The Heart Surgery Forum

How to Use a Right Internal Thoracic Artery Graft in On- and Off-Pump Coronary Artery Bypass Grafting

2024-06-24T18:36:36-07:00

In coronary artery bypass grafting, internal thoracic artery grafts and other arterial grafts have shown superior results compared with saphenous vein grafts. The right internal thoracic artery (RITA) has been reported as one of these various arterial graft options. However, there are some limitations and concerns associated with using the RITA. This review presents the current topics and scientific evidence on the use of RITA grafts in coronary artery bypass grafting. The reviewed papers mainly focus on the operative results of using the RITA, graft configurations and target vessels, and the comparison between on- or off-pump coronary artery bypass procedure. The results of these studies suggest the followings. The method of using the RITA (either in situ or as a free graft) should be selected based on the need to reach crucial targets and the number of required target vessels. A free RITA graft anastomosed to the aorta with modified proximal anastomosis allows for the revascularization of multiple vessels with acceptable flow characteristics. For revascularization of the right coronary artery system with low-grade proximal stenosis, the RITA should not be used. The decision to use cardiopulmonary bypass depends on the patient's condition, target vessels, as well as the experience of institution. Skeletonized harvesting is more effective in preventing sternal wound infections in coronary artery bypass grafting using bilateral internal thoracic arteries compared with using a single internal thoracic artery.

Comparison of the Efficacy of Dual Antiplatelet Treatment at Different Treatment Times in Patients with High Bleeding Risk after PCI: A Systematic Review and Meta-analysis of Randomized Controlled Trials

2024-06-17T17:33:03-07:00

Objective: This study conducted a systematic review and meta-analysis to evaluate the efficacy and complications of dual antiplatelet therapy in patients with high bleeding risk after percutaneous coronary intervention (PCI) at different treatment durations. Methods: Related studies were searched in PubMed, Web of Science, Cochrane Library, Google Scholar, China national knowledge infrastructure (CNKI), Wanfang, Embase, and VIP databases from the establishment of the database to May 2023. Randomized controlled trials (RCTs) of dual antiplatelet treatment (DAPT) time limit for germination of the coronary artery were screened, and results were integrated and analyzed. The study assessed literature quality using the Jadad scale and conducted meta-analyses with RevMan 5.4, applying appropriate models based on heterogeneity and using Egger's test for publication bias. Sensitivity analysis identified factors contributing to heterogeneity. Results: Fifteen studies with 193,086 patients with PCI, comprising 102,661 cases of DAPT short-term treatment groups (<12 months) and 88,988 cases of DAPT long-term treatment groups (≥12 months), were analyzed. Meta-analysis results showed that the total mortality of short-term DAPT PCI was significantly reduced compared with long-term treatment (relative risk (RR) = 0.49, 95% CI: 0.48–0.51). Cardiac mortality showed a significant decrease (RR = 0.50, 95% CI: 0.48–0.52); Myocardial infarction: The risk of myocardial infarction was significantly reduced (RR = 0.68, 95% CI: 0.66–0.70); There was a significant increase in the risk of stroke (RR = 1.45, 95% CI: 1.37–1.53); The incidence of target vessel revascularization (TVR) showed a significant increase (RR = 1.35, 95% CI: 1.08–1.69); The risk of major bleeding was significantly increased (RR = 1.46, 95% CI: 1.40–1.51). Definite stent thrombosis and incidence of minor bleeding did not increase significantly. Conclusion: Short-course dual antiplatelet therapy (DAPT) has been shown to decrease overall mortality, cardiac mortality, and the risk of myocardial infarction in patients following percutaneous coronary intervention (PCI). However, it is associated with an elevated risk of major bleeding, stroke, and target vessel revascularization (TVR), while the risks of definite stent thrombosis and minor bleeding did not increase significantly. Additional high-quality RCTs should be used to verify the conclusions.

