Optimized arterial perfusion strategy in total arch replacement for acute type A aortic dissection with malperfusion syndrome / 中国胸心血管外科临床杂志

@#Objective    To investigate the effect of optimized arterial perfusion strategy on total arch replacement for acute type A aortic dissection (AAAD) with malperfusion syndrome (MPS). Methods    From 2017 to 2019, 51 patients with AAAD and MPS who had received total arch replacement with optimized arterial perfusion strategy in our hospital were included in the optimized perfusion group, including 40 males and 11 females, with an average age of 47.43±13.39 years. A total of 40 patients with AAAD and MPS who had been treated with traditional Sun's surgery were taken as the traditional control group, including 31 males and 9 females, with an average age of 50.66±12.05 years. The perioperative clinical data of the two groups were compared. Results    The preoperative baseline data of the two groups were basically consistent (P>0.05). The comparison of operative data between the optimized perfusion group and the traditional control group showed that in the optimized perfusion group, the extracorporeal circulation time, aortic occlusion time, and circulation-out cerebral perfusion time were significantly less than those in the traditional control group (223.64±65.13 min  vs. 266.77±87.04 min, 114.48±27.28 min vs. 138.20±39.89 min, 8.28±3.81 min vs. 50.53±23.60 min, all P≤0.05). The lowest intraoperative nasopharyngeal temperature in the optimized perfusion group was significantly higher than that in the traditional control group (27.10±1.18℃ vs. 23.6±3.30℃, P=0.000). Postoperative wakefulness time of the optimized perfusion group was earlier than that of the traditional control group (4.50±1.35 h vs. 5.27±1.15 h, P=0.019). The volume of blood transfusions in the optimized perfusion group was significantly less than that in the traditional control group (13.25±9.06 U vs. 16.95±7.53 U, P=0.046). There was no significant difference in ICU time and invasive ventilation time between the two groups (P>0.05). Postoperative complications of the two groups showed that the incidence of postoperative continuous renal replacement therapy in the optimized perfusion group was significantly lower than that in the traditional control group, with a statistically significant difference (21.6% vs. 42.5% P=0.003). The incidence of postoperative delirium, coma, low cardiac row syndrome and limb ischemia in the optimized perfusion group was lower than that in the traditional control group, but the difference was not statistically significant (P>0.05). The incidence of postoperative hemiplegia, sepsis, and secondary thoracotomy in the optimized perfusion group was higher than that in the traditional control group, and the difference was not statistically significant (P>0.05). Postoperative mortality in the optimized perfusion group was significantly lower than that in the traditional control group (13.7% vs. 27.5%), but the difference was not statistically significant (P=0.102). Conclusion    Optimized arterial perfusion strategy and its related comprehensive surgical technique reduce surgical trauma, shorten the operation time, reduce perioperative consumption of blood products. Postoperative wakefulness is rapid and the incidence of complications of nervous system, kidney and limb ischemia is low. Optimized arterial perfusion strategy is suitable for operation of AAAD with MPS by inhibiting the related potential death risk factors to reduce operation mortality.

Application of 3D printing technology in the personalized surgery of right ventricular double outlet / 中国胸心血管外科临床杂志

@#Objective    To evaluate the clinical value of three-dimensional (3D) printing model in accurate and minimally invasive treatment of double outlet right ventricle (DORV). Methods    From August 2018 to August 2019, 35 patients (22 males and 13 females) with DORV aged from 5 months to 17 years were included in the study. Their mean weight was 21.35±8.48 kg. Ten patients who received operations guided by 3D printing model were allocated to a 3D printing model group, and the other 25 patients who received operations without guidance by 3D printing model were allocated to a non-3D printing model group. Preoperative transthoracic echocardiography and CT angiography were performed to observe the location and diameter of ventricular septal defect (VSD), and to confirm the relationship between VSD and double arteries. Results    The McGoon index of patients in the 3D printing model group was 1.91±0.70. There was no statistical difference in the size of VSD (13.20±4.57 mm vs. 13.40±5.04 mm, t=−0.612, P=0.555), diameter of the ascending aorta (17.10±2.92 mm vs. 16.90±3.51 mm, t=0.514, P=0.619) or diameter of pulmonary trunk (12.50± 5.23 mm vs. 12.90±4.63 mm, t=−1.246, P=0.244) between CT and 3D printing model measurements. The Pearson correlation coefficients were 0.982, 0.943 and 0.975, respectively. The operation time, endotracheal intubation time, ICU stay time and hospital stay time in the 3D printing model group were all shorter than those in the non-3D printing model group (P<0.05). Conclusion    The relationship between VSD and aorta and pulmonary artery can be observed from a 3D perspective by 3D printing technology, which can guide the preoperative surgical plans, assist physicians to make reasonable and effective decisions, shorten intraoperative exploration time and operation time, and decrease the surgery-related risks.

