Patients Undergoing Valve Replacement Surgery Research Articles

Short Term Effect of Vitamin D Supplementation on the Clinical Outcomes in Patients Undergoing Valve Replacement Surgery

Short Term Effect of Vitamin D Supplementation on the Clinical Outcomes in Patients Undergoing Valve Replacement Surgery

Human Coronary Micro‐artery Dysfunction is Associated with Structural and Smooth Muscle Cell Phenotypic Alterations

Autoregulation is compromised in patients with coronary heart disease. A lack of myogenic reactivity and endothelial dysfunction each contribute to a reduced ability to control blood flow within the coronary microcirculation. Little is known how coronary arterial smooth muscle structure and phenotype links to vascular reactivity.Right atrial appendage biopsies from consented patients undergoing valve replacement surgery, and from pigs were collected at clinical standards under general anesthesia. Human and porcine arteries from right atrial appendage samples were isolated and mounted for pressure myography. Confocal imaging established vasomotor responses, cellular viability, and immunohistochemical localization of proteins. The human study complies with the Helsinki Declaration and the animal study complies with the UK Animal (Scientific Procedures) Act, 1986.Here, we compared the structural features of human patient intra‐myocardial coronary arteries (IMCAs) with equivalently handled porcine IMCAs, representing healthy, juvenile controls. More than half the human IMCAs failed to develop ≥10% myogenic tone, even those in which constituent smooth muscle cells (SMCs) could adequately mobilize intracellular Ca2+required for contraction. 3D confocal revealed a novel, distinct layer of longitudinally‐arranged sub‐intimal SMCs (l‐SMCs) between the endothelium and the expected circumferentially‐arranged SMCs responsible for radial contraction (r‐SMC) in the majority of human and porcine IMCAs.Contractile function strongly correlated with SMC phenotype, with the synthetic markers L‐caldesmon and vimentin highly expressed in SMCs with poor contractile function, namely the human r‐SMCs and the porcine l‐SMCs. Thus, we propose that l‐SMCs retain an immature, synthetic phenotype in healthy vessels with functional r‐SMCs but, with loss of r‐SMC function in aged patients, l‐SMCs may play a reparative role and can adopt a contractile phenotype in an attempt to restore function and control myocardial perfusion. The role of l‐SMCs in maintaining the integrity of arterial function warrants further investigation.Support or Funding InformationThis work was supported by the British Heart Foundation (grant numbers FS/08/033/25111, FS/13/16/30199, IG/13/5/30431, PG/18/11/33552) and by the Oxford BHF Centre of Research Excellence (RE/13/1/30181).This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Evaluation of SERENE-CAG score for assessing suitability for coronary angiography preoperatively in patients undergoing valve replacement surgery

AimsThe aim of this study was to identify better selection criteria for subjecting patients of rheumatic heart disease (RHD) to preoperative coronary angiography (CAG) based on indigenous scoring system (SERENE-CAG [Selecting Patients Of Rheumatic Heart Disease Undergoing Valve Surgery For Presurgical Coronary Angiography]). MethodsThis prospective study included all consecutive 798 patients of RHD patients undergoing preoperative CAG from January 2016 to December 2017 over a duration of 2 years. Multivariate logistic regression analysis was performed with the presence of significant CAD [coronary artery disease] as the dependent variable with traditional risk factors of CAD. An additive score was developed using coefficient derived logistic regression for those variables that were significant. Receiver-operator curve analysis was performed to assess the ability of this score to predict diseased vs normal CAG. ResultsA total of 798 patients had a mean age of 51.7 ± 12.5 years. Significant CAD requiring revascularization along with valve surgery was identified in 50 (6.26%) patients. Male gender was found as significant predictors of CAD with odds ratio 2.6. A SERENE CAG SCORE of >2.8 resulted in sensitivity of 80% and specificity of 36.9% of predicting CAD in RHD patients with positive and negative predictive value of 7.8% and 96.5%, respectively. ConclusionThe prevalence of CAD in RHD patients is low. Patient risk can be minimized by exploring noninvasive modalities for screening of CAD and by more appropriate selection of patients for invasive coronary angiogram. Using threshold SERENE-CAG score of >2.8 would result in deferring 34.6% of normal angiograms.

