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To assess the association of genetically-predicted lipid traits and lipid-modification via licensed or investigational targets with heart failure (HF).Two-sample Mendelian randomization (MR) study was conducted using summary-level genome-wide association studies (GWASs) from UK Biobank and HERMES Consortium. Genetic variants obtained from UK Biobank GWAS data were selected as instrumental variables to predict the level of lipid traits (low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), apolipoprotein B (ApoB) and apolipoprotein AI (ApoAI)) and lipid-modifying effect of eight drug targets (HMGCR, PCSK9, NPC1L1, PPARA, LPL, ANGPTL3, APOC3 and CETP). In this study, we observed that genetically-predicted LDL-C, TG, HDL-C or ApoB were significantly related to HF, which were mainly mediated by CHD. Drug target MR analyses identified PCSK9, CETP and LPL as potential targets to prevent HF. The genetic proxy of LDL-C and ApoB increase modified by PCSK9 showed similar evidence in increasing risk of HF (PLDL-C = 1.27*10-4; PApoB = 1.94*10-4); CETP played a role in HF risk via modifying all investigational lipid traits with the strongest evidence though ApoB (P = 5.87*10-6); LPL exerted effects on HF via modifying most lipid traits with the strongest evidence observed via modifying TG (P = 3.73*10-12).This two-sample MR study provided genetic evidence of the associations between lipid traits and HF risk, which were mostly mediated by CHD. Besides, drug target MR studies indicated that PCSK9 inhibition, CETP inhibition and LPL activation were effective in HF reduction.Start-up Fund for high-level talents of Fujian Medical University.Dyslipidemia is a well-established cause of coronary heart disease, but the relationship between lipids and heart failure is unclear and it is still unknown if lipid-modifying treatment could prevent heart failure. This study provided genetic evidence that dyslipidemia is related to a higher risk of heart failure, mainly through the increased risk of coronary heart disease. This study identified three drug targets that may reduce the risk of heart failure via modifying lipids, including PCSK9 inhibition, CETP inhibition and LPL activation.

Abnormal drainage of the inferior vena cava to the left atrium and Budd–Chiari syndrome are different congenital malformations. The combination of these two disorders is very rare. We report a case of a 35-year-old woman with anomalous inferior vena cava drainage into the left atrium resulting in delayed hypoxic symptoms after interventional therapy for Budd–Chiari syndrome 17 years ago. We speculate that an abnormality of the Eustachian valve is the cause of these two disorders. After surgical treatment, the patient's oxygen saturation returned to normal.

Background Owing to the increase in both intravenous drug injections and intracardiac and vascular interventional treatments among drug users, the incidence of infective endocarditis (IE) involving the tricuspid valve, which sits between the two right heart chambers, has gradually increased. This study aimed to compare the clinical outcomes of different surgical procedures for tricuspid infective endocarditis (TIE). Methods We retrospectively analyzed fifty-six patients who underwent tricuspid valve surgery at our hospital from January 2006 to August 2019. All patients were diagnosed with TIE and indicated a need for surgery. Perioperative and follow-up data were collected to summarize and analyze the clinical outcomes of different surgical approaches, including tricuspid valvuloplasty (TVP) and tricuspid valve replacement (TVR) for TIE. Results Cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, postoperative mechanical ventilation time, and intensive care unit (ICU) stay time were shorter in the TVP group than in the TVR group. Additionally, the incidence of red blood cell transfusion and postoperative complications was lower in the TVP group than in the TVR group. The postoperative 30-day mortality rates were similar between both the groups. Fifty-two patients were followed up for an average of 5.50 ± 3.79 years. The postoperative 3-, 5-, and 7-year survival rates were 100%, 100%, and 95.5% in the TVP group and 96.7%, 96.7%, and 96.7% in the TVR group, respectively. The 5-year and 10-year reoperation rates were 0% and 0% in the TVP group and 6.7% and 20% in the TVR group, respectively. Conclusion Both TVR and TVP for TIE significantly improved the functional status of the heart with satisfactory efficacy. TVP was found to be superior to TVR in reducing the need for postoperative blood transfusions, reducing the risk of postoperative complications, and reducing the need for long-term reoperations.

BackgroundPostoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, which is associated with age and massive bleeding. However, whether thyroid hormone (TH) level can affect POAF remains controversial.AimTo investigate the occurrence and risk factors of POAF, in particular, the preoperative TH level of patients was introduced into this study as a variable for analysis, and a column graph prediction model of POAF was constructed.MethodsPatients who underwent valve surgery in Fujian Cardiac Medical Center from January 2019 to May 2022 were retrospectively analyzed and divided into POAF group and NO-POAF group. Baseline characteristics and relevant clinical data were collected from the two groups of patients. Independent risk factors for POAF were screened using univariate analysis and binary logistic regression analysis, and a column line graph prediction model was established based on the regression analysis results, and the diagnostic efficacy and calibration of the model were evaluated using the Receiver Operating Characteristic Curve (ROC) and calibration curve.ResultsA total of 2,340 patients underwent valve surgery, excluding 1,751 patients, a total of 589 patients were included, including 89 patients in POAF group and 500 patients in NO-POAF group. The total incidence of POAF was 15.1%. The results of the Logistics regression analysis showed that gender, age, leukocytes and TSH were risk factors of POAF. The area under the ROC curve of the nomogram prediction model for POAF was 0.747 (95% CI: 0.688–0.806, P χ2 = 11.141, P = 0.194 > 0.05, the calibration curve was well fitted.ConclusionThe results of this study show that gender, age, leukocyte and TSH are risk factors of POAF, and the nomogram prediction model has a good prediction effect. Due to the limited sample size and included population, more studies are needed to validate this result.

Objectives To evaluate the efficacy of sacubitril/valsartan for the treatment of patients with chronic heart failure (CHF) after cardiac valve surgery (CVS). Methods Data were collected from 259 patients who underwent CVS due to valvular heart disease and were admitted to the hospital with CHF from January 2018 to December 2020. The patients were divided into Group A (treatment with sacubitril/valsartan) and Group B (treatment without sacubitril/valsartan). The duration of treatment and follow-up was 6 months. The two groups’ prior and clinical characteristics, post-treatment data, mortality, and follow-up data were analysed. Results The effective rate of Group A was higher than that of Group B (82.56% versus 65.52%, P Conclusions Sacubitril/valsartan can effectively improve the cardiac function of patients with CHF after CVS by increasing LVEF and reducing LVEDD, LVESD, NT-proBNP, and BP, with good safety.

Background To investigate the seasonal, monthly, and daily distributions of the incidence of Stanford type-A acute aortic dissection (TAAAD) and identify seasonality in the duration of hospital stay and in-hospital mortality of TAAAD in south-eastern China. Methods We enrolled patients diagnosed with TAAAD between 1 June 2017 and 31 May 2021. Participants were divided into seasonal, monthly, and daily groups according to the need for analysis. Analysis of variance was applied to compare the number of TAAAD in different seasons, months, and days. χ2 test was used to compare in-hospital mortality among the four groups. Non-parametric methods were used for all comparisons of the duration of hospital stay. Univariate logistic and multivariable logistic regression analyses were performed to assess the duration of hospital stay. Results Of the 485 patients, 154 were diagnosed in winter (31.8%), 115 in spring (23.7%), 73 in summer (15.1%), and 143 in autumn (29.5%). The daily, monthly, and seasonal distributions of TAAAD were significantly different (P = 0.04, P P P = 0.89). However, significant differences were observed in the seasonal distribution of the duration of hospital stay for TAAAD [winter was 17.0 (4.0–24.0) days, spring was 20.0 (14.0–29.0) days, summer was 20.0 (12.5–31.0) days, and autumn was 20.0 (13.0–30.0) days, P P Conclusions Our study confirmed that the incidence of TAAAD exhibits seasonal, monthly, and daily variations in south-eastern China. Moreover, the daily incidence of TAAAD is higher on weekdays than that on weekends.