3D Transesophageal Echocardiography in the Selection of Occluder Size for Left Atrial Appendage Occlusion: A Meta-Analysis

2024-07-15T22:15:36-07:00

Background: Left atrial appendage occlusion (LAAO) can effectively reduce the risk of stroke in atrial fibrillation (AF) patients. However, the structure of left atrial appendage (LAA) varies greatly among individuals, and the size of the occluder influences the surgical success rate and prognosis. This study used a meta-analysis to investigate whether three dimensional-transesophageal echocardiography (3D-TEE) can prompt physicians to select the appropriate size of the occluder, thereby improving prognosis in patients with LAAO. Methods: Studies on 3D-TEE-assisted selection of occluder sizes in the treatment of LAAO were searched in pubmed, cochrane, Web of Science, CNKI, Wanfang, and Weipu public databases from the inception of each database to June 10, 2024. The QUADAS-2 tool was used to assess the quality of the studies. Results: 10 studies published between 2016 and 2024 were finally included, with a total sample size of 552 cases. The maximum opening of the LAA obtained by 3D-TEE, coronary angiography (CAG) and video-assisted thoracic surgery (VATS) significantly correlated with the size of the occluder (p < 0.05). 3D-TEE was superior to 2D-TEE in measuring the maximum (p = 0.04) and minimum diameters (p = 0.01) of LAA openings, and to DSA in measuring depth (p = 0.01). Conclusion: 3D-TEE can be applied to obtain LAA opening data close to the size of the occluder with minimal side effects and to assist physicians in selecting the appropriate occluder.

Distinct Roles of Omental and Latissimus Dorsi Flaps for Blocking Infection Pathways and Protecting A Left Ventricular Assist Device

2024-08-18T19:28:18-07:00

Left ventricular assist devices (LVADs) are vital for managing severe heart failure in transplant-ineligible patients, but device exposure and infection pose significant challenges. This report details a 42-year-old man with dilated cardiomyopathy and bronchial asthma who presented with an externalized LVAD following a HeartMate II to HeartMate III exchange due to malfunction. Our tailored surgical strategy treated the LVAD driveline and main body as two distinct parts. This distinction is crucial, as major upstream infections typically originate from the driveline. We applied flaps to these parts for different purposes, maximizing their unique characteristics. The omental flap, chosen for its flexibility, blood supply, and immunological activation upon foreign body contact, covered the driveline. The latissimus dorsi flap provided vascularity and mechanical protection for the LVAD. Additionally, we review the omentum's basic physiological aspects, which are often unfamiliar to clinicians. Infection has not recurred in 6 months postoperatively, demonstrating the approach's effectiveness.

Cardiac Hemangioma Located in the Interatrial Septum: A Case Report and Literature Review

2024-07-31T23:56:22-07:00

Cardiac hemangiomas are extremely rare benign tumors that can occur in any part of the heart. We report the case of an adult female with no history of structural heart disease or symptoms of discomfort. Cardiac ultrasound showed a mass on the right atrial surface of the atrial septum. Intraoperatively, the mass was identified within the atrial septum, at the junction of the inferior vena cava and the ostium of the coronary sinus. The mass did not enter the left or right atrial cavities. The mass was successfully removed, and cardiac hemangioma was confirmed by postoperative pathology. This report discusses the clinical manifestations, diagnostic approaches, and treatment options for cardiac hemangiomas based on an analysis of previously reported cases. Owing to the risk of arrhythmia in patients with hemangiomas in the atrial or ventricular septum, surgical resection is recommended.

