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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

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.

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.

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.

Background: Lipid metabolism plays an important role in viral infections. We aimed to assess the causal effect of lipid-lowering drugs (HMGCR inhibitiors, PCSK9 inhibitiors, and NPC1L1 inhibitior) on COVID-19 outcomes using two-sample Mendelian randomization (MR) study. Methods: We used two kinds of genetic instruments to proxy the exposure of lipid-lowering drugs, including expression quantitative trait loci of drugs target genes, and genetic variants within or nearby drugs target genes associated with low-density lipoprotein (LDL cholesterol from genome-wide association study). Summary-data-based MR (SMR) and inverse-variance-weighted MR (IVW-MR) were used to calculate the effect estimates. Results: SMR analysis found that a higher expression of HMGCR was associated with a higher risk of COVID-19 hospitalization (odds ratio [OR] = 1.38, 95% confidence interval [CI] = 1.06–1.81). Similarly, IVW-MR analysis observed a positive association between HMGCR-mediated LDL cholesterol and COVID-19 hospitalization (OR = 1.32, 95% CI = 1.00–1.74). No consistent evidence from both analyses was found for other associations. Conclusions: This two-sample MR study suggested a potential causal relationship between HMGCR inhibition and the reduced risk of COVID-19 hospitalization. Funding: Start-up Fund for high-level talents of Fujian Medical University., eLife digest The virus SARS-CoV-2 has caused millions of infections and deaths during the COVID-19 pandemic, but as of December 2021, no new drugs targeted to SARS-CoV-2 specifically exist. Thus, it is important to identify existing drugs that can reduce the infection and mortality of this virus, since repurposing old drugs is faster and cheaper than developing new ones. Fats, such as cholesterol, can play an important role in viral infections, meaning that drugs intended to lower the levels of fats in the blood could have a protective effect against SARS-CoV-2. To test this hypothesis, Huang, Xiao, et al. carried out a Mendelian randomization study to investigate if there is a link between drugs that lower fats and outcomes of SARS-CoV-2 infection, including susceptibility, hospitalization, and severe disease. This approach consists on grouping people according to their version of a particular gene, which minimizes the effect of variables that can cause spurious associations, something known as confounding bias. Thus, Mendelian randomization studies allow scientists to disentangle cause and effect. Using this method, Huang, Xiao, et al. found an association between statins (a type of drug that decreases the levels of bad cholesterol) and a reduced risk of being hospitalized after being infected with SARS-CoV-2. These findings suggest that statins could benefit patients infected with SARS-CoV-2, and indicate that they should be prioritized in future clinical trials for treating COVID-19.

Aortic dissection (AD) is a disease with high mortality and lacks effective drug treatment. Recent studies have shown that the development of AD is closely related to glucose metabolism. Lactate dehydrogenase A (LDHA) is a key glycolytic enzyme and plays an important role in cardiovascular disease. However, the role of LDHA in the progression of AD remains to be elucidated. Here, we found that the level of LDHA was significantly elevated in AD patients and the mouse model established by BAPN combined with Ang II. In vitro, the knockdown of LDHA reduced the growth of human aortic vascular smooth muscle cells (HAVSMCs), glucose consumption, and lactate production induced by PDGF-BB. The overexpression of LDHA in HAVSMCs promoted the transformation of HAVSMCs from contractile phenotype to synthetic phenotype, and increased the expression of MMP2/9. Mechanistically, LDHA promoted MMP2/9 expression through the LDHA-NDRG3-ERK1/2-MMP2/9 pathway. In vivo, Oxamate, LDH and lactate inhibitor, reduced the degradation of elastic fibers and collagen deposition, inhibited the phenotypic transformation of HAVSMCs from contractile phenotype to synthetic phenotype, reduced the expression of NDRG3, p-ERK1/2, and MMP2/9, and delayed the progression of AD. To sum up, the increase of LDHA promotes the production of MMP2/9, stimulates the degradation of extracellular matrix (ECM), and promoted the transformation of HAVSMCs from contractile phenotype to synthetic phenotype. Oxamate reduced the progression of AD in mice. LDHA may be a therapeutic target for AD.

The highly heterogeneous characteristics of Wharton's jelly mesenchymal stem cells (WJ-MSCs) may be responsible for the poor clinical outcomes and poor reproducibility of treatments based on WJ-MSCs. Exploration of WJ-MSC heterogeneity with multimodal single-cell technologies will aid in establishing accurate MSC subtyping and developing screening protocols for dominant functional subpopulations. Here, the characteristics of WJ-MSCs are systematically analyzed by single cell and spatial transcriptome sequencing. Single-cell transcriptomics analysis identifies four WJ-MSC subpopulations, namely proliferative_MSCs, niche-supporting_MSCs, metabolism-related_MSCs and biofunctional-type_MSCs. Furthermore, the transcriptome, cellular heterogeneity, and cell-state trajectories of these subpopulations are characterized. Intriguingly, the biofunctional-type MSCs (marked by S100A9, CD29, and CD142) selected in this study exhibit promising wound repair properties in vitro and in vivo. Finally, by integrating omics data, it has been found that the S100A9

