ObjectiveTo summarize the surgical experience of aortic regurgitation with lower ejection fraction (EF). MethodsWe retrospectively analyzed the clinical data of 34 patients with aortic regurgitation and lower ejection fraction received aortic valve replacement in the General Hospital of Shenyang Military Region between January 2012 and December 2013. There were 27 males and 7 females with age of 21-74 (51.03±12.06) years. All surgical procedures were performed under general anesthesia during cardiopulmonary bypass. ResultsThere was no operative mortality. Cardiopulmonary bypass time was 40-155 (60.92±22.89) minutes, aortic clamping time varied from 24 to 79 (37.12±12.61) minutes. Postoperative ventilator-assisted time was 4 to 67 (16.12±12.74) hours. The patients were discharged 8-15 (11.03±2.04) days after surgery. When discharged, EF value was 30% to 48% (41%±4%) and significantly improved compared with that before operation (P<0.01). Pulmonary artery systolic pressure varied from 33 to 50 (38.35±4.35) mm Hg and decreased significantly than that before operation (P<0.01). Left ventricular end-diastolic volume reduced to 168-380 (269.12±52.01) ml and obviously decreased than that before operation (P<0.01). ConclusionSurgical treatment can be carried out on patients with aortic insufficiency and lower EF. Treatment results are satisfactory.
ObjectiveTo investigate the restoration of left atrial function and its relationship with atrial fibrosis of patients after mitral valve replacement (MVR)and concomitant radiofrequency ablation (RFA)for atrial fibrillation (AF). MethodsClinical data of 32 patients with mitral valve disease and chronic AF who underwent surgical treatment in General Hospital of Shenyang Military Area Command from January to August 2010 were retrospectively analyzed in this cohort study. There were 11 male and 21 female patients with their age of 49.8±8.7 years. There were 14 patients with rheumatic mitral stenosis (MS), 8 patients with rheumatic MS and mitral regurgitation, and 10 patients with mitral valve prolapse. Preoperative AF duration was 3.6±4.6 years. All the patients received MVR and concomitant RFA for AF. According to the cutting off extent of left atrial fibrosis (10.9%), all the 32 patients were divided into 2 groups. There were 19 patients with more severe left atrial fibrosis ( > 10.9%)in group A and 13 patients with milder left atrial fibrosis ( < 10.9%)in group B. Immunohistochemistry was performed to examined left atrial fibrosis, and echocardiography was performed to examined the structure and function of left atrium. ResultsThere was no perioperative death. Cardiopulmonary bypass time was 84.6±22.6 minutes, aortic cross-clamping time was 47.6±15.6 minutes, and ICU stay was 3.2±1.5 days. All the 32 patients were followed up for longer than 6 months (1.3±0.6 years). The extent of left atrial fibrosis of the 32 patients was 4.8%-18.3% (10.7%±4.2%). There was no statistical difference in left atrial diameter (LAD), left atrial fractional area change (LAFAC)or mitral annular motion between group A and group B preoperatively and 3 months after surgery respectively (P > 0.05). At 6 month after surgery, LAD of group B was significantly smaller than that of group A (P < 0.05), late diastolic mitral annular velocity (Am)of group B was significantly higher than that of group A (P < 0.05), and there was also some improvement in LAFAC of group B compared with group A (P=0.067). Among the 32 patients, 28 patients (87.5%)restored sinus rhythm (SR)3 months after surgery, and 21 patients (65.6%)maintained SR longer than 6 months after surgery. Patients in group B were more likely to maintain SR than patients in group A (P=0.010). ConclusionImprovement of left atrial function can be observed 6 month after MVR and concomitant RFA for AF, which is related to the extent of left atrial fibrosis.
ObjectiveTo investigate acute physiologic and chronic health evaluation Ⅱ(APACHE Ⅱ) score system for severity evaluation and prognosis prediction of patients undergoing cardiac surgery. MethodsA total of 3 566 patients who were admitted in ICU after cardiac surgery in the Department of Cardiovascular Surgery of General Hospital of Shenyang Military between December 1, 2011 and August 31, 2013 were enrolled in this study. There were 1 873 males and 1 693 females with their average age of 45.8±23.7 years (range, 10 days to 82 years). All the patients were evaluated with APACHE Ⅱ and expected mortality was calculated. Receiver operating characteristic(ROC) curve was drawn to compare expected and actual mortality and evaluate predictive value of APACHE Ⅱ. ResultsA total of 3 373 patients survived the operation, and 193 patients died postoperatively with the mortality of 5.41%. The area under the ROC curve was 0.917 (P=0.000) with 95% confidence interval of[0.885,0.949]. The cut-off point of APACHE Ⅱ was 15.50, with a sensitivity of 80.3%,a specificity of 95.6%,an accuracy rate of 79.5%,a positive predictive value of 86.9%,and a negative predictive value of 93.1%. Expected and actual mortality increased with increasing APACHE Ⅱ,which were both positively correlated. ConclusionAPACHE Ⅱ score system can be used to evaluate severity and predict prognosis of patients undergoing cardiac surgery, which provides reference for rational utilization of ICU resource.