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@#Committee of Minimally Invasive Cardiovascular Surgery (CMICS) annually investigates the minimally invasive cardiovascular surgery performed by departments of cardiovascular surgery of all hospitals in China of last year, and makes classification and summary according to the operation amount of minimally invasive surgery, regional and hospital distribution, and publishes it on the theme report of China Minimally Invasive Cardiovascular Surgery Conference (CMC). In 2021, CMICS published the 2018-2019 annual data of Chinese cardiovascular surgery in the form of a white paper for the first time in the Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, which attracted great attention from peers. In this statistical report, CMICS will focus on the volume of minimally invasive cardiovascular surgery, regional and hospital distribution in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region, and Taiwan Province) in the 2020—2021 for your reference.
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Objective:To summarize the clinical characteristics and surgical treatment experience of pregnant women with acute Stanford type A aortic dissection.Methods:From January 2005 to December 2018, a total of 12 patients with acute Stanford type A aortic dissection were treated in Zhongshan Hospital affiliated to Fudan University. Two patients died of sudden aortic dissection rupture during emergency CTA examination. The other 10 patients underwent surgical treatment, the age was 22-40 years[mean(30.7±5.8) years], the pregnancy was 15-39 weeks[mean(28.8±6.5) weeks], two cases in the second trimester of pregnancy, seven cases in the third trimester of pregnancy and one case in puerperium. Among them, seven cases were Marfan syndrome, one case was bicuspid aortic valve malformation, two cases were complicated with pregnancy hypertension.Results:One case died during perioperative period and died of rupture of abdominal aortic dissection in twelfth day after operation. One fetus was diagnosed as stillborn before operation. Before December 2013, six patients underwent surgeries, the mean cardiopulmonary bypass time was(96.8±16.5)min, aortic occlusion time was(70.8±19.3)min, intensive care unit time was(3.4±2.3) days, ventilator-assisted mechanical ventilation time was(21.6±15.6)h. After January 2014, four patients underwent surgeries, the mean cardiopulmonary bypass time was(202.3±6.4)min, the aortic cross-blocking time was(137.5±10.3)min, circulatory arrest time was(27.3±8.8)min, intensive care unit time was(12.0±5.7) days, and the ventilator-assisted mechanical ventilation time was(40.3±24.4)h. The postoperative complications included tracheotomy in two cases, hemodialysis in one case, poor wound healing in one case. One patient who had been treated with Bentall was followed up to sixth year and died of progressive rupture of descending arch dissection. One patient was followed up to seventh year after Bentall surgery, redo Bentall and Sun’s procedure were performed because of artificial valve infection, and was discharged uneventful. No adverse cardiovascular events occurred in other patients.Conclusion:Surgical treatment should be actively considered in pregnancy complicated with acute Stanford type A aortic dissection. Multi-disciplinary team cooperation can effectively improve the safety and effect of operation.
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@#The advent of transcatheter aortic valve replacement (TAVR) has brought up a new treatment option for patients with severe aortic valve disease. However, with the continuous expansion of surgical indications, problems such as structural valve deterioration caused by biological prosthesis have become increasingly prominent. In the newly announced 5-year follow-up results of COMMENCE (SAVR) trial, the aortic bioprosthesis using the new RESILIA biotissue material demonstrated extraordinary clinical safety, efficacy and durability with zero structural valve deterioration and excellent hemodynamic evaluation results. As a result, patients with valvular heart disease have more diverse therapeutic options. However, the choice between surgical aortic valve replacement (SAVR) and TAVR, biological prosthesis and mechanical prosthesis, etc, has become more and more prominent, which brings more difficulties to clinicians. This paper reviews the research background, 5-year follow-up results of COMMENCE trial and the implications for aortic valve surgery in China.