Dilated cardiomyopathy (DCM) is a common cause of heart failure. However, genetic-level treatments are not available for this condition. In this study, we searched for biological markers and therapeutic targets for DCM from a genetic perspective. We chose microarray datasets of idiopathic DCM with heart failure tissues and normal function (NF) heart tissues, which were downloaded from the Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) were analyzed by the GEO2R tool. Gene ontology (GO) and gene set enrichment analysis were used to analyze the functions of DEGs and the pathways in which they are involved. Next, protein-protein interaction networks were built to filter out the hub genes from DEGs. The expression of hub gene was validated by other GEO datasets. Receiver operating characteristic (ROC) curves were plotted to verify the accuracy of the genetic diagnosis. In the end, the mRNA-miRNA-lncRNA network was built to find potentially correlative genes. Twenty-eight common DEGs in total were screened, and GO analysis showed that DEGs were mainly associated with neutrophil degranulation and activation, regulation of Wnt signaling pathway and the development of cardiac cell and tissue. Five hub genes (asporin [ASPN], osteoglycin [OGN], secreted frizzled-related protein 4 [SFRP4], membrane metalloendopeptidase [MME], and natriuretic peptide gene [NPPA]) were shown to be highly expressed in the validation sets and accurate in distinguish between DCM and NF by ROC curves. miRNA prediction of the hub genes revealed that hsa-mir-28b-5p was associated with SFRP4, ASPN, and MME. All of them may serve as biological diagnostic indicators and provide direction for treatment at the genetic level.

Background: Accumulated studies have revealed that heart rates are associated with all-cause mortality in cardiac surgery patients, but the results remain controversial. This meta-analysis aimed to evaluate the predictive value of increased perioperative heart rate for all-cause mortality after cardiac surgery. Methods: We searched PubMed, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases for studies from inception to October 11, 2021. Two researchers independently screened the studies. Titles, authors, publication years, and hazard ratios were extracted. We used a random-effects model to combine the HRs and 95% confidence intervals. Several subgroup analyses were conducted. Statistical significance was set at p < .05. Results: Eleven studies were included in the meta-analysis of 33,849 patients and 3166 (9.4%) deaths. The HR of higher perioperative heart rates was 2.09 (95% CI 1.53–2.86, p < .001, I2 = 81%). The HR with a 10-bpm increase in preoperative heart rate was 1.19 (95% CI 1.11–1.26, p < .001, I2 = 51%). Subgroup analysis showed patients with higher preoperative heart rates had an HR of 1.88 (95% CI 1.51–2.34, p < .001, I2 = 0%), and patients with a higher postoperative heart rate had an HR of 2.29 (95% CI 1.28– 4.09, p < .0001, I2 = 91%) compared to patients with lower postoperative heart rates. Conclusion: Increased perioperative heart rate is associated with all-cause mortality in patients undergoing cardiac surgery.

Objective: The impact of vascular aging on cardiovascular diseases has been extensively studied; however, little is known regarding the cellular and molecular mechanisms underlying age-related vascular aging in aortic cellular subpopulations. Approach and Results: Transcriptomes and transposase-accessible chromatin profiles from the aortas of 4-, 26-, and 86-week-old C57/BL6J mice were analyzed using single-cell RNA sequencing and assay for transposase-accessible chromatin sequencing. By integrating the heterogeneous transcriptome and chromatin accessibility data, we identified cell-specific TF (transcription factor) regulatory networks and open chromatin states. We also determined that aortic aging affects cell interactions, inflammation, cell type composition, dysregulation of transcriptional control, and chromatin accessibility. Endothelial cells 1 have higher gene set activity related to cellular senescence and aging than do endothelial cells 2. Moreover, construction of senescence trajectories shows that endothelial cell 1 and fibroblast senescence is associated with distinct TF open chromatin states and an mRNA expression model. Conclusions: Our data provide a system-wide model for transcriptional and epigenetic regulation during aortic aging at single-cell resolution.

Previous studies have demonstrated that admission hyperglycemia is a predictor of mortality and poor prognosis in patients with cardiovascular diseases, such as acute myocardial infarction. However, the prognostic value of admission hyperglycemia in patients with acute type A aortic dissection (AAAD) has never been explored. To clarify the association between hyperglycemia and in-hospital outcomes, we retrospectively analyzed 734 patients with AAAD. The interest endpoints were in-hospital mortality rate, the duration of intensive care unit and hospital stays, the occurrence of prolonged mechanical ventilation (PMV), and other complications. All patients were divided into the normal blood glucose group (≤ 140 mg/dL) and hyperglycemia group (140 mg/dL), to compare the in-hospital outcomes rate in the two groups. There were 531 (72.3%) patients with normal blood glucose levels and 203 (27.7%) patients with hyperglycemia. The in-hospital mortality rate was 21.1%, and no statistically significant differences were found between the two groups (20.3% versus 23.2%, P = 0.403). PMV is the most frequent postoperative complication, the incidence of which was significantly higher in the hyperglycemia group than in the normal blood glucose group (59.6% versus 50.8%, P = 0.040). The logistic regression analysis revealed that hyperglycemia (odds ratio (OR): 1.492; 95% CI: 1.014 to 2.197; P = 0.042) was an independent risk factor for PMV after adjusting for confounding factors. Age (OR: 1.021; 95% CI: 1.006-1.037; P = 0.007) and body mass index (OR: 1.101; 95% CI: 1.051-1.153; P0.001) were also associated with PMV. In conclusion, our study showed for the first time that a strong correlation between admission hyperglycemia and increased postoperative PMV in patients with AAAD, but not with in-hospital mortality rate.

OBJECTIVEAortic dissection (AD) is a dangerous cardiovascular disease. However, its regulatory mechanism remains poorly understood. Autophagy is an important pathway for maintaining cellular homeostasis. Recent studies have shown that glycolysis and autophagy are essential for the development of AD. Elevated glycolysis can promote cells autophagy, but the relationship between the two is unclear. Enolase 2 (ENO2) is a glycolytic enzyme. Here, we investigated whether ENO2 can regulate autophagy in vascular smooth muscle cells (VSMCs) involved in the progression of AD.APPROACH AND RESULTSThe levels of ENO2 and autophagy-related proteins in aortic tissues from AD patients were identified by qRT-PCR, Western blot and IHC. We found that autophagosome clearance was impaired in aortic tissues and positively correlated with elevated ENO2 expression. Furthermore, aortic application of smooth muscle-specific adeno-associated virus (AAV) inhibiting ENO2 expression attenuated the development of AD in mice. in vitro experiments, downregulation of ENO2 partially restored PDGF-BB-induced impairment of autophagic flux, as evidenced by reduced expression of Beclin-1, SQSTM1, LC3BII/I and increased levels of LAMP2 in human aortic vascular smooth muscle cells (HAVSMCs). Similarly, increased levels of ENO2 exacerbated the autophagic dysfunction in HAVSMCs. Mechanistically, ENO2 may block autophagic flux through the ENO2-GAP43-ATF4 pathway and disrupt cellular homeostasis.CONCLUSIONSOur data reveal a perturbing role of ENO2 in the homeostasis of VSMCs, suggesting ENO2 as a potential target for intervention in AD.

