Gao P.,Peking Union Medical College |
Gao P.,Research Center for Cardiovascular Regenerative Medicine |
Xiong H.,Peking Union Medical College |
Zheng Z.,Peking Union Medical College |
And 5 more authors.
Platelets | Year: 2010
"One-stop" hybrid coronary revascularization has emerged to be a reliable and attractive alternative for selected patients with multivessel coronary artery disease. However, the optimal antiplatelet regimen of the one-stop hybrid procedure still remains controversial. We modified the antiplatelet protocol in order to reduce the risk of perioperative bleeding and maximally inhibit platelet activity. This study sought to investigate whether the inhibition of platelet activity by this modified antiplatelet protocol is comparable with the conventional protocol widely used and recommended in percutaneous coronary interventions (PCI). Twenty three patients undergoing one-stop hybrid procedure and 20 patients undergoing conventional PCI were enrolled in this prospective study. The modified antiplatelet protocol included perioperative use of aspirin; clopidogrel was administered immediately before PCI with a 300 mg loading dose, followed by a maintenance dose of 75 mg/day for 12 months. Blood samples were obtained before the operation and 2 hours, day 1 and day 3 after operation. Platelet aggregation was induced with: 1) arachidonic acid (AA) (final concentration 0.5 mmol/L) to assess the efficacy of aspirin; 2) adenosine diphosphate (ADP) (final concentration 10 mol/L) to assess the specific efficacy of clopidogrel. Platelet counts were statistically lower in the hybrid group than in the PCI control group (p=0.0018) on day 1 after operation. AA-induced platelet aggregation increased significantly in comparison with the preoperative baseline values (p=0.0079) and the PCI control group (p=0.0023) on day 1 after operation. ADP-induced platelet aggregation gradually decreased in the hybrid group, and achieved similar platelet inhibition with the PCI group on 2 hours and day 1 after operation. No major adverse clinical events such as death, perioperative myocardial infarction, stent thrombosis or reoperation for bleeding occurred in both groups within 30 days after procedure. These results demonstrate that our modified antiplatelet therapy can sufficiently inhibit platelet activity similarly as the conventional protocol for PCI early after operation. Thus, this modified protocol, with continuous use of aspirin and intraoperative administration of loading dose clopidogrel, might be a safe and effective antiplatelet strategy for the one-stop hybrid coronary revascularization. © 2010 Informa Healthcare Ltd.
Hu S.-S.,Peking Union Medical College |
Hu S.-S.,Research Center for Cardiovascular Regenerative Medicine |
Xiong H.,Peking Union Medical College |
Zheng Z.,Peking Union Medical College |
And 9 more authors.
Heart Surgery Forum | Year: 2012
Background: The purpose of this study was to evaluate the feasibility, safety, and midterm outcomes of a simultaneous hybrid revascularization strategy for left main coronary artery disease (LMCAD), compared with conventional off-pump coronary artery bypass grafting (OPCAB). Methods: We compared the in-hospital and midterm outcomes of a simultaneous hybrid revascularization strategy (minimally invasive direct coronary bypass grafting of the left anterior descending coronary artery [LAD] and percutaneous intervention to non-LAD lesions) in 20 patients with LMCAD in an enhanced operating room. These patients were matched by propensity score to a group of 20 control patients who underwent standard OPCAB between September 2007 and December 2009. Results: All baseline clinical characteristics of the 2 groups were similar. All of the patients in the 2 groups underwent surgery uneventfully without conversion to on-pump coronary artery bypass grafting. Compared with OPCAB, the patients in the hybrid group had shorter lengths of stay in the intensive care unit (34.8 ± 37.6 hours versus 50.7 ± 34.5 hours, P = .01). Transfusion requirements were reduced in the hybrid patients compared with the OPCAB patients (5% versus 40%, P = .01). The 2 groups did not differ with respect to the occurrence of other important morbidities. During the mean (±SD) follow-up of 18.5 ± 9.8 months, the group of patients who underwent the simultaneous hybrid procedure experienced an incidence of major adverse cardiac or cerebrovascular events that was similar to that of the OPCAB control group (100% versus 90%, respectively; P = .31). Conclusions: The midterm follow-up indicated that the simultaneous hybrid revascularization procedure for LMCAD is feasible, safe, and effective. These promising early findings warrant further prospective investigations.
Xin Y.,Chinese Academy of Sciences |
Xin Y.,Research Center for Cardiovascular Regenerative Medicine |
Wang Y.-M.,Research Center for Cardiovascular Regenerative Medicine |
Wang Y.-M.,Chinese PLA General Hospital |
And 7 more authors.