Strategy and effects of the areo-medical evacuation team in Mali to prevent and control COVID-19 pneumonia epidemic / 上海预防医学

This article summarizes the strategy and effects of preventing and controlling the epidemic in the evacuation support of the aero medical evacuation team of the 7th peacekeeping medical contingent of China to Mali， to actively respond to the coronavirus disease-19 （COVID-19 ）epidemic based on existing medical conditions and further provide scientific evidence for guaranteeing military medical service in public health emergencies.

Prediction model for survival in patients with biliary tract cancer: a development and validation study / 中华流行病学杂志

Objective@#The aim of the present study was to investigate the survival rate and its prognostic factors for patients with biliary tract cancer, and then a prognostic risk prediction model was constructed to predict the survival probability of patients.@*Methods@#A total of 14 005 patients with biliary tract cancer (including gallbladder cancer, extrahepatic bile duct cancer, and ampulla of Vater cancer), who were diagnosed between 2010 and 2015 in the US National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER) were included in the development cohort. The prognostic risk factors of biliary tract cancer were investigated using multivariate Cox regression models. The predictive nomograms were then constructed to predict the overall survival probability of 1, 3, and 5 years, and the predictive discrimination and calibration ability of the nomograms were further evaluated. Meanwhile, 11 953 patients who were diagnosed during 2004 to 2009 from SEER Program were then selected to validate the external predictive accuracy of the prediction models.@*Results@#The 1, 3 and 5-year cumulative survival rates of patients with biliary tract cancer were 41.9%, 20.4% and 15.3%, respectively, in the development cohort. Age greater than 50 years, African Americans and Native Americans and Alaska Natives, higher T, N and M stage and poor histological differentiation grade were risk factors for death, while married status, Asia-Pacific Islanders, insured status and surgery on primary site were protective factors. Gender was not significantly associated with the overall survival. The C statistic of the prediction model was 0.73 (95%CI: 0.72-0.74), and the calibration curve showed that the interaction curves of predictive and actual survival rates of 1, 3 and 5 years were close to the 45 degree diagonal. Results in the validation cohort were similar with those in the construction cohort, with a C statistic of 0.70 (95%CI: 0.69-0.72), indicating high external applicability of the prediction model. Findings from gallbladder cancer, extrahepatic bile duct cancer, and ampulla of Vater cancer are in consistent with the overall biliary tract cancer.@*Conclusions@#The survival rate of patients with biliary tract cancer is relatively poor, and the survival prediction model based on prognostic factors has high prediction accuracy. In the future, this prognostic prediction model could be applied to clinical practice to guide individualized treatment for patients with biliary tract cancer.

Treatment strategy of mechanical hemolysis after mitral valve repair / 医学研究生学报

Objective　In recent yaers, mitral valve repair has been widely used in the surgical treatment of congenital and secondary mitral valve lesions. To investigate the mechanism and treatment strategy of mechanical hemolysis after mitral valve repair.　Methods　A total of 451 consecutive patients registrated in general hospital of southern theatre command who underwent mitral valve repair surgery between August 2010 and June 2018,of whom 16(3.5%) had complicated mechanical hemolysis(hemoglobinuria, jaundice, anemia), were retrospectively analyzed. Echocardiographic examination showed that there were 3 cases of mild mitral regurgitation(MR), 9 cases of moderate MR and 4 cases of severe MR, among which 75% of mitral regurgitation flow were rapid regurgitant jets (Vmax>4m/s). According to the treatment strategy,all cases were divided into two groups: the aggressive reoperation group（n=10）,patients received re-repair procedures within 1 week after hemolysis diagnosis. The conservative treatment group(n=6), patients received symptomatic treatment of hemodialysis, blood transfusion, diuresis, alkalization of urine, liver protection and oral metoprolol et al. All patients were followed up for 2 to 36 months, with an average (16±7.5) months, and the postoperative echocardiographic results, hemolysis symptom improvement and cardiac function were compared.　Results　No death occurred in the two groups after operation. The symptoms of patients in the aggressive reoperation group receded rapidly and discharged from hospital. 4 patients in the conservative treatment group received reoperation 3~11 weeks after surgery due to poor treatment effect (1 patient underwent re-repair and 3 patients underwent replacement), the other 2 patients received long-term conservative treatment. The cardiac function of the patients undergoing reoperation was maintained at level I~II. Echocardiographic examination showed that mild MR(n=10), mild~moderate MR(n=3), and no recurrence of mechanical hemolysis. Two patients with long-term conservative treatment, mild~moderate anemia, urinogen +~++, moderate MR, cardiac function at level II, were in a subclinical hemolytic state.　Conclusion　Mechanical hemolysis frequently occurs immediately or soon after mitral valve repair. Hemoglobinuria, jaundice, anemia and postoper echocardiography found the mitral regurgitant flow with high-shear stress, these helpful to the diagnosis. Surgery is an important factor affecting hemolysis. Hemolysis can be a sign of surgical failure, re-repair operation is the best treatment as soon as possible after the hemolysis has been diagnosed.Conservative treatment is not the priority choice.

