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Chinese Medical Journal 2011年第6期124卷 958-960页

作者： GUO Hong-wei PAN Shi-wei SONG Yun-hu hu sheng-shou Department of Surgery Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical college Beijing 100037 China

Severe tricuspid regurgitation with permanent pacemaker wire passing through the orifice of bioprosthetic tricuspid valve is extremely rare. We present a case of such kind of patient and redid bioprosthetic tricuspid valve replacement. A hawk mouth forceps for bone surgery was used to cut off the mental ring of ruined bioprosthetic tricuspid valve and the ruined valve was removed. A new bioprosthetic tricuspid valve was implanted and the wire of permanent pacemaker was left outside the ring of bioprosthetic tricuspid valve. This method may be helpful for such kind of patient.

关键词： tricuspid valve replacement bioprosthetic valve complete atrioventricular block reoperation

Is the European System for Cardiac Operative Risk Evaluation useful in Chinese patients undergoing heart valve surgery？

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Chinese Medical Journal 2012年第20期125卷 3624-3628页

作者： ZHENG Shuai ZHENG Zhe FAN Hong-guang hu sheng-shou Department of Cardiovascular Surgery Research Center for Cardiovascular Regenerative MedicineFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Cardiac Surgery Beijing Anzhen HospitalCapital Medical UniversityBeijing 100029China

Background The European System for Cardiac Operative Risk Evaluation （EuroSCORE） is one of the most widely used risk models for the predicting mortality after cardiac surgery. The aim of this study was to validate the EuroSCORE model for predicting operative mortality in heart valve surgery on a Chinese multicenter database and comparing the performance of EuroSCORE with our new risk stratification system, the Sino System for Coronary Operative Risk Evaluation （SinoSCORE）. Methods Data from patients undergoing heart valve surgery between January 2007 and December 2008 were retrospectively collected, from 43 hospitals in China. The EuroSCORE and the SinoSCORE were calculated for each patient. Mortality was defined as any in-hospital death. Area under the receiver operating characteristics curve （AUC） was used to study the discriminatory abilities of the models. The Hosmer-Lemeshow （H-L） goodness-of-fit test was used to study the calibration of the predictive models. Results A total of 15 367 patients were analyzed. For the entire cohort, the observed mortality was 2.34%, the predicted mortality was 3.71% （additive）, 3.19% （logistic） and 3.66% （SinoSCORE）. AUC was 0.747 for SinoSCORE, 0.699 additive and 0.696 for logistic EuroSCORE. Calibration of SinoSCORE and additive EuroSCORE was good （H-L： P=-0.250 and P=0.051, respectively）, but the logistic EuroSCORE model had a poor calibration （H-L： P〈0.05）. The discriminatory ability and calibration of the SinoSCORE were good in low- and high-risk patients, However, the discriminatory ability of the EuroSCORE model was poor in all risk deciles. Conclusions The EuroSCORE does not accurately predict mortality in Chinese patients with heart valve surgery, and the SinoSCORE is superior to the EuroSCORE at predicting in-hospital mortality in Chinese heart valve surgery patients.

关键词： risk evaluation " European System for Cardiac Operative Risk Evaluation " heart valve surgery

Mitigated calcification of glutaraldehyde-fixed bovine pericardium by tannic acid in rats

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Chinese Medical Journal 2008年第17期121卷 1675-1679页

作者： WANG De JIANG Hong LI Jun ZHOU Jian-ye hu sheng-shou Research Center for Cardiovascular Regenerative Medicine Ministry of Health Cardiovascular Institute and Fuwai Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing 100037 China

