Undergoing Heart Valve Replacement Surgery Research Articles

Impact of 1-week preoperative auto-CPAP treatment on postoperative outcomes in patients undergoing heart valve replacement surgery: a prospective randomized controlled trial.

Whether preoperative continuous positive airway pressure (CPAP) treatment improves postoperative outcomes in patients undergoing cardiac valve replacement (CVR) remains unknown. This study was to evaluate the effects of 1-week perioperative auto-continuous positive airway pressure (CPAP) treatment on postoperative heart and pulmonary outcomes in patients with obstructive sleep apnea (OSA) and valvular heart disease. Thirty-two patients with OSA and valvular heart disease were randomly assigned to 1-week CPAP (n = 15) group and non-CPAP treatments (n = 17) group. After the treatment, all patients underwent CVR surgery. The length of ICU and hospital stays, postoperative cardiac and respiratory complications were assessed and compared between the 2 groups. The results showed there was no significant difference in the baseline characteristics between the CPAP and non-CPAP treatment groups. The length of postoperative ICU and hospital stays, as well as the duration of mechanical ventilation were significantly reduced in the CPAP treatment group compared to the non-CPAP treatment group; however, there were no significant differences in cardiac complications (postoperative arrhythmias, pacemaker use, first dose of dopamine in the ICU, and first dose of dobutamine in the ICU), and respiratory complications (reintubation and pneumonia). We concluded that in patients underwent CVR, preoperative use of auto-CPAP for OSA significantly decreased the duration of mechanical ventilation, and postoperative stays in the ICU and hospital.Clinical Trial Registration: https://ClinicalTrials.gov, identifier NCT03398733.

The association between preoperative blood calcium and postoperative blood loss in patients undergoing heart valve replacement surgery.

Bleeding after heart valve surgery is a serious clinical challenge. Hypocalcemia has been associated with the extent of bleeding in patients with spontaneous intracerebral hemorrhage. However, the association between blood calcium levels and bleeding extent in heart valve replacement patients has not been clearly established. This study aimed at determining the association between blood calcium levels and perioperative hemorrhage after heart valve replacement therapy. Based on preoperative blood calcium levels, patients were grouped into the hypocalcemia group and normocalcemia group. Postoperative bleeding, blood product use, and complications were monitored during hospitalization. The association between blood calcium levels and major bleeding was determined by multivariable logistic regression models. In the first 12h after surgery, bleeding in hypocalcemia group was significantly larger than that of the normocalcemia group (338 ± 234mL vs 232 ± 96mL; p = .024). The outcome was the same when the overall chest tube output was considered (950 ± 447mL vs 738 ± 220mL; p = .038). The incidence of major bleeding was 65.91% in the hypocalcemia group and 18.97% in the normocalcemia group (p = .001). Postoperative complications in the two groups were similar. After adjusting for multiple covariates, the adjusted odds ratios (OR) for participants in hypocalcemia group was 10.01 (95% CI 3.35-34.82), compared with that in normocalcemia group (p < .001). In patients undergoing heart valve surgery, preoperative blood concentrations of calcium are associated with postoperative blood loss. Hypocalcemia before operation may increase the risk of postoperative bleeding. When patients with valvular heart disease present with hypocalcemia before surgery, prompt intervention may lead to better control of postoperative bleeding.

High-dose ulinastatin reduces postoperative bleeding and provides platelet-protective effects in patients undergoing heart valve replacement surgery

The aim of this prospective study was to investigate the effect of a high dose of ulinastatin on platelets and coagulation in patients undergoing mitral valve and/or aortic valve replacement with cardiopulmonary bypass (CPB). 273 patients were enrolled in this open-label study. According to patients' willingness, 243 patients were assigned to the ulinastatin group and 30 to the control group. In the ulinastatin group, ulinastatin (300,000 U) was given after the induction of anesthesia, ulinastatin (400,000 U) was added to the CPB pump prime, and then ulinastatin (300,000 U) was administered after weaning from CPB. Complete blood count and coagulation function test were conducted 1 day before surgery and on the first postoperative day. Bleeding and other safety events were recorded during hospitalization. Less postoperative major bleeding occurred in the ulinastatin group (0.4 vs. 6.7%, p=0.03). Moreover, 1 day after CPB, platelet count in the ulinastatin group increased significantly compared to that in the control group (157.7±71.0 vs. 132.1±59.6, p=0.03). Interestingly and contrary to what was expected, activated partial thromboplastin time (APTT) and prothrombin time (PT) did not differ significantly between the two groups. Ulinastatin application did not cause significant increase in total costs (p=0.89). In heart valve replacement surgery with CPB, high-dose ulinastatin could reduce postoperative bleeding and promote platelet recovery with no significant additional medical cost.