Surgical treatment of aorta coarctation / 医学研究生学报

Congenital coarctation of the aorta is a complex and common congenital heart disease, which can be combined with other heart defects. The clinical symptoms vary from the severity of the disease. In 1944, Crafoord successfully performed surgical repair of coarctation of the aorta, along with the progress of surgical Methods and the advent of interventional techniques, the treatment effect is improved, But no matter what kind of treatment it is, restenosis, aortic aneurysm, hypertension and other complications cannot be avoided. From long-term analysis of the followup Results , the overall effect of surgical treatment is still better than interventional treatment. This article reviews the surgical treatment of coarctation of the aorta.

Issues about pulmonary valve replacement: retrospective single center analysis with 9 years of follow-up data / 中华胸心血管外科杂志

Objective To study the pulmonary valve replacement(PVR) operation indications and timing,the choice of prosthetic valve,and the anticoagulation methods.Methods Between June 2006 and April 2017,10 patients(median age 22.5 years,range 10 to 46) underwent PVR at our hospital.These issues above were discussed by analysing data from the patients and literature review.Results The 10 patients were all diagnosed with congenital heart disease(CHD),6 with CHD and infective endocarditis and 4 with postoperation of complex CHD like tetralogy of Fallot or pulmonary artery atresia.Five patients had prior cardiac operations.Bioprosthesis valve was implanted in 2 cases,while mechanical valve in 8.The international normalized ratio(INR) was maintained between 1.8 and 2.5 for patients with mechanical valve.There was one in-hospital death,and the other 9 patients were all followed up.The median follow-up was 65 months(range,3-110 months).During follow-up,there was no death,and reoperation was undertaken in one patient who had ceased anticoagulation for 2 years with a mechanical valve,and bioprosthesis valve was chosed in reoperation,Except of this patient,no valve thrombus or severe bleeding complication happened.All prosthetic valves demonstrated normal function by cardiac color ultrasound.The mean peak transvalvular pressure gradient for the mechanical valves was 12.0 mmHg(range,8.7-14.0 mmHg),while for the bioprosthesis valves was 24.7 mmHg(1 mmHg =0.133 kPa) (range,22-27 mmHg) (P ＜ 0.01).Overall actuarial survival at 7 years for patients receiving bioprosthesis valve PVR was 100％,while for mechanical valve was 85 ％ (P =0.617);Overall actuarial freedom from reoperation at 7 years for patients receiving bioprosthesis valve PVR was 100％,while for mechanical valve was 71％ (P =0.414).The findings of literature review were as follows:the risk of valve thrombus or severe bleeding complication for mechanical pulmonary valve was not higher than bioprosthesis pulmonary valve under standard anticoagulant therapy;the durability of bioprosthesis pulmonary valves was unsatisfactory,while the medium and long term effects of mechanical valves were good;the hemodynamic properties of mechanical pulmonary valve were better than bioprosthesis pulmonary valve;the lowintensity anticoagulation method was safe and effective for Chinese people.Conclusion PVR is a safe and effective treatment for patients with severe pulmonary valve regurgitation or stenosis,and the medium and long term effects of mechanical valve are satisfactory.PVR is recommended as early as meeting the operation indications.The choice of a prosthetic valve should be careful and individual.At present,the bioprosthesis valves are implanted in pulmonery valve position more than mechanical valves.However,in select patients and by standard anticoagulant therapy,mechanical pulmonry valves will bring better benefit.The low-intensity anticoagulation method(INR 1.8-2.5) is safe and effective,and recommened for Chinese people.

