Abstract: Objective To observe the physical characteristics of decellularized porcine pulmonary valved conduits crosslinked by carbodiimide (EDC). Methods [WTBZ]Twenty porcine pulmonary valved arteries were mobilized on relative asepsis condition. They were cut longitudinally into three samples at the junction position of pulmonary valve (every sample was comprised of a part of the pulmonary conduit wall and the corresponding valve). The samples were randomly divided into three groups by lotdrawing method. Group A was the control group which was made up of the fresh porcine arterial valved conduit samples without any other treatments. Group B was comprised of porcine pulmonary samples decellularized by trypsindetergent digestion. Group Cincluded the decellularized porcine pulmonary samples crosslinked by EDC. We observed the water content, thickness, tensile strength, and shrinkage temperature of all the samples, based on which the physical characeteristics of these samples were analyzed. Results [WTBZ]Complete cellfree-pulmonary conduit matrix was achieved by trypsindetergent digestion. Compared with group A, in group B, the water content of pulmonary wall was significantly higher (P=0.000), while the water content of pulmonary valve was not significantly different; the thickness of pulmonary wall and valve (P=0.000，0.000) and tensile strength of pulmonary wall and valve (Plt;0.01） was significantly lower, while shrinkage temperature was not significantly different. Compared with group B, in group C, the water content of pulmonary wall was significantly lower (P=0.000), while the water content of pulmonary valve, and the thickness of pulmonary wall and valve were not significantly different; the tensile strength of pulmonary wall (Plt;0.01) and valve (P=0.000), and the shrinkage temperature of them (P=0.000, 0.000) were significantly higher. Compared with group A, in group C, the water content of pulmonary wall and valve, and the tensile strength of them were not statistically different, while the thickness of pulmonary wall and valve was significantly lower (P=0.000, 0.000), and the shrinkage temperature of them was significantly higher (P=0.000, 0.000). Conclusion [WTBZ]EDC crosslinking method is available for treating decellularized porcine pulmonary valved conduits in order to enhance its tensile strength, and decrease water content of pulmonary wall.
Objective To investigate the diagnosis and treatment methods of primary cardiac malignant tumors，so as to improve its’ level of diagnosis and treatment. Methods From April 2004 to June 2008, 19 patients with primary cardiac malignant tumors were diagnosed and treated in the department of cardiac surgery in this hospital. Male 11, Female 8.Age of the patients was 40.7±12.1 years(17-64 years). Preoperative diagnosis were occupying lesion in cardiac, malignant tumors were possible. Complete resections of malignant tumors were achieved by cardiopulmonary bypass (CPB) in 3 cases, and partially resected in 1 case, heart transplantation was performed in 1 case, only biopsies were performed in 5 cases. 9 cases (47.4%) lost the chances of operative treatments. Results There were no operative and hospitalstay deaths. Hospital stay was 10±7 d（9-15 d）, all patients were safely discharged from hospital. Two cases suffered from postoperative pericardial effusions，and high temperature happened in 1 patient, these 3 cases recovered by puncture and symptomatic treatment. The pathological diagnosis: leiomyosarcoma in 1case, malignant mesothelioma in 1 case and hemangioendothelial sarcoma in 8 cases. 14 cases (73.7%) were followed up from 1 to 38 months, 14 cases died of tumor recurrence or metastasis, the mortality was 73.7%, 5 cases (26.3%) were failed to be followed up. Conclusion The prognosis of patient with primary cardiac malignant tumor is still poor. Earlier diagnosis and complete surgical removal of the tumor as soon as possible may improve the patients’qualities of lives.
To retrospectively summarize the medical rescue organization and strategy of West China Hospital medical team during the Wenchuan earthquake so as to provide reference for rescue practice in the future. We emphasize that the key point to improve the efficiency of rescue is scientifically assigning and util izing medical resource according to the demand at the actual locale of the earthquake and the characters of various stages of the earthquake .
