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.

Outcomes and preoperative evaluation of transfemoral transcatheter aortic valve replacement (TAVR) in the treatment of pure native aortic valve regurgitation / 中国胸心血管外科临床杂志

@#Objective    To assess outcomes of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation. Methods    A total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed. There were 83 males and 46 females with an average age of 72.26±8.97 years. The patients were divided into a pure native aortic valve regurgitation group (17 patients) and an aortic valve stenosis group (112 patients). Results    The incidence of valve in valve was higher in the pure native aortic valve regurgitation group (47.0% vs. 16.1%, P<0.01). There was no statistical difference between the two groups in conversion to surgery, intraoperative use of extracorporeal circulation, intraoperative left ventricular rupture, postoperative use of extracorporeal membrane oxygenation (ECMO), peripheral vascular complications, disabled stroke, death, or pacemaker implantation. There was no statistical difference in the diameter of annulus (25.75±2.21 mm vs. 24.70±2.90 mm, P=0.068) or diameter of outflow tract (25.82±3.75 mm vs. 25.37±3.92 mm, P=0.514) between the pure native aortic valve regurgitation group and the aortic valve stenosis group. Conclusion    Transfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation. The diameter of annulus plane, the diameter of outflow tract and the shape of outflow tract should be evaluated.

Advances in the pathogenesis of aortic dissection / 中国胸心血管外科临床杂志

@#Aortic dissection is a catastrophic emergency with a high mortality rate, and its full pathogenesis remains unknown to researchers, which brings a heavy burden to the individuals, society and family because of its poor prognosis. Improving the efficiency of its diagnosis and treatment and defining the pathogenic mechanism clearly is a research hotspot. Recently, utilizing bioinformatics to find diagnostic biomarker of aortic dissection has attracted the attention of many researchers. Besides, exploring the relationship between pathogenic mechanism and inflammatory process, extracellular matrix degradation, elastic fiber fracture and the phenotypic transformation of vascular smooth muscle cells is also a hot topic. We summarize recent progress made in the pathogenesis of aortic dissection. We hope to identify key molecules driving aortic dissection and provide reliable reference for the diagnosis, medical treatment and prevention of aortic dissection.

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.

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.

Study on periodic changes in onset of aortic dissection / 中华心血管病杂志

Objective@#To investigate theperiodic changes in onset of aortic dissection.@*Methods@#The clinical data of 1 121 patients with acute aortic dissection from Hebei province, treated at Fuwai hospital from January 1, 2010 to December 31, 2016, were collected and analyzed retrospectively. The regularity for the onset of aortic dissection was analyzed according to daytime (1:00 to 6:00, 7:00 to 12:00, 13:00 to 18:00, and 19:00 to 24:00), weekday, month, and quarter. Meanwhile,the differences in various type of aortic dissection patient were also compared.@*Results@#The patients were (51.4±12.0) years old,77.88% (873 cases)were male and 69.05% (774 cases) were type A aortic dissection.The peak period for the onset of the disease in a day was from 13:00 to 18:00 (401 cases. 35.77%),and disease onset was less frequent from 1:00 to 6:00 (196 cases, 17.48%).The peak weekday of disease onset was Monday (173 cases, 15.43%) , and disease onset was less frequent on Friday (153 cases, 13.65%) . The peak month of disease onset was January (135 cases, 12.04%), and disease onset was less frequent in July(54 cases, 4.82%). The peak season of disease onset was winter (349 cases, 31.13%), and disease onset was less frequent in summer (184 cases, 16.41%). Number of disease onset was similar between ≥65 years old and<65 years old groups, with or without hypertension groups, with or without Marfan syndrome groups at different periods of a day, each weekday, and seasons(all P>0.05).@*Conclusion@#There are periodic changes in the onset of acute aortic dissection,which is higher in winter than in summer, higher in the afternoon than in the morning.

