Ginsenoside (GS-Rb1) is one of the most important active compounds of ginseng, with extensive evidence of its cardioprotective properties. However, the miRNA mediated mechanism of GS-Rb1 on cardiomyocytes remains unclear. Here, the roles of miRNAs in cardioprotective activity of GS-Rb1 were investigated in hypoxic- and ischemic-damaged cardiomyocytes. Neonatal rat cardiomyocytes (NRCMs) were first isolated, cultured, and then incubated with or without GS-Rb1 (2.5–40 μM) in vitro under conditions of hypoxia and ischemia. Cell growth, proliferation, and apoptosis were detected by MTT and flow cytometry. Expressions of various microRNAs were analyzed by real-time PCR. Compared with that of the control group, GS-Rb1 significantly decreased cell death in a dose-dependent manner and expressions of mir-1, mir-29a, and mir-208 obviously increased in the experimental model groups. In contrast, expressions of mir-21 and mir-320 were significantly downregulated and GS-Rb1 could reverse the differences in a certain extent. The miRNAs might be involved in the protective effect of GS-Rb1 on the hypoxia/ischemia injuries in cardiomyocytes. The effect might be based on the upregulation of mir-1, mir-29a, and mir-208 and downregulation of mir-21 and mir-320. This might provide us a new target to explore the novel strategy for ischemic cardioprotection.
Background This cohort study collected the clinical data of patients who underwent off-pump coronary artery bypass grafting (OPCABG) during hospitalization to observe the occurrence of postoperative atrial fibrillation (POAF), construct a POAF prediction model for CABG patients based on the left atrial diameter (LAD), and assist clinicians in making better medical decisions. Methods In this study, all patients who had no prior history of arrhythmia and who had received isolated OPCABG between May 1, 2021, and February 1, 2022, at Beijing Anzhen Hospital Affiliated to Capital Medical University (n=749) were reviewed. Depending on an optimal cutoff obtained from receiver operating characteristic (ROC) curve analysis, patients were separated into two groups: a group with POAF (n=188) and a group without POAF (n=561). The incidence of POAF was then compared. Prediction models were built, and nomograms were plotted was plotted. Model evaluation, including calibration curve and decision curve analysis, was performed. Results In all, 188 out of 749 (25.1%) patients who underwent cardiac surgery experienced POAF. Multifactorial logistic regression analysis showed that age ≥66 years, LAD ≥39 mm, and post-OPCABG atrial fibrillation (AF) were independently associated. The prognostic nomogram model showed good concordance index (C-index) scores. Decision curve analysis suggested the clinical benefit of the prediction models. Conclusions In this study, a prediction model for patients with POAF after OPCABG was assessed, which was shown to make more accurate predictions compared with the original risk prediction system. It may assist doctors to optimize management of patients with POAF.
Background: Little is known regarding the potential impact of haematocrit differences in the association between cardiopulmonary bypass reoxygenation and acute kidney injury following Tetralogy of Fallot repair. Methods: We investigated the association of perfusate oxygenation during aortic occlusion associated with acute kidney injury between 204 normal and 248 higher haematocrit children with Tetralogy of Fallot, aged 1 month-18 years, who were surgically repaired in 2012-2018. Normal and higher haematocrit children were defined as having a preoperative haematocrit within and above age- and sex-specific reference intervals, respectively. Acute kidney injury was determined as a binary variable according to the Kidney Disease Improving Global Outcomes criteria. Results: After adjusting for baseline and clinical covariates, a significant interaction between the haematocrit and continuous perfusate oxygenation on acute kidney injury was found (pinteraction = 0.049): a higher perfusate oxygenation was associated with a greater acute kidney injury risk among higher haematocrit children (adjusted odds ratio = 1.50, 95% confidence interval = [1.02, 2.22] per SD, p = 0.038) but not among normal haematocrit children (adjusted odds ratio = 0.91, 95% confidence interval = [0.51, 1.63] per SD, p = 0.73). After a similar adjustment, there was a marginal interaction between tertiles of perfusate oxygenation and haematocrit on acute kidney injury (pinteraction = 0.09): the middle and top tertiles of perfusate oxygenation were associated with a trend towards increased acute kidney injury risks among higher haematocrit children (adjusted odds ratio = 1.69, 95% confidence interval = [0.61, 4.66]; adjusted odds ratio = 2.25, 95% confidence interval = [0.84, 5.99], respectively) but not among normal haematocrit children (adjusted odds ratio = 1.16, 95% confidence interval = [0.46, 2.94]; adjusted odds ratio = 0.45, 95% confidence interval = [0.15, 1.36], respectively) compared with the bottom tertile. Conclusion: Preoperative haematocrit differences significantly modify the association of perfusate oxygenation with acute kidney injury, highlighting differential control of reoxygenation for different haematocrit children with Tetralogy of Fallot in the management of cardiopulmonary bypass.
Aims This study sought to characterize the rotation of the transcatheter heart valve (THV) and evaluate the neo‐commissures overlap with coronary arteries in type‐0 bicuspid aortic valve (BAV). Methods and Results This was a single‐center, 10‐patient, retrospective observational cohort. Pre‐TAVI computed tomography and procedural fluoroscopy were analyzed. Coplanar fluoroscopic views were coregistered to pre‐TAVI computed tomography to characterize THV rotation and determine coronary overlap. The incidence of severe coronary artery overlap with one coronary artery was 90%. According to our prediction line, type‐0 BAV has predicted a higher incidence of overlap with one coronary artery, but lower incidence with both coronary arteries compared to the tricuspid aortic valve (TAV). The rotational angles in two different phases were 3.8 ± 3.2° versus 11.8 ± 8.0° (p = .01) in patients with mixed cusp fusion. Commissural angles in final and initial deployment were 9.6 ± 6.6 versus 18.1 ± 11.0° (p = .021). Applying hypothetic “commissure‐middle view” in 0°, ±5°, and ±10°, the incidence of overlap with one coronary artery are 20%, 40%, and 90% separately. Conclusions The THV rotation existed and was activated in the last 1/3 deploying phase. With the observed tendency of “automatic commissural alignment,” applying the “commissure‐middle” view in type‐0 BAV may optimize valve alignment and avoid coronary artery overlap.
