwent repeated heart valve surgery were more likely to have chronic obstructive pulmonary disease （COPD)， New York Heart Association (NYHA） classⅢ-Ⅳ， and atrial fibrillation， preoperatively. Their cardiopulmonary bypass time and aortic cross clamp time were comparatively longer. They also had more postoperative morbidities such as LCOS， acute renal failure and acute respiratory distress syndrome （ARDS）. Multivariate logistic regression showed that preoperative critical state （OR=2.82， P=0.002）， cardiopulmonary bypass time longer than 120 minutes （OR=1.13， P=0.008）， concomitant coronary artery bypass grafting （OR=1.64， P=0.005）， postoperative LCOS（OR=4.52， P＜0.001）， ARDS （OR=3.11， P＜0.001） and acute renal failure （OR=4.13， P＜0.001）were independent risk factors of perioperative death of patients undergoing repeated heart valve surgery. Conclusion Repeated heart valve surgery is a difficult surgical procedure with comparatively higher risks. Full preoperative assessment of the valvular lesions， proper timing for surgery and perioperative management are helpful to reduce postoperative mortality and morbidity.
Objective To investigate clinical features and risk factors of prolonged postoperative recovery of pediatric patients in ICU after total cavopulmonary connection（TCPC），provide evidence for risk stratification management strategy， and enhance their postoperative recovery. Methods We conducted a retrospective analysis of clinical data of 81 patients undergoing TCPC in Fu Wai Hospital from January 2010 to July 2012. Three patients who died postoperatively were excluded from analysis. Prolonged postoperative recovery was defined as patients whose postoperative mechanical ventilation time was longer than that of 75% of all the patients. A total of 78 patients were divided into normal recovery group and prolonged recovery group. There were 59 patients in the normal recovery group including 34 male and 25 female patients with their age of 62.5±20.7 months，and 19 patients in the prolonged recovery group including 11 male and 8 female patients with their age of 64.8±29.8 months. Perioperative variables were compared between the two groups. Results The average cardiopulmonary bypass time of all the 81 patients was 107.6±54.1 （33-350） minutes. The average aortic cross-clamping time of 17 patients was 46.4±31.5 （22-143） minutes. Three patients （3.7%） died postoperatively because of severe low cardiac output syndrome and thrombosis in the extracardiac conduit. The mechanical ventilation time and ICU stay were 7.5 hours and 1.6 days respectively in the normal recovery group，which were both significantly prolonged in the prolonged recovery group. Preoperative high hemoglobin level，coexistence of intracardiac anomalies，longer cardiopulmonary bypass time，and non-fenestrated procedure were the main risk factors of prolonged postoperative recovery. Conclusion Early extubation and fast track recovery can be achieved in most of TCPC patients. Risk stratification management strategies may contribute to successful postoperative recovery of critical patients after TCPC.
Objective To determine risk factors associated with postoperative hypoxemia after surgery for acute aortic dissection. Methods We retrospectively analyzed clinical data of 116 patients with acute aortic dissection who underwent endovascular stent-graft exclusion or open surgery in Qingdao Municipal Hospital from February 2007 to February 2012. All the 116 patients were diagnosed as acute aortic dissection by CT angiography （CTA），including 60 patients with Stanford type A aortic dissection and 56 patients with Stanford type B aortic dissection. According to whether they had postoperative hypoxemia，all the 116 patients with acute aortic dissection were divided into hypoxemia group［arterial partial pressure of oxygen （PaO2） /fraction of inspired oxygen （FiO2） ＜200 mm Hg］：33 patients including 28 males and 5 females with their age of 52.7±11.4 years； and non-hypoxemia group（PaO2/FiO2≥200 mm Hg）：83 patients including 66 males and 17 females with their age of 55.0±13.8 years. Perioperative clinical data were analyzed and compared between the two groups. Multivariate logistic regression was performed to identify risk factors of postoperative hypoxemia after surgery for acute aortic dissection. Results The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.4% （33/116）. Perioperative death occurred in 13 patients（11.2%，including 8 patients in the hypoxemia group and 5 patients in the non-hypoxemia group）. Univariate analysis showed that preoperatively the percentages of patients with body mass index（BMI） ＞ 25 kg/m2，smoking history，duration from onset to operation ＜24 h，preoperative PaO2/FiO2≤300 mm Hg，and patients undergoing open surgery in the hypoxemia group were significantly higher than those in the non-hypoxemia group（P＜0.05）. Deep hypothermic circulatory arrest（DHCA） ratio，blood transfusion in 24 hours postoperatively，mechanical ventilation time，length of ICU stay and hospital stay in the hypoxemia group were significantly higher or longer than those in the non-hypoxemia group（P＜0.05）. Logistic multivariate regression identified BMI＞25 kg/m2（RR=98.861，P=0.006），DHCA（RR=22.487，P=0.007），preoperative PaO2/FiO2≤300 mm Hg（RR=9.080，P=0.037） and blood transfusion＞6 U in 24 hours postoperatively（RR=32.813，P=0.003） as independent predictors of postoperative hypoxemia for open-surgery patients，while BMI＞25 kg/m2 （RR=24.984，P=0.036） and preoperative PaO2/FiO2 ratio≤300 mm Hg （RR=21.145，P=0.042） as independent predictors of hypoxemia for endovascular stent-graft exclusion patients. Conclusion Postoperative hypoxemia is a common complication after surgery for acute aortic dissection. Early interventions for obesity and preoperative hypoxemia，and reducing perioperative blood transfusion may decrease the incidence of postoperative hypoxemia after surgery for acute aortic dissection.
