ABSTRACT
@#Objective To analyze the clinical efficacy of transthoracic occlusion via a right subaxillary incision and conventional surgery in the treatment of ventricular septal defect (VSD). Methods The clinical data of patients with congenital VSD undergoing right subaxillary incision surgery in our hospital from January 2017 to January 2020 were retrospectively analyzed. According to the surgical methods, the patients were divided into two groups: a conventional surgery group (conventional group) and a transthoracic occlusion group (occlusion group). There were 221 patients in the conventional group, including 97 males and 124 females, with an average age of 2.6±2.2 years and an average weight of 13.4±6.2 kg; there were 185 patients in the occlusion group, including 90 males and 95 females, with an average age of 3.2±2.6 years and an average weight of 14.7±6.6 kg. The clinical effectiveness was compared. Results The success rate of surgery was 100% in both groups. The intraoperative blood loss was less in the occlusion group (P<0.05). The incision length, operation time, postoperative mechanical ventilation time, retention time in the intensive care unit, the time to resume normal diet and normal activities after operation were all shorter than those in the conventional group (P all <0.05). The total cost during hospitalization of the conventional group was less than that of the occlusion group (P<0.001). There was no statistical difference in the incidence rate of perioperative complications between the two groups (P>0.05). During the follow-up (15.8±8.8 months), the incidence of complications in the conventional group was higher than that in the occlusion group with a statistical difference (P<0.001). Conclusion Compared with conventional surgery, transthoracic occlusion for VSD via right subaxillary incision has the advantages of smaller incision, shorter operation time, less blood loss, shorter postoperative recovery time and less long-term complications. However, the total hospitalization cost is relatively high, mainly because of the high consumables cost, and the long-term effects still need further comparative observation.
ABSTRACT
Objective:To investigate the safety and early and mid-term efficacy of upper sternal mini-incision with debranching technique in B aortic dissection involving the arch.Methods:18 patients with B aortic dissection involving the arch who were admitted into our center from November 2017 to January 2019 were enrolled, to evaluate the intraoperative and postoperative conditions, including special intraoperative treatment, time of operation、poseoperative drainage、time of use ventilators, time of staying in ICU, complications etc, 12-24 months follow-up were performed after operation.Results:No death occurred, 1 case with acute renal failure, 1 case with type I endoleak, 1 case with paraplegia occurred during hospitalization, 1 patient with sudden vomiting of blood 30 days after discharge from hospital who was found aortoesophageal fistula, underwent emergency surgery to replace thoracic aortic and repair esophageal fistula, all of them were cured and discharged, the rate of complication was 22.2%(4/18). none of the other patients had any phenomena such as agnail、distal rupture、twisted or displaced of the stents、ischemic of coronary artery、cerebrovascular accident, etc.Conclusion:The result of upper sternal mini-incision with debranching technique in B aortic dissection involving the arch is satisfied, the early and mid-term survival rate is significantly improved, the patient's prognosis are improved.
ABSTRACT
@#Objective To investigate the application of ascending aorta cannulation and brachiocephalic trunk cannulation in acute type A aortic dissection. Methods We screened 183 patients with acute type A aortic dissection from January 2017 to January 2020 in our hospital. They were divided into 2 groups according to the cannulation strategy: ascending aorta cannulation and brachiocephalic trunk cannulation (a DAC group, n=42, 33 males and 9 females with a median age of 50 years) and the single axillary artery cannulation (an AAC group, n=141, 116 males and 25 females with a median age of 51 years). The general clinical data, intraoperative data and early postoperative results of the two groups before and after matching with propensity scores were compared. Results Before propensity-score matching, the operation time, cardiopulmonary bypass time, aortic occlusion time and ICU stay in the DAC group were all shorter than those in the AAC group (P<0.05). The early postoperative mortality, and rates of brain complications, renal failure and pulmonary complications in the DAC group were significantly lower than those in the AAC group. After propensity-score matching, the operation time in the DAC group was significantly shorter than that in the AAC group (P<0.05). The early postoperative mortality, and rates of brain complications and pulmonary complications in the DAC group were significantly lower than those in the AAC group. Conclusion Ascending aorta cannulation and brachiocephalic trunk cannulation can provide a safe, fast and effective method of establishing cardiopulmonary bypass for some acute type A aortic dissection patients, and significantly shorten the operation time without increasing surgical complications.
