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1.
Article in Chinese | WPRIM | ID: wpr-912299

ABSTRACT

Objective:To compare the mid-term result of two different valve-sparing root replacement techniques in acute type A aortic dissection: including reimplantation and remodeling.Methods:From March 2009 to December 2019, 41 patients with acute type A dissection and root involvement, who underwent a valve-sparing root replacement using reimplantation(36 cases) or remodeling(5 cases) were retrospectively analyzed in current study. The average age was(44.63±11.34) years old, 36 males. The differences of perioperative variables, postoperative aortic insufficiency and postoperative survival were compared between the two groups.Results:Thirty-day mortality for two groups was 2.8% and 20%( P=0.23). Remodeling group was significantly inferior to reimplantation group in terms of blood consumption(red blood cells, plasma and platelets), postoperative mechanical ventilation time, reoperation for bleeding and hemofiltration for acute renal failure. The median follow-up time of 39 discharged survivors was 34.56(3-121) months, and the follow-up rate was 100%. There was no follow-up death, no bleeding or embolism events, and no cardiovascular reoperation. Grade 2 or sever aortic regurgitation in remodeling group was significantly higher than that in reimplantation group( P=0.02). A Cox regression analysis identified that the remodeling technique was the independent risk factors of postoperative aortic regurgitation. Conclusion:Compared with remodeling technique, reimplantation technique has better perioperative and mid-term results in patients with acute type A aortic dissection. The rate of reoperation for bleeding, the blood consumption and the postoperative aortic regurgitation are significantly reduced. The long-term results need further follow-up.

2.
Article in Chinese | WPRIM | ID: wpr-906107

ABSTRACT

Objective:To establish the fingerprint of Baoyuantang substance benchmark, and to analyze and identify the common peaks. Method:A total of 15 batches of Baoyuantang substance benchmark were prepared, ultra performance liquid chromatography-diode array detector method (UPLC-PDA) was used to establish the fingerprint of the substance benchmark, and the methodology was developed. The chromatographic conditions were as follows:ACQUITY UPLC BEH Shield C<sub>18</sub> column (2.1 mm×100 mm, 1.7 μm), mobile phase of 0.05% formic acid solution (A) and 0.05% formic acid acetonitrile solution ( B) for gradient elution (0-0.5 min, 5%-19%B; 0.5-6 min, 19%B; 6-10 min, 19%-27%B; 10-20 min, 27%-45%B; 20-20.1 min, 45%-95%B; 20.1-23 min, 95%B), the flow rate of 0.4 mL·min<sup>-1</sup>, the column temperature of 30 ℃, the detection wavelength at 203 nm and 260 nm, and the injection volume of 2 μL. Similarity evaluation system of traditional Chinese medicine fingerprint (2012 edition) was used to establish the fingerprint and generate the control fingerprint. The chemical constituents of Baoyuantang substance benchmark were identified by comparison of standard substances and UPLC-electrospray ionization tandem mass spectrometry (UPLC-ESI-MS/MS) with full information tandem mass spectrometry (MS<sup>E</sup>) and scanning range of <italic>m</italic>/<italic>z</italic> 50-1 200. Result:The similarities of 15 batches of Baoyuantang substance benchmark were above 0.90 by comparing with the control fingerprint. There were 37 common peaks, 22 of which were identified through UPLC-ESI-MS/MS, including liquiritin, violanthin, ginsenoside Rg<sub>1</sub>, ginsenoside Rb<sub>1</sub>, ginsenoside Re and so on. These components were all from Astragali Radix, Ginseng Radix et Rhizoma, Zingiberis Rhizoma Recens and Glycyrrhizae Radix et Rhizoma. Conclusion:This method is accurate, stable and reliable, which will basically reflect the overall chemical composition characteristics of Baoyuantang, and it provides experimental basis for development of the granules of this famous classical formulas.