Objective To analyze risk factors of malignancy in patients with small pulmonary nodules （diameter ≤2 cm） using univariate analysis and multivariate logistic regression，and establish a mathematical prediction model to estimatethe probability of malignancy. Methods Clinical data of 147 patients with small pulmonary nodules who underwentsurgical resection with definite postoperative pathological diagnosis from January 2005 to September 2012 in the 161st Central Hospital of PLA were retrospectively analyzed. There were 84 male and 63 female patients with their age of 31-78（56.2±10.1） years. Univariate analysis using Chi-square test or t test was performed to analyze risk factors including patientage，gender，symptoms，history and quantity of smoking，history of heavy drinking，history of tumor，tumor site，diameter，lobulation，spiculation，pleural indentation，ground-glass opacity，cavity，enlarged hilar and mediastinal lymph nodes.Independent predictors of malignancy were screened with multivariate logistic regression analysis. A mathematical predictionmodel was built to estimate the probability of malignancy and then examined. Results Univariate analysis showed that there was statistical difference in patient age（t=7.146，P＜0.001），heavy smoking history（χ2=6.169，P=0.013），nodule diameter（t=3.375，P=0.001），spiculation（χ2=5.609，P=0.018），lobulation（χ2=5.675，P=0.017），and pleural indentation（χ2=12.994，P＜0.001）between benign and malignant small pulmonary nodule groups. Multivariate logistic regression analysis showed that patient age （OR=1.110，P=0.000），nodule diameter （OR=2.050，P=0.029），lobulation （OR=1.672，P=0.045），spiculation（OR=2.054，P=0.032） and pleural indentation（OR=4.090，P=0.024）were independent predictors of malignancy in patients with small pulmonary nodules （P＜0.05） . The mathematical prediction model to estimate the probability of malignancy was：Logit （P） =ez/ （1 ＋ ez），Z=-6.657 ＋ （0.104×age） ＋ （0.718×diameter） ＋ （0.720×spiculation） ＋（0.514×lobulation） ＋ （1.409×pleural indentation），and e was natural logarithm. Both Hosmer-Lemeshow test （χ2=1.802，P=0.986） and maximum likelihood ratio test （Cox-Snell R2=0.310，Nagelkerke R2=0.443） showed satisfactory goodness of fit. The diagnostic accuracy was 85.71%，sensitivity was 87.50%，specificity was 81.40%，positive predictive value was 91.92%，and negative predictive value was 72.92% when the cut-off value was 0.58. Conclusions Patient age，nodule diameter，spiculation，lobulation and pleural indentation are independent predictors of malignancy in patients with small pulmonary nodules. The mathematical prediction model can accurately estimate the probability of malignancy for patients with small pulmonary nodules.
Esophageal cancer is a common gastrointestinal cancer，and the incidence in China is the highest in the world. Esophagectomy represents the gold standard for patients with resectable esophageal cancer，but postoperative morbidity and mortality rates remain high. In recent years，there have been many reports on the pathogenesis of morbidity and mortality after esophagectomy without reaching any concrete conclusion. This review focuses on the pathogenesis，prophylaxis and therapeuticsof pulmonary infection after esophageal cancer resection．
Abstract： Objective?To analyze the risk factors for early shunt dysfunction after systemic-pulmonary shunt in order to improve early postoperative outcomes. Methods We retrospectively analyzed the clinical records of 189 patients who underwent systemic-pulmonary shunt in General Hospital of Shenyang Military District between February 2002 and December 2010. There were 87 males and 102 females with their age ranging from 3 months to 50（5.3±6.2）years，and body weight ranging from 3 to 56（17.7±11.0）kg. There were 94 patients with tetralogy of Fallot （TOF） and pulmonary artery stenosis，51 patients with pulmonary atresia （PA） and ventricular septal defect，4 patients with PA and intact ventricular septum，10 patients with functional single ventricle （SV） and pulmonary stenosis（PS），6 patients with SV and PA，6 patients with double outlet right ventricle and PS，8 patients with transposition of the great arteries（TGA） and PS，and 10 patients with TGA and PA. The surgical procedures included central aorto-pulmonary shunt （Waterston） in 105 patients, modified Blalock-Taussig shunt in 61 patients and Melbourne shunt in 23 patients. Results Early postoperative death occurred in 13 patients （6.9%）. There were 12 patients （6.3%） with intra-operative severe hypotension or arrhythmia, 10 patients （5.3%） with postoperative severe low cardiac output, and 10 patients （5.3%） with early shunt dysfunction within the first 24 h postoperatively. Univariate analysis identified low body weight （P=0.027）, shunt size with diameter＜4 mm （P=0.025） and severe intra-operative adverse event （hypotension or arrhythmia with P=0.002） were risk factors for early shunt dysfunction. In multivariate analysis, intra-operative adverse event was an independent risk factor for early shunt dysfunction（P=0.017）. Conclusion Early outcomes after systemic-pulmonary shunt can be significantly improved by preventing intra-operative severe hypotension or arrhythmia and choosing shunt size larger than 4 mm，especially for patients with young age, low body weight, and poorly-developed pulmonary artery.