ABSTRACT
@#Objective To reveal the risk factors for delayed recovery and complications in infants with weight≤ 5.0 kg after surgical ventricular septal defect (VSD) closure. Methods We retrospectively reviewed a consecutive series of 86 patients with weight≤5.0 kg who were admitted to our institution for surgical VSD closure between January 2016 and July 2019, including 31 males and 55 females with an age of 17-266 (80.3±40.4) d and a weight of 2.5-5.0 (4.4±0.6) kg. The VSDs were divided into perimembranous (n=65, 75.6%), subaortic (n=17, 19.8%) and subaortic combined muscular types (n=4, 4.7%). Mechanical ventilation (MV) time≥24 h or ICU stay≥72 h were defined as delayed recovery. Death, sudden circulatory arrest, complete heart block requiring a permanent or temporary pacemaker implantation, neurological complications, reoperation (for residue shunt or valvular regurgitation), reintubation and diaphragmatic paralysis were considered as significant major adverse events. Results There was no death, reoperation due to residual VSD or neurological complication. Totally 51 (59.3%) patients had MV timec≥24 h and 51 (59.3%) patients stayed in the ICU≥ 72 h. Two (2.3%) patients required temporary pacemaker and six (7.0%) patients required reintubation. During the follow-up of 3-36 (15.8±8.8) months, 1 patient died of pneumonia after discharge, 5 patients suffered mild tricuspid valve regurgitation and 1 patient suffered decreased left ventricular systolic function in the follow-up. No aortic valve injuries occurred. Conclusion For patients whose weight≤5.0 kg, short-term results of surgical VSD closure are excellent. Low weight and age may prolong MV time; low birth weight and pulmonary hypertension may prolong ICU stay, but are not independent risk factors.
ABSTRACT
Objective To discuss the application of deep hypothermic circulatory arrest in surgical treatment of complex thoracoabdominal aortic aneurysms and its near-midterm effect.Methods The clinical data of 34 cases of thoracoabdominal aortic aneurysm in the center from August 2009 to June 2018 were analyzed retrospectively.All the patients underwent surgery under deep hypothermic circulatory arrest.There were 23 males and 11 females; aged 23 -67 years, mean(42.26 ±10.96) years old; Crawford type Ⅰ in 12 cases and Crawford type Ⅱ in 22 cases; aneurysms with a maximum diameter of 50 -120 mm, mean(65.26 ±16.09) mm;Marfan syndrome 15 cases, atherosclerosis 14 cases, aortic coarctation in 5 cases;22 cases of hypertension;28 cases of first aortic surgery, 6 cases of re-aortic surgery.Surgical transthoracic and abdominal incision, ext-racapsular approach, femoral artery and inferior vena cava intubation, deep hypothermic circulatory arrest technique to complete proximal anastomosis, arterial tube reconstruction of intercostal artery, abdominal organ blood supply artery and four The bifur-cated vessels were anastomosed, and the bifurcated vessels were anastomosed with the "Y"type artificial blood vessel trunk. The bilateral radial arteries were end-to-end anastomosis in the 10 mm artificial blood vessels of the "Y"type artificial blood vessels.Results There were no complications of cranial nerve system in the whole group , deep hypothermic circulatory arrest (17.68 ±4.88) min, ventilator assist time(34.88 ±16.04) hours, postoperative renal failure in 5 cases, after CRRT treat-ment After recovery, 1 case of paraplegia after operation, muscle strength recovered after cerebrospinal fluid drainage and de-compression, and 1 case died in the whole group, and died of multiple organ failure.The patients were followed up for 3 months to 5 years, and the results were satisfactory.The survivors did not die.The survivors did not die.However, 5 patients underwent thoracic aortic replacement under deep hypothermic circulatory arrest for the first time , and 4 patients underwent reo-peration because of distal vasodilation.The reconstructed intercostal artery occlusion occurred in 4 patients, but no paraplegia occurred.Conclusion When cross clamping the aorta is not feasible,it is safe to perform proximal anastomosis with deep hy-pothermic circulatory arrest.