3.
Article in Chinese | WPRIM | ID: wpr-862669

ABSTRACT

Objective::To prepare 15 batches of Banxia Xiexintang substance benchmark and lyophilized powder from different places, and the lyophilized powder was analyzed by ultra-high performance liquid chromatography with diode array detection (UHPLC-DAD) and desorption electrospray ionization-mass spectrometry imaging (DESI-MSI) in order to investigate the advantages of DESI-MSI in quality control of famous classical formulas. Method::Taking Banxia Xiexintang as the research model, fingerprints of the substance benchmark and lyophilized powder were established by UHPLC-DAD, and the content of index components and the yield of dry extract were also investigated. Meanwhile, as the research carrier, the lyophilized powder corresponding to Banxia Xiexintang was dissolved in methanol and dotted on qualitative filter paper with 5 μL quantitative capillary, and fixed it on the slide to make samples. The samples were analyzed on a DESI-MSI system in positive and negative ion mode with methanol-formic acid (1 000∶1, flow rate of 3 μL·min-1) as spray solvent, N2 as spray gas (pressure of 0.5 MPa). The scanning range was 100-1 200 Da, the spatial resolution was 300 μm, the spray voltage was 3 kV, the sampling cone voltage was ±40 V, incidence angle of sprayer was 60 degree, its collection angle was 10 degree, the ion source temperature was 120 ℃. Result::DESI-MSI could not only detect the index components of liquiritin, baicalin and wogonoside, as well as the common peaks of liquiritin apioside, berberine and glycyrrhizic acid, but also analyzed them semi-quantitatively, the analysis results were basically consistent with UHPLC-DAD. At the same time, DESI-MSI could detect 16 other components from Glycyrrhizae Radix et Rhizoma, Coptidis Rhizoma, Scutellariae Radix, Jujubae Fructus and Ginseng Radix et Rhizoma, such as licoricesaponin G2, palmatine, coptisine, rutin and ginsenoside Rg1, and present their relative content visually. The qualitative analysis ability of DESI-MSI was much better than UHPLC-DAD. Conclusion::DESI-MSI can be used as the quality control method for substance benchmark and lyophilized powder and dispensing granules of famous classical formulas with advantages of high sensitivity, strong analytical ability, no complex sample processing, qualitative and relative content analysis of complex samples without reference substance.

4.
Article in Chinese | WPRIM | ID: wpr-873007

ABSTRACT

Shaoyao Gancaotang, first seen in Treatise on Febrile and Miscellaneous Diseases, is composed of Paeoniae Radix Alba and Glycyrrhizae Radix et Rhizoma Praeparata cum Melle in equal proportion.It has the functions of preserving Yin to nourish blood, harmonizing liver and spleen, relieving spasm and pain.This formula is applied in leg and foot spasm and abdominal pain caused by blood deficiency, body fluid consuming and the unmoistened muscles and veins.It has been highly praised and used by medical experts throughout the ages and has extended its application scope.Modern pharmacological studies have shown that Shaoyao Gancaotang has significant effects in antispasmodic, analgesic, antitussive and other areas, and is used to treat spastic diseases, painful diseases, inflammatory diseases and so on.This paper will systematically elaborate the historical evolution, compatibility analysis, pharmacological and pharmacodynamic studies, modern clinical application of Shaoyao Gancaotang, in order to provide theoretical basis and reference for the development of this famous classical formula.

5.
Article in Chinese | WPRIM | ID: wpr-826388

ABSTRACT

To investigate the risk factors associated with acute renal failure (ARF) after thoracoabdominal aortic aneurysm (TAAA) surgery. A total of 156 patients underwent TAAA repair between January 2009 and December 2017. Renal failure was defined based on the Kidney Disease Improving Global Outcomes criteria. The patients were divided into ARF group and non-ARF group based on the presence/absence of postoperative ARF. The risk factors of ARF were analyzed by univariate analysis and multivariate logistic analysis. The subjects included 111 males and 45 females aged (40.4±10.9) years (range:19-65 years). The surgical reasons included aortic dissection (=130,83.3%),aneurysm (=22,14.1%),and pseudoaneurysm (=4,2.6%). The degrees of repair included Crawford extent I in 6 patients (3.8%),extent Ⅱ in 128 patients (82.1%),extent Ⅲ in 20 patients (12.8%),and extent Ⅳ in 2 patients(1.3%). There were 3 patients presented with aortic rupture and 6 patients received emergent operations. Nine patients (5.8%) died within 30 days after surgery,and 8 patients (5.1%) suffered from permanent paraplegia. Thirty-six patients (23.1%) had ARF after surgery,and 18 of them needed dialysis. Multivariate logistic analysis showed that smoking ( =2.637,95%=1.113-6.250,=0.028),packed red blood cell usage in operation (≥6 U) ( =5.508,95%=2.144-11.930,=0.000),reoperation for bleeding (=3.529,95%=1.298-9.590,=0.013) were independent risk factors for ARF after TAAA repair. Smoking,packed red blood cell usage in operation (≥6 U),reoperation for bleeding are the independent risk factors of ARF after TAAA surgery.


