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Zhang L.,PLA Institute of Cardiac Surgery
Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences | Year: 2012

To determine the impact of prior percutaneous coronary intervention (PCI) on outcome of coronary artery bypass graft (CABG) surgery. Perioperative data were collected from 1306 patients undergoing CABG from January 2002 to November 2010, including 117 patients with prior PCI and 1 189 patients without prior PCI. Among 117 patients with prior PCI, 99 patients had a single PCI procedure and 18 had multiple PCI procedures. The surgical outcomes including in-hospital mortality and major adverse cardiac events were compared between two groups. Patients with prior PCI were younger, less likely to have triple vessel and left main stem disease, and less recent myocardial infarction. Interval time between PCI and CABG was (13.39 ± 13.81) months. There were no significant difference in in-hospital mortality (1.7% compared with 0.5 % P=0.156) and major adverse cardiac events (including postoperative myocardial infarction, stroke, and in-hospital death,2.6% compared with 1.1% P=0.167) between two groups. There was no association between prior PCI and isolated CABG. Good outcomes can be obtained in the group of patients undergoing CABG who have had previous PCI. Source

Wang G.,PLA Institute of Cardiac Surgery | Gao C.,PLA Institute of Cardiac Surgery
Postgraduate Medical Journal | Year: 2014

Robotic cardiac surgery with the da Vinci robotic surgical system offers the benefits of a minimally invasive procedure, including a smaller incision and scar, reduced risk of infection, less pain and trauma, less bleeding and blood transfusion requirements, shorter hospital stay and decreased recovery time. Robotic cardiac surgery includes extracardiac and intracardiac procedures. Extracardiac procedures are often performed on a beating heart. Intracardiac procedures require the aid of peripheral cardiopulmonary bypass via a minithoracotomy. Robotic cardiac surgery, however, poses challenges to the anaesthetist, as the obligatory one-lung ventilation (OLV) and CO2 insufflation may reduce cardiac output and increase pulmonary vascular resistance, potentially resulting in hypoxaemia and haemodynamic compromise. In addition, surgery requires appropriate positioning of specialised cannulae such as an endopulmonary vent, endocoronary sinus catheter, and endoaortic clamp catheter under the guidance of transoesophageal echocardiography. Therefore, cardiac anaesthetists should have a working knowledge of these systems, OLV and haemodynamic support. Source

Li L.,PLA Institute of Cardiac Surgery | Yao Y.,Peking Union Medical College | Wang H.,Chinese PLA General Hospital | Ren Y.,Chinese PLA General Hospital | And 3 more authors.
European Journal of Pharmacology | Year: 2010

Lysophosphatidylcholine (LPC), which accumulates in the ischemic myocardium, is responsible for mechanical and metabolic derangements of hearts, and also contributes to the development of ventricular arrhythmias. We examined the effects of pravastatin on the LPC-induced cardiac dysfunction in isolated rat hearts. Rat hearts were randomly divided into four groups. The groups comprised a control group (n= 10), a group treated with LPC (5 μM) (n= 20), a group treated with pravastatin (400. ng/ml) (n= 10) and a group treated with both LPC and pravastatin (n= 20). Our data suggest that, pravastatin possesses some protective profiles against LPC, as manifested by better recovery of cardiac function (improvement in heart rate, left ventricular developed pressure, maximal and minimal first derivatives of left ventricular developed pressure, coronary flow and coronary resistance, less release of biomarkers of cardiac injury (lactate dehydrogenase, creatine kinase-MB and endothelin-1), and attenuation of ventricular arrhythmias (ventricular tachyarrhythmia and ventricular fibrillation). © 2010 Elsevier B.V. Source

Zhang L.,PLA Institute of Cardiac Surgery | Gao C.-Q.,PLA Institute of Cardiac Surgery | Wang R.,PLA Institute of Cardiac Surgery | Li L.-B.,PLA Institute of Cardiac Surgery | And 2 more authors.
Chinese Journal of Tissue Engineering Research | Year: 2014