Background Studies suggest that high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) can prevent reintubation in critically ill patients with a low risk of extubation failure. However, the safety and effectiveness in patients at high risk of extubation failure are still debated. Therefore, we conducted a systematic review and meta-analysis to compare the efficacies of HFNC and NIV in high-risk patients. Methods We searched eight databases (MEDLINE, Cochrane Library, EMBASE, CINAHL Complete, Web of Science, China National Knowledge Infrastructure, Wan-Fang Database, and Chinese Biological Medical Database) with reintubation as a primary outcome measure. The secondary outcomes included mortality, intensive care unit (ICU) length of stay (LOS), incidence of adverse events, and respiratory function indices. Statistical data analysis was performed using RevMan software. Results Thirteen randomized clinical trials (RCTs) with 1457 patients were included. The HFNC and NIV groups showed no differences in reintubation (RR 1.10, 95% CI 0.87–1.40, I2 = 0%, P = 0.42), mortality (RR 1.09, 95% CI 0.82–1.46, I2 = 0%, P = 0.54), and respiratory function indices (partial pressure of carbon dioxide [PaCO2]: MD − 1.31, 95% CI − 2.76–0.13, I2 = 81%, P = 0.07; oxygenation index [P/F]: MD − 2.18, 95% CI − 8.49–4.13, I2 = 57%, P = 0.50; respiratory rate [Rr]: MD − 0.50, 95% CI − 1.88–0.88, I2 = 80%, P = 0.47). However, HFNC reduced adverse events (abdominal distension: RR 0.09, 95% CI 0.04–0.24, I2 = 0%, P I2 = 0%, P = 0.06; facial injury: RR 0.27, 95% CI 0.09–0.88, I2 = 0%, P = 0.03; delirium: RR 0.30, 95%CI 0.07–1.39, I2 = 0%, P = 0.12; pulmonary complications: RR 0.67, 95% CI 0.46–0.99, I2 = 0%, P = 0.05; intolerance: RR 0.22, 95% CI 0.08–0.57, I2 = 0%, P I2 = 93%, P = 0.02). Subgroup analysis by language, extubation method, NIV parameter settings, and HFNC flow rate revealed higher heterogeneity in LOS, PaCO2, and Rr. Conclusions In adult patients at a high risk of extubation failure, HFNC reduced the incidence of adverse events but did not affect reintubation and mortality. Consequently, whether or not HFNC can reduce LOS and improve respiratory function remains inconclusive.

BackgroundLow-density lipoprotein cholesterol (LDLc) and body mass index (BMI) are not always correlated and their relationship is probably dependent on age, indicating differential age-specific effects of these two factors on health outcomes. We thus aimed to discriminate the effects of LDLc and BMI on the risk of coronary heart disease (CHD) across different age groups.MethodsThis is a prospective cohort study of 368,274 participants aged 38-73 years and free of CHD at baseline. LDLc and BMI were measured at baseline, and incident CHD was the main outcome. Cox proportional hazards model and restricted cubic spline (RCS) regression were used to estimate hazard ratio (HR) and 95% confidence interval (CI) of exposure on CHD.ResultsSimilar relationships of LDLc and BMI with CHD risk were observed in overall population but in differential age-specific patterns. Across the age groups of =65 years, the LDLc-CHD association diminished with the adjusted HRs decreasing from 1.35, 1.26, 1.19, 1.11 to 1.08; while no declining trend was found in BMI-CHD relationship with the adjusted HRs of 1.15, 1.11, 1.12, 1.13 and 1.15, respectively. The interaction and mediation between LDLc and BMI on CHD risk were only present at young-age groups. And the LDLc-CHD but not BMI-CHD association was dependent on sex, metabolic syndrome and lipid-lowering drugs use.ConclusionThere were differential age-specific effects of LDLc and BMI on the risk of developing CHD, calling for future efforts to discriminate the age-different benefits from lipids management or weight control on the primary prevention for CHD.Clinical PerspectiveWhat Is New?This study shows, for the first time, that there were differential age-specific effects of LDLc and BMI on the risk of developing coronary heart disease (CHD), in which the LDLc-CHD association diminished with increasing age while no declining trend was found in BMI-CHD relationship.The interaction and mediation between LDLc and BMI on the risk of coronary heart disease were only present in young adults.What Are the Clinical Implications?Future efforts are called to discriminate the age-different benefits from lipids management or weight control on the primary prevention for CHD.Findings from this study highlighted that lipids management at young age was expected to have a much more favorable benefit in CHD prevention; and weight control shouldn’t be overlooked, especially for elderly adults, as lipid-lowering therapy might not contribute to the reduction of obesity-related CHD.

Background: Tricuspid valve surgery is the standard treatment for tricuspid valve disease refractory to pharmacologic therapy. However, patients with tricuspid regurgitation after previous left heart valves replacement with reduced right ventricular (RV) function are at greater risk of surgery. We compared the clinical outcomes of tricuspid valve replacement in this subgroup of patients through mini-thoracotomy and conventional full-sternotomy approach. Methods: We identified 44 patients at our institution with tricuspid regurgitation and reduced right ventricular function after left heart valves replacement who underwent either total thoracoscopic tricuspid valve replacement (T-TVR) or conventional tricuspid valve replacement (C-TVR) from December 2014 and May 2021. Patient clinical characteristics, hospital course, and postoperative changes in RV function were retrospectively reviewed and analyzed. Results: Baseline characteristics between T-TVR and C-TVR were comparable including a high incidence of liver dysfunction and renal insufficiency. There were no statistically differences between the two groups in terms of hospital mortality (8.0% vs. 21.1%, P = 0.211). Patients in the T-TVR group had less total drainage volume (201.60±77.05 ml vs 614.74±182.31 ml, p Conclusions: T-TVR represents a viable alternative to current surgical strategies as a potentially sicker cohort demonstrated similar hospital mortality compared to conventional surgery, with reduced length of hospital stay, fewer blood transfusions, and more favorable in promoting RV functional recovery in the early period. Future prospective, randomized-controlled trials with longer follow-up durations are needed to validate these findings.

Objectives In adult aortic arch surgery, moderate hypothermic circulatory arrest (HCA) with selective antegrade cerebral perfusion (SACP) (MoHACP) is widely used, but the application of mild HCA with SACP (MiHACP) is still controversial. This meta-analysis aimed to compare clinical outcomes using MiHACP or MoHACP. Methods Studies comparing outcomes of MiHACP or MoHACP in adult aortic arch surgery were searched from four databases from inception through April 2022. Primary outcomes were postoperative permanent neurological deficit (PND), temporary neurological deficit (TND), and mortality. Secondary outcomes included other common complications. Meta-analysis was conducted using a random-effects model in all cases. Results Eleven comparative studies were included, with 1555 patients in MiHACP group and 1499 patients in MoHACP group, and the mean HCA temperature were 29.4°C and 24.8°C, respectively. Postoperative PND, TND, mortality, paraplegia, dialysis, tracheotomy, reexploration for bleeding, and chest tube drainage volume were comparable in the two groups ( p > 0.05). Ventilator time, intensive care unit and in-hospital length of stay were shorter in MiHACP group ( p < 0.05). Outcomes were also comparable or had some benefits in MiHACP group when subgroup analyses were conducted according to hemiarch or total arch replacement, unilateral or bilateral SACP, HCA time, emergency aortic dissection surgery, and concomitant procedure. Conclusion The present meta-analysis showed acceptability of MiHACP in adult aortic arch surgery. Results need to be taken with caution as moderate risk of bias and very low quality of evidence were observed in this meta-analysis. Randomized controlled trials are needed for further analysis.

Background Increasingly, the shared risk factors and pathological processes of atherosclerosis and abdominal aortic aneurysm (AAA) are being recognized. However, the exact mechanism underlying the shared pathogenesis of atherosclerosis and AAA formation remains unclear. Methods The aim of our study was to identify the hub genes involved in the pathogenesis of atherosclerosis and AAA. Our analysis was based on two gene expression profiles for atherosclerosis (GSE28829) and AAA (GSE7084), downloaded from the Gene Expression Omnibus (GEO) database. Common differential genes were identified and an enrichment analysis of differential genes was conducted, with construction of protein-protein interaction networks, and identification of common hub genes and predicted transcription factors. Results The analysis identified 133 differentially expressed genes (116 upregulated and 17 downregulated), with the enrichment analysis identifying a potential important role of integrins and chemokines in the common immune and inflammatory responses of atherosclerosis and AAA. Regulation of the complement and coagulation cascades and regulation of the actin cytoskeleton were associated with both diseases, with 10 important hub genes identified: TYROBP, PTPRC, ITGB2, ITGAM, PLEK, CTSS, LY86, ITGAX, CCL4, and FCER1G. Conclusions Findings identified a common pathogenetic pathway between atherosclerosis and AAA, with integrin-related genes playing a significant role in both diseases. The common pathways and hub genes identified provide new insights into the shared mechanisms of these two diseases and can contribute to identifying new therapeutic targets and predicting the therapeutic effect of biological agents.

