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Left ventricular reconstruction with no-patch technique：early and late clinical outcomes

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Chinese Medical Journal 2010年第23期123卷 3412-3416页

作者： hu sheng-shou FAN Hong-guang ZHENG Zhe FENG Wei WANG Wei SONG Yun-hu WANG Li-qing YUAN Xin ZHANG Shi-ju Department of Cardiovascular Surgery Research Center for Cardiovascular Regenerative Medicine Fu Wai Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing 100037 China

Background Few studies have evaluated late clinical outcome of no-patch technique in patients with large left ventricular aneurysms. The objectives of this study were to evaluate a no-patch surgical technique to reconstruct the left ventricle in patients with left ventricular aneurysm and to assess early and late clinical *** In 1995, we began using a no-patch technique in patients with dyskinetic left ventricular aneurysms. A total of 145 patients underwent left ventricular reconstruction with this technique and were followed up for （59±29） months （range,1-127 months）. Risk factors for early mortality were analyzed by bivariate analyses. Cox＇s proportional hazards model was used to calculate risk factors for all-cause mortality and hospital readmission. Kaplan-Meier methodology was used to analyze late *** One week after operation, left ventricular end-diastolic diameter had decreased from （61±8） mm to （55±8）mm, and geometry of the left ventricle was restored to a more normal conical shape. Early mortality was 3% and late mortality 11%. Over a 5-year follow-up period, hospital readmission was 28%. One-, 5-, and 10-year survival estimates were 95% （95% confidence interval （CI） 91%-99%）, 86% （95% CI 78%-94%）, and 74% （95% CI 60%-88%）.Readmission-free survival at 1 and 5 years after operation was 87% （95% CI81%-93%） and 60% （95% CI50%-70%）,*** The no-patch technique for left ventricular reconstruction is an effective and simple procedure that can achieve satisfactory early and late clinical outcomes in patients with left ventricular aneurysms.

关键词： left ventricular reconstruction no-patch technique follow-up clinical outcome

Surgical outcome and clinical follow-up in patients with symptomatic myocardial bridging

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Chinese Medical Journal 2007年第18期120卷 1563-1566页

作者： huANG Xiao-hong WANG Shui-yun XU Jian-ping SONG Yun-hu SUN Han-song TANG Yue DONG Chao YANG Yue-jin hu sheng-shou Special Medical Care Centre Fuwai Hospital and CardiovascularInstitute Chinese Academy of Medical Sciences Beijing 100037China Department of Cardiovascular Surgery Fuwai Hospital andCardiovascular Institute Chinese Academy of Medical SciencesBeijing 100037 China Department of Cardiovascular Medicine Fuwai Hospital andCardiovascular Institute Chinese Academy of Medical SciencesBeijing 100037 China

Background Myocardial bridging with systolic compression of the left anterior descending coronary artery （LAD） may be associated with myocardial ischaemia. The clinical outcome in patients with surgical treatment for symptomatic myocardial bridging remains undetermined. This study assessed the middle- and long-term results of surgical treatment for symptomatic myocardial bridging. Methods From 1997 to 2006, 37 463 patients received selective coronary angiography in the Fuwai Cardiovascular Hospital, Beijing, China. Of these, 484 patients had angiographic diagnosis of myocardial bridging. Of the 484 patients, 35 underwent surgery for treatment of myocardial bridging with significant systolic arterial compression. Among the surgical treatment patients, 24 presented with other cardiac disorders, and the remaining 11 symptomatic patients with isolated myocardial bridging were included in the follow-up study. Results The angiographic prevalence of myocardial bridging was 1.3% in this study. The coronary angiographies of the 11 patients revealed myocardial bridging in the middle segment of LAD causing systolic compression 〉75% （ranging from 75% to 90%）. The mean age of patients was 48,4 years. Surgical myotomy was performed in 3 patients and coronary artery bypass grafting （CABG） in 8 patients. Eight patients were operated on with an off-pump approach and 3 with a cardiopulmonary bypass technique after median sternotomy. Conversion to on-pump CABG surgery was necessary in 1 patient because of perforation of the right ventricle. The left internal mammary artery was used in all patients with CABG. The acute clinical success rate was 100% with respect to the absence of myocardial infarction, death or other major in-hospital complications. All of the patients were followed up clinically. The median follow-up was 35.3 months （range： 6 to 120 months）. Nine patients were free from symptoms and one of them continued taking beta blockers. The remaining 2 patients with myotomy