Background Bioprosthetic heart valves derived from glutaraldehyde （Glut）-fixed xenografts have been widely used to replace diseased cardiac valves. However, calcification and degeneration are common following their implantation. Inflammation is closely associated with calcification of Glut-fixed xenografts via macrophage infiltration. Tannic acid （TA） possesses anti-inflammatory effects. This study was designed to investigate the anti-calcification of TA treatment on the Glut-fixed bovine pericardium （BP） in a rat subdermal model. Methods Fresh BP was divided into two groups （10 in each group） and separately subjected to different fixation procedures as follows：（1） Glut group： fixation with 0.6% Glut alone; （2） Glut/TA group： fixation with 0.6% Glut and subsequent 0.3% TA. Then the BP samples were subdermally implanted in juvenile male Sprague-Dawley rats and explanted 21 days after implantation. Each explanted BP sample was divided into three parts for calcium content analysis von Kossa＇s staining and immunohistochemical staining, and reverse transcription-polymerase chain reaction study. Results The data from quantitative calcium analysis and von Kossa＇s staining showed that Glut-fixed BP developed significantly more calcification than Glut/TA-fixed BP （（90.3＋32.5） mg/g dry weight vs （6.4_＋1.3） mg/g dry tissue, P 〈0.01）. Immunostaining demonstrated lower matrix metalloproteinase-9 and tenascin-C expression as well as macrophage infiltration into Glut/TA-fixed BP than in its Glut-fixed counterpart （P 〈0.01 for all）. Additionally, the reverse transcription-polymerase chain reaction study showed that higher levels of expression of matrix metalloproteinase-9 and tenascin-C mRNA occurred within Glut-fixed BP than within the Glut/TA-fixed ones （P 〈0.01 for all）. Conclusion TA exerts excellent anti-calcification effects on Glut-fixed BP via inhibiting macrophage infiltration and expression of matrix metalloproteinase-9 and tenascin-C.

关键词： tannic acid calcification macrophage pericardium bioprosthesis xenograft

Repair of left ventricular aneurysm： ten-year experience in Chinese patients

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Chinese Medical Journal 2009年第17期122卷 1963-1968页

作者： FAN Hong-guang ZHENG Zhe FENG Wei YUAN Xin WANG Wei hu sheng-shou Department of Cardiovascular Surgery Center for CardiovascularRegenerative Medicine Fu Wai Hospital Peking Union MedicalCollege and Chinese Academic of Medical Sciences Beijing100037 China

Background A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm （LVA）. This study aimed to explore the early and long-term clinical outcomes and to identify predictors for survivals and hospital re-admission after the repair of left ventricular aneurysm. Methods We followed up 497 patients who had undergone LVA repair from a single center in China between 1995 and 2005. The perioperative parameters were recorded. Risk factors for early mortality and long-term results were analyzed by multivariate Logistic regression. Cox＇s proportional hazard model was used to calculate risk factors for major adverse cardiac and cerebrovascular events, cause of death and re-admission. Kaplan-Meier curve was employed to analyze long-term survival. Results The operative mortality was 2.0%. The long-term mortality was 11.1% and cardiac causes contributed to 61.8% of the overall long-term mortality. Four hundred and thirty-two patients survived during the follow-up period and 37.5% of them had been re-admitted at least one time. One hundred and five patients experienced major adverse cardiac and cerebrovascular events. Survival analysis exhibited that the probability of survival at 1 and 5 years after operation was 96% and 86% respectively. Previous atrial fibrillation was the independent risk factor for early mortality. Independent risk factors for long-term mortality were poor left ventricular ejection fraction and stroke, and risk factors for cardiac mortality were intraventricular block, stroke and poor left ventricular ejection fraction. Stroke, intraventricular block and advanced age were independent risk factors for major adverse cardiac and cerebrovascular events, and New York Heart Association （NYHA） class Ill-IV was the only risk factor for hospital re-admission. Conclusions Postinfarction LVA can be repaired and satisfying early and long-term clinical outcome can be obtained. Endoventricular circular plasty technique is

关键词： heart aneurysm surgical procedures, operative follow-up studies risk factors outcome assessment

Coronary artery bypass grafting for Kawasaki disease

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Chinese Medical Journal 2010年第12期123卷 1533-1536页

作者： GUO Hong-wei CHANG Qian XU Jian-ping SONG Yun-hu SUN Han-song hu sheng-shou Department of Surgery Fu Wai Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing 100037 China