Clinical Efficacy of Transcatheter Closure of Patent Foramen Ovale with Positive Foaming Test

2024-07-18T23:04:19-07:00

Background and Aims: To explore and evaluate the clinical therapeutic effect of interventional occlusion in the treatment of patent foramen ovale (PFO) with positive foaming test in the prevention and treatment of cryptogenic stroke (CS) and to provide clinical basis for individualized treatment of CS patients with PFO. Methods: A total of 151 patients who was admitted to Beijing Anzhen Nanchong Hospital Hospital from January 2019 to June 2021 were divided into two groups: drug therapy group (n = 63) and interventional occlusion + drug therapy group (n = 88). The general clinical data of the patients were collected by retrospective study, including sex, age, body weight, right to left shunt (RLS) magnitude, the degree of migraine before treatment, and telephone follow-up of all patients after treatment. Results: There was no significant difference in general clinical data (p > 0.05). In the interventional occlusion + drug therapy group, the stroke recurrence rate within 6th month after operation was significantly lower than that in the drug therapy group, and the difference was statistically significant (p < 0.05); The degree of migraine was lower than that in the drugs treatment group at the 3rd month after operation and the difference was statistically significant (p < 0.01); The degree of migraine at the 6th month was lower than that in the drug therapy group but the difference was not statistically significant (p > 0.05). The results of comprehensive generalized analysis showed that the risk of moderate or severe headache in the interventional occlusion + drug therapy group decreased by 40% (odds ratio [OR] = 0.60, p < 0.05). The degree of migraine in female patients was statistically lower after three and six months postoperatively (p < 0.05 and p = 0.01, respectively). Combined with generalized analysis, the risk of moderate or severe migraine in female patients was reduced by 55%. There were significant differences in the migraine before operation, migraine at the 3rd month and migraine at the 6th month in patients with three different kinds RLS grades (p < 0.01, p < 0.01, p < 0.05). Compared with the preoperative migraine and the migraine at the 3rd month, patients with RLS grade 3 had the most obvious migraine relief at the 6th month after operation than those with RLS grade 2. Conclusion: Compared with the drug therapy, interventional occlusion + drug therapy can reduce the risk of CS recurrence, improve the prognosis and significantly reduce the degree of migraine. Patients of different genders had different degrees of migraine, women had a lighter degree of migraine and a reduced risk of moderate or severe migraine, women benefited more after treatment. Patients with different RLS grades have different postoperative migraine relief. Patients with preoperative RLS grade 3 have the most obvious postoperative migraine relief and patients with preoperative RLS grade 3 benefit more after treatment.

Association between Thyroid Function and Postoperative Outcomes in Patients with Acute Coronary Syndrome after Treatment with PCI: A Retrospective Study

2024-07-02T19:42:43-07:00

Objective: This study aims to investigate the relationship between thyroid function and prognosis in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). Methods: According to the thyroid function status of the patients at admission, they were divided into the euthyroid group (Group A), subclinical hyperthyroidism group (Group B), subclinical hypothyroidism group (Group C), and low T3 group (Group D). The clinical data of the four patient groups were compared. The logistic regression model was used to analyze the relationship between thyroid function and postoperative outcomes in patients with ACS undergoing PCI. Results: A total of 200 ACS patients who underwent PCI treatment in our hospital from January 2022 to October 2023 were selected as the research population. The incidences of subclinical hyperthyroidism, subclinical hypothyroidism, and low T3 syndrome were 17.00% (34/200), (36/200), and 29.50% (59/200), respectively. Univariate analysis of variance showed significant differences in age, diabetes, smoking history, systolic pressure and heart rate at admission, shock index, blood urea nitrogen (BUN), Cr, glucose (GLU), fibrinogen (FIB), glycosylated hemoglobin (HbA1c), creatine kinase isoenzyme (CK-MB), and CRP among all groups (p < 0.05). Thyroid function markers differed significantly across the groups (p < 0.001). Specifically, Group B exhibited the lowest thyroid stimulating hormone (TSH) levels (0.23 ± 0.09 mIU/L), whereas Group C displayed the highest (8.05 ± 3.72 mIU/L). Group D showed the lowest free triiodothyronine (FT3) levels (2.74 ± 0.51 pmol/L), and Group B had the highest free thyroxine (FT4) levels (16.31 ± 2.62 pmol/L). A significant difference in the incidences of cardiovascular death and heart failure was observed among the four groups (p < 0.05). Notably, Group D showed higher incidences of cardiovascular death (11.86%) and heart failure (50.85%). Similarly, at 1-year follow-up, a significant difference in the incidences of cardiovascular death and heart failure were found among the four groups (p < 0.05). Specially, Group D exhibited higher rates of cardiovascular death (15.25%) and heart failure (27.12%). Logistic regression analyses highlighted FT3 as a significant predictor of adverse events during hospitalization (OR = 0.335, 95% CI: 0.222–0.506, p < 0.001), while TSH emerged as an independent risk factor for adverse events during 1-year follow-up (OR = 1.136, 95% CI: 1.040–1.240, p = 0.005). Conclusion: Patients with ACS have a higher incidence of mild thyroid dysfunction. Compared with patients with euthyroid function, patients with low triiodothyronine (T3) syndrome have a worse prognosis after PCI treatment. Serum FT3 concentration and TSH can be used as predictors of poor prognosis in ACS patients.