Coronary artery disease prevalence amongst patients undergoing valve replacement surgery: A South African perspective

Background: The prevalence of coronary artery disease (CAD) amongst patients presented for valve surgery has important implications for routine angiography. Information on the frequency of CAD in predominantly black patients presented for valve surgery in South Africa has not been published. Methods: A retrospective, descriptive study of 116 patients presented for valve surgery that underwent coronary angiography between 2010 and 2011 was performed. CAD was defined as stenosis of 70% or greater in one or more epicardial vessels or ≥50% in the left main coronary artery, as defined by quantitative coronary angiography. Results: Median age was 57.4 (IQR 43 - 67) years (56.9% females). Black patients represented 66.4%, whites 19.8%, and, coloured and Indian patients 13.8%. Hypertension and smoking were the most common cardiovascular risk factors (26.7% and 16.4% respectively). Diabetes mellitus, dyslipidaemia, chronic kidney disease and prior CAD occurred collectively in 15.5% of study subjects. HIV prevalence was 12%, half of whom were on antiretroviral therapy. An isolated valve lesion occurred in 69% of patients, with the remainder having 2 or more lesions. The most common valve lesion was aortic stenosis (43.1%), followed by mitral stenosis (36.2%), aortic regurgitation (29.3%), mitral regurgitation (25.9%) and tricuspid regurgitation (19%). The predominant aetiology was rheumatic heart disease (58.6%), followed by degenerative valve disease (24.1%). CAD was documented in 10 patients (8.6%), of whom 8 had single vessel disease and 2 had double vessel disease. Conclusion: The low prevalence of CAD found in younger, asymptomatic black patients without cardiovascular risk factors referred for valve surgery, raises the question of whether routine pre-operative coronary angiography in this sub-group is appropriate.

Multi‐omics Studies Identify the Role of PPAR Pathway in Rheumatic Heart Disease Patients with Chronic Atrial Fibrillation

BackgroundAtrial fibrillation (AF) is one of the most common arrhythmia encountered in the clinical practice. The estimated prevalence of AF in the general population is as high as 1–2%. In this study, we aimed to identify the molecular changes and mechanisms responsible for chronic atrial fibrillation in rheumatic heart disease (RHD).MethodsPatients with rheumatic heart diseases (N=162) were enrolled in this study and classified into chronic AF group and sinus rhythm (SR) group based on their clinical manifestation. The atrial tissue (N=62) and plasma (N=100) samples were collected from the patients undergoing valve replacement surgery. Multi‐omics Studies were fulfilled with RNA Sequencing (RNA‐seq), isobaric tags for relative and absolute quantification (iTRAQ) and gas chromatography‐mass spectrometer (GC‐MS). ELISA was used to validate the proteins.ResultsThe differential genes/proteins were identified in the tissue or in the plasma samples between RHD‐AF patients and RHD‐SR patients. Combined analysis of transcriptomics, proteomics, and metabolomics revealed that the PPAR signaling pathway plays an important role in AF. The expression of multiple proteins were associated with PPARα,β,γ in tissue samples. On the other hand, only PPARα downstream alternations were identified in the study of plasma samples (APO‐A1 and APO‐A2). These proteins may be potential biomarkers for the diagnosis and treatment of AF in the future.ConclusionsWe for the first time identified the differentially expressed genes/proteins and related metabolites from plasma and tissue in chronic AF patients. Our study suggests that AF may impair the energy metabolism in the heart by altering the PPAR pathway, thus presenting metabolic remodeling in the heart.Support or Funding InformationSupported by grants from the National Natural Science Foundation of China (81641017), Zhejiang Provincial Natural Science Foundation (LY15H020008), & Tianjin Binhai Key Platform for Creative Research Program (2012‐BK110004), Binhai New Area Health Bureau (2014BHKY010, 2012BWKZ008, 2016BWKY007, 2016BWKZ003).This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Effect of intralipid on myocardial injury during valve replacement surgery with concomitant radiofrequency ablation: A randomized controlled trial.