This study sought to investigate the differentially expressed miRNAs in Aortic dissection (AD) and explore the downstream mechanisms in regulating AD.Exosomes of AD patients and healthy people were isolated by differential centrifugation, and the differentially expressed miRNAs were evaluated by RNA sequencing. The downstream target of miR-222-3p was predicted by bioinformatics method and validated by dual-luciferase assay. Angiotensin II and Promethazine were used to establish AD mouse model and platelet-derived growth factor BB (PDGF-BB) was used to induce human vascular smooth muscle cells (HVSMCs) to elucidate the effect of miR-222-3p upregulation on AD in vivo and in vitro. The relative level of miR-222-3p was evaluated by RT-qPCR. The level of several proteins was investigated by Western blot. Immunofluorescence staining was used to detect the stress fiber formation. Cell migration was evaluated by wound healing and Transwell assay. The proliferation, cell cycle and apoptosis of HVSMCs were assessed by CCK-8 and flow cytometry, respectively.MiR-222-3p was downregulated in AD and PDGF-BB induced HVSMCs. The upregulation of miR-222-3p alleviated the symptom of AD in vivo by targeting STAT3, and inhibited stress fiber formation, abnormal migration, proliferation and apoptosis of HVSMCs induced by PDGF-BB by regulating the expression of α-SMA, SM22α, MMP2, MMP9 and p-Smad2.The upregulation of miR-222-3p attenuates the progression of AD. Our study provides a theoretical basis for exploring new strategies against AD.

Background: Hepatic dysfunction (HD) is a serious complication after cardiovascular surgery. However, risk factors of developing hepatic dysfunction after acute type A aortic dissection (AAAD) are largely unclear. Methods: The clinical data of 227 patients with AAAD repaired by modified triple-branched stent graft implantation from January 2018 to January 2020 were collected retrospectively, including preoperative , surgical and postoperative information. Logistics regression was used to explore the potential risk factors of HD. Results: In the early stage after operation, a total of 57 patients were complicated with HD, accounting for 25.11%. The hospital mortality rate in these patients with HD was 19.30%, while the rate in patients without HD was only 6.5%. We found that preoperative body mass index (BMI)>30kg/㎡(OR: 7.054, 95%CI: 1.798-27.678, P=0.005), preoperative renal insufficiency(OR:7.575,95%CI:2.923-19.629, P=0.000),preoperative moderate/severe pericardial effusion(OR: 16.409, 95%CI: 2.81-93.444, P=0.002) and cardiopulmonary bypass time>180min (OR: 7.190, 95%CI: 3.113-16.608, P＝0.000) were independent risk factors for HD after AAAD repaired by modified triple-branched stent graft implantation. Conclusions: Preoperative BMI>30kg/㎡, preoperative renal insufficiency, preoperative moderate/severe pericardial effusion and cardiopulmonary bypass time>180min are independent risk factors for HD after total arch repair with modified triple-branched stent graft implantation in AAAD patients. And the occurrence of HD after operation would prolong the time of mechanical ventilation and the hospitalization time of ICU, and significantly increase the in-hospital mortality of patients. Keywords: risk factors,acute type A aortic dissection,hepatic dysfunction, modified triple-branched stent graft implantation, total arch repair

Background In recent years, due to the increase in intravenous drug injection and intracardiac and vascular interventional treatments among drug users, infective endocarditis involving the right heart of the tricuspid valve has gradually increased.At present, there is no systematic report on surgical treatment of tricuspid infective endocarditis. This paper summarizes the experience of surgical treatment of 56 patients with tricuspid infective endocarditis in our hospital and analyzes its clinical effect. Methods From January 2006 to August 2019, 56 cases of tricuspid infective endocarditis treated by tricuspid valve surgery in our hospital were analyzed retrospectively.including 23 cases of tricuspid valvuloplasty (TVP) and 33 cases of tricuspid valve replacement (TVR). All patients were complicated with tricuspid valve vegetations or moderate and severe tricuspid regurgitation and had surgical indications.The perioperative data were collected and followed up for 6 months to 14 years to summarize and analyze the clinical effect of surgical treatment of tricuspid infective endocarditis. Results Compared with TVR group, the CPB time (79.68 ± 19.02min VS 107.39 ± 25.64min, P P P P = 0.015) in TVP group were shorter. The perioperative red blood cell transfusion (4.87 ± 3.81U VS 7.55 ± 5.42U, P P P = 0.855). A total of 52 cases were followed up for an average of (5.50 ± 3.79) years.The postoperative 3-year, 5-year and 7-year survival rate were 100%,100%,91.7% in TVP group and 95.2%, 93.8% and 87.5%.The 5-year and 10-year reoperation rate were 0%, 0% in TVP group and 6.7%, 20% in TVR group. Conclusion Surgical treatment of severe tricuspid valve endocarditis has achieved good mid-term clinical results, and the rate of avoiding reoperation is better in TVP group than in TVR group.

