Abstract： Arginine vasopressin （AVP） is closely related to the pathogenesis of a variety of cardiovascular diseases and kidney diseases. Currently it is often used for the treatment of severe peripheral vasodilatory shock， and particularly beneficial for patients with refractory catecholamine-resistant vasodilatory shock. For some patients who do not have adequate AVP level in plasma after cardiovascular surgery， external low-dose AVP infusion is helpful to decrease the heart rate, and the dosage and duration of catecholamine use. Early initiation of low-dose AVP infusion may be beneficial for postoperative patients’ hemodynamic recovery without adverse complications. More randomized control trials are needed to provide evidence for rational usage， dosage and duration of AVP administration.
In recent years，West China Hospital of Sichuan University actively participated in medical assistance and rescue in Wenchuan，Yushu and Lushan earthquakes. However，professional roles of cardiovascular surgeons in medical assistance and rescue in earthquakes remain unclear because of the particularity of cardiovascular surgery, which often affects the assembly of medical assistance and rescue teams. Thus，we need to explore the necessity for cardiovascular surgeons to join medical rescue teams within 72 hours after earthquake. In this article，medical rescue work of cardiovascular surgeons within 72 hours after 2008 “5•12” Wenchuan earthquake and 2013 “4•20” Lushan earthquake is analyzed and compared to identify professional roles of cardiovascular surgeons in medical rescue within 72 hours after earthquake. It is necessary for cardiovascular surgeons to join medical rescue teams within 72 hours after earthquake.
Objective To introduce a novel approach using parallel placement of another oxygenator in the recirculation line as oxygen supply for oxygenator failure without circulatory arrest in cardiopulmonary bypass （CPB），and confirm its outcomes in an animal experiment. Methods A traditional piglet CPB model was established. Oxygenator failure model was established by reducing fraction of inspired oxygen （FiO2） from 80% to 21% after aortic cross-clamp and cardiac arrest in CPB. Another oxygenator was then parallel placed in the recirculation line to supply 100% oxygen.Dynamic changes in partial pressure of oxygen （PaO2），mixed venous oxygen saturation （SvO2），arterial oxygen saturation（SaO2） and blood pH of blood samples from the arterial perfusion duct were monitored with different blood flow of400 ml/min，800 ml/min and 1 100 ml/min. Results When FiO2 was reduced to 21%，PaO2 decreased to 64-67 mm Hg（P＜0.001），SaO2 decreased significantly to 88%-90% （P＜0.001），SvO2 decreased to 69%-72% （P＜0.001），and blood pH decreased too，all indicating oxygenator failure. After parallel placement of another oxygenator in the recirculation line was performed，PaO2，SaO2 and SvO2 all significantly increased，as well as blood pH. When the blood flow in the recirculation line achieved 33% or above of overall arterial perfusion flow，clinical oxygen demand was generally satisfied. Conclusion Parallel placement of another oxygenator in the recirculation line may be utilized as a treatment strategy for oxygenator failure without circulatory arrest and changeover of failed oxygenator.