Background: Cell therapy by the implantation of autologous bone marrow cells has been used for the treatment of ischemic heart diseases in clinical trials for decade. However, as the outcomes of cell transplantation obviously vary among patients, it is essential to identify the risk factors that may influence the level and function of progenitor cells in bone marrow, in order to identify the patients who would benefit the most from this treatment. Objective: To observe the impact of perioperative cardiovascular risk factors on number and function of bone marrow progenitor cells from patients undergoing coronary artery bypass grafting surgery. Methods: We collected clinical and laboratory data from 44 patients scheduled to undergo sternotomy for coronary artery bypass grafting procedures. Bone marrow was aspirated from the sternum during the operation and bone marrow mononuclear cells were isolated by density centrifugation with Ficoll lymphoprep and then detected using trypan blue exclusion method. Levels of progenitor cells in bone marrow were evaluated using flow cytometry. Function of bone marrow progenitor cells were assessed by clonogenic and migration assays. Results and Conclusion: We assessed the number of bone marrow mononuclear cells out of 20 mL bone marrow in duplicate samples from patients with coronary heart disease scheduled for coronary artery bypass grafting that was (10-89)×106 cells with over 95% activity. A negative correlation was observed between the number of bone marrow mononuclear cells and the age (n=44, r=-0.788, P=0.001). Levels of CD34 +, CD133+, and CD34+ CD133+ cells in bone marrow mononuclear cells was (0.94±0.39)%, (0.46±0.28)%, and (0.53±0.26)%. Levels of CD34+ cells and CD133+ cells in patients with diabetes were significantlylower than those in patients without diabetes. Female, advanced age and poor heart function were related with reduced colony-forming ability of progenitor cells. A positive correlation was observed between level of CD34+ cells and migration ability of bone marrow mononuclear cells. The results show that by density gradient centrifugation, we can harvest a sufficient number of bone marrow mononuclear cells in the treatment for ischemic heart disease. Age, gender, diabetes, heart function are correlated with bone marrow mononuclear cell number and functions. Source

Gao C.,PLA Institute of Cardiac Surgery | Yang M.,PLA Institute of Cardiac Surgery | Wang G.,PLA Institute of Cardiac Surgery | Wang J.,PLA Institute of Cardiac Surgery | And 3 more authors.
Heart Surgery Forum | Year: 2010

Background: Atrial septal defect (ASD) repairs have successfully been performed on the arrested heart with the da Vinci S Surgical System (Intuitive Surgical). This study assessed the feasibility, safety, and efficacy of the use of the da Vinci S Surgical System for on-pump ASD repairs on the beating heart without cross-clamping the aorta. Methods: This prospective study included 24 consecutive patients who underwent ASD repair surgery between June 2008 and June 2009. All of the procedures were completed with the da Vinci S robot via 3 port incisions in the right chest and a 1.5-cm working port. The operations were carried out on the beating heart with mild hypothermic cardiopulmonary bypass (CPB) without cross-clamping the aorta. Venting the heart from the working port provided adequate visualization of the operative field. Results: All patients underwent complete repairs. Fourteen patients underwent ASD closure with a fresh autogenous pericardial patch, and 10 patients underwent direct ASD closure. Concomitant surgery was required in 4 patients. The mean (±SEM) CPB time was 65.6 ± 17.7 minutes, and the mean operative time was 98.5 ± 19.3 minutes. No patient required transfusion of red blood cells. The length of patient stay in the intensive care unit was 0.5 to 1.0 days. The length of hospital stay was 4 to 5 days. Follow-up transthoracic echocardiography evaluations showed no residual atrial septal leakage. There were no operative deaths, strokes, or other complications. All of the patients were discharged. Conclusions: We have shown that use of the da Vinci S Surgical System to perform on-pump ASD repairs on the beating heart without cross-clamping the aorta is feasible, safe, and effective. © 2010 Forum Multimedia Publishing, LLC. Source

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