Extra-anatomic bypass for complex aortic coarctation in adults / 中华外科杂志

<p><b>OBJECTIVE</b>To demonstrate an effective operation of extra-anatomic bypass for complex aortic coarctation in adults.</p><p><b>METHODS</b>Between July 1997 and October 2010, 51 patients underwent extra-anatomic aortic bypass. There were 39 male and 12 female patients. Mean age was (40 ± 14) years (ranging from 18 to 63 years). Operative technique of extra-anatomic bypass consisted of performing an ascending-to-descending or abdominal or femoral aorta bypass (8, 39 and 4 patients). Concomitant procedures were performed in 38 patients: 10 isolated aortic valve replacements (AVR), 11 aortic root replacements (Bentall), 4 ascending aorta replacements including 3 concomitant AVR, 5 mitral valve replacements including 3 concomitant AVR, 4 ventricular septal defect correcting with AVR, and 4 coronary artery bypass graft.</p><p><b>RESULTS</b>Mean follow-up time was (30 ± 9) months (ranging from 5 to 60 months). Two patients were reoperated for hemorrhage in descending aorta anastomosis, one of whom was dead of multiple organ failure in perioperative period. Upper-extremity blood pressure after coarctation correction with extra-anatomic aortic bypass was significantly improved (< 10 mmHg, 1 mmHg = 0.133 kPa). Arterial hypertension was well improved, except 10 patients controlled with less drug therapy. All grafts were patent without obstruction or pseudoaneurysm formation in the follow-up period evaluated by vascular ultrasound and computed tomographic angiogram.</p><p><b>CONCLUSION</b>Extra-anatomic aortic bypass is a safe and effective option for complex aortic coarctation in adults.</p>

Validation of four different risk stratification models in patients undergoing heart valve surgery in a single center in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Several risk stratification models have been developed for cardiac surgery. This study aimed to evaluate the accuracy of four existing risk stratification models, the Fuwai System for Cardiac Operative Risk Evaluation (FuwaiSCORE), the Society of Thoracic Surgeons 2008 cardiac surgery risk model for isolated valve surgery (the STS model), the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the initial Parsonnet's score (the Parsonnet model) in predicting prolonged intensive care unit (ICU) stay in Chinese patients undergoing heart valve surgery.</p><p><b>METHODS</b>Data were collected retrospectively from records of 1333 consecutive patients who received heart valve surgery in a single center between November 2006 and December 2007. Prolonged ICU stay was defined as not less than 124 hours. Calibration was assessed using the Hosmer-Lemeshow (H-L) goodness of fit test. Discrimination was assessed using the receiver-operating-characteristic (ROC) curve area.</p><p><b>RESULTS</b>The FuwaiSCORE showed good calibration and discrimination compared with other risk models. According to the H-L statistics, the value of the FuwaiSCORE was 12.82, P > 0.1. The area under ROC curve of the FuwaiSCORE was 0.81 (95%CI 0.78 - 0.84).</p><p><b>CONCLUSIONS</b>Our study suggests that the FuwaiSCORE is superior to the other three risk models in predicting prolonged length of ICU stay in Chinese patients with heart valve surgery. Having fewer variables, the system is much easier for bedside use than other systems.</p>