This study aimed to evaluate the effect of intralipid postconditioning (ILPC) on myocardial damage in patients undergoing valve replacement surgery with concomitant radiofrequency ablation (RFA) for atrial fibrillation (AF). Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing valve replacement surgery with concomitant RFA. Sixty-nine patients were randomly assigned to ILPC group (n = 34) or control group (n = 35): ILPC group received an intravenous infusion of 20% intralipid (2 mL/kg) just 10 minutes before aortic cross-unclamping, and control group received an equivalent volume of normal saline. Serum cardiac troponin-T (cTnT) and creatine kinase-MB (CK-MB) was measured before surgery and at 4, 12, 24, 48, and 72 hours after surgery. The primary endpoints were the 72-hour area under the curve (AUC) for cTnT and CK-MB. The total 72-hour AUC of cTnT (P = .33) and CK-MB (P = .52) were comparable between 2 groups. The left ventricle ejection fraction at discharge (P = .011) was higher in the ILPC group than that in the control group, while the AF recurrence did not differ significantly between 2 groups. There was no observed beneficial effect of ILPC on myocardial injury documented by the cardiac biomarkers in patients undergoing valve replacement surgery with concomitant RFA, and the effect of intralipid against myocardial I/R injury is undetectable within the background of massive biomarker release following ablation owing to localized myocardial necrosis. Besides, there are no other published data about the cardioprotective role of intralipid in patients undergoing this procedure and benefits of this protection need further studies to validate.

Periodontal microbiota and microorganisms isolated from heart valves in patients undergoing valve replacement surgery in a clinic in Cali, Colombia

Periodontitis is an infectious disease that affects the support tissue of the teeth and it is associated with different systemic diseases, including cardiovascular disease. Microbiological studies facilitate the detection of microorganisms from subgingival and cardiovascular samples. To describe the cultivable periodontal microbiota and the presence of microorganisms in heart valves from patients undergoing valve replacement surgery in a clinic in Cali. We analyzed 30 subgingival and valvular tissue samples by means of two-phase culture medium, supplemented blood agar and trypticase soy agar with antibiotics. Conventional PCR was performed on samples of valve tissue. The periodontal pathogens isolated from periodontal pockets were: Fusobacterium nucleatum (50%), Prevotella intermedia/ nigrescens (40%), Campylobacter rectus (40%), Eikenella corrodens (36.7%), Gram negative enteric bacilli (36.7%), Porphyromonas gingivalis (33.3%), and Eubacterium spp. (33.3%). The pathogens isolated from the aortic valve were Propionibacterium acnes (12%), Gram negative enteric bacilli (8%), Bacteroides merdae (4%), and Clostridium bifermentans (4%), and from the mitral valve we isolated P. acnes and Clostridium beijerinckii. Conventional PCR did not return positive results for oral pathogens and bacterial DNA was detected only in two samples. Periodontal microbiota of patients undergoing surgery for heart valve replacement consisted of species of Gram-negative bacteria that have been associated with infections in extraoral tissues. However, there is no evidence of the presence of periodontal pathogens in valve tissue, because even though there were valve and subgingival samples positive for Gram-negative enteric bacilli, it is not possible to maintain they corresponded to the same phylogenetic origin.

Utility of Brain Magnetic Resonance Imaging in the Surgical Management of Infective Endocarditis

Brain magnetic resonance imaging (MRI) is frequently obtained in patients with infective endocarditis, yet its utility in predicting outcomes for valve replacement surgery in patients is unknown. The objective of this study was to determine how brain MRI findings impact clinical management and outcomes. Demographic and clinical data from electronic medical records at Mayo Clinic were retrospectively reviewed for patients hospitalized with definite or possible infective endocarditis according to the modified Duke criteria between January 1, 2007 and December 31, 2014. There were 364 patients included in the study. Cardiac valve replacement surgery was performed in 195 of 364 (53.6%) patients, and 95 (48.7%) of the surgical patients underwent preoperative MRI, which was associated with preoperative neurologic symptoms in 56 of 95 (58.9%) patients (odds ratio = 12.92; 95% confidence interval, 5.98-27.93; P <.001). Postoperative neurologic complications occurred in 24 of 195 (12.3%) patients, including new ischemic stroke in 4 of 195 (2.1%) and new intracerebral hemorrhage in 3 of 195 (1.5%). No patients with microhemorrhages developed postoperative hemorrhage. No significant differences existed in rates of postoperative complications between patients with and those without preoperative MRI. There were no substantial associations between preoperative MRI findings and postoperative neurologic complications, functional outcomes as described by the modified Rankin Scale score, or 6-month mortality. In patients undergoing valve replacement surgery, preoperative MRI findings were not associated with differences in postoperative outcomes, irrespective of finding or timing of valve replacement surgery.