Subject(s)
Acute Kidney Injury , Adult , Aged , Aortic Aneurysm, Thoracic , General Surgery , Blood Transfusion , Blood Vessel Prosthesis Implantation , Female , Humans , Male , Middle Aged , Postoperative Complications , Reoperation , Retrospective Studies , Risk Factors , Smoking , Treatment Outcome , Young Adult
6.
Article in Chinese | WPRIM | ID: wpr-826362

ABSTRACT

To evaluate the early and mid-term results after surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with DeBakey typeⅠor Ⅲ aortic dissection. The clinical data of 130 patients who underwent TAAA repair for chronic DeBakey typeⅠ(groupⅠ, =47)or type Ⅲ(group Ⅲ, =83)aortic dissections in our center between January 2009 and December 2017 were retrospectively analyzed.Early postoperative results,midterm survival,and re-interventions were compared between these two groups. The 30-day mortality rate was 6.9%(=9)in the overall cohort,with no statistic difference between groupⅠand group Ⅲ(10.6% 4.8%;=0.803, =0.370).The incidence of major adverse events(38.3% 51.8%;=2.199, =0.138),5-year actuarial survival rate [(81.7±5.9)% (87.2±4.2)%;=0.483, =0.487],and 5-year actuarial freedom from all reinterventions [(84.5±6.7)% (85.5±4.8)%;=0.010, =0.920] showed no significant differences between these two groups. The early and mid-term outcomes after surgical repair of TAAA are similar for DeBakey typeⅠ and type Ⅲ patients.However,studies with larger sample sizes are still required.


Subject(s)
Aneurysm, Dissecting , Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Hospital Mortality , Humans , Postoperative Complications , Retrospective Studies , Treatment Outcome
7.
Article in Chinese | WPRIM | ID: wpr-827509

ABSTRACT

OBJECTIVE@#To investigate the clinical outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH) after surgeries in Yunnan Province.@*METHODS@#We retrospectively analyzed the demographic features, vascular risk factors, severity at admission, and aneurysm locations in 85 patients with aSAH receiving surgical interventions in Yunnan Province. All the patients were treated by aneurysm clipping or coiling and followed up for clinical outcomes and recovery of daily activities evaluated by modified Rankin Scale (mRS) and Activities of Daily Living (ADL) scale, respectively.@*RESULTS@#Thirty-four of the patients (40.0%) underwent aneurysm clipping and 51 (60.0%) underwent aneurysm coiling. During a median follow- up period of 66.23 months (IOR, 12.03 months), 84.7% of the patients had low mRS scores, and 78.8% lived independently. The WFNS grade at admission was significantly correlated with the follow-up mRS scores (95%: 1.48-19.09, =0.011) and ADL (95%: 2.55-28.77, 0.05), but the cost of hospitalization was significantly higher in coiling group than in the clipping group ( < 0.001).@*CONCLUSIONS@#Both aging and a high WFNS grade at admission are associated with a poor prognosis of aSAH, for which aneurysm clipping and coiling have similar long- term outcomes, but for patients with a high WFNS score, aneurysm clipping is favored over coiling in terms of health economics.

8.
Article in Chinese | WPRIM | ID: wpr-802973

ABSTRACT

Objective@#To investigate the clinical value of serum adiponectin in patients with preeclampsia and its relationship with insulin resistance.@*Methods@#From May 2017 to May 2018, 80 cases of preeclampsia diagnosed and treated in obstetrics department of the Second People′s Hospital of Liaocheng were selected in the research.According to the severity of the disease, they were divided into severe preeclampsia group and mild preeclampsia group, with 40 cases in each group, and 40 healthy pregnant women in the same period were selected as the control group.The serum adiponectin level and insulin resistance index (HOMA-IR) were detected and compared among the groups, and the correlation between them was analyzed.@*Results@#The serum adiponectin and HOMA-IR in the severe preeclampsia group were (5.08 ±1.13)mg/L, (3.08 ±1.54), respectively, which in the mild preeclampsia group were (6.55±1.46)mg/L, (2.62±1.34), respectively, which in the control group were (11.67±3.53)mg/L, (1.13±0.53), respectively.there were statistically significant difference among the three groups (all P<0.05). The serum adiponectin level in the severe preeclampsia group was lower than that in the mild preeclampsia group and control group(P<0.05), and the HOMA-IR in the severe preeclampsia group was higher than that in the mild preeclampsia group and control group (P<0.05). The serum adiponectin level in the mild preeclampsia group was lower than that in the control group, and the HOMA-IR was higher than that in the control group, the differences were statistically significant (all P<0.05). The serum adiponectin level of preeclampsia patients with insulin resistance was (4.89±1.25)mg/L, which was significantly lower than that of non-insulin resistance patients[(6.78±1.75)mg/L], and the difference was statistically significant (t=6.254, P<0.05). Pearson correlation analysis showed that serum adiponectin level was negatively correlated with HOMA-IR (r=-0.617, P<0.05).@*Conclusion@#The serum adiponectin level and insulin resistance index of preeclampsia patients are significantly decreased, and there is a significant negative correlation between them.