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Objective:To investigate the effectiveness and safety of transcatheter closure of atrial septum defect(ASD) in adults using echocardiography as the only imaging tool.Methods:From April 2017 to August 2019, 118 patients with congenital atrial septum defect were treated by cardiac surgery in Zhongshan Hospital affiliated to Fudan University. There were 31 males and 87 females, aged 15-72 years old[mean(40.3±15.3) years old]. 117 cases of atrial septum defect were secondary foramen and 1 case was residual shunt after repair of atrial septum defect by transthoracic echocardiography. The patients with tricuspid insufficiency and pulmonary hypertension were followed up by transesophageal echocardiography.Results:The transcatheter closure of atrial septum defect(ASD) was successfully performed in 114 patients. 3 patients were successfully treated with right fourth intercostal small incision atrial defect occlusion due to the coaxial problem of occlusive device and atrial defect. One patient underwent repair of atrial septum defect during the correction of right ventricular injury. The selected size of occluder ranged from 12 mm to 38 mm. One case of ethmoidal orifice was successfully blocked with double occlusive device. There was no occlusive device displacement, no obvious residual shunt, peripheral vascular injury and other complications occurred in successful occlusive patients. 110 patients were directly transferred back to the general ward after extubation. The postoperative hospital stay was(2.3±1.1) days and the total hospitalization time was(4.5±1.7) days. There were 7 patients with tricuspid regurgitation above mild to moderate before operation, and 6 patients with tricuspid regurgitation decreased to mild regurgitation after occlusion. One month after operation, the pulmonary artery pressure of 51 patients with moderate and severe pulmonary hypertension decreased from(50.4±11.4)mmHg to(38.9±12.9) mmHg( P<0.05). The occlusive device was well fixed and no residual shunt was found. Conclusion:Transesophageal echocardiography guided transcatheter closure of atrial septum defect is not only safe and effective in adult cardiac surgery, but also can avoid radiation and contrast agent injury.
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Objective To summarize the treatment decision-making strategy and its long-term efficacy for advanced elderly patients with severe valvular heart disease and clear indications for surgery.Methods Clinical data of 196 patients aged 75 years and older firmly diagnosed as severe valvular heart diseases were retrospectively analyzed.The patients were divided into the surgical group (a mean age of 77.4±2.0 years,n=126)and the conservative group(a mean age of 80.5±5.0 years,n =70).Factors affecting therapeutic decision-making were analyzed,and the differences in a long-term survival were compared between the two groups.Results The most common reason for choosing conservative treatment was the recommendation of the doctor giving a preliminary diagnosis and worrying about the high-risk surgery for the patients(62.9％,44/70).Only 26(37.1％)patients in the conservative group were evaluated by cardiac surgeons,among whom 12 (17.1％)patients were considered to have surgical contraindications,and 14 (20.0％) patients themselves or their family members chose conservative treatment for the fear of surgical risks.Patients in the operation group were mainly from the outpatient department of cardiac surgery,and only 8 (6.3 ％)cases were referred from department of internal medicine.Logistic regression analysis showed that female,chronic renal insufficiency,advanced age,pneumonia and emergency hospital admissions were independent predictors for the conservative option(P ＜0.01),while patients with isolated aortic valve disease tended to receive surgical treatment.Overall 5-year survival was higher in the surgical group than in the conservative group (76.4％ vs.39.9％,P ＜ 0.01).Cox regression analysis disclosed that the conservative treatment option was the single risk factor for long-term survival in all series.Conclusions Many factors affect the process of therapeutic decision-making for patients with severe valvular heart diseases,and a multidisciplinary collaboration is the best way for the optimal treatment strategy for those patients.
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By means of literature review, theoretical analysis and analogy analysis, the authors analyzed the characteristics and risk exposure of online medical information transmission. According to whether the sender has a clear intention or target and whether the receiver intends to search,the transmission models of such information fall into four types: "clear-active", "unclear-active", "unclear-passive", and"clear-passive". The characteristics of online medical information transmission include the complexity of multiple dimensions and multiple levels, multiple sources of information, multiple directions and media of transmission, and the rapid development of mobile internet medical information technology. The risk exposure of online medical information transmission can be classified into three categories: the risk of information dissemination source, that of transmission process and that of receiver′s individual behavior. Transmission risks mostly come from quality gaps of information dissemination sources, uncontrollable transmission paths, numerous influencing factors, difficulties in information screening and poor regulating systems.