Analysis of Risk Factors for Recurrent Pneumothorax in Patients after Primary Spontaneous Pneumothorax Surgery: A Single-Center Retrospective Study

2024-07-12T01:12:00-07:00

Background: Recurrent pneumothorax is a prevalent issue following primary spontaneous pneumothorax (PSP) surgery. This study identifies risk factors for PSP recurrence after surgery. Methods: This study included participants who had undergone surgery for PSP at our hospital from February 2021 to February 2024. Relevant demographic, clinical, radiological, and laboratory data were collected for each participant, and statistical analysis was performed using SPSS 29.0 statistical software (SPSS Inc., Chicago, IL, USA). Chi-squared tests, t-tests, and binary logistic regression analysis were utilized to assess the associations between risk factors and the likelihood of pneumothorax recurrence. Results: A total of 100 participants who underwent surgery for PSP at a single center were included in the analysis. The participants were 18–39 years old, with 53 participants in the no recurrent pneumothorax group and 47 participants in the recurrent pneumothorax group. No significant differences in demographic and clinical characteristics were observed between the two groups. The binary logistic regression analysis showed that c-reactive protein (odds ratio (OR) = 2.144, p < 0.001), white blood cell count (OR = 2.493, p = 0.011), neutrophil-to-lymphocyte ratio (OR = 3.031, p < 0.001), and chest tube duration (OR = 9.716, p = 0.010) were independent risk factors for the recurrence of PSP. Conclusion: This study emphasizes the crucial role of postoperative inflammatory response in the recurrence of PSP. Clinicians should monitor and manage these inflammatory markers to optimize postoperative management strategies, reduce recurrence rates, and improve long-term patient outcomes.

Impact of Early Enteral Nutrition on Postoperative Recovery in Cardiac Surgery Patients: A Cross-sectional Observational Study

2024-07-31T23:54:11-07:00

Background: The impact of early enteral nutrition (EEN) on postoperative outcomes in cardiac surgery patients remains underexplored despite its potential benefits. This study investigated the effects of EEN on recovery markers and complications in this patient population. Methods: For this purpose, a cross sectional-observational study was carried out on 180 patients who underwent heart surgery. The patients were randomly assigned to receive either EEN within 6–12 hours after the surgery or usual postoperative care. The main outcomes assessed were infection rates, duration of hospitalization and total morbidity. The secondary outcomes assessed included the duration until the first bowel movement, gastrointestinal problems, wound healing and patient satisfaction. Albumin and pre-albumin levels were used to evaluate the nutritional status. Results: The use of EEN resulted in a substantial decrease in infection rates (13 vs. 24%, p > 0.05) and a shorter duration of hospital stay (7.5 vs. 8.8 days, p < 0.05). The overall morbidity rate was slightly lower, however the difference was only marginally significant (17 vs. 28%). Patients with EEN also exhibited a reduced duration until the first bowel movement (48 vs. 72 hours, p < 0.05), a lower incidence of gastrointestinal problems (10 vs. 22%, p < 0.05), and enhanced wound healing. The EEN group had a superior nutritional state at discharge, characterized by elevated levels of albumin and pre-albumin. The EEN group exhibited a higher level of patient satisfaction compared to the group didn't receive EEN (90 vs. 75%, p < 0.05). Conclusion: EEN had a considerable positive impact on the postoperative outcomes of patients undergoing cardiac surgery. It effectively reduced the infection rates, hospital stay duration and gastrointestinal issues. Additionally, EEN improved nutritional markers and enhanced patient satisfaction. These findings endorsed the integration of EEN into conventional postoperative therapy to enhance recovery.