9.
Journal of Chinese Physician ; (12): 1339-1344,1348, 2019.
Article in Chinese | WPRIM | ID: wpr-798096

ABSTRACT

Objective@#We investigated the clinical characteristics and the most important risk factors of urinary calculi in children.@*Methods@#Using Cochrane Library, PubMed, ProQuest, ELEVIER Science Direct, Embase, Springerlink, China National Knowledge Infrastructure (CNKI), and Wanfang database, we reviewed literature on clinical characteristics of urinary calculi in children from January 2003 to September 2018, and data was analyzed using STATA 14.0.@*Results@#Incidence of calculi in male children was 62.1% [95% CI (57.2%, 67.1%)]. 39.4% [95% CI (26.5%, 52.2%)] children with urolithiasis had a family history of positive stones, 25.3% [95% CI (19.2%, 31.3%)] had a history of urinary infection, and 16.6% [95% CI (12.3%, 20.9%)] had abnormal urinary anatomy. In addition, urinary calculi were most commonly found in the kidney [63.6%, 95% CI (49.9%, 77.3%)], followed by ureter [17.2%, 95% CI (13.4%, 21.0%)], and bladder [12.4%, 95% CI (6.9%, 18.7%)]. The single component of urinary calculi in children accounted for 58.8% [95% CI(48.7%, 68.9%)], the most common component was calcium oxalate [49.4%, 95% CI (36.7%, 62.1%)], followed by uric acid [7.9%, 95% CI (4.1%, 11.6%)]. The most common urinary metabolic disorders were hypernatremia [38.8%, 95% CI (27.9%, 49.7%)], followed by hypercalciuria [33.4%, 95% CI (27.3%, 39.4%)].@*Conclusions@#Heredity metabolic abnormalities, urinary tract infection, and anatomical structural abnormalities are important risk factors of urinary calculi in children. Stone recurrence could be reduced and prevented by regulating metabolic disorders, managing urinary tract infection, and correcting anatomical abnormality.

10.
Journal of Chinese Physician ; (12): 1339-1344,1348, 2019.
Article in Chinese | WPRIM | ID: wpr-791146

ABSTRACT

Objective We investigated the clinical characteristics and the most important risk factors of urinary calculi in children.Methods Using Cochrane Library,PubMed,ProQuest,ELEVIER Science Direct,Embase,Springerlink,China National Knowledge Infrastructure (CNKI),and Wanfang database,we reviewed literature on clinical characteristics of urinary calculi in children from January 2003 to September 2018,and data was analyzed using STATA 14.0.Results Incidence of calculi in male children was 62.1% [95% CI (57.2%,67.1%)].39.4% [95% CI (26.5%,52.2%)] children with urolithiasis had a family history of positive stones,25.3% [95% CI (19.2%,31.3%)] had a history of urinary infection,and 16.6% [95% CI (12.3%,20.9%)] had abnormal urinary anatomy.In addition,urinary calculi were most commonly found in the kidney [63.6%,95% CI (49.9%,77.3%)],followed by ureter [17.2%,95% CI (13.4%,21.0%)],and bladder [12.4%,95% CI (6.9%,18.7%)].The single component of urinary calculi in children accounted for 58.8% [95% CI(48.7%,68.9%)],the most common component was calcium oxalate [49.4%,95% CI (36.7%,62.1%)],followed by uric acid [7.9%,95% CI (4.1%,11.6%)].The most common urinary metabolic disorders were hypernatremia [38.8%,95% CI (27.9%,49.7%)],followed by hypercalciuria [33.4%,95% CI (27.3%,39.4%)].Conclusions Heredity metabolic abnormalities,urinary tract infection,and anatomical structural abnormalities are important risk factors of urinary calculi in children.Stone recurrence could be reduced and prevented by regulating metabolic disorders,managing urinary tract infection,and correcting anatomical abnormality.

