Patients with pathological tracheal loss more than a certain length may need tracheal transplantation.Traditional natural tissue and autologous tissue have failed to produce satisfactory clinical outcomes to replace the trachea because of local infection，tracheal stenosis，tracheomalacia，immune rejection et al. In recent years，the emergence oftissue engineering trachea provides a new idea for tracheal transplantation. But scientists have not yet reached a consensus about how to choose ideal extracellular matrix to construct tissue engineering trachea. At present research and applicationof tissue engineering trachea，extracellular matrices mainly include allogenic trachea，allogenic aorta and biologicalcomposite materials. Each allogenic matrix or biological composite material has its own advantages and disadvantages. Therefore，this article mainly summarizes recent application and research progress of extracellular matrix in long segmental tracheal defect and its future perspective.
Objective To summarize our clinical experience of endovascular repair of aortic pseudoaneurysms，andexplore the etiology of the disease，treatment indications，and early and midterm results of the procedure. Methods From November 2009 to May 2012，52 patients with aortic pseudoaneurysms received endovascular aortic repair （EVAR） in FuWai Hospital. There were 44 male and 8 female patients with their age of （53.8±13.5 ） years. Their onset syndromes includedchest or back pain in 46 patients and hoarseness in 5 patients. There were 23 acute patients and 29 chronic patients. Aortic pseudoaneurysms located at the descending thoracic aorta in 51 patients and the abdominal aorta in 1 patient. The meandiameter of the aortic pseudoaneurysms was （45.1±33.8） mm. All the patients were diagnosed using enhanced CT scan of the aorta. Three patients received emergency EVAR. All the patients received EVAR through the femoral arteries under general anesthesia. Forty-six patients underwent isolated EVAR，5 patients received hybrid technique for EVAR via the neck，and 1 patient received hybrid technique including EVAR and total arch replacement via median sternotomy under normothermia. The average diameter of stent-grafts was （34.2±3.3） mm and the average length was （157.7±20.3） mm. Enhanced CT scan of the aorta was performed before discharge，3 months and 1 year after EVAR during follow-up. Results There was no in-hospital death and EVAR was 100% successful. All the patients （100%） were followed up for 1-31 （12.6±7.9）months after discharge. Their chest or back pain symptoms all significantly improved. Their hoarseness improved too duringfollow-up. One patient’s hoarseness disappeared early after EVAR but recurred 5 months after EVAR. Enhanced CT scan showed enlargement of the stent-graft without endoleak. One patient underwent emergency EVAR for sudden onset of massivehemoptysis，recovered well before discharge，and was readmitted to hospital 5 months after EVAR because of fetid sputum and hemoptysis，who was diagnosed as Behcet’s disease and cured after anti-infection and immunosuppressive therapy. One patient had recurrent fever before and 6 months after EVAR and was cured by antibiotic therapy. Intraoperative angiographyshowed trivial typeⅠendoleak in 4 patients right after stent-graft deployment，which disappeared in enhanced CT scan 3-6 months after EVAR. Intraoperative angiography showed no endoleak in all the other patients，and their enhanced CT scans 3 months and 1 year after EVAR showed complete sealing between the stent-grafts and the aortic wall，thrombus in the pseudoaneurysm sac and decreased diameters of the pseudoaneurysms without endoleak. Two patients had hemiplegia 1 dayand 6 days after EVAR respectively，1 patient was cured and discharged and the other patient survived with hemiplegicsequelae. One patient with an abdominal aortic pseudoaneurysm died of sudden onset of cerebral infarction at home 3 monthsafter EVAR. Conclusions Endovascular repair of descending aortic pseudoaneurysms is safe and effective with good early and midterm results，and longer follow-up is needed for its long-term outcomes. Individualized treatment plan is basedon the location of the pseudoaneurysms. Preoperative meticulous medical history and physical examination are both importantfor the differentiation of the etiology of aortic pseudoaneurysms. Postoperative treatment based on the etiology and close follow-up are also needed to ensure long-term results.
Abstract: Objective To determine the incidence, course, potential risk factors and outcomes of postoperative noninfectious fever in aortic surgical patients. Methods We reviewed 549 patients who received operation for aortic aneurysm or dissection in Beijing FuWai Cardiovascular Disease Hospital from January 2006 to January 2008. After excluding patients with a known source of infection during hospitalization, patients who had preoperative oral temperature greater than or equal to 38.0℃, patients who underwent emergency surgery, patients who died of other reasons other than feverrelated factors, and patients with incomplete data, we finally enrolled a total of 463 patients for final analysis. Depending on whether the patients developed a noninfectious fever after operation, we classified them into the febrile group (n=345, highest oral temperature ranging from 38.0-39.3℃) and the afebrile group (n=118, without postoperative fever). Univariate analysis was performed between these two groups of patients, with respect to demographics, operative data and postoperative conditions. Risk factors for postoperative fever were considered for the multivariate logistic regression model if they had a P value≤0.001 in the univariate analysis. Results After operation, 74.5%(345/463) of the patients had noninfectious fever. The minimum temperature of febrile patients on the operation day and the first postoperative day were both higher than afebrile patients（P=0.000，0.000）. The maximum temperature of febrile patients on the operation day, the first, second，third and fourth postoperative days were also higher than afebrile patients（P=0.000，0.000, 0.047, 0.018）. Univariate analysis demonstrated that weight (P=0.000), surgical type (P=0.000), minimum intraoperative bladder temperature (P=0.000), temperature upon ICU admission (P=0.000) and blood transfusion (P=0.000) were all risk factors for noninfectious postoperative fever. The multivariate logistic regression showed that surgical sites of thoracic and thoracoabdominal aorta (odds ratio: 4861; 95% confidence interval: 3.029，5.801; P=0.004), lower minimum intraoperative bladder temperature (odds ratio: 1.117; 95% confidence interval:1.013，1.244;P=0.040) and higher temperature on admission to the ICU (odds ratio: 2.570; 95% confidence interval:1.280，5.182;P=0.008) were significant predictors for postoperative noninfectious fever. Conclusion Noninfectious postoperative fever following aortic surgery is very common. Predictors of noninfectious postoperative fever following aortic surgery include surgical sites (thoracic or thoracoabdominal aorta), low intraoperative core temperature and temperature elevation in the immediate postoperative period.
