BACKGROUND Aortic dissection is a complex and dangerous cardiovascular disease,with many complications in the perioperative period,including severe acute respiratory distress syndrome(ARDS),which affects prognosis and...BACKGROUND Aortic dissection is a complex and dangerous cardiovascular disease,with many complications in the perioperative period,including severe acute respiratory distress syndrome(ARDS),which affects prognosis and increases mortality.Despite the effect of prone positioning(PP)in improving oxygenation in patients with severe ARDS,reports about PP early after cardiac surgery are few and such an opt-ion may be an issue in cardiac surgery patients because of the recent sternotomy.CASE SUMMARY A 40-year-old male patient diagnosed with acute type A aortic dissection on October 22,2021 underwent ascending artery replacement plus total aortic arch replacement plus stent elephant trunk implantation under cardiopulmonary bypass.Unfortunately,he developed ARDS on postoperative day 1.Despite comprehensive treatment with aggressive pulmonary protective ventilation,fluid management with continuous renal replacement therapy,the condition continued to deteriorate and rapidly progressed to severe ARDS with a minimum oxygenation index of 51.We are ready to implement salvage therapy,including PP and extracorporeal membrane oxygenation(ECMO).Due to the large amount of pericardial mediastinal and thoracic drainage after thoracotomy,ECMO may result in massive postoperative bleeding.Prolonged prone ventilation is often inappropriate after thoracotomy.Therefore,we chose short-term PP for<6 h.Finally,the oxygenation index greatly improved and the diffuse exudation in both lungs of the patient was significantly reduced with short-term prone positioning.CONCLUSION Intermittent short-term PP can improve early postoperative severe ARDS after acute aortic dissection.展开更多
Objective: To evaluate the clinical effect and quality of life (QOL) in coronary artery bypass grafting (CABG) patients treated according to syndrome differentiation of TCM. Methods: Eighty-two CABG patients were allo...Objective: To evaluate the clinical effect and quality of life (QOL) in coronary artery bypass grafting (CABG) patients treated according to syndrome differentiation of TCM. Methods: Eighty-two CABG patients were allocated in the control group (n = 39) treated with conventional method of western medicine, and the TCM-treated group (n展开更多
Objective Metabolic syndrome (MS),a disorder involving multiple metabolic abnormalities such obesity,hypertension,diabetes or abnormal glucose tolerance anddyslipidemia,has been observed in many patients receiving cor...Objective Metabolic syndrome (MS),a disorder involving multiple metabolic abnormalities such obesity,hypertension,diabetes or abnormal glucose tolerance anddyslipidemia,has been observed in many patients receiving coronary artery bypass procedures. In this study we try to examine the perioperative effects of metabolic syndrome on the off-pump coronary artery展开更多
Although the lung injury caused by cardiopulmonary bypass(CPB)has been extensively investigated,the incidence and mortality of lung injury after CPB remain a prominent clinical problem.The poor outcome has been attrib...Although the lung injury caused by cardiopulmonary bypass(CPB)has been extensively investigated,the incidence and mortality of lung injury after CPB remain a prominent clinical problem.The poor outcome has been attributed to multifactorial etiology,including the systemic inflammatory response and ischemia reperfusion(I/R)injury during CPB.Lung injury after CPB is a complex pathophysiological process and has many clinical manifestations of mild to severe disease.Which is associated with prognosis.To alleviate this lung injury,interventions that address the pathogenesis are particularly important.This review summarizes the pathogenesis,mechanism and treatment options of lung injury after CPB,such as lung protection with intralipid.展开更多
Despite the technique of cardiopulmonary bypass(CPB)improved the development of modern cardiac surgery,many factors during CPB have been reported to induce acute respiratory distress syndrome(ARDS).The present study w...Despite the technique of cardiopulmonary bypass(CPB)improved the development of modern cardiac surgery,many factors during CPB have been reported to induce acute respiratory distress syndrome(ARDS).The present study was to investigate which pro-inflammatory factors involved in the early phase of ARDS.Ten patients underwent valve replacement surgery with or without ARDS were enrolled for analysis of pulmonary function and inflammatory factors release including white blood cell(WBC),neutrophils,CD11b,CD18,interleukin(IL)-8 and tumor necrosis factor-α(TNF-α).The results demonstrated that the ratio of arterial oxygen tension/fraction of inspire oxygen(PaO_(2)/FiO_(2))was greatly reduced in ARDS patients,but only the release of TNF-α was significantly increased,which was reversely correlated to the values of PaO_(2)/FiO_(2).Also,the count of neutrophils adhesive to pulmonary endothelial cells was significantly increased in ARDS patients.Therefore,we concluded that TNF-α was quickly up-regulated and involved in the pathogenesis of CPB-induced ARDS via guiding primed neutrophils to pulmonary interstitium.展开更多
