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Objective:To summarize the experience of emergency treatment of type A aortic dissection during the prevalence of COVID-19.Methods:Retrospectively analyzed the data of 29 patients undergoing emergency surgery for type A aortic dissection during the outbreak of corona virus disease-19 ( COVID-19) in Wuhan Asian Heart Hospital from January 23 to March 31, including 25 males and 4 females aged 34-72 years with mean age (49.17±9.63) years.There were 10 cases in Wuhan and 19 cases outside the city.All patients were diagnosed and indicated for emergency surgery through online consultation before transportation.After the primary exclusion of COVID-19 by pulmonary CT scanning in the emergency department, the patients were admitted to the isolation ward. Emergency surgery was performed after emergency nucleic acid testing and preoperative examing. Postoperatives were carried to a single room in the ICU for isolation until COVID-19 was excluded, nucleic acid testing and reexamination of pulmonary CT were performed if they were fever during hospitalization.All medical personnel involved in the operation and perioperative management took three levels of protection and medical observation.Results:There were 5 cases of type A1 in the aortic root, 2 cases of type A2, 22 cases of type A3, 2 cases of simple arch, 27 cases of complex type (Sun's classification).12 cases of Bentall, 2 cases of Wheats, 15 cases of ascending aorta replacement, 14 cases of aortic valve repair, 25 cases of aortic arch replacement, 23 cases of trunk stents, 2 cases of hybridization, 6 cases of concurrent coronary artery bypass grafting, and 2 cases of tricuspid valvuloplasty.In the whole group, 1 case of COVID-19 was confirmed and 1 was suspected.The time of cardiopulmonary bypass was(224.00±21.14)min, the blocking time was(146.17±18.75)min, the postoperative ventilator assisted(65.07±10.36)h, the hospitalization time was(27.03±5.64)days, there were no hospitalized deaths, 4 cases of postoperative liver function damage, 6 cases of acute renal function damage, and 7 of pulmonary infection.None of the medical staff involved in the operation and perioperative management were infected with COVID-19.Conclusion:During the period of major infectious diseases, the admission and treatment procedures of critical and severe patients should be standardized, and the control of nosocomial infection should be strengthened. Emergency surgery is an effective means to rescue type A active vein interlayer, and the safety of protecting medical staff is guaranteed.
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Objective To implement hypothermia during blood purification to investigate its effect and risk in the treatment of postoperative cardiogenic shock in valvular heart disease.Methods A non-blinded prospective randomized controlled trial (RCT) was conducted.Patients with valvular heart disease suffering from postoperative cardiogenic shock admitted to intensive care unit (ICU) of Wuhan Asian Heart Hospital from January 2011 to December 2014 were enrolled,and they were randomly divided into normothermic continuous blood purification (CBP) group (NT group) and hypothermia C BP group (HT group) according to random number table and envelope enclosed method.The patients in both groups were given continuous renal replacement therapy (CVVH),the blood temperature in NT group was remained at 36.5-37.3 ℃,and it was controlled at 34.0-35.0 ℃C in HT group.The data were collected before and 1,2,3 days after treatment,including cardiac index (CI),the oxygen supply/oxygen consumption ratio (DO2/VO2),acute physiology and chronic health evaluation 1Ⅲ (APACHE Ⅲ) score,multiple organ dysfunction (MODS) score.The length of ICU stay,duration of mechanical ventilation,duration of CBP,ICU mortality and the incidence of complication were recorded.Results A total of 95 patients were enrolled,with 47 patients in NT group,and 48 in HT group.There was no significant difference in gender,age,preoperative cardiac function,cardiothoracic ratio and type of valve replacement between two groups.Compared with those before treatment,no significant difference Was found in CI,DO2/VO2 ratio,APACHE Ⅲ score,MODS score on 1,2,3 days after treatment in NT group (all P ＞ 0.05).But in HT group,DO2/VO2 ratio was significantly improved on 1 day after treatment (2.5 ± 0.7 vs.1.8 ± 0.4,P ＜ 0.05),CI (mL·s-1·m-2:50.01±8.34 vs.31.67±11.67),APACHE Ⅲ score (50.6±6.2 vs.77.5±5.5),and MODS score (6.0± 1.5 vs.9.3±3.4) were significantly improved 3 days after treatment (all P ＜ 0.05).Compared with those in NT group,DO2/VO2 ratio in HT group was significantly increased from 1 day after treatment (2.5 ± 0.7 vs.1.8± 0.4,P ＜ 0.05),and CI (mL·s-1·m-2:38.34 ± 10.00 vs.35.01 ± 6.67),APACHE Ⅲ score (68.9 ± 7.1 vs.81.2 ± 7.3),and MODS score (8.9± 2.7 vs.10.6 ± 2.4) were significantly improved from 2 days after treatment (all P ＜ 0.05).In respect of clinical outcomes,compared with NT group,the length of ICU stay (days:6.9 ± 3.4 vs.12.5 ± 3.5,t =2.024,P =0.017) and duration of mechanical ventilation (days:4.2± 1.3 vs.7.5±2.7,t =1.895,P =0.034) in HT group was significantly shortened,duration of C BP was also significantly shortened (days:4.6 ± 1.4 vs.10.5 ± 4.0,t =2.256,P =0.019),and ICU mortality was significantly lowered (12.50％ vs.23.40,x2 =1.987,P =0.024),but there was no significant difference in incidence of infection (54.17％ vs.53.19％,x2 =0.689,P =0.341),ventricular arrhythmia (31.25％ vs.36.17％,x2 =0.772,P =0.237),and muscle fibrillation (14.58％ vs.8.51％,x2 =0.714,P =0.346),and blood loss (mL:617.0±60.7 vs.550.9±85.2,t =1.290,P =0.203) between HT group and NT group.The incidence of bradycardia in HT group was significantly higher than that of the NT group (29.17％ vs.14.89％,x2 =2.368,P =0.029).Conclusion Blood purification under hypothermia is a safe and effective therapeutic procedure for postoperative cardiogenic shock in patients with valvular heart disease,and it may improve the prognosis of postoperative patients.
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Objective To analyze the risk factors of hypoxemia after coronary artery bypasses grafting (CABG) along with cardiopulmonary bypasses and to understand the regular pattern and characteristics of hypoxemia after CABG. Methods The risk factors of hypoxemia were studied by one way analysis and multivariate logistic regression analysis in 86 patients with hypoxemia after CABG along with cardiopulmonary bypass. Results One way analysis indicated that hypoxemia after CABG along with cardiopulmonary bypass was related to senility ( ≥ 65 years ), smoking history, diabetes mellitus, chronic obstructive pulmonary disease ( COPD), left ventricular ejection fraction ( LVEF ＜ 45 % ), obesity before operation, transfusion ( ≥ 1000 ml );multivariate analysis indicated that pulmonary dysfunction before operation, longer extracorporeal circulation time ( ≥2 h), hypoalbuminemia and pulmonary infection were independent risk factors of hypoxemia after CABG along with cardiopulmonary bypass. Conclusion Multiple risk factors contributed to hypoxemia after CABG along with cardiopulmonary bypass. Increase the awareness of risk factors of perioperative hypoxemia may guide the prevention and treatment, even alleviate or avoid the hypoxemia postoperatively.