Objective To compare the early outcomes of domestic third-generation magnetically levitated left ventricular assist device (LVAD) with or without concomitant mitral valvuloplasty (MVP). Methods The clinical data of 17 end-stage heart failure patients who underwent LVAD implantation combined with preoperative moderate to severe mitral regurgitation in Fuwai Central China Cardiovascular Hospital from May 2018 to March 2023 were retrospectively analyzed. The patients were divided into a LVAD group and a LVAD+MVP group based on whether MVP was performed simultaneously, and early outcomes were compared between the two groups. Results There were 4 patients in the LVAD group, all males, aged (43.5±5.9) years, and 13 patients in the LVAD+MVP group, including 10 males and 3 females, aged (46.8±16.7) years. All the patients were successful in concomitant MVP without mitral reguragitation occurrence. Compared with the LVAD group, the LVAD+MVP group had a lower pulmonary artery systolic pressure and pulmonary artery mean pressure 72 h after operation, but the difference was not statistically different (P>0.05). Pulmonary artery systolic pressure was significantly lower 1 week after operation, as well as pulmonary artery systolic blood pressure and pulmonary artery mean pressure at 1 month after operation (P<0.01). There was no statistically significant difference in blood loss, operation time, cardiopulmonary bypass time, aortic cross-clamping time, mechanical ventilation time, or ICU stay time between the two groups (P>0.05). The differences in 1-month postoperative mortality, acute kidney injury, reoperation, gastrointestinal bleeding, and thrombosis and other complications between the two groups were not statistically significant (P>0.05). Conclusion Concomitant MVP with implantation of domestic third-generation magnetically levitated LVAD is safe and feasible, and concomitant MVP may improve postoperative hemodynamics without significantly increasing perioperative mortality and complication rates.
Objective To explore the effect of pulmonary arterial hypertension on the children with functional single ventricle in the early period after Fontan operation. Methods Forty-three children with pulmonary arterial hypertension after Fontan operation were enrolled in our department between January 2015 and December 2016. There were 24 males and 19 females at a median age of 4.3 years ranging from 2.5 to 4.8 years. The pulmonary arterial pressure was evaluated by cardiac catheterization. There were 23 children diagnosed without pulmonary hypertension (a non-PAH group) including 16 males and 7 females, while 20 patients were diagnosed with pulmonary hypertension (a PAH group) including 8 males and 12 females. Postoperative parameters related to outcomes were compared between the two groups. Results There was no death in the non-PAH group, but the mortality of children in the PAH group was 20.0% (4/20, χ2=5.34, P=0.02). The central venous pressure (t=–2.50, P=0.02), N-terminal prohormone of brain natriuretic peptide (NT-proBNP, Z=–3.50, P<0.01), peritoneal dialysis rate (χ2=5.40, P=0.02), incidence of arrhythmia (χ2=4.40, P=0.03) in the PAH group were significantly higher than those of the non-PAH group. The early postoperative utilization rate of pulmonary vascular targeting agents in the PAH group was significantly higher than that in the non-PAH group (χ2=6.30, P=0.04). Conclusion Pulmonary arterial hypertension is one of the most important factors which influence the early postoperative prognosis of children with functional single ventricle after Fontan operation.
Objective To investigate the effect of preoperative lower-limb muscle strength on perioperative blood loss, postoperative pain, and functional recovery in patients undergoing total knee arthroplasty (TKA).Methods A retrospective analysis was conducted on the clinical data of 380 patients who underwent TKA and met the selection criteria between February 2023 and December 2024. Based on the gender-specific median of standardized preoperative lower-limb extensor isokinetic muscle strength (IMS), the patients were divided into a low-extensor strength group and a high-extensor strength group, with 190 cases in each group. The following data of the two groups were collected and compared, including age, gender, body mass index, comorbidities, surgical side, length of hospital stay, Kellgren-Lawrence grade, perioperative parameters [including hematocrit (Hct) and hemoglobin (Hb) levels within 1 week preoperatively and 2-3 days postoperatively, with the calculation of Hct loss and Hb loss (the difference between the pre- and post-operative measurements), and whether intraoperative allogeneic blood transfusion was performed], preoperative knee flexion and extension IMS, 5-time sit-to-stand (5-STS) test within 2 weeks preoperatively, as well as visual analogue scale (VAS) score for pain and active range of motion (AROM) within 2 weeks preoperatively and 1 day postoperatively. Pearson correlation analysis was used to analyze the correlation between preoperative lower-limb extensor IMS and TBL. Through multiple linear regression analysis, the effect of IMS on TBL was further explored after adjusting for confounding factors such as age, body mass index, hypertension, diabetes mellitus, coronary atherosclerotic heart disease, and chronic obstructive pulmonary disease. Results There was no significant difference between the two groups in age, gender, body mass index, surgical side, Kellgren-Lawrence grade, comorbidities, length of hospital stay, preoperative Hct and Hb levels, intraoperative allogeneic blood transfusion rate, and changes in VAS scores (P>0.05). The high-extensor strength group was superior to the low-extensor strength group in preoperative VAS scores, AROM, 5-STS, as well as postoperative Hct and Hb loss, and the changes of AROM and TBL were less than those in the low-extensor strength group, with all differences being significant (P<0.05). Pearson correlation analysis showed a negative correlation between preoperative lower-limb extensor IMS and TBL (r=–0.460, P=0.043). Multiple linear regression analysis showed that after adjustment, a lower TBL was associated with a higher preoperative lower-limb extensor IMS. Specifically, for every 1 N·m increase in preoperative lower-limb extensor IMS, TBL decreased by 9.973 mL. TBL was not significantly affected by other factors such as age, body mass index, and comorbidities. Conclusion Higher preoperative lower-limb muscle strength is associated with reduced intraoperative blood loss during TKA and improved postoperative pain relief and functional recovery. These findings highlight the critical role of preoperative muscle strength management, providing scientific evidence for designing standardized postoperative rehabilitation protocols and offering guidance for optimizing surgical timing to maximize recovery outcomes.