Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root / Reconstrução da raiz da aorta reforçada para dissecção aguda da aorta tipo A envolvendo a raiz da aórtica

OBJECTIVE: There are debates regarding the optimal approach for AAAD involving the aortic root. We described a modified reinforced aortic root reconstruction approach for treating AAAD involving the aortic root. METHODS: A total of 161 patients with AAAD involving the aortic root were treated by our modified reinforced aortic root reconstruction approach from January 1998 to December 2008. Key features of our modified approach were placement of an autologous pericardial patch in the false lumen, lining of the sinotubular junction lumen with a polyester vascular ring, and wrapping of the vessel with Teflon strips. Outcome measures included post-operative mortality, survival, complications, and level of aortic regurgitation. RESULTS: A total of 161 patients were included in the study (mean age: 43.3 1 15.5 years). The mean duration of follow-up was 5.1 1 2.96 years (2-12 years). A total of 10 (6.2%) and 11 (6.8%) patients died during hospitalization and during follow-up, respectively. Thirty-one (19.3%) patients experienced postoperative complications. The 1-, 3-, 5-, and 10-year survival rates were 99.3%, 98%, 93.8%, and 75.5%, respectively. There were no instances of recurrent aortic dissection, aortic aneurysm, or pseudoaneurysm during the entire study period. The severity of aortic regurgitation dramatically decreased immediately after surgery (from 28.6% to 0% grade 3-4) and thereafter slightly increased (from 0% to 7.2% at 5 years and 9.1% at 10 years). CONCLUSION: This modified reinforced aortic root reconstruction was feasible, safe and durable/effective, as indicated by its low mortality, low postoperative complications and high survival rate.

OBJETIVO: Há um debate sobre a melhor abordagem para dissecção aguda da aorta tipo A (DAAA) envolvendo a raiz da aorta. Nós descrevemos abordagem aórtica reforçada modificada de reconstrução de raiz para o tratamento DAAA envolvendo a raiz da aorta. MÉTODOS: Um total de 161 pacientes com DAAA envolvendo a raiz da aorta foram tratados pelo nosso abordagem reforçada modificada da reconstrução da raiz da aorta de janeiro de 1998 a dezembro de 2008. As características-chave da nossa abordagem modificada foram a colocação de um remendo de pericárdio autólogo na falsa luz, forro do lúmen supravalvar com um anel vascular, poliéster e envolvimento dos vasos com tiras de teflon. A avaliação pós-operatória incluiu mortalidade, sobrevivência, complicações, e grau de insuficiência aórtica. RESULTADOS: Um total de 161 pacientes foram incluídos no estudo (média de idade: 43,3 1 15,5 anos). A duração média de acompanhamento foi de 5,1 1 2,96 anos (2-12 anos). Um total de 10 (6,2%) e 11 (6,8%) pacientes morreram durante a internação e durante o acompanhamento, respectivamente. Trinta e um (19,3%) pacientes apresentaram complicações pós-operatórias. A 1 -, 3 -, 5 -, e as taxas de sobrevivência de 10 anos foram 99,3%, 98%, 93,8% e 75,5%, respectivamente. Não houve casos de dissecção aórtica recorrente, aneurisma ou pseudoaneurisma da aorta durante o período de estudo. A gravidade da regurgitação aórtica diminuiu drasticamente logo após a cirurgia (de 28,6% para grau 0 de 3-4%) e, posteriormente, teve ligeiro aumento (de 0% a 7,2% em 5 anos e de 9,1% aos 10 anos). CONCLUSÃO: A reconstrução da raiz da aorta reforçada modificada é viável, segura e durável/eficaz, como indicado pelas baixas mortalidade e complicações pós-operatórias e taxa de sobrevivência elevada.

Effect of miR-214 on invasive capacity of esophageal squamous carcinoma cell line Eca109 / 第二军医大学学报

Objective To investigate the effect of miR-214 on the invasive capacity of esophageal squamous carcinoma cell line Eca109, and to explore the possible molecular mechanism. Methods We prepared miR-214 double-stranded mimic and transfected it into Eca109 cells with Lipofectamine 2000. Eca109 cells transfected with nonsense miRNA mimics were taken as control. The expression of mature miR-214 was determined by qPCR. The capacity of cell invasion was determined by Matrigel-coated Transwell assay. E-cadherin protein expression and the percentage of E-cadherin positive cells were examined by Western blotting analysis and flow cytometry, respectively. Results The expression level of mature miR-214 in the miR-214 mimic transfection group was significantly higher than that in the control group 48 h after transfection (P<0.01). Eca109 cells transfected with miR-214 mimic showed a significantly lower cell invasive capacity compared to that of cells transfected with control miRNA mimic (P<0.05). Moreover, E-cadherin protein expression and the ratio of E-cadherin positive cells in miR-214 mimic transfection group were both significantly lower than those in the control group (P<0.05). Conclusion Our data suggest that miR-214 may inhibit the invasive capacity of esophageal squamous carcinoma cells by repressing the epithelial-mesenchymal transition.