Effect of intralipid postconditioning on myocardial injury in patients undergoing valve replacement surgery: a randomised controlled trial

ObjectiveThis study was conducted to determine whether the administration of intralipid just before aortic cross-unclamping would reduce myocardial injury in patients undergoing valve replacement surgery.MethodsSeventy-three adult patients, scheduled for elective...

Effects of remote ischemic preconditioning on acute myocardial injury in patients undergoing valve replacement

This study investigated the effects of remote ischemic preconditioning (RIPC) on acute myocardial injury and clinical outcome in adult patients undergoing valve replacement surgery. Sixty-three adult patients scheduled for elective valve replacement undergoing cardiopulmonary bypass (CPB) were randomly assigned to control or remote ischemic preconditioning treatment. RIPC was applied beginning with the first surgical incision by three times of inflating the cuff to 200mmHg for 5min, followed by 5min of deflation. The plasma creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) were determined. The preoperative, intraoperative, and postoperative characteristics, and hemodynamics values were recorded during the study. There were no significant differences in patient preoperative, intraoperative, and postoperative characteristics and hemodynamics values between groups. The activity of CK-MB and cTnI was significantly lower in RIPC group than CON group at 4 and 48h after aortic unclamping. The present study demonstrated that remote ischemic preconditioning might reduce release of CK-MB and cTnI in patients undergoing valve replacement. However, RIPC does not improve the clinical outcome of these patients.

Clinical analysis of infective endocarditis complicated with intracranial hemorrhage

Objective To analyze the clinical characteristics of infective endoearditis complicated with intracranial hemorrhage. Methods The clinical characteristics, brain CT and MRI results and prognosis of 7 patients with infective endocarditis and intracranial hemorrhage admitted between January 1991 and May 2015 were retrospectively analyzed. Results All seven patients presented varying degrees of fever, cardiac murmur and neurological symptoms. The continuous fever lasted from 21 d to 227 d (average 91 d). Mitral valve (4 cases) and aortic valve (3 cases) were the most common affected ones. The brain CT or MRI scan presented intracranial hemorrhage in 6 cases. More than 2 hemorrhage locations were found in 5 patients and parietal lobe was most common one (4 cases). All patients were treated with antimicrobial agents and three patients underwent valve replacement surgery. Three patients were cured and another 2 died due to fatal hemorrhage. Conclusions Patients with long fever history and ineffective antimicrobial treatment are prone to intracranial hemorrhage. Brain CT or MRI scan need be performed in infective endocardits when neurological symptoms are present, and brain angiography should be also considered if necessary. Key words: Endocarditis, bacterial; Intracranial hemorrhage; Aneurysm, infected

Mannose-binding lectin 2 (Mbl2) gene polymorphisms are related to protein plasma levels, but not to heart disease and infection by Chlamydia.

The presence of the single nucleotide polymorphisms in exon 1 of the mannose-binding lectin 2 (MBL2) gene was evaluated in a sample of 159 patients undergoing coronary artery bypass surgery (71 patients undergoing valve replacement surgery and 300 control subjects) to investigate a possible association between polymorphisms and heart disease with Chlamydia infection. The identification of the alleles B and D was performed using real time polymerase chain reaction (PCR) and of the allele C was accomplished through PCR assays followed by digestion with the restriction enzyme. The comparative analysis of allelic and genotypic frequencies between the three groups did not reveal any significant difference, even when related to previous Chlamydia infection. Variations in the MBL plasma levels were influenced by the presence of polymorphisms, being significantly higher in the group of cardiac patients, but without representing a risk for the disease. The results showed that despite MBL2 gene polymorphisms being associated with the protein plasma levels, the polymorphisms were not enough to predict the development of heart disease, regardless of infection with both species of Chlamydia.

Increased expression of NF-AT3 and NF-AT4 in the atria correlates with procollagen I carboxyl terminal peptide and TGF-β1 levels in serum of patients with atrial fibrillation.

BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice. Unfortunately, the precise mechanisms and sensitive serum biomarkers of atrial remodeling in AF remain unclear. The aim of this study was to determine whether the expression of the transcription factors NF-AT3 and NF-AT4 correlate with atrial structural remodeling of atrial fibrillation and serum markers for collagen I and III synthesis.MethodsRight and left atrial specimens were obtained from 90 patients undergoing valve replacement surgery. The patients were divided into sinus rhythm (n = 30), paroxysmal atrial fibrillation (n = 30), and persistent atrial fibrillation (n = 30) groups. NF-AT3, NF-AT4, and collagen I and III mRNA and protein expression in atria were measured. We also tested the levels of the carboxyl-terminal peptide from pro-collagen I, the N-terminal type I procollagen propeptides, the N-terminal type III procollagen propeptides, and TGF-β1 in serum using an enzyme immunosorbent assay.ResultsNF-AT3 and NF-AT4 mRNA and protein expression were increased in the AF groups, especially in the left atrium. NF-AT3 and NF-AT4 expression in the right atrium was increased in the persistent atrial fibrillation group compared the sinus rhythm group with similar valvular disease. In patients with AF, the expression levels of nuclear NF-AT3 and NF-AT4 correlated with those of collagens I and III in the atria and with PICP and TGF-β1 in blood.ConclusionsThese data support the hypothesis that nuclear NF-AT3 and NF-AT4 participates in atrial structural remodeling, and that PICP and TGF-β1 levels may be sensitive serum biomarkers to estimate atrial structural remodeling with atrial fibrillation.

Differential Release Kinetics of Cardiac Biomarkers in Patients Undergoing Valve Replacement Surgery.

Differential release kinetics of cardiac biomarkers including brain natriuretic peptide (BNP), Troponin-I, and CK-MB following valve replacement (VR) are not well characterized. We serially measured these biomarkers 24 hours prior, six hours, 24 hours, 48 hours, and one month following mitral/aortic VR in 100 patients. Baseline BNP, Tn-I, and CK-MB levels were 304.01 pg/mL, 0.03 ng/mL, and 0.99 ng/mL, respectively. While BNP levels decreased at six hours, and then peaked at 24 hours, Tn-I and CK-MB levels increased within six hours and then showed declining trends by 24 hours. While Tn-I and CK-MB levels normalized at one month, 33% patients still had BNP >200 pg/mL. Those with baseline BNP >200 pg/mL more commonly had AF, higher RV systolic pressure, longer inotrope and ventilator duration, and longer mean ICU/hospital stay as compared to those with lower BNP, although echocardiographic left ventricular ejection fraction and Tn-I/CK-MB levels were similar. Inotrope duration >42 hours, ventilation time >29 hours, and ICU stay >4 days was seen in 42% versus 19%, 30% versus 9%, and 33% versus 14%, respectively, in those with BNP >/<200 pg/mL. Baseline BNP had a significant positive correlation with mean inotrope duration, ICU, and hospital stay. Baseline BNP was also a significant predictor of inotrope duration (odds ratio [OR]=5.9, 95% confidence interval [CI]=1.20-29.68, p=0.01) and ventilation time (OR=4.7, 95% CI=1.76-17.21, p=0.02). Release kinetics of cardiac biomarkers is significantly different following VR; BNP levels increase following an initial transient decline. Only BNP was a predictor of postoperative variables.

Effect of Morphine and Fentanyl on Inflammatory Biomarkers in Rheumatic Heart Patients Undergoing Valve Replacement Surgery

Background: Cardiopulmonary bypass (CPB) is well known to be associated with a complex physiological response that is clinically manifested as a systemic inflammatory response syndrome. The aim of the study is to compare between the effect of morphine and fentanyl as part of a balanced anesthetic technique on the inflammatory reaction that occurs in cardiac valve replacement surgeries after CPB. Material and methods: Thirty patients undergoing cardiac surgery with cardiopulmonary bypass were randomized to receive either morphine or fentanyl as part of a standardized opioid-isoflurane anesthetic; Group 1 (15 patients received morphine, IV. Group 2 (15 patients received fentanyl. Hemodynamic data were recorded. Serum concentrations of interleukin [(IL)-6 and IL-10] and [(CD 11b, CD 11c, and CD 18] were measured. Results: There was a significant decrease in Heart Rate (HR) and Mean arterial pressure (MAP) in morphine group compared to fentanyl group. However, there were no significant differences between both groups in central venous pressure (CVP) and the incidence of intra operative arrhythmias. Serum levels of IL-6 and IL-8 concentrations increased in all patients after CPB. The increase in serum IL-6 levels was significantly attenuated in the morphine group compared to the fentanyl group at 3 and 24 hrs post CPB (P<0.05). The increase in IL-6 and IL- 10 concentrations was significantly attenuated in morphine group compared to the fentanyl group at 4hrs and 24hrs post-CPB (P<0.05). The reduction in adhesion molecules expression (CD 11b, CD 11c and CD 18) were significantly more in the morphine group than in the fentanyl group at 4 hrs and 24 hrs post-CPB (P<0.05). Conclusion: There were perturbations in the release of circulating cytokines, adhesions molecules and postoperative hyperthermia which attenuated by the use of morphine.