Hypertension is a key risk factor for spontaneous coronary artery dissection (SCAD) and aortic dilation. Circulating proteins play key roles in a range of biological processes and represent a major source of druggable targets. The aim of this study was to identify circulating proteins that were associated with blood pressure (BP), SCAD and aortic dilation. We identified shared genetic variants of BP and SCAD in genome-wide association studies, searched for circulating protein affected by these variants and examined the association of circulating protein levels with BP, aortic aneurysm and dissection (AAD) and aortic diameters by integrating data from circulating protein quantitative trait loci (pQTL) studies and genome wide association study (GWAS) in individuals from the UK Biobank using two-sample Mendelian randomization analysis methods. Single nucleotide polymorphisms (SNPs) in JAG1, ERI1, ULK4, THSD4, CMIP, COL4A2, FBN1, FAM76B, FGGY, NUS1, and HNF4G, which were related to extracellular matrix components, were associated with both BP and SCAD. We found 49 significant pQTL signals among these SNPs. The regulated proteins were encoded by MMP10, IL6R, FIGF, MMP1, CTSB, IGHG1, DSG2, TTC17, RETN, POMC, SCARF2, RELT, and GALNT16, which were enriched in biological processes such as collagen metabolic process and multicellular organism metabolic process. Causal associations between BP and AAD and aortic diameters were detected. Significant associations between circulating levels of cathepsin B, a well-known prorenin processing enzyme, and BP and aortic diameters were identified by using several Mendelian randomization analysis methods and were validated by independent data.ConclusionThe present study identified the association between circulating cathepsin B and BP and aortic diameters. The findings indicated that BP-associated genetic variants may influence aortic dilation risk by circulating proteins that regulate BP.

Retrograde false lumen flow through distal entry tears poses a challenge in the treatment of chronic DeBakey IIIb aneurysms. In the present report, we have described the feasibility and outcomes of false lumen occlusion using an atrial septal occluder (ASO) in chronic DeBakey IIIb dissection associated with a descending aneurysm.All the patients who had undergone thoracic endovascular aortic repair for chronic DeBakey IIIb aortic dissection at our institution from January 2014 to November 2020 were retrospectively reviewed. The primary endpoints were technical success and in-hospital postoperative results. The secondary endpoints included the midterm survival status and aortic remodeling outcomes.A total of 37 patients (age, 56.24 ± 10.47 years) with persistent retrograde false lumen perfusion and aneurysm formation at the thoracic segment were treated using an ASO for false lumen occlusion. We achieved 100% technical success. No spinal cord ischemia or in-hospital death was observed. The median follow-up time was 36 months (interquartile range, 24-51 months). After the procedure, three patients (8.1%) had had an endoleak (type Ia in two patients and type II in one patients), and five patients had required late reintervention. The overall 5-year survival rate was 71%. One aortic-related death (2.7% of the total cohort) occurred during follow-up at 9 months. Complete thrombosis of the false lumen along the treated aortic segment was recorded postoperatively in 34 patients (91.9%) at the final follow-up using computed tomography angiography. In a mixed-effects model, a diameter analysis revealed that the thoracic true lumen diameter had increased and the thoracic false lumen diameter had decreased significantly (0.256 mm/mo, P .001; and -0.512 mm/mo, P .001, respectively).The combination of standard thoracic endovascular aortic repair and false lumen occlusion using the ASO to promote false lumen thrombosis and remodeling in the treated segments is a technically feasible and effective alternative treatment of chronic DeBakey IIIb dissection with an associated descending aneurysm. This approach yielded satisfactory midterm survival outcomes and a low incidence of aortic-related death in our patients. However, further studies with more subjects and a prospective design should verify our findings before routine clinical implementation of this technique.

The main strategy of tissue repair and regeneration focuses on the application of mesenchymal stem cells and cell-based nanoparticles, but there are still multiple challenges that may have negative impacts on human safety and therapeutic efficacy. Cell-free nanotechnology can effectively overcome these obstacles and limitations. Mesenchymal stem cell (MSC)-derived natural small extracellular vesicles (sEVs) represent ideal nanotherapeutics due to their low immunogenicity and lack of tumorigenicity. Here, sEVs harvested from Wharton's jelly mesenchymal stem cells (WJMSCs) were identified. In vitro results showed that WJMSC-sEVs efficiently entered chondrocytes in the osteoarthritis (OA) model, further promoted chondrocyte migration and proliferation and modulated immune reactivity. In vivo, WJMSC-sEVs notably promoted chondrogenesis, which was consistent with the effect of WJMSCs. RNA sequencing results revealed that sEV-microRNA-regulated biocircuits can significantly contribute to the treatment of OA, such as by promoting the activation of the calcium signaling pathway, ECM-receptor interaction pathway and NOTCH signaling pathway. In particular, let-7e-5p, which is found in WJMSC-sEVs, was shown to be a potential core molecule for promoting cartilage regeneration by regulating the levels of STAT3 and IGF1R. Our findings suggest that WJMSC-sEV-induced chondrogenesis is a promising innovative and feasible cell-free nanotherapy for OA treatment.