Small incision surgical treatment for children with tight filum terminale type of tethered cord syndrome / 局解手术学杂志

Objective To explore the efficacy and complications of small insicion surgical treatment and the routine microscopic surgical treatment for children with tight filum terminale type of tethered cord syndrome.Methods According to the clinical manifestations and imaging findings,a total of 43 children with tethered cord syndrome were classified into two groups.Namely the control group (30 cases) who underwent the routine microscopic surgery and the observation group (13 cases) who underwent the small insicion surgical treatment.The difference including prognosis,complications,hospital stays,size of the wound between the two groups were analyzed.Results The 43 children were followed up for 3 to 24 months with an average of 9 months.The results indicated that the postoperative effective rate of the control group was 93.3％,while it was 100％ in the observation group.The difference between the two groups was not statistically significant(P ＞ 0.05).The rate of complications of the control group was 6.67％ whlie it was 0.00％ in the observation group,and the difference of the two groups was statistically significant(P ＜ 0.05).The difference of hospital stays and the size of the wound between the two groups were statistically significant (P ＜ 0.05).Conclusion The small insicion surgical treatment could guarantee the surgical effect for children with tight filum terminale type of tethered cord syndrome,and it can reduce the surgical trauma,post operation hospitalization duration,incidence of complications and intraoperative scar tissues.

Coarctation of the aorta with hypoplastic aortic arch :Analysis of midterm and longterm outcomes with autologous pulmonary patch aortoplasty / 医学研究生学报

Objective Previously we have reported the early and midterm benifit of autologous pulmonary patch in repairing aortic coarctation of hypoplastic aortic arch.This study aimed to assess its reliability and midterm and longterm outcomes.Methods We retrospectivly analyzed 42 pediatric patients with coarctation of the aorta (CoA) with hypoplastic aortic arch undergoing surgical repair with autologous pulmonary patch from May 2009 to May 2017 in General Hospital of Guangzhou Military Command of PLA.All the patients were allocated into either senior group (＞ 1 years) or junior group (≤1 years) according to the age of operation.The trans-coarctation gradient,pulmonary pressure and aortic Z value change were compared between two groups before and after the repair.Results There were 8 cases had early postoperative complications.However,no death had been reported during the postoperative time and the followed up period ranged from 4 months to 106 months (40.0± 15.5) months).The average pressure gradient of coarctation segment for all the patients was (11.9±6.4) mmHg,including 5 cases more than 25 mmHg.The pressure gradient and mean pulmonary arterial pressure after operation were significantly lower than those before operation (P＜0.05),The postoperative aortic arch Z value was greater than the preoperative value (P＜0.05).Compared with the preoperative period,the Z value of proximal transverse arch increased significantly(-0.64±0.44) vs (1.27±0.66),P＜0.05.Compared with junior group,the senior group had higher preoperative and postoperative pulmonary artery pressure (P＜0.05),and longer CPB time,aortic block time,ventilation time,ICU time and hospital stay time (P＜0.05).However,patients in the junior group had a higher pressure gradient through the aorta arch(P＜0.05) and a smaller Z value transverse arch aortic proximal and isthmus(P＜0.05) during the long-term period.The time of selective cerebral perfusion had no statistical difference between the two groups (P＞ 0.05).Conclusion Early surgery for coarctation of aorta with hypoplastic aortic arch,autologous pulmonary patch aortoplasty is a relatively ideal option with better midterm and longterm outcomes.

Transcatheter pulmonary valve replacement in sheep:medium-term evaluation of a novel polymeric prosthetic heart valve / 中华胸心血管外科杂志

Objective To evaluate medium-term valvular functionality after transcatheter pulmonary valve replacement in sheep using a novel polymeric prosthetic pulmonary valve(PPHV). Methods In this study, we designed a novel polymeric trileaflet transcatheter pulmonary valve with a balloon-expandable stent, and the valve leaflet was made of 0. 1mm expanded polytetrafluoroethylene( ePTFE) . We chose bovine pericardium valve as control. Pulmonary valve stents were implanted in situ by right ventricular apical approach in 12 healthy sheep(10 for polymeric valve and 2 for bovine pericardium valve) weighing anaverageof(22.1±2.3)kg. Echocardiography,angiography,64-rowcomputedtomography(CT),andautopsywereusedto assess valvular function 12 weeks after implantation. Results Two PPHVs failed to be implanted in situ of pulmonary valve po-sition. Implantation was successful in the other 10 sheep. One sheep died of pneumonia, and the other 9 sheep survived at the end of follow-up. Echocardiography 12 weeks after implantation showed all the PPHVs exhibited good functionality and no sig-nificant insufficiency. The peak-peak transvalvular pressure gradient of the PPHVs was(28.2 ±8.0)mmHg(16-38 mmHg) (1 mmHg=0. 133 kPa), while that of two bovine pericardium valves were 16 and 21 mmHg. Angiography and CT 12 weeks after implantation demonstrated orthotopic position and normal operation of the valves,and no deformation of the valved stents. Pathological examination of the explanted PPHVs 12 weeks after implantation showed no degradation or damage of the ePTFE leaflets and most of the leaflets were thin and pliable, without significant thrombus or calcification, while visible pannus over-growth was found at the bottom of the valve leaflets, in the commissural areas and on the sealing cuff. Conclusion The medi-um-term effects of the novel ePTFE pulmonary valve after transcatheter pulmonary valve implantation in sheep is good. The no-vel PPHV exhibits good anti-adhesion, anti-degradation, anti-thrombus, anti-calcification performance and good biomechanical property. The hemodynamic parameter of PPHV is comparable to bovine pericardium valve. Optimizing the valve design might eliminate the problem about pannus overgrowth.