Heart valve surgery: EuroSCORE vs. EuroSCORE II vs. Society of Thoracic Surgeons score.

This is a validation study comparing the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with the previous additive (AES) and logistic EuroSCORE (LES) and the Society of Thoracic Surgeons' (STS) risk prediction algorithm, for patients undergoing valve replacement with or without bypass in Pakistan. Clinical data of 576 patients undergoing valve replacement surgery between 2006 and 2013 were retrospectively collected and individual expected risks of death were calculated by all four risk prediction algorithms. Performance of these risk algorithms was evaluated in terms of discrimination and calibration. There were 28 deaths (4.8%) among 576 patients, which was lower than the predicted mortality of 5.16%, 6.96% and 4.94% by AES, LES and EuroSCORE II but was higher than 2.13% predicted by STS scoring system. For single and double valve replacement procedures, EuroSCORE II was the best predictor of mortality with highest Hosmer and Lemmeshow test (H-L) p value (0.346 to 0.689) and area under the receiver operating characteristic (ROC) curve (0.637 to 0.898). For valve plus concomitant coronary artery bypass grafting (CABG) patients actual mortality was 1.88%. STS calculator came out to be the best predictor of mortality for this subgroup with H-L p value (0.480 to 0.884) and ROC (0.657 to 0.775). For Pakistani population EuroSCORE II is an accurate predictor for individual operative risk in patients undergoing isolated valve surgery, whereas STS performs better in the valve plus CABG group.

Effects of dexmedetomidine pretreatment on haemodynamics and bispectral index during anesthetic induction in patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass

Objective To evaluate the influence of dexmedetomidine(Dex)(highly selective α2-adrenergic receptor agonist) on haemodynamics and bispectral index (BIS) during anesthetic induction in patients undergoing valve replacement surgery.Methods Thirty NYHA class Ⅱ or Ⅲ patients,aged between 30 y and 70 y,undergoing cardiac value replacement with cardiopulmonary bypass,were randomly divided into two groups (n=15):Dex group(group D) and control group(group C).In group Dex,pump diluted with saline to 50 ml of Dex (4 mg/L)0.5 μg/kg was administered iv 10 min before the induction of anesthesia,while in group C,same volume of 0.9％ normal saline was given.The patients were premedicated with intramuscular morphine and scopolamine.Anesthesia was induced with 0.06 mg/kg,fentanyl 6 μg/kg,etomidate 0.3 mg/kg and pipecuronium 0.10 mg/kg.Anesthesia was maintained with midazolam,fentanyl,intermittently.In two group,heart rate(HR),arterial blood pressure(ABP)[systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)] and bispectral index(BIS) were recorded at the time before Dex infusion(T1),5 min after loading dose(T2),10 min after loading dose(T3),1,3 min after anesthesia induction(T4,T5),just before endotracheal intubation(T6),endotracheal intubation(T7) and 1,3,5 min after endotracheal intubation(T8-10).Results BIS of T2,T3 in group D was decreased significantly [from(92.6±2.5) to (73.2±1.9) and (70.1±2.3)](P＜0.05 or P＜0.01) compared with T1.During anesthesia induction compared with T3,BIS in both groups were decreased significantly.During endotracheal intubation compared with T6,BIS of T7 (34.8±2.2) was increased significantly in group C(P＜0.05 or P＜0.01),while BIS in group C were similar to the initial values.Compared with group C,BIS decreased significantly at time T2～5、T7 in group D (P＜0.05 or P＜0.01).Before anesthesia induction compared with T1,ABP of T2、T3 in group D was increased slightly,HR of T2、T3 was decreased significantly (P＜0.05 or P＜0.01); During anesthesia induction compared with T3,ABP and HR in both groups were decreased significantly.Compared with T6,DBP,MAP and HR of T7,T8 were increased slightly,that of T9,T10 were similar to the values in group D.During endotracheal intubation,while ABP and HR of T7-T1o was increased significantly in group C (P＜0.05 or P＜0.01).Compared with group C,SBP,MAP of T4-T10 and DBP of T3-T10 were increased significantly in group D.HR of T2-T10 were decreased significantly in group D (P＜0.05 or P＜0.01).Conclusions Dex pretreatment might decrease BIS and alleviate haemodynamics reaction during anesthetic induction in patients undergoing valve replacement surgery with cardiopulmonary bypass. Key words: Dexmedetomidine; Valve replacement; Bispectral index; Stress reaction; Hemodynamics