11.
Article in Chinese | WPRIM | ID: wpr-753778

ABSTRACT

Objective To investigate the clinical value of serum adiponectin in patients with preeclampsia and its relationship with insulin resistance.Methods From May 2017 to May 2018,80 cases of preeclampsia diagnosed and treated in obstetrics department of the Second People′s Hospital of Liaocheng were selected in the research.According to the severity of the disease , they were divided into severe preeclampsia group and mild preeclampsia group,with 40 cases in each group ,and 40 healthy pregnant women in the same period were selected as the control group.The serum adiponectin level and insulin resistance index (HOMA-IR) were detected and compared among the groups,and the correlation between them was analyzed.Results The serum adiponectin and HOMA -IR in the severe preeclampsia group were ( 5.08 ±1.13 ) mg/L, ( 3.08 ±1.54 ), respectively, which in the mild preeclampsia group were (6.55 ±1.46)mg/L,(2.62 ±1.34),respectively,which in the control group were (11.67 ± 3.53)mg/L,(1.13 ±0.53),respectively.there were statistically significant difference among the three groups (all P<0.05).The serum adiponectin level in the severe preeclampsia group was lower than that in the mild preeclampsia group and control group (P<0.05),and the HOMA-IR in the severe preeclampsia group was higher than that in the mild preeclampsia group and control group (P<0.05).The serum adiponectin level in the mild preeclampsia group was lower than that in the control group ,and the HOMA-IR was higher than that in the control group ,the differences were statistically significant (all P<0.05).The serum adiponectin level of preeclampsia patients with insulin resistance was (4.89 ±1.25) mg/L, which was significantly lower than that of non -insulin resistance patients [( 6.78 ± 1.75)mg/L],and the difference was statistically significant ( t =6.254, P <0.05 ).Pearson correlation analysis showed that serum adiponectin level was negatively correlated with HOMA -IR (r=-0.617,P<0.05).Conclusion The serum adiponectin level and insulin resistance index of preeclampsia patients are significantly decreased , and there is a significant negative correlation between them.

12.
Article in Chinese | WPRIM | ID: wpr-776009

ABSTRACT

Objective To evaluate the early and midterm results of surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with Marfan syndrome(MFS). Methods The clinical data of patients with MFS undergoing TAAA repair in Fuwai Hospital between January 2009 and December 2017 were retrospectively analyzed.These patients were divided into two groups:MFS group(=58)and non-MFS group(=98).The baseline data,early postoperative results,and midterm follow-up outcomes were compared between these two groups. Results MFS patients were significantly younger(32 years old 45 years old,=9.603,=0.000)and more frequently had a history of aortic aneurysm or dissection(19% 0,=19.996,=0.000)than non-MFS patients.However,the proportions of males and smokers were significantly lower when compared with non-MFS patients(55.2% 80.6%,=11.489,=0.001;13.8% 46.9%,=17.686,=0.001).There was no significant difference in proportion of emergency operation,prophylactic cerebrospinal fluid drainage,operation time,intra-operative circulation management,and intra-operative blood transfusion(all >0.05).The 30-day mortality rate was significantly lower in MFS group than in non-MFS group(0 9.2%, [Formula: see text]=5.034,=0.025). Conclusions For patients with MFS,TAAA repair provides lower 30-day mortality and comparative middle-term survival.However,the re-intervention rate is higher among MFS patients,highlighting the importance of close follow-up.


Subject(s)
Adult , Aneurysm, Dissecting , Aortic Aneurysm, Thoracic , General Surgery , Blood Vessel Prosthesis Implantation , Female , Humans , Male , Marfan Syndrome , Middle Aged , Retrospective Studies , Treatment Outcome
13.
Article in Chinese | WPRIM | ID: wpr-706998

ABSTRACT

Objective To study the effects of five different kinds of Chinese medicine materials on dissolution of pills; To evaluate their in vitro - in vivo correlation.Methods Five different types of traditional Chinese medicine materials, such as starch, fiber, protein, grease and polysaccharide materials, were selected by uniform design to the proposed 8 model formulation and preparation of pills, and the cumulative release rate and in vivo plasma concentration of berberine hydrochloride were determined by HPLC. The effects of Chinese medicine materials on the drug release behavior of pills in vitro - in vivo were investigated. And the in vitro - in vivo correlation of the pills was evaluated.Results Starch and fiber materials could promote the release of the pills, and protein and grease materials has a blocking effect on the pills dissolution. Polysaccharide materials have no significant effect on the dissolution of the pills. Pills in vitro - in vivo correlation was significant.Conclusion Chinese medicine materials have the characteristics of medicine-assisted unity, which can control the dissolution and bioavailability of pills by adjusting the proportion of powder in the prescription. And the pills have good correlation in vitro - in vivo.