Background Kawasaki disease （KD） is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first *** study aimed to evaluate the efficacy of coronary artery bypass grafting （CABG） in patients with KD. Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient （mean 2.5±0.8）. Various bypass grafts were used in patients, i.e. the left internal mammary artery （LIMA） in 3 patients, bilateral internal mammary artery （IMA） in 2 patients, LIMA plus gastroepiploic artery （GEA） in 1 patient and total saphenous vein grafts （SVGs） in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass （CPB）, after being supported with intra-aortic balloon pump （IABP）, the patient was weaned from CPB successfully. Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months （mean 27 months）, clincal angina disappeared or improved. Cardiac function was in Class I-II （NYHA）.Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

关键词： coronary artery bypass grafting Kawasaki disease myocardial ischemia coronary aneurysm coronary aneurysmectomy

Summary of Report on Cardiovascular Diseases in China,2012

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Biomedical and Environmental Sciences 2014年第7期27卷 552-558页

作者： WANG Wen hu sheng shou KONG Ling Zhi GAO Run Lin Zhu Man Lu WANG Yong Jun WU Zhao Su CHEN Wei Wei YANG Jin Gang MALi Yuan LIU Ming Bo For the editorial board National Center for Cardiovascular Diseases Beijing 100037 China. National Health and Family PlanningCommission of the People's Republic of China Beijing 100044 China. Beijing Tiantan Hospital 8eijing 100050 China. Beijing Anzhen Hospital Beijing 100029 China.

The prevalence of cardiovascular diseases （CVDs） is associated with the socioeconomic prosperity, lifestyle changes, accelerated process of ageing and urbanization. The prevalence of CVDs is continuously increasing in China and will remain an upward trend in the next 10 years. CVDs are the leading cause of death for Chinese in both urban area and rural area. Nowadays, 41.09% of deaths in rural area and 42.52% of deaths in urban area are caused by CVDs in China. The burden of CVDs remains heavy and has become an important public health problem. Effective strategies should be enforced urgently for the prevention of CVDs under the supervision of the government. In 2012, the Ministry of Health of China and 14 governmental departments jointly issued the Work Plan for Chronic Disease Prevention and Control in China （2012-2015）, a guideline for the prevention of chronic diseases, especially CVDs in China.

关键词： area Summary of Report on Cardiovascular Diseases in China,2012

Major risk-stratification models fail to predict outcomes in patients with multivessel coronary artery disease undergoing simultaneous hybrid procedure

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Chinese Medical Journal 2013年第3期126卷 450-456页

作者： WANG Hao-ran ZHENG Zhe XIONG hui XU Bo LI Li-huan GAO Run-lin hu sheng-shou Research Center for Cardiac Regenerative Medicine of the Ministry of Health Cardiovascular Institute & Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events （MACCE） in patients with multivessel disease undergoing hybrid coronary revascularization. Methods The data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification （GRC） calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization. Results During a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power （area under curve （AUC）） of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 （95% confidence interval 0.42-0.77）, 0.65 （0.47-0.82）, 0.57 （0.39-0.75） and 0.65 （0.46-0.83）, respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 （P=0.86）, 5.39 （P=0.37）, 13.81 （P=0.32） and 0.02 （P=0.89）, respectively. Conclusions In patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.

关键词： hybrid coronary revascularization risk stratification model multivessel coronary artery disease

Outcome of surgery for sinus of Valsalva aneurysm with discrete membranous subaortic stenosis

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Chinese Medical Journal 2012年第9期125卷 1552-1555页

作者： GUO Hong-wei CHANG Qian YU Cun-tao SUN Xiao-gang QIAN Xiang-yang hu sheng-shou Department of Surgery Fuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

