Short-and mid-term results after adventitial inversion technique for root repair in acute type A aortic dissection / 中华胸心血管外科杂志

Objective:To evaluate the safety and effectiveness of adventitial inversion technique for root repair in patients with acute type A aortic dissection(ATAAD).Methods:Between 2015 and 2018, ATAAD patients with dissected root and underwent open surgery were included. The exclusion criteria were as follows: previous root intervention, traumatic dissection and patient underwent root replacement(Bentall or David procedure). 490 ATAAD patients were included, 366(74.69%) male and 124(25.31%) female, aged(51.28±10.99) years(range 24-77 years). The clinical data were retrospectively analyzed with ANOVA/ nonparametric test and Chi- square test. Follow-up mortality and reoperation were displayed with Kaplan- Meier curve. Results:All patients were technically divided into three groups: adventitial inversion(A), direct suture(B) and Cabrol-shunt(C). The mean age in group A was(53.05±11.09) years, whereas worse cardiac and renal function occurred in group C. The mean duration of HCA, CPB and ACC were shortest, with a highest average of minimum rectal temperature during surgical interval in group A. Postoperative complications and early mortality were similar among groups. There were no significant differences of mid-term mortality and reoperation among these three techniques. Though no late reintervention for aortic root was found in both group A and B, the root diameter was more stable in group A during follow-up period[(33.14±3.74)mm vs.(34.51±3.83)mm vs.(33.89±3.89)mm, P=0.008]. Conclusion:Adventitial inversion technique is safe and effective for root repair in patients with ATAAD, achieving satisfactory short- and mid-term effects.

Early and mid-term results of type Ⅱ hybrid arch repair with zone 0 stent graft deployment for acute type A aortic dissection / 中华胸心血管外科杂志

Objective:By analyzing the early- and mid-term clinical results of type Ⅱ hybrid aortic arch repair(HAAR) for the treatment of acute type A aortic dissection(ATAAD), the efficacy of hybridization technique in the application of acute type A aortic dissection was evaluated systematically.Methods:We retrospectively studied the records of patients with ATAAD who were admitted to the Beijing Fuwai Hospital between January 2016 and December 2018. 504 patients were included for analysis , 383 men and 121 women, mean age(50.0±11.7) years, the rate of hypertension was 79.6%, the average time of onset to operation was(69.5±40.0) hours. During this period, 110 continuous patients underwent hybrid aortic arch repair(HAAR) without deep hypothermic circulatory arrest, the landing zone of stent was located in ascending aorta(zone 0); 394 consecutive patients with ATAAD involving the aortic arch received traditional total aortic arch replacement with frozen elephant trunk(FET). A propensity score-matching analysis was applied to adjust for age and gender.The preoperative, perioperative and postoperative data in the HAAR group and FET group were compared.Results:For all 504 patients , male patients accounted for 75.9%. There were 24 cases of early death(4.8%), 20 cases of stroke(4.0%) and 7 cases of paralysis(1.4%). HAAR group showed more age[(62.1±6.8) years vs (46.6±10.4) years, P<0.001)], hypertension(87.3% vs 77.4%, P=0.033), coronary artery disease(13.6% vs 6.1%, P=0.016) and chronic obstructive pulmonary diseases(12.7% vs 3.6%, P=0.001) than the FET group. HAAR group showed shorter cardiopulmonary bypass time[(143.7±53.7) min vs (175.3±52.7) min, P<0.001] and aortic cross-clamping time[(78.5±33.6) min vs (106.9±37.8) min, P<0.001] than the FET group. Between the two groups there was no significant difference in operative mortality, rate of reoperation, and late mortality. Follow-up period ranged from 2 to 43 months, averaged(22.6±11.1) months. During folloe-up period , there were 5 cases of death(4.9%) and 3 cases of reoperation(3.1%) in HAAR group, 10 cases of death(2.7%) and 11 cases of reoperation(3.3%) in FET group. 3 patients lost follow-up because of not been rechecked in the outpatient department or the phone was not connected. Conclusion:This single -stage hybrid arch procedure offers an alternative approach to acute type A dissection and associated with acceptable early and midterm major morbidity and mortality in old-age patients. Future further researches are required to confirm the long-term outcomes.

Surgical treatment of thoracic aortic graft infection / 中华胸心血管外科杂志

Aortic graft infections(AGI) are uncommon complications of aortic surgery, although they carry a high mortality. Due to its special anatomical location, the thoracic aorta has less surrounding covered tissue. Once the graft infection occurs, the condition is often more dangerous. Therefore, the treatment of AGI of thoracic aorta is particularly important. This article reviews the surgical treatment of thoracic aorta graft infections.

