Methods and results of surgical treatment for aortic root pathology due to Stanford A aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effectiveness of surgical approaches, outcomes and prognosis of aortic root pathology due to Stanford A aortic dissection.</p><p><b>METHODS</b>Retrospective analysis the clinical data of 161 patients (122 male and 39 female, mean age of (44 ± 21) years) underwent surgical treatment for Stanford A aortic dissection between January 2001 and June 2011. There were 146 patients of acute aortic dissection and 15 patients of chronic aortic dissection. All the patients had aortic root pathologies that included commissural prolapsed in 140 cases, more than moderate aortic insufficiency in 75 cases, aortic sinus intima rupture in 15 cases, right and/or left coronary artery tearing in 8 cases, right and/or left coronary artery dissection in 16 cases, aortic root aneurysm in 31 cases.</p><p><b>RESULTS</b>Aortic root replacement (Bentall procedures) were used in 72 cases, aortic root remodeling (including aortic valve replacement) in 80 cases, aortic root reimplantation (David procedure) in 9 cases. The cardiopulmonary bypass time was shorter in aortic root remodeling group ((193 ± 42) minutes) than the other two groups ((210 ± 61) minutes, (197 ± 34) minutes, F = 3.22, P = 0.04). The in-hospital mortality was 8.1% (13 cases), 5 cases (6.9%) in aortic root replacement group, 7 cases (8.8%) in aortic root remodeling group, 1 case in aortic root reimplantation. The cause of death included respiratory failure (4 cases), permanent neurological deficits (3 cases), multiple organ failure (4 cases), acute renal failure (2 cases). The survivors were followed up for 6 months to 6 years. There was no patient required reoperation for aortic root pathologies. There was no statistically significant difference between aortic root remodeling group and reimplantation group (P > 0.05).</p><p><b>CONCLUSIONS</b>The surgical treatment for aortic root pathology due to Stanford A aortic dissection is challenging. Appropriate procedures according to the specialty of aortic root pathology can be performed with favorable functional results.</p>

Clinical analysis of the edge-to-edge technique for mitral regurgitation due to myxomatous degeneration / 中华外科杂志

<p><b>OBJECTIVES</b>To explore the feature of the edge-to-edge technique and its effect for mitral regurgitation due to myxomatous degeneration.</p><p><b>METHODS</b>The in-patient data and follow-up outcomes of 58 patients after the edge-to-edge technique for mitral regurgitation due to myxomatous degeneration from January 2000 to January 2009 were analyzed retrospectively. Of the 58 patients, 32 patients were male and 26 patients were female, and the age range was from 43 years to 65 years with a mean of (56 ± 6) years, and moderate mitral regurgitation was observed in 18 patients and severe regurgitation in 40 patients, and the prolapse of the anterior leaflet was observed in 50 patients and the prolapse of the bileaflet in 8 patients. The edge-to-edge technique was performed in all patients and the annuloplasty was performed in 44 patients.</p><p><b>RESULTS</b>There was no perioperative death and serious complication. Postoperative transthoracic echocardiography of all the survivors indicated that the dimensions of left atrial and left ventricular were obviously decreased (P < 0.05) and mitral insufficiency was obviously improved (no regurgitation was observed in 9 patients and trace regurgitation in 30 patients and mild regurgitation in 19 patients) and there was no mitral stenosis. Totally 58 patients were followed up from 24 months to 95 months with a mean of (58 ± 20) months. During the follow-up, there were 2 deaths for noncardiac factors. Freedom from recurrent moderate or severe mitral regurgitation at 5 years after operations was 91.9%. According to undergoing combined annuloplasty or not, 58 patients were divided into the edge-to-edge technique group (14 cases) and the edge-to-edge technique + annuloplasty group (44 cases), and the survival analysis shows there was significant difference on freedom from long-term recurrent moderate or severe mitral regurgitation after operations between two groups (χ(2) = 4.034, P = 0.045) and long-term effect of the latter group was better.</p><p><b>CONCLUSIONS</b>The edge-to-edge technique can be conveniently used and bring about satisfactory perioperative and long-term effects for mitral regurgitation due to myxomatous degeneration. The combination of the edge-to-edge technique and the annuloplasty can improve the long-term effect significantly.</p>