Correlation between of aortic dissection onset and climate change / 中华外科杂志

Objective@#To explore the relationship between the incidence of aortic dissection and climate change.@*Methods@#The characteristics of 345 acute aortic dissection patients came from Beijing in Department of Vascular Surgery, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College from January 2005 to December 2015 were analyzed, retrospectively. There were 266 male and 79 female patients with a mean age of (49±12) years. There were 209 cases of Stanford type A aortic dissection, and 136 cases of type B. According to Fuwai aortic dissection classification: type A 8 cases, type B 95 cases, type Cp 13 cases, type Ct 187 cases, type Cd 40 cases, type D 2 cases. Meanwhile, monthly maximum temperature, minimum temperature, average temperature, average pressure, amount of rainfall, sunshine, relative humidity and other meteorological data were collected. Rank-sum test was used to analyze the difference of onset of aortic dissection in different seasons and months. Generalized additive models were implied to explore climate change and the onset of aortic dissection.@*Results@#The onset of aortic dissection was related to season. Winter had higher morbidity compared to summer (M(QR): 3(2) vs. 2(2), Z=1.97, P=0.05). The occurrence of aortic dissection was associated with month.December had the largest quantity, July had the least (2(3) vs. 2(1), Z=2.42, P=0.02). The mean temperature was statistically significant for indicating the change of aortic dissection onset. It meaned that onset probability was increased with the decrease of temperature (RR=1.01, 95%CI: 1.00 to 1.02, P=0.04).@*Conclusions@#The onset of aortic dissection had something to do with season and month. The incidence of aortic dissection increases with temperature decreases.

The relationship between different time periods and the prognosis of acute type A aortic dissection surgery / 中华胸心血管外科杂志

Objective Nowadays, emergency surgery is the most important method to treat acute type A aortic dissec-tion.There are many factors that can affect the prognosis, but the relationship between time period and the prognosis of aortic dissection surgery has not been reported.Therefore, the purpose of this study was to explore the relationship between different time periods and the prognosis of acute type A aortic dissection surgery .Methods We retrospectively analyzed the characteris-tics of acute type A aortic dissection surgery in Fuwai Hospital from 2010 to 2015.All patients were divided into two groups ac-cording to different time period .Propensity matching analysis was used to compare in-hospital mortality and post-operative com-plications of these groups.Results There were 698 cases acute aortic dissection surgery during study period.321 cases were operated in the nighttime(45.98％), the others were operated during daytime(54.02％).After propensity score matching, the operation time, extracorporeal bypass time, and the aortic blocking time of nighttime group were longer than daytime group , and there was a statistical difference(P<0.01).There was a statistical difference between the two groups of postoperative con-tinuous renal replacement therapy.Nighttime group had higher incidence(15.94％ vs.5.64 ％, P<0.01).There was statis-tically significant in 30-day mortality between daytime group and nighttime group(5.26％ vs.10.53％, P=0.03).The mul-tiple-factor risk analysis of 30-day mortality in the whole group found that nighttime surgery was an independent risk factor ( OR 2.13, 95％CI 1.19-3.81, P=0.01).Conclusion For acute type A aortic dissection surgery, nighttime surgery may be the important factor for increasing 30-day mortality.For relatively stable patients, avoiding nighttime surgery may increase survival rate.

The current treatment about the aortic intramural hematoma / 中华胸心血管外科杂志

The purpose of the current treatment about the aortic intramural hematoma(IMH)is to prevent aortic rupture or conversion to typical dissection. Due to the different influence of human race,IMH type,severity and progression factors on this disease,the management of IMH remains controversial. Therefore,we reviewed current therapy of Aortic intramural hema-toma(IMH). And we provided a reference for further study on this disease by analyzing and comparing the relatively radical strategies and the close follow-up treatment(wait-and-watch strategy)strategies.

Short-term Effect and Risk Factor Analysis on the Timing of Intra-aortic Balloon Pump Implantation for Coronary Artery Bypass Grafting in Patients With High Risk Coronary Artery Disease / 中国循环杂志

