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To further demonstrate the gold standard role of adrenal vein sampling (AVS) in the subtyping diagnosis of primary aldosteronism (PA). In this study, 9 patients with special PA, whose functional advantages indicated by AVS were contrary to the results of CT examination, were selected. Laparoscopic adrenalectomy was performed based on AVS results, and the surgical outcome was followed up. Nine patients, aged[ M ( Q 1 , Q 3 )] 58.0 (52.0, 63.0) years, including 7 males and 2 females, were followed up for 12 (9, 12) months. CT revealed unilateral morphological abnormalities in 5 cases (the functional advantage side indicated by AVS was contrary to the results of CT examination), and bilateral abnormalities in 4 cases (AVS results confirmed unilateral abnormalities). During the follow-up, all 9 patients achieved complete biochemical remission, 4 patients achieved complete clinical remission, and 5 patients achieved partial clinical remission. The study indicates that compared with CT imaging, AVS has better accuracy in PA subtyping, and selecting surgical side based on AVS results is a reliable and effective strategy.

Objective: To investigate the clinical characteristics and correlated factors of preoperative sleep disorders in patients undergoing various types of cardiac surgery. Methods: The data of patients at the Structural Heart Surgery Center of Beijing Anzhen Hospital, Capital Medical University, from April 2023 to February 2024 were retrospectively collected. Patients were categorized into five groups based on cardiac surgical diagnosis: coronary heart disease, valvular disease, large vessel disease, congenital heart disease, and others. Each group was further subdivided into normal sleep (NS) and sleep disorder (SD) groups based on the Pittsburgh Sleep Quality Index (PSQI) scores. Demographic information, cognitive function, psychiatric symptoms, and other relevant data were collected. Clinical characteristics were compared between groups, and factors associated with preoperative sleep disorders were analyzed using multivariate logistic regression. Results: A total of 1 016 patients aged (58.6±12.7) years were included in the study, including 701 males and 315 females. The incidence of SD was 45.6% (463/1 016). Multivariate logistic regression analysis showed that aging was a risk factor for sleep disorders in patients with coronary heart disease ( OR =1.050, 95% CI : 1.026-1.077) and valvular disease ( OR =1.033, 95% CI : 1.013-1.053). High Self-rating Depression Scale (SDS) score was a risk factor for sleep disorders in patients with valvular disease ( OR =1.050, 95% CI : 1.013-1.091). High score on the Montreal Cognitive Assessment (MoCA) subitem-abstraction ability was a protective factor for sleep disorders in patients with coronary heart disease ( OR =0.695, 95% CI : 0.490-0.981). Conclusions: The risk factors of preoperative sleep disorders in cardiac surgery patients vary based on the type of cardiac disease. Aging, depression and abstraction ability correlate with sleep disorders in cardiac surgical patients.

Objective: To investigate the predictive value of preoperative triglyceride-glucose (TyG) index on atrial fibrillation recurrence after valvular surgery with concurrent Cox-maze Ⅳ ablation. Methods: The data of the patients who underwent valvular surgery with concurrent Cox-maze Ⅳ ablation from June 2017 to May 2022 in the Department of Cardiac Surgery, Beijing Anzhen Hospital were retrospectively collected, and the patients were divided into the recurrence group and non-recurrence group. Baseline clinical data and results of laboratory tests were collected and TyG index was calculated. The univariate and multivariate Cox proportional regression analysis were used to explore the risk factors of atrial fibrillation recurrence after Cox-maze Ⅳ ablation. The value of TyG index in predicting atrial fibrillation recurrence was obtained by plotting receiver operating characteristic (ROC) curve. Results: A total of 424 patients were in the final analysis, including 300 males and 124 females, with an average age of (58.2±13.4) years. The median follow-up time was 32.7 months (17.3-49.6 months). There were 117 and 307 patients in the recurrence and non-recurrence groups, respectively. Compared with the non-recurrence group, the TyG index in the recurrence group was higher (9.21±0.38 vs 8.34±0.72, P =0.011). The multivariate Cox regression analysis showed that TyG index ( HR =2.021, 95% CI : 1.374-3.245, P <0.001), C-reactive protein level ( HR =1.127, 95% CI : 1.007-1.535, P =0.026) and mitral stenosis ( HR =1.038, 95% CI : 1.004-1.483, P <0.001) were risk factors for atrial fibrillation recurrence after Cox-maze Ⅳ ablation. In addition, TyG index was a predictor of atrial fibrillation recurrence according to ROC curve analysis [area under the curve (AUC)=0.847, 95% CI : 0.796-0.871, P <0.001]. Conclusion: The TyG index is an effective indicator to predict the recurrence of atrial fibrillation after valvular surgery with concurrent Cox-maze Ⅳ ablation.