The effect of progressive muscle relaxation on sleep quality and postoperative pain in patients undergoing heart valve replacement surgery

Background and aims: To investigate the effect of progressive muscle relaxation on sleep quality and postoperative pain in patients undergoing heart valve replacement surgery. Methods: In this quasi-experimental study, 60 patients undergoing surgery that enter were randomly divided into the muscle relaxation (n=30) or control group (n=30). Data were collected by Pittsburgh Sleep Quality Index and McGill Pain Questionnaire before and after the intervention. Patients in the control group received routine care, but patients in the muscle relaxation group performed a progressive relaxation technique twice a week for one month. Results: Most of the male participants in both groups had diplomas. There is no significant difference between the two groups of relaxation and control regarding age, gender, occupation, and education levels. The mean sleep quality score in the control group was not significantly reduced after the intervention. However, the mean sleep quality in the relaxation group before 13.90±2.23 and after the intervention was 8.03±2.01 significantly decreased (P&lt;0.001). Also, the pain score was significantly reduced after the progressive relaxation group in the intervention group (P&lt;0.001). Although the two groups were the same in all the dimensions of sleep quality before the intervention, significant differences were observed between groups after the intervention in all the dimensions. Conclusion: Progressive muscle relaxation has an influential role in the pain decrease and sleep quality of patients undergoing heart valve replacement surgery and can be used as a safe and cost-free method for patients.

Tropisetron Preconditioning Decreases Myocardial Biomarkers in Patients Undergoing Heart Valve Replacement Surgery

BackgroundCardioplegic arrest during the heart valve replacement surgery frequently leads to myocardial damage. Tropisetron (TRP) has been demonstrated to reduce myocardial ischemia-reperfusion injury and inflammation in animals. We examined the efficacy of TRP in lowering myocardial biomarkers in patients undergoing heart valve replacement surgery.MethodsA total of seventy-five patients, scheduled for elective heart valve replacement surgery, were randomly chosen to receive either 10 ml of normal saline or 10 mg/10 ml of TRP immediately after anesthesia induction. Blood samples for the measurement of cardiac troponin I (cTnI), creatine kinase (CK-MB), lactate dehydrogenase (LDH), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-10 (IL-10) were taken before anesthesia, as well as 4, 12, and 24 h after aortic cross-clamp release to evaluate myocardial injury using two-way ANOVA for repeated measurements. The study was registered at www.chictr.org.cn (number, ChiCTR-1800018681).ResultsTreatment with TRP decreased the increment of cTnI (Fgroup = 4.911, p = 0.030; Ftime = 55.356, p = 0.001; Fgroup × time = 5.340, p = 0.002) at 12 and 24 h; of CK-MB (Fgroup = 6.552, p = 0.013; Ftime = 49.276, p = 0.001; Fgroup × time = 7.627, p = 0.003) at 4, 12, and 24 h; of TNF-α (Fgroup = 4.153, p = 0.046; Ftime = 28.244, p = 0.002; Fgroup × time = 4.692, p = 0.006) at 4 and 12 h; and of LDH (Fgroup = 4.275, p = 0.043; Ftime = 63.225, p = 0.001; Fgroup × time = 2.501, p = 0.083) at 24 h after the release of the aortic cross-clamp. It increased IL-10 (Fgroup = 5.958, p = 0.018; Ftime = 31.226, p = 0.002; Fgroup × time = 1.464, p = 0.236) at 12 h after the release of the aortic cross-clamp. Multiple linear regression analysis showed that cardiopulmonary bypass (CPB) time was a risk factor, and that TRP treatment was a protective factor for postoperative cTNI change (β = 4.449, 95% CI [0.97–7.92], p = 0.013 for CPB time; and β = −381, 95% CI [−613.4 to −148.5], p = 0.002 for TRP treatment).ConclusionsTropisetron had cardioprotective and anti-inflammatory effects in patients undergoing heart valve replacement surgery with cardioplegic arrest. The addition of TRP and reduction of CPB time should be considered for myocardial protection in heart valve replacement surgery.Clinical Trial Registration[www.chictr.org.cn/index.aspx], identifier [ChiCTR1800018681].