Objective: To evaluate short-term effect and risk factors for the timing of intra-aortic balloon pump (IABP) implantation with coronary artery bypass grafting (CABG) in high risk coronary artery disease (CAD) patients. Methods: A total of 197 high risk CAD patients received IABP with CABG in our hospital from 2010-01 to 2015-12 were retrospectively analyzed. There were 91 (46.2%) male and the mean arterial pressure (MAP) was (70.3±8.2) mmHg. Based on IABP implantation time, the patients were divided into 2groups: Pre-operative IABP group,n=89 and Intra- , post-operative IABP group,n=108. Peri-operative condition, durations of mechanical ventilation and ICU stay were compared between 2 groups; survival condition was studied by Kaplan-Meier analysis; risk factors causing 30-day mortality was assessed by Logistic regression analysis and its sensitivity and specialty was measured by ROC curve. Results: The mean durations for aortic clamping and cardiopulmonary bypass were (86.7±37.3) min and (147.3±18.4) min in all 197 patients. The age, gender, blood levels of CK-MB c-TnI, creatinine, MAP and European cardiac surgery system scoring were similar between 2 groups, allP>0.05. Compared with Intra- , post-operative IABP group, Pre-operative IABP group had decreased CK-MB (130.6±25.4) mmol/L vs (149.7±18.2) mmol/L at 48h post-operation and mechanical ventilation time (81.5±10.3) h vs (107.9±11.5) h, less in-hospital stay (21.3±4.1) d vs (27.7±9.4) d, reduced acute kidney injury (3.4% vs 23.1%), brain complication (5.6% vs 19.4%) and 30-day mortality (4.5% vs 36.1%), allP<0.05. Kaplan-Meier analysis indicated that the median survival time was longer in Pre-operative IABP group, (27.9±1.2 vs 16.5±2.2) dP<0.05; Logistic regression analysis and ROC curve demonstrated that IABP re-implantation (OR=2.37, 95% CI 1.42-5.72,P=0.01) was an important risk factor for 30-day mortality with the sensitivity of 75.3% and specialty of 67.4%. Conclusion: Pre-operative IABP implantation was helpful for decreasing post-operative level of CK-MB, reducing mechanical ventilation, in-hospital time and short-term mortality in high risk CAD patients; IABP re-implantation was the risk factor for short-term mortality.

The reconstruction of left subclavian artery in thoracic endovascular aortic repair for aortic arch disease / 中华胸心血管外科杂志

Objective This study was designed to evaluate the prognosis of the reconstruction of left subclavian artery (LSA)in thoracic endovascular aortic repair(TEVAR)for patients with aortic arch disease.Methods From January 2010 to August 2016,55 patients with aortic arch disease(left vertebral artery dominance)who had undergone TEVAR including LSA covered in Fuwai Hospital were enrolled.28 patients received concomitant reconstruction of LSA.The study endpoints includ-ed: postoperative death, reoperation, stroke and aorta-related adverse events.Results Follow-up data were obtained from all patients.The mean follow-up time was(30.0 ±17.5)months.All patients were diagnosed with left vertebral artery dominance by preoperative computerized tomography of aorta.The preoperative diameter of left vertebral artery was(4.88 ±0.85)mm while the right vertebral artery was(3.00 ±0.75)mm.There were no in-hospital deaths,reoperations and aorta-related adverse events.Three patients died and 2 patients experienced Type Ⅳ endoleak during the follow up.Conclusion The mid-term prognosis of the reconstruction of left subclavian artery in thoracic endovascular aortic repair for patients with aortic arch disease are good and long-term follow-up is necessary.

Outcome analysis of ECMO applying in extracorporeal cardiopulmonary resuscitation in adult cardiac arrest patients / 中华胸心血管外科杂志

Objective Summarizing single clinical experience with extracorpomreal membrane oxygenation(ECMO) as a supplement to extracorporeal cardiopulmonary resuscitation(ECPR) in adult patients with cardiac arrest to explore new ideas.Methods We retrospectively analyzed the characteristics of 17 patients who underwent ECMO as part of ECPR from July 2005 to September 2014 at Fuwai Hospital,and analyzed the differences between the survival group(n =6) and the in-hospital death group.Results The mean CPR time was(44.53 ± 21.39) min.The support duration of ECMO was(106.38-± 70.43) h.12 patients of all were successfully weaned from ECMO,and 6 patients survived to hospital discharge.There were significant differences between the two groups in terms of the last serum creatinine and blood lactate acid level before ECMO,and the time to lactate normalization.11 patients died,7 patients developed bleeding,and 8 cases developed infection.Conclusion Single-center data showed that applying ECMO as a means of ECPR improved the survival rate in cardiac arrest patients.Additionally,creatinine and lactic acid were good indicators for assessing prognosis.Refractory circulatory dysfunction and neurologic complications have an adverse impact on the survival of cardiac arrest patients.