14.
Article in Chinese | WPRIM | ID: wpr-735032

ABSTRACT

Objective To summarize the experience and strategy of surgical treatment of Kommerell diverticulum and related aortic dissection aneurysm.Methods From November 2012 to January 2018,4 patients(all males),with median age of 44 (from 40 to 49) years old,underwent surgical treatment in our institution.All the patients had fight-sided aortic arch and aberrant left subclavian artery.One patient had type A aortic dissection and other 3 had type B aortic dissection(one had chronic type B dissection).The patient with type A aortic dissection had Bentall procedure plus total arch replacement and frozen elephant trunk implantation.One patient with chronic type B aortic dissection received type 2 hybrid aortic arch repair.One patient with acute type B aortic dissection had ascending aorta and total arch replacement plus frozen elephant trunk implantation followed by TEVAR.The last patient underwent graft replacement of aorta,total arch and descending thoracic aorta.Results There was no operative mortality.The median mechanical ventilation time was 229 (from 13 to 485) hours,the median ICU stay was 12 (from 2 to 27) days.One patient died from respiratory and circulatory failure due to compression of left main bronchus on the 17th day after operation.One patient had irritating cough due to mild compression of bifucation of trachea and the symptom resolved spontaneously before discharge.One patient had critical illness polyneuropathy after operation and received mechanical ventilation therapy for 485 hours.He recovered through neurotrophic drug treatment.The median follow-up time is 15 (from 4 to 36) months.The patients with type A dissection had delayed dilation of descending thoracic aorta beyond the frozen elephant trunk and received TEVAR 6 months later.The CT scans of the other two patients during follow-up time showed good morphology and patency of graft and branches.There was no anastomotic leakage and pseudoaneurysm.Conclusion The decision making of treatment of Kommerell diverticulum and related aortic dissection should be on the basis of classification of aortic dissection.Operation combined with TEVAR is safe and effective.

15.
Article in Chinese | WPRIM | ID: wpr-621396

ABSTRACT

Objective To summarize experience of concomitant endovascular aneurysm aortic repair(EVAR) and coronary artery bypass grafting(CABG) for patients of severe coronary artery disease(CAD) complicated with infra-renal abdominal aortic aneurysm(AAA) or infra-renal abdominal penetrating aortic ulcer(PAU).Methods Between January 2013 and December 2016,13 patients with severe CAD and infra-renal AAA/PAU who underwent CABG and EVAR were enrolled in this study.12 patients (92.3 %) were male and 1 patient was female (7.7 %),the mean age of(63.7 ± 7.3) years.11 patients with CAD related symptoms,2 patients with AAA/PAU related symptoms,abdominal aortic lesions include:AAA in 3cases,PAU in 10 cases,2 patients combined with PAU of the thoracic aorta.CABG and EVAR manipulations were performed according to the routine protocol,patients who were combined with thoracic aorta PAU were treated with thoracic endovascular aortic repair (TEVAR) simultaneously.Results 7 patients received EVAR followed by CABG;6 patients received CABG followed by EVAR,TEVAR were performed in 2 patients.For all the patients,there were 11 cases of CABG were performed under the cardiopulmonary bypass(CPB) (ON-PUMP) and 2 others cases were performed without CPB(OFF-PUMP).On the average(2.5 ± 0.7)grafts were performed.The time of aortic clamp and CPB averaged were(50.7 ± 16.5)min and (58.0 ± 11.2)min respectively for the ON-PUMP CABG patients.Totally 30 thoracic aorta and abdominal aorta stent grafts were implanted in 13 patients.The duration of postoperative mechanical ventilation time was (17.8 ± 7.0) hours,Median intensive care stay was (2.7 ± 1.9) days,while hospital stay was(8.1 ± 2.4)days.All the patients was discharged.1 patient suffered wound unhealing 2 days after discharging,followed by sternal infection,he was re-admitted and received pectoralis major myocutaneous flap transfer operation,29 days after this operation,he suffered sudden cardiac arrest and eventually dead.The other 12 surviving patients was followed up for 1 ~ 36 months,The results showed that the patency of the grafts in all patients was good,no EVAR related secondary interventions were required.Conclusion For the patients with surgical indications,the procedure of one stage CABG and EVAR completed by one surgical team was safe and feasible.Comparing with the traditional one stage or staged surgical repair,this strategy showed less surgical trauma,shorter operation time,lower perioperative risks,more efficacy and more conducive to the overall management of patients.

