Carotid Endarterectomy with Stent Graft Removal and End to End Bypass in the Treatment of In-Stent Occlusion after Endovascular Therapy of Carotid Gunshot Injury.

Carotid jugular fistula and pseudoaneurysm are easy to form after gunshot injury of carotid artery. Endovascular therapy, such as stent graft implantation, can successfully block the fistula and pseudoaneurysm cavity. However, the possibility of in-stent restenosis or occlusion will lead to treatment failure. The authors describe the case of a 30-year-old man with carotid jugular fistula and pseudoaneurysm after gunshot injury of left carotid artery who had received stent graft placement. However, two years after stent graft, the stenosis of proximal carotid artery near stent was found and gradually aggravated. During the follow-up, transient amaurosis of his left eye occurred intermittently and in-stent occlusion and severe stenosis of proximal carotid artery were found by computed tomography angiography (CTA) in our center. Carotid endarterectomy (CEA)with stent graft removal and end to end bypass using vascular graft was performed to reconstruct the blood flow of left carotid artery. To the extent of the authors' knowledge, this case illustrates a rare CEA and vascular graft bypass in the treatment of in-stent occlusion following the gunshot injury to the carotid artery. The successful treatment of this rare case provides an option to deal with this kind of tricky problem.

Simulation Training in Minimally Invasive Direct Coronary Artery Bypass Grafting.

BACKGROUND: To evaluate the effect of minimally invasive direct coronary artery bypass (MIDCAB) simulator for cardiac residency training. METHODS: A total of 26 resident surgeons who had never trained for coronary artery anastomosis participated in this training program. They received coronary artery anastomosis training on off-pump coronary artery bypass grafting (OPCAB) simulator for 15 h. After training, their performance of anastomosis was evaluated on the OPCAB simulator according to 12 items and a 5-point global rating scale. Based on the total score of assessment, those with an individual score of 12-36 formed group A, while group B was composed of the remaining trainees. The two groups then received another 15 h coronary artery anastomosis training on the MIDCAB simulator, and the performance was assessed. RESULTS: Trainees improved their performance of coronary artery anastomosis after training on the OPCAB simulator. Group A was composed of 7 trainees with an individual with a total score of 12-36 points and group B was composed of the remaining 19 trainees. After MIDCAB simulator training, significant differences were noted in the pre- and post-training values in the A group (P < .001), and the assessment value of group A was significantly better than those of group B (P < .05). No significant difference was detected between pre- and post-training values in group B after MIDCAB simulator training (P > .05). CONCLUSION: We concluded that trainees who performed well in OPCAB simulation training can also perform better in MIDCAB, and our designed MIDCAB simulator was useful for residency training.

Experience with porcine beating heart simulator for coronary artery bypass surgery residency training.

OBJECTIVE: To evaluate the effect of our uniquely designed beating heart simulator for coronary artery bypass surgery residency training. METHODS: The balloon of intra-aortic balloon pump (IABP) was inserted into the left ventricle of an isolated porcine heart to form a beating heart simulator. This model simulated off-pump coronary artery bypass grafting (OPCABG), and the nonbeating heart model simulated the on-pump coronary artery bypass grafting (ONCABG) for training of surgeons. From 2017 to 2019, 60 trainees were randomly divided into nonbeating and beating heart simulator training groups. The training period was 3 months. The performance of anastomosis was evaluated at the beginning (after 1 month), midpoint (after 2 months), and at the end of the assessment (after 3 months). RESULTS: Trainees improved their performance of coronary artery anastomosis respectively after 3 months of training, whether they were trained on beating heart simulator or nonbeating heart simulator (P < .05). On both nonbeating and beating heart simulator test, trainees in the beating group performed better than those in the nonbeating group in the use of microsurgical instruments, anastomotic quality, and anastomotic speed after 3 months of training (P < .05). CONCLUSIONS: The effect of our uniquely developed beating heart simulator training was better than those of nonbeating heart simulator for OPCABG and ONCABG training of surgeons during residency.

Influence of CaR-CaMCSE-H2S pathway on ischemia reperfusion related oxidative stress / 心血管康复医学杂志

Objective :To analyze influence of calcium sensitive receptor/cystathionine-γ-lyase hydrogen sulfide (CaR-CaM/CSE-H2S) pathway on ischemia reperfusion (I/R ) related oxidative stress .Methods :A total of 50 CSE gene knockout rats were selected as CSE gene knockout group ,another 50 normal rats were simultaneously enrolled as normal control group .Myocardial ischemia reperfusion injury (MIRI ) model was established in only CSE gene knockout group .Plasma total antioxidant capacity ,levels of reactive oxygen species (ROS) ,superoxide dismutase (SOD ) and malonyl diadehyde (MDA ) , expressions of cell apoptosis indexes (Bax , Bcl-2 , Caspase-3 mRNA , Caspase-8 mRNA ,Caspase-9 mRNA) ,calcium sensitive receptor (CaR) expression ,CSE activity and H2S content were measured and compared between two groups .Results : Compared with normal control group ,there were sig-nificant reductions in plasma total antioxidant capacity [(11.78 ± 1.14) U/ml vs.(10.20 ± 1.25) U/ml] ,SOD level [ (772.79 ± 5.21) nmol/L vs.(558.94 ± 5.36) nmol/L] ,CaR expression [ (2.85 ± 1.01)% vs.(1.04 ± 0.33)% ] , CSE activity [ (18.30 ± 1.70) nmol·L-1·min-1·g prot vs.(11.50 ± 1.50) nmol·L-1·min-1·g prot] and H2 S content [ (48.55 ± 1.35) μmol/g prot vs .(30.59 ± 1.41) μmol/g prot] ,and significant rise in levels of ROS [ (90.48 ± 1.42) U/ml vs.(99.74 ± 1.45) U/ml] and MDA [ (4.33 ± 1.15) U/ml vs.(4.98 ± 1.12) U/ml] ,ex-pressions of Bax [ (0.25 ± 0.05) vs.(0.47 ± 0.23)] ,Bcl-2 [ (0.18 ± 0.02) vs.(0.35 ± 0.05)] ,Caspse-3 mRNA [ (0.16 ± 0.04) vs.(0.25 ± 0.05)] ,Caspse-8 mRNA [ (0.20 ± 0.10) vs.(0.44 ± 0.15)] and Caspse-9 mRNA [(0.05 ± 0.01) vs.(0.15 ± 0.05)] in CSE gene knockout group ,P＜0.01 all.Conclusion :During I/R ,coronary en-docardial CaR expression down regulates ,CSE activity reduces and endogenous H2S generation decreases ,which ag-gravate oxidative stress injury caused by I/R .