ABSTRACT
Objective:To discuss the essentials of anesthesia management and treatment strategies for emergency transcatheter aortic valve replacement (TAVR), and to provide standardized recommendations for the development of emergency TAVR technology in China.Methods:This study retrospectively analyzed the relevant data of patients undergoing emergency TAVR surgery in the Second Affiliated Hospital of Zhejiang University School of Medicine from March 2019 to February 2021, including baseline patient characteristics, perioperative echocardiography data, prognosis and 30-day follow-up. Post-operative data were compared with pre-operative data using paired-sample test.Results:Thirteen patients, aged (75.62±9.63) years, underwent emergency TAVR surgery, and 6 of them were male. Eleven patients were New York Heart Association class Ⅳ. The preoperative Society of Thoracic Surgeons score was (20.31±15.15)%. The trans-aortic valve differential pressure was significantly reduced after surgery [(68.92±30.66)mmHg vs. (2.70±2.36)mmHg, P<0.01]. Two patients died within 30 days after surgery, one patient developed a new third degree atrioventricular block, one patient had a stroke, and 4 patients developed pulmonary infection. Conclusions:Emergency TAVR surgery is a feasible and effective rescue strategy for patients with aortic stenosis in critical condition. The establishment of anesthesia standard operation procedure process for TAVR surgery helps ensure homogenized medical behavior and good teamwork.
ABSTRACT
Objective:To analysis the mid-stage prognosis of transapical aortic valve implantation(TA-TAVI) using J-Valve? system for the treatment of high-risk aortic regurgitation(AR) patients.Methods:Data of 25 patients with aortic regurgitation who had underwent transapical aortic valve implantation using J-Valve? system were collected in the Second Affiliated Hospital of Medical College of ZheJiang University from September 2016 to June 2020 . Analysis and summarize their postoperative all-cause mortality, the incidence of adverse events and the improvement in cardiac function.Results:There were 25 patients, including 19 males, the age rage from 59-83 years, the average age was(72.3±27.11) years. The levels of aortic regurgitation was evaluated by transthoracic echocardiography preoperatively, showed that severe AR accounted for 88%. The New York Heart Association(NYHA) of grade 3 or above was 92%. The most common comorbidity was hypertension, accounted for 68%. Coronary heart disease and history of cardiac surgery was 5 and 3 relatively in this study. The Society of Thoracic Surgeons score before surgery was 1.511%-27.674%, the average of STS score was 4.27(2.914-6.033)%. Successful J-Valve implantation was obtained in all 25 cases, no conversion to thoracotomy. After surgery, 2 patients required permanent pacemaker implantation, 1 patient needed continuous renal replacement therapy(CRRT) due to acute kidney injury, 1 occurred moderate or above paravalvular leak. The results showed good therapeutic effects in early-stage, low incidences of adverse events. The continued improvement of cardiac function and ventricular reverse remodeling could be observed in mid-stage.Conclusion:In this study, we can summarize that high-risk patients with aortic regurgitation treated with transapical aortic valve implantation using J-Valve? system can acquire great perioperative safety and mid-stage prognosis.
ABSTRACT
Objective:To explore the evaluation of transesophageal echocardiography(TEE) in patients with massive regurgitation of posterior mitral valve prolapse undergoing transapical off-pump NeoChord repair.Methods:Eight patients from April to July 2019 in the Second Affilliated Hospital of Zhejiang Univerity with massive regurgitation of posterior mitral valve prolapse underwent NeoChord repair mitral valve morphology, prolapse position and regurgitation degree were evaluated before NeoChord implantation by TEE. Under TEE guidance, the puncture site was identificated, the position and length of artificial chordae were adjusted during implantation. NeoChord′s function and positon after implantation were observed. The complications were monitored during the operation.Results:Mitral valve repair by NeoChord system was successfully performed with implantation of 2 to 4 artificial chordaes in eight patients respectively. Intraoperative TEE and pre-discharge transthoracic echocardiography(TTE) showed moderate MR in two patients, mild to moderate MR in one patient, mild MR in the remaining five patients. Reexaminations with TTE at 1 month after operation showed moderate MR in six patients, and mild to moderate MR in two patients. And no postoperative complications were noted.Conclusions:NeoChord system is a safe, effective and feasible treatment method for patient with mitral valve prolapse, TEE plays an important role during NeoChord implantation.