The application value of diaphragm ultrasound in the weaning of ventilator for patients undergoing heart valve replacement

Objective: To explore the role of diaphragm ultrasound in guiding the successful weaning of ventilators in patients undergoing heart valve replacement. Methods: Prospectively selected 103 patients who received heart valve replacement in the Department of Cardiac Surgery, Fuwai Hospital of the Chinese Academy of Medical Sciences from December 2019 to February 2021 were selected, who have received mechanical ventilation for ≥48 h and have entered the pre-weaning spontaneous breathing test. The patients were divided into a successful weaning group (n=83) and failed weaning group (n=20) according to the patient's weaning result. Receiver operating characteristic (ROC) curve was used to evaluate the value of diaphragm thickening rate and diaphragmatic excursion to predict the result of ventilator weaning. Results: Among 83 patients in the successful weaning group, 52 were male patients and 31 were female patients, with an average age of (56.5±5.5) years; 20 patients in the failed weaning group included 12 male patients and 8 female patients, with an average The age is (57.3±6.2) years old.The left DTF, right DTF, left DE, and right DE of the patients in the successfully weaned group were (39.0±17.8)%, (57.7±1.2)%, (11.9±4.3) mm, (18.5±1.4) mm, respectively, which were higher than those in the weaning failure group (18.1±4.5)%, (19.9±2.3)%, (6.2±2.8) mm, (11.9±1.5) mm, respectively. And the differences were statistically significant (all P<0.05). ROC curve analysis showed that the best cut-off values, the sensitivity and the specificity for the thickening rate of the left diaphragms of patients with successful weaning were 61%, 90.46% and 87.83%, respectively; while the best cut-off values, the sensitivity and the specificity for the thickening rate of the right diaphragms of patients with successful weaning were 88%, 96.07% and 89.67%, respectively. The optimal cut-off values, the sensitivity and the specificity of mobility of the left right diaphragms of patients are 11.3 mm, 81.38% and 80.24%, respectively; while the optimal cut-off values, the sensitivity and the specificity of right diaphragms of patients were 12.7 mm, 87.23% and 85.56%, respectively. Conclusion: Diaphragm ultrasound can more accurately predict the outcome of ventilator weaning in patients undergoing heart valve replacement surgery, and it has good clinical application value.

Effect of NPC1L1 polymorphism on warfarin stable dose in Chinese patients under heart valve replacement surgery.

Warfarin is the most often anticoagulant choice for preventable thromboembolism. Notably, vitamin K plays a vital role in the process of warfarin's anticoagulant effect. Therefore, we presume NPC1L1, a key transporter of vitamin K (VK) intestinal absorption, may modulate the anticoagulant effect of warfarin. Studies have shown that NPC1L1(-762T>C, rs2073548) and p53 (P72R, rs1042522) variations are implicated in influencing NPC1L1 expression. This study aimed to assess the association between these two variants and warfarin stable dose (WSD). A two-stage extreme phenotype design was used to explore the influence of these two variants (rs2073548, rs1042522) on WSD variance in 655 Chinese patients undergoing heart valve replacement surgery. NPC1L1 rs2073548, p53 rs1042522, VKORC1 rs9923231 and CYP2C9*1/*3 polymorphisms were genotyped by polymerase chain reaction-restriction fragment polymorphism (PCR-RFLP) or Sanger sequencing, respectively. WSD was identified when target monitoring international normalized ratio (INR) value at 2.0-3.0. In the discovery phase, NPC1L1 rs2073548 A allele carriers occupied a significantly higher rate in the low dose group (P=.019). However, in the validation group, warfarin dosage in patients with the rs2073548 AA, AG and GG genotypes were 2.91±0.97mg/day, 3.02±1.00mg/day and 3.00±1.06mg/day, respectively. Multiple linear regression analysis results suggested that CYP2C9*3 and VKORC1 rs9923231, but not NPC1L1 rs2073548, were independent predictors of WSD in Chinese heart valve replacement (HVR) surgical patients.