Objective To investigate the fluctuations in arterial leukocyte phospholipase D (PLD) activity during the perioperative period of open heart surgery under cardiopulmonary bypass ( CPB), and the relationship between PL...Objective To investigate the fluctuations in arterial leukocyte phospholipase D (PLD) activity during the perioperative period of open heart surgery under cardiopulmonary bypass ( CPB), and the relationship between PLD activity and systemic inflammatory response induced by CPB.Methods Arterial blood was obtained from 26 patients undergoing open heart surgery at 8 different time points during the perioperative period, from which leukocytes were isolated for determination of PLD activity, CD11b expression and myeloperoxidase (MPO) activity. Plasma IL-6, IL-8 and C-reactive protein were also determined. The 26 cases were retrospectively divided into 3 groups according to perfusion time in order to detect the possible influences of CPB on PLD activity and IL-6 and IL-8 levels.Results When the ascending aorta was declamped, average arterial leukocyte PLD activity was 0. 305±0.132 nmol choline·min-1·mg-1, 5. 0 times higher of the pre-CPB value, and remained (5. 4 times higher of the pre-CPB level) at 72 hours after CPB. Leukocyte CD11 b expression and plasma IL-6 and IL-8 levels increased significantly at the end of CPB, while MPO activity and C-reactive protein concentration reached their peaks at 1 and 24 hours, respectively, after CPB. At the end of CPB, the arterial leukocyte PLD activity of patients whose CPB duration was longer than 90 minutes were 1. 82- and 1. 74-fold that of the other two groups with CPB lasting between 90 and 60 minutes and less than 60 minutes.Conclusions Arterial leukocyte PLD activity rises significantly in CPB and its elevation is earlier and more persistent than other inflammation-related indicators tested; longer CPB duration leads to higher leukocyte PLD activity at the end of CPB. These results imply that PLD could be a new target for prevention of systemic inflammatory response induced by CPB.展开更多
Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG).Methods: One week after operation, thirty-sev...Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG).Methods: One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre- or post-operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored.Results: In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri-operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation.Conclusion: TCM SD conducting in peri-operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri-operative complications and elevating success rate of operation.展开更多
Coronary artery bypass grafting (CABG) is considered as a more complete means of revascularization than percutaneous coronary intervention (PCI). However, acute coronary syndrome (ACS) can still occur after CABG. The ...Coronary artery bypass grafting (CABG) is considered as a more complete means of revascularization than percutaneous coronary intervention (PCI). However, acute coronary syndrome (ACS) can still occur after CABG. The culprit vessel can be the graft vessel or the native vessel. Many questions remain unanswered in the Chinese literature regarding this topic: what are the short- and long-term pathological changes that induce ACS? Is there any difference between arterial and venous grafts with respect to the frequency of restenosis? Are there any patterns of ACS-related vessels in different periods after CABG? We aim to answer these fundamental questions by analyzing coronary angiographies of patients with recurrent ACS following CABG and provide evidence for reducing post-CABG restenosis.展开更多