ObjectiveTo summarize the clinical experience and risk factors for acute kidney injury (AKI) in neonates undergoing congenital cardiac surgery and demonstrate whether neonatal AKI after cardiac surgery was independently related to perioperative short-term outcomes. MethodsMedical records of neonates undergoing congenital heart surgery from January 2014 to September 2021 were retrospectively reviewed. The patients were divided into an AKI group and a non-AKI group according to whether the AKI occured after the surgery. Multivariate logistic analysis was performed to analyze the risk factors for postoperative AKI and the relationship between postoperative AKI and postoperative short-term outcomes. ResultsA total of 609 patients were included. There were 395 males and 214 females with an age at surgery of 1.0-28.0 d and weight of 1.9-4.8 kg. After cardiac surgery, 139 neonates developed AKI. Multivariate logistic analysis showed that less intraoperative urine output [OR=0.96, 95%CI (0.94, 0.99), P=0.005], more intraoperative infusion of red blood cells [OR=1.49, 95%CI (1.16, 1.91), P=0.002], longer intraoperative deep hypothermic circulatory arrest time [OR=1.02, 95%CI (1.00, 1.04), P=0.020], higher vasoactive-inotropic score [OR=1.03, 95%CI (1.01, 1.04), P<0.001] and elevated lactate (increasing by 5 mmol/L) [OR=2.90, 95%CI (1.76, 4.76), P<0.001] when transferred to ICU were independent risk factors for AKI. AKI was an independent risk factor for increased in-hospital mortality [OR=12.61, 95%CI (3.00, 37.48), P<0.001]. ConclusionLess intraoperative urine output, more intraoperative infusion of red blood cells, longer intraoperative deep hypothermic circulatory arrest time, higher vasoactive-inotropic score and elevated lactate when transferred to ICU are independent risk factors for AKI. Furthermore, AKI is an independent risk factor for perioperative death after cardiac surgery.
ObjectiveTo analyze the early outcomes of 203 neonates with low birth weight (<2 500 g) undergoing cardiac surgery, and to analyze the causes of death during hospitalization.MethodsFrom June 2003 to June 2017, medical records of 203 neonates with low birth weight undergoing congenital heart surgery in Guangdong General Hospital were reviewed retrospectively. There were 124 males and 79 females, including 151 premature infants. The average birth weight was 1 719±515 g, the average age at operation was 32.7±20.2 d and the average weight at operation was 1 994±486 g. The causes of death during hospitalization (including neonates given up on treatments) were analyzed.ResultsTotally 103 patients had pneumonia, 98 patients needed mechanical ventilation to support breathing and 26 patients needed emergency operation before operation. All patients undergoing congenital heart surgery were treated with general anesthesia with tracheal intubation, including 107 patients under non cardiopulmonary bypass (CPB) and 96 patients under CPB with a mean CPB time of 96.5±71.7 min and a mean aorta cross-clamp time of 51.8±45.5 min. The average postoperative mechanical ventilation time was 9.1±21.5 d and the average postoperative length of stay was 26.7±19.3 d. The major postoperative complications included pneumonia, anemia, atelectasis, septicemia, intrapleural hemorrhage, diaphragm paralysis and cardiac dysfunction. Twenty-nine patients died during hospitalization and the overall mortality rate was 14.3%. Four patients died in the operation room, 14 patients died 72 hours after operation and 2 patients were given up. The main causes of hospitalized death were low cardiac output syndrome, severe infection, disseminated intravascular coagulation disorder, acute renal failure and pulmonary hypertension crisis.ConclusionOverall, early cardiac surgery for low birth weight neonates is safe and effective. The difficulty of the cardiac surgery is the key to the prognosis. Strengthening perioperative management can improve the quality of operation and reduce the risk of mortality and morbidity during hospitalization.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis with surgical taboos or high risk. With the update of the guidelines, the indication of TAVR has been extended to the intermediate-risk aortic stenosis population, and even has a tendency to further expand to the low-risk population. This review highlights the research progress and new evidence of TAVR in respects of patient selection, valve and approach selection, ethnic differences, and surgical complications such as perivalvular leakage, cardiac conduction block, vascular complications, stroke, acute kidney injury, and coronary artery occlusion.
