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BACKGROUND: Obstructive sleep apnea (OSA) is associated with a higher prevalence of postoperative atrial fibrillation in patients who underwent cardiac surgery. However, whether OSA is a risk factor for postoperative atrial fibrillation after septal myectomy remains unclear. We hypothesized that OSA was associated with postoperative atrial fibrillation after septal myectomy. METHODS: A total of 99 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were included in our manuscript. Polysomnography was performed in all patients, and the heart rhythm was continuously monitored during the perioperative period. RESULTS: In the present study, 25 (25.3%) patients developed postoperative atrial fibrillation after septal myectomy. The prevalence of postoperative atrial fibrillation was significantly higher in patients with OSA and increased with the worsening severity of OSA. Notably, the apnea-hypoxia index was significantly higher in patients with postoperative atrial fibrillation among the different OSA groups. In receiver operating characteristic analysis, the area under the curve for the apnea-hypopnea index was 0.785 (95% CI: 0.684–0.887, P

BACKGROUND: Hypertrophic cardiomyopathy (HCM) with extreme interventricular septal thickness (IVST) is associated with a higher incidence of adverse cardiovascular events. However, the results of these patients who underwent septal myectomy are unclear. METHODS: We studied 47 HCM patients with IVST ≥30 mm who underwent septal myectomy between 2011 and 2018 in Anzhen Hospital. After a 2:1 propensity score matching, the study cohort included 141 patients and 94 patients with IVST

Background Type 2 diabetes mellitus is common in cardiovascular disease. It is associated with adverse clinical outcomes for patients who had undergone coronary artery bypass and valve operations. The aim of this study was to evaluate the impact of type 2 diabetes mellitus on the midterm outcomes of patients with hypertrophic cardiomyopathy who underwent septal myectomy. Methods We retrospectively analyzed the data of 67 hypertrophic cardiomyopathy patients with type 2 diabetes mellitus who underwent septal myectomy from two medical centers in China from 2011 to 2018. A propensity score–matched cohort of 134 patients without type 2 diabetes mellitus was also analyzed. Results During a median follow-up of 28.0 (interquartile range: 13.0–3.0) months, 9 patients died. The cause of death of all of these patients was cardiovascular, particularly sudden cardiac death in 3 patients. Patients with type 2 diabetes mellitus had a higher rate of sudden cardiac death (4.5% vs. 0.0%, p = 0.04). The Kaplan–Meier survival analysis revealed that the rates of predicted 3-year survival free from cardiovascular death (98.1% vs. 95.1%, p = 0.14) were similar between the two groups. However, the rates of predicted 3-year survival free from sudden cardiac death (100% vs. 96.7%, p = 0.01) were significantly higher in hypertrophic cardiomyopathy patients without type 2 diabetes mellitus than in those with type 2 diabetes mellitus. Furthermore, after adjustment for age and sex, only N-terminal pro-brain natriuretic peptide (hazards ratio: 1.002, 95% confidence interval: 1.000–1.005, p = 0.02) and glomerular filtration rate ≤ 80 ml/min (hazards ratio: 3.23, 95% confidence interval: 1.34–7.24, p = 0.047) were independent risk factors for hypertrophic cardiomyopathy patients with type 2 diabetes mellitus. Conclusions Hypertrophic cardiomyopathy patients with and without type 2 diabetes mellitus have similar 3-year cardiovascular mortality after septal myectomy. However, type 2 diabetes mellitus is associated with higher sudden cardiac death rate in these patients. In addition, N-terminal pro-brain natriuretic peptide and glomerular filtration rate ≤ 80 ml/min were independent risk factors among hypertrophic cardiomyopathy patients with type 2 diabetes mellitus.

The triglyceride–glucose index is a valuable marker of insulin resistance. However, the predictive value of this index for postoperative atrial fibrillation in patients undergoing septal myectomy remains unclear. A total of 409 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were recruited in this study. The triglyceride–glucose index was calculated for all patients preoperatively. All patients underwent clinical data collection, blood sampling, and standard echocardiographic examinations during hospitalization. The prevalence of postoperative atrial fibrillation was approximately 15% in the present study. Multivariate logistic regression revealed that age (odds ratio [OR]: 1.053, 95% CI: 1.016–1.090, P = 0.004), hypertension (OR: 2.399, 95% CI: 1.228–4.686, P = 0.010), left atrial diameter (OR: 1.101, 95% CI: 1.050–1.155, P < 0.001), and triglyceride–glucose index (OR: 4.218, 95% CI: 2.381–7.473, P < 0.001) were independent risk factors for postoperative atrial fibrillation in patients undergoing septal myectomy. In receiver operating characteristic curve analysis, the triglyceride–glucose index could provide a moderate predictive value for postoperative atrial fibrillation after septal myectomy 0.723 (95% CI: 0.650–0.796, P < 0.001). Moreover, adding the triglyceride–glucose index to conventional risk factor model could numerically but not significantly increase our ability to predict postoperative atrial fibrillation (area under the receiver: 0.742 (0.671–0.814) vs. 0.793 (0.726–0.860), p = 0.065) after septal myectomy. In our retrospective cohort study, the triglyceride–glucose index was identified as an independent predictor of postoperative atrial fibrillation in patients undergoing septal myectomy.