The effect of phased written health education combined with healthy diet on the quality of life of patients after heart valve replacement

BackgroundTo observe the effect of phased written health education combined with healthy diet on the quality of life of patients after heart valve replacement.MethodsOne hundred-thirty patients who underwent heart valve replacement surgery in our hospital from January 2018 to January 2020 were enrolled as the research subjects. They were randomly divided into study group (65 patients, phased written health education combined with health Diet) and control group (65 cases, routine health education). The drug compliance and the degree of anticoagulant drugs knowledge were compared between the two groups in the first and second stage rehabilitation and the recovery stage. The health behavior ability and quality of life at different phases were also observed.ResultsDuring the first and the second stage rehabilitation, and the recovery stage, the drug compliance of the study group was superior to that of the control group, with statistical significance (P < 0.05). Meanwhile, the knowledge of anticoagulant drugs in the study group was better than that in the control group, with statistical significance (P < 0.05). Before intervention, there was no significant difference in health behavior ability and quality of life between the two groups (P > 0.05). The healthy behavior ability of study group for each stage was superior to the control group, the difference was significant (P < 0.05). The healthy behavior ability and quality of life showed the same results with statistical significance (P < 0.05).ConclusionThe use of phased written health education combined with healthy diet in patients after heart valve replacement can effectively improve patients’ medication compliance, anticoagulant drugs knowledge, healthy behavior ability and quality of life at different stages, and is worthy of clinical application.

Electroacupuncture preconditioning attenuates myocardial ischemia-reperfusion injury by inhibiting mitophagy mediated by the mTORC1-ULK1-FUNDC1 pathway

Myocardial ischemia/reperfusion (I/R) is an important complication of reperfusion therapy for myocardial infarction, and trimetazidine is used successfully for treatment of ischemic cardiomyopathy by regulating mitochondrial function. Moreover, electroacupuncture (EA) preconditioning was demonstrated to be cardioprotective in both in vivo rodent models and in patients undergoing heart valve replacement surgery. However, the mechanisms have not been well elucidated. Mitophagy, mediated by the mTORC1-ULK1-FUNDC1 (mTOR complex 1-unc-51-like autophagy-activating kinase 1-FUN14 domain-containing 1) pathway, can regulate mitochondrial mass and cell survival effectively to restrain the development of myocardial ischemia/reperfusion injury (MIRI). In this study, we hypothesized that EA preconditioning ameliorated MIRI via mitophagy. To test this, rapamycin, an mTOR inhibitor, was used. The results showed that EA preconditioning could reduce the infarct size and risk size, and decrease the ventricular arrhythmia score and serum creatine kinase-myocardial band isoenzyme (CK-MB), lactate dehydrogenase (LDH), and cardiac troponin T (cTnT) in MIRI rats. Moreover, it also attenuated MIRI-induced apoptosis and mitophagy accompanied by elevated mTORC1 level and decreased ULK1 and FUNDC1 levels. However, these effects of EA preconditioning were blocked by rapamycin, which aggravated MIRI, reduced adenosine triphosphate (ATP) production, and antagonized infarct size reduction. In conclusion, our results indicated that EA preconditioning protected the myocardium against I/R injury by inhibiting mitophagy mediated by the mTORC1-ULK1-FUNDC1 pathway.

Role of PPAR Pathway in Atrial Fibrillation Associated with Heart Valvular Disease: Transcriptomics and Proteomics in the Human Atrial Tissue