Background Sinus of Valsalva aneurysm （SVA） is a rare cardiac anomaly, and SVA with discrete membranous subaortic stenosis is even rarer. The aim of the study was to make sure the incidence of SVA with discrete membraneous subaortic stenosis in SVA and their surgical results. We retrospectively analyzed 234 patients receiving surgical repair of SVA and reported the incidence of ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis. We also reported seven cases of SVA combined with discrete membranous subaortic stenosis and their surgical results.Methods Between January 1999 and December 2009, seven patients of SVA with discrete membranous subaortic stenosis underwent surgical repair of SVA and resection of subaortic discrete membrane. There were six male and one female patients. The mean age was （33.71±13.25） years （range 16–52 years）. Associated cardiovascular lesions were aortic regurgitation （n=7）, ventricular septal defect （n=5）, coarctation of aorta （n=1）, bicuspid aortic valve （n=1）, patent ductus arteriosus （n=1）, and aortic valve stenosis （n=1）. The aortic valve was replaced in four patients and valvuloplasty was done in three. The other co-existing anomalies were corrected at the same time. All the seven patients were followed up from 18 to 125 months （mean （63.14±39.54） months）. Among 234 SVA patients who underwent surgical repair, the number of cases with coexisting ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis was 129, 108, and 7, respectively.Results There was neither early death after operation nor late death during the follow-up period. All the seven patients were in the New York Heart Association （NYHA） functional classes I and II. There was no recurrence of discrete subaortic membrane during the follow-up period. The incidence of ventricular septal defect, aortic valve incompetence, and discrete membranous subaortic stenosis among 234 SVA patients was 55.13%,

关键词： discrete membranous subaortic stenosis sinus of Valsalva aneurysm repair rupture

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正值“复合”（Hybrid）技术的时代

中华心血管病杂志 2008年第1期36卷 1-2页

作者：胡盛寿中国医学科学院北京协和医学院阜外心血管病医院 100037

随着医学技术的不断进步，近50年来心血管病的治疗手段日新月异，而“患者利益至上”这一原则却是永恒不变的。所有患者都渴望一种最适合于自己的、创伤小、疗效佳的治疗手段。

关键词：复合医学技术心血管病患者利益治疗

Passive graft perfusion in off-pump coronary artery bypass grafting

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Chinese Medical Journal 2007年第3期120卷 192-196页

作者： LU Feng JI Bing-yang LIU Jin-ping LIU Ming-zheng WANG Gu-yan hu sheng-shou Department of Cardiovascular Surgery Department of Cardiopulmonary Bypass Department of An esthesiology Cardiovascular Institute ＆ Fuwai Hospital Peking Union MedicalCollege ＆ Chinese Academy of Medical Sciences Beijing 100037China Department of Pediatrics Penn State College of Medicine USA

Background Myocardial protection during off-pump coronary artery bypass grafting （OPCABG） is a multifactorial problem in which maintaining stable systemic hemodynamics is very important. In this study passive graft perfusion （PGP） was applied to investigate the effect during and after OPCABG as evaluated by cardiac troponin I （CTnl） and hemodynamic indexes. Methods Thirty first-time patients underwent OPCABG under one surgeon. They were randomly divided into two groups： The passive graft perfusion group （PGP, n=15） received distal coronary perfusion during the anastomosis and immediate graft perfusion after the distal anastomosis. The control group, no graft perfusion group, （NGP, n=15） received no graft perfusion after the distal anastomosis. The results of the two protocols were evaluated by concentration of CTnl and hemodynamic indexes before induction and after operation. Results There were no statistically significant differences between these two groups in their perioperation parameters. The level of CTnl increased postoperatively, reached its peak at 6 hours （P〈0.05） and recovered by the 6 days postoperative. Compared with the control group the concentration of CTnl in the PGP group was significantly lower at 6 and 24 hours （P〈0.01）. Compared with the NGP group, cardiac index （CI） in the PGP group was higher at 12 and 24 hours after operation （P〈0.05）. The period of mechanical ventilation was significantly shorter in the PGP group than in the NGP group （P〈0.05）. Conclusion PGP can increase the flow to the myocardium and shorten the heart ischemia time, thus maintain stable systemic hemodynamics, supply a satisfactory CI after surgery and improve surgery outcome.

关键词： passive graft perfusion coronary artery bypass grafting myocardial protection off-pump