Strategy of dealing with left subclavian artery in total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experiences of ligating left subclavian artery (LSA) in total arch replacement and stented elephant trunk implantation for Stanford type A aortic dissection patients with difficulty in exposing the LSA.</p><p><b>METHODS</b>Total arch replacement and stented elephant trunk implantation were performed on 79 consecutive patients from January 2008 to June 2010. Twenty-nine cases of the cohort undertook LSA ligation due to bad exposure. There were 21 males and 8 females patients, aged from 19 to 55 years with a mean of (44 ± 12) years. There were 12 acute dissections, 4 sub-acute dissections and 13 chronic dissections. Based on thoroughly evaluation of the Willis' circle and bilateral vertebral arteries through pre-operative imaging and intra-operative circulative parameters, if the collateral circulation was considered sufficient, LSA was ligated directly and only the innominate artery and carotid artery were reconstructed; if considered insufficient, an additional bypass from ascending aorta to left axillary artery was performed.</p><p><b>RESULTS</b>All the 29 operations were completed successfully. There was one patient died from pulmonary infection and the others recovered well.Blood pressure of left arms were lower than right postoperatively [(78 ± 17) mmHg vs. (126 ± 24) mmHg, 1 mmHg = 0.133 kPa, P < 0.01], but oxygen saturation, skin temperature and strength of the left hand were normal compared to the right. All the survived patients have been followed 1 - 27 months and none of them presented with any symptoms of left subclavian artery steal syndrome and ischemia of left arms.</p><p><b>CONCLUSIONS</b>Ligation of LSA under strict evaluation of collateral circulation could be safe in Type A dissection patients with bad exposure due to big ascending aortic aneurysm and will simplify the procedure significantly.</p>

Congenital quadricuspid aortic valve: analysis of 11 surgical cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR). The diagnosis and treatment of the disease were reported in 11 cases.</p><p><b>METHODS</b>Eleven patients (nine men and two women, mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated. Medical records, echocardiograms and surgical treatment were reviewed.</p><p><b>RESULTS</b>In accordance with the Hurwitz and Roberts classification, the patients were classified as type A (n = 2), type B (n = 7), type F (n = 1) and type G (n = 1). Three patients were associated with other heart diseases, including infective endocarditis and mitral prolaps, left superior vena cava, aortic aneurysm. All had aortic regurgitation (AR) except two with aortic stenosis (AS), detected by color-flow Doppler echocardiography. The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography. All patients underwent successful aortic valve replacement.</p><p><b>CONCLUSION</b>Quadricuspid aortic valve is a rare cause of aortic insufficiency, while echocardiography plays an important role in diagnosing the disease. Aortic valve replacement is the major therapy for the disease.</p>

Reoperative valve replacement in patients undergoing cardiac reoperation: a report of 104 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To review the experience of reoperative valve replacement for 104 patients.</p><p><b>METHODS</b>From January 2002 to December 2009, 104 patients underwent heart valve replacement in reoperations, accounting for 2.92% of the total patient population (3557 cases) who had valve replacement during this period. In this group, 53 male and 51 female patients were included with a median age of 46 years (ranged from 13 to 72 years). The reasons of reoperation included 28 cases suffered from another valve lesion after valve replacement, 10 cases suffered from valve lesion after mitral valvuloplasty, 19 cases suffered from perivalvular leakage after valve replacement, 18 cases suffered from valve lesion after previous correction of congenital heart defect, 7 cases suffered from bioprosthetic valve decline, 10 cases suffered from prosthetic valve endocarditis, 9 cases suffered from dysfunction of machine valve, and 3 cases suffered from other causes. The re-operations were mitral and aortic valve replacement in 2 cases, mitral valve replacement in 59 cases, aortic valve replacement in 24 cases, tricuspid valve replacement in 16 cases, and Bentall's operation in 3 cases. The interval from first operation to next operation was 1 month-19 years.</p><p><b>RESULTS</b>There were 8 early deaths from heart failure, renal failure and multiple organ failure (early mortality 7.69%). Major complications were intraoperative hemorrhage in 2 cases, re-exploration for mediastinal bleeding in 2 cases and sternotomy surgical site infection in 1 case. Complete follow-up (3 months-7 years and 2 months) was available for all patients. Two patients died, one patient died of intracranial hemorrhage, and another cause was unknown.</p><p><b>CONCLUSION</b>Satisfactory short-term and long-term results can be obtained in reoperative valve replacement with appropriate timing of operation control, satisfactory myocardial protection, accurate surgical procedure and suitable perioperative treatment.</p>

