Objective To evaluate outcomes of vacuum sealing drainage（VSD）for the treatment of wound infection after cardiac surgery.?Methods?We retrospectively analyzed clinical data of 70 patients（with valvular heart disease，congenital heart disease or coronary heart disease）who underwent cardiac surgery via mid-sternotomy and had postoperative wound infection from Jan. 2008 to Jan. 2012 in General Military Hospital of Guangzhou Command. According to different treatment strategy for wound infection, all the patients with wound infection （incision longer than 5 cm） were randomly divided into VSD group （n=35） and control group（n=35） by random number table，while VSD treatment was used for patients in VSD group and routine treatment was used for patients in control group. Treatment outcome，duration of wound infection, duration of antibiotic treatment and treatment cost were compared between the two groups.?Results?There was no in-hospital death in both groups. Wound exudate significantly decreased and fresh granulation tissue grew well in the wound in most VSD group patients after VSD treatment. The cure rate of VSD group was significantly higher than that of control group （94.3% vs. 60.0%，P＜0.05）. Duration of wound infection （12.9±3.4 d vs. 14.8±4.1 d；t=-2.094，P=0.040）and duration of antibiotic treatment （7.0±1.5 d vs. 8.3±1.9 d；t=-2.920，P=0.005） of VSD group were significantly shorter than those of control group. There was no statistical difference in treatment cost between the two groups. Fifteen patients in VSD group were followed up （42.9%） for 3 months with good wound healing, and 20 patients in VSD group were lost in follow-up.?Conclusion?VSD is effective for the treatment of wound infection after cardiac surgery with shortened treatment duration and similar treatment cost compared with routine treatment.
Abstract： Objective To explore the application of lower sternal incision with on-pump， beating heart intracardiac procedures in mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 42 patients （minimal incision group） with valvular heart diseases who underwent MVR via lower sternal incision under the beating heart condition in Xinqiao Hospital of the Third Military Medical University from January 2011 to December 2011. There were 16 male and 26 female patients with their average age of 42.3±12.7 years in the minimal incision group. We also randomly selected 42 patients with valvular heart diseases who underwent MVR via routine midline sternotomy during the same period in our department as the control group. There were 18 male and 24 female patients with their average age of 43.8±13.1 years in the control group. Operation time， cardiopulmonary bypass time， major complications， chest drainage in postoperative 24 hours， skin incision length and average postoperative hospital stay were observed and compared between the two groups. Results There was no major perioperative complication such as in-hospital death. There was no reexploration for postoperative bleeding， complete atrioventricular block， embolism or perivalvular leakage in the minimal incision group. There was no statistical difference in cardiopulmonary bypass time， operation time， or the incidence of reexploration for postoperative bleeding， wound infection and perivalvular leakage between the two groups（P＞0.05）. The skin incision length in the minimal incision group was shortened by 5.2 cm compared to that in the control group （7.9±1.4 cm vs. 13.1±3.3 cm， P=0.000）. Chest drainage in postoperative 24 hours in the minimal incision group was significantly less than that of the control group （183.6±40.2 ml vs. 273.4±59.9 ml， P=0.000）. Postoperative hospital stay in the minimal incision group was significantly shorter than that of the control group （8.1±1.3 d vs. 10.6±2.1 d， P=0.000）. Forty patients in the minimal incision group were followed up for 3-15 months and 2 patients were lost during follow-up. Four patients had postoperative wound pain， and the majority of patients didn’t have significant wound scar formation but a satisfactory quality of life. Thirty-eight patients in the control group were followed up for 3-15 months， 4 patients were lost during follow-up， and 17 patients had postoperative wound pain. Conclusion Lower sternal incision with beating heart can reduce the surgical injury， simplify the operation procedure and improve the therapeutic efficacy. It is a safe， effective and esthetic surgical approach for MVR.