Objective: To evaluate the predictive value of the proportion of hibernating myocardium (HM) in total perfusion defect (TPD) on reverse left ventricle remodeling (RR) after coronary artery bypass graft (CABG) in patients with heart failure with reduced ejection fraction (HFrEF) by 99m Tc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) combined with 18 F-flurodeoxyglucose (FDG) gated myocardial imaging positron emission computed tomography (PET). Methods: Inpatients diagnosed with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2016 to January 2022 were prospectively recruited. MPI combined with 18 F-FDG gated PET was performed before surgery for viability assessment and the patients received follow-up MPI and 18 F-FDG gated PET at different stages (3-12 months) after surgery. Δ indicated changes (post-pre). Left ventricular end-systolic volume (ESV) reduced at least 10% was defined as RR, patients were divided into reverse remodeling (RR+) group and the non-reverse group (RR-). Binary logistic regression analysis was used to identify predictors of RR. Receiver operating characteristic (ROC) curve analysis was performed and the area under the curve (AUC) was calculated to assess the cut-off value for predicting RR. Additionally, we retrospectively enrolled inpatients with HFrEF at the Cardiac Surgery Center, Anzhen Hospital of Capital Medical University from January 2021 to January 2022 as the validation group, who underwent MPI and 18 F-FDG gated PET before surgery. Echocardiography was performed before CABG and after CABG (3-12 months). In the validation group, the reliability of obtaining the cut-off value for the ROC curve was verified. Results: A total of 28 patients with HFrEF (26 males; age (56.9±8.7) years) were included in the prospective cohort. HM/TPD was significantly higher in the RR+ group than in the RR- group ((51.8%±17.9%) vs . (35.7%±13.9%), P =0.016). Binary logistic regression analysis revealed that HM/TPD was an independent predictor of RR (Odds ratio=1.073, 95% Confidence interval: 1.005-1.145, P =0.035). ROC curve analysis revealed that HM/TPD=38.3% yielded the highest sensitivity, specificity, and accuracy (all 75%) for predicting RR and the AUC was 0.786 ( P =0.011). Meanwhile, a total of 100 patients with HFrEF (90 males; age (59.7±9.6) years) were included in the validation group. In the validation group, HM/TPD=38.3% predicted RR in HFrEF patients after CABG with the highest sensitivity, specificity and accuracy (82%, 60% and 73% respectively). Compared with the HFrEF patients in the HM/TPD<38.3% group ( n =36), RR and cardiac function improved more significantly in the HM/TPD≥38.3% group ( n =64) (all P <0.05). Conclusions: Preoperative HM/TPD ratio is an independent factor for predicting RR in patients with HFrEF after CABG, and HM/TPD≥38.3% can accurately predict RR and the improvement of cardiac function after CABG.

The data of 56 patients with mitral valve prolapse undergoing thoracoscopy-assisted mitral valvuloplasty in the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University from May 2019 to December 2020 were retrospectively analyzed. Among them, 31 cases were male and 25 cases were female, with a mean age of (45±14) years. There was no death during perioperative period. No patient was converted to median sternotomy. The duration of cardiopulmonary bypass (CPB), aortic cross-clamp and operation was (207±58) min, (134±59) min, and (374±90) min, respectively. The intraoperative blood loss was (690±268) ml, and 5 (8.9%) patients required blood transfusion. Postoperative mechanical ventilation duration was (19±9) h, and 24-hour pleural fluid drainage volume was (460±247) ml. The length of intensive care unit (ICU) and hospital stay was (25±6) h and (13±4) d, respectively. Therefore, thoracoscopy-assisted mitral valvuloplasty has the advantages of reliable curative effect, less trauma, less complications, fast recovery and satisfactory perioperative outcomes.

Objective: To assess the impacts of incomplete revascularization following off-pump coronary artery bypass grafting (OPCABG) on perioperative outcomes in octogenarians. Methods: A retrospective analysis of 242 octogenarian patients with coronary artery disease (CAD) hospitalized in Beijing Anzhen Hospital from June 2008 to July 2016 was performed. These patients were divided into the complete revascularization group ( n= 181) and the incomplete revascularization group ( n= 61) depending on whether they underwent complete revascularization. The impacts of incomplete revascularization following OPCABG on perioperative outcomes were summarized and compared between the two groups. Results: Among the 242 patients over 80 years who received OPCABG, there were 198 males (81.8%). Compared to the complete revascularization group, those in the incomplete revascularization group were older [(83.2±1.5) vs (81.5±1.1) years old, P= 0.03], with more carotid stenosis (44.3% vs 25.4%, P= 0.01), more involved in the diagonal and circumflex branch of coronary artery (49.2% vs 17.1%, P= 0.01; 83.6% vs 70.2%, P= 0.03), shorter operative time [(4.1±1.7) h vs (4.7±1.2) h, P= 0.03), longer preoperative [(7.1±2.3) d vs (5.2±2.0) d, P= 0.01] and total hospitalization time [(16.3±6.8) d vs (12.5±4.2) d, P= 0.01], however, the differences of the in-hospital mortality and incidence of other perioperative complications were not statistically significant between the two groups (all P> 0.05). Conclusion: Compared with complete revascularization, incomplete revascularization following OPCABG in CAD patients over 80 years old does not increase the perioperative mortality and the incidence of other complications, and it reduces the operative time. However, it increases the time of preoperative and total hospital stay.