The optimal treatment for acute non-A-non-B aortic dissection remains controversial. Triple-branched stent graft (TBSG) implantation has been used to treat acute type A aortic dissection. This study aimed to evaluate the safety and efficacy of TBSG as a treatment for acute non-A-non-B aortic dissection.Fifty patients with non-A-non-B dissection received TBSG implantation in our center between January 2014 and December 2019. Early mortality, morbidity, and dissected aorta remodeling during follow-up were calculated.There were no deaths in-hospital or within 30 days. Postoperative complications included pneumonia (n = 12), acute kidney injury (n = 6; preoperative renal malperfusion, n = 4), transient cerebral injury (n = 6; preoperative cerebral malperfusion, n = 4), pleural effusion (n = 4), and pericardial effusion (n = 2). During follow-up, 1 patient experienced a stroke, and 2 patients required secondary interventional therapy for residual dissection below the level of the TBSG. All implanted TBSGs had good positioning, and all sidearm stent graft grafts were fully patent. No retrograde aortic dissection or type I endoleak was detected.TBSG implantation for acute non-A-non-B aortic dissection had a low incidence of mortality and morbidity, featuring good remodeling of the dissected aortic wall during follow-up. The early outcomes of this technique were satisfactory.

Background The risk factors for complete atrioventricular block (CAVB) after device closure of perimembranous ventricular septal defect (pmVSD) remain unclear. Objective The objective of this study is to analyze the incidence and risk factors for CAVB after device closure for pmVSD. Methods We reviewed 1884 patients with pmVSD undergoing successful device occlusion between June 2005 and January 2020. Permanent CAVB was defined as CAVB requiring implantation of permanent pacemaker (PPM) or extraction of occluder. Results In total, 14 (0.7%) patients developed permanent CAVB. Of these patients, 10 (0.5%) required PPM implantation. Four permanent CAVBs occurred within 7 days after the procedure (acute), 2 between 7 and 30 days (subacute), 3 between 30 days and 1 year (late), and 5 more than 1 year (very late). None of the subacute, late, and very late CAVB recovered normal conduction with medication and eventually required device removal or PPM implantation. Four patients with acute CAVB and 1 with subacute CAVB underwent device removal, and 4 (80%) of them recovered normal conduction. Multivariate regression revealed that the ratio of device to defect size was the only independent risk factor for permanent CAVB (odds ratio, 3.027; 95% confidence interval, 1.476-6.209; P=0.003). Conclusion The incidences of permanent CAVB after occlusion for pmVSD and PPM implantation were 0.7% and 0.5%, respectively. The ratio of device to defect size was the only independent risk factor for permanent CAVB. Device removal is an effective therapeutic modality for recovering normal conduction in acute and subacute CAVB patients.

Background: Circulating low-density lipoprotein cholesterol (LDL-C) plays a causal role in coronary artery disease (CAD). However, genetic risk factors of CAD were not yet fully understood. The aim of the study was to identify additional factors that contributed to CAD.Methods: We conducted integrative analysis on publicly available data from genome-wide association studies and quantitative trait locus studies by employing two-sample Mendelian randomization methods to examine the associations of gene expression and circulating protein levels with LDL-C and CAD.Results: We found that mRNA expression levels of SORT1, PSRC1 and CELSR2 in liver cells were significantly associated with both LDL-C and CAD (P < 5.0 × 10-8). Higher expression levels of SORT1, PSRC1 and CELSR2 in the liver were significantly associated with lower circulating LDL-C level (beta= -0.142, -0.138 and -0.171, respectively) and CAD risk (beta= -0.10, -0.097 and -0.121, respectively). Expression levels of 31 genes in blood cells associated with LDL-C level were found. Expressions of PSRC1, IL6R, GGCX, VAMP8, LIPA, NT5C2, SWAP70, EIF2B2, FURIN, FES and ATP5G1 in blood cells were significantly associated with CAD. Higher circulating granulins and apolipoprotein B levels, which were strongly affected by PSRC1 and APOB variants, were significantly associated with higher LDL-C level (beta = 0.22 and 1.35) and CAD risk, with odds ratios of 1.15 (1.10-1.19) and 1.45 (1.21-1.74), respectively. Conclusions: This study identified gene expressions in liver and blood cells and circulating granulins and apolipoprotein B that were genetically associated with LDL-C and CAD and provided evidence for exploring the potential causal relationship.

Background and Purpose:VIM (vimentin) is a cytoskeletal intermediate filament protein, which has been linked to atherosclerosis and thrombosis; both are important causes of stroke. We examined the relationship between circulating VIM and incidence of stroke, and if carotid plaque could modify the association in a prospective population-based cohort.Methods:This prospective study was based on the Malmö Diet and Cancer Cohort. A total of 4688 participants (39.7% men; mean age, 57.6 years) were examined and blood samples were collected between 1991 and 1994. Incidence of stroke was followed up to 2018. Cox’ proportional hazards regression was used to assess the relationship between VIM and stroke.Results:During a mean follow-up of 22.0 years, a total of 528 subjects were diagnosed with stroke, among which 434 were ischemic stroke. Participants in the highest quartile (vs 1stquartile) had 1.34× higher risk of total stroke (95% CI, 1.03–1.74) and 1.47× higher of ischemic stroke (95% CI, 1.10–1.98) after adjustment for potential confounders. A significant interaction was found between carotid plaque and VIM with respect to incidence of both total stroke and ischemic stroke (P=0.041 and 0.011, respectively). After stratifying by carotid plaque, high VIM had stronger association with stroke in participants with carotid plaque, especially for the risk of ischemic stroke (adjusted hazard ratio,1.66 [95% CI, 1.23–2.25] for quartile 4 versus quartile 1 to 3).Conclusions:VIM is positively associated with the incidence of stroke, especially in individuals with carotid plaque. Further studies are needed to confirm the observed associations.