Objective To compare perioperative outcomes of minimally invasive aortic valve surgery by a right anterior minithoracotomy (RAMT) and conventional sternotomy. Methods A retrospective analysis of patients who underwent isolated aortic valve surgeries in our hospital between May 2021 and August 2023 with a minimal incision via the right anterior minithoracotomy approach (a RAMT group) or conventional incision via the full sternotomy approach (a conventional group). A propensity score-matching analysis was performed to balance preoperative data and compare perioperative data of the two groups. ResultsThere were 58 patients in the RAMT group, including 46 males and 12 females with an average age of 52.0±14.1 years; 128 patients were enrolled in the conventional group, including 87 males and 41 females with an average age of 60.0±12.4 years. After propensity-score matching, there were 51 patients in each group. The RAMT patients had a longer mean operation time, cross-clamping time and cardiopulmonary bypass time compared to the conventional group (all P<0.05). However, ICU length of stay, ventilator-assisted time and postoperative hospital stay were significantly shorter in the RAMT group (all P<0.05). Patients in the RAMT group had lower 24 hour chest drain output (P<0.05). RAMT was associated with a trend towards a lower blood transfusion rate in comparison to the sternotomy group, although this was not statistically significant (P>0.05). The occurrence of all-cause death, stroke and perioperative complications was also similar in both groups (P>0.05). Conclusion Right anterior mini-thoracotomy is associated with less trauma, faster recovery, less postoperative drainage, and shorter hospital stay than conventional approach. Right anterior mini-thoracotomy in patients undergoing isolated aortic valve surgery is a safe approach and can be performed by a wide range of surgeons.
ObjectiveTo investigate the early clinical efficacy of minimally invasive coronary artery bypass grafting (MICS CABG) for multivessel coronary artery disease. MethodsThe patients who received off-pump coronary artery bypass grafting in the Central China Fuwai Hospital of Zhengzhou University from June 2021 to June 2023 were enrolled. Patients were divided into two groups according to the operative technique used, including a traditional midline sternotomy group where the full median sternotomy was performed, and a left chest small incision group where left anterior mini-thoracotomy was performed. The clinical data of the two groups were compared. ResultsA total of 143 patients were enrolled, including 70 patients in the traditional midline sternotomy group and 73 patients in the left chest small incision group. The age of the patients in the left chest small incision group and the traditional midline sternotomy group was 63.8±8.0 years and 63.0±7.8 years, respectively; the proportions of males were 69.9% and 74.3%, respectively. The differences were not statistically significant (all P>0.05). All patients in the two groups successfully completed the operation, and no patients in the left chest small incision group were converted to thoracotomy. The patients in the left chest small incision group showed less postoperative drainage within postoperative 24 hours (239.4±177.7 mL vs. 338.0±151.9 mL, P<0.001), lower perioperative blood transfusion rate [32.9% (24/73) vs. 51.4% (36/70), P=0.028], higher postoperative myoglobin level within postoperative 24 hours [366.1 (247.9, 513.0) ng/mL vs. 220.8 (147.2, 314.9) ng/mL, P<0.001], shorter intensive care unit stay [45.5 (31.5, 67.5) h vs. 68.0 (46.0, 78.5) h, P=0.001] and postoperative hospital stay (10.8±4.0 d vs. 13.1±5.3 d, P=0.028] compared to the traditional midline sternotomy group. There was no significant difference in the incidence of major adverse cardiac and cerebrovascular event between the two groups [2.7% (2/73) vs. 2.9% (2/70), P=1.000]. ConclusionCompared to the full median sternotomy, MICS CABG leads to a good clinical result with smaller trauma, faster overall recovery, and less perioperative blood transfusion.
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.
In recent years, the number of lung surgeries has increased year by year, and the number of patients with postoperative cough has also increased gradually. Chronic cough after lung surgery seriously affects patients' quality of life and surgical outcome, and has become one of the clinical problems that clinicians need to solve. However, there is currently no guideline or consensus for the treatment of chronic cough after lung surgery in China, and there is no standardized treatment method. Therefore, we searched databases such as PubMed, Web of Science, CNKI, and Wanfang databases ect. from 2000 to 2023 to collected relevant literatures and research data, and produced the first expert consensus on chronic cough after lung surgery in China by Delphi method. We gave 11 recommendations from five perspectives including timing of chronic cough treatment, risk factors (surgical method, lymph node dissection method, anesthesia method), prevention methods (preoperative, intraoperative, postoperative), and treatment methods (etiological treatment, cough suppressive drug treatment, traditional Chinese medicine treatment, and postoperative physical therapy). We hope that this consensus can improve the standardization and effectiveness of chronic cough treatment after lung surgery, provide reference for clinical doctors, and ultimately improve the quality of life of patients with chronic cough after lung surgery.