Objective To analyze the etiologies, surgical treatment and outcomes of retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) for Stanford type B aortic dissection. Methods The clinical data of patients with RTAD after TEVAR for Stanford type B aortic dissection receiving operations in Changhai Hospital from March 2014 to August 2018 were analyzed. All patients were followed-up by clinic interview or telephone. Results A total of 16 patients were enrolled, including 13 males and 3 females with a mean age of 49.1±12.2 years. The main symptoms of RTAD were chest pain in 12 patients, headache in 1 patient, conscious disturbance in 1 patient, and asymptomatic in 2 patients. All the 16 patients received total arch replacement with the frozen elephant trunk technique. Bentall procedure was used in 2 patients, aortic root plasticity in 10 patients and aortic valve replacement in 1 patient. The primary tear in 10 patients was located in the area which were anchored by bare mental stent, and in the other 6 patients it was located in the anterior part of ascending aorta. The mean cardiopulmonary bypass time was 152.2±29.4 min, aortic cross-clamping time was 93.6±27.8 min and selective cerebral perfusion time was 29.8±8.3 min. There was no death in hospital or within postoperative 30 days. The follow-up period was 32-85 (57.4±18.3) months. No death occurred during the follow-up period. One patient underwent TEVAR again 3 years after this operation and had an uneventful survival. Conclusion Total arch replacement with the frozen elephant trunk technique is a suitable strategy for the management of RTAD after TEVAR for Stanford type B aortic dissection.
Objective To summarize the experience of providing medical supplies for the medical rescue after the Wenchuan earthquake so as to provide information for similar tasks in the future. Methods We collected and analyzed relevant data from the Medical Supply Group of the Headquarters for Earthquake Resistance and Disaster Relief. Results ① The Medical Supply Group of the Headquarters for Earthquake Resistance and Disaster Relief was set up immediately after the quake. Professional software for the medical supply information management was developed to ensure the completeness and timeliness of relevant data. ② Within the first 3 days after the quake, 12 460 medical device parts were delivered to the disaster area, which effectively ensured the availability of medical supplies for the “golden 72 hours”. ③ A great amount of donated material from other provinces and overseas also arrived. These donations reached a peak 2 weeks after the quake. A total of 428 411 drug products, 196 504 medical device parts and 5 999.4 tons of disinfection material were successfully delivered to most of the quake-stricken areas within 24 hours after its delivery to Sichuan province. ④ Three months after the quake, the remaining 193 831 drug products, 96 423 medical device parts and 2 000 tons of disinfection material were disposed appropriately. A regional medical supply warehouse was established to reserve 129 895 drug products, 74 018.4 medical device part and 231.28 tons of disinfection material. On the 115th day after the quake, a portion of these reserves were allocated to the quake-hit areas in Panzhihua, Liangshan, and Yunnan province. ⑤ Nearly 20 tons of drug products, 10 tons of medical devices and 724.54 tons of disinfection materials were properly destroyed due to expiration or disqualification. ⑥ Based on the data collected during the disaster relief work, a series of articles were published. Conclusion The medical supply work for the medical rescue after the Wenchuan earthquake was efficient, well-organized, transparent, and open.
ObjectiveTo analyze the etiologies, operation techniques and outcomes of redo aortic root replacement after cardiac surgery.MethodsBetween December 2013 and December 2019, 30 patients who had at least one previous cardiac operation received aortic root replacement in our hospital, including 20 males and 10 females with an average age of 50.4±12.7 years. The mean time interval between this operation and the previous one was 8.0±8.5 years. The principal indication for surgery was aortic sinus dilatation and ascending aortic aneurysm in 14 patients (47%), acute aortic dissection in 5 patients (17%), pseudoaneurysm in 3 patients (10%), prosthetic valve endocarditis in 4 patients (13%), prosthetic leakage in 4 patients (13%). Bentall procedure was used in all 30 patients, with concomitant mitral valve plasticity or replacement in 5 patients, tricuspid valve plasticity in 6 patients, coronary artery bypass grafting in 3 patients, and total aortic arch replacement and elephant trunk procedure in 2 patients.ResultsThe mean cardiopulmonary bypass time was 96-296 (161.3±43.0) min, and the mean aortic occlusion time was 48-117 (85.7±20.4) min. There were 5 in-hospital deaths with an overall in-hospital mortality of 17%. The causes of deaths were low cardiac output syndrome in 2 patients and septic shock in 3 patients. The follow-up time was 3-75 (33.5±21.1) months. Three patients died during the follow-up, 1 patient died of septic shock and 2 died of cerebral hemorrhage.ConclusionRedo aortic root replacement is difficult to deal with, and the risk is high. Preoperative evaluation is required, appropriate surgical approach, adequate myocardial protection, and a complete surgical plan are essential to ensure the success of the operation.