Objective: To compare the improvement of quality of life in the patients with left main coronary artery disease and multi-vessel disease between off-pump coronary artery bypass grafting (OPCABG) and percutaneous coronary intervention (PCI) within one year after revascularization. Methods: This study was a prospective study. Between January and July 2018, 840 patients with complex coronary heart disease accepted revascularization therapy, 420 of whom underwent OPCABG and 420 for PCI, with a mean age of 61 years and a male rate of 74% (622/840). European Quality of Life-5 Dimensions (EQ-5D) and Seattle Angina Questionnaire (SAQ) were employed to assess the quality of life and health status of patients. Inverse probability weighting (IPW) was used to adjust treatment selection bias. Results: All-cause mortality (3.6% vs 1.3%, P= 0.045), major adverse cardiac and cerebrovascular events (MACCE) (11.3% vs 4.1%, P< 0.001) and target lesion revascularization (8.3% vs 1.2%, P< 0.001) were higher in PCI group than those in OPCABG group. EQ-5D scores in PCI group were significantly higher than those in OPCABG group at 1 month after operation ( P< 0.001), but there was no significant difference between the two groups at 12 months after operation ( P= 0.210). In SAQ scale, the frequency score of angina pectoris in OPCABG group was higher than that in PCI group in 1 month, 6 months and 12 months after operation (all P< 0.05). The physical activity limitation score in PCI group was significantly higher than that in OPCABG group at one month after operation ( P< 0.01). There was no significant difference between OPCABG group and PCI group in terms of stable state of angina pectoris, satisfaction of treatment and the knowledge of disease. Conclusions: In the short term, the quality of life of patients with left main coronary artery disease and multi-vessel disease treated with OPCABG is better than PCI. However, the improvement of quality of life in the medium and long term still needs to be identified in future follow-up study.

Objective: To characterize the hemodynamic force towards coronary plaque based on noninvasive coronary computed tomographic angiography and to investigate its relationship with plaque features and stenosis severity by computational fluid dynamics. Methods: Twenty-six patients underwent invasive fractional flow reserve measurement following coronary computed tomography angiography examination from March to September 2016 were retrospectively included. Computational fluid dynamics was applied and wall shear stress (WSS) and axial plaque stress (APS), which extracted the axial component of hemodynamic stress acting on stenotic lesions, were calculated based on the results of noninvasive coronary computed tomographic angiography. Plaque analysis was performed to elucidate plaque features and relative plaque burden. The fluid dynamics distributions in lesions with different stenosis severity were investigated. Results: Thirty-one coronary plaques with satisfactory imaging quality were analyzed, there were 11 (35.5%) dominant low WSS (<1 Pa) lesion and 20 high WSS lesion (64.5%), 8(25.8%) net retrograde APS lesion and 23(74.2%) anterograde lesion. Plaque volume was (78.5±48.6) mm(3) and plaque burden was (69.1±12.1)% in the low WSS group, which was(60.5±57.3) mm(3), and(57.5±14.0)%, respectively in the high WSS group, the plaque burden was significantly higher in the low WSS group than in the high WSS group ( P =0.028), while the percentage of calcified plaque, fibrotic plaque and lipid core volume were similar between the two groups ( P >0.05). Plaque volume was (79.7±69.1) mm(3) and plaque burden was(68.7±13.7)% in the group with anterograde-dominant APS plaque, which was(61.7±24.9)mm(3), and(68.9±10.4)%, respectively in the net retrograde APS lesion group ( P >0.05). Percentage of lipid core area was significantly higher in the anterograde lesion group than in the retrograde lesion group ((25.1±18.1)% vs.(10.8±12.7)%, P =0.049). Both WSS and APS were significant higher in the severe obstructive coronary stenosis group than in non-severe obstructive coronary stenosis group ( P <0.05). Although there was no difference in WSS between functional coronary ischemia group and non-functional coronary ischemia group ( (13.3±8.7) Pa vs. (12.5±14.2) Pa, P >0.05), the distribution of APS was different between the functional coronary ischemia group and non-functional coronary ischemia group ((1 698.8±652.6) Pa vs. (981.4±787.5) Pa, P <0.05). Conclusion: WSS and APS can uniquely characterize the stenotic segment and has a strong relationship with lesion geometry. APS may be related to the necrotic core plaque and functional coronary ischemia. Clinical application of these hemodynamic and geometric indices may be helpful to assess the future risk of plaque progress and plaque rupture, which will be helpful on determining respective treatment strategy for patients with coronary artery disease.