Clinical effects of type Ⅱ hybrid aortic arch repair for type A aortic dissection in elderly and non-elderly patients / 中国胸心血管外科临床杂志

@#Objective    To discuss the efficacy of type Ⅱ hybrid aortic arch repair for type A aortic dissection in patients of different age groups. Methods    We retrospectively analyzed the clinical data of 126 patients with type A aortic dissection admitted to the Fuwai Hospital between January 2016 and December 2018, including 78 (61.9%) males and 48 (38.1%) females, with an average age of 61.8±6.9 years. The patients were divided into an elderly group (≥60 years, n=82) and a non-elderly group (<60 years, n=44). The preoperative, intraoperative and postoperative data of patients in the two groups were compared. Results    The age between the elderly and non-elderly group was significantly different (65.9±4.1 years vs. 54.3±4.1 years, P<0.010), and no significant difference was found between the two groups in other preoperative baseline data. There were 6 (4.8%) patients of early death, 3 (2.4%) patients of stroke and 2 (1.6%) patients of paralysis. A total of 194 stents were implanted, and the average dimeter of the stents was 33.6±1.8 mm and the average length was 199.0±6.7 mm. The non-elderly group had shorter mechanical ventilation time (31.9±41.7 h vs. 61.0±89.2 h, P=0.043) and ICU stay time (77.8±51.4 h vs. 143.1±114.4 h, P<0.001) than the elderly group. There was no significant difference in in-hospital mortality rate, reoperation rate or survival rate between the two groups (P>0.05). Follow-up time was 1-43 (22.6±10.8) months, and 3 patients were lost. There were 104 (82.5%) patients of complete thrombus formation of false lumen in stent and endoleak was reported in 11 (9.2%) patients. Conclusion    Type Ⅱ hybrid aortic arch repair offers an alternative approach to acute type A aortic dissection with acceptable early and mid-term clinical effects. The non-elderly patients have a similar early treatment effect to the elderly patients, but have a better mid-term outcome.

Risk Factor Analysis for Peri-operative Mortality in Patients With Total Anomalous Pulmonary Venous Connection / 中国循环杂志

To analyze the risk factors for peri-operative mortality in patients with total anomalous pulmonary venous connection (TAPVC). Methods: A total of 563 TAPVD patients including atrial septal defect, ventricular septal defect and patent ductus arteriosus treated in our hospital from 1996-10 to 2012-12 were retrospectively investigated. There were 219 (38.9%) male, the mean age of patients was (4.6±9.0) years and the mean body weight was (13.2±14.6) kg. The patients were divided into 2 groups: Death group, n=34 and Survival group, n=529. Risk factors for peri-operative mortality were studied by single and multi Logistic regression analysis. Results: The overall peri-operative mortality was 6.0% (34/563). Compared with Survival group, Death group had more patients≤1 year of age (P=0.008), the higher ratio of elective surgery (P=0.002), the longer cardiopulmonary bypass time (P=0.000) and longer aorta clamping time (P=0.001). Multi Logistic regression analysis presented that the age≤1 year was the independent risk factor for TAPVC peri-operative death (OR=3.802, P=0.013) and elective surgery was the protective factor for TAPVC peri-operative death (OR=0.234, P=0.027). Conclusion: The patient's age≤1 year was the independent risk factor for TAPVC peri-operative death, while elective surgery was the protective factor for TAPVC peri-operative death.

Surgical treatment of failure interventional cases in congenial heart disease / 中华胸心血管外科杂志

Objective To summarize the cases of surgical treatment of patients with patent ductus arteriosus (PDA),atrial septal defect(ASD),or ventricular septal defect(VSD) after failure of congenital cardiac catheterization(CCC).Methods From January 2000 to December 2013 in our hospital 26 patients were retrospectively studied,follow-up results recorded for each patient by telephone and outpatient follow-up review.Results There were no deaths.The average age of the patients was (18.8 ± 17.9) (3.0-67.0) years old.The median time of the intervals between interventions and surgeries were 14 days(2 hours to 5 years),the median length of hospital stay were 10 days(7-21 days),median cardiopulmonary bypass time was 67minutes (0-206 minutes),the median blocking time 40 minutes (0-90 minutes),the median time of mechanical ventilation 8.5 hours (2.0-88.0 hours),median ICU stay one day (1-6 days).The average follow-up were (93.0 ± 49.3) months (7.0-182.4 months).Surgical results were satisfactory.Conclusion Interventional treatment of congenital heart disease (CHD) is safe after all,but should strictly the indications controlled,the operations completed by skilled doctors.If there are complex complications,surgical intervention should be concerned,and the results are satisfactory.Patients after CCC should be followed up regularly.