ABSTRACT
Objective To explore the treatment experience of acute type-A aortic dissection with lower limb malperfusion.Methods From December 2012 to December 2016,479 cases of acute type A aortic dissection were treated surgically,including 39 patients with lower limb ischemia,including 27 males and 12 females,with mean age of(5 1.4 ± 12.4) years.All patients were treated with deep hypothermic circulatory arrest and were treated with single pump,double-tube and double-injected limbs.According to the patient's lower limb ischemia time,symptoms and signs,limb ischemia was assessed.If necessary,femoral artery-femoral arterial bypass was performed.For patients undergoing femoral arterial-femoral prosthetic bypass during the same period,postoperative follow-up monitoring,if necessary,secondary femoral-femoral arterial vascular bypass or osteofascial decompression.Results Early mortality rate was 17.9％ (7/39).32 cases of postoperative survival.The follow-up rate was 93.8％ (30/32),3 months to 3 years after the operation,the results were satisfactory.The over lower limb malperfusion recovery rate of follow-up patients was 96.7％ (29/30).Conclusion Positive operation for acute type-A aortic dissection with lower limb malperfusion is safe,feasible and effective.Concomitant or secondary bypass procedures are also possible to restore distal perfusion when necessary.Comprehensive evaluation of patient' s status is strongly recommended for optimal surgical decision making.
ABSTRACT
Objective To investigate the blood-saving effect of tranexamic acid in patients undergoing Stanford type A aortic dissection surgery.Methods Fifty-six patients of both sexes with acute Stanford type A aortic dissection, aged 34-58 yr, weighing 62-84 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ , with their left ventricular ejection fraction ＞ 40％, undergoing emergency surgery, were randomly divided into 2 groups: control group (group C, n=26) and tranexamic acid group (group TA, n=30).Tranexamic acid was infused as a bolus of 10 mg/kg over 30 min before skin incision followed by an infusion of 10 mg · kg-1 · h-1 throughout the surgery in group TA.The equal volume of normal saline was given instead in group C.The total volume of drainage at 24 h after operation, the postoperative requirement of allogeneic red blood cells, fresh frozen plasma and platelets, and re-thoracotomy for bleeding were recorded.The postoperative mechanical ventilation time, duration of intensive care unit stay, and complications after operation were also recorded.Results Compared with group C, the total volume of drainage at 24 h after operation, and the requirement of allogeneic red blood cells, fresh frozen plasma and platelets were significantly reduced, the incidence of rethoracotomy for bleeding was decreased, the postoperative mechanical ventilation time, and duration of intensive care unit stay were shortened, and the incidence of postoperative acute lung injury and transient neurological dysfunction were decreased in group TA.Conclusion Tranexamic acid has blood-saving effect and can reduce postoperative bleeding and allogeneic blood transfusion in patients undergoing Stanford type A aortic dissection surgery.
ABSTRACT
Objective To investigate the clinical efficacy of mesalazine combined with bifico in the treatment of ulcerative co -litis (UC) and its effect on toll-like receptor 4 (TLR4) and myeloid differentiation factor 88 (MyD88).Methods A total of 86 cases of UC was randomly divided into the observation and control groups with 43 cases in each group .The observation group was given me-salazine combined bifico treatment , and the control group was given mesalazine , and eight weeks as a course of treatment .The clinical efficacy was observed .Serum TLR4 and MyD88 were tested.Adverse reaction in treatment was recorded .Results The total effective rate (95.35%) in observation group was significantly higher than that (81.40%) in control group( P 0.05 ) .Conclusions Mesalazine combined with bifico in the treatment of UC is safe and effective . The effect may be related to regulation of peripheral blood TLR 4 and MyD88 content .