Background This study was aimed to investigate the incidence and outcomes of patients with postoperative hepatic dysfunction (PHD) after total arch repair of acute type A aortic dissection, and further explore the risk factors for severe adverse outcomes. Methods The clinical data of 227 patients with AAAD treated by modified triple-branched stent graft implantation from January 2020 to January 2021 were collected retrospectively. Including preoperative, surgical and postoperative data. Logistics regression was used to determine the independent risk factors of severe adverse outcomes in postoperative HD patients. Results In the early stage after operation, a total of 153 patients were complicated with PHD, accounting for 67.4%. The incidence of severe adverse outcomes in patients with PHD was 43.1%. We found that preoperative moderate/severe pericardial effusion [odds ratio (OR): 11.645, 95% confidence interval (CI): 1.144, 143.617, P = 0.045], preoperative imaging data suggest the celiac trunk involvement [OR: 6.136, 95% CI 1.019, 36.930, P = 0.048], CPB time > 180 min [OR: 4.855, 95% CI 1.218, 15.761, P = 0.034], decreased early postoperative serum albumin [OR: 0.935, 95% CI 0.856, 0.985, P = 0.026] were independent risk factors for severe adverse outcomes in patients with PHD. Conclusions PHD was associated with increased early mortality and morbidity. Preoperative moderate/severe pericardial effusion, preoperative celiac trunk involvement, cardiopulmonary bypass (CPB) time > 180 min and decreased early postoperative serum albumin were identified as independent risk factors for severe adverse outcomes in patients with PHD.

Background: Blood urea nitrogen (BUN) and serum albumin (SA) are related to mortality in patients with cardiovascular diseases, such as acute aortic dissection. However, there are no data on the relationship between BUN-to-albumin ratio (BA-R) and mortality in patients with acute type A aortic dissection (ATAAD). Thus, the aim of this study was to evaluate the prognostic value of BA-R for the prediction of in-hospital mortality in patients who underwent emergency surgery for ATAAD.Methods: Patients who were diagnosed with ATAAD and underwent emergency surgery within 48 h of onset at our hospital between January 2015 and December 2021 were included in this study. The primary endpoint of this study was postoperative in-hospital mortality (POIM). The data of the survivors and non-survivors were retrospectively compared. Univariate and multivariable logistic regression analyses were performed to investigate the association between BA-R and POIM.Results: A total of 557 patients with ATAAD were enrolled in this study. Of these, 505 survived and 52 did not. The preoperative BA-R of the non-survivor group was significantly higher than that of the survivor group (0.27 [0.18, 0.46] vs. 0.12 [0.10, 0.16] mmol/g; P < 0.001). Univariate regression analysis showed that preoperative BA-R ≥0.155 mmol/g, serum creatinine level ≥96.3 µmol/mL, SA level Conclusion: Preoperative BA-R is a simple, rapid, and potentially useful prognostic indicator of POIM in patients with ATAAD.

Purpose: Older patients with acute type A aortic dissection (ATAAD) have higher risk of mortality than that of younger patients when a total arch reconstruction (TAR) is required. Triple-branched stent graft (TBSG) implantation is a novel technique for TAR. However, early outcomes of a TBSG implantation in older patients have not been reported. This study aimed to evaluate the early outcomes of the TBSG technique in older patients with ATAAD. Methods: From February 2015 to December 2020, 640 patients who simultaneously underwent an emergent open aortic surgery and TBSG implantation for ATAAD were enrolled in this study. They were categorized into the younger (age < 70 years old, n=573) and older groups (age > 70 years, n=67). Clinical data of all patients were retrospectively reviewed. Result: The mean ages of the patients in the younger and older groups were 45.3 ± 9.6 years old and 73.5 ± 3.0 years old, respectively. Preoperative characteristics were similar between the two groups, except for weight and incidence of moderate or greater aortic regurgitation, which were lower in the older group than those in the younger group. Surgical procedure and duration (i.e., duration for cardiopulmonary bypass, aortic cross-clamp, selected cerebral perfusion, and total circulation arrest) were comparable between the two groups (p>0.05). Patients in the older group had higher incidence of dialysis for acute kidney injury and longer ICU stay compared with those in the younger group. However, the incidences of 30-day mortality (5.1% in younger group vs. 7.5% in older group, p=0.407) and other major complications (i.e., neurological adverse events) were similar between the two groups. Conclusion: TBSG implantation for ATAAD resulted in an acceptable mortality rate in patients above 70 years old; thus, it could be a feasible surgical procedure to perform in older patients with ATAAD when a TAR is required.

Objective: There have been no studies on postoperative kinesiophobia in patients with acute type A aortic dissection (AAAD). In this study, we conducted a cross-sectional investigation on the occurrence of postoperative kinesiophobia in patients with AAAD, and discussed the influence of related variables on kinesiophobia. Methods: A total of 312 patients diagnosed with AAAD treated with surgery at Our Center from January 2019 to December 2021 were enrolled. The level of kinesiophobia was assessed using the Cardiac Motor fear Scale (TSK-SV-HEART), and patients with kinesiophobia were classified as patients with TSK > 37. Univariate analysis and multivariate logistic regression analysis were used to determine the influence of related factors on kinesiophobia in AAAD patients. Results:A total of 264 patients were included in this study, and the mean score of postoperative kinesiophobia was 38.15±6.66, with an incidence of 46.2%. Multivariate logistic regression analysis showed that the following variables could reduce the occurrence of kinesiophobia: Education level (OR=11.34, 95%CI: 3.62-35.54), general self-efficacy (OR=0.73, 95%CI: 0.61–0.87), family care index (OR=0.26, 95%CI: 0.15–0.46), facing style (OR=0.66, 95%CI: 0.54–0.81); Two variables increased the level of kinesiophobia: avoidance style (OR=1.73, 95%Cl: 1.40–2.15) and yielding style (OR=2.04, 95%CI: 1.56–2.66) were risk factors for kinesiophobia in patients with acute type A aortic dissection (P < .001). Conclusion:The incidence of postoperative kinesiophobia in patients with AAAD is high, and it is related to various factors. Medical staff must be attentive to the potential occurrence of kinesiophobia during postoperative rehabilitation.

Background To compare the early and late postoperative outcomes of chordal reconstruction (CR) and quadrangular resection (QR) in patients with posterior mitral valve prolapse (PMPL). Methods Between January 2008 and December 2018, 305 patients with PMPL who underwent mitral valve plasty (MVP) were included in this retrospective analysis. The CR and QR procedures were performed in 169 patients (CR group) and 136 patients (QR group), respectively. Early and late postoperative outcomes were compared between the groups. Results Follow-up was complete in 96.4% (294/305) of patients, with a mean follow-up of 81.2 ± 30.4 months. No 30-day mortality was observed in any of the patients. The success rate of the mitral valve repair was similar in both groups (99.4% vs. 98.5%, P = 0.850). The incidence of early postoperative hemolysis was lower in the CR group than in the QR group (0.00% vs. 3.0%, P = 0.024). Postoperative left ventricular end-diastolic diameter (LVEDD) decreased more significantly in the CR group than in the QR group at 3 months (8.15 [1.30,12.65] vs. 3.25 [− 0.05, 8.75] mm, P P = 0.653), but the time interval between the initial operation and reoperation was shorter in the QR group than in the CR group (84.3 ± 36.1 vs. 120.9 ± 27.6 months, P = 0.026). The LVEDD enlargement was more significant in the QR group than in the CR group (4.5 [3.6, 4.5] vs. 2.4 [1.3, 2.8] mm, P Conclusion CR and QR are effective techniques for patients with PMPL. Both techniques resulted in a low incidence of recurrent MR. However, CR can reduce early postoperative hemolysis and LVEDD more significantly. During the long-term follow-up, reoperations due to recurrent MR were performed at a longer interval after the initial operation. LVEDD expansion was better avoided in the CR group.