Additional file 1. Supplemntal material (enlarged figures) hADMSC-sEVs promoted neovascularization in the nude mice fat grafting model (rows meaned different staining and lines represents different groups and months).

Background: Small extracellular vesicles (sEVs) with genetic information secreted by cells play a crucial role in the cellular microenvironment. In this study, our purpose is to explore the characteristics of the small extracellular vesicles of human adipose-derived stem cells (hADSC-sEVs) and studied the role of hADSC-sEVs in improving the survival rate of grafted fat.Methods: In the present study, we used the transmission electron microscopy, nano-tracking analysis, nanoflow surface protein analysis, zeta potential value to identify sEVs. SEVs' trajectory was traced dynamically to verify whether hADSC-sEVs can be internalized into human umbilical vein endothelial cells (HUVECs) in vitro. The angiogenic property of hADSC-sEVs was observed by measuring the volume, weight and histological analysis of the grafted fats in nude mice modles. Results: Our research showed that the extracellular vesicles were sEVs with double-layer membrane structure and the diameter of which is within 30-150nm. hADSC-sEVs exert biological influence mainly through internalization into cells. Compared with the control group, the hADSC-sEVs group had a significantly higher survival rate of grafted fat, morphological integrity and a lower degree of inflammation and fibrosis. And immunohistochemistry showed that hADSC-sEVs significantly increased the neovascularisation and the expression of CD34, VEGFR2 and KI-67 in the graft tissue. Conclusions: As a potential nanomaterial, hADSC-sEVs has been explored in the field of cell-free application of stem cell technology. hADSC-sEVs promoted the survival of grafted fats by promoting the formation of new blood vessels, which is another promising progress in the field of regenerative medicine. We believe that hADSC-sEVs will have a broad application prospect in the field of regenerative medicine in the future.

Background: The mid-term and long-term efficacies of valve preservation in acute DeBakey I aortic dissection(AD) are controversial. Thus, it is unclear whether middle-aged patients with acute DeBakey I AD should undergo valve-sparing procedures or the Bentall procedure in an emergency setting.Methods: This study included 213 middle-aged Chinese patients(30-60 years old) who were treated for acute DeBakey I AD between January 2009 and June 2015. The treatments involved valve-sparing aortic root replacement(VSARR)(117 patients) or the Bentall procedure(96 patients). Preoperative, intraoperative, postoperative, and follow-up data were analyzed. Echocardiography and thoracoabdominal computed tomography angiography(CTA) findings were reviewed at 3 months, 1 year, and then annually after surgery. Results: No significant differences were observed in terms of the preoperative, intraoperative, in-hospital mortality, and postoperative parameters. There were also no significant differences in aortic regurgitation(AR). However, follow-up examinations using CTA revealed that 6 patients had endoleakage at the distal end of the triple-branched stent(0/110 patients [0.0%] vs. 6/90 patients [6.7%], P=0.022). The anticoagulation-related thromboembolism/bleeding events was significantly lower in group A than in group B(0/110 patients [0.0%] vs. 11/90 patients [11.1%], P=0.001). And postoperative aortic valve re-operation rate was significantly lower in group A (1/110 patients [0.9%] vs. 8/90 patients [8.9%], P=0.020). There was no significant difference in survival during the follow-up period (log-rank P>0.05).Conclusion: For middle-aged patients with acute DeBakey I AD, VSARR were associated with a lower rate of endoleakage at the distal end of the triple-branched stent, thromboembolism/bleeding events and aortic valve re-operation(vs. the Bentall procedure) .

Background: Abnormal body mass index (BMI) has been related to a higher risk of adverse perioperative outcomes in patients undergoing cardiac surgery. However, the effects of BMI in patients with acute type A aortic dissection (AAAD) on postoperative outcomes remain unclear. The aims of this study were to explore the relationships of BMI and postoperative early adverse outcomes in AAAD patientsMethods: Patients who underwent AAAD surgery at Fujian Province Cardiac Medical Research Center from June 2013 to March 2020 were retrospectively evaluated. They were divided into three groups on the basis of Chinese BMI classification established by the World Health Organization: normal group (BMI 18.5-23.9 kg/m2), overweight group (BMI 24-27.9 kg/m2), and obesity group (BMI > 28kg/m2). Preoperative, intraoperative, and postoperative data were collected. Multivariable and univariable logistic regression analysis models were performed to identify whether BMI was independently associated with postoperative adverse outcomes.Results: Of 777 cases, 31.9% were normal weight, 52.5% were overweight, and 15.6% were obese. The percentage of prolonged mechanical ventilation (44.9% vs 55.8% vs 66.1%, respectively; P PP