Long-Term Clinical Outcomes of Transcatheter Aortic Valve Replacement Using J-Valve System for Patients with Pure Native Aortic Regurgitation

2024-09-05T00:25:50-07:00

Background: The J-Valve, an “on-label” transcatheter heart valve, has been used for over a decade in patients with pure native aortic regurgitation (PNAR); however, long-term follow-up outcomes have not yet been documented. This study aims to evaluate the long-term safety and efficacy of transcatheter aortic valve replacement (TAVR) in patients with PNAR. Methods: We retrospectively reviewed 36 patients with PNAR who underwent TAVR using the J-Valve. Clinical data were collected, and follow-up assessments were performed via telephone or during outpatient visits. Results: The median follow-up duration was 5.26 years, and the cumulative 5-year survival rate was 74.0%. The initial procedural success rate of the J-Valve was remarkably high at 94.44%. There was no significant morphological or hemodynamic structural valve deterioration observed among these patients. Only one patient experienced moderate paravalvular leakage, which required surgical aortic valve replacement 4 years after the TAVR. Additionally, no instances of moderate or severe intra-prosthetic regurgitation were detected in this cohort. A significant reduction in left ventricular end-diastolic dimension was observed during the follow-up period compared to pre-operative measurements (p < 0.001). Conclusions: The J-Valve exhibited favorable long-term clinical outcomes, robust valve durability, and optimal hemodynamic performance in patients with PNAR.

Efficacy of Double Valve Replacement/Repair in Patients with Reduced Left Ventricular Ejection Fractions

2024-08-11T17:41:21-07:00

Introduction: A reduced left ventricular ejection fraction (LVEF) is a known risk factor for double valve replacement or aortic valve replacement in combination with concomitant mitral valve repair (DVR) and is associated with high morbidity and mortality rates. In this study, we sought to analyze the 30-day mortality and long-term survival rates of patients with reduced LVEFs. Methods: A multicenter, retrospective, observational cohort study of patients who underwent DVR was performed at four centers from January 2016 to December 2021. LVEFs were categorized as 41%–50% (n = 120) or ≤40% (n = 58). For the effects of risk factors on 30-day mortality, binary logistic regression was performed. Survival rates were assessed with the Kaplan–Meier method. Results: A total of 178 patients who underwent DVR were included in this study, of whom 67.42% (n = 120) had LVEFs ranging from 41–50% and 32.58% (n = 58) had LVEFs ≤40%. More mechanical valves and tricuspid valve-forming rings were applied in the LVEF ≤40% group (68.97% versus 53.33%, p = 0.047; 31.03% versus 10.83%, p = 0.001). The 30-day mortality rates of DVR patients with LVEFs ranging from 41–50% and ≤40% were 8.33% and 17.24%, respectively (p = 0.078). During the follow-up period, there were no significant differences in long-term survival (log rank p = 0.75). On multivariable logistic regression analysis, age >65 years [odds ratio (OR): 5.559, 95% confidence interval (CI): 1.668–18.524, p = 0.005] and cardiopulmonary bypass (CPB) duration >200 min (OR: 5.031, 95% CI: 1.773–14.277, p = 0.002) were significantly associated with the likelihood of 30-day mortality. Conclusions: Although the differences in 30-day mortality and long-term survival rates between DVR patients with LVEFs ranging from 41–50% and ≤40% were not statistically significant in our cohort, an age >65 years and a CPB duration >200 min were predictors of 30-day mortality.

