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OBJECTIVES The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) was developed to update EuroSCORE and incorporated refinement and modification of several risk factors. SinoSCORE was designed by Chinese scholars based on 9839 patients who underwent coronary artery bypass grafting (CABG) at 43 participating institutions. This study was designed to validate the EuroSCORE II and SinoSCORE in Chinese patients undergoing CABG and to compare their performance overall and per subgroup. METHODS A total of 4507 adult receiving CABG at our institution between January 2010 and April 2014 were included in this retrospective study. Patients were stratified for cardiovascular risk using EuroSCORE II and SinoSCORE. The performance of EuroSCORE II and SinoSCORE was analysed with a focus on discrimination power and calibration. RESULTS The in-hospital mortality rate for the entire cohort was 1.4%, while the mortality rate predicted by EuroSCORE II was 1.47 ± 1.2% (95% CI 1.43-1.50) and by SinoSCORE was 2.86 ± 3.5% (95% CI 2.76-2.96). The C-statistics of EuroSCORE II and SinoSCORE were 0.728 and 0.716, respectively. The Hosmer-Lemeshow test indicated that EuroSCORE II had poor goodness of fit while SinoSCORE performed slightly better. When patients were divided into quartiles based on predicted risk, respectively defined as group I, II, III and IV, EuroSCORE II underestimated mortality rates of patients scored IV, but overestimated mortality rates in all other groups; SinoSCORE underestimated mortality rates of patients scored I and overestimated mortality rates in all other groups. EuroSCORE II only achieved good discrimination for patients scored I (area under the receiver operating characteristic curve, AUC = 0.707 > 0.70), and SinoSCORE achieved poor discrimination for all subgroups except group II (AUC = 0.754 > 0.70). EuroSCORE II overestimated the mortality rate in the isolated CABG group and underestimated mortality rates in patients with other cardiac surgeries. SinoSCORE overestimated mortality rates in all pathology subgroups. The AUC values of EuroSCORE II and SinoSCORE were 0.694 and 0.687, respectively, for isolated CABG. The AUC values of EuroSCORE II and SinoSCORE were 0.772 and 0.669 for combined cardiac surgery CABG. CONCLUSIONS EuroSCORE II could predict mortality in the entire group and in the low-middle risk group, but not in the high-risk group, in which it underestimated mortality. SinoSCORE overestimated mortality rates in the entire group and in all subgroups. Risk models should be targeted to different heart diseases, and the statistical methods of established risk systems should be improved.

Background: Optimization of blood-saving strategies during open heart surgery in infants is still required. This study aimed to study a comprehensive blood-saving strategy during cardiopulmonary bypass (CPB) on postoperative recovery in low-weight infants undergoing open heart surgery. Methods: This was a prospective study of 86 consecutive infants (weighing

To investigate the feasibility and diagnostic value of a preoperative transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) for the assessment of structural heart disease (SHD).Fourty-four patients underwent cardiac surgery at Tianjin Chest Hospital. The patients were preoperatively assessed using TTE-guided 3DPM, which was compared to conventional three-dimensional transthoracic echocardiography (3DTTE) along with direct intraoperative findings, which were considered the "gold standard." Twelve patients had SHD, including four with mitral prolapse, two with partial endocardial cushion defects, two with secondary atrial septal defects, two with rheumatic mitral stenosis, one with tetralogy of Fallot, and one with a ventricular septal defect (VSD). Thirty-two patients who did not have SHDs were designated as the negative control group.The sensitivity and specificity of the TTE-guided 3DPM were greater than or equal to those of the 3DTTE. The P-value of the McNemar test of 3DTTE was.05, which indicates that the difference was not statistically significant (Kappa = 0.745, P .001). The P-value of the McNemar test of TTE-guided 3DPM was.05, which indicates that the difference was not statistically significant (Kappa = 0.955, P .001). A comparison of 3DTTE and TTE-guided 3DPM resulted in a P-value.05, which indicates that the difference was not statistically significant (Kappa = 0.879, P .001). TTE-guided 3DPM displayed the 3D structure of SHDs and cardiac lesions clearly and was consistent with the intra-operative findings.Transthoracic echocardiography-guided three-dimensional printed model (TTE-guided 3DPM) provides essential information for preoperative evaluation and decision making for patients with SHDs.

Objectives To compare the therapeutic efficacy of recombinant human brain natriuretic peptide and prostaglandin E1 in the treatment of pulmonary hypertension after mitral valve replacement. Methods Sixty patients with postoperative pulmonary hypertension were divided randomly into 3 groups that received saline, prostaglandin E1, and natriuretic peptide infusions for 12 hours each. The hemodynamics data were monitored consecutively, and the levels of thromboxane A2 and cyclic guanosine monophosphate were detected pretreatment, after treatment, and 1 week after surgery. Results The arterial pressure, pulmonary arterial pressure, and pulmonary capillary wedge pressure decreased 1 hour after prostaglandin E1 treatment and rebounded after treatment discontinuation. The pulmonary arterial pressure and pulmonary capillary wedge pressure in the natriuretic peptide group decreased 3 hours after treatment; pulmonary arterial pressure decreased less than that of the prostaglandin group, and there was no evidence of hemodynamic rebound after treatment discontinuation. The natriuretic peptide had no significant effects on arterial pressure. In both the prostaglandin and natriuretic peptide groups, cyclic guanosine monophosphate increased after the treatment, which was even higher in the latter group. Prostaglandin E1 could lead to the decrease of thromboxane A2, which was not seen in the natriuretic peptide group. Conclusions Both brain natriuretic peptide and prostaglandin E1 can effectively reduce pulmonary hypertension; however, natriuretic peptide has a slower and milder efficacy. The effects of these 2 drugs in reducing the pulmonary arterial pressure may be mediated through different pathways.