Objectives: Pulmonary artery hypertension (PAH) is a serious disease for which there is no effective treatment. Its pathogenesis is complex and has not yet been clarified. Tex261 is a protein-coding gene whose functional enrichment nodes include the transporter activity of COP II. However, the role of Tex261 in PAH remains unknown.Methods: Sugen5416/Hypoxic PAH models were established, and pulmonary arteries (PAs) were isolated for proteomic sequencing. The binding sites between Hif-1α and Tex261 were verified by dual-luciferase reporter gene assay. Cell proliferation was detected by MTS and EdU assays. For determination of the preventive and therapeutic effects of Tex261, intratracheal instillation of adeno-associated virus (AVV6) with Tex261 vectors was performed.Results: Tex261 was screened according to the proteomic sequencing data. Hif-1α inhibited Tex261 promoter activity under hypoxia. Decreased Tex261 expression promoted PASMC proliferation. Tex261 regulated Sec23 via the Ndrg1-mediated Akt pathway. Tex261 overexpression improved the pressure and vessel remodeling of PAs induced by Sugen5416/hypoxia.Conclusion: Hypoxia suppressed Tex261 expression through Hif-1α activation. The decreased Tex261 could promote Ndrg1 and depress Akt activity and then inhibit Sec23 activity, which leads to cell proliferation and vessel remodeling. Elevated Tex261 has some preventive and therapeutic effects on rats with PAH.

BackgroundPostoperative delirium (POD) is an acute brain dysfunction that is frequently observed in patients undergoing cardiac surgery. Increasing evidence indicates POD is related to higher mortality among cardiac surgical patients, but the results remain controversial. Moreover, a quantitative evaluation of the influence of POD on hospital days, intensive care unit (ICU) time, and mechanical ventilation (MV) time has not been performed.ObjectiveThis study aimed to evaluate the correlation between POD and outcomes in patients undergoing cardiac surgery by a systematic review and meta-analysis.Materials and methodsA total of 7 electronic databases (Cochrane Library, PubMed, EMBASE, CINAHL Complete, MEDLINE, Wan-fang database, and China National Knowledge Infrastructure) were searched from January 1980 to July 20, 2021, with language restrictions to English and Chinese, to estimate the impact of the POD on outcome in patients who underwent cardiac surgery. The meta-analysis was registered with PROSPERO (Registration: CRD42021228767).ResultsForty-two eligible studies with 19785 patients were identified. 3368 (17.0%) patients were in the delirium group and 16417 (83%) were in the non-delirium group. The meta-analysis showed that compared to patients without POD, patients with POD had 2.77-fold higher mortality (OR = 2.77, 95% CI 1.86–4.11, P < 0.001), 5.70-fold higher MV (>24h) rate (OR = 5.70, 95% CI 2.93–11.09, P < 0.001); and longer MV time (SMD = 0.83, 95% CI 0.57–1.09, P < 0.001), ICU time (SMD = 0.91, 95% CI 0.60–1.22, P < 0.001), hospital days (SMD = 0.62, 95% CI 0.48–0.76, P < 0.001).ConclusionThe synthesized evidence suggests that POD is causally related to the increased risk of mortality, prolonged length of ICU and hospital stay, and a longer duration of MV time. Future research should focus on the interventions for POD, to reduce the incidence.Systematic review registration[www.crd.york.ac.uk/PROSPERO], identifier [CRD42021228767].

To evaluate the risk factors of postoperative hypoxemia in patients after triple-branched stent graft implantation surgery with acute type A aortic dissection by conducting a nomogram.We evaluated 97 patients with acute type A aortic dissection (2020-2021), who underwent triple-branched stent graft implantation surgery. The independent risk factors were screened using univariate and multivariate logistic regression. We integrated significant factors as well as potential interference factors to build the nomogram model. The accuracy of the nomogram model was determined by using receiver operating characteristic curves (ROC), decision curve analyses (DCA), and calibration plots. Internal verification was evaluated using bootstrap validation.Logistic regression analysis illustrated that the postoperative lactic acid, postoperative creatinine, and intraoperative aortic occlusion time were all independent risk factors for hypoxemia. Age, sex, and body mass index (BMI) were clinically relevant for predicting postoperative hypoxemia. We established a nomogram based on these six risk factors. The ROC (area under the curve [AUC] = 0.765), DCA, and calibration confirmed good discriminatory applicability and accuracy of the nomogram. Bootstrap validation (AUC = 0.76) verified the applicability of the nomogram.The nomogram model could serve as a tool for the prediction of postoperative hypoxemia in patients after modified triple-branched stent graft implantation surgery with acute type A aortic dissection.

Objectives To investigate the seasonal, monthly, and daily distribution of the incidence of Stanford type A acute aortic dissection (TAAAD) and identify seasonality in the length of hospital stay and in-hospital mortality of TAAAD in southeastern China. Methods We enrolled patients diagnosed with TAAAD from June 1, 2017, to May 31, 2021. Participants were divided into seasonal, monthly, and daily groups according to the need for analysis. An analysis of variation was applied to compare the number of TAAAD in different seasons, months, and days. The χ2 test was used to compare in-hospital mortality among the four groups. Nonparametric methods were used for all comparisons of the length of hospital stay. Results Of the 485 patients, 154 were diagnosed in winter (31.8%), 115 in spring (23.7%), 73 in summer (15.1%), and 143 in autumn (29.5%). The daily, monthly, and seasonal distributions of TAAAD were significantly different (P = 0.04, P

BackgroundThe benefits of breast milk oral care in mechanically ventilated preterm infants remain controversial. This study aimed to systematically review the evidence on the benefits of breast milk oral care in mechanically ventilated preterm infants.MethodsThe randomized controlled trials of breast milk oral care for mechanically ventilated preterm infants were searched in EMBASE, PubMed, Cochrane Library, Web of Science, WANFANG Date and China National Knowledge Infrastructure databases. The retrieval language was limited to Chinese and English, and the final search was conducted until March 2022. Outcome measures included ventilator-associated pneumonia (VAP), mechanical ventilation time (MVT), length of stay (LOS), necrotizing enterocolitis (NEC), late-onset sepsis, mortality during hospitalization, time of full intestinal feeding and time of full oral feeding. Two researchers independently screened the literature, extracted the data, and conducted the literature quality assessment. Meta-analysis was mainly performed using RevMan 5.3.ResultsEight articles involving 1,046 preterm infants were included. Our meta-analysis showed that compared with the control group, breast milk oral care could reduce the incidence of VAP [RR = 0.41, 95% CI (0.23, 0.75), P = 0.003] and NEC [RR = 0.54, 95% CI (0.30, 0.95), P = 0.03], and shorten the MVT [MD = −0.45, 95% CI (−0.73, −0.18), P = 0.001] and LOS [MD = −5.74, 95% CI (−10.39, −1.10), P = 0.02]. There were no significant differences in the mortality during hospitalization [RR = 0.94, 95% CI (0.67, 1.33), P = 0.74], the incidence of late-onset sepsis [RR = 0.79, 95% CI (0.40, 1.59), P = 0.51], the time of full intestinal feeding [MD = −2.42, 95% CI (−5.37, 0.52), P = 0.11] and the time of full oral feeding [MD = −3.40, 95% CI (−10.70, 3.91), P = 0.36] between the two groups.ConclusionsOral care of breast milk can reduce the incidence of VAP and NEC, shorten MVT and LOS in mechanically ventilated preterm infants. However, due to the quality and quantity limitations of the included studies, larger sample size and more strictly designed clinical trials are still needed in the future to further confirm the findings of this study.