ABSTRACT
Objective To analyze the mortality in people aged 70 years and over who had undergone aortic valve replacement (AVR) for aortic stenosis.Methods The clinical data of 246consecutive cases aged 70 years and over,who had received AVR,were retrospectively analyzed.The 144 cases (58.5 % ) had hypertension,42 cases ( 17.1 %) had atrial fibrillation,27 cases ( 11.0 % )were obeses,and 18 cases (7.3%) had undergone previous heart surgery.Results The 29 cases (11.8%) were dead within 30 days after operation.Among them,15 cases (8.8%) were with isolated AVR and the other 14 cases (18.7%) were with an associate procedure,the difference was significant (P ＜ 0.05).The rate of postoperative complication was 24 .4%.The commoncomplications were:48 cases (19.5%) with low cardiac output,24 cases (9.8%) with renal dysfunction,52 cases (21.1% ) with prolonged ventilatory support and 12 cases (4.9%) with sepsis.In the Poisson regression analysis,the main predictors of mortality were low cardiac output,renal failure,sepsis and associate procedure.The main predictors of morbidity were CBP time ＞ 120 min,atrial fibrillation and chronic obstructive pulmonary disease.Conclusions The balance between the benefits and risks of the surgery should be well evaluated before deciding to perform AVR.
ABSTRACT
Objective To explore the radical surgery for tetralogy of Fallot combined with right pulmonary artery stenosis.Methods Thirteen cases with tetralogy of Fallot combined with right pulmonary artery stenosis accepted radical surgery,among them 7 cases who-had a long right pulmonary artery stenosis accepted aortic transaction for radical surgery of tetralogy of Fallot;5 cases who had the entrance stenosis of the right pulmonary artery accepted right pulmonary artery patch expansion for radical surgery of tetralogy of Fallot;One case who had the distortion and stenosis after pulmonary shunt accepted the radical surgery for tetralogy of Fallot after seperation and expansion.Results There were no operation-related deaths,post-operative low cardic output and perfusion lung occurred for all the cases.Ten cases had grade 1 cardiac function and 3 cases had grade 2,respectively.Conclusion Right pulmonary artery stenosis increased the risks during the radical surgery for tetralogy of Fallot,but it is still the primary operation choice.
ABSTRACT
Objective To evaluate the value of carotid artery bruit in predicting carotid stenosis in patients with cerebral arterial thrombosis. Methods Two hundred cerebral arterial thrombosis patients were divided into bruit group and no bruit group according to carotid artery auscultation,with 100 cases in each group. The patients with cardiac murmur, vein sound and thyroid noise were excluded from bruit group. The examination of carotid artery auscultation (transcranial Doppler sonography ) was managed in all the patients,and digital subtraction angiography (DSA) about aortic arch and the whole brain were perfomed. The carotid stenosis rate, site, degree were compared and the relationship between carotid bruit grade and carotid stenosis degree were evaluated. Results The carotid stenosis rate in bruit group [67% (67/100)] was higher than that in no bruit group [29%(29/100)](P＜ 0.01 ). There was significant difference in the carotid stenosis site and degree between two groups (P ＜0.05). Carotid bruit were significantly associated with stenosis near carotid bifurcation or serious stenosis (P ＜ 0.05). The carotid bruit grade was positively related with the carotid stenosis degree (P ＜ 0.05 ). Conclusions Carotid bruit is associated with site and degree of carotid stenosis. Carotid bruit is valuable in screening for carotid stenosis in patients with cerebral arterial thrombosis.