A novel double-ring aortic valve stent: its development and experimental study / 介入放射学杂志

Objective To discuss the feasibility and effectiveness of transcatheter implantation of double-ring aortic valve stent through puncturing the tip of the heart under thoracotomy.Methods A novel double-ring aortic valve stent was independently designed by the authors.Three healthy goats were selected for this study.A small incision on the left anterolateral thoracic wall was made to expose the cardiac apex,than the puncturing of the left ventricular apex was performed to establish the working pathway.Guided by fluoroscopy,along a hard guide wire a double-ring aortic valve stent was inserted through a 22-French sheath to the site above the aortic valve.By utilizing the opened outer ring of the stent,the double-ring aortic valve stent was accurately placed at the bottom of the aortic valve sinus.Then,the balloon was inflated and the stent was released to substitute the original aortic valve of the experimental goat.The experiment results were evaluated immediately after the procedure.Results Transcatheter aortic valve implantation (TAVI) was successfully accomplished in all the three experimental goats.DSA was performed immediately after the procedure and anatomy evaluation indicated that the position of the implanted artificial aortic valve was satisfactory,which could replace the work of original valve.Conclusion It is technically feasible and clinically effective to use this novel double-ring aortic valve stent to perform TAVI through transapical route by puncturing the left ventricular apex.

Protective effect of nano carbon tracer on parathyroid function in the surgery of thyroid cancer / 中华内分泌外科杂志

Objective To investigate the effect of nano carbon tracer for protecting parathyroid function in the surgery of thyroid cancer.Methods A total of 178 patients with thyroid cancer admitted in our hospital from Jun.2014 to Mar.2016 were collected and divided into the control group and the observation group according to the random number table method,89 cases in each group.The control group received routine surgery,while the observation group received nanocarbon suspension during surgery.The levels of serum parathyroid hormone and serum calcium in the 2 groups were measured at 3 days after surgery,and the patients with low parathyroid hormone,normal parathyroid hormone and low calcium were counted.Results The rate of ormal serum calcium in the observation group was 91.01％(81/89),significantly higher than 67.42％(60/89) in the control group (P＜ 0.05).The rate of normal parathyroid hormone in observation group was 94.38％ (84/89),significantly higher than 64.04％ (57/89) in the control group (P＜0.05).Conclusion The nano carbon tracer is helpful for protection of parathyroid function in the surgery of thyroid cancer.

Surgical treatment of tetralogy of fallot in 142 infants: 5-year follow-up data / 第二军医大学学报

Objective To summarize the clinical experiences of surgical treatment of tetralogy of Fallot (TOF) in infants, and to evaluate its short- and midterm efficacy. Methods The clinical data of 142 infants with TOF preoperatively diagnosed by cardiac color Doppler ultrasound and or cardiac CT angiography were retrospectively reviewed. There were 79 males and 63 females with a mean age of (6.4 ± 2.7) months (range 112 months) and a mean body weight of (6.7±1.4) kg (range 3.0-12.0 kg). The mean McGoon index was 1.59 ± 0.34 (range 0.80-2.47) and the left ventricular end diastolic volume index was 25.5 ± 5.9 (range 14.0-36.3). One-stage radical operation was performed in 138 cases under moderate hypothermic cardiopulmonary bypass, and staging radical operation was performed in 4 cases. Results The mean time of cardiopulmonary bypass, arrest of the ascending aorta, post-operative ventilation, and 1CU stay were (95.0 ± 21.7) min, (54.3 ± 15.1) min, (40.2 ± 30.5) h. and (5.0 ± 3.5) d. respectively. Two cases died in the early postoperative period, with the mortality being 1. 4%. Reoperation in the early postoperative period was performed in 4 cases (2.8%). The incidence rate of postoperative complications was 7.0% (10/142). including low cardiac output syndrome, pulmonary infection, acute renal failure and so on. Medium term clinical follow-up was achieved in 127 (89.4%) cases. The mean follow-up time ranged from 11 to 62 months (median 37 months). There was no death or reoperation during the follow-up period. The cardiac function NYHA class I was found in 117 cases, and class II in 10 cases. During the follow-up period, all patients had normal right ventricular ejection fraction, and various degrees of pulmonary regurgitation (PR). including trace or mild PR in 113 cases (89.0%) and moderate PR in 14 cases (11.0/m). Conclusion Radical operation of TOF in infants is safe and effective, with satisfactory short- and medium-term outcomes. Optimizing operation method and strengthening the perioperative management are the keys to improve the successful rate of operation in TOF infants, with satisfactory early- and mid-term curative effect.