Objective To investigate clinical diagnosis，timing of surgery and perioperative therapeutic strategies for blood culture-negative infective endocarditis （IE）. Methods Clinical data of 240 IE patients who were admitted tWuhan Asia Heart Hospital between July 2008 and July 2012 were retrospectively analyzed. According to their blood cultureresults，all the patients were divided into blood culture-negative group and blood culture-positive group. In the blood culture-negative group，there were 158 patients including 88 male and 70 female patients with their age of 51.3±10.1 years. In the blood culture-positive group，there were 82 patients including 45 male and 37 female patients with their age of 48.9±9.8 years. All the patients underwent surgical treatment，and the surgical procedures included complete vegetations excision，debridement of infected valves，removal of necrotic tissue around the annulus，and concomitant heart valve replacement or intracardiac repair. Postoperatively，all the patients received routine monitoring in ICU，cardiac glycosides，diuretics，other symptomatic treatment and adequate dosages of antibiotics for 4-6 weeks. Results Four patients died postoperatively in this study including 1 patient for low cardiac output syndrome and 3 patients for multiple organ dysfunction syndrome，1 patient in the blood culture-positive group and 3 patients in the blood culture-negative group respectively. There was no statistical difference in surgical mortality between the 2 groups （χ2=0.15，P=0.70）. All the other patients were discharged successfully and followed up for 6 to 36 months with the median follow-up time of 22 months. During follow-up, 2 patients died including 1 patient for cerebral infarction 2 years after surgery and another patient for cerebral hemorrhage 3 yearsafter surgery. Conclusion Patients with blood culture-negative IE should receive adequate dosage and duration of broad-spectrum antibiotics to control the infection rapidly, and aggressive surgical therapy to decrease in-hospital mortality and improve their quality of life and prognosis.
Abstract: Objective To observe the combined protective effects of U50 488H and hypothermia preservation on isolated rabbit hearts preconditioned. Methods Forty rabbits were randomly divided into five groups, 8 rabbits in each group. The perfusion model of isolated rabbit hearts was established by the Langendorff device. In the control group: the isolated rabbit hearts were preserved with the University of Wissconsin solution (UW ) for six hours; groupI : the isolated rabbit hearts were preconditioned with St. ThomasII cardioplegic solution containing U50 488H (1. 6mmo l/L ) and then preserved with hypothermic preservation for four hours; groupII ; the precondition was the same as group II , hypothermic preservat ion fo r six hours; group III : the precondit ion was the same as group I , hypothermic preservation for eight hours; group IV : the precondit on was the same as group I , hypothermic preservation for ten hours. The cardiac function, myocardial sarcoplasmic reticulum calcium ion adenosine triphosphatase (SRCa2+ -ATPase) act ivity and calcium ion concentrations in mitochondria were determined at thirty minutes after reperfusion. Results As the hypothermic preservation time increased from four to ten hours, the recovery rate of each index of cardiac function, coronary artery flow (Cf) and SRCa2+ -ATPase activity also decreased, but the calcium ion concentrations in the mitochondria increased. Cardiac function index recovery rates in group I and group II w ere higher than those in group III and groupIV respectively (P lt; 0. 05, 0. 01) ,meanwhile recovery rates of cardiac function index in group III were higher than that in group IV (P lt; 0. 05). Recovery rate of Cf in groupII ( 84. 56%±10. 38%)were higher than those in group III (79. 45%±9. 67% ) and group IV (68. 31%±6. 84% , P lt;0.01) , meanwhile the recovery rate of Cf in group III was higher than that in group IV (P lt; 0. 05). SRCa2+ -A Tpase activity in group II (4. 43±0. 41μmo l/m g?h)were higher than those in control group (3. 04±0. 22Lmo l/mg?h ) , group III (3. 26±0. 29Lmo l/m g?h) and group IV (2. 57±0. 63Lmo l/m g?h, P lt; 0. 05) , SRCa2+ -ATPase activity in group III was higher than that in group IV (P lt; 0. 01). The calcium ion concentrations in mitochondria in group II (38176±4. 30μmo l/g ?dw ) and in the control group (40. 23±3. 75μmol/g ?dw )were less than those in group III (43125±5116μmol/g?dw ) and groupIV (45. 78±3. 26μmol/g?dw , P lt; 0. 05, 0. 01) respect ively. Conclusion The hypothermic preservation time for isolated dono r’s hearts p re-treated with St. Thomas II cardioplegic solution containing U 50 488H should the kep tunder 8h. The myocardial protection effects of both UW solution and U50 488H- containing St. Thomas II cardioplegic solution on isolated dono r’s hearts appear to be the same at 6 hours.
