Recent clinical trials showed that dabigatran was superior to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation, however whether it is suitable for the lifelong anticoagulation in patients after heart valve replacement, remains controversial. Many animal experiments showed that dabigatran group was better than heparin and warfarin in the prevention of thrombosis and bleeding complications after valve replacement. Randomized, phaseⅡstudy to evaluate the safety and pharmacokinetics of oral dabigatran etexilate in patients after heart valve replacement (RE-ALIGN) clinical trial showed that dabigatran wasn't as effective as warfarin in preventing thrombosis, but increases the risk of bleeding. And there are some case reports about thrombosis and bleeding complications after taking dabigatran. At present, the efficacy and safety of dabigatran applying in patients after heart valve replacement still needs further study.
Although the survival rate reported in each center is different, according to the present studies, compared to conventional cardiopulmonary resuscitation (CCPR), extracorporeal cardiopulmonary resuscitation (ECPR) can improve the survival rate of cardiac arrest patient, no matter out-of-hospital or in-hospital. The obvious advantage of ECPR is that it can reduce the nervous system complications in the cardiac arrest patients and improve survival rate to hospital discharge. However, ECPR is expensive and without the uniformed indications for implantation. The prognosis for patients with ECPR support is also variant due to the different etiology. If we want to achieve better result, the ECPR technology itself needs to be further improved.
ObjectiveTo summarize surgical treatment experience on unruptured aneurysm of the sinus of Valsalva (SVA). MethodsClinical data of 33 patients with unruptured SVA underwent surgical repair at Fu wai Hospital between February 2007 and January 2012 were retrospectively analyzed. There were 27 males and 6 females with their mean age of 28.5±13.5 years (ranged from 4.5 to 58.0 years). The unruptured SVA originated in the right coronary sinus in 29 cases (87.8%), in non-coronary in 2 cases (6.1%) and in left coronary sinus in 2 cases (6.1%). There were 29 cases with ventricular septal defect and 20 cases with aortic valve insufficiency (AI). ResultsOnly 52.8% of unruptured SVA were correctly diagnosed by echocardiography preoperatively. All unruptured SVA received active surgical management, with no early death after operation. Thirty patients (90.9%) were followed up for 22 to 81 months (mean 42.9±18.8 months) and in NYHA classⅠorⅡ. None SVA recurrence occurred. Postoperative AI could be improved better by using the repair route only through the chamber of right ventricle for patients with unruptured SVA originated in right coronary sinus. ConclusionFor unruptured SVA patients who associated with other kinds of cardiovascular lesions, active surgical repair for unruptured SVA can achieve satisfactory results.
Aortic dissection is a catastrophic emergency with a high mortality rate, and its full pathogenesis remains unknown to researchers, which brings a heavy burden to the individuals, society and family because of its poor prognosis. Improving the efficiency of its diagnosis and treatment and defining the pathogenic mechanism clearly is a research hotspot. Recently, utilizing bioinformatics to find diagnostic biomarker of aortic dissection has attracted the attention of many researchers. Besides, exploring the relationship between pathogenic mechanism and inflammatory process, extracellular matrix degradation, elastic fiber fracture and the phenotypic transformation of vascular smooth muscle cells is also a hot topic. We summarize recent progress made in the pathogenesis of aortic dissection. We hope to identify key molecules driving aortic dissection and provide reliable reference for the diagnosis, medical treatment and prevention of aortic dissection.
