ObjectiveTo explore the effect of the reimplantation procedure with the De Paulis Valsalva graft in patients with aneurysms. MethodsWe retrospectively analyzed the clinical data of 38 patients underwent valve-sparing aortic root replacement using De Paulis graft in our hospital between September 2005 and July 2013.There were 32 male and 6 female patients at age of 45.5±12.4 years. We compared the parameters of pre-operation and post-operation and followed up the patients for 5 years. ResultsThere were 2(5.3%) deaths in hospital. The follow-up time was 2-95 months with following-up rate of 92.1%(35/38). A total of 2 patients(5.3%) had grade 3 to grade 4 aortic insufficiency. And one of these patients received aortic valve replacement after 1 year. At 5 years of following-up, one patient died of septic shock due to pacemaker infection. One patient died of kidney failure due to renal artery dissection aneurysm affected with impaired renal function and long-term hemodialysis. ConclusionThe reimplantation type of valve-sparing procedure can be facilitated by the use of the De Paulis valsalva graft and can be performed with satisfactory perioperative and mid-term results.
ObjectiveTo explore the difference between minimally invasive direct and conventional thoracotomy off-pump coronary artery bypass surgery (CABG). MethodsWe selected 276 patients underwent off-pump CABG surgery in our hospital from June 2005 through June 2014. There were 55 patients with minimally invasive off-pump CABG surgery and 221 patients conventional thoracotomy surgery. By using the method of peopensity score matching, we selected 55 conventional thoracotomy patients as a control group in our study. There were 41 males and 14 females at age of 60.8±10.5 years with minimally invasive off-pump CABG surgery, 44 males and 11 females at age of 60.6±12.5 years with conventional thoracotomy. ResultsThere was no statistical difference in surgery time, stay in the intensive care unit (ICU) time between conventional thoracotomy surgery and minimally invasive off-pump CABG. Compared with conventional thoracotomy surgery, minimally invasive off-pump CABG patients had statistical improvement in post-operative hospital stay time (7.3±3.1 d vs. 8.8±3.9 d, P=0.01), postoperative drainage (684(0-2 790)ml vs. 739(50-4 460)ml, P=0.03), perioperative blood transfusion (1.91(0-20)U vs. 6.62(0-20)U, P=0.00), surgery incision length (5.6±1.1 cm vs. 26.3±4.5 cm, P=0.00). ConclusionOverlooking the learning curve, minimally invasive direct off-pump CABG surgery has more advantages than conventional thoracotomy surgery. It is a safe and effective procedure.
ObjectiveTo summary the safety and efficiency of the minimally invasive direct cardiac surgery (MIDCS) approach in elderly patients with heart disease. MethodsWe retrospectively analyzed the clinical data of 60 patients underwent MIDCS in Beijng Anzhen Hospital between April 2010 and January 2013. There were 34 males and 26 females with mean age of 66.4±4.8 years and mean weight of 66.1±10.6 kg. ResultsMean cardiopulmonary bypass time and aortic cross-clamp time was 141.2±57.2 minutes and 99.8±37.6 minutes respectively. A total of 37 patients (90.2%) recovered to beat automatically after heart ceased operation. Median mechanical ventilation time was 17.1±9.1 hours. Mean intensive care unit stay was 22.1±12.2 hours. Mean post operative hospital stay was 7.0±2.5 days. Mean incision length was 5.3±0.9 cm. Mean pericardial draining volume was 466.6±412.1 ml in the first day after operation. No transfusion occurred in 27 (45.0%) patients. Early postoperative mortality was 3.3% (2/60). There were 2 patients of reexplorations for bleeding, 1 patient of the twice tracheal intubation, 1 patient of cardiac arrest after operation, 2 patients of poor healing of skin incision, and 1 patient of injury of right phrenic nerve. When leaving hospital, 47 patients were in heart functional class Ⅰ, 8 patients in class Ⅱ, and 3 patients in class Ⅲ. ConclusionMIDCS is associated with good operative effect in the near future with superior safety and broad application range in elderly patients with heart disease.
ObjectiveTo provide experimental data and theoretical support for further studying the maturity of cardiac patches in other in vitro experiments and the safety in other in vivo animal experiments, through standard chemically defined and small molecule-based induction protocol (CDM3) for promoting the differentiation of human induced pluripotent stem cells (hiPSCs) into myocardium, and preliminarily preparing cardiac patches. MethodsAfter resuscitation, culture and identification of hiPSCs, they were inoculated on the matrigel-coated polycaprolactone (PCL). After 24 hours, the cell growth was observed by DAPI fluorescence under a fluorescence microscope, and the stemness of hiPSCs was identified by OCT4 fluorescence. After fixation, electron microscope scanning was performed to observe the cell morphology on the surface of the patch. On the 1st, 3rd, 5th, and 7th days of culture, the cell viability was determined by CCK-8 method, and the growth curve was drawn to observe the cell growth and proliferation. After co-cultured with matrigel-coated PCL for 24 hours, hiPSCs were divided into a control group and a CDM3 group, and continued to culture for 6 days. On the 8th day, the cell growth was observed by DAPI fluorescence under a fluorescence microscope, and hiPSCs stemness was identified by OCT4 fluorescence, and cTnT and α-actin for cardiomyocyte marker identification. ResultsImmunofluorescence of hiPSCs co-cultured with matrigel-coated PCL for 24 hours showed that OCT4 emitted green fluorescence, and hiPSCs remained stemness on matrigel-coated PCL scaffolds. DAPI emitted blue fluorescence: cells grew clonally with uniform cell morphology. Scanning electron microscope showed that hiPSCs adhered and grew on matrigel-coated PCL, the cell outline was clearly visible, and the morphology was normal. The cell viability assay by CCK-8 method showed that hiPSCs proliferated and grew on PCL scaffolds coated with matrigel. After 6 days of culture in the control group and the CDM3 group, immunofluorescence showed that the hiPSCs in the control group highly expressed the stem cell stemness marker OCT4, but did not express the cardiac markers cTnT and α-actin. The CDM3 group obviously expressed the cardiac markers cTnT and α-actin, but did not express the stem cell stemness marker OCT4. ConclusionhiPSCs can proliferate and grow on matrigel-coated PCL. Under the influence of CDM3, hiPSCs can be differentiated into cardiomyocyte-like cells, and the preliminary preparation of cardiac patch can provide a better treatment method for further clinical treatment of cardiac infarction.