Objective To determine the safety and efficacy of early postoperative mobilization in patients who have undergone surgical repair of acute type A aortic dissection. Design Randomized controlled trial. Setting Heart Medical Center. Subjects Seventy-seven patients with acute type A aortic dissection were assessed. Intervention Patients were randomly allocated into: (1) the control group (usual care) ( n = 38) and (2) the intervention group (early goal-directed mobilization) ( n = 39). Main Measures The primary outcome was the patient's functional status. The secondary outcomes included vital signs, serious adverse events, muscle strength, intensive care unit-acquired weakness, grip strength, duration of mechanical ventilation, length of stay, readmission rate, and health-related quality of life after 3 months. Results The vital signs of the patients were within the tolerable ranges during the entire intervention. No serious exercise-related adverse events were observed in the intervention group. The Barthel Index score ( P = 0.013), Medical Research Council score ( P = 0.001), grip strength ( P = 0.001), and health-related quality of life ( P = 0.001) were higher in the intervention group. Intensive care unit acquired weakness ( P = 0.019), duration of mechanical ventilation ( P = 0.002), intensive care unit stay ( P = 0.002), and total length of stay ( P = 0.010) were lower in the intervention group. Patients in the intervention group had a higher physical health-related quality of life ( P = 0.015) at 3 months post-surgery. There was no difference in readmission rates. Conclusions Delivery of early goal-directed mobilization in acute type A aortic dissection was safe and facilitated the recovery of daily living ability, shorter hospital stay, and improved quality of life after discharge.

Objective: To evaluate the efficacy of sacubitril/valsartan for the treatment of patients with chronic heart failure (CHF) after cardiac valve surgery (CVS).Methods: Data of 259 patients who underwent CVS due to organic heart disease, and who were admitted to the hospital with CHF from January 2018 to December 2020, were collected. The patients were divided into Group A (treatment with sacubitril/valsartan) and Group B (treatment without sacubitril/valsartan). The duration of treatment and follow-up was 6 months. Prior-treatment clinical characteristics, post-treatment data, mortality, and follow-up data of the two groups were analyzed.Results: The total effective rate of Group A was higher than that of Group B (82.56% versus 65.52%, P < 0.05). The left ventricular ejection fraction (LVEF) was improved in both groups (11.14 ± 10.16 versus 7.15 ± 11.18, P = 0.004). The left ventricular end-diastolic/-systolic diameter (LVEDD/LVESD) in Group A decreased more than that in Group B (3.58 ± 9.21 versus 0.27 ± 14.44, P=0.026; 4.21 ± 8.15 versus 1.14 ± 12.12, P=0.016, respectively). The N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) in both groups decreased (1305.65 ± 2000.85 versus 675.91 ± 1649.84, P=0.012). The systolic and diastolic blood pressure (SBP/DBP) in Group A decreased more than that in Group B (13.13 ± 23.98 versus 1.81 ± 10.89, P < 0.001; 8.28 ± 17.79 versus 2.37 ± 11.41, P = 0.005, respectively). Liver and renal insufficiency, hyperkalemia, symptomatic hypotension, Angioedema or acute heart failure have no statistical differences between the two groups.Conclusion: Sacubitril/valsartan can effectively improve the cardiac function of CHF patients after CVS by increasing LVEF, reducing LVEDD, LVESD, NT-proBNP and BP, with good safety.

Aortic dissection (AD) is mainly caused by hypertension and Marfan syndrome. However, it is unclear whether the cellular components and functions are different between the two causes. A total of 11 aortic samples were collected for single-cell RNA analysis and 20 clusters were disclosed, including VSMCs, fibroblasts, endothelial cells, T cells, B cells, monocytes, macrophages, mast cells, and neutrophils components. There were differences in cell subclusters and function between hypertension and Marfan patients. The cells also had different differentiations. Cellchat identified cell ligand–receptor interactions that were associated with hypertension and Marfan-induced AD involving SMC, fibroblast, mo-macrophages, and T-cell subsets. This study revealed the heterogeneity of cellular components and gene changes in hypertension and Marfan-induced AD. Through functional analysis and the changes in intercellular communication, the possible mechanisms of different causes of AD were explained from a new perspective, so we can better understand the occurrence and development of diseases.

Objective: To evaluate the perioperative clinical efficacy of preoperative human fibrinogen treatment in patients with acute Stanford type A aortic dissection (ATAAD).Methods: Data of 159 patients with ATAAD who underwent emergency surgical treatment in our hospital from January 2019 to December 2020 were retrospectively analyzed. Patients were divided into two groups according to whether human fibrinogen was administered before surgery. The preoperative clinical data, surgical data, postoperative data, complications related to the coagulation function, and mortality of the two groups were compared and analyzed.Results: The in-hospital mortality was similar in the two groups (2.9% versus 9.3%, P = 0.122). However, group A had a significantly shorter operation time (279.24±39.03 versus 298.24±45.90, P=0.008), lower intraoperative blood loss (240.48±96.75 versus 353.70±189.80, P＜0.001), and reduced intraoperative transfusion requirement of red blood cells (2.61±1.18 versus 6.05±1.86, P＜0.001). The postoperative suction drainage within 24 hours in group A was significantly decreased (243.24±201.52 versus 504.22±341.08，P=0.002). The incidence of postoperative acute kidney injury (AKI) in group A was lower than that in group B (3.8% versus 14.8%, P =0.023). Similarly, the incidence of postoperative hepatic insufficiency in group A was lower than that in group B (1.9% versus 9.3%, P =0.045). In group A, the mechanical ventilation time was shorter (47.68±28.61 versus 118.21±173.16, P=0.004) along with reduced ICU stay time (4.06±1.18 versus 8.09±9.42, P=0.003), and postoperative hospitalization days (19.20±14.60 versus 23.50±7.56, P=0.004).Conclusion: Preoperative administration of human fibrinogen in patients undergoing ATAAD surgery can effectively reduce the intraoperative blood loss, blood transfusion amount, shorten the operation time, reduce postoperative complications, and improve the early prognosis of patients, in addition to being highly safe.

Pulmonary hypertension (PH) is mainly characterized by abnormal pulmonary vascular hyperplasia and vascular remodeling, but its mechanism is complicated and currently unclear. Cysteine and glycine-rich protein 2 (Csrp2) has been reported to promote cell proliferation and migration, and affect cell cycle progression. As a new invasive actin-binding factor, Csrp2 increased the invasion and even metastasis of some cancer cells. It was associated with tumor recurrence and chemotherapy resistance. However, the role of Csrp2 in PH remains unknown. We found that Csrp2 expression was increased both in pulmonary arteries (PAs) and smooth muscle cells (PASMCs) in PH. Csrp2 enhanced PASMC proliferation and phenotypic transition. The Wnt3α-β-catenin/lymphoid enhancer-binding factor 1 (LEF1) pathway is involved in cell proliferation and phenotypic transition regulated by Csrp2 expression. These results suggest that hypoxia downregulates YinYang-1 (YY1) and then increases Csrp2 expression. Increased Csrp2 promotes PASMC proliferation and phenotypic transition by activating the Wnt3α-β-catenin/LEF1 pathways, which leads to pulmonary vascular remodeling and even provides a new theoretical basis for studying the pathogenesis and therapeutic targets of PH.

