Background Predictors and clinical outcomes of VF-ACC and the relative VF-ACC incidence with various access routes have not been well documented. This study aimed to identify predictors, clinical outcomes, and relative incidences of ventricular fibrillation after the release of an aortic cross-clamp (VF-ACC) with various access routes in valvular surgery.Patients and methods In this single-center and retrospective cohort study, we screened 228 consecutive patients undergoing valve surgery, and a total of 119 patients were included in the study. The primary outcomes were the relative incidence and predictors of VF-ACC with access routes, and secondary endpoints included effects of VF-ACC on 30-day mortality, perioperative ventricular arrhythmias (VAs), and heart failure with ejection fraction < 50% (HFEF < 50%).Results VF-ACC incidence varied on the basis of access routes. VF-ACC occurred in 58.3% of patients with aortic valve replacement via transverse aortotomy (TAo-AVR), in 48.6% of patients with aortic and mitral replacements via transseptal and transverse aortotomy access (TSAo-MAVR), and in 20% of patients with mitral valve replacement via transseptal access (TS-MVR). Seven independent risk factors were identified: HTK solution (AOR: 4.90, p = 0.002), smoking status (AOR: 6.30, p = 0.001), cerebrovascular disease (CBD) [(AOR: 7.08, p = 0.022)], regional wall motion abnormality (RWMA) [(AOR: 8.33, p < 0.001)], perioperative VAs (AOR: 4.85, p = 0.001), HFEF < 50% (AOR: 5.66, p = 0.002), and left ventricular mass index (LVMI) [(AOR: 0.962, CI: 0.941–0.984)].Conclusions VF-ACC was the most common in TAo-AVR and the least common in TS-MVR. HTK solution, smoking status, CBD, perioperative VAs, HFEF < 50%, and RWMA were associated with an increased risk of VF-ACC, and low LVMI acted as a protective factor. Patients with VF-ACC commonly experienced perioperative VAs or HFEFs < 50%.Clinical trial registration: ChiCTR2100050961.
Background Sevoflurane, as a widely used inhaled general anesthetic, has cardioprotective effects in ischemia-reperfusion injury (I / R). The purpose of this study was to investigate the effect of rapamycin signal target protein on sevoflurane post-processing in H9c2 rat cardiomyocytes. Material and Methods In the experiment use H9c2 rat cardiomyocytes were cultured with sevoflurane. Immunofluorescence staining was performed on H9c2 cardiomyocytes. The morphological structure of mitochondria was analyzed by laser confocal microscope and ImageJ + Mina software. Cardiomyocyte apoptosis was measured by immunofluorescence staining. Western blot was used to detect the expression of rapamycin signal target protein and apoptosis protein in H9c2 cells. Results The experimental results show that sevoflurane post-treatment (SPC) increased the expression of rapamycin signal target protein and alleviated the I / R injury of H9c2 cells (p < 0.05). SPC can promote the mitochondrial fusion of cardiomyocytes by activating rapamycin signal target, reduce mitochondrial division and maintain the normal structure of mitochondria, so as to protect central myocytes from ischemia-reperfusion injury (p < 0.05). Moreover, SPC reduced the apoptosis rate of cardiomyocytes and the expression level of apoptotic proteins caspase-3 and caspase-9 after myocardial I / R injury. The anti apoptotic effect may be the reason for the protective effect of SPC on H9c2 cells (p < 0.05). The use of the inhibitor rapamycin can eliminate this protective effect. Conclusion SPC activates rapamycin signal target to reduce myocardial I / R injury by maintaining myocardial function, promoting mitochondrial fusion and reduce cardiomyocyte apoptosis.
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