OBJECTIVES To study the perioperative outcomes and long-term survival rates in patients undergoing thoracic endovascular aortic repair (TEVAR) for uncomplicated type B dissection. METHODS A total of 751 patients with uncomplicated type B dissection who underwent TEVAR at our centre between May 2001 and December 2013 were retrospectively reviewed. The mean age of all patients (619 males and 132 females) was 52.8 ± 10.9 years. The follow-up period ranged from 1 to 170 months (median 70 months). RESULTS Five patients died during the perioperative period (mortality rate 0.7%). Four patients (0.5%) developed retrograde type A dissection. Two patients (0.3%) developed paraplegia and 1 patient developed incomplete paralysis (0.1%). There were no postoperative cerebral infarctions. The 5- and 10-year survival rates were 96.5% [95% confidence interval (CI) 95.0–98.0%] and 83.0% (95% CI 77.9–88.4%), respectively. The 5- and 10-year reintervention rates were 4.6% (95% CI 3.0–6.2%) and 7.9% (95% CI 5.3–10.5%), respectively. CONCLUSIONS Although the application of TEVAR for patients with uncomplicated dissection is still under debate, many patients who have undergone TEVAR have benefitted substantially from the treatment. Our data showed that TEVAR had low mortality and complication rates both in the short- and long-term follow-up periods. TEVAR may be considered as a first choice for patients with uncomplicated type B dissection.

BACKGROUND The incidence of obstructive sleep apnea (OSA) is significantly higher in patients who undergo coronary artery bypass grafting (CABG). OSA is correlated with a higher incidence of postoperative complications in patients undergoing CABG. However, whether OSA is associated with a decrease in renal function and a higher incidence of dialysis after CABG remains unclear. METHODS Data from 178 consecutive patients who underwent isolated CABG at Anzhen Hospital between June 2019 and June 2020 were analyzed. Polysomnography was performed in all the patients. RESULTS A total of 142 (79.8%) patients were diagnosed with OSA, 78 with mild OSA, and 64 with moderate-to-severe OSA. Compared to patients without OSA, the level of creatinine was significantly increased, and the level of estimated glomerular filtration rate (eGFR) was decreased in patients with OSA. In addition, the percentage of patients undergoing dialysis during the perioperative period increased with the severity of OSA (0.0% vs. 2.6% vs. 18.8%, P=0.02). Multiple linear regression analysis showed that age (β=-0.29, P

Background This study aimed to evaluate the clinical outcomes of one-staged hybrid procedure for aortic lesions involving the distal aortic arch. Methods We retrospectively studied 99 consecutive patients who underwent the hybrid procedure (thoracic endovascular aortic repair combined with supra-arch branch vessel bypass) in our center between April 2009 and January 2020 for lesions involving the distal aortic arch. Results Median age was 64.0 (57.0-69.0) years, and 83 (83.8%) patients were male. There were five deaths in the perioperative period (three due to cerebral infarction and two due to intimal rupture). During the median follow-up of 41.0 months, 20 patients died, three had endoleak, one had a newly formed intimal tear, and two had femoral artery pseudoaneurysm. The 5- and 10-year survival rates of the total population were 72.2% and 48.8%, respectively. Additionally, there was no difference in the 5-year survival rate among the four groups according to different pathologies (Type B aortic dissection, aortic ulcer, aortic aneurysm, aortic pseudoaneurysm: 74.7%, 78.2%, 61.1%, and 75.5%, respectively, p = .58). Furthermore, there was no difference in the 5- and 10-year survival rates between the two groups according to the different bypass methods (right axillary artery [RAA]-left axillary artery [LAA] vs. RAA-LAA-left common carotid artery: 74.1% vs. 68.9%, p = .38). Conclusions Although one-staged hybrid procedure has fewer complications in high-risk patients with lesions involving the distal aortic arch, the long-term survival rate is not optimistic.