To investigate the function of C/EBPAortic vascular smooth muscle cells (VSMCs) were isolated, cultured, and identified from AD rats. Then, C/EBPThe protein levels of C/EBPOur data indicated that during the development of AD, C/EBP

Objective: Controversial opinions exist for aortic valve replacement(AVR) through partial upper sternotomy in obese patients. Moreover, this study sought to investigate the potential clinical advantage of partial upper sternotomy aortic valve replacement (mini-AVR) over conventional full sternotomy aortic valve replacement (con-AVR) in obese patients.Methods: This was a retrospective and observational study. From January 2015 to December 2020, a total of 184 obese [body mass index (BMI)≥30 kg/m2] patients undergoing isolated primary AVR were included: 98 patients underwent conventional full sternotomy and 86 patients underwent partial upper sternotomy. Propensity score(PS) matching was applied to eliminate the basline imbalances in the mini-AVR and the con-AVR groups.Results: After one-to-one propensity score matching,two groups of 60 patients were obtained.No in-hospital death occurred in the two groups.In addition,cardiopulmonary bypass time and total operative time were similar across the 2 groups, but the aortic cross-clamp time was significantly shorter in the con-AVR group (P = .022). The amount of mediastinal drainage at 48 hours after surgery (P=.018) and postoperative blood transfusions (P=.014) were significantly lower in the mini-AVR group. There was no difference in ventilation time (P=.145), but a shorter intensive care unit stay time (P=.021) in the mini-AVR group.Conclusion: This study demonstrates that aortic valve replacement through a mini-AVR in obese patients is a safe and effective procedure. It outperformed con-AVR in terms of blood loss,blood product transfusion,and ICU stay.

Background: Triosephosphate isomerase 1 (TPI1) is a crucial enzyme in glycolysis/gluconeogenesis and has been associated with a variety of diseases. However, there is little information on TPI1 and aortic aneurysms (AA). This study was designed to reveal the association between TPI1 and aortic aneurysms, and the mechanisms underlying TPI1 activity in AAs. Methods: Tandem Mass Tag (TMT)-based Liquid chromatography mass spectrometry/mass spectrometry (LC-MS/MS) and the Mann-Whitney test were used to compare variables between AA and normal aortic tissues. Gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were analyzed using Fun-Rich software. The expression of the TPI1 protein in human aortic tissues was verified by Western blotting. A mouse AA model was established by infusing Ang-II for 4 weeks, then the expression of TPI1, SM22, α-SMA, OPN and MMP2/9 proteins were evaluated by western blotting. TPI1 overexpression was achieved by transfection of TPI mRNA, and its effect on gene expression was studied by RT-qPCR and western blotting, which included SM22, α-SMA, OPN, and MMP2/9. Ang II-induced expression of TPI1 and phenotypic-related genes in VSMCs. Results: TPI1 is closely related to the glycolysis/gluconeogenesis pathway and is higher in AA. Expression of TPI1 was upregulated in AA aortic samples of both human and mouse models, p

Circulating proteins play functional roles in various biological processes and disease pathogenesis. The aim of this study was to highlight circulating proteins associated with aortic aneurysm and dissection (AAD) and spontaneous coronary artery dissection (SCAD). We examined the associations of circulating molecule levels with SCAD by integrating data from a genome-wide association study (GWAS) of CanSCAD and 7 pQTL studies. Mendelian randomization (MR) analysis was applied to examine the associations between circulating molecule levels and AAD by using data from UK Biobank GWAS and pQTL studies. The SCAD-associated SNPs in 1q21.2 were strongly associated with circulating levels of extracellular matrix protein 1 (ECM1) and 25 other proteins (encoded by CTSS, CAT, CNDP1, KNG1, SLAMF7, TIE1, CXCL1, MBL2, ESD, CXCL16, CCL14, KCNE5, CST7, PSME1, GPC3, MAP2K4, SPOCK3, LRPPRC, CLEC4M, NOG, C1QTNF9, CX3CL1, SCP2D1, SERPINF2, and FN1). These proteins were enriched in biological processes such as regulation of peptidase activity and regulation of cellular protein metabolic processes. Proteins (FGF6, FGF9, HGF, BCL2L1, and VEGFA) involved in the Ras signaling pathway were identified to be related to AAD. In addition, SCAD- and AAD-associated SNPs were associated with cytokine and lipid levels. MR analysis showed that circulating ECM1, SPOCK3 and IL1b levels were associated with AAD. Circulating levels of low-density lipoprotein cholesterol and small very-low-density lipoprotein particles were strongly associated with AAD. The present study found associations between circulating proteins and lipids and SCAD and AAD. Circulating ECM1 and low-density lipoprotein cholesterol may play a role in the pathology of SCAD and AAD.

We describe a one-stop procedure for aortopulmonary collateral artery (APCA) and postoperative complications of Tetralogy of Fallot (TOF). Postoperative complications of TOF include right ventricular outflow tract stenosis, pulmonary valvular annular stenosis, pulmonary regurgitation, and aortopulmonary artery stenosis. The one-stop procedure was defined as after APCA embolization. The heart continued to function under cardiopulmonary bypass during median sternotomy to reconstruct the right ventricular outflow tract with a valved conduit and replace the aortopulmonary artery. A biological valved was sewed within the valved conduit in an artificial blood vessel in vitro and subsequently was used in the procedure and achieved significant results.

Objective. To compare the efficacy of the percutaneous presuture technique (PPST) and the femoral artery incision technique (FAIT) under local anesthesia in the treatment of endovascular aortic repair (EVAR) for patients with uncomplicated type B aortic dissection (uTBAD). Method. Two hundred and ninety-five patients diagnosed with uTBAD who underwent EVAR under local anesthesia from June 2017 to December 2021 were consecutively and randomly selected for retrospective analysis. The PPST was performed in 178 cases and the FAIT was performed in 117 cases. The clinical characteristics and surgical and postoperative data from the two groups were analyzed. Results. There were no significant differences in clinical characteristics between the two groups ( p > 0.05 ). The operative time of the PPST group was significantly shorter than that of the FAIT group (46 (33, 58) versus 72 (67.5, 78.0) minutes, p < 0.001 ), as was the operative approach procedure time (6 (4.5, 9.0) versus 38 (36.5, 43.5) minutes, p < 0.001 ), and length of postoperative hospital stay (5.19 ± 2.26 versus 8.33 ± 3.76 days, p < 0.001 ). There were fewer postoperative approach-related procedural complications in the PPST group than in the FAIT group (2 versus 12, p < 0.001 ); similarly, the average frequency of postoperative wound disinfection was significantly lower in the PPST group (1.08 ± 0.39 versus 3.31 ± 0.91 times, p < 0.05 ). Obesity was identified as an independent risk factor for postoperative approach-related procedural complications (OR, 22.26; 95% CI, 4.74–104.49; p < 0.001 ). Conclusions. The PPST has comparable safety and efficacy to the FAIT in EVAR under local anesthesia. It can shorten the length of hospital stay, reduce operation time, lower the risk of wound-related complications, reduce the frequency of postoperative wound disinfection, and hasten postoperative recovery. It can therefore be used as a first-line surgical technique in EVAR of uTBAD under local anesthesia, especially in obese patients.

AimsTo assess the association of lipid traits and lipid-modification via licensed or investigational targets with heart failure (HF) risk using 2-sample Mendelian randomization (MR) study.Methods and resultsGenetic variants obtained from genome-wide association studies (GWASs) in UK Biobank as instrumental variables to investigate the association of lipid traits (low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), apolipoprotein B (ApoB) and apolipoprotein AI (ApoAI)) and lipid-modifying effect of eight licensed or investigational drug targets with HF risk by using the inverse-variance weighted method. In this study, we observed that genetically-predicted levels of LDL-C, TG, LDL-C and ApoB were significantly related to HF risk, which were mainly mediated by CHD. Further MR analyses identified PCSK9, CETP and LPL, but not HMGCR, as potential targets to prevent HF. The genetic proxy of LDL-C and ApoB increase modified by PCSK9 showed similar evidence in increasing risk of HF (PLDL-C=1.27*10−4; PApoB=1.94*10−4); CETP played a role in HF risk via modifying all investigational lipid traits with the strongest evidence though ApoB (P=5.87*10−6); LPL exerted effects on HF via modifying most lipid traits with the strongest evidence observed via modifying TG (P=3.73*10−12).ConclusionsThis 2-sample MR study provided genetic evidence of the associations between lipid traits and HF risk, which were mostly mediated by CHD. Besides, drug target MR studies indicated that PCSK9 inhibition, CETP inhibition and LPL activation, but not statins, were effective in reducing HF risk.