To evaluate the safety and efficacy of percutaneous closure of the single secundum atrial septal defects (ASD) guided by transthoracic echocardiography (TTE) and/or transesophageal echocardiography (TEE). From January, 2014 to December, 2014, thirty-two patients with single secundum ASD from Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, were treated with percutaneous closure of ASD guided by TTE or TEE. Thirty-two patients underwent ASD closure successfully, except one patient showed trivial residual shunts, which disappeared one month later. The remaining 31 patients were subjected to TTE. At once or at the 1st or 3rd month after the procedure, no ASD migration or residual shunts were observed. Percutaneous closure of ASD guided by TTE or TEE is a safe and effective surgery method with minimal invasion and can avoid the chest incision and radioscopy.目的：探讨经胸超声心动图(transthoracic echocardiography，TTE)和/或经食道超声心动图(transesophageal echocardi-ography，TEE)引导下经皮房间隔缺损封堵术的安全性及有效性。方法：选取2014年1—12月福建医科大学附属协和医院心血管外科单纯性继发孔型房间隔缺损患者32例，均在TTE和/或TEE监测下行经皮房间隔缺损封堵术。结果：32例患者全部封堵成功，1例术后即刻TTE复查存在少量残余分流，术后1个月复查示残余分流消失。其余31例患者在术后即刻、1个月、3个月复查TTE，均未见封堵器移位、残余分流等并发症。结论：超声心动图引导下经皮封堵房间隔缺损是一种微创、安全、有效的新型手术方法。.

To explore the safety and efficacy of "chimney graft" technique during thoracic endovascular aneurysm repair (TEVAR) in aortic arch lesions.Th e methods, results and the incidence of complications in 25 patients, who received "chimney stent" therapy for aortic arch disease, were reviewed and analyzed.From August, 2010 to August, 2014, 25 aortic arch lesions were treated by TEVAR with "chimney stent", 18 patients were male and 7 were female. The average age was 38-78(65±5.8) years old. Five patients received "chimney stents" for left common carotid artery, while 20 patients received "chimney stent" for left subclavian artery. Three cases showed small amount of Type I leak under immediate postoperative angiography without treatment. The leak was disappeared 1month later. Two patients appeared left upper limb weakness and one of them showed dizzinesss simultaneously. Both of them recovered gradually in follow-up process. Th ere was no limb ischemia or necrosis. Th e locations of aortic and "chimney stent" were stable without any migration and leak complications."Chimney graft" technique is a safe and effective treatment for aortic arch lesions due to lack of proximal anchoring zone. The follow up results in a short-term is satisfied.

Autologous fat grafting is an effective reconstructive surgery technique; however, its success is limited by inconsistent graft retention and an environment characterized by high oxidative stress and inflammation. Adipose-derived stem cells (ADSCs) increase the survival of fat grafts, although the underlying mechanisms remain unclear. Here, TLR4−/− and Nrf2−/− mice were used to explore the effects of oxidative stress and inflammation on the viability and function of ADSCs in vitro and in vivo. Enrichment of fat grafts with ADSCs inhibited inflammatory cytokine production, enhanced growth factor levels, increased fat graft survival, downregulated NADPH oxidase (NOX)1 and 4 expression, increased vascularization and reduced ROS production in a manner dependent on toll-like receptor (TLR)-4 and nuclear factor erythroid 2-related factor 2 (Nrf2) expression. Immunohistochemical analysis showed that exposure to hypoxia enhanced ADSC growth and promoted the differentiation of ADSCs into vascular endothelial cells. Hypoxia-induced inflammatory cytokine, growth factor and NOX1/4 upregulation, as well as increased ROS production and apoptosis in ADSCs were dependent on TLR4 and Nrf2, which also modulated the effect of ADSCs on promoting endothelial progenitor cell migration and angiogenesis. Western blot analyses showed that the effects of hypoxia on ADSCs were regulated by crosstalk between Nrf2 antioxidant responses and NF-κB- and TLR4-mediated inflammatory responses. Taken together, our results indicate that ADSCs can increase the survival of fat transplants through the modulation of inflammatory and oxidative responses via Nrf2 and TLR4, suggesting potential strategies to improve the use of ADSCs for cell therapy.

To investigate the methods and effectiveness of multiple surgical treatment for complex aortic arch and descending aorta disease, including cardiopulmonary bypass operation, hybrid operation, and total endovascular aneurysm repair (EVAR).Between October 2006 and September 2011, 48 patients with complex aortic arch and descending aorta disease were treated. There were 31 males and 17 females, aged from 28 to 81 years (mean, 52.4 years). The disease duration ranged from 1 to 90 days (mean, 10.2 days). There were 30 cases of type B aortic dissection involving the aortic arch, 11 cases of thoracic aortic aneurysm, 3 cases of thoracic pseudoaneurysme, 3 cases of penetrating aortic ulcer, and 1 case of aortoesophageal fistula. Cardiopulmonary bypass operation, hybrid operation, and total EVAR were performed in 15, 12, and 21 cases, respectively.In the patients undergoing cardiopulmonary bypass operation, the following complications occurred: 1 case of bleeding, 1 case of coma, 3 cases of psychiatric disorders, 4 cases of pneumonia, 2 cases of acute renal insufficiency, and 2 cases of multi-organ dysfunction; finally 3 patients died. In the patients undergoing hybrid operation, cerebral infarction and renal function failure occurred in 1 case. In the patients undergoing total EVAR, no complication occurred. A total of 41 patients were followed up 2 to 60 months (mean, 28.6 months). Slight left subclavian steal syndrome occurred in 3 cases, but self relieved. Other patients recovered to normal life.In the surgical treatments of complex aortic arch and descending aorta disease, cardiopulmonary bypass operation will be gradually replaced by EVAR because of the surgical trauma and risk, hybrid operation is an important technique, and total EVAR will be the future progress.