Objective To compare the early and late outcomes of different techniques of proximal root reconstruction during the repair of acute type A aortic dissection, including aortic valve (AV) resuspension, isolated supracoronary ascending aorta replacement, and aortic root replacement procedure (Bentall). Methods All patients who underwent acute Type A aortic dissection repair between January 2010 and December 2015 in Fuwai Hospital were retrospectively analyzed in our study. There were 673 patients with 512 males and 161 females at mean age of 48.80±11.22 years. There were 403 patients as an AV resuspension group (287 males and 116 females at average age of 50.61±9.95 years), 95 patients as an isolated supracoronary ascending aorta replacement group (76 males and 19 females at average of 49.83±12.21 years), and 175 patients as an AV resuspension group (149 males and 26 females at average of 44.07±11.99 years). The differences of preoperative aortic insufficiency, intraoperative variables and postoperative aortic insufficiency were compared in the three groups. Results Five hundred ninety-one patients (87.8%) had aortic valve commissure involved. The proportion of mild degree, moderate degree, and severe degree among the three groups were statistically significant (31.7%, 52.4%, 15.9%; 87.4%, 12.6%, 0.0%; 23.4%, 56.0%, 20.6%; P < 0.01). The diameter of aortic sinus in the three groups was 39.06±5.11 mm, 38.27±4.41 mm, 50.39±6.22 mm, respectively, with a statistical difference ( P< 0.01). The duration of surgery, cardiopulmonary bypass time, aorta cross-clamp time were also statistically significant (P < 0.01). The in-hospital mortality was 11.73% in the whole group. There was no difference among the three groups (12.2% vs. 13.7% vs. 9.7%, P=0.58). Five-year survival rate was similar (83.06% vs. 81.27% vs. 83.05%, P=0.85). The 5-year free from over moderate aortic insufficiency rate were 95.2%, 98.6% and 100% respectively, with no statistical difference (P=0.07). There was no re-do operation for aortic root diseases in the whole group. Conclusion According to aortic root processing strategy in our center, AV resuspension, isolated supracoronary ascending aorta replacement, and aortic root replacement can achieve satisfactory results. However, there is higher incidence of aortic insufficiency through AV resuspension. Further study is needed to evaluate its efficacy.
Objective To explore impact of climate change on aortic dissection and to put forward a new way about prediction and prevention of aortic dissection. Methods We retrospectively analyzed the characteristics of acute aortic dissection patients came from Hebei province in Fuwai Hospital between 2010 and 2016 year. Meanwhile, we collected monthly maximum temperature, minimum temperature, average temperature, average pressure, amount of rainfall, sunshine, humidity and other meteorological data. Generalized model was implied to explore climate change and the incidence of aortic dissection. Results A total of 1 121 acute aortic dissection patients from Hebei province were admitted in Fuwai Hospital during the period of 6 years. There were 774 patients were type A aortic dissection, and 347 patients were type B aortic dissection. The average age was 51.4±12.0 years. There were 873 males and 248 females. There were 889 (79.3%) patients with hypertension, 99 (8.83%) with Marfan syndrome. It was found that temperature, humidity and air pressure were all statistically significant for indication aortic dissection through single variable analysis (P<0.01). The temperature was only variable by one-way analysis of variance (P<0.01). The lowest temperature has the best predictive effect on the occurrence of aortic dissection. The relative risk was 1.02 with 95% confidence interval 1.02 to 1.03. Conclusion The change of climatic conditions can affect the occurrence of aortic dissection, and the lowest temperature is an important trigger factor for aortic dissection onset.