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Objective To investigate the clinical characteristics,surgical experience and mid-term outcome of coronary artery bypass graft surgery in patients aged ≤ 40 years.Methods From Jan.,2009 to Dec.,2015,12 patients with median age of (37.9 ± 2.5) years (range 32-40 years,10 males) were diagnosed with coronary artery disease and underwent coronary artery bypass graft surgery at Zhongshan Hospital,Fudan University.The clinical characteristics included five cases with hypertension,three cases with diabetes mellitus,four cases with hyperlipemia,eight cases with smoking history,seven cases with myocardial infarction.Six cases had at least one branch totally occluded.Two cases once underwent percutaneous coronary intervention surgery and implanted with five and three stents respectively.The perioperative data and follow-up results were retrospectively analysed.Results There was no in-hospital death and no death during follow-up period.Surgical techniques included bilateral internal mammary arteries combined with radial artery were operated in six cases,bilateral internal mammary arteries combined with great saphenous vein in two cases,left internal mammary arteries combined with great saphenous vein in four cases,off-pump in nine cases and on-pump in three cases.The mean follow-up time was (47.8 ± 24.3) months.During the follow-up one case suffered with saphenous vein graft restenosis 5 years after the surgery and underwent percutaneous coronary intervention.Other cases were all alive and assessed New York Heart Association's function class Ⅰ-Ⅱ.Conclusions Younger patients usually suffer with severe coronary artery disease when diagnosed because they often have excellent compensative capacity and the pathogenesis is concealed.The mid-term results of coronary artery bypass graft surgery in patients aged ≤40 years are satisfactory.
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Objective To evaluate the safety and effectiveness of a newly domestic bovine pericardium using a juvenile sheep model and to provide proof for clinical use.Methods Under the off-pump condition,8 domestic bovine pericardiums were implanted into the pulmonary artery and the descending aorta of 4 juvenile sheep as the trial group.As the control group,four imported bovine pericardiums were implanted into two juvenile sheep.Before the surgery,the juvenile sheep were given a physical examination and some laboratory tests.Ultrasonic cardiographs were taken after 1 month and 2 months of implantation.Sheep were sacrificed after 90 days and compared with the extent of endothelialization,inflammation and calcification of the two groups.Results (1) All the juvenile sheep survived without any complications.(2) Ultrasonic cardiograph showed the absence of leakage,thrombus,calcification,neoplasm or any structural deterioration.(3) Gross examination showed there was no intimal hyperplasia.The thickness and tenacity of all patches had no change compared with the pre-operation condition.All the patches showed smooth and pliable faces without degeneration,as well as absence of macroscopically calcification.(4) There was not any positive result in microbiological tests in both groups.The degree of inflammation,necrosis and calcification had no significant differencs between the two groups.Conclusions The data shows that the domestic bovine pericardium,a newly developed Chinese domestic-design and manufactured bovine pericardium,can exhibit long-term satisfactory safety and efficacy in the implantation of the pulmonary artery and the descending aorta of juvenile sheep.
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Objective Acute renal failure (ARF) requiring renal replacement therapy (RRT) was reported in 0.33％to 9.5％ patients after cardiac surgery.This study was designed to assess the clinical usefulness and accuracy of 3 clinical tools for the prediction of ARF after cardiac surgery in Chinese patients.Methods Five hundred and four eligible patients with complete clinical data in our institution received prospective assessment for RRT and acute kidney injury (AKI) between June,2009 and November,2010.The clinical tools used were Cleveland ARF Score,acute kidney injury prediction following elective cardiac surgery(AKICS) and Simplified Renal Index(SRI).Hosmer—Lemeshow goodness-of-fit test was used to estimate the calibration.Discrimination was determined with receiver operating characteristic (ROC) curves and area under a ROC curve (AUC).Results Follow-up was completed in all 504 patients.The overall incidence of postoperative RRT was 3.17％(16/504) with a mortality of 37.5％,and the incidence of AKI was 5.36％ ( 27/504 ).Discrimination for the prediction of RRT and AKI was good for SRI measured with AUROCs:0.759 (95％ CI,0.643-0.874) for RRT and 0.773 (95％ CI,0.677-0.868 ) for AKI.SRI score performed better in terms of discrimination than Cleveland ARF score and AKICS in our study,which did not consist with results reported by other centers.Conclusion SRI scoring system is the most useful among three tools for predicting postoperative RRT and should be the first choice in Chinese patients for whom a cardiac surgery is planned.It can also be used in predicting the composite end point of AKI with an extended application in patients at risk for postoperative kidney dysfunction.