To summarize the clinical experience of vascular bypass grafting combined with endovascular aortic repair (EVAR) for aortic dilatation disease.Between January 2008 and August 2011, 12 patients with aortic dilatation disease were treated with vascular bypass grafting combined with EVAR. Of 12 patients, 11 were male and 1 was female, aged 47-81 years (mean, 65.9 years). All cases were diagnosed through computed tomography angiography (CTA), including 1 case of Stanford type A dissection, 5 cases of Stanford type B dissection, 4 cases of aortic arch aneurysm, and 2 cases of abdominal aortic aneurysm. Eight patients received neck artery bypass grafting before EVAR, and 4 patients underwent femoral artery bypass grafting after EVAR.After operation, pulmonary infection occurred in 3 patients, renal insufficiency in 2 patients, cerebral infarction in 1 case, decreased hemoglobin and platelets in 7 cases, and poor healing of groin wound in 1 case. Eleven patients were followed up 3-42 months, with an average of 18.6 months. In 1 case undergoing EVAR of the thoracic and abdominal aorta, EVAR was performed again because new aneurysms formed at 6 months after operation, and the patient achieved good recovery after 3 months. CTA showed reduced false lumen, thrombosis formation, no endoleak, no deformation or displacement of stent, and anastomotic patency of artificial blood vessels in the other patients at 3, 6, and 12 months after operation.Vascular bypass grafting combined with EVAR can expand the indications for endovascular repair. It not only provides sufficient anchoring area, but also ensures the blood supply to vital organs, simplifies the surgical procedure, and reduces the difficulty of endovascular treatment.

Background It has been reported that ischemic postconditioning (IPO) or mesenchymal stem cell (MSC) engraftment could protect organs from ischemia/reperfusion (I/R) injury. We investigated the synergetic effects of combined treatment on lung injury induced by I/R. Methods Adult Sprague-Dawley rats were randomly assigned to one of the following groups: sham-operated control, I/R, IPO, MSC engraftment, and IPO plus MSC engraftment. Lung injury was assessed by arterial blood gas analysis, the wet/dry lung weight ratio, superoxide dismutase level, malondialdehyde content, myeloperoxidase activity, and tissue histologic changes. Cytokine expression was detected using real-time polymerase chain reaction, Western blotting, and enzyme-linked immunosorbent assay. Cell apoptosis was determined by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end assay and annexin V staining. Results MSC engraftment or IPO alone markedly attenuated the lung wet/dry weight ratio, malondialdehyde and myeloperoxidase production, and lung pathologic injury and enhanced arterial partial oxygen pressure, superoxide dismutase content, inhibited pro-inflammatory cytokine levels, and decreased cell apoptosis in lung tissue, compared with the I/R group. In contrast, IPO pretreatment enhanced the protective effects of MSC on I/R-induced lung injury compared with treatment alone. Moreover, in the combined treatment group, the number of MSC engraftments in the lung tissue was increased, associated with enhanced survival of MSCs compared with MSC treatment alone. Additional investigation showed that IPO treatment increased expression of vascular endothelial growth factor and stromal cell-derived factor-1 in I/R lung tissue. Conclusions IPO might contribute to the homing and survival of transplanted MSCs and enhance their therapeutic effects through improvement of the microenvironment of I/R injury.