ObjectiveAtrial fibrillation (AF) is one of the most common cardiac arrhythmias. Previous studies have shown that electrical, contractile, and structural remodeling play the key role in the onset and maintenance of AF. Heart valvular disease (HVD) is associated with an increased risk of thromboembolic events, mainly in patients with AF. However, the molecular mechanism of AF in HVD remains unrevealed, although there was an attempt to discover the plasma biomarkers in HVD.MethodsHuman atrial tissues from patients with HVD in persistent AF preoperatively for at least 6 months or remaining sinus rhythm (as control) undergoing heart valve replacement surgery were studied by combined transcriptomics and proteomics. Owing to the fact that there are maximal 8 Isobaric tags in proteomics analysis by iTRAQ technology, 8 tissue samples were allocated, including left atrial tissues from 3 AF patients (AFLA) and right atrial tissues (3 AFRA and 2 SRRA) from 5 patients. The analysis of transcriptomics and proteomics were from the same samples. Big data obtained from omics study were analyzed by bioinformatics tools. The fold changes of &gt;1.2 (or &lt;0.8) and P value &lt; 0.05 were considered as significant.ResultHierarchical clustering analysis revealed that the genomic expressions of three groups have differences in transcriptomics. Pairwise comparison was performed and differentially expressed genes were identified, including 193 genes up‐regulated and 279 genes down‐regulated. Heat map from differentially expressed proteins in proteomics analysis indicates that there are significant differences in patients with or without AF and between the left and right atrium. Based on Gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, we found that the expression of genes and proteins associated with PPARα, β/δ, γ was altered in omics study in AF patients. Genes/proteins, such as FATCD36, SCD‐1, FABP, ADIPO, APOA1, APOA2, FATP, FADS2, ACBP, CPT‐1, aP2, CAP, and etc., are included in the PPAR pathway. These genes/proteins may be developed as potential biomarkers for disease pathogenesis and progress in AF.ConclusionOur study provides an integrative analysis of transcriptomics and proteomics in human atrial tissues of AF‐associated HVD patients and reveals that PPAR signaling pathway plays an important role in pathogenesis of AF. Some of differential proteins may become biomarkers and provide new diagnostic and therapeutic methods for AF in the future.Support or Funding InformationThis work was supported by the National Natural Science Foundation of China [81870288 &amp; 81870227]; the Non‐profit Central Research Institute Fund of Chinese Academy of Medical Sciences [2019XK310001&amp; 2018TX31002]; Tianjin Science and Technology Committee[18PTZWHZ00060];Binhai New Area Health Bureau (2018BWKZ005)

Immunosuppressive profile of patients operated for acquired heart diseases under artificial circulation. A prospective study

Objective. To study the dynamics of immunosuppressive cell populations in patients who underwent heart valve replacement surgery under artificial circulation. Materials and methods. We investigated the dynamics of MDSC, PD-1-positive cells among Th and Tcyt and PD-L1-positive monocytes in patients operated on for the heart under cardiopulmonary bypass in the volume of prosthetic heart valves, the study points were before surgery, immediately after surgery and after 1, 3, 7 days. The study was carried out on a CytoFlex laser flow cytometer. Results. In the group of patients without complications and in the group with complications outside the infection, an increase in all MDSC populations was observed 1 day after surgery, with a return to baseline values within a week. The dynamics of MDSC in a patients with sepsis was characterized by an increase within 3 days with the achievement of maximum figures in comparison with the previous groups. In patients without complications, an increase in PD-L1+, PD-1+ CD4+ and PD-1+CD8+ monocytes were observed immediately after surgery and one day later. In the case of the development of infectious complications in the postoperative period, a relatively moderate increase in the monocyte content was observed only by 3 days after the operation. The content of PD-1 positive T cells increased moderately up to 7 days among Th, and significantly by 7 days, followed by a decrease among Tcyt. Conclusions. A high initial content of Mon-MDSC is a risk factor for the development of postoperative infectious complications. A significant increase in immunosuppressive populations in the early postoperative period can be regarded as an unfavorable variant of the course of the compensatory anti-inflammatory syndrome.

Risk estimation model for acute kidney injury defined by KDIGO classification after heart valve replacement surgery.

Risk prediction for postoperative acute kidney injury (AKI) has a great clinical value to achieve early prevention strategies for AKI after cardiac surgery. We aimed to identify the patients at risk of postoperative AKI and to create patient risk group for AKI using a simple risk estimation model in patients undergoing heart valve replacement surgery. Between May 2008 and February 2018, 219 consecutive patients undergoing heart valve replacement surgery with or without concomitant coronary artery bypass grafting (CAGB) were included in the study. To define postoperative AKI and its severity stages, KDIGO classification which is the latest uniform classification for determining and staging of AKI was used. The AKI incidence was 38.8%, and Class I was the dominant stage (43.5%). Postoperative AKI development was associated with a serious of postoperative adverse events, early, and long-term mortality. Furthermore, the incidence of poor outcomes increased with the degree of AKI severity. The presence of older age, chronic obstructive pulmonary disease, NYHA class III-IV, diabetes, concomitant CABG, and longer cardiopulmonary bypass duration was found to be an independent predictor for AKI, and each factor was scored according to the integer value of their odds ratio, based on risk estimation model. Patient risk groups from mild to severe for AKI development were created. The patients at severe risk group exhibited a significantly higher rate of adverse events, early, and long-term mortality as well as lower long-term survival rates. The risk estimation model is a useful tool to identify the patients at risk and to create patient risk groups for postoperative AKI defined by KDIGO after heart valve replacement surgery.