关键词： myocardial bridging myocardial ischaemia myotomy coronary artery bypass grafting coronary angiography

Clinical application of BVS5000 left ventricular assist device in heart failure patients

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Chinese Medical Journal 2008年第10期121卷 877-880页

作者： LUO Xin-jin hu sheng-shou SUN Han-song XU Jian-ping LIU Ping ZHENG Zhe MA Wei-guo ZHANG Yan Department of Cardiovascular Surgery Fu Wai Hospital PekingUnion Medical College Beijing 100037 China

Background Mechanical ventricular assistance is an important therapeutic method for severe heart failure patients. A variety of ventricular assist devices have been designed for use, The purpose of this report was to describe the experience of using Abiomed BVS5000 as a means of left ventricular support as a clinical treatment for heart failure patients. Methods From February 2004 to April 2006, 12 male patients were supported with Abiomed BVS5000 left ventricular assist device （LVAD） at Fu Wai Hospital. The average age was （55.2±9.6） years （range 39 to 68 years）. The mean body surface area was （1.76±0.1） m^2 （range 1.6 to 1.9 m^2 ）. Devices were inserted for post-cardiotomy shock after coronary artery bypass graft in 11 patients （92%） and in 1 dilated cardiomyopathy patient for acute cardiogenic shock. Modified cannulation methods by inserting the arterial cannulae in femoral artery and inserting the venous cannula in left atrium through a segment of bovine jugular vein were used in 7 patients. In this way, the device could be taken off without re-sternotomy when support was finished. A comparison was made between the modified method and routine left atrium-to-ascending aorta cannulating method. Results The median duration of support was 5 （3-43） days, with support flow rate of 3.8-4.5 L/min. There were 9 （75%） patients weaned from support and 8 （67%） patients discharged from the hospital. Four （33%） patients were dead. The most common morbidity was adverse neurological events. There is no statistical difference between modified and routine method on average in BVS5000 support duration, in assisted flow rate, in mechanical ventilation duration, in the intensive care unit stay and thoracic drainage. Conclusions The Abiomed BVS5000 is valuable to support patients with acute cardiogenic shock for short-term use. By the modified cannulating method, the weaning procedure can be effectively simplified. Optimization of inserting indication remains challenging and attr

关键词： heart failure surgical treatment left ventricular assist devices

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中国冠状动脉旁路移植手术风险评估

中华心血管病杂志 2010年第10期38卷 901-904页

作者：郑哲张路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心外科 100037

目的建立适合中国人群的冠状动脉旁路移植（CABG）手术风险评估系统（Sino system fbr coronary operative risk evaluation,SinoSCORE）.方法收集了中国心血管外科注册登记研究2007-2008年间接受CABG的临床资料完备的9564例成年患者... 详细信息

目的建立适合中国人群的冠状动脉旁路移植（CABG）手术风险评估系统（Sino system fbr coronary operative risk evaluation,SinoSCORE）.方法收集了中国心血管外科注册登记研究2007-2008年间接受CABG的临床资料完备的9564例成年患者的临床资料,按9∶1的比例随机分为建立模型组（建模组）和验证组.在建模组中根据logistic回归构建加法模型.在验证组中采用Homser-Lemeshow（HL）卡方检验对模型进行校准,并运用ROC曲线下面积评价模型的区分度,并与EuroSCORE模型比较.设定相应界值将患者分为高危、中危、低危.结果建模组模型纳入了11个危险因素：年龄＞65岁（65～69岁,3分 70～74岁,5分 ≥75岁,6分）,术前NYHA心功能分级（Ⅲ级,3分,Ⅳ级,7分）,慢性肾功能衰竭史（6分）,外周血管病史（5分）,慢性阻塞性肺病（4分）,术前2周心房扑动或心房颤动（2分）,左心室射血分数＜50%（4分）,非择期手术（5分）,合并瓣膜手术（4分）,术前危重状态（分）,体质指数（＞24 kg/m2,-2分＜18 kg/m2,5分）.HL卡方0.44,ROC曲线下面积0.80.验证组HL卡方为0.34,ROC曲线下面积为0.78,EuroSCORE用于验证组后HL卡方0.60,ROC曲线下面积0.73.患者分为低危（≤1分）,中危（2～5分）,高危（≥6分）,不同分组患者采用本模型计算得到的预期死亡率与实际死亡率均较吻合.结论本研究建立的中国冠状动脉手术风险评估系统是一个简单、客观、准确的评分模型,可以很好预测当前中国接受CABG术患者的手术风险.