16.
Chinese Circulation Journal ; (12): 556-559, 2017.
Article in Chinese | WPRIM | ID: wpr-618998

ABSTRACT

Objective: To explore the safety and strategy of thoracic endovascular aortic repair (TEVAR) combining coronary artery bypass grafting (CABG) as one-stop performance in treating the patients with coronary artery disease (CAD) and thoracic aorta disease. Methods: A total of 20 patients received one-stop treatment of TEVAR combining CABG in our hospital from 2009-04 to 2016-01 were retrospectively analyzed. There were 18 male and the mean age of patients was (65.2±8.5, 51-82) years. The performance strategy and peri-operative management were studied. Results: There were 1/20 patient received 2 stents implantation in thoracic aorta and 19 received 1 stent in thoracic aorta those including 1 case with endovascular repair of abdominal aortic aneurysm, 1 with right iliac artery stent implantation and 1 with carotid endarterectomy at meanwhile. The average number of coronary artery bypass branch was (2.4±0.94, 1-4) and 10 (50%) patients received internal mammary artery grafting. The average in-hospital time in all 20 patients was (22.4±11.6, 8-58) days. There were 6 (30%) patients received blood transfusion; 1 (5%) having low cardiac output syndrome received extracorporeal membrane oxygenation (ECMO), then received the second thoracotomy for hemostasis due to excessive pleural effusion; 2 (10%) patients died at 30 days post-operation. 1 patient lost contact and 17 received clinical or telephone follow-up visit at the average of (13.4+13.6, 1-49) months; 2 patients died for cerebral hemorrhage at 12 and 49 months post-operation, the rest 15 had disappeared symptoms and improved quality of life, no operation related death occurred. Conclusion: TEVAR combining CABG as one-stop performance presented good mid-term effect in treating the patients with CAD and thoracic aorta disease; in otherwise, the operative time and risk might be increased by two step performance.

17.
Article in Chinese | WPRIM | ID: wpr-608288

ABSTRACT

Objective The aim of this study is to evaluate clinical outcomes of patients with acute type A intranural hematoma of the aorta(IMH) received surgical treatment.Methods We analyzed 40 consecutive patients with acute type A aortic IMH in Fuwai hospital.The patients are from 2012.1.1 to 2015.12.31.The average age of patients is(56 ± 11) years.Clinical outcomes and morphological evolution by CT were analyzed for 2 years.Results Most of the patients were treated medically during their initial hospitalization.There were 2 patients died in in-hospital and no 2-year mortality.16 patients (40%) were received acute surgery,24 patients(60%)were received normal surgery.Conclusion Surgical treatment would be a favorable treatment option in type A acute IMH.

18.
Article in Chinese | WPRIM | ID: wpr-495487

ABSTRACT

Objective To investigate the impact of acute kidney injury ( AKI ) on early and long-term outcome using RIFLEcriteria in patients after acute type A dissection surgery.Methods Between January 2006 and June 2011, 286 cases a-cute type A dissection patients underwent deep hypothermic circulatory arrest surgery were retrospectively analyzed .Using RIFLEcriteria to classfy AKI to risk, injury and failure stages and comparing 30-day mortality, dialysis, ventilation time, ICU stay, hospital stay and cost, and three-year mortality.Multivariate analyses were performed to identify predictors of failure stage.Results AKI was detected in 160 patients(55.9%), and risk 85 cases(29.7%), injury 39 cases(13.6%), failure 36 cases(12.6%).Dialysis rate, ventilation time, ICU stay, cost, and 30-day mortality increased with worsening severity of renal injury, and these was significant increased in failure stage than other groups .There was no association between severity of renal injury and 3-year mortality.Multiple logistic regression showed that malperfusion syndrome ( OR =3.499, 95%CI:1.019-12.013, P=0.047) and WBC(OR=1.121, 95%CI:1.017 -1.237, P=0.022) were independent predictors of renal failure.Conclusion Postoperative mild and morderate acute kidney injury were common in acute type A dissection pa-tients.The severe acute kidney injury had association with poor early outcome .