Artificial Organs | Year: 2010
Our aim was to study the aging effects on the in vitro biological properties of bone marrow-derived mesenchymal stem cells (BMSCs) for construction of tissue-engineered heart valves. BMSCs were taken from teenagers with congenital heart diseases, and middle-aged and elderly patients with valvular diseases. Proliferative abilities were compared among the three groups by using colony-forming unit counting and growth curves (5-bromo-2′- deoxyuridine assay). Cell differentiation, vascular endothelial growth factor (VEGF) release under hypoxic condition, and migratory abilities were compared as well. Colony-forming units in the teenage group were significantly greater than those in the other two groups (P < 0.05), and significantly higher counts were observed in the middle age group than in the aged group (P < 0.05). Growth curves presented similar trends in which cells' proliferative abilities in the aged group decreased significantly (P < 0.05), while no differences were noted between the two nonaged groups. The differentiation potential to endothelial cells, osteoblasts and adipocytes, VEGF releases, and migratory abilities differed significantly between the aged group and nonaged groups (P < 0.05). However, no differences were noted between the two nonaged groups. BMSCs from older patients with heart valve diseases could be harvested and expanded successfully, and the phenotype and morphology were uniform as nonaged groups. However, the proliferative and differentiation properties of aged cells, as well as cytokine release and migratory abilities, are significantly impaired.
Zhang C.,Chinese Academy of Sciences |
Zhang C.,Research Center for Cardiovascular Regenerative Medicine |
Hou J.,Chinese Academy of Sciences |
Hou J.,Research Center for Cardiovascular Regenerative Medicine |
And 6 more authors.
Annals of Thoracic Surgery | Year: 2011
Background: The tissue-engineered cardiac patch can alleviate ventricular remodeling and improve functional recovery in experimental myocardial infarction. However, the size of the engineered patch is limited due to insufficient vascularization. This study evaluated the effects of autologous atrial tissue patch cardiomyoplasty and omentopexy in rats with myocardial infarction. Methods: Myocardial infarction was induced by left coronary artery ligation in Sprague-Dawley rats. Three weeks later, either a patch of left atrium (A group) or omentum (O group) or both (OA group) were placed over the infarct zone. The atrial tissue patch was harvested from the autologous left atrial appendage along its long axis. The rats in the Control group received rethoracotomy only. After 4 weeks, the survival of the transplanted atrial tissue patch, ventricular remodeling, and cardiac performance were examined. Results: After 4 weeks, surviving myocardium was only detected in the OA group, as indicated by immunolabeling of cardiac troponin-I. Compared with the Control group, only animals in the OA group showed improved heart function assessed by left ventricular ejection fraction (57.9% ± 5.8% vs 47.5% ± 4.5%, p < 0.05) and left ventricular fractional shortening (25.2% ± 3.6% vs 20.7% ± 2.0%, p < 0.05). The histologic analysis demonstrated increased scar thickness in the OA group. This was accompanied by increased angiogenesis of the border zone but decreased expression and activity of matrix metalloproteinase and endothelin-1 levels. Conclusions: The omentopexy supported the survival of the autologous atrial tissue patch, which resulted in attenuated ventricular remodeling and restoration of heart function in rats with myocardial infarction. Our findings might represent a novel therapeutic strategy for heart failure. © 2011 The Society of Thoracic Surgeons.
Chen H.,Research Center for Cardiovascular Regenerative Medicine |
Chen H.,Chinese Academy of Sciences |
Zhou J.,Research Center for Cardiovascular Regenerative Medicine |
Sun H.,Chinese Academy of Sciences |
And 5 more authors.
ASAIO Journal | Year: 2011
We investigated the outcome of FW-II axial pump on healthy sheep (weight, 60-70 kg) for 2 weeks by perioperatively hematological and chemical tests, and circulating activated platelet and leukocyte-platelet aggregates measurements by flow cytometry assays. Complete necropsy and histopathological examinations and thorough pump inspection were performed at study termination for evidence of thrombi. In this experimental series, one sheep died of pulmonary edema, the other four sheep reached the scheduled endpoint of 14 days without device-related problems, and flow range was maintained at 2.5-4.0 L/min. The number of red blood cells and platelets decreased within first 3 days but increased gradually after the first postoperative week. In all animals, serum glutamic oxaloacetic transaminase increased significantly after surgery but gradually returned to normal limits within 2 weeks. Platelet activation, granulocyte-platelet aggregates, and monocyte-platelet aggregates reached the peak at postoperative day 2. Postexplant examinations indicated round thrombus in the hub areas of pumps. No evidence of ischemia or infarction was found in the explanted hearts, livers, spleens, kidneys, and brains of the five animals. Our results demonstrate that FW-II ventricular assist device (VAD) is a promising device for left ventricular (LV) support with moderate anticoagulation. © 2011 Amercian Society of Artificial Internal Organs.