Objective To summarize treatment experience and evaluate clinical outcomes of surgical therapy for Stanford type A aortic dissection （AD）. Methods Clinical data of 48 patients with Stanford type A AD who underwent surgical treatment in General Hospital of Lanzhou Military Region from October 2006 to March 2013 were retrospectively analyzed. There were 41 males and 7 females with their age of 26-72 （47.6±9.2） years. There were 43 patients with acute Stanford type A AD （interval between symptom onset and diagnosis＜14 days） and 5 patients with chronic AD. There were 19 patients with moderate to severe aortic insufficiency and 6 patients with Marfan symdrome but good aortic valve function，who all received Bentall procedure，total arch replacement and stented elephant trunk implantation. There were 8 patients with AD involving the aortic root but good aortic valve function who underwent modified David procedure，total arch replacement and stented elephant trunk implantation. There were 10 patients with AD involving the ascending aorta who received ascending aorta replacement，total arch replacement and stented elephant trunk implantation. There were 5 patients with AD involving partial aortic arch who underwent ascending aorta and hemiarch replacement. Patients were followed up in the 3rd，6th and 12th month after discharge then once every year. Follow-up evaluation included general patient conditions，blood pressure control，chest pain recurrence，mobility and computerized tomography arteriography （CTA）. ResultsCardiopulmonary bypass time was 121-500 （191.4±50.6） minutes，aortic cross-clamp time was 58-212 （112.3±31.7） minutes，and circulatory arrest and selective cerebral perfusion time was 26-56 （34.8±8.7） minutes. Postoperative mechanicalventilation time was 32-250 （76.2±35.6） hours，and ICU stay was 3-20 （7.1±3.4） days. Thoracic drainage within 24 hours postoperatively was 680-1 600 （1 092.5±236.3） ml. Seven patients （14.5%） died perioperatively including 2 patients with multiple organ dysfunction syndrome，2 patients with low cardiac output syndrome，1 patient with renal failure，1patient with delayed refractory hemorrhage，and 1 patient with coma. Twenty patients had other postoperative complicationsand were cured or improved after treatment. A total of 38 patients ［92.7% （38/41）］ were followed up for 3-48 （13.0±8.9） months，and 3 patients were lost during follow-up. During follow-up，there were 36 patients alive and 2 patients who died of other chronic diseases. There was no AD-related death during follow-up. None of the patients required reoperation for AD or false-lumen expansion. CTA at 6th month after discharge showed no anastomotic leakage，graft distortion or obstruction.Conclusion According to aortic intimal tear locations，ascending aorta diameter and AD involving scopes，appropriate surgical strategies，timing and organ protection are the key strategies to achieve optimal surgical results for Stanford type A AD. Combined axillary and femoral artery perfusion and increased lowest intraoperative temperature are good methods for satisfactory surgical outcomes of Stanford type A AD.
Abstract： Objective To evaluate the incidence and prognosis of postoperative acute kidney injury （AKI） in patients after cardiovascular surgery， and analyse the value of AKI criteria and classification using the Acute Kidney Injury Network （AKIN） definition to predict their in-hospital mortality. Methods A total of 1 056 adult patients undergoing cardiovascular surgery in Renji Hospital of School of Medicine， Shanghai Jiaotong University from Jan. 2004 to Jun. 2007 were included in this study. AKI criteria and classification under AKIN definition were used to evaluate the incidence and in-hospital mortality of AKI patients. Univariate and multivariate analyses were used to evaluate preoperative， intraoperative， and postoperative risk factors related to AKI. Results Among the 1 056 patients， 328 patients（31.06%） had AKI. In-hospital mortality of AKI patients was significantly higher than that of non-AKI patients （11.59% vs. 0.69%， P＜0.05）. Multivariate logistic regression analysis suggested that advanced age （OR=1.40 per decade）， preoperative hyperuricemia（OR=1.97）， preoperative left ventricular failure （OR=2.53）， combined CABG and valvular surgery （OR=2.79）， prolonged operation time （OR=1.43 per hour）， postoperative hypovolemia （OR=11.08） were independent risk factors of AKI after cardiovascular surgery. The area under the ROC curve of AKIN classification to predict in-hospital mortality was 0.865 （95% CI 0.801-0.929）. Conclusion Higher AKIN classification is related to higher in-hospital mortality after cardiovascular surgery. Advanced age， preoperative hyperuricemia， preoperative left ventricular failure， combined CABG and valvular surgery， prolonged operation time， postoperative hypovolemia are independent risk factors of AKI after cardiovascular surgery. AKIN classification can effectively predict in-hospital mortality in patients after cardiovascular surgery， which provides evidence to take effective preventive and interventive measures for high-risk patients as early as possible.
