With the prevalence of atrial fibrillation and the increasing use of intracardiac pacemakers, the incidence of isolated tricuspid regurgitation is gradually increasing. Severe isolated tricuspid regurgitation has a seriously negative effect on the survival rate and life quality of patients. As the major invasive therapy, surgery is not routinely carried out due to high perioperative mortality. This article attempts to summarize the etiology, natural course and adverse consequences of isolated tricuspid regurgitation, current treatment strategies, surgical indications and techniques, efficacy evaluation, prognostic factors and transcatheter treatment progress of isolated tricuspid regurgitation, aiming to provide references for cardiologists and further researches.
Objective To review our experience of minimally invasive direct coronary artery bypass grafting （MIDCAB） via a lower median ministernotomy in 72 cases. Methods Via a lower median ministernotomy,the left internal mammary artery was harvested to bypass the left anterior descending coronary artery. Saphenous vein was resected and used for single - or multi-vessel coronary revascularization on the beating heart. Results There were 1 operative death （1.4 % ）. Complications occurred in 3 patients （4.2%）. The operative duration was 195.6 ± 50. 6 min. The number of distal anastomoses was 2.3±0. 8（1-4）. The median time to tracheal extubation, and lengths of postoperative ICU and hospital stays were 11 hours, 3 and 9 days, respectively. Total chest drainage was 8. 54±5.9 ml/kg and 47 patients needed blood transfusion with an amount of 1 091.3±636.2 ml. The incision on the chest wall was 9 to 11 cm long in all cases. Sixty-six patients （92.9%, 66/71） were followed-up for a duration of 36.2±17.6 months. There were no late death and 43 patients （65.2%） were free from angina. Eighteen patients （27.3%, 18/ 66） experienced marked relief of their symptoms. Conclusions MIDCAB is possible via a lower ministernotomy for single - or multi-vessel coronary revascularization. The small incision reduces the risk of infection and blood loss. It is safe, easy and requires no special operative instruments.
Abstract: Objective To study the impact of different kinds of mechanical circulation support devices on plasma free hemoglobin(FHb). Methods From Mar. 2004 to Dec. 2005, 20 patients received mechanical circulation support in Fu Wai Hospital, who were divided into 4 groups according to the different type of supporting devices. 9 got extracorporeal membrane oxygenation (ECMO) treatment, 8 received BVS5000 left ventricular support, 2 got MEDOS left ventricular support and 1 received AB5000 left ventricular support. Random control group included 9 cardiotomy patients after CPB supporting and 9 patients with offpump coronary artery bypass grafting during the same period. Parameters such as FHb, Tbil, Dbil, Cr and BUN were monitored throughout the supporting term. The results were compared according to the different types of mechanical circulation support devices. Results The elevation of FHb caused by CPB could be decreased to normal within 1d. However, in BVS5000 group, the elevated FHb level decreased to normal till 2 days later. The others mechanical circulation support devices such as ECMO, MEDOS, AB5000 elevated the FHb throughout the whole supporting period. Compared with those in ECMO group, the patients in BVS5000 group had obviously lower level of FHb since the third day after the beginning of supporting. In patients who got ECMO treatment, there was a trend that the elevation degree of FHb was lower in those with support flow rate less than 2.5 L/min. For most patients got devices support, there was also an elevation of Tbil and BUN level during the supporting period. Conclusion Mechanical circulation support devices, such as ECMO, BVS5000, MEDOS and AB5000, can cause red cell destruction in acceptable level. BVS5000 has much smaller impact on cell destruction than others do in postoperative patients.
Objective To investigate the surgical indications and the mid and long term results of morphologic tricuspid valve replacement for corrected transposition of the great arteries（cTGA）. Methods From September 1997 to September 2007, 18 cases with cTGA were treated in Fu Wai Hospital. There were 15 male and 3 female, aged from 16 to 51 years（33.3±12.8 years）, and weighed from 47 to 90 kg(60.9±14.7 kg). There were 10 cases with isolated morphologic tricuspid valve insufficiency, 3 complicated with ventricular septal defect, 2 complicated with ventricular septal defect and pulmonary valve stenosis, 2 with morphologic tricuspid valve insufficiency after septal defect repair, and 1 with mechanical valve dysfunction after morphologic tricuspid valve replacement. The preoperative mean morphologic right ventricle ejection fraction was 562%±11.6%. Of the 18 cases, 12 were in grade Ⅱ and 6 were in grade Ⅲ according to New York Heart classification（NYHA）.All the cases had undergone morphologic tricuspid valve replacement. Postoperative indices such as cardiac function and morphological right ventricle ejection fraction were followed up. Results One patient died of postoperative low cardiac output syndrome. Two had pervavlvular leak, which were cured by pervavlvular leak repair at 7th and 30th day after operation, respectively. Sixteen were followed up with a followup time of 57.0±407 months. There was no statistical significance between preoperative and postoperative mean morphologic right ventricle ejection fraction（52.8%±9.2% vs.56.2%±11.6%; t=2.062, Pgt;0.05）. The followup showed that 12 were in NYHA grade Ⅰ or Ⅱ, and 4 were in NYHA grade Ⅲ. There was no statistical significance between preoperative and postoperative percentage of cases in NYHA grade Ⅲ（χ2=1.532，Pgt;0.05）. Conclusion Morphologic tricuspid valve replacement can prevent the further damage to morphologic right ventricular function caused by morphologic tricuspid valve insufficiency. The mid and long term results were satisfying. During the followup, the morphologic right ventricle can function appropriately.