Evaluation of surgical technique and indication on descending aortic aneurysms / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the surgical technique and indication on descending aortic aneurysms.</p><p><b>METHODS</b>From January 1996 to June 2006, 41 patients with descending aortic aneurysm underwent operation, including DeBakey type III dissection in 26, false aneurysm in 6, true aneurysm in 4, and residual or newly complicated type III dissection after the surgery of Marfan syndrome in 5. Operations were performed by left heart bypass in 9, femoral-femoral bypass in 7, pulmonary-femoral bypass in 2, and deep hypothermic circulatory arrest in 23. The whole thoracic descending aorta was replaced in 15, and intercostal arteries were reimplanted in 12.</p><p><b>RESULTS</b>One patient died of acute renal failure with the hospital mortality 2.4%. Main complications: respiratory dysfunction in 6, renal dysfunction in 6, recurrent nerve injuries in 4, chylothorax in 2, and no paraplegia.</p><p><b>CONCLUSIONS</b>Surgical intervention of descending aortic aneurysm still has its unique advantages and indications; surgical safety is markedly improved by the use of deep hypothermic circulatory arrest.</p>

Impact of different brain protection techniques upon postoperative temporary neurological dysfunction in aortic surgery with the aid of deep hypothermic circulatory arrest / 中华外科杂志

<p><b>OBJECTIVE</b>To assess impact of different brain protection techniques upon postoperative temporary neurological dysfunction in aortic surgery with the aid of deep hypothermic circulatory arrest.</p><p><b>METHODS</b>From January 2003 to December 2005, 78 patients who met the inclusion criteria entered the present cohort, 43 of whom were under the aid of deep hypothermic circulatory arrest plus retrograde cerebral perfusion (RCP group) and the other 35 under deep hypothermic circulatory arrest plus selective antegrade cerebral perfusion (SCP group). The present and grades of postoperative temporary neurological dysfunction were assessed by independent observers with the same criterion. The impact of duration of deep hypothermic circulatory arrest upon the postoperative temporary neurological dysfunction was also evaluated.</p><p><b>RESULTS</b>The incidence of postoperative temporary neurological dysfunction was significantly higher in the RCP group than in the SCP group (15, 34.9% vs. 4, 11.4%, P<0.05). And long duration of deep hypothermic circulatory arrest (more than 50 min) has a negative impact on the postoperative temporary neurological dysfunction rate.</p><p><b>CONCLUSIONS</b>Applying selective antegrade cerebral perfusion as the brain protection technique and shortening the duration of deep hypothermic circulatory arrest can reduce the incidence of temporary neurological dysfunction and preserve cerebral function more effectively.</p>

