ObjectiveTo explore clinical outcomes of papaverine via the aortic root under cardiopulmonary bypass (CPB) in coronary artery bypass grafting. MethodsA total of 263 patients with coronary artery disease underwent CPB in coronary artery bypass grafting in Beijing Anzhen Hospital from August 2003 through December 2014 were included. According to whether or not they received papaverine perfusion via the aortic root in the first perfusion during CPB, all the 263 patients were divided into two groups including an intervention group and a control group. There were 176 patients in the intervention group including 109 males and 67 females with their average age of 64.37±23.54 years. They received aortic root perfusion of 60 mg papaverine diluted into 20 ml during the first perfusion, and repeated aspiration was performed 8 to 10 times in CPB when the heart beat weak. In the control group, there were 87 patients including 55 males and 32 females with their average age of 65.98±29.13 years. Patients in the control group received routine procedures of CPB except papaerine perfusion. Clinical effectiveness was compared between the two groups. ResultsThere was no in-hospital death. CPB supporting time after heart re-beating (9.58±3.21 min vs. 19.74±5.67 min, t=-1.133, P=0.000), dopamine usage 3.12±1.27 μg/(kg·min) vs. 4.98±2.53 μg/(kg·min),t=-0.913, P=0.031), epinephrine usage 0.018±0.009 μg/(kg·min) vs. 0.047±0.011 μg/(kg·min), t=-0.811, P=0.018) and nor epinephrine usage 0.021±0.011 μg/(kg·min) vs. 0.037±0.010 μg/(kg·min), t=-0.823, P=0.019) of the intervention group were significantly shorter or lower than those of the control group. Automatic heart re-beating rate of the intervention group was significantly higher than that of the control group (98.86% vs. 70.11%,t=-1.372, P=0.000). A total of 176 patients in the nitroglycerin group were followed up for 6-121 months, and 16 patients were lost during follow-up. During the follow-up period, 6 patients were hospitalized for cardiac events, and 2 died in 29 months and 103 months after surgery, and 9 died from cardiac events. ConclusionFor the patients undergoing on-pump coronary artery bypass grafting, some myocardial protection strategies including papaverine perfusion via the aortic root in the first perfusion, use of norepinephrine, and aortic root squeezing in high frequency by hand can significantly increase the automatic heart re-beating rate, shorten the CPB supporting time after heart re-beating, and improve postoperative clinical outcomes.
Objective To investigate the surgical treatment of adult secondary atrial septal defect with paroxysmal atrial fibrillation. Methods We retrospectively analyzed the clinical data of 84 patients with adult secondary atrial septal underwent surgical treatment in Beijing Anzhen Hospital from January 2002 through May 2013. There were 31 males and 53 females at mean age of 56.3 (24-72) years. Eleven patients were treated by cardiopulmonary bypass operation with 6 patients by radiofrequency catheter ablation simultaneously. Seventy three patients were implanted with septal defect closure with 52 patients by radiofrequency ablation simultaneously. Rhythm of the heart was detected at the immediate postoperative period, 7 days, 3 months and 6 months after the operation. Results No preoperative death, thoraecotomy and no arrhythmic complications in all the patients no matter with or without RF occurred. In the patients with cardiopulmonary bypass operation, the time of aortic occlusion was 35.21±12.32 min, the cardiopulmonary bypass time was 45.67±16.93 min, and the ICU observation time was 11.87±12.36 hours. In the patients with septal defect closure implanted, ICU observation time was 10.93+13.67 hours. The incidences of atrial fibrillation in the patients with radiofrequency ablation on postoperative 7 days，3 months and 6 months were lower than those in the patients without radiofrequency ablation (P<0.05). Conclusion For adult secondary atrial septal defect patients with paroxysmal atrial fibrillation, no matter cardiopulmonary bypass operation or septal defect closure implanted, radiofrequency ablation at the same time is safety and can reduce incidence of recurrence of atrial fibrillation.