Heart failure is a leading cause of death in human populations. Because of the insufficient numbers of donor hearts, ventricular assist as a way for the treatment of heart failure and its clinical use is increasing. Initially ventricular assist devices were approved as a bridge-to-recovery indication, and these systems are now increasingly being used as a bridge-to-transplant (BTT) , destination therapy (DT) or permanent support. According to the different structure and working mechanism, ventricular assist device is generally divided into three generation. This review makes a summary on the type of blood pump and its research progress in clinical application.
Objective To summarize the clinical experiences of venoarterial extracorporeal membrane oxygenation (ECMO) which provides temporary cardiopulmonary assist for critical patients, and preliminary analysis of the cause of failure. Methods From February 2005 to October 2008, 58 adult patients (male 42, female 16) undergoing cardiogenic shock required temporary ECMO support. Age was 44.8±17.6 years, and support duration of ECMO was 131.9±104.7 hours. There were 24 patients (41.4%) with coronary heart disease, 11 patients (19.0%) with cardiomyopathy, 10 patients (17.2%) with cardiac valve disease,and 9 patients (15.5%) with congenital heart disease. Results 22 patients died in hospital. 11 patients (50%) died of multisystem organ failure, 5 patients (22.7%) died of refractory heart failure despite the ECMO support. Another patients died of bleeding and severe pulmonary hypertension etc. The percentage for patients need cardiac resuscitation before ECMO support and patients with acute renal failure treated by continuous renal replacement therapy (CRRT) under ECMO support were obviously higher in dead patients than those in survivor patients (45.5% vs.19.4%, 40.9% vs. 5.6%; P=0.043，0.001). All of the discharged patients were reassessed, mean followup time were 15.6 months. Three patients died of refractory heart failure， 1 patient died of neurologic complications. The other 32 survivors were in good condition with cardiac symptom of New York Heart Association class Ⅰ or Ⅱ. Conclusion ECMO offers effective cardiopulmonary support in adults. Early intervention and control of complications could improve our results with increasing experience. Combining using CRRT during the ECMO support is associated with significantly higher mortality rate. Suffered cardiac arrest prior to ECMO also influences the survival.
Abstract： Objective To compare minimally invasive technique with multiple short incisions and traditional open technique for great saphenous vein (GSV) harvesting in coronary artery bypass grafting (CABG). Methods Fortyseven patients underwent first time CABG between November 2007 to January 2009. These patients included 37 males and 10 females with their age ranged from 43 to 78 years and their average age was 61.3±84 years old. The patients were prospectively randomized into the minimally invasive harvesting group (group A,n=21) and the traditional open harvesting group (group B, n=26). For group A, we adopted the method of minimally invasive technique with multiple short incisions, while for group B, the traditional long incisions were adopted. The incision length, GSV harvesting time, lower limbs suture time and incision complications were compared between the two groups. Results During harvesting, no injury to the saphenous vein trunk or complications related to the quality of venous grafts occurred in both groups. There were no significantly differences in the number of venous grafts and the GSV length between the two groups. Group A had significantly longer GSV harvesting time than group B (51.9±11.5 min vs. 40.3±7.6 min,P=0.000). However, incision length (16.1±4.1 cm vs. 49.2±7.2 cm, P=0.000), incision suture time (11.0±3.0 min vs. 33.6±4.8 min,P=0.000) and lower limbs total operation time (62.6±14.9 min vs.73.8±11.6 min,P=0.006) in group A were much shorter than those in group B. Fortyseven patients were followed up (100%) and the followup time ranged from 3 to 26 months. The rate of leg wound complications such as serous exudates, hematomas and wound infection was 4.8% (1/21) in Group A and 34.6% (9/26) in Group B. These complications were all cured with additional treatments. Group A had lower leg wound complication rate than Group B (Plt;0.05). Conclusion Our study demonstrates that minimally invasive technique for GSV harvesting can be performed at a satisfactory speed and helpful in decreasing the lower limb incision complication rate.
Coronary artery bypass grafting (CABG) is an effective method for the treatment of coronary heart disease at present. However, there is still a high rate of vein graft occlusion after CABG, which has a serious impact on the short and long-term clinical results. Venous access technique has been considered as an important factor on affecting the long-term patency rate. Compared with harvesting technology of the open saphenous vein harvesting, no-touch technology retained the surrounding tissue and vascular adventitia of great saphenous vein, and it avoided the high pressure of expansion vein. After CABG was performed by using the no-touch technique, the vein grafts obtained a better short and long-term patency rate, but the effect still needs further clinical verification.