Effect of Edaravone Combining Ulinastatin on Brain Protection in Patients of Type A Aortic Dissection After Total Arch Replacement / 中国循环杂志

Objective: To observe the effect of edaravone combining ulinastatin on brain protection in patients of type A aortic dissection (AAD) after total arch replacement. Methods: A total of 60 AAD patients with total arch replacement in our hospital from 2014-09 to 2016-01 were prospectively studied. Based on peri-operative application of edaravone and ulinastatin, the patients were divided into 2 groups: EU group: 1) the patients received ulinastatin 300000 U/8h and edaravone 0.5mg/Kg/12h from administration to 3 days post-operation, 2) during cardiopulmonary bypass, the patients received ulinastatin 300000 U/2h and edaravone 0.5mg/Kg; Control group, the patients had no such treatment.n=30 in each group. The following items were observed:①operative condition;②blood levels of speciifc brain injury markers as S-100 and neuron speciifc enolase (NSE) at different time points: beginning of surgery (T0), opening aorta clamp (T1), right after cardiopulmonary bypass (T2), entering ICU (T3), 24h post-operation (T4) and 3 days post-operation (T5); ③post-operative condition. Results:①Durations of operation, cardiopulmonary bypass, cardiac arrest and bilateral antegrade selective cerebral perfusion (BACP), the frequency of BACP and UACP (unilateral antegrade selective cerebral perfusion), the lowest rectal temperature and blood levels of S-100, NSE at T0 were similar between 2 groups.②Compared with Control group, EU group had decreased S-100 and NSE from T1 to T5,P0.05. Conclusion: Edaravone combining ulinastatin had brain protective effect in AAD patients after total arch replacement;it may reduce blood speciifc brain injury markers while the clinical signiifcance should be further investigated.

Protective effects of high-dose ulinastatin on vital organs in patients receiving total arch replacement for type A aortic dissection / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the protective effects of high-dose ulinastatin on the vital organs in patients undergoing total arch replacement for type A aortic dissection.</p><p><b>METHODS</b>Between September 2014 and March 2016, 66 patients with type A aortic dissection underwent total arch replacement at our center. Thirty-six of the patients received ulinastatin treatment at 300 000 U/8 h from admission to 3 days postoperatively and at 300 000 U/2 h during cardiopulmonary bypass surgery (UTI group), and the other 30 patients did not receive perioperative ulinastatin treatment (control group). The surgical data and blood biochemistry profiles on days 1, 3, and 5 postoperatively were compared between the two groups, and the postoperative ICU stay, re-operation for bleeding, ventilation for over 7 days, ultrafiltration for postoperative renal failure, tracheotomy, incidences of pulmonary and neurological complications and hospital death were also compared.</p><p><b>RESULTS</b>s The operating time, cardiopulmonary bypass time, ACP time, cardiac arrest time, the lowest rectal temperature and frequency of bilateral and unilateral antegrade selective cerebral perfusion were similar between the two groups (P>0.05). Compared with those in the control group, patients in UTI group had lower lactate, S-100 and neuron specific enolase levels on the first postoperative day and higher OI on the 1st, 3rd, and 5th postoperative days (P<0.05), but serum creatinine, blood urea nitrogen, total bilirubin, and alanine aminotransferase levels were comparable between the two groups (P>0.05). No significant differences were found in the frequency of re-operation for bleeding, ultrafiltration for renal failure, tracheotomy, neurological complications or hospital death after the operation between the two groups, but the patients in UTI group had a shorter ICU time, a less frequent long-term ventilation and a lower incidence of pulmonary infection (P<0.05).</p><p><b>CONCLUSION</b>High-dose ulinastatin offers protection on pulmonary function and lowers the specific brain injury markers in patients with type A aortic dissection after total arch replacement, but its protective effects on brain is uncertain.</p>