De Ritis ratio as a significant prognostic factor of international normalized ratio ≥4 in the initial 10 days of warfarin therapy.

Aim: To assess the relationship between the De Ritis ratio on admission and warfarin sensitivity in the initial 10 days of anticoagulation therapy. Methods: We retrospectively reviewed data from 906 patients who underwent heart valve replacement surgery. Results: A De Ritis ratio of 1.19 was identified as the optimal cutoff according to the ROC curve. Patients with a high De Ritis ratio achieved an international normalized ratio (INR) ≥4 more easily and earlier than those with a low De Ritis ratio in the initial 10 days of warfarin therapy. Multivariate analysis showed that a high De Ritis ratio was an independent predictor of an INR ≥4 (HR: 2.567; p < 0.001). Conclusion: A De Ritis ratio ≥1.19 on admission was significantly associated with an INR ≥4 in the initial 10 days of warfarin therapy among patients underwent heart valve replacement surgery.

LIM kinase 1 acts as a profibrotic mediator in permanent atrial fibrillation patients with valvular heart disease

Atrial fibrillation (AF) is the most frequently diagnosed cardiac arrhythmia worldwide. Patients with permanent atrial fibrillation are at an increased risk of developing valvular heart disease. Atrial fibrosis occurs in this pathophysiological setting. LIM kinase 1 (LIMK1) is a serine/threonine kinase that regulates microtubule stability and actin polymerization in fibroblasts. LIMK1 has been implicated in the pathogenesis of atrial fibrillation. Clinical data and biopsies of the right atrial appendage were collected from 50 patients with valvular heart disease who underwent heart valve replacement surgery. Data from patients with permanent atrial fibrillation (AF) and patients with sinus rhythm (SR) were compared. We found that AF patients had upregulated expression of LIMK1 as well as higher fibrosis. Transforming growth factor-β (TGF-β) stimulation induced the differentiation of cardiac fibroblasts into myofibroblasts as well as upregulated expression of LIMK1. Downregulation of LIMK1 by siRNA inhibited TGF-β induced fibroblast-myofibroblast transition, as evidenced by the downregulation of the expression of several differentiation markers, namely alpha-smooth muscle actin and type I and III collagen. Our findings revealed that increased LIMK1 protein levels may contribute to atrial fibrosis, and suggested that LIMK1 might be involved in AF development by promoting fibrogenesis associated with TGF-β.

Snail1 is positively correlated with atrial fibrosis in patients with atrial fibrillation and rheumatic heart disease.

The present study investigated the association between Snail1 and atrial fibrosis in patients with atrial fibrillation (AF) and rheumatic heart disease (RHD) and to determine the possible mechanism underlying this interrelation. A total of 19 patients were included in the current study and were divided into two groups: A sinus rhythm (SR) group (n=9) and an AF group (n=10). All patients underwent heart valve replacement surgery, during which ~200 mg right atrium tissue was obtained. Hematoxylin and eosin and Masson's trichrome-stained sections were used to evaluate the morphological changes of cardiomyocytes and the level of fibrosis. Immunohistochemistry was applied to observe the location and expression of Snail1. Reverse transcription-quantitative polymerase chain reaction was used to measure Snail1 mRNA levels. Western blotting was used to determine changes in the expression of Snail1, as well as in the expression of proteins involved in the Wnt pathway, including Wnt1, Wnt 3a, Wnt8a, Wnt5a and Wnt11. Compared with the SR group, expanded cardiomyocytes and higher collagen deposition was detected in the atrial tissue of the AF group. The expression of Snail1 mRNA and protein was significantly higher in the AF group than in the SR group (P<0.05). Additionally, the expression of Wnt1, 3a and 8a in the canonical Wnt signaling pathway, and Wnt5a and 11 in the noncanonical Wnt signaling pathway were significantly increased in the AF group. Furthermore, the phosphorylation level of glycogen synthase kinase 3β (GSK3β) and the levels of β-catenin and GSK3β were significantly increased in the AF group compared with the SR group (P<0.05). Snail1 may be involved in the development and maintenance of atrial fibrosis in patients with atrial fibrillation and rheumatic heart disease and may be developed as a novel biomarker to evaluate myocardial fibrosis in the future. Additionally, the current study suggests that the Wnt signaling pathway may participate in the process of increased Snail1 expression and atrial fibrosis in patients with AF and RHD.