The application of stem cell therapy for ischemic heart disease has aroused widespread interest. There have been many experimental studies concerning a variety of tissue stem cells such as bone marrow，blood，skin and skeletalmuscle stem cells，and their origins, differentiation and protein expressions are compared. In recent years，it is found that adipose-derived stromal cells （ADSCs） have potential advantages over other types of stem cells in that they are widely available and easily harvested through a simple liposuction procedure，and have a high regenerative capacity and therapeuticpotential for myocardial infarction. This review describes molecular and biological properties of ADSCs，their differentiationpotential，and regenerative and therapeutic potential for myocardial repair.
Abstract： Objective To construct an Anticoagulation Therapy Database of Chinese Patients after Heart Valve Replacement in accordance with blood coagulation characteristics of Chinese patients， fill the gap of Chinese clinical research in valvular heart diseases， and provide a scientific and objective basic data and information exchange platform. Methods A national multicentre，prospective and cohort clinical research method was applied to establish an anticoagulation therapy database of Chinese patients after heart valve replacement， using the Internet as a platform. A case report form （CRF）， which was in line with the actual situation of Chinese anticoagulation patients after heart valve surgery， was formulated through the discussion of experts from 36 cardiovascular surgery centers in China in the starting meeting of National Science amp; Technology Support Program during the Twelfth Five-year Plan Period.We planned to prospectively include patients receiving warfarin anticoagulation therapy and formal anticoagulation monitoring after heart valve replacement from January 1, 2011 to December 31, 2014. Database was constructed using warehousing technology， which allowed not only data monitoring， query and statistics， but also regular data backup and system updates. Results A network database entitled Anticoagulant Therapy Database of Chinese Patients after Heart Valve Replacement was constructed and linked with the homepage of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery （http：//www. zgxxwkzz. com）， which constituted a national Internet information platform. From 1 January 2011 to 1 December 2012， 8 452 anticoagulation patients after heart valve replacement from 34 level-3A hospitals in China had been registered in the database. Further follow-up of these patients was being carried out in respective hospitals. Conclusion A large multi-center and open database and network information platform has been constructed. The database variables are in line with clinical characteristics of Chinese anticoagulation patients after heart valve replacement， which provide scientific and objective basic data and support for future clinical research and systemic analysis.
Abstract： Objective To summarize surgical results of secondary subaortic stenosis （SSS） after congenital heart disease （CHD） operations，and analyze the pathogenesis of SSS. Methods We retrospectively analyzed clinical data of 19 patients who underwent surgical repair for SSS in Guangdong General Hospital from 1st June 2008 to 31st December 2012. There were 10 males and 9 females. CHD types included double outlet right ventricle，ventricular septal defect and partial atrioventricular septal defect，et al. The median age of the patients when they received their first CHD operations was 4 months （15 days to 5 year and 11 months）. The median age of the patients when they received SSS repair was 5 years and 3 months （1 year to 15 years and 3 months）. The median time interval from CHD operation to SSS repair was 4 years and 10 months （8 months to 13 years and 11 months）. Results All the patients successfully received their SSS repair. There was no surgical death in this study. Median cardiopulmonary bypass time was 79 （39 to 172） minutes，and median aortic cross-clamp time was 42 （22 to 124） minutes. Median postoperative hospital stay was 7 （5 to 9） days. Postoperatively， 1 patient required permanent pacemaker implantation. All the patients were followed up after discharge for a median durationof 1 year and 10 months （5 months to 4 years and 4 months） . During follow-up， none of the patients had any clinical symptom，their heart function was normal，and there was no late death. One patient received another subaortic stenosis repair for gradually aggravating left ventricular outflow tract stenosis. Conclusions SSS is very rare after CHD operations. The pathogenesis of SSS is perhaps related to abnormal blood flows in the left ventricular outflow tract after CHD operations. The pathogenesis time of SSS and types of CHD leading to SSS cannot be predicted. Subaortic stenosis repair is a simple and safe procedure for SSS，but postoperatively left ventricular outflow tract stenosis may appear and aggravate again.