Analysis of the Application Value of the Six Sigma Methodology in Nursing Management after Percutaneous Coronary Intervention

2024-07-23T00:47:29-07:00

Objective: The incidence of postoperative complications after percutaneous coronary intervention (PCI) is relatively high, seriously affecting the prognosis of patients. This study explores the application value of the Six Sigma methodology in the preventive management of complications after PCI. Methods: The clinical data of 102 patients who underwent PCI in our hospital from March 2021 to January 2022 were retrospectively analyzed. In accordance with different management methods, these patients were divided into the reference group (n = 49, conventional management method) and the observation group (n = 53, Six Sigma methodology). The anxiety and depression levels, quality of life, cardiac function indexes (left ventricular ejection fraction, left ventricular end-diastolic volume, left ventricular end-systolic volume, and stroke volume), and incidence of complications were compared between the two groups. Results: Before management, no difference was observed in anxiety and depression levels, quality of life, and cardiac function indexes in both groups (p > 0.05). After management, the observation group demonstrated lower anxiety and depression levels, higher quality of life, and lower incidence of complications than the reference group did (p < 0.05), with no significant difference in cardiac function indexes (p > 0.05). Conclusions: The Six Sigma methodology can improve the quality of life and reduce the incidence of postoperative complications, with a high promotion and application value in nursing management after PCI.

CABG Case Volume and Patient Outcomes at the Veterans Healthcare Administration: On-Pump versus Off-Pump

2024-07-14T18:14:23-07:00

Objective: To evaluate use trends and perioperative outcomes of on- and off-pump coronary artery bypass graft (CABG) in US Veterans. Methods: We retrospectively reviewed 44,960 Veteran Health Administration (VHA) patients who underwent isolated CABG between 2008–2021. Multivariable logistic regression was used to analyze associations between surgical technique and outcomes. Adjusted hazard ratios (aHR) are reported. p < 0.05 using two sided tests was considered significant. Results: 6169/44,960 (13.7%) patients underwent isolated off-pump CABG and 38,791/44,960 (86.3%) patients underwent on-pump CABG. Between 2008 and 2021, the proportion of off-pump procedures decreased: 18.8% between 2008–2012, 11.6% between 2013–2017, and 8.6% between 2018–2021 (χ² = 712.78, df = 2, p < 0.001). Groups were found to be well balanced with respect to age, history of chronic obstructive pulmonary disease (COPD), history of diabetes, history of prior cardiac surgery, as well as left ventricular ejection fraction and history of smoking, and thus an analysis was conducted using the entire cohort. After covariate adjustment, group status was found to not be a predictor of death (aHR = 0.92, 95% confidence interval (95% CI) = 0.66–1.28, p = 0.62), stroke (aHR = 1.33, 95% CI = 0.83–2.12, p = 0.23), myocardial infarction (MI) (aHR = 0.86, 95% CI = 0.51–1.46, p = 0.58). However, given the large imbalance between group size, the groups were then propensity matched on age, history of chronic obstructive pulmonary disease (COPD), diabetes hypertension, smoking, prior cardiac surgery, and left ventricular ejection fraction, resulting in a smaller cohort of 12,130 patients: 5961 (49.1%) on pump and 6169 (50.9%) off pump. After covariate adjustment, the on-pump group in the matched cohort had increased risk of the following within 30 days: death (aHR = 2.60, 95% CI = 1.50–4.51, p < 0.001), stroke (aHR = 1.61, 95% CI = 1.09–2.38, p = 0.016), acute renal failure (aHR = 2.31, 95% CI = 1.46–3.66, p < 0.001), atrial fibrillation (aHR = 1.39, 95% CI = 1.23–1.57, p < 0.001), intraoperative death (aHR = 1.67, 95% CI = 1.07–2.59, p = 0.023), and prolonged intubation (aHR = 1.53, 95% CI = 1.27–1.85, p < 0.001). They also experienced increased length of stay (Beta = 0.05, p < 0.001). Group did not predict risk of reintubation, perioperative myocardial infarction, or postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR). Conclusions: In a propensity matched cohort of veterans undergoing isolated CABG, off-pump technique was associated with decreased risk of multiple perioperative outcomes measures. However, the proportion of off-pump procedures within the VHA decreased between 2008–2021. This may be secondary to more selective use as overall volume has decreased, though additional study is needed to evaluate these trends.