Comparison of the myocardial protective effect of sevoflurane versus propofol in patients undergoing heart valve replacement surgery with cardiopulmonary bypass

BackgroundThis study aimed to compare myocardial protective effects of anaesthesia with intravenous infusion of propofol versus inhalation of sevoflurane in patients undergoing heart valve replacement surgery with cardiopulmonary bypass.MethodsSeventy-six patients undergoing valve replacement with cardiopulmonary bypass were randomly assigned to propofol or sevoflurane anesthesia during the surgery, respectively. For assessing myocardial injury, cardiac troponin I (cTnI) and creatine kinase isozyme (CK-MB) were determined before induction (T0), 0.5 h (T1) and 3 h (T2) after aortic unclamping, and 24 h (T3) and 48 h (T4) after surgery. The concentrations of interleukin (IL)-6 and IL-10 as the systemic inflammatory and anti-inflammatory markers were also measured at above time points.ResultsIn the sevoflurane group, the plasma concentrations of cTnI and CK-MB from Tl to T4 and the levels of IL-6 and IL-10 from T1 to T2 were lower than those in the propofol group. Moreover, a higher ratio of automatic heart beat recovery and a shorter length of intensive care unit or hospital stay were found in the sevoflurane group comparing with the propofol group.ConclusionSevoflurane anaesthesia produced more prominent myocardial protection and attenuated inflammatory response than propofol anaesthesia in patients with valve replacement surgery under cardiopulmonary bypass, resulting in shorter ICU and in-hospital stay.Retrospective clinical trial registrationIdentified as ChiCTR-IOR-16009979 at http://www.chictr.org.cn/.

Hypoxic encephalopathy after heart valve replacement: etiology and pathogenesis, diagnostic criteria and treatment

Reviewed in this paper are modern approaches in the intensive therapy of acute hypoxic encephalopathy developing in a number of occasions after the heart valve replacement surgery. The study is based on the results of neurological, neuropsychological and neurophysiological (EEG) examinations of 240 patients who underwent heart valve replacement surgery under cardiopulmonary bypass conditions complicated later by the development of hypoxic encephalopathies of varying severity and who received complex intensive care. Relying on many years of experience in the treatment of heart surgery patients in whom manifestations of encephalopathy developed in the early postoperative period, or were delayed, we have formulated the following algorithms of therapy. (1) Maintenance of normal blood gas: Hb&gt;100 g/L, pH 7.45, PaCO2 35 mmHg. (2) Maintenance of hemodynamics: ABPsystolic&gt;90 mmHg. (3) Supplying fluids and electrolytes: isoosmolar infusion solutions, adding of KCl and MgSO4 to the infusion. (4) Antiedemic therapy: 15% mannitol or 40% glycerol solution. (5) If necessary (in case of psychomotor agitation, seizures), short-acting barbiturates (sodium thiopental), neuroleptics (haloperidol), propofol. No benzodiazepines in case of psychoses (6) Cerebral metabolism stimulation (not earlier than 48 hours after surgery) with cholinomimetics, nootropics, cerebral blood flow protectors. Cholinomimetics are allowed on the first day after surgery. This algorithm and the above-mentioned groups of drugs, especially central cholinomimetics, allow for correcting the neurocognitive impairment in the discussed group of patients quickly and effectively.

