Objective To systematically review the efficacy, safety and economic value of hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) for Chinese patients with multivessel coronary artery disease. Methods We searched PubMed, WanFang Data, CNKI, Web of Science and The Cochrane Library (Issue 2, 2016) to collect case-control studies about HCR versus CABG for Chinese patients with coronary multivessel disease from the January 1996 to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.1 software. Results A total of 9 studies, involving 1 231 patients were included. The results of meta-analysis showed that: compared with the CABG groups, HCR group had lower length of ICU stay (MD=–25.84, 95% CI –42.55 to –9.13,P=0.002) and intubation time (MD=–4.06, 95% CI –6.43 to –1.69,P=0.000 8). However, there were no significant differences between both groups in the length of hospital stay (MD=–0.64, 95% CI –2.53 to 1.25,P=0.51), the incidence of atrial fibrillation (OR=1.41, 95% CI 0.86 to 2.30,P=0.17) and renal failure (OR=1.56, 95% CI 0.89 to 2.74,P=0.12). No significant differences were found between both groups in mortality (OR=0.36, 95% CI 0.12 to 1.11,P=0.07), the incidence of myocardial infarction (OR=0.32, 95% CI 0.06 to 1.85,P=0.20) and the incidence of target vessel revascularization (OR=1.16, 95% CI 0.48 to 2.76,P=0.74). But the incidence of the stroke (OR=0.35, 95% CI 0.14 to 0.91,P=0.03) and MACCEs (OR=0.37, 95% CI 0.20 to 0.70,P=0.002) of the HCR group were lower than those of the patients of the CABG group. Conclusion The current evidence shows that, compared with the CABG groups, HCR had lower incidence of stroke and MACCEs, however, the safety and efficacy were not significantly different between both groups. Due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo explore the changes of focal adhesion kinase (FAK) in the fibrotic atrium of patients with valvular atrial fibrillation and explore its downstream signaling pathways.MethodsA total of 45 patients with mitral valve disease were included in this study and were divided into a valvular atrial fibrillation group (VAF, ≥6 months, 25 patients) and a sinus rhythm group (SR, 20 patients) based on having atrial fibrillation or not. The atrial appendage tissue was obtained during the operation , histopathological examination and Western blotting were performed. The degree of atrial fibrosis and changes in FAK and its downstream pathways in fibrotic myocardium were observed.ResultsThis study revealed a higher degree of atrial fibrosis in valvular atrial fibrillation and disordered cell arrangement. Expression of fibroblast differentiation marker alpha smooth muscle actin (α-SMA) was significantly increased in atrial fibrillation, and the expression of FAK and downstream AKT/S6K pathway proteins was up-regulated, while the other signal was observed, there was no significant change in ERK1/2 signaling pathway.ConclusionAtrial fibrosis in valvular atrial fibrillation is an important feature of atrial structural remodeling. We found overproduction of collagen fibers disrupted the continuity of atrial myocytes, leading to abnormal conduction and providing a matrix environment for the development of atrial fibrillation. The expression of focal adhesion kinase and downstream AKT/S6K signaling pathway in fibrotic myocardium may be involved in the process of atrial fibrosis, providing a basis for the study of its mechanism.