The etiology of vasoplegic syndrome （VS） is not completely elucidated and the clinical im- portance remains speculative. Methods Twenty-four patients who underwent coronary artery bypass grafting and developed VS we...The etiology of vasoplegic syndrome （VS） is not completely elucidated and the clinical im- portance remains speculative. Methods Twenty-four patients who underwent coronary artery bypass grafting and developed VS were compared with 48 control patients without VS in a 2：1 case control study. Cases and controls were matched by gender, age （ ± 5 years old） and operation date （ ±1 week）. Results The inde- pendent predictors of VS were lower ejection fraction （OR 10.75, 95% CI 2.93-39.44, when LVEF 〈 0.45） and diuretic use （OR 8.98, 95% CI 2.59-31.10） in logistic regression analysis. Conclusion lower ejection fraction （ 〈 0.45） and diuretic use are independent risk factors for VS occurrence.展开更多
In patients with history of coronary artery disease angina pectoris is usually attributed to the progression of atherosclerotic lesions. However,in patients with previous coronary artery bypass graft operation(CABG) u...In patients with history of coronary artery disease angina pectoris is usually attributed to the progression of atherosclerotic lesions. However,in patients with previous coronary artery bypass graft operation(CABG) using internal mammary artery grafts,great vessel disease should also be considered. Herein we present two patients with history of CABG whose symptoms were suspicious for coronary ischemia. During cardiac catheterization reverse blood flow was observed from the left artery disease to the left internal mammary artery(LIMA) graft in both cases. After angioplasty and stent implantation of the left subclavian artery antegrade flow was restored in the LIMA grafts and both patients had complete resolution of symptoms.展开更多
Metabolic syndrome(MS)is defined as the constellation of obesity,insulin resistance,high serum triglycerides,low high-density lipoprotein cholesterol,and high blood pressure.It increasingly affects more and more peopl...Metabolic syndrome(MS)is defined as the constellation of obesity,insulin resistance,high serum triglycerides,low high-density lipoprotein cholesterol,and high blood pressure.It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare,cost,and quality of life associated consequences.MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease.Conservative treatment,which includes diet,exercise,and antidiabetic agents,is the mainstay of treatment,but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations.Bariatric surgery has recently emerged as an appropriate alternative treatment with promising longterm results.Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates.Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with nonalcoholic steatohepatitis has increased more than fivefold over the past 15 years.In this review,we summarize current state of evidence on the surgical treatment of MS.展开更多
基金Supported by the Chongqing Medical Scientific Research Project(Joint Project of Chongqing Health Commission and Science and Technology Bureau),No.2020FYYX163Chongqing Medical Key Discipline Construction Project,No.ZDXK202103Fundamental Research Funds for the Central Universities and Advanced Middle-Aged and Young Medical Talents Project in Chongqing,No.2022CDJYGRH-014。
文摘BACKGROUND Aortic dissection is a complex and dangerous cardiovascular disease,with many complications in the perioperative period,including severe acute respiratory distress syndrome(ARDS),which affects prognosis and increases mortality.Despite the effect of prone positioning(PP)in improving oxygenation in patients with severe ARDS,reports about PP early after cardiac surgery are few and such an opt-ion may be an issue in cardiac surgery patients because of the recent sternotomy.CASE SUMMARY A 40-year-old male patient diagnosed with acute type A aortic dissection on October 22,2021 underwent ascending artery replacement plus total aortic arch replacement plus stent elephant trunk implantation under cardiopulmonary bypass.Unfortunately,he developed ARDS on postoperative day 1.Despite comprehensive treatment with aggressive pulmonary protective ventilation,fluid management with continuous renal replacement therapy,the condition continued to deteriorate and rapidly progressed to severe ARDS with a minimum oxygenation index of 51.We are ready to implement salvage therapy,including PP and extracorporeal membrane oxygenation(ECMO).Due to the large amount of pericardial mediastinal and thoracic drainage after thoracotomy,ECMO may result in massive postoperative bleeding.Prolonged prone ventilation is often inappropriate after thoracotomy.Therefore,we chose short-term PP for<6 h.Finally,the oxygenation index greatly improved and the diffuse exudation in both lungs of the patient was significantly reduced with short-term prone positioning.CONCLUSION Intermittent short-term PP can improve early postoperative severe ARDS after acute aortic dissection.