ABSTRACT
Objective To evaluate the technique of coronary bypass grafting and its early result in 286 consecutive patients.Methods Two hundred and eighty-six patients from June 2002 to December 2005 underwent coronary artery bypass grafting.The average unmber of grafts was 3.3.Two hundred and eighty-three patients had left internal mammary artery bypassed to the left anterior descending branch.Other grafts were from saphenous veins.Results All patiens were clinical recovery.Respirator assisted within 0～28 hours(average 10).Conclusion Coronary artery bypass can be safely done with low mortality excellent surgical results even in patients with multi-vessel coronary artery disease.
ABSTRACT
Objective To evaluate the value of thoracotomy through small right subaxillary oblique incision for pediatric ventricular septal defect(VSD). Methods From November 2001 to December 2008,1539 children with VSD underwent thoracotomy through small right subaxillary oblique incision in our hospital.At the fourth intercostal space between the anterior and middle axillary lines,a straight or oblique incision was made,then along the inferior edge of the fourth rib the chest was opened,and the right edge of the pericardium was fixed at the thoracic retractor.Afterwards,off-pump circulation was established and minimally invasive cardiac surgery was carried out.Results The procedure was completed successfully in all the 1539 patients.The cross-clamp time was(22.8?11.4) min(11 to 48 min),and CPB time was(33.0?14.9) min(27 to 64 min).Two patients(0.13%,2/1539) died in 24 hours after the operation.One of them died of severe allergic reaction to protamine.And the other died of severe low cardiac output in 4 hours after the surgery,because of an injury to the left coronary artery.In this series,the postoperative complications included incisional infection in 3 cases,atelectasis in 9,perfusion lung in 5,low cardiac output in 5,infectious endocarditis in 3 and acute renal failure in 4.These 29 cases were discharged after the complications being cured.Follow-up was available in 1446 cases for(47.0?11.2) months(range,6~91 months).During the period,small residual shunts in the VSD were detected in 5 cases,and other cases showed no abnormalities.Conclusions Thoracotomy through small right subaxillary oblique incision is minimally invasive,safe and effective for pediatric VSD.
ABSTRACT
Objective Hotelling T2 Test was used to analyze the effect of sibutramine and to provide some information for new drug's exploration. Method Fifty-five patients with body mass index (BMI) over 25kg/m2 were selected according to generally accepted including and excluding criteria. The subjects were divided into 2 groups randomly. Control group was given placebo, and the experimental group were given sibutramine. Biological and biochemical indexes were examined pre-,during and post- clinical trial. Hotelling T2 test was used to compare the index mean vector of different phases. Results There were significant statistical differences between the two groups. (P
ABSTRACT
Objective To investigate the age related bone mineral density and the prevalence of osteoporosis at different skeletal sites in old women(age super-40 years) in Changsha countryside. Methods 627 healthy women from Changsha countryside (40 to 85 years)were involved. BMD measurements were taken at various sites,included anteroposterior and lateral lumbar spine, hip and forearm by Hologic QDR4500A dual energy X-ray absorptiometry (DEXA). Data were analyzed in-groups divided by an interval of every 5 years of age.Results ⑴Compared with 40 years～ old women, 75～85 years old women's total bone loss rates were highest at the word's triangle (56 62%) and lowest at the 1/3 site of the distal forearm (29 82～31 43%). ⑵The rank of osteoporosis detection rate from high to low after age 40 was lateral lumbar spine (38 72%), forearm, ward's triangle (27 52%) and anteroposterior lumbar spine ; femur neck and major trochanter (8 28% and 8 85%).⑶the prevalence of osteoporosis at least at one site of these women were(1 127?1 3)% in the age of 40～, (2 3?3 99)% in the age of 45～, (10 16?9 2)% in the age of 50～, (28 85?15 63)% in the age of 55～,(46 55?21 35)% in the age of 60～, (63 31?20 62)% in the age of 65～, (76 67?17 5)% in the age of 70～, (77 07?17 67)% in the age of 75～85. Before 60 years old the prevalence of osteoporosis stands out at lumbar spine (P