Failing surgical bioprosthesis in aortic and mitral position

Bioprosthetic heart valves are preferentially selected over mechanical prostheses in the majority of patients undergoing valve replacement surgery. These bioprostheses are prone to structural degeneration, and hence an increasing number of patients are presenting with bioprosthetic failure requiring redo surgery. In selected high-risk cases, successful implantation of a transcatheter aortic valve (TAV) within the failing bioprosthetic surgical aortic valve (SAV) or mitral valve (SMV) has been performed. Herein, we summarise the available evidence, describe the technical challenges, and highlight important procedural considerations for these innovative interventions.

Release kinetics of cardiac biomarkers in patients undergoing valve replacement surgery for rheumatic heart disease

Results Mean baseline BNP, TnI and CK-MB levels were 304.01 pg/ml, 0.03 ng/ml and 0.99 ng/ml. BNP initially decreased within 6 hours of surgery, and peaked at 24 hours; TnI and CKMB showed an early rise, with declining trends by 24 hrs. Peak BNP levels occurred in 90% patients by 24-48 hrs, while for TnI and CKMB this occurred in only 15-30%. Mean delta (peak-baseline) BNP, TnI, CKMB was 660.1pg/ml, 8.1ng/ml and 32.3ng/ml. At 1 month, levels of all biomarkers were not significantly different from baseline. Patients with higher baseline BNP more commonly had atrial fibrillation (71vs 33%,p=.02), higher right ventricular systolic pressure (69.7vs43.9 mm Hg, p 42 hrs, ventilation time>29 hrs and ICU stay>4 days was seen in 42%vs19%, 30%vs9% and 33%vs14% respectively in patients with baseline BNP >/ 42 hrs, ventilation time>29 hrs and ICU stay>4 days.

Abstract 154: Transcriptomic Analysis Reveals Upregulation of The Pro-Apoptotic, Extracellular Matrix-Degrading Granzyme System in Human Aortic Valve Calcification

Background: Calcific Aortic Valve Stenosis (CAVS) is a major valvular disease that leads to myocardial hypertrophy and heart failure. It shares many hallmarks with atherosclerosis, however, many of the specific mechanisms remain to be discovered. We used a DNA-microarray to study the transcriptomic changes in human aortic valve tissue during different stages of stenosis. Methods and Results: RNA was extracted from severely stenotic aortic valves of patients undergoing valve replacement surgery (n=5) and non-sclerotic control valves from patients with aortic insufficiency (n=5). A GeneChip Human Genome U133 Plus 2.0 Array (Affymetrix) was used to study the transcriptomic changes. Among the most upregulated genes were pro-apoptotic Granzymes, which are an integral part of the T-cell-mediated cytotoxic reaction. They have also been shown to be able to degrade the extracellular matrix (ECM). These findings were validated in a larger sample population (n=26) using qRT-PCR. Indeed, significantly increased expression of Granzymes A, B, H, K and M as well as granzyme co-effector Perforin 1 (PRF1) was detected in stenotic valves compared to normal valves. The most significant increase was seen in Granzyme B mRNA levels (7.1-fold; P&lt;0.001) and the gene expression of PRF1 was also markedly upregulated (3.6-fold; P&lt;0.001). Furthermore, the localization of granzymes within the valves and the effect of statin medication on their expression were studied. Conclusions: To our knowledge, this is the first time that the upregulation of the Granzyme system has been studied in human aortic valves. Its involvement indicates an active T-cell-mediated cytotoxic response as well as active degradation of the ECM. This opens up novel possibilities for the treatment and diagnosis of CAVS.