文摘Objective: To evaluate the clinical effect and quality of life (QOL) in coronary artery bypass grafting (CABG) patients treated according to syndrome differentiation of TCM. Methods: Eighty-two CABG patients were allocated in the control group (n = 39) treated with conventional method of western medicine, and the TCM-treated group (n
文摘Objective Metabolic syndrome (MS),a disorder involving multiple metabolic abnormalities such obesity,hypertension,diabetes or abnormal glucose tolerance anddyslipidemia,has been observed in many patients receiving coronary artery bypass procedures. In this study we try to examine the perioperative effects of metabolic syndrome on the off-pump coronary artery
文摘Although the lung injury caused by cardiopulmonary bypass(CPB)has been extensively investigated,the incidence and mortality of lung injury after CPB remain a prominent clinical problem.The poor outcome has been attributed to multifactorial etiology,including the systemic inflammatory response and ischemia reperfusion(I/R)injury during CPB.Lung injury after CPB is a complex pathophysiological process and has many clinical manifestations of mild to severe disease.Which is associated with prognosis.To alleviate this lung injury,interventions that address the pathogenesis are particularly important.This review summarizes the pathogenesis,mechanism and treatment options of lung injury after CPB,such as lung protection with intralipid.
基金supported by National Natural Science Foundation of China(Grant No.81070117 to Dr.Jin Liu,Grant No.81100180 to Dr.Tao Li and Grant No.30872455 to Dr.Lei Du).
文摘Despite the technique of cardiopulmonary bypass(CPB)improved the development of modern cardiac surgery,many factors during CPB have been reported to induce acute respiratory distress syndrome(ARDS).The present study was to investigate which pro-inflammatory factors involved in the early phase of ARDS.Ten patients underwent valve replacement surgery with or without ARDS were enrolled for analysis of pulmonary function and inflammatory factors release including white blood cell(WBC),neutrophils,CD11b,CD18,interleukin(IL)-8 and tumor necrosis factor-α(TNF-α).The results demonstrated that the ratio of arterial oxygen tension/fraction of inspire oxygen(PaO_(2)/FiO_(2))was greatly reduced in ARDS patients,but only the release of TNF-α was significantly increased,which was reversely correlated to the values of PaO_(2)/FiO_(2).Also,the count of neutrophils adhesive to pulmonary endothelial cells was significantly increased in ARDS patients.Therefore,we concluded that TNF-α was quickly up-regulated and involved in the pathogenesis of CPB-induced ARDS via guiding primed neutrophils to pulmonary interstitium.
基金This work was supported by the National Natural Science Foundation of China(No.39670836)and the Science Foundation of Zhejiang Provincial Health Department(NO,222ZX033).
文摘Objective To investigate the fluctuations in arterial leukocyte phospholipase D (PLD) activity during the perioperative period of open heart surgery under cardiopulmonary bypass ( CPB), and the relationship between PLD activity and systemic inflammatory response induced by CPB.Methods Arterial blood was obtained from 26 patients undergoing open heart surgery at 8 different time points during the perioperative period, from which leukocytes were isolated for determination of PLD activity, CD11b expression and myeloperoxidase (MPO) activity. Plasma IL-6, IL-8 and C-reactive protein were also determined. The 26 cases were retrospectively divided into 3 groups according to perfusion time in order to detect the possible influences of CPB on PLD activity and IL-6 and IL-8 levels.Results When the ascending aorta was declamped, average arterial leukocyte PLD activity was 0. 305±0.132 nmol choline·min-1·mg-1, 5. 0 times higher of the pre-CPB value, and remained (5. 4 times higher of the pre-CPB level) at 72 hours after CPB. Leukocyte CD11 b expression and plasma IL-6 and IL-8 levels increased significantly at the end of CPB, while MPO activity and C-reactive protein concentration reached their peaks at 1 and 24 hours, respectively, after CPB. At the end of CPB, the arterial leukocyte PLD activity of patients whose CPB duration was longer than 90 minutes were 1. 82- and 1. 74-fold that of the other two groups with CPB lasting between 90 and 60 minutes and less than 60 minutes.Conclusions Arterial leukocyte PLD activity rises significantly in CPB and its elevation is earlier and more persistent than other inflammation-related indicators tested; longer CPB duration leads to higher leukocyte PLD activity at the end of CPB. These results imply that PLD could be a new target for prevention of systemic inflammatory response induced by CPB.