Hybrid cardiovascular surgical procedure is an emerging concept that combines the skills and techniques of minimally invasive surgery and interventional catheterization. It allows surgeons to use interventional equipment and techniques during operations, which are traditionally used by physicians, in order to reduce the magnitude of therapeutic interventions and to increase therapeutic effectiveness. This review provides a snapshot of the main application and progress of current hybrid procedures in the field of cardiovascular surgery, including the hybrid therapy of coronary artery disease, congenital heart disease and thoracic aortic aneurysm, also discusses the precondition with which the hybrid procedure should ideally be performed.
Cardiopulmonary bypass(CPB) is associated with thrombocytopenia and platelet dysfunction. The primary cause of acquired platelet defect is thought to be activation and release of alpha granules during CPB. Before CPB, platelet-rich plasma (PRP) was prepared by obtaining the required amount of patient’s whole blood by autologous plateletpheresis. PRP could be reinfused after operation in order to protect the function and quantities of the platelets. On the other hand, PRP could be made into autologous platelet gel (APG). APG contains supraphysiologic amounts of growth factors, and has adequate tensile strength and adhesive ability. Therefore, it can be used for hemostasis in operation, sealing wound and enhancing incision or dehiscent sternal wounds healing.
ObjectiveTo analyze the causes and preventions of stent graft induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for Stanford type B dissection, particularly from the standpoint of biomechanical behavior of stent graft. MethodsSINE was defined as the new tear caused by the stent graft itself, excluding those arising from natural disease progression or any iatrogenic injury from the endovascular manipulation. Twentytwo patients with SINE were retrospectively collected and analyzed out of 650 cases undergoing TEVAR for type B dissection from August 2000 to June 2008 in our center. An additional case included was referred to our center in 14 months after TEVAR performed in another hospital. ResultsTotally, there were 24 SINEs found in 23 cases, including SINE at the proximal end in 15 cases, at the distal end in 7, and at both in 1, and 6 patients died. The incidence was 3.4% ( 22/650) in our hospital, and the mortality was 26.1% (6/23). All 16 proximal SINEs was located at the greater curve of the arch and caused retrograde type A dissection. All 8 distal SINEs occurred at the dissected flap, and 5 of them caused enlarging aneurysm while 3 remained stable. All 23 cases had the endograft placed across the distal aortic arch during the primary TEVAR. ConclusionsSINE is not rare following TEVAR for type B dissection, and associates with a high substantial mortality. The stress yielded by the endograft seems to play a predominant role in its occurrence. It is of significance to take the stressinduced injury into account during both design and placement of the endograft.
3D printing technology has a promising prospect of medical use and clinical value, and may play an important role in the field of thoracic and cardiovascular surgery, such as preoperative diagnosis, surgical planning, surgical approach alternatives and organ replacement. This review focuses on the development of 3D printing technology in recent years and its use and prospect in the field of thoracic and cardiovascular surgery including surgical teaching and simulation, personalized prosthesis implantation, and artificial organ transplantation.
ObjectiveTo investigate the clinical application of fresh autologous pericardial patch transplantation in cardiovascular surgery. MethodFrom January 2008 to December 2014, we used fresh autologous pericardial patch as a repair material in surgical treatment of congenital heart disease, valvular and vascular malformation. A total of 239 patients were included (130 males, 109 females), with a mean age of 0.40±13.80 years ranging from 0.25-69.00 years, including 180 infants. ResultThe time of intensive care unit (ICU) stay was 3-15 days and the time of ventilator-assisted breathing was 4-100 hours. Postoperative atelectasis and pleural effusion occured in 8 patients and was cured successfully by closed thoracic drainage and anti-infection therapy. Nine patients died within 30 days after surgery, including 3 deaths caused by low cardiac output syndrome and acute renal failure, 5 deaths caused by multiple organ failure, and 1 death caused by malignant arrhythmia. All patients had no infective endocarditis, thrombosis, hemolysis, blood vessel stenosis, or calcification of pericardial patch. The cause of death was associated with the primary lesion, but not with transplanted pericardium. We followed up 198 patients for 3-64 months. During follow-up, echocardiography showed no patch graft vegetation, thrombosis, perforation or calcification. ConclusionThe fresh autologous pericardium is a good material for repairing cardiac defects.