ABSTRACT
Objective To establish a long-term survival model of deep hypothermic circulatory arrest (DHCA) in rats,which could contribute to the research of organ damage mechanism and clinical treatments related to DHCA.Methods Twenty Sprague-Dawley rats were randomly (random number) divided into the sham group (n=10) and DHCA group (n=10).After anesthesia,a 20 G catheter was cannulated in the tail artery for arterial inflow,a multiorificed catheter in the right jugular vein for venous drainage,and a 24G catheter in the branch of left femoral artery for artery blood pressure monitoring.Rats in the DHCA group underwent DHCA procedure for 40 min after brain temperature cooled to 18℃,then rewarmed for 40 min,till the brain temperature were above 34℃.Rats in the sham group were cannulated but did not undergo cardiopulmonary bypass (CPB).Hemodynamic parameters and blood gas analysis were measured for 5 times (pre-CPB,15 min after CPB,10 min after rewarming,40 min after rewarming,and 30 min after CPB).Results One rat in the DHCA group died,and the rest rats survived.The lactate level in the DHCA group after rewarming during operation was significantly higher than that in the sham group (7.84 mmol/L vs 1.93 mmol/L,P＜0.05).Conclusions In this study,40-min DHCA model in rats is characterized by safe and long-term survival.
ABSTRACT
Objective To evaluate the efficacy and safety of holmium laser in situ fenestration for aortic arch diseases during thoracic endovascular repair.Methods The clinical data of 12 patients with aortic dissection or aortic pseudoaneurysm was analyzed from Nov 2016 to Feb 2017.After thoracic aorta stenting the left common carotid artery and left subclavian artery were reconstructed using holmium laser in situ fenestration.Results The success rate of operation was 100％,no type Ⅰ or type Ⅱ endoleak occurred,1 case complicated with left retinal artery occlusion.All patients were followed up for 6 to 9 months,the mean time was 7.3 months.The location of the stent graft was good.The left carotid artery and left subclavian artery kept patent.Conclusions The laser in situ fenestration technique can provide the opportunity of stenting for patients with aortic arch lesion near the branch.Short term follow-up results were satisfactory.
ABSTRACT
Objective:To investigate the protective function of tocilizumab in human cardiac myocytes ischemia-reperfusion injury.Methods:The human cardiac myocytes were treated by tocilizumab with different concentrations(1.0 mg/mL, 3.0 mg/mL, 5.0 mg/mL) for 24 h,then cells were cultured in ischemia environment for 24 h and reperfusion environment for 1 h. The MTT and flow cytometry were used to detect the proliferation and apoptosis of human cardiac myocytes, respectively. The mRNA and protein expressions of Bcl-2 and Bax were measured by qRT-PCR and western blot, respectively.Results:Compared to the negative group, pretreated by tocilizumab could significantly enhance the proliferation viability and suppress apoptosis of human cardiac myocytes after suffering ischemia reperfusion injury(P<0.05).The expression of Bcl-2 in tocilizumab treated group were higher thanNC group(P<0.05), while theBax expression were lower(P<0.05).Conclusions:Tocilizumab could significantly inhibit apoptosis and keep the proliferation viability of human cardiac myocytes after suffering ischemia reperfusion injury. Tocilizumab may obtain a widely application in the protection of ischemia reperfusion injury.
ABSTRACT
Objective To evaluate the efficacy and security of one-stop hybrid cardiac surgery for the treatment of elderly patients with complex heart disease.Methods From November 2013 to March 2014,a total of 5 patients[4 male,age:71-78years] underwent one-stop hybrid approach in the hybrid operating room with chronic obstructive pulmonary disease (COPD) in 3 cases,2 cases of diabetes,3 cases of hypertension,valvular heart disease in 3 cases,PDA in 1 case,4 patients with multivessel coronary disease.Right minimally invasive cardiac surgery(coronary artery bypass grafting or valvular surgery) and percutaneous intervention were performed in an enhanced operative unit.The efficacy and security of one-stop hybrid cardiac surgery were evaluated after the procedure.Results The one-stop hybrid procedure was successful in all patients.Operation time was (125 ± 28) minutes,CPI time was (65 ± 33) minutes,CPB time was (60 ± 23) minutes,Aortic cross clamping time was (42 ± 18) minutes,postoperative mechanical ventilation time was (20.5 ±6.5)hours and ICU monitoring time was (68.9 ± 16.6)hours.Hospitalization time was (9.8 ± 3.7) days.Patients remained free from angina,prosthetic valve dysfunction and patent ductus arteriosus recanalisation(rang 1 to 5 months) follow-up period.Conclusion One-stop hybrid cardiac surgery provides a reasonable,feasible and safe alternative for treating elderly patients with complex heart disease.