Background: Acute type A aortic dissection (ATAAD) is a life-threatening disease. The aim of this study was to examine the role of tear size in the hemodynamic change and help improve the treatment level of this extremely dangerous disease. Methods: A total of 120 ATAAD patients treated in our institution from November 2014 to December 2016 were divided into three groups according to proximal and distal tear size ratio (PDTSR). There were 35 patients in group A (PDTSR ≥2:1), 44 patients in group B (1:2< PDTSR <2:1), and 41 patients in Group C (PDTSR ≤1:2). Three computational fluid dynamics (CFD) models with different PDTSRs were established to investigate the hemodynamic difference in the three groups. Results: The mean age (± SD) of the 120 patients included in this study was 47.7±10.1 years. Patients in Group A had a significantly larger proximal tear size (219.1±76.5 vs. 127.7±70.1 vs. 75.7±49.7 mm 2 ; P<0.001). The mortality of the patients in group A was significantly higher than those in group B and group C in the acute phase (37.1% vs. 2.3% vs. 2.4%, respectively; P<0.001). A proximal tear larger than a distal tear was found to be significantly associated with preoperative death in logistic regression analysis (odds ratio: 15.89; 95% confidence interval, 2.702-93.477; P=0.002).Conclusions: A proximal tear larger than a distal tear was associated with a significantly high-pressure difference between false and true lumens and more blood flow into the false lumen. In such cases, patients would experience extremely high mortality and morbidity.
Background: Considering the progressive nature of complicated Stanford type B aortic dissection (TBAD), operation must anticipate the need for later interventions. Recently we have used a modified stent elephant trunk (SET) procedure to treat these patients. And we review the indications, considerations for planning, and operative details for this this modified SET procedure. Methods: Ten patients (seven males and three females) with complicated TBAD underwent a modified SET procedure in Anzhen Hospital, Beijing in the period between January 2019 and December 2019. The patients, whose ages ranged from 29-52 (42±7.23), suffered complications with hypertension. Under deep hypothermic circulatory arrest, all the patients received SET implantation via an incision of the aortic arch. Before the patients were discharged, a computed tomography angiography (CTA) was performed to ensure the safety and accuracy of the procedure. Results: The average surgery time was 4.0-5.5 (4.65±0.47) hours, cardiopulmonary bypass (CPB) time was 115-163 (138.6±15.64) minutes, aortic cross-clamping time was 32-59 (42±7.72) minutes, and selective cerebral perfusion (SCP) time was 15-32 (21.7±5.56) minutes. The SCP flow and nasopharyngeal temperature were 5-8 (6.8±1.23) mL/kg/min and 23.5-26.8 (25.22±0.96) ℃, respectively. During SCP, the blood pressure of the left upper limb was 20-31 (25.5±3.81) mmHg. Aorta cannulation position: vascular graft was anastomosed to the innominate artery (IA) and left subclavian artery (LSA) in seven cases, and with IA, LSA, and the right femoral artery in three cases. Ventilation time was 5-15 (8.8±2.94) h, retention time in ICU was one day, and post-operative hospitalization time was 6-8 (6.9±0.74) days. None of the patients died, or experienced endoleakage or neurological complications. Conclusions:The application of a modified stented elephant trunk procedure in the treatment of TBAD is safe and efficient.
Objective: We sought to evaluate the outcomes of integrated aortic-valve and ascending-aortic replacement (IR) vs. partial replacement (PR) in patients with bicuspid aortic valve (BAV)-related aortopathy.Methods: We compared long-term mortality, reoperation incidence, and the cumulative incidence of stroke, bleeding, significant native valve or prosthetic valve dysfunction, and the New York Heart Association (NYHA) functional classes II-IV between inverse probability-weighted cohorts of patients who underwent IR or PR for BAV-related aortopathy in a single center from 2002 to 2019. Patients were stratified into different aortic diameter groups (“valve type” vs. “aorta type”).Results: Among patients with “valve type,” aortic valve replacement in patients with an aortic diameter > 40 mm was associated with significantly higher 10-year mortality than IR compared with diameter 35–40 mm [17.49 vs. 5.28% at 10 years; hazard ratio (HR), 3.22; 95% CI, 1.52 to 6.85; p = 0.002]. Among patients with “aorta type,” ascending aortic replacement in patients with an aortic diameter 52–60 mm was associated with significantly higher 10-year mortality than IR compared with diameter 45–52 mm (14.49 vs. 1.85% at 10 years; HR, 0.04; 95% CI, 1.06 to 85.24; p = 0.03).Conclusion: The long-term mortality and reoperation benefit that were associated with IR, as compared with PR, minimizing to 40 mm of the aortic diameter among patients with “valve type” and minimizing to 52 mm of the aortic diameter among patients with “aorta type.”Trial Registration: Treatment to Bicuspid Aortic Valve Related Aortopathy (BAVAo Registry): ChiCTR.org.cn no: ChiCTR2000039867.
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