Background: Cardiac surgery is associated with inflammatory responses that are known to affect its outcome. The present study was designed to define whether post-operative release of interleukin (IL)-6, 8 and tumor necrosis factor-alpha (TNF-α) is related to the presence of a certain allele in functional polymorphism and its relationship to clinical outcome after off-pump coronary artery bypass (OPCAB). Methods: One hundred and forty-five patients undergoing first time elective OPCAB were genotyped for IL-6(−174G>C), IL-8(−251A>T) and TNF-α(−308G>A) polymorphisms using polymerase chain reaction (PCR) and gene sequencing. Cytokine levels were measured in plasma samples taken before the operation and 4, 24 and 72 h postoperatively by suspension array system. Results: Levels of IL-6 and IL-8 increased significantly after OPCAB. Patients with IL-6−174GG and IL-8−251AA genotypes had higher post-operative circulating levels of IL-6 and IL-8, respectively. Logistic regression showed that IL-8−251AA genotype was an independent risk factor of ventilation time more than 1 day (OR = 11.80, 95% CI: 1.87–74.48) and hospital staying more than 14 days (OR = 38.00, 95% CI: 4.15–347.87) after surgery. Conclusions: OPCAB results in post-operative inflammatory responses. Genetic backgrounds alter the extent of inflammatory response and might relate to clinical outcome of OPCAB.

BACKGROUND AND AIM OF THE STUDY Atrial fibrillation (AF) ablation has become an effective concomitant procedure, which is increasingly used. We questioned whether results are related to surgeon's experience. METHODS Patients (n = 141) with persistent AF (pAF) underwent concomitant left atrial (LA) endocardial ablation, performed by six surgeons. Follow-up (FU) was after 3, 6, and 12 months (mean 8 +/- 4.1 months). FU was 97% complete. Results were analyzed according to surgeon's volume: >20 (group A, n = 85) and

Objectives: Minimally invasive cardiac surgery has been developed to offer patients the benefits of open heart operations with decreased pain and limited skin incision. A limited superior median sternotomy has been shown to provide a good exposure for aortic valve replacement (AVR) and good results. In this study we report the results of minimally invasive AVR compared to standard sternotomy AVR performed in the same period. Methods: From May 1996 to January 1998, 86 patients received isolated aortic valve replacement by the limited superior median sternotomy(group 1). As a control group (group 2), 78 patients were enrolled who underwent isolated aortic valve replacements by standard sternotomy in the same period. Results: Median ischemic time and median bypass time between the two groups showed no significant difference (P . 0:05). Median entire operation time in group 1 was obviously shorter than that in group 2 (P , 0:01). Median postoperative drainage was 229 ml in group 1, 369 ml in group 2. The difference between the two groups (P , 0:05) was significant. Median postoperative respiratory support time was 7.43 h in group 1, 11.26 h in group 2, with significant difference (P , 0:05). Median duration of hospital stay were 6.2 days in group 1, 9.4 days in group 2, with significant difference (P , 0:01). Reoperations for bleeding were two in group 1, four in group 2, superficial wound infection and sternum disruption occurred once in group 1 and four times in group 2. There were two hospital deaths respectively in the two groups (not procedure related). Conclusions: The limited superior median sternotomy provides good exposure to the left ventricular outflow tract, aortic valve, ascending aorta, and even to the mitral valve through the roof of the left atrium. Therefore it seems to be suitable for all kinds of aortic valve operations. Besides less pain, shorter skin incision, shorter respiratory support time and lower blood loss, it has more advantages as opening and closure of the sternum is faster; decreasing infection and disruption of the sternum, and finally decreasing the time required for hospitalization and recovery. q 1999 Elsevier Science B.V. All rights reserved.

An infant, 2 months old, underwent cardiac surgery because of congenital heart defects and pulmonary hypertension. Surgery was performed in hypothermia and cardiac standstill. On the second day after surgery the infant had to be resuscitated due to a combination of acute left-ventricular failure, pulmonary vascular hypertension and a slight right-to-left-shunt. A breakthrough in the treatment was achieved by using levosimendan to improve left-ventricular function and to decrease vascular resistance.

Cardiac surgery in Jehovah’s Witness patients remains a challenge in the presence of concomitant congenital or acquired coagulation disorders and anaemia. We report a case of a 66-year-old female Jehovah’s Witness suffering from severe calcified aortic valve stenosis requiring aortic valve replacement. The anaemic patient suffered from concomitant platelet dysfunction and deficiency of factors V and VII due to gammopathy of immunoglobulin G. The patient was preoperatively treated with recombinant erythropoietin in combination with folic acid and iron, which resulted in an increase of the haematocrit from 0.335 to 0.416 after 22 days of treatment. Haemostasis was improved by high dose aprotinin and additional desmopressin, which could be demonstrated to be effective by a preoperative test. The patients intra- and postoperative course was uneventful, her total chest tube loss was 130 ml, and she was able to be discharged without the need of any blood transfusions. The beneficial properties of erythropoietin and desmopressin in Jehovah’s Witness patients are discussed.

Multislice computed tomography images of a patient with extreme aortic allograft degeneration and Dacron graft calcification after right ventricular outflow tract reconstruction 23 years previously (Figure 1). The extra-anatomic horseshoe graft was taken …