Background Obstructive sleep apnea (OSA) is a common disease associated with worse structural and functional impairment of the heart in patients with hypertrophic obstructive cardiomyopathy (HOCM). Hypothesis The presence and severity of OSA can decrease the right ventricular ejection fraction (RVEF) in patients with HOCM. Methods In total, 151 consecutive patients with a confirmed diagnosis of HOCM at Fuwai Hospital between September 2017 and September 2018 were included. Polysomnography and cardiac magnetic resonance imaging were performed in all patients. Results Overall, 84 (55.6%) patients were diagnosed with OSA. The RVEF significantly decreased with the severity of OSA (none, mild, moderate‐severe: 46.1 ± 8.2 vs 42.9 ± 7.5 vs 41.4 ± 7.4, P = .009). The apnea‐hypopnea index (AHI) was significantly high in patients with RVEF40%, RVEF40%, those with RVEF

The aim of this study was to evaluate the effect of 3-dimensional (3D) printing in treatment of hypertrophic obstructive cardiomyopathy (HOCM) and its roles in doctor-patient communication.3D-printed models were constructed preoperatively and postoperatively in seven HOCM patients received surgical treatment. Based on multi-slice computed tomography (CT) images, regions of disorder were segmented using the Mimics 19.0 software (Materialise, Leuven, Belgium). After generating an STL-file (StereoLithography file) with patients' data, the 3D printer (Objet350 Connex3, Stratasys Ltd., USA) created a 3D model. The pre- and post-operative 3D-printed models were used to make the surgical plan preoperatively and evaluate the outcome postoperatively. Meanwhile, a questionnaire was designed for patients and their relatives to learn the effectiveness of the 3D-printed prototypes in the preoperative conversations.The heart anatomies were accurately printed with 3D technology. The 3D-printed prototypes were useful for preoperative evaluation, surgical planning, and practice. Preoperative and postoperative echocardiographic evaluation showed left ventricular outflow tract (LVOT) obstruction was adequately relieved (82.71±31.63 to 14.91±6.89 mmHg, P0.001), the septal thickness was reduced from 21.57±4.65 to 17.42±5.88 mm (P0.001), and the SAM disappeared completely after the operation. Patients highly appreciated the role of 3D model in preoperative conversations and the communication score was 9.11±0.38 points.A 3D-printed model is a useful tool in individualized planning for myectomies and represent a useful tool for physician-patient communication.

Background: Percutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy (HCM). This study aimed to determine the clinical outcome of these two strategies. Methods: From January 2011 to January 2015, 226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, after operations and in the follow-up. Categorical variables were compared using Chi-square or Fisher’s exact tests. Quantitative variables were compared using the paired samples t-test. Results: Interventricular septal thickness was significantly reduced in both groups (21.27 ± 4.43 mm vs. 18.72 ± 4.13 mm for PTSMA, t = 3.469, P < 0.001, and 21.83 ± 5.03 mm vs. 16.57 ± 3.95 mm for MMSM, t = 10.349, P < 0.001, respectively). The left ventricular outflow tract (LVOT) pressure gradient (PG) significantly decreased after the operations in two groups (70.30 ± 44.79 mmHg vs. 39.78 ± 22.07 mmHg for PTSMA, t = 5.041, P < 0.001, and 74.58 ± 45.52 mmHg vs. 13.95 ± 9.94 mmHg for MMSM, t = 16.357, P < 0.001, respectively). Seven patients (10.29%) in the PTSMA group required a repeat operation in the follow-up. Eight (11.76%) patients were evaluated for New York Heart Association (NYHA) III/IV in the PTSMA group, which was significantly more than the five (3.16%) in the same NYHA classes for the MMSM group at follow-up. Less than 15% of patients in the PTSMA group and none of the patients in the MMSM group complained of chest pain during follow-up. Conclusions: Both strategies can not only relieve LVOT PG but also improve heart function in patients with HCM. However, MMSM might provide a more reliable reduction in gradients compared to PTSMA. Key words: Hypertrophic Cardiomyopathy; Myectomy; Percutaneous Transluminal Septal Myocardial Ablation

