Background: Previous studies have shown that transcatheter aortic valve implantation (TAVI) is the best alternative therapy to surgical aortic valve replacement (SAVR) in high-risk surgical patients with aortic stenosis (AS). However, it is not clear whether TAVI can be utilised in low-risk surgical patients with AS. This study aimed to evaluate the safety and efficacy of TAVI in low-risk patients. Methods: From the outset of our initiative until June 2021, PubMed, EMBASE, and Cochrane were thoroughly searched, yielding the selection of 3 randomised controlled trials including 2633 patients with AS, to assess outcome measures at distinct follow-up time periods. Results: The mean Society of Thoracic Surgeons Predicted Risk of Mortality score of patients was 2.2. At the 30-day and 1-year follow-up, TAVI was associated with a lower incidence of all-cause mortality, cardiovascular mortality, acute kidney injury (stage 2 or 3), life-threatening or significant bleeding, and new atrial fibrillation (NAF), but an increased risk of permanent pacemaker implantation. At the 2-year follow-up, TAVI only had an advantage in NAF (RR, 0.27; 95% CI, 0.14–0.51; P＜0.0001) without any significant difference in any of the other outcome measures. Conclusions: For low-risk surgical patients with AS, the efficacy of TAVI was superior to that of SAVR by the 30-day and 1-year follow-up. This was most evident by the 2-year follow-up, except for the advantages of NAF, with no other significant differences.

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.

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.

Abstract 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: We developed an integrated triple-branched stent to treat acute DeBakey type I aortic dissection and modified it to enhance its adaptability. However, whether the patients treated by the modified stent would achieve better long-term prognosis is unknown. Methods: This study enrolled 147 patients with acute DeBakey type I aortic dissection. The original integrated triple-branched stents were used in 57 patients (group A) between July 2012 and August 2013, and the modified stents in 90 patients (group B) between September 2013 and March 2015. Clinical characteristics, surgical data, postoperative complications, mortality, and follow-up data of the two groups were analyzed. Results: The two groups presented comparable early death rate (group A=7.0%, group B=5.9%, p=0.719). The incidence of postoperative acute kidney injury was lower in group B (10.0%) vs group A (24.6%) (p=0.018). Compared with the original integrated triple-branched stent graft, the modified stent could reduce the risk of early postoperative acute kidney injury [OR (95%CI)=0.36(0.14, 0.94)]. Early endoleak rate was lower in group B (1.0%) vs group A (9.4%) (p=0.004). During follow-up, there were five deaths in group A (9.4%) and six deaths in group B (7.2%) (p=0.646). Chronic kidney injury (7.5% vs 3.6%, p=0.311), delayed endoleak (11.3% vs 4.8%, p=0.157), and late reinterventions (7.5% vs 2.4%, p=0.155) in the two groups were similar. Conclusions: In patients with acute DeBakey type I aortic dissection, the modified stent could provide feasible and safe treatment outcomes, with better protection of kidney function and reduced early endoleak. However, they had similar long-term effects.