Risk factors for prolonged postoperative ICU stay in the patients with Stanford type A aortic dissection.

OBJECTIVE: To investigate the independent risk factors for postoperative prolonged ICU stay in patients with Stanford type A aortic dissection (TAAD) and assess the clinical outcomes of prolonged ICU stay. METHOD: The clinical data of 100 patients with TAAD admitted to the Department of Cardiovascular Surgery, First Affiliated Hospital of Anhui Medical University from December 2018 to September 2022 were retrospectively collected and analyzed. Patients were divided into two groups, based on the postoperative ICU stay (7 days as the threshold), regular ICU stay group (< 7 days) and prolonged ICU stay group (≥ 7 days). First, preoperative and intraoperative materials were collected for univariate analysis. Then, the significant variables after univariate analysis were analyzed using logistic regression, and the final independent risk factors for prolonged ICU stay were determined. Meanwhile, the postoperative clinical outcomes were analyzed with the aim of assessing the clinical outcomes due to prolonged ICU stay. RESULTS: There were 65 and 35 patients in the regular ICU stay group and the prolonged ICU stay group, respectively. In accordance with the result of univariate analysis in the two groups, emergency surgery (χ2 = 13.598; P < 0.001), preoperative urea nitrogen (t = 3.006; P = 0.004), cardiopulmonary bypass (CPB) time (t = 2.671; P = 0.001) and surgery time (t = 2.630; P = 0.010) were significant. All significant variates were analyzed through logistic regression, and it was found that emergency surgery (OR = 0.192; 95% CI: 0.065-0.561), preoperative urea nitrogen (OR = 0.775; 95% CI: 0.634-0.947) and cardiopulmonary time (OR = 0.988; 95% CI: 0.979-0.998) were independent risk factors for prolonged postoperative ICU stay. The Receiver Operating Characteristic (ROC) curves of these three factors were also effective in predicting postoperative prolonged ICU stay (Emergency surgery, AUC = 0.308, 95% CI: 0.201-0.415; Preoperative urea nitrogen, AUC = 0.288, 95% CI: 0.185-0.392; cardiopulmonary time, AUC = 0.340, 95% CI: 0.223-0.457). Moreover, compared with a single factor, the predictive value of combined factors was more significant (AUC = 0.810, 95% CI: 0.722-0.897). For the comparison of postoperative data in the two groups,, compared with the regular ICU stay group, the incidence of adverse events in the prolonged ICU stay group increased significantly, including limb disability of limbs (χ2 = 22.182; P < 0.001), severe organ injury (χ2 = 23.077; P < 0.001), tracheotomy (χ2 = 17.582; P < 0.001), reintubation (χ2 = 28.020; P < 0.001), 72 h tracheal extubation after surgery (χ2 = 29.335; P < 0.001), 12 h consciousness recovery after surgery (χ2 = 18.445; P < 0.001), ICU re-entering (χ2 = 9.496; P = 0.002) and irregular discharging (χ2 = 24.969; P < 0.001). CONCLUSION: Emergency surgery, preoperative urea nitrogen, and CPB time are risk factors for postoperative prolonged ICU stay after TAAD surgery. Furthermore, prolonged ICU stay is associated with worse clinical outcomes. Hence, a reasonable strategy should be adopted proactively focusing on the risk factors to shorten ICU stays and improve clinical outcomes.

Assisted Da Vinci robotic surgery combined with 3D printing technology applied in septal myectomy.

Generally, the standard surgical route of Morrow begins with the incision of median sternal, which leads to more trauma, pains and discomforts to patients with hypertrophic obstructive cardiomyopathy (HOCM). It is more difficult and rough to perform the competed resection of hypertrophic myocardium due to complicated anatomical morphology of left ventricular outflow tract and limited visual field of left ventricle during surgery. As the novel surgical strategy, firstly, under the guiding of 3D printing technology, the platform of effective preoperative evaluation focusing on how to resect the hypertrophic myocardium is established. Then, combined with assisted Da Vinci robotic surgery system, the outcome of patient with HOCM is positive and promised.

The surgical strategy of hormonally active primary cardiac paraganglioma sarcoma: A case report.

Cardiac paraganglioma is a kind of rare neuroendocrine tumor characterized by the persistent secretion of catecholamines. Under excessive exposure of catecholamines, some atypical symptoms are presented, including hypertension, arrhythmias, and headache. The case of surgical treatment of a 28-year-old woman with primary cardiac paraganglioma is presented for experience sharing and surgical skill improvements.

The Surgical Strategy for Progressive Dilatation of Aortic Root and Aortic Regurgitation After Repaired Tetralogy of Fallot: A Case Report.

It has been found that postoperative progressive dilatation of aortic root is not rare for adult patients with repaired Tetralogy of Fallot (TOF), which leads to severe aortic regurgitation or even fatal dissection. Therefore, clinically, surgical treatment for both regurgitated aortic valve and dilated root is needed based on preoperative assessments and individual treatment strategies.

The spatial distribution of microplastic in the sands of a coral reef island in the South China Sea: Comparisons of the fringing reef and atoll.

Microplastic pollution of coral reef ecosystems has received increasing attention since the discovery that several typical coral types have the ability to ingest (micro-) plastics. However, data on the distribution of microplastics in coral reef ecosystems are still very limited. The study reported here selected sands/sediments from coral reef islands located in the South China Sea as a representative study site. The abundance of microplastics was found to reach 90 ±â€¯5 items/kg and 530 ±â€¯7 items/kg at the Weizhou Island and Sanya Lu Hui Tou (LHT) sites (fringing reef), respectively. Each of these qualities are lower than the quantity of microplastics collected from the Xisha Islands (atoll) (60 ±â€¯3 to 610 ±â€¯11 items/kg), which experiences less human activity and pollution. Moreover, further investigation demonstrated that the differences in the microplastics in the sands of these atolls and fringing reefs were determined not only by their sources, but were also dependent on their water exchange rates. The primary type and color of the microplastics found in these four sampling zones was red polypropylene and there was a greater proportion of smaller size particles (<1 mm) in the remote atolls of the Nansha and Xisha islands than in the other fringing reef sites. Additionally, there were no obvious differences found in the abundance of microplastics and the compositions/structures of coral sand in the Weizhou Island and Sanya LHT sites.