Transcatheter aortic valve implantation assisted with microcatheter: a new method to avoid coronary artery obstruction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Lack of fluoroscopic landmarks can make valve deployment more difficult in patients with absent aortic valve (AV) calcification. The goal of this article was to evaluate the feasibility and effectiveness of transcatheter implantation of a valved stent into the AV position of a goat, assisted with a microcatheter which provides accurate positioning of coronary artery ostia to help valved stent deployment.</p><p><b>METHODS</b>The subjects were 10 healthy goats in this study. A microcatheter was introduced into the distal site of right coronary artery (RCA) through femoral artery sheath. A minimal thoracic surgery approach was used to access the apex of the heart. The apex of the left ventricle was punctured; a delivery catheter equipped with the valved stent was introduced over a stiff guidewire into the aorta arch. We could accurately locate the RCA ostia through the microcatheter placed in the RCA under fluoroscopy. After correct valve position was confirmed, the valved stent was implanted after rapid inflation of the balloon. The immediate outcome of the function of the valved stents was evaluated after implantation.</p><p><b>RESULTS</b>All ten devices were successfully implanted into the AV position of the goats. Immediate observation after the procedure showed that the valved stents were in the desired position after implantation by angiography, echocardiogram. No obstruction of coronary artery ostia occurred, and no moderate to severe aortic regurgitation was observed.</p><p><b>CONCLUSIONS</b>When the procedure of transcatheter implantation of a balloon-expandable valved stent into the AV position of goats is assisted with microcatheter positioning coronary artery ostia, the success rate of operation can be increased in those with noncalcified AV.</p>

Transcatheter pulmonary valve implantation in sheep: 4-week evaluation of a novel self-expanding ultramicroporous expanded polytetrafluoroethylene (ePTFE) valved stent / 第二军医大学学报

Objective To evaluate the early valve function following in situ transcatheter pulmonary valve implantation in sheep using a novel self-expanding ultramicroporous expanded polytetrafluoroethylene (ePTFE) pulmonary valve. Methods We designed a novel polymeric trileaflet transcatheter pulmonary valve with a self-expanding nitinol stent; the valve leaflet was made of 0.1-mm phosphorylcholine coated ultramicroporous ePTFE. Pulmonary valve stents were implanted in situ via the right ventricular apical approach in 7 healthy sheep, with an average weight of (27.2±1.2) kg. Right anterolateral thoracotomy was performed in the sheep under general anesthesia. Then the right ventricular apex was exposed, two purse-string sutures were made and the transcatheter valved stents were implanted in situ by puncturing the right ventricular apex. Angiography and hemodynamic measurements were obtained immediately after implantation to assess the valve function. Color Doppler echocardiography and hemodynamic measurements were used to assess the valve function 4 weeks after implantation. Results Implantation was successful in all the 7 sheep. Angiography immediately after implantation showed that all the prosthetic valves were in the orthotopic position and exhibited normal open and close function, without stenosis or insufficiency. One sheep died 16 days after implantation due to pulmonary infection with infective endocarditis. All the other sheep were in a good condition during a 4-week follow-up. Echocardiography 4 weeks later showed that all the prosthetic valves were at the orthotopic position and had normal function, with no significant thrombus or neoplasm. Echocardiography demonstrated no regurgitation in 4 sheep and trace regurgitation in 2 sheep. Hemodynamic findings showed that the peak-to-peak transvalvular pressure gradient of the polymeric valves was (6.0±2.2) mmHg (1 mmHg=0.133 kPa) immediately after operation and (9.5±2.7) mmHg at 4 weeks after operation, with the latter being significantly higher than that before implantation ([3.5±1.0] mmHg, P<0.05). Conclusion The right ventricular apical approach has a high successful rate for transcatheter pulmonary valve implantation, and the early function of the self-expanding ultramicroporous ePTFE pulmonary valved stents is satisfactory in sheep.