Increased TRPM6 expression in atrial fibrillation patients contribute to atrial fibrosis

BackgroundTransient receptor potential (TRP) family plays important roles in cardiovascular system. We investigated the relationship between transient receptor potential channel subfamily M6 (TRPM6) and atrial fibrosis in rheumatic heart disease patients with atrial fibrillation (AF). MethodsThe right atrial tissue samples were obtained from 64 patients with rheumatic heart diseases who underwent heart valve replacement surgery, and composed of 34 sinus rhythm (SR) patients and 30 AF patients. Hematoxylin and Eosin (HE) staining was used to observe cross-sectional area (CSA) of myocardial cell. Masson staining and measurement of connective tissue growth factor (CTGF), transforming growth factor beta 1 (TGF-β 1), and collagen type I/III (Collagen I/III) were performed to determine atrial fibrosis. The mRNA and protein levels of TRPM6 were detected by real-time quantitative polymerase chain reaction (RT-PCR) and western blotting, respectively. ResultsMarked increases were observed in CSA of myocardial cell and myocardial collagen volume fraction in AF group compared with the SR group (all P<0.05). The mRNA levels of myocardial fibrosis markers (CTGF, TGF-beta 1, Collagen I/III) in AF group increased significantly compared to the SR group (all P<0.05). TRPM6 mRNA and protein levels in AF group were elevated markedly in comparison with SR group (P<0.01). ConclusionThese findings revealed that increased TRPM6 mRNA and protein levels may contribute to atrial fibrosis, and suggested that TRPM6 might be involved in AF development by promoting fibrogenesis.

Combined Treatment of Ulinastatin and Tranexamic Acid Provides Beneficial Effects by Inhibiting Inflammatory and Fibrinolytic Response in Patients Undergoing Heart Valve Replacement Surgery

To investigate the effect of ulinastatin and tranexamic acid administered alone or in combination on inflammatory cytokines and fibrinolytic system in patients undergoing heart valve replacement surgery during cardiopulmonary bypass (CPB). CPB-induced fibrinolytic hyperfunction and systemic inflammatory response syndrome (SIRS) are the leading causes responsible for the occurrence of postsurgical complications such as postsurgical cardiac insufficiency and lung injury, which may lead to an increase in postsurgical bleeding, prolongation of hospital stay, and increased costs. One hundred twenty patients undergoing heart valve replacement surgery during CPB were randomly assigned into 4 groups of 30 patients each: blank control group (Group C), tranexamic acid group (Group T), ulinastatin group (Group U), and tranexamic acid-ulinastatin combination group (Group D). Physiological saline, tranexamic acid, ulinastatin, and a combination of tranexamic acid and ulinastatin were given to each group, respectively. Arterial blood was collected from the radial artery at 4 time points: after induction of anesthesia (T1), unclamping the ascending aorta (T2), and at 1 hour (T3) and 24 hours (T4) after CPB. The levels of plasma tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), neutrophil elastase (NE), and the concentrations of tissue plasminogen activator (t-PA) and α2-antiplasmin (α2-AP) were detected. The changes in the volume of pericardial mediastinal drainage after surgery were observed and recorded. The plasma TNF-α, IL-6, and NE levels significantly increased in patients from all 4 groups at time points of T2, T3, and T4 in comparison to those before CPB (P < .05), and the plasma TNF-α and IL-6 levels in groups U and D were significantly lower than those in the other 2 groups (P < .05). The plasma t-PA, α2-AP, and D-dimer concentrations significantly increased in patients from all 4 groups at T2 and T3 compared with those before CPB (P < .05), and the plasma t-PA and D-dimer concentrations were significantly lower in groups T and D than those in groups U and C (P < .05) at T2 and T3. The plasma α2-AP concentrations in groups T and D were significantly higher than those in Group C at T3 (P < .05). The volumes of pericardial mediastinal drainage per body surface area were significantly lower in groups T and D than those in Group C 6 hours after the surgery (P < .05). Ulinastatin inhibits the release of inflammatory medium and reduces the inflammatory response during CPB. Tranexamic acid can effectively inhibit the fibrinolytic hyperfunction caused by CPB and thus decreases postsurgical bleeding. In addition, it exhibits a minor anti-inflammatory response. As a consequence, a combined treatment of ulinastatin and tranexamic acid reduces postsurgical bleeding and shortens postoperative hospital stay in patients undergoing heart valve replacement surgery.

An overview of artificial heart valve replacement in infants and children.

Prosthetic heart valve replacement in infants and children poses unique problems. This article provides an overview of the factors specific to children with regard to indications and timing of valve replacement, types of artificial valves, constraints, and ramifications of valve choice in children. Anticoagulation, pregnancy, and other issues related to long-term management are reviewed.