Objective To summarize the recent research situation and progress of decellularized matrix in tissue engineered trachea transplantation and to forecast the possible perspects. Methods Recent original articles about study and application for decellularized matrix in tissue engineered trachea were reviewed. The application and study of different decellularized matrices involved in animals or patients with tracheal lesions were elaborated. Results Decellularized matrices researched and applied in tissue engineered trachea include jejunum, urinary bladder, aorta, and trachea. Conclusion Decellularized urinary bladder matrix and jejunal matrix appears to be efficacious method for the patch repair of partial circumferential tracheal defects. The application of decellularized aortic matrix may need more study, and decellularized tracheal matrix has a bright future in long tracheal defects.
Objective To review the strategies on repairing elastic fibers in aorta. Methods Literature concerningelastic fiber as well as its repairment was consulted and summarized from three aspects: enhancement of the expressions ofits components, improvement of the condition of its assembly, and reduction of the destructive effects. Results Elastinis concerned as the main protein to be enhanced with three different methods including gene transfection, stimulationwith ectogenesis factors, and induction of phenotype transition of smooth muscle cell. Fibul in and lysyl oxidases show theabil ity to improve the assembly of the elastic fiber, while the related mechanisms are not clear. Matrix metalloproteinasesare regarded as the main destructive factors, and researches focus on reducing their expression as well as their destructiveeffects. Conclusion To assure a high-qual ity repair of elastic fibers in aorta, their components should be sufficientlyexpressed and effectively assemblyed, and the destructive effects caused by dangerous factors should also be reduced.
ObjectiveTo investigate the effect of sleeve gastrectomy on preventing adipose infiltration and LOX-1 expression in aortic epithelium of high-fat-diet-induced obese rats. MethodsTwenty-four Wistar rats were randomized into normal chow group (CO group), high-fat diet group (HD group), and high-fat diet combined with sleeve gastrectomy group (SG group). Rats of three groups before operation and CO group after operation were fed with normal diet, rats of HD and SG group were fed with high-fat diet. Body weight of all the rats were examined on day 10, 20, and 30 after operation, respectively. Animals were sacrificed on day 30 after operation and plasma HDL and LDL were detected by ELISA, LOX-1 and LOX-1 mRNA expression in aortic epithelium were measured by Western blot and real-time RT-PCR, respectively. Immunochemical histological Nile red stain was adopted in adipose infiltration examination of aorta. ResultsThe body weights in HD group were much higher than those of other groups （Plt;0.01）. The HDL in CO, HD, and SG groups was (32.9±6.2) mg/dl, (43.4± 4.0) mg/dl, and (37.5± 4.3) mg/dl, respectively. The LDL in CO, HD, and SG groups was (31.8±4.5) mg/dl, (53.3±5.1) mg/dl, and (40.5±3.7 ) mg/dl, respectively. The HDL and LDL values in HD group were higher than those of other two groups (Plt;0.05, Plt;0.01). The LOX-1 protein and mRNA expressions in HD group were much higher than those of other groups (Plt;0.01). Adipose staining in HD group was also ber than that of other groups. ConclusionsHigh-fat diet can induce elevation of LOX-1 protein and mRNA expression in aorta. Sleeve gastrecto my can relieve plasma LDL level, as a result, LOX-1 protein and mRNA expression should be down-regulated.
Objective To analyze clinical outcome of the technique of comprehensive aortic root and valve reconstruction (CARVAR) applying in aortic valve and root disease. Methods We retrospectively analyzed the clinical data of 106 patients with aortic valve and root disease underwent CARVAR technique in our hospital from July 2012 to July 2015. There were 72 males and 34 females at the average age of 57.3 (11-67) years. We operated the CARVAR technique and analyzed the early and midterm clinical outcomes. Results There was no mortality and low cardiac output syndrome postoperatively. But there were 2 cases of renal insufficiency or failure and 1 case of infective endocarditis. The average ejection fraction was 54%. The mean area of aortic valve orifice was 2.2±0.8 cm2. The aortic valve pressure gradient was 11.2±2.3 mm Hg. There were 2 cases of mild aortic valve regurgitation. The result of operation was satisfying with a stable hemodynamics and few complications. The follow-up after surgery showed that there was no obvious abnormity in aortic valve and root. Conclusion Using CARVAR technique to cure aortic valve and root disease is an effective treatment and it can achieve satisfactory early and midterm clinical outcomes.
An 89 years old male patient was admitted to the First Medical Center of Chinese PLA General Hospital due to chest tightness and shortness of breath for half a month. Severe aortic valve stenosis was found in post admission assessment. We proposed to perform transcatheter aortic valve replacement surgery. Preoperative evaluation showed severe distortion of the descending aorta. We used the double guide wire technique and a 14F long sheath to assist the stepwise balloon expansion, and successfully completed the valve implantation. For patients with severe tortuous aorta, how to successfully complete transcatheter aortic valve replacement, this case may provide some reference.