Experimental study of transcatheter aortic valve implantation assisted with snare to fix the delivery system / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and effectiveness of transcatheter aortic valve implantation assisted with snare to fix the delivery system.</p><p><b>METHODS</b>This study was made in 5 healthy goats. After the abdomen was opened and the abdominal aorta was exposed, a stiff guide wire was advanced into the apex of the left ventricle through abdominal arterial puncture points. The delivery catheter equipped with valved stent was inserted into the descending aorta under fluoroscopy along the stiff guide wire. A minimal thoracic surgery approach was used to access the apex of the heart. A J-type guidewire and 5 F multifunction catheter were placed transapically and across the aortic valve down to the descending aorta. The snare was introduced through the 5 F catheter into the ascending aorta and was controlled to seize the head of stent delivery catheter. Then the delivery catheter was advanced into the left ventricle. The valved stent was positioned in the desired position under aortography and then the balloon was dilated and the valved stent was deployed into the aortic annulus assisted with snare to fix the catheter to prevent stent dispositions. Aortic angiography and echocardiography were performed to evaluate of valve performance post procedure.</p><p><b>RESULTS</b>The interventional procedure was completed successfully in all 5 goats. The mean aortic annulus diameter was (23.8 ± 2.6) mm, two valved stent of 23 mm diameter and three valved stent of 26 mm in diameter were implanted. The operation duration and X-ray exposure time were (112.3 ± 19.5) min and (16.8 ± 5.2) min, respectively. Immediate observation after procedure showed that the valved stents were in the desired position after implantation by angiography and echocardiography. No moderate to severe aortic regurgitation was observed. All goats were alive at 1 month post procedure.</p><p><b>CONCLUSIONS</b>The procedure of transcatheter implantation of a balloon-expandable valved stent into the aortic valve position of goats assisted with snare to fix the delivery catheter is feasible and effective. This procedure might be suitable also for patients with noncalcified aortic stenosis.</p>

An experiment study of transcatheter transapical aortic valve implantation with a new domestic balloon-expandable bioprosthetic aortic valve in goats / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and effectiveness of transcatheter transapical implantation of a new domestic balloon-expandable bioprosthetic aortic valve in goats.</p><p><b>METHODS</b>We developed a new tube-like balloon-expandable bioprosthetic aortic valve which was made from cobalt-chromium alloy and bovine pericardium. Briefly, fresh bovine pericardium was trimmed into artificial leaflets and sutured into the cobalt-chromium alloy stent by hand post cell extracting and anti-calcification treatments. A left anterolateral mini-thoracotomy was performed in the 5(th) intercostal space of 5 goats. After opening the pericardium, the apex of the left ventricle was punctured, a stiff guidewire was positioned across the aortic arch and anchored in the descending aorta. The delivery catheter (22 F) was then introduced through the stiff guidewire into the aorta arch under fluoroscopic guidance. After correct valve position was confirmed by digital subtraction angiography, the valved stent was implanted after rapid inflation of the balloon. The immediate results of implanted valved stents were evaluated with angiography and echocardiography.</p><p><b>RESULTS</b>Four devices were successfully implanted into aortic valve position of goats and one goat died of severe aortic valve regurgitation because the valved stent was implanted below the normal position.Immediate observation after procedure in 4 goats by angiography and echocardiography showed that the valved stents were in the desired position after implantation. Mild paravalvular leakage were found in 3 out of the 4 survived goats and there were no moderate to severe aortic regurgitation in survived goats.</p><p><b>CONCLUSION</b>The procedure of transcatheter transapic aortic valve implantation with our new-type domestic balloon-expandable valved stent and delivery system is feasible and effective.</p>

Phosphorylcholine coating enhances biocompatibility of expanded polytetrafluoroethylene used in polymeric prosthetic heart valves / 中国组织工程研究

BACKGROUND:Our preliminary study found that the monocusp valves made of ultramicropore expanded polytetrafluoroethylene (ePTFE) revealed no significant thrombus, calcification, or degradation 20 weeks after implanted into the descending aorta and the left pulmonary artery in sheep, which verified the good property of ePTFE. However, the surface of ePTFE in the left pulmonary artery was covered with obvious neointima. OBJECTIVE: To assess the biocompatibility of phosphorylcholine-coated ePTFE. METHODS:ePTFE surface was modified by phosphorylcholine derivative. Then the changes of surface shape, tensile stress at yield and elasticity modulus, water contact angle, and protein absorption capacity of ePTFE after surface modification were observed. (1) Hemolytic test: the leaching solution of phosphorylcholine-coated ePTFE, leaching solution of uncoated ePTFE, normal saline, and distiled water were added to the diluted human blood, respectively. (2) Platelet count test: the phosphorylcholine-coated ePTFE, uncoated ePTFE, high density polyethylene, and Zymosan A were added to the whole blood samples from healthy volunteers, respectively. (3) Platelet activation test: the phosphorylcholine-coated ePTFE, uncoated ePTFE, γ-Globulins, and Zymosan A were added to the whole blood samples from healthy volunteers, respectively. RESULTS AND CONCLUSION: The mean micropore diameter of ePTFE was significantly decreased after phosphorylcholine coating (P significantly strengthened after phosphorylcholine coating (P ePTFE in biomechanical properties and hemolytic test. The platelet count test and platelet activation test demonstrated that phosphorylcholine coating significantly improved anti-thrombus function of ePTFE. So, phosphorylcholine coating can enhance anti-thrombus function, suppress protein adsorption, and improve biocompatibility of ePTFE.