Objective To investigate predictors for mortality among patients with Stanford type A acute aortic dissection (AAD) and to establish a predictive model to estimate risk of in-hospital mortality. Methods A total of 999 patients with Stanford type A AAD enrolled between 2010 and 2015 in our hospital were included for analysis. There were 745 males and 254 females with a mean age of 49.8±12.0 years. There were 837 patients with acute dissection and 182 patients (18.22%) were preoperatively treated or waiting for surgery in the emergency department and 817 (81.78%) were surgically treated. Multivariable logistic regression analysis was used to investigate predictors of in-hospital mortality. Significant risk factors for in-hospital death were used to develop a prediction model. Results The overall in-hospital mortality was 25.93%. In the multivariable analysis, the following variables were associated with increased in-hospital mortality: increased age (OR=1.04, 95% CI 1.02 to 1.05, P<0.000 1), acute aortic dissection (OR=2.49, 95% CI 1.30 to 4.77, P=0.006 1), syncope (OR=2.76, 95% CI 1.15 to 6.60, P=0.022 8), lower limbs numbness/pain (OR=7.99, 95% CI 2.71 to 23.52, P=0.000 2), type Ⅰ DeBakey dissection (OR=1.72, 95% CI 1.05 to 2.80, P=0.030 5), brachiocephalic vessels involvement (OR=2.25, 95% CI 1.20 to 4.24, P=0.011 7), acute liver insufficiency (OR=2.60, 95% CI 1.46 to 4.64, P=0.001 2), white blood cell count (WBC)>15×109 cells/L (OR=1.87, 95% CI 1.21 to 2.89, P=0.004 9) and massive pericardial effusion (OR=4.34, 95% CI 2.45 to 7.69, P<0.000 1). Based on these multivariable results, a reliable and simple bedside risk prediction tool was developed. Conclusion Different clinical manifestations and imaging features of patients with Stanford type A AAD predict the risk of in-hospital mortality. This model can be used to assist physicians to quickly identify high risk patients and to make reasonable treatment decisions.
ObjectiveTo assess outcomes of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation.MethodsA total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed. There were 83 males and 46 females with an average age of 72.26±8.97 years. The patients were divided into a pure native aortic valve regurgitation group (17 patients) and an aortic valve stenosis group (112 patients).ResultsThe incidence of valve in valve was higher in the pure native aortic valve regurgitation group (47.0% vs. 16.1%, P<0.01). There was no statistical difference between the two groups in conversion to surgery, intraoperative use of extracorporeal circulation, intraoperative left ventricular rupture, postoperative use of extracorporeal membrane oxygenation (ECMO), peripheral vascular complications, disabled stroke, death, or pacemaker implantation. There was no statistical difference in the diameter of annulus (25.75±2.21 mm vs. 24.70±2.90 mm, P=0.068) or diameter of outflow tract (25.82±3.75 mm vs. 25.37±3.92 mm, P=0.514) between the pure native aortic valve regurgitation group and the aortic valve stenosis group.ConclusionTransfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation. The diameter of annulus plane, the diameter of outflow tract and the shape of outflow tract should be evaluated.
ObjectiveTo discuss the efficacy of type Ⅱ hybrid aortic arch repair for type A aortic dissection in patients of different age groups.MethodsWe retrospectively analyzed the clinical data of 126 patients with type A aortic dissection admitted to the Fuwai Hospital between January 2016 and December 2018, including 78 (61.9%) males and 48 (38.1%) females, with an average age of 61.8±6.9 years. The patients were divided into an elderly group (≥60 years, n=82) and a non-elderly group (<60 years, n=44). The preoperative, intraoperative and postoperative data of patients in the two groups were compared.ResultsThe age between the elderly and non-elderly group was significantly different (65.9±4.1 years vs. 54.3±4.1 years, P<0.010), and no significant difference was found between the two groups in other preoperative baseline data. There were 6 (4.8%) patients of early death, 3 (2.4%) patients of stroke and 2 (1.6%) patients of paralysis. A total of 194 stents were implanted, and the average dimeter of the stents was 33.6±1.8 mm and the average length was 199.0±6.7 mm. The non-elderly group had shorter mechanical ventilation time (31.9±41.7 h vs. 61.0±89.2 h, P=0.043) and ICU stay time (77.8±51.4 h vs. 143.1±114.4 h, P<0.001) than the elderly group. There was no significant difference in in-hospital mortality rate, reoperation rate or survival rate between the two groups (P>0.05). Follow-up time was 1-43 (22.6±10.8) months, and 3 patients were lost. There were 104 (82.5%) patients of complete thrombus formation of false lumen in stent and endoleak was reported in 11 (9.2%) patients.ConclusionType Ⅱ hybrid aortic arch repair offers an alternative approach to acute type A aortic dissection with acceptable early and mid-term clinical effects. The non-elderly patients have a similar early treatment effect to the elderly patients, but have a better mid-term outcome.