Veno-Arterial Extracorporeal Membrane Oxygenation for Postcardiotomy Refractory Hemorrhage in Children

2024-07-23T00:43:41-07:00

Background: Refractory hemorrhage is generally considered a relative contraindication to the application of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Previous reports have presented the use of ECMO in the presence of various hemorrhages. Methods: Our clinical experience involves six pediatric patients supported with ECMO for postcardiotomy refractory hemorrhage. Results: All patients were weaned from ECMO successfully. Only one patient died of protein-losing enteropathy two months after ECMO weaning. The ECMO duration ranged from 32 to 134 hours. Conclusion: In our experience, ECMO could be used for postcardiotomy refractory hemorrhage. The timing of ECMO implantation, anticoagulation regimen and auxiliary measures are the keys to successful treatment.

Evaluation of Left Ventricular Remodeling and Prognosis after PCI in Acute Myocardial Infarction Using Real-Time, Three-Dimensional Echocardiography Combined with Layer-Specific Strain Imaging

2024-07-21T18:18:20-07:00

Aim: This study aimed to evaluate left atrial and left ventricular volumes, strains, and strain rates in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) using real-time three-dimensional echocardiography and layer-specific strain techniques. The relationships between these parameters and left ventricular remodeling (LVR) and prognosis were also explored. Methods: The study included 217 patients with first-episode STEMI who underwent emergency PCI. Echocardiography and myocardial strain analyses were performed within 24 h post-PCI. Patients were categorized into early and non-early LVR groups based on the increase in left ventricular end-diastolic volume (LVEDV). The occurrence of major cardiovascular adverse events (MACE) was followed up for one-year post-PCI. Differences in clinical data and ultrasound parameters between the groups were compared, and the predictive value of myocardial strain indicators for late LVR was analyzed using a multivariate logistic regression model and receiver operating characteristic (ROC) curves. Results: Early LVR occurred in 54.8% of patients and was characterized by decreased left ventricular systolic function, more segments with abnormal movement, and reduced absolute strain values in the three layers of the left ventricular wall myocardium, with a compensatory increase in left atrial strain rate during the contraction phase. The early LVR group showed a higher incidence of MACE at the one-year follow-up. At 6 months post-PCI, 29.9% of patients developed late LVR, which was not completely related to early LVR. Late LVR was associated with a higher incidence of MACE. The longitudinal strain value of each layer of left ventricular myocardium obtained from layer-specific strain imaging showed predictive value for advanced LVR. Conclusions: More than half of patients with STEMI develop early LVR post-PCI, with a higher incidence of MACE during one-year of follow-up, necessitating attention to early LVR in clinical practice. Late LVR, which develops in some patients after 6 months, is also linked to a higher incidence of MACE. Accurate monitoring of the myocardial deformation function using layer-specific strain imaging is expected to become a reference indicator for clinical diagnosis and treatment. Monitoring the structure and function of the left atrium and mitral valve alongside the LVR is important for prognostic assessment and for formulating diagnostic and treatment plans.

