Development status and new challenges of heart transplantation / 器官移植

Heart transplantation is the primary therapeutic option for patients with end-stage heart failure. The shortage of donors has been the main limiting factor for the increasing quantity of heart transplantation. With persistent updating and introduction of novel technologies, the donor pool has been increasingly expanded, such as using the heart from older donors, donors infected with hepatitis C virus, donors dying from drug overdose or donation after cardiac death (DCD) donors, etc. Meantime, the proportion of recipients with advanced age, multiple organ dysfunction, mechanical circulatory support and human leukocyte antigen antibody sensitization has been significantly increased in recent years. The shortage of donors, complication of recipients' conditions, individualized management of immunosuppressive therapy and prevention and treatment of long-term cardiac allograft vasculopathy are all challenges in the field of heart transplantation. In this article, novel progresses on donor pool expansion, improving the quality of recipients, strengthening the diagnosis and treatment of rejection, and preventing cardiac allograft vasculopathy were reviewed, aiming to prolong the survival and enhance the quality of life of patients with end-stage heart failure on the waiting list or underwent heart transplantation.

Management of cardiopulmonary bypass in elderly patients with acute type A aortic dissection of aortic arch recon-struction / 中华胸心血管外科杂志

Objective To summarize the clinical experience of cardiopulmonary bypass( CPB) in acute type A aortic dis-section received aortic arch reconstruction on age over 70 years patients. Methods From April 2013 to December 2017, 35 elderly patients aged over 70 who were involved the aortic arch, brachiocephalic trunk, left common carotid artery and left sub-clavian artery and severe arch lesions, large false lumen and large rupture risk of acute A aortic dissection were reconstructed by triple-branched stent graft in emergency extracorporeal circulation. During the period of cardiopulmonary bypass, selective cere-bral perfusion and discontinuous arrest under moderate hypothermia(25 degrees C) were used to reduce the time of cerebral is-chemia and hypoxia, and to strengthen the management of the protection of important organs. Results Cardiopulmonary by-pass time was(144.85 ±32.98)minutes, and aortic cross clap time was(51.82 ±17.59)minutes, and selective cerebral per-fusion time was(12.17 ±4.70)minutes, discontinuous arrest time was(4.50 ±3.54) minutes, the lower body arrest time was (16. 6 ± 7. 49) minutes. All patients were smoothly weaned from cardiopulmonary bypass. 35 patients resuscitated within 48 hours, of which 3 patients had transient mental disorders in the early stage and recovered before hospital discharge;2 patients had cerebral infarction. Hospital mortality in this group was 17. 1％(6/35). Conclusion Advanced age is not a contraindica-tion to the reconstruction of the arch of the aortic dissection. Reasonable management of cardiopulmonary bypass can provide an important guarantee for the reconstruction of the elderly patients with acute type A aortic dissection.

Management of cardiopulmonary bypass in elderly patients with acute type A aortic dissection of aortic arch reconstruction / 中华胸心血管外科杂志

Objective@#To summarize the clinical experience of cardiopulmonary bypass(CPB) in acute type A aortic dissection received aortic arch reconstruction on age over 70 years patients.@*Methods@#From April 2013 to December 2017, 35 elderly patients aged over 70 who were involved the aortic arch, brachiocephalic trunk, left common carotid artery and left subclavian artery and severe arch lesions, large false lumen and large rupture risk of acute A aortic dissection were reconstructed by triple-branched stent graft in emergency extracorporeal circulation. During the period of cardiopulmonary bypass, selective cerebral perfusion and discontinuous arrest under moderate hypothermia(25 degrees C) were used to reduce the time of cerebral ischemia and hypoxia, and to strengthen the management of the protection of important organs.@*Results@#Cardiopulmonary bypass time was(144.85±32.98)minutes, and aortic cross clap time was(51.82±17.59)minutes, and selective cerebral perfusion time was(12.17±4.70)minutes, discontinuous arrest time was(4.50±3.54) minutes, the lower body arrest time was(16.6±7.49)minutes. All patients were smoothly weaned from cardiopulmonary bypass.35 patients resuscitated within 48 hours, of which 3 patients had transient mental disorders in the early stage and recovered before hospital discharge; 2 patients had cerebral infarction. Hospital mortality in this group was 17.1%(6/35).@*Conclusion@#Advanced age is not a contraindication to the reconstruction of the arch of the aortic dissection. Reasonable management of cardiopulmonary bypass can provide an important guarantee for the reconstruction of the elderly patients with acute type A aortic dissection.

Surgical strategy for aortic regurgitation attributable to Behcet disease / 中华胸心血管外科杂志

Objective To investigate the surgical strategy for aortic regurgitation attributable to Behcet disease.Methods The follow-up results of 18 patients with aortic regurgitation attributable to Behcet disease were retrospectively analyzed and the surgical effects of different surgical methods were summarized.Results 6 cases underwent isolate aortic valve replacement several times,one case was survial,the motality was 83 percent.5 cases with severe paravalvular leakage after initial aortic valve replacement underwent the modified Bentall procedure,in which the valved conduit was proximally attached to the left ventricular outflow tract.In these patients one case underwent re-do operation because of the fight coronary pseudoaneurysm and died of the low cardica output in postoperative 7 months.One case underwent re-do operation because of the prosthetic detachment and died of the low cardiac output in postoperative 11 months,the motality was 40 percent.7 cases underwent the modified Bentall procedure using the pericardium skirt below the valve sewing ring,one case underwent the re-do operation because of the prosthetic detachment and died of the low cardiac output in postoperative 15 months.The mortality was 14.3 percent.Conclusion The modified Bentall procedure with the valved conduit using the pericardium skirt below the valve sewing ring could prevent the prosthetic detachment and paravalvular leakage effectively.

Comparison of Bovine jugularvein conduit and homograft in right ventricular outflow tract reconstruction / 中华胸心血管外科杂志

Objective To compare the clinical efficacy of BalMedic bovine jugular vein conduit (BalMedic) with homograft in right ventricular outflow tract reconstruction.Methods Totally 10 patients were implanted homograft to reconstruct right ventricular outflow tract,while 14 patients were implanted BalMedic from January 2003 to July 2009,and the function of the implanted conduit was evaluated by Doppler echocardiography one year after operation.Results 9 patients in group Homograft were cured,while 1 patient died of multiple organ failuie caused by infective endocarditis,which was confirmed associated to the conduit.13 patients in group BalMedic were cured,while 1 patient died of heart failure 2 days after operation,which no independent with the conduit.No stenosis of the pulmonary valve and further stoma had been found in both two groups,and they were no significant different( P ＞0.05 ).There were no thrombus aud aneurysm in both two groups.Two patients in group Homograft had low-grade regurgitation with pulmonary valve,while one had middle-grade regurgitation.And 4 patients in group BalMedic had low-grade regurgitation with pulmonary valve,no else became worse.Conclusion Both homograft and BalMedic can be used in reconstruction of right ventricular outflow tract.BalMedic may have better prospect.