关键词：心脏外科手术危险性评估死亡率

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从整合医学视角看心血管学科未来发展

医学与哲学（A） 2013年第3期34卷 19-21页

作者：胡盛寿张浩中国医学科学院/北京协和医学院/国家心血管病中心/阜外心血管病医院/心血管疾病国家重点实验室北京100037

心血管疾病已经成为威胁国人健康的首位疾病。现代医学的发展使药物、介入和外科手术成为治疗心血管疾病的三大基石,但专科的进一步细化也带来相当多的弊端。因此,需要以患者为核心,摒弃学科的分野,将各种医学知识和防治手段有机融合,... 详细信息

心血管疾病已经成为威胁国人健康的首位疾病。现代医学的发展使药物、介入和外科手术成为治疗心血管疾病的三大基石,但专科的进一步细化也带来相当多的弊端。因此,需要以患者为核心,摒弃学科的分野,将各种医学知识和防治手段有机融合,构建一个新的整合医学体系去培养年轻医师,切实控制心血管疾病。

关键词：心血管疾病整合医学医学模式

合并肺动脉高压心脏移植患者术后早期血流动力学分析及处理

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中华心血管病杂志 2007年第4期35卷 337-339页

作者：刘平胡盛寿宋云虎杜娟中国医学科学院中国协和医科大学阜外心血管病研究所阜外心血管病医院心血管外科北京100037

目的观察和探讨心脏移植患者术前肺动脉压力和肺循环阻力与术后右心功能不全的关系,及降低因术后早期肺动脉高压造成右心功能损害的临床措施。方法 54例接受同种原位心脏移植手术的患者,根据术前肺动脉收缩压(sPAP)≥45mm Hg(1 mm Hg=0.... 详细信息

目的观察和探讨心脏移植患者术前肺动脉压力和肺循环阻力与术后右心功能不全的关系,及降低因术后早期肺动脉高压造成右心功能损害的临床措施。方法 54例接受同种原位心脏移植手术的患者,根据术前肺动脉收缩压(sPAP)≥45mm Hg(1 mm Hg=0.133 kPa)或<45 mm Hg,分为Ⅰ组34例和Ⅱ组20例。统计术前血流动力学指标心排指数(CI)、肺循环阻力(PVR)、中心静脉压(CVP)。Swan-Ganz 导管连续监测术后60 h 内的平均肺动脉压(mPAP)、PVR、CI 等指标的动态变化。床旁超声分别监测和评价术后3、7、14、21天和1个月时的三尖瓣反流程度。术后肺动脉高压及右心功能维护治疗措施包括利尿、NO 吸入、静脉注射前列环素(Ilomedin 20)、血液滤过等。结果本组患者无术后早期死亡(术后30天内)。Ⅰ、Ⅱ组患者术前的 sPAP 分别为(60±12)mm Hg 和(25±9)mm Hg(P<0.01);PVR 分别为(358±150)dyn·s^(-1)·cm^(-5)和(140±68)dyn·s^(-1)·cm^(-5)(P<0.01)。术后早期出现右心功能不全的患者Ⅰ组24/34(70.6%)例,Ⅱ组7/20(35.0%)例,两组比较,差异有统计学意义(P=0.01)。Ⅰ组患者术后早期肺动脉压力和 PVR 仍明显高于Ⅱ组患者,并且在较长的时间后才逐渐下降至正常或仍维持偏高水平。Ⅰ组患者术后早期三尖瓣反流的严重程度高于Ⅱ组患者(P<0.05),但随着术后时间的延长,两组患者三尖瓣反流程度差异无统计学意义。结论心脏移植患者术前肺动脉高压的严重程度是影响术后早期右心功能的关键因素。通过有效的降低和防治术后早期肺动脉高压,降低右心负荷,可以明确降低和缩短因肺动脉高压造成术后早期右心功能损害的严重程度和持续时间,有利于术后早期心功能的恢复并维持良好的远期心功能状态。