文摘Objective: To explore the patterns of Syndrome Differentiation (SD) of coronary heart disease (CHD) patients in peri-operative stage of coronary artery bypass graft (CABG).Methods: One week after operation, thirty-seven CHD patients, who received CABG of internal mammary artery or great saphena vein under conventional general anesthesia with low or middle temperature extracorporeal circulation were differentiated as various syndromes, with the pre- or post-operational EKG, color Doppler echocardiography were done during and after operation. The hemodynamic parameters were monitored.Results: In the CHD patients, 64.9% were differentiated as Qi-Yin deficiency, 67.6% were complicated with phlegm syndrome and 62.2% with blood stasis, suggesting that Qi-deficiency, phlegm and stasis are the basic pathogenetic factors in patients with CABG. Moreover, the peri-operative syndrome was correlated with the condition of coronary artery lesion, heart and lung functions before operation, and the extracorporeal circulation time during the operation.Conclusion: TCM SD conducting in peri-operative stage might be useful in exploring the patterns of syndrome alteration which provided a basis for preventing peri-operative complications and elevating success rate of operation.
文摘Coronary artery bypass grafting (CABG) is considered as a more complete means of revascularization than percutaneous coronary intervention (PCI). However, acute coronary syndrome (ACS) can still occur after CABG. The culprit vessel can be the graft vessel or the native vessel. Many questions remain unanswered in the Chinese literature regarding this topic: what are the short- and long-term pathological changes that induce ACS? Is there any difference between arterial and venous grafts with respect to the frequency of restenosis? Are there any patterns of ACS-related vessels in different periods after CABG? We aim to answer these fundamental questions by analyzing coronary angiographies of patients with recurrent ACS following CABG and provide evidence for reducing post-CABG restenosis.
文摘The etiology of vasoplegic syndrome （VS） is not completely elucidated and the clinical im- portance remains speculative. Methods Twenty-four patients who underwent coronary artery bypass grafting and developed VS were compared with 48 control patients without VS in a 2：1 case control study. Cases and controls were matched by gender, age （ ± 5 years old） and operation date （ ±1 week）. Results The inde- pendent predictors of VS were lower ejection fraction （OR 10.75, 95% CI 2.93-39.44, when LVEF 〈 0.45） and diuretic use （OR 8.98, 95% CI 2.59-31.10） in logistic regression analysis. Conclusion lower ejection fraction （ 〈 0.45） and diuretic use are independent risk factors for VS occurrence.
文摘In patients with history of coronary artery disease angina pectoris is usually attributed to the progression of atherosclerotic lesions. However,in patients with previous coronary artery bypass graft operation(CABG) using internal mammary artery grafts,great vessel disease should also be considered. Herein we present two patients with history of CABG whose symptoms were suspicious for coronary ischemia. During cardiac catheterization reverse blood flow was observed from the left artery disease to the left internal mammary artery(LIMA) graft in both cases. After angioplasty and stent implantation of the left subclavian artery antegrade flow was restored in the LIMA grafts and both patients had complete resolution of symptoms.
文摘Metabolic syndrome(MS)is defined as the constellation of obesity,insulin resistance,high serum triglycerides,low high-density lipoprotein cholesterol,and high blood pressure.It increasingly affects more and more people and progressively evolves into a serious issue with widespread healthcare,cost,and quality of life associated consequences.MS is associated with increased morbidity and mortality due to cardiovascular or chronic liver disease.Conservative treatment,which includes diet,exercise,and antidiabetic agents,is the mainstay of treatment,but depends on patient compliance to medical treatment and adherence to lifestyle modification recommendations.Bariatric surgery has recently emerged as an appropriate alternative treatment with promising longterm results.Sleeve gastrectomy and Roux-en-Y gastric bypass constitute the most commonly performed procedures and have been proven both cost-effective and safe with low complication rates.Liver transplantation is the only definitive treatment for end-stage liver disease and its utilization in patients with nonalcoholic steatohepatitis has increased more than fivefold over the past 15 years.In this review,we summarize current state of evidence on the surgical treatment of MS.
