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Jiang W.-J.,Ministry of Education | Jiang W.-J.,Capital Medical University | Jiang W.-J.,Key Laboratory of Remodeling Related Cardiovascular Disease | Cui Y.-C.,Capital Medical University | And 14 more authors.
Texas Heart Institute Journal | Year: 2015

Pericardial calcification is detrimental to the long-term durability of valvuloplasty. However, whether calcification susceptibility differs between heterologous and autologous pericardium is unclear. In this study, we compared the progression of calcification in vivo between autologous and heterologous pericardium. We randomly divided 28 rabbits into 4 equal groups. Resected rabbit pericardium served as autologous pericardium, and commercial bovine pericardium served as heterologous pericardium. We subcutaneously embedded one of each pericardial patch in the abdominal walls of 21 of the rabbits. The 7 control rabbits (group A) received no implants. The embedded samples were removed at 2 months in group B, at 4 months in group C, and at 6 months in group D. Each collected sample was divided into 2 parts, one for calcium-content measurement by means of atomic-absorption spectroscopy, and one for morphologic and histopathologic examinations. When compared with the autologous pericardium, calcium levels in the heterologous pericardium were higher in groups B, C, and D (P <0.0001, P <0.0002, and P <0.0006, respectively). As embedding time increased, calcium levels in the heterologous pericardium increased faster than those in the autologous, especially in group D. Disorganized arrangements of collagenous fibers, marked calculus, and ossification were seen in the heterologous pericardium. Inflammatory cells—mainly lymphocytes and small numbers of macrophages—infiltrated the heterologous pericardium. The autologous pericardium showed a stronger ability to resist calcification. Our results indicate that autologous pericardium might be a relatively better choice for valvuloplasty. © 2015 by the Texas Heart ® Institute, Houston

Jiang W.-J.,Capital Medical University | Jiang W.-J.,Beijing Institute of Heart | Jiang W.-J.,Precision for Medicine | Jiang W.-J.,Key Laboratory of Remodeling related Cardiovascular Disease | And 38 more authors.
International Journal of Cardiology | Year: 2016

Objective Mitral regurgitation is common in patients with aortic root aneurysm. Mitral valve repair (MVP) or replacement (MVR) can be performed for these patients through either a transverse aortotomy (TA) or transseptal approach (TS). This study sought to compare the early outcomes of mitral valve surgery through the TA and TS approaches and decide which is optimal for this subset of patients. Methods Between March 2013 and April 2015, we operated on 99 patients (81 males, 81.8%) with aortic root aneurysm who developed mitral regurgitation. Mean age was 47.8 ± 16.5 years. MVR was performed in 66 patients (TAR = 27; TSR = 39) and MVP in 33 (TAP = 8; TSP = 25). The baseline and operative outcomes data were compared between patients with MVR and MVP through the TA vs TS approaches. Results Preoperatively, the mitral regurgitation area was significantly larger in the MVR than MVP groups (8.9 ± 2.0 vs 7.8 ± 3.8 cm2, p = 0.0009), and in the TSP vs TAP groups (8.5 ± 4.1 vs 5.6 ± 1.3 cm2, p = 0.0049), but no significant difference was found between the TAR and TSR groups (8.7 ± 2.2 vs 9.0 ± 1.8 cm2, p = 0.4681); the aortic sinus size was significantly larger in the TAR than TSR group (66.7 ± 15.8 vs 52.1 ± 8.8 mm, p = 0.0061). Subvalvular structure was preserved in 12 MVR patients (18.2%). In MVP patients, Kay annuloplasty was used in 11 (33.3%) and annuloplastic ring in 22 (66.7%). The times of cardiopulmonary bypass (CPB) and cross-clamp in patients with TA approach were significantly shorter compared to those with the TS approach (139 ± 34 vs 176 ± 38 min, p = 0.0001; 101 ± 26 vs 129 ± 31 min, p = 0.0002). No cases of mortality, stroke and renal failure occurred in the whole series. The amount of transfusion, lengths of ICU and hospital stay did not differ between patients with MVR and MVP, and between the TA and TS approaches. Conclusions Both the TA and TS approaches achieved good early outcomes in MV surgery for patients with root aneurysm. The transverse aortotomy was associated with shorter CPB and cross-clamp times. Surgical approaches should be selected according to the underlying mitral valve etiology and the size of the aortic root. © 2016

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