Effects of Indobufen Combined with Clopidogrel on Left Ventricular Function and Inflammatory Factors in Patients after PCI

2024-07-14T18:17:15-07:00

Background: Percutaneous intracoronary intervention (PCI) is the preferred method for treating coronary heart disease. However, the insufficient coagulation function after the procedure may lead to poor vascular reperfusion, thereby affecting cardiac function. Indobufen and clopidogrel have antiplatelet and anti-inflammatory effects, but the impact of their combined use on left ventricular function and inflammatory factors in patients after PCI remains unclear. This study aimed to explore the influence of indobufen combined with clopidogrel on left ventricular function and inflammatory factors in patients after PCI. Methods: Medical records of 100 patients who underwent PCI surgery were selected for retrospective analysis. Their admission time ranged from January 2022 to June 2023. All research subjects who met the inclusion criteria were assigned to two groups according to different treatment methods with 57 cases in the control and 43 cases in the observation. The left ventricular function, inflammatory factors, coagulation function levels, and occurrence of complications were compared between the two groups. Results: After going through treatment, the levels of left ventricular end-diastolic volume, left ventricular end-systolic diameter, and left ventricular end-diastolic diameter of the observation group were significantly lower than those of the control. The ejection fraction significantly increased in the observation group, and the difference between two groups was significant (p < 0.05). Furthermore, the level of high-sensitivity C-reactive protein in the observation was significantly lower than that of the control benefiting from treatment with a significant difference (p < 0.05). The activated partial thromboplastin time, prothrombin time, and thrombin time levels of all patients significantly increased (p < 0.05) with no difference between the two groups (p > 0.05). The complication rate in the control patients was 17.54% (10/57), and that in the observation patients was 9.30% (4/43). No significant difference existed between the two groups (p > 0.05). Conclusions: Indobufen combined with clopidogrel treatment for patients after PCI significantly improved left ventricular function, inhibited inflammatory response, enhanced coagulation function, and had high safety. These results can provide some basis for the treatment of patients after clinical PCI.

Influences of V-A Mode Assisted ECMO Combined with Intra-Aortic Balloon Counterpulsation on Disease Outcome and Troponin Level in Patients with Acute Fulminant Myocarditis

2024-06-10T17:47:47-07:00

Introduction: The acute fulminant myocarditis (AFM) is a special type of myocarditis, characterized by rapid onset, progression with abnormal hemodynamics causing high mortality. The combination of extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon counterpulsation (IABP) in these cases have improved the acute phase attacks resulting in increased survival of the effected individuals. To observe the effect of vein-artery (V-A) mode assisted ECMO combined with IABP on the disease outcomes and troponin level in patients with acute fulminant myocarditis (AFM). Methods: A total of 45 patients with AFM were admitted to our hospital from January 2016 to December 2021, they were divided into group A (21 patients, receiving traditional treatment) and group B (24 patients, receiving V-A mode assisted ECMO and IABP based on traditional treatment) according to the treatment plan. The hypersensitive troponin (hs-cTnI), B-type natriuretic peptide (BNP), arterial blood gas analysis index, multiple organ dysfunction score (MODS), simplified acute physiology score II (SAPS II), cardiac ultrasound index, and disease outcomes were compared between the two groups. Results: After treatment, the hs-cTnI, BNP, blood lactic acid, MODS score and SAPS score in both groups were lower than before treatment (p < 0.05), the arterial oxygen saturation (SaO₂), left ventricular ejection fraction (LVEF) and cardiac index (CI) was higher than before treatment (p < 0.05), the hs-cTnI, BNP, blood lactic acid, MODS score and SAPS Ⅱ score in group B were lower than group A (p < 0.05), SaO₂, LVEF and CI was higher than group A (p < 0.05). The in-hospital mortality of group B (9.52%, 2/21) was lower than group A (45.83%, 11/24) (χ² = 7.188, p = 0.007). Among the recovered discharged patients, the length of stay in group B (19 patients, 14.42 ± 4.59 days) was shorter than group A (13 patients, 18.34 ± 5.72 days) (t = 2.147, p = 0.040). Conclusions: V-A mode assisted ECMO combined with IABP can improve the condition and arterial blood gas analysis index and cardiac function of AFM patients, alleviate myocardial injury, reduce mortality in the hospital, and shorten the hospitalization time of the recovered patients.