关键词：心脏移植肺动脉高压心室功能障碍右三尖瓣闭锁不全

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仿生医学——一个新的医学理论体系的创立

医学与哲学 2005年第7期26卷 73-74页

作者：解启莲胡盛寿河北医科大学第一医院河北石家庄050031 中国医学科学院心血管病研究所北京100037

医学发展呼唤原始性创新。大自然是人类创新的不竭源泉,国际上仿生学研究如火如荼。为了强化将仿生方法、仿生技术贯穿到科研创新的全过程,引导医学科技人员巧妙寻找源头创新,率先提出创立仿生医学体系,并初步建立起仿生医学的学科框架... 详细信息

医学发展呼唤原始性创新。大自然是人类创新的不竭源泉,国际上仿生学研究如火如荼。为了强化将仿生方法、仿生技术贯穿到科研创新的全过程,引导医学科技人员巧妙寻找源头创新,率先提出创立仿生医学体系,并初步建立起仿生医学的学科框架,以便更好地把握学科前沿和判断发展趋势,为我国在仿生医学学科领域的领先作用奠定重要基础。

关键词：仿生医学仿生医学仿生医学体系

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安徽沿淮地区协调发展研究

特区经济 2009年第2期 182-183页

作者：胡传省荀守奎安徽理工大学人文社科部安徽理工大学经济管理学院安徽淮南232001

安徽沿淮地区存在的诸多问题可以概括为环境保护和经济发展问题。要实现沿淮地区协调发展,就必须探讨环境保护和经济发展的相应策略,并为之营造必备的条件;而且,有关部门可借助于绩效评价及时发现和解决策略执行中存在的问题,以促进沿... 详细信息

安徽沿淮地区存在的诸多问题可以概括为环境保护和经济发展问题。要实现沿淮地区协调发展,就必须探讨环境保护和经济发展的相应策略,并为之营造必备的条件;而且,有关部门可借助于绩效评价及时发现和解决策略执行中存在的问题,以促进沿淮地区经济社会进步。

关键词：安徽沿淮地区策略绩效评价

心脏移植术后早期静脉注射依诺前列环素(Iloprost)对血流动力学的影响

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中国循环杂志 2006年第3期21卷 225-227页

作者：刘平胡盛寿杜娟中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院外科ICU 北京市100037 中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院外科北京市100037

目的:通过在同种异体原位心脏移植术后早期病人静脉持续注射依诺前列环素(Iloprost),观察用药前后体／肺循环血流动力学变化,寻找对术前合并肺动脉高压的心脏移植病人术后治疗的有效方案。方法:7例术前合并肺动脉高压的同种异体原位心... 详细信息

目的:通过在同种异体原位心脏移植术后早期病人静脉持续注射依诺前列环素(Iloprost),观察用药前后体／肺循环血流动力学变化,寻找对术前合并肺动脉高压的心脏移植病人术后治疗的有效方案。方法:7例术前合并肺动脉高压的同种异体原位心脏移植病人,当术后早期肺动脉收缩压大于45 mmHg(1 mmHg= 0．133 kPa)时,开始静脉持续注射依诺前列环素,共8例次。药物剂量平均为2．2μg／h(1-6μg／h),持续时间平均54小时(36-68小时)。监测并记录用药开始和停药时的心排血指数(CI)、射血分数(EF)、中心静脉压(CVP)、平均肺动脉压(MPAP)、舒张末期心室容量(EDV)、肺循环阻力(PVR)和体循环阻力(SVR)。结果:心排血指数、射血分数、中心静脉压、平均肺动脉压、舒张末期心室容量、肺循环阻力和体循环阻力用药前后均有显著性差异(P<0．05-0.01)。7例病人均存活。结论:静脉持续注射依诺前列环素可以有效的降低术前合并肺动脉高压的心脏移植病人术后早期的肺循环阻力和肺动脉压力,改善血流动力学指标。药物副作用小。

关键词：前列环素血流动力学心脏移植