Abstract： Objective To evaluate prediction validation of Sino System for Coronary Operative Risk Evaluation （SinoSCORE） on in-hospital mortality in adult heart surgery patients in West China Hospital.?Methods?We included clinical records of 2 088 consecutive adult patients undergoing heart surgery in West China Hospital from January 2010 to May 2012, who were also included in Chinese Adult Cardiac Surgical Registry.We compared the difference of preoperative risk factors for the patients between Chinese Adult Cardiac Surgical Registry and West China Hospital. SinoSCORE was used to predict in-hospital mortality of each patient and to evaluate the discrimination and calibration of SinoSCORE for the patients.?Results?Among the 2 088 patients in West China Hospital, there were 168 patients （8.05%） undergoing coronary artery bypass grafting （CABG）, 1 884 patients （90.23%） undergoing heart valve surgery, and 36 patients （1.72%） undergoing other surgical procedures. There was statistical difference in the risk factors including hyperlipemia, stroke, cardiovascular surgery history, and kidney disease between the two units.The observed in-hospital mortality was 2.25% （47/2 088）. The predicted in-hospital mortality calculated by SinoSCORE was 2.35% （49/2 088） with 95% confidence interval 2.18 to 2.47. SinoSCORE was able to predict in-hospital mortality of the patients with good discrimination （Hosmer Lemeshow test: χ2=3.164, P=0.582） and calibration （area under the receiver operating characteristic curve of 0.751 with 95% confidence interval 0.719 to 0.924）. Conclusion SinoSCORE is an accurate predictor in predicting in-hospital mortality in adult heart surgery patients who are mainly from southwest China
Abstract： Objective To evaluate graft patency at one year after coronary artery bypass grafting （CABG） and analyze the risk factors of graft occlusion. Methods We prospectively included 71 consecutive patients with coronary heart disease who underwent CABG in First Affiliated Hospital of Harbin Medical University from June to December 2010. There were 37 males and 34 females with their average age of 59.8±7.7 years. All the patients underwent CABG performed by the same surgeon， and received standard drug therapy after surgery. At 1 year after CABG， 256-slice multislice computed tomography （MSCT） angiography was performed to evaluate graft patency. All the patients were divided into two groups according to their graft patency during follow-up， including 16 patients in the occluded graft group and 55 patients in patent graft group. Preoperative， intra-operative and postoperative variables were collected. Univiariate analysis and logistic regress analysis were performed to analyze risk factors of graft occlusion. Results The graft patency was 91.0% （172/189） at 1 year after CABG. Univiariate analysis showed that pre-operative cholesterol （t=-2.389，P=0.017）， diffused coronary artery disease （χ2=4.449，P=0.042）， diameter of target vessels （t=5.064，P=0.000）， non-adherence to prescribed antiplatelet medications （χ2=10.175，P=0.008） were potential risk factors of graft occlusion after CABG. Logistic regress analysis showed that diameter of target vessels ［RR=0.014，95% CI （0.001，0.229），P=0.003］ and non-adherence to prescribed antiplatelet medications ［RR=13.375，95% CI （1.075，175.536），P=0.044］ were significant risk factors for graft occlusion. Conclusion The graft patency is satisfactory at 1 year after CABG. Graft patency after CABG is closely related to the stenosis degree of target vessels and adherence to prescribed antiplatelet medications after surgery.
Abstract： Quality of life （QOL） refers to an individual’s perception and subjective evaluation of their health and well-being, and has become an important index to evaluate the outcomes of clinical treatment in the last past decades. There are a large number of different instruments to evaluate QOL, and the 36-Item Short Form Health Survey （SF-36） is currently one of the most widely used instruments. In recent years, SF-36 has been used to evaluate QOL of valvular heart disease patients to investigate the risk factors those influence their postoperative QOL, provide more preoperative evaluation tools for clinical physicians, and improve postoperative outcomes of patients with valvular heart disease. However, it is now just the beginning to use SF-36 to examine QOL of valvular heart disease patients. Because of significant differences in sample size, follow-up period, country and culture, current research has some controversial results. This review focuses on the progress in evaluating QOL in postoperative patients with valvular heart disease using SF-36.