To investigate the effect of cardiomyopeptidin for injection on energy metabolism in isolated hearts of young rats after ischemia-reperfusion injury.Fifty young healthy SD rats(aged 20 +/- 3 days and weighing 50-70 g) were randomly divided into 5 groups: a normal control group (NC group, n = 10 ): the isolated hearts were stable for 20 min, and then 150 min continuous perfusion; a normal + cardiomyopeptidin group (NCMP group, n = 10): the same as the normal control group, but K-H buffer solution was added with 50 mg/L cardiomyopeptidin, and 3 ischemia-reperfusion injury model groups, including a model control group (n = 10): the isolated rat hearts were perfused with K-H buffer and then arrested with cardioplegic solution; a CMP1 group (n = 10): the ST.Thomas'II cardioplegic solution was added with 100 mg/L cardiomyopeptidin; CMP2 group (n=10): K-H buffer and ST.Thomas'II cardioplegic solution was added with 50 mg/L and 100 mg/L cardiomyopeptidin respectively. The cardiac functional indexes were monitored, including heart rate, myocardial contractility and diastolic function, peak systolic and diastole myocardial velocities and coronary flow. In the 3 ischemia-reperfusion injury model groups, myocardial ultrastructure was observed through transmission electron microscopy; the creatine kinase isoenzyme (CK-MB) concentration was measured in the fluid outflow of coronary; the content of Na+-K+ ATPase, Ca2+-Mg2+ ATPase, total ATPase, superoxide dismutase (SOD), malondialdehyde (MDA), nitric oxide(NO), total nitric oxide synthase (TNOS), inducible nitric oxide synthase (iNOS) and aldosereductase were measured in the myocardium tissue; the relative expression levels of iNOS, eNOS, and Akr1b4 mRNA in the myocardial tissue were also detected by real-time fluorescence quantitative PCR.In the NC group, after prolonged perfusion, the cardiac function of isolated hearts had no significant change. Cardiomyopeptidin for injection had no significant effect on normal isolated hearts. Compared with the model control group, the cardiac function indexes and coronary flow in the groups treated with cardiomyopeptidin decreased much less. Cardiac myofibrillar fragmentation and mitochondrial swelling were observed in the control group, while in the CMP groups, the myocardial structure was nearly complete, and only mild mitochondria swelling and degeneration could be seen. After the reperfusion, the content of CK-MB was increased in the control group. Compared with the model control group, the CK-MB content was lower in the CMP1 and CMP2 groups. There was a slight decline in the contents of Na+-K+ ATPase, Ca2+-Mg2+ ATPase, and Total ATPase in the CMP1 and CMP2 groups, and an increase in SOD activity (P0.01 or P0.05). The concentration of NO and MDA produced after the ischemia-reperfusion injury was much lower in the CMP1 and CMP2 groups. The activity of iNOS and aldosereductase was inhibited, the expression levels of iNOS, and Akr1b4 mRNA were significantly down-regulated in the CMP1 and CMP2 groups. These changes were more prominent in the CMP2 group (P0.01 or P0.05). The eNOS mRNA levels in the CMP2 group was up-regulated (P0.05).Cardiomyopeptidin for injection may improve the energy metabolism, improve coronary blood flow and cardiac function after the reperfusion, thus protecting immature myocardial against ischemia-reperfusion injury in young rats. Administration of it in both K-H buffer and ST.Thomas'II cardioplegic solution is better than adding it in cardioplegic solution alone. The mechanism may be associated with the inhibition the mRNA expression of iNOS and Akr1b4 in cardiomyocytes, the inhibition activity of iNOS and aldosereductase, and the decrease of NO production.

To establish the modified model of cervical heterotopic cardiac transplantation in rats for investigation of cardiac chronic rejection.Forty healthy male Wistar rats, aged 10 weeks, weighing 250-300 g, were applied as the donor group, and forty healthy male SD rats, aged 10 weeks, weighing 300-350 g, served as the recipient group. The donors' pulmonary artery was anastomosed to the recipients' right external jugular vein by non-suture cuff technique while the donors' innominate artery was anastomosed to the recipients' right common carotid artery by suture microvascular anastomosis. All recipients received cyclosporin to prevent acute allograft rejection.Forty consecutive successful transplantations were performed. Neither anastomosis leakage nor vessel obstruction occurred. The total operation time was 40-50 minutes. The time of cuff vascular anastomosis was 2-3 minutes and that of microvascular anastomosis was 9-12 minutes. All recipients survived for more than 30 days and all allografts were examined at 30 days after the transplantation. Pathological manifestations of allograft vessels were chronic rejection.This modified model of cervical heterotopic cardiac transplantation is simple, practical and highly reproducible and is applicable for investigation of chronic rejection in various organ transplantation studies.

To investigate the surgical technique of establishing a reliable rat model of orthotopic liver transplantation.A total of 200 adult male SD rats weighing 200-250 g and 60 adult male Wistar rats weighing 230-280 g were adopted. The weight of donor was 30 g less than that of receptor. Syngeneic group of SD-SD rats (SD-SD group, n = 70) and allogeneic group of SD-Wistar rats (SD-Wistar group, n = 60) liver transplantation were performed, respectively. Orthotopic liver transplantations in rats were performed using modified Kamada's two-cuff technique. Under the sufficient exposure of the porta hepatis, the liver was perfused through the cold of perfusion of portal vein without touching the liver. The anastomosis of the suprahepatic vena cave was sutured end- to-end with 8-0 prolene line. Guided by double line, the continuity of portal vein was established by cuff method easily. The fluid was supplemented sufficiently after operation to maintain the stabilization of hemodynamics.The time for donor operation and receptor operation was (38.2 +/- 2.5) minutes and (45.6 +/- 3.5) minutes, and anhepatic time was (15.1 +/- 2.2) minutes.The successful rate was 93%. The survival rate after 1 week was 92%. There was a significant difference when compared with traditional method (P0.05). There were 64 survivals in SD-SD group and 57 in SD-Wistar group after liver transplantation, and the survival time was 2-9 months (mean 145 days) and 8-20 days (mean 10.5 days) respectively. The liver function recovered well in SD-SD group, while in SD-Wistar group the liver functional failure and acute rejection occurred in pathology 3-5 days after liver transplantation, all of which ended with death without any therapy.The modified method is proved to be ideal for its advantages of simple operation, short anhepatic phase and high operative successful rate.

To investigate the rehabilitation of the sexual function of male patients after heart transplantation.Eleven discharged adult male cardiac transplant recipients (ranging 32-54 years) with a normally functioning allograft for at least 9 months were questioned on their pre- and post-operative sexual function.All the recipients complained of a significant pretransplantive decrease and 10 stated a significant posttransplantive increase in sexual function.The sexual function of the male recipients was significantly improved after cardiac transplantation. Psychosocial factors affecting the rehabilitation of sexual function should not be neglected.