The study was conducted to evaluate the surgical results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either classic Morrow septal myectomy or modified procedure. The modified Morrow septal myectomy has gained interest as a new treatment for patients with drug-refractory symptoms of HOCM; however, its benefits in comparison to the classic procedure are unknown. In all, 236 symptomatic HOCM patients underwent surgical treatment from January 2006 to January 2015. Among them, 86 patients were treated by the classic Morrow myectomy and 150 patients via the modified procedure. Septal thickness, maximal left ventricular outflow tract (LVOT) pressure gradient (PG), and the presence of a permanent pacemaker were recorded after operation and follow-up The left ventricular septal thickness (22.1 ± 11.9 vs 17.1 ± 4.0 mm for classic procedure, and 22.3 ± 4.4 vs 16.1 ± 3.5 mm for modified procedure; P

Stent graft-induced new entry (SINE) is an infrequent complication, but high mortality rates have been observed after thoracic endovascular aortic repair. New entry after a stent-graft implantation of 50 mm is rare. To our knowledge, this article is the first-reported case of the surgical management of SINE after a large stent-graft implantation.

Aberrant right subclavian artery (ARSA) is an uncommon congenital vascular abnormality. Acute Stanford type A aortic dissection with ARSA is rare. We report a strategy for Stanford type A aortic dissection with ARSA. The ascending aorta and the total aortic arch were replaced and a frozen elephant trunk was implanted into the descending aorta. The right subclavian artery was reconstructed with the perfusion branch of a four-branch prosthetic graft. Two weeks later, the proximal part of the ARSA was sealed with a vascular plug.

To the Editor: We report two cases of arch replacement combined with frozen elephant trunk implantation procedure using the collared anastomosis technique for giant arch and thoracic aorta dilatation. A 62-year-old hypertensive female patient was admitted because of endoleak after thoracic endovascular aortic repair (TEVAR). The patient underwent TEVAR procedure because of Stanford type B aortic dissection 5 years ago. The proximal diameter of the stent graft was 50 mm. Another patient was a 52-year-old man suffering from arch and thoracic aneurysm. The diameter of the aneurysm was 52 mm. The ascending aorta and aortic valve of the two patients were normal. Aortic arch replacement and frozen elephant trunk implantation were performed. We developed the one-stage open procedure for arch pathology and obtained satisfactory results.[1] However, the diameters of the thoracic aorta were larger than the diameter of the frozen elephant trunk, resulting in difficulty in suture placement. As such, frozen elephant trunk procedure with a four-branched hybrid graft is suitable for such implantation case. However, the four-branched hybrid graft is still unavailable in China. As such, we made one using a four-branched graft, a hollow graft patch, and a frozen elephant trunk during cooling. The steps were as follows: (1) Deploying the frozen elephant trunk out of the body; (2) anastomosing the graft and the frozen elephant trunk together (hybrid graft); (3) trimming a hollow graft patch; (4) suturing the graft patch at the joint of the hybrid graft; and (5) binding the frozen elephant trunk as previously mentioned [Figure 1a]. Figure 1 The hybrid graft we made using a four-branched graft, a hollow graft patch, and a frozen elephant trunk (a). The collar of the hybrid graft, the wall of the proximal aneurysm, and the proximal part of the previously implanted stent graft were anastomosed ... The endoleak can result in the persistent expansion of the aorta and is reported to be an important factor of aortic rupture. Sac enlargement was reported as the key cause of endoleak.[2] For the first case, the stent graft implanted 5 years ago had a diameter of 50 mm and adhered to the aortic wall rigidly. As such, we left it in the aorta instead of pulling it out. The proximal naked part of the stent graft was trimmed, and then the frozen elephant trunk was deployed inside the previous stent graft. Then, the collar of the hybrid graft, the wall of the proximal aneurysm, and the proximal part of the previously implanted stent graft were anastomosed together as a “sandwich” [Figure 1b]. For the second case, the frozen elephant trunk of the hybrid graft was deployed inside the thoracic aorta, and then the collar of the hybrid graft and the wall of the proximal aneurysm were anastomosed together. No endoleak was detected during postoperative computed tomography at 6 months. In aorta surgery, size matching between the graft and the wall of the aneurysm is important. An unmatched size would result in bleeding because of undistributed tension. For our two cases, the size of the graft did match the size of the thoracic aorta well. With this technique, the two patients were discharged from the hospital without any complication. The collared anastomosis technique has several advantages. First, the collared anastomosis technique reduced the tension of the stoma. Second, the collared anastomosis technique decreased the difficulty in suture placement. Finally, the collared anastomosis technique excluded the space between the frozen elephant trunk and previous stent graft or thoracic aorta. The collared anastomosis technique could be an option for patients who have giant arch and thoracic aorta dilatation.