Surgical interventions for complex native valve endocarditis / 中华外科杂志

<p><b>OBJECTIVE</b>To elucidate the early and long-term results of surgical treatment for complex infective endocarditis with prosthetic valve replacement.</p><p><b>METHODS</b>Fifty-seven patients of complex native valve endocarditis, including 25 cases of aortic valve, 16 of mitral valve and 16 of double valves, who underwent operative interventions with prosthetic valve replacement between December 1988 and June 2002, were analyzed retrospectively. Intraoperative findings demonstrated aortic annular abscesses (n = 19), root abscesses (n = 4), mitral posterior annular abscesses (n = 11), myocardial abscesses (n = 6), massive leaflet destruction (n = 32) and valvular vegetations (n = 55). Complex reconstruction of the aortic and mitral annulus was required in 35 patients. Associated procedures included Bentall's procedure (n = 4), aortic valve replacement (n = 21), mitral valve replacement (n = 16) and double valve replacements (n = 16).</p><p><b>RESULTS</b>The operative mortality was 11%. Complications included low cardiac output syndrome, recurrence of endocarditis, multiple organ failure, ventricular arrhythmia, bleeding, mediastinal infection, respiratory insufficiency and heart block. Follow-up was 100% complete at a mean of 5.93 years. There were five late deaths (3 prosthetic valve endocarditis, 2 valve-related). The NYHA functional status recovered to Class I in 17 patients, Class II in 27 and Class III in 2 at 1 year follow-up. Kaplan-Meier analysis showed the 5-year actuarial freedom from reoperation was (84 +/- 3)%, and actuarial survivorship at 5 years was (61 +/- 9)%.</p><p><b>CONCLUSIONS</b>Urgent or even emergency operation is advocated for complex infective endocarditis. Proper intraoperative reconstruction of the aortic and mitral annulus and optimized perioperative management, especially the strategy for prevention of recurrent endocarditis, are of great importance in achieving satisfied early and long-term clinical outcomes.</p>

Fetal bone marrow stromal cells support the in vitro expansion of human hematopoietic bone marrow progenitor cells: requirement for cell-to-cell interactions and colony-stimulating factors / 第二军医大学学报

Objective： To elucidate the role of bone marrow stromal cells in cooperation with exogenous cytokines in hematopoiesis. Methods： Fetal bone marrow stromal cells (FBMSC) was combined with cytokines including SCF,IL-3,IL-6,GM-CSF in a 5-day liquid culture system of adult bone marrow mononuclear cells, then we cultured bone marrow derived CD34+-enriched cells with FBMSC+SCF+IL-3+IL-6+G-CSF+EPO for 2 weeks. Results：FBMSC were in good cooperation with above mentioned exogenous cytokines. When CD34+-enriched cells from adult bone marrow were cultured with combinations of FBMSC, SCF, IL-3, IL-6, G-CSF and EPO, total nucleated cells, CFU-GM, BFU-E and CD34+ cells were increased by 119.6±30.9, 54.6±17.4, 25.2±4.4, 11.1±4.2 folds, respectively. Conclusion：FBMSC in cooperation with exogenous cytokines support the in vitro expansion of human hematopoietic progenitor cells efficiently.

Fetal bone marrow stromal cells support the in vitro expansion of human hematopoietic bone marrow progenitor cells: requirement for cell-to-cell interactions and colony-stimulating factors / 第二军医大学学报

Objective： To elucidate the role of bone marrow stromal cells in cooperation with exogenous cytokines in hematopoiesis. Methods： Fetal bone marrow stromal cells (FBMSC) was combined with cytokines including SCF,IL-3,IL-6,GM-CSF in a 5-day liquid culture system of adult bone marrow mononuclear cells, then we cultured bone marrow derived CD34+-enriched cells with FBMSC+SCF+IL-3+IL-6+G-CSF+EPO for 2 weeks. Results：FBMSC were in good cooperation with above mentioned exogenous cytokines. When CD34+-enriched cells from adult bone marrow were cultured with combinations of FBMSC, SCF, IL-3, IL-6, G-CSF and EPO, total nucleated cells, CFU-GM, BFU-E and CD34+ cells were increased by 119.6±30.9, 54.6±17.4, 25.2±4.4, 11.1±4.2 folds, respectively. Conclusion：FBMSC in cooperation with exogenous cytokines support the in vitro expansion of human hematopoietic progenitor cells efficiently.