A novel regulable sutureless aortic arch prosthesis: An experimental study / 第二军医大学学报

Objective: To develop a novel regulable sutureless aortic arch prosthesis and to apply it in an animal experimental study. Methods: The arch skeleton of the prosthesis was made of tandem Z-shape NiTiNOL wire; the branch skeleton was made of laser-cut NiTiNOL tube; and the whole skeleton was coated with thin ePTFE film. The blood vessel was anastomosed by direct ligature, needing no manual suturing. The prosthesis was applied in swine aortic arch operations under the bypass condition. The practicality for surgery and the feasibility of anastomosis of the prosthesis were assessed. Results: Aortic arch operations were successfully performed in 6 of the 8 experimental animals. The prostheses were easy to use, and the mean bypass time was only 10 min. The blood loss of the anastomoses was less than 100 ml within 8 h postoperatively in 5 animals; one had more blood loss due to prosthesis mismatch. Conclusion: The novel regulable sutureless aortic arch prosthesis has satisfactory practicality for surgery and reliable anastomosis, making it promising in future clinical application.

Ibutilide and amiodarone in management of new-onset atrial fibrillation after coronary artery bypass grafting: A comparison of safety and efficacy / 第二军医大学学报

Objective To compare the safety and efficacy of ibutilide and amiodarone in converting post-coronary artery bypass grafting (CABG) new-onset atrial fibrillation (AF) to sinus rhythm. Methods This study was a prospective, singleblinded, randomized clinical trial. Totally 100 patients who met the inclusion criteria were enrolled and were intravenously treated with ibutilide (group A) or amiodarone (group B). In group A, Ibutilide was administered at a dose of 1 mg in 10 min, which was repeated after an interval of another 10 min if the arrhythmia was not converted; ibutilide was not given anymore no matter the conversion was achieved or not. In group B, amiodarone was administered at a dose of 5 mg/kg for the first 30 min, followed by 1 200 mg in the next 24 h; amiodarone was not given anymore no matter the conversion was achieved or not. Immediate conversion rate, conversion time and post-operative recurrence rate within 30 days were compared between the two groups. Results No severe adverse reactions were observed in both groups. The immediate conversion rate of group A was significantly higher than that of group B (82% vs 58% , P0.05). Conclusion Ibutilide and amiodarone are both safe in converting post-CABG new-onset AF to sinus rhythm, and ibutilide is more effective, more rapid in functioning and with a higher efficacy.

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>

Amiodarone in prevention of atrial fibrillation after coronary artery bypass grafting / 第二军医大学学报

Objective: To evaluate the role of amiodarone in preventing atrial fibrillation after coronary artery bypass grafting (CABG). Methods: Totally 184 patients receiving CABG under cardiopulmonary bypass (CPB) were randomly divided into amiodarone group (n=94) and placebo group (n=90), and patients in each group were further divided into ≥ 60 years and < 60 years subgroups. Patients in amiodarone group received routine drugs + amiodarone and those in placebo group received routine drugs + placebo. Results: The overall incidence of postoperative AF (paroxysmal and persistent) was significantly higher in the placebo group compared with the amiodarone group (32. 2% vs 6. 4%, P<0. 01, OR=7.0). The incidences of postoperative AF were similar in patients aged <60 years between the placebo group and the amiodarone group, but were significantly different in patients aged ≥ 60 (P<0.05 or P<0.01). The postoperative AF incidence was significantly different between 2 age subgroups (P<0.05 or P<0.01) in the placebo group, but not in amiodarone group. Conclusion: Amiodarone can effectively prevent post-operative AF, especially for patients aged ≥ 60 years. Amiodarone should be recommended to patients receiving CABG who aged ≥ 60 years.

A novel regulable sutureless aortic arch prosthesis:an experimental study / 第二军医大学学报

Objective:To develop a novel regulable sutureless aortic arch prosthesis and to apply it in an animal experimental study.Methods:The arch skeleton of the prosthesis was made of tandem Z-shape NiTiNOL wire;the branch skeleton was made of laser-cut NiTiNOL tube;and the whole skeleton was coated with thin ePTFE film.The blood vessel was anastomosed by di- rect ligature,needing no manual suturing.The prosthesis was applied in swine aortic arch operations under the bypass condi- tion.The practicality for surgery and the feasibility of anastomosis of the prosthesis were assessed.Results:Aortic arch opera- tions were successfully performed in 6 of the 8 experimental animals.The prostheses were easy to use,and the mean bypass time was only 10 min.The blood loss of the anastomoses was less than 100 ml within 8 h postoperatively in 5 animals;one had more blood loss due to prosthesis mismatch.Conclusion:The novel regulable sutureless aortic arch prosthesis has satisfactory practicality for surgery and reliable anastomosis,making it promising in future clinical application.