Background: Cardiac surgery patients are at a risk of postoperative nausea, vomiting, and aspiration pneumonia, but conventional 4–6-h fasting can exacerbate thirst. Early oral hydration is recommended, but the post-extubation time for intervention remains unclear. This study aimed to investigate the effects of early thirst management on thirst, the oral environment, gastrointestinal adverse reactions, and aspiration pneumonia in cardiac surgery patients.Methods: A total of 84 cardiac surgery patients were randomly divided into two groups for either conventional oral hydration or early oral hydration. The primary outcome was thirst intensity. The secondary outcomes were adverse gastrointestinal reactions (nausea and vomiting), aspiration pneumonia, unstimulated saliva flow rates, salivary pH, oral odor, oral mucosal moisture, and patients' satisfaction. At 1 h post-extubation, patients were evaluated for thirst intensity and intervention readiness. Patients who passed the evaluation were subjected to thirst management. Results: The patient demographic and clinical characteristics did not significantly vary between the groups. The scores for thirst (3.38 versus 8.24，F=306.21, P＜0.001), oral mucosa (2.03 versus 3.90, P＜0.001), halitosis (2.77 versus 3.76, P＜0.001) were significantly lower in the early oral hydration group than in the conventional oral hydration group. The early oral hydration group was associated with significantly higher salivary pH (6.44 versus 0, P＜0.001), unstimulated saliva flow rates (0.18 versus 0, P＜0.001) and patient satisfaction (4.28 versus 3.15, P＜0.001) than the conventional oral hydration group. Gastrointestinal adverse reactions did not significantly vary (7.70% versus 4.88%, P=0.60), and aspiration pneumonia was not observed in both groups.Conclusion: The early oral hydration significantly alleviated thirst, stabilized the oral environment without exacerbating gastrointestinal adverse reactions and aspiration pneumonia, and increased patient satisfaction.Trial registration: Chinese Clinical Trial Registry: ChiCTR2100049206. Registered 25 July 2021.

Background: Medication adherence is crucial for patients with mechanical heart valve replacement. Although families functioning is positively associated with medication adherence, little is known about the underlying mechanisms.Objective: To test whether family functioning affects medication adherence through illness perceptions and whether this mediating effect was moderated by medication literacy.Methods: 319 patients after mechanical heart valve replacement were included in this cross-sectional study from June 2021 to October 2021. Data regarding family functioning, illness perceptions, medication adherence, and medication literacy were collected through questionnaires. The moderated mediation model was examined by Hayes’s PROCESS macro, based on the bootstrapping method.Results: The results revealed illness perceptions partially mediated the association of family functioning on medication adherence [β = 0.08, 95% confidence intervals: (0.04, 0.12)], and this effect was stronger for patients with low medication literacy than those with high literacy [β = −0.36, 95% CI: (−0.50, −0.22)]. Furthermore, the relationship between family functioning and medication adherence was only significant in patients with low medication literacy [β= 0.36, 95% CI: (0.23, 0.50)].Conclusion: The mediating effect of illness perceptions between family functioning and medication adherence was moderated by medication literacy. Efforts to improve medication adherence by targeting at improving family functioning may be more effective when considering illness perceptions, especially for patients with limited medication literacy.

Background: Risk factors for acute kidney injury (AKI) after Stanford type A aortic dissection (TAAD) repair are inconsistent in different studies. This meta-analysis systematically analyzed the risk factors so as to early identify the therapeutic targets for preventing AKI. Methods: Studies exploring risk factors for AKI after TAAD repair were searched from four databases from inception to June 2022. The synthesized incidence and risk factors of AKI and its impact on mortality were calculated. Results: Twenty studies comprising 8223 patients were included. The synthesized incidence of postoperative AKI was 50.7%. Risk factors for AKI included cardiopulmonary bypass (CPB) time >180 min [odds ratio (OR), 4.89, 95% confidence interval (CI), 2.06–11.61, I2 = 0%], prolonged operative time (>7 h) (OR, 2.73, 95% CI, 1.95–3.82, I2 = 0), advanced age (per 10 years) (OR, 1.34, 95% CI, 1.21–1.49, I2 = 0], increased packed red blood cells (pRBCs) transfusion perioperatively (OR, 1.09, 95% CI, 1.07–1.11, I2 = 42%), elevated body mass index (per 5 kg/m2) (OR, 1.23, 95% CI, 1.18–1.28, I2 = 42%) and preoperative kidney injury (OR, 3.61, 95% CI, 2.48–5.28, I2 = 45%). All results were meta-analyzed using fixed-effects model finally (p < 0.01). The in-hospital or 30-day mortality was higher in patients with postoperative AKI than in that without AKI [risk ratio (RR), 3.12, 95% CI, 2.54–3.85, p < 0.01]. Conclusions: AKI after TAAD repair increased the in-hospital or 30-day mortality. Reducing CPB time and pRBCs transfusion, especially in elderly or heavier weight patients, or patients with preoperative kidney injury were important to prevent AKI after TAAD repair surgery.

This study aimed to determine whether family-centred care (FCC) intervention reduces the ICU delirium prevalence.A systematic review and meta-analysis.The databases, including PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Complete, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), WANFANG Data and VIP Information, were systematically searched up to 30 November 2021. The search term includes keywords related to intensive care units, delirium and family-centred care. Meta-analyses were performed and presented by risk ratio (RR), mean difference (MD) and corresponding 95% confidence intervals (CIs).The meta-analysis results showed that compared with the usual care, FCC intervention has positive effects on reducing ICU delirium prevalence [RR = 0.54, 95% CIs (0.36, 0.81), p .05]. However, no effect was observed on ICU stays, mechanical ventilation duration and ICU-acquired infection between the two groups.Family-centred care is an effective intervention to reduce the ICU delirium prevalence. But the result should be treated cautiously as the high levels of heterogeneity, further high-quality studies are required to determine the effectiveness of FCC intervention in the ICU setting.

BackgroundCorticosteroids can effectively inhibit systemic inflammation induced by cardiopulmonary bypass. Recently clinical trials and meta-analyses and current guidelines for cardiac surgery do not support corticosteroids prophylaxis during cardiac surgery because of an increase in myocardial infarction and no benefit for patients. The aim of this study is to determine whether specific corticosteroids dose ranges might provide clinical benefits without increasing myocardial infarction.MethodsThe PubMed, Web of Science, Embase, Clinical Trials, and Cochrane databases were searched for randomized controlled trials (RCTs) published before August 1, 2021.Results88 RCTs with 18,416 patients (17,067 adults and 1,349 children) were identified. Relative to placebo and high-dose corticosteroids, low-dose corticosteroids (≤20 mg/kg hydrocortisone) during adult cardiac surgery did not increase the risks of myocardial infarction (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.43–2.17; p = 0.93). However, low-dose corticosteroids were associated with lower risks of atrial fibrillation (OR: 0.58, 95% CI: 0.44–0.76; p p = 0.04). Furthermore, low-dose corticosteroids significantly shortened the mechanical ventilation times (mean difference [MD]: −2.74 h, 95% CI: −4.14, −1.33; p = 0.0001), intensive care unit (ICU) stay (MD: −1.48 days, 95% CI: −2.73, −0.22; p = 0.02), and hospital stay (MD: −2.29 days, 95% CI: −4.51, −0.07; p = 0.04).ConclusionLow-dose corticosteroids prophylaxis during cardiac surgery provided significant benefits for adult patients, without increasing the risks of myocardial infarction and other complications.