ABSTRACT
Objective:To investigate the safety and effect of the operation of the upper sternum small incision assisted by normothermic cardiopulmonary bypass in the treatment of aortic valve disease.Methods:From March 2014 to June 2016, the clinical data of 25 patients who underwent single incision minimally invasive aortic valve replacement assisted by normothermic cardiopulmonary bypass in The Second Hospital of Hebei Medical University and 25 patients who underwent aortic valve replacement under hypothermia cardiopulmonary bypass were analyzed retrospectively.The former was used as minimally invasive surgery group, and the sternum was sawn in " J" shape through a small incision on the upper sternum.In the latter group, aortic valve replacement was performed under cardiopulmonary bypass.The operation effect and complications of the two groups were compared.Results:There was no death in the two groups.There was no significant difference in operation time between minimally invasive surgery group and routine operation group ( P>0.05). The time of aortic occlusion and cardiopulmonary bypass in minimally invasive surgery group ((50.0±6.8), (69.5±9.7) min) was longer than those in routine operation group ((45.8±7.2), (65.0±8.8) min), the difference was statistically significant ( t=2.120, 2.052, all P<0.05). In the minimally invasive operation group, red cell volume, plasma volume, intraoperative bleeding volume, incision length, postoperative 24-h drainage volume, postoperative 24-h leukocyte count, postoperative 24-h C-reactive protein concentration, postoperative 24-h total blood transfusion volume, ventilator-assisted time, ICU stay time and drainage tube retention time(85.1(42.3, 181.3) ml, 108.5(79.4, 173.8) ml, 186.4(132.6, 307.6) ml, (4.2±0.8) cm, 130.0(88.1, 224.3) ml, 14.2(9.8, 17.1)×10 9/L, 14.0(9.9, 23.2) mg/L, 186.6(135.3, 302.1) ml, 3.7(2.3, 6.8) h, 25.2(20.6, 35.6) h, 31.2(26.4, 41.9) h) were lower than those in the routine operation group (354.2(150.2, 507.2) ml, 211.9(119.2, 281.5) ml, 378.4(220.9, 496.5) ml, (13.8±6.5) cm, 365.8(171.8, 511.3) ml, 20.4(13.6, 24.7)×10 9/L, 28.6(14.4, 39.3) mg/L, 405.1(185.3, 570.1) ml, 7.7(4.2, 10.2) h, 52.8(30.8, 69.3) h, 57.2(37.6, 71.9) h), the difference between the two groups was statistically significant ((the statistical values were Z=3.393, 2.696, 2.781, t=7.329, Z=3.151, 2.638, 2.493, 2.597, 2.472, 3.254, 3.338, respectively; all P<0.05). There was no significant difference between the minimally invasive operation group and the routine operation group( P>0.05). The total incidence of postoperative complications in the minimally invasive operation group and the routine operation group was (12% (3/25) and 44% (11/25)), the difference was statistically significant ( P=0.025). Conclusion:CPB with normal temperature has the advantages of less trauma, fewer complications and faster recovery in the operation of single incision in the upper part of sternum.
ABSTRACT
Objective To explore the operative indication operation time and post-operative care for infants with large ventricular septal defects (VSD).Methods Eighty-eight infants who suffered from large VSD were selected,male 53 cases,female 35 cases,aged from 3 to 18 months[average (7.5-±2.9) months],weight from 5 to 13 kg [average (7.9 ± 1.9) kg].All patients underwent VSD repair and other accompanied anomaly corrections under cardiopulmonary bypass.Fifty-eight cases were operated through right atrium,14 cases through pulmonary artery and 16 cases through right ventricle.Patch repairs were done in all patients,78 cases given bovine pericardium patches,10 cases given self pericardium patches treated by Glutaral.Patients were sent to the intensive care unit after surgery,vasoactive drugs were used as a routine method.Antibotics were selected based on their sputum cultures postoperatively.Nutritional support was given in the earlier stage.Results There were no hospital death,average hospitalization days were (15.2 ± 5.9) days (from 11 to 32 days).The main complication were pneumonia (5 cases),bad coalesce of incision (4 cases),atelectasis (3 cases),minimal residual shunt of VSD (3 cases).All patients were discharged from hospital,76 cases were followed up from 1 to 12 months,2 cases had residual shunt of VSD,the residual shunt of the other case disappeared;76 patients had no clinical symptom,28 patients body weight returned to normal after 6 months of operation.There was no other complication and death.Conclusion Early surgical treatment for infants with large VSD is a safe and effective way with a better prognosis.
ABSTRACT
Objective To investigate the dynamic changes in the fibrinolytic system during and after open heart surgery performed with cardiopulmonary bypass (CPB) and the effect of epsilon-aminocaproic acid (EACA) on fibrinolysis, postoperative blood loss and transfusion requirements.Methods Forty patients (24 males, 16 females) aged 17-43 yr undergoing valve replacement with CPB were randomized to receive EACA 200 mg?kg-1 (group A) or normal saline (group B) added to the priming solution. The patients were premedicated with intramuscular morphine 0.2 mg?kg-1 and scopolamine 0.3 mg. Anesthesia was induced with midazolam 0.2 mg ? kg, fentanyl 10 ?g?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with isoflurane inhalation and intermittent i.v. boluses of fentanyl and vecuronium. The patients were mechanically ventilated (VT = 10 ml?kg-1 , RR = 10-12 bpm, I:E = 1:2) after tracheal intubation. Blood samples were taken before skin incision (baseline) , 8 and 30 min on CPB, 10 min after protamine administration and 2 h after operation for determination of tissue type plasminogen activator (t-PA) activity, plasminogen activator inhibitor (PAI) activity, plasmin (Plm) activity and D-dimer. The amount of blood drained from chest and bank blood infused within 24 h after operation were recorded.Results (1) Group B (control group): PAI activity was maintained stable perioperatively. The t-PA activity and t-PA/PAI ratio increased significantly during operation but returned to the baseline value 2 h after operation. D-dimer level also significantly increased during and after operation. The Plm activity increased significantly at 8h on CPB and 10 min after protamine administration compared to the baseline value. (2) The t-PA activity and t-PA /PAI ratio were significantly lower in group A than in group B. The D-dimer level and Plm activity were also significantly lower in group A than in group B during and after operation. The amount of blood loss and bank blood infused within 24 h after operation was 40% and 37% less than that in group B.Conclusion Fibrinolytic system is activated during CPB as shown by the increase in plasminogen and t-PA/PAI ratio. EACA is effective in reducing postoperative blood loss and blood transfusion through inhibition of the activation of fibrinolytic system.