Risk factors of venous thromboembolism following lung cancer resection / 中华胸心血管外科杂志

Objective To identify risk factors for postdischarge venous thromboembolism(VTE) following lung resection.Methods Patients undergoing anatomic resection for lung cancer were identified in our institution from 2005-2015.Patient demographic and clinical characteristics were evaluated for any association with post-discharge VTE.Predictors of post-discharge VTE were identified using multivariable analysis.Results VTE occurred in 1.6％ (117) of the 7 154 patients identified.43.6％ (51) VTE events occurred following hospital discharge.Undergoing pneumonectomy was associated with a threefold increased risk for post-discharge VTE compared with lobectomy(2.03％ vs.0.64％,P ＜ 0.01),as was open resection compared to minimally invasive resection(0.86％ vs.0.53％,P＜0.01).Prolonged operative time(＞75％) was also associated with increased risk for post-discharge VTE compared to shorter operative time.Multivariable analysis identified older age,obesity,pneumonectomy,and prolonged operative time as independent predictors for post-discharge VTE.Conclusion The risk for VTE extends after hospital discharge,few patients are managed with post-discharge prophylaxis.Post-discharge prophylaxis should be considered for those at high risk for VTE,particularly for older patients,those who are obese,and following extended or lengthy resections.

Predictors of survival after treatment of recurrence after esophagectomy / 中华胸心血管外科杂志

Objective To investigate the prognostic factors of postoperative single metastasis in patients with esophageal cancer after treatment.Methods The clinical data of patients with single lesion metastasis from 2002 to 2016 were analyzed retrospectively.Demographic and clinicopathologic data were reviewed.Predictors of PRS after definitive therapy for isolated EC recurrence were determined by the multivariable Cox proportional hazards model.Results Of the 1 016 curative esophagectomies,383 patients(37.7％) experienced recurrences(median followup 53 months).114 (11.2％) received definitive treatment of isolated EC recurrence(63 were treated surgically with or without chemotherapy-radiotherapy[CTRT] and 51 received definitive CTRT alone).Median time to recurrence(TTR) was 18 months.The 1-year and 3-year PRSs were 78.9％ and 38.6％ (median survival 28 months).On multivariable analysis;TTR was the only significant independent predictor for survival after recurrence (HR =0.982,95 ％ CI:0.95-1.03,P =0.036).No pronounced difference was found in disease-free survival or in PRS between recurrent patients treated with operation with or without CTRT and patients who received definitive CTRT.Conclusion A select subgroup of patients with isolated EC recurrence can be treated with curative intent.TTR was the best predictor for PRS.

Efficacy of Partial Cardiac Auto-transplantation for Treating the Patients With Giant Left Atrium / 中国循环杂志

Objective: To explore the clinical effcacy and short-term survival rate of partial cardiac auto-transplantation for treating the patients with giant left atrium. Methods: A total of 7 patients with rheumatic heart disease received partial cardiac auto-transplantation in our hospital from 2012-08 to 2013-05 were retrospectively studied. The patients were at the age of (54.9±5.0) years including 3 male, all of them combined with giant left atrium and pre-operative atrial ifbrillation (AF), 6 of them received radio-frequency ablation. All patients were monitored for their baseline condition, operative status, peri-operative mortality and complication occurrence for clinical analysis. Results: All 7 patients received mitral valve replacement, 5 had aortic valve replacement and 2 had aortic valve-plasty, the mean aortic cross clamp time was (271.7±29.0) min. The average left atrial diameter decreased from (91.7±3.5) mm to (64.8±8.1) mm, left ventricular ejection fraction (LVEF) improved from (38.3±6.5) % to (47.4±6.1) % at discharge, allP Conclusion: Partial cardiac auto-transplantation may obviously reduce left atrial diameter with good clinical effect in certain patients with giant left atrium.

Management of cardiac surgery with cardiopulmonary bypass in pregnancy / 中华胸心血管外科杂志

Cardiac surgery carried out on cardiopulmonary bypass(CPB) in a pregnant woman is associated with poor neonatal outcomes although maternal outcomes are similar to cardiac surgery in non-pregnant women.Most adverse maternal and fetal outcomes from cardiac surgery during pregnancy are attributed to effects of CPB.The CPB is associated with utero-placental hypoperfusion due to a number of factors,which may translate into low fetal cardiac output,hypoxia and even death.Better maternal and fetal outcomes may be achieved by early pre-operative optimization of maternal cardiovascular status,use of perioperative fetal monitoring,optimization of CPB,delivery of a viable fetus before the operation and scheduling cardiac surgery on an elective basis during the second trimester.

Sun's procedure for patients with acute type A aortic dissection / 中华胸心血管外科杂志

Objective To analyze the early outcomes of the Sun' s procedure,which is an approach integrating total arch replacement using a 4-branched graft with implantation of a special stented graft in the descending aorta,and observe the mortality,morbidity and mid-term clinical results of postoperative in patients with acute type A aortic dissection (AAAD).Methods Clinical data of 61 consecutive AAAD patients undergoing the Sun' s procedure were analyzed.There were 53 male and 8 female,aged (54 ± 12) years.61 patients had postoperative follow-up and the clinical effect of Sun' s procedure were retrospectively analyzed.Results Cardiopulmonary bypass time was (229 ± 46) min,aortic clamping time was (147 ± 37) min and unilateral selective cerebral perfusion time was (35 ± 9) min.Reoperation for excessive bleeding in 5 cases (8.2％),acute renal failure in 3(4.9％),tracheotomy patients for pulmonary infection in 3(4.9％),and spinal cord injury in 2 (3.3％),delayed thoracic incision healing in 1 (1.6％),and osteofascial compartment syndrome of the right lower limb in 1 (1.6％).The 30 day mortality is 8.2％,and the leading causes was low cardiac output syndrome in 2(3.3％),multi-organ failure in 1 (1.6％),pulmonary infection in 1 (1.6％) and ruptured of abdominal aortic dissection in 1 (1.6％).The average follow-up time is(5.1 ± 0.7) years.Postoperative 1 year survival rate was 91.8％,5 year survival rate was 83.6％.Conclusion The Sun' s procedure has generated a relatively lower mortality rate in 61 patients with AAAD.Postoperative survival rate is high,and the reoperation rate is low.

Acute type A aortic dissection:indications for valve sparing aortic root reconstruction / 中华胸心血管外科杂志

Objective To prove that valve sparing aortic root reconstruction may have an impact on the outcome and longevity of the repair for patients with acute type A aortic dissection.Methods Clinical data of 98 consecutive AAAD patients undergoing the valve sparing aortic root reconstruction were analyzed.The postoperative follow-up and the clinical effect of the procedure were retrospectively analyzed.Results Pre-operative grade of aortic insufficiency was(2.3 ± 0.5), CPB-time was (217.8 ± 43.1)min, aortic cross clamp time was(142.7 ± 37.4)min and stay on ICU (11.1 ± 5.7) days, while hospitalisation was(14.3 ± 3.2) days.8 patients(8.2％) died peri-operatively.None of the early deaths were valve-related.Rethoracotomy rate was 3.1％.All patients followed up(19.3 ± 7.6) (6-68) months.Survival at 1 year was 90.8％.Freedom from valvular reoperation was 97.9％ at 3 years.At last investigation, mean grade of aortic insufficiency for AADA was 0.5 ± 0.3 (0-3).Conclusion Regardless of the underlying indication, the aortic valve preserving reimplantation technique can be performed with favourable functional results.