19.
Chinese Journal of Surgery ; (12): 119-124, 2016.
Article in Chinese | WPRIM | ID: wpr-349221

ABSTRACT

<p><b>OBJECTIVE</b>To assess the safety and efficacy of off-pump technique with normothemia to extend thoracoabdominal aortic aneurysm replacement compared with traditional hypothermic circulatory arrest.</p><p><b>METHODS</b>From January 2004 to December 2013, 128 consecutive patients underwent surgical repair of thoracoabdominal aortic aneurysm (type Crawford Ⅱ) in Fuwai Hospital. The mean age was (37±11) years. The patients included 74 cases (57.8%) with chronic Stanford A dissection, 34 cases (26.6%) with chronic Stanford B dissection, 20 cases (15.6%) with thoracoabdominal aortic true aneurysm. There were 71 patients who underwent hypothermic circulatory arrest surgery (cardiopulmonary bypass (CPB) group) and 57 patients who underwent off-pump surgery with normothermia (off-pump group). The clinic data was compared between the 2 groups using paired t tests and χ(2) test. Kaplan-Meier survival analysis was used for postoperative survival stays.</p><p><b>RESULTS</b>The mean CPB time in CPB group was (251 ±87) minuets and the circulatory arrest time was (45±24) minuets. Spinal cord ischemia time in the two groups was (21±12) minuets and (18±10) minuets (t=5.68, P=0.51). The operation time, ventilator time, length of ICU stay and length of hospital stay of off-pump group were shorter than CPB group ((408±114) minuets vs.(630±156) minuets, t=-7.67, P=0.05; (18±13) hours vs. (113±89) hours, t=-3.86, P=0.00; (4±2) days vs.(10±9) days, t=-4.19, P=0.00; (15±7) days vs.(25±14) days, t=-4.47, P=0.00). The intraoperative blood loss in off-pump group and CPB group was (900±750) ml and (1 400±400) ml (t=-2.23, P=0.04). The mortality was 1.7% and 9.8% in the off-pump group and CPB groups (χ(2)=3.544, P=0.05). The cerebral complication rate in the normal temperature group was 1.7% vs. 22.6% in extracorporeal group (χ(2)=9.35, P<0.05). A total of 113 patients were followed up, with a follow-up rate of 88.2%. Duration of follow-up was (78±54) months. Five patients died during the follow-up period, including 2 who died of cerebral infarction and 3 paraplegia patients who died of infection. Eight patients had phase Ⅱ aortic arch replacement after a mean time of 6 months. The overall postoperative survival rate was 97%, 93% and 87% at 3 years, 5 years and 7 years, respectively.</p><p><b>CONCLUSION</b>Off-pump technique with normothemia was associated with a lower risk of a composite outcome of mortality and major adverse cardiac and cerebrovascular events during repair of extensive thoracoabdominal aortic aneurysm.</p>


Subject(s)
Adult , Aorta , General Surgery , Aortic Aneurysm, Thoracic , General Surgery , Blood Vessel Prosthesis Implantation , Methods , Cardiopulmonary Bypass , Heart Arrest, Induced , Methods , Humans , Length of Stay , Survival Rate
20.
Article in Chinese | WPRIM | ID: wpr-480016

ABSTRACT

Objective To analyze the etiology and surgical results through 17 cases with retrograde aortic dissection after thoracic endovascular repair.Methods From March 2009 to March 2014,17 patients were diagnosed with retrograde type A aortic dissection after thoracic endovascular repair,the mean age was 53 years,13 male and 4 female.Type B aortic dissection as the primary disease were 13 cases,aortic aneurysm and aortic ulcer were 2 cases respectively.All cases with new type A aortic dissection were diagnosed by cardiac ultrasound and aortic computed tomography.All patients were received aortic root and total aortic arch replacement plus elephant trunk procedure.All patients were followed by clinic interview or telephone.Results The interval time was from 1 to 2 200 days,5 patients were diagnosed before discharge,12 patients during clinical follow-up.The primary tear in 12 patients were located the area which were anchored by bare mental stent,in 2 cases were nearby the bare stent,the other 3 cases were located anterior part of ascending aorta.1 patient was died due to cerebral hemorrhage after operation.3 patients had renal insufficiency after operation and all were cured by hemofiltration;neurological complication occurred in 3 patients including that 1 patient stroked,1 patient cerebral hemorrhage and 1 patient had transient brain dysfunction,4 patients had pulmonary complication and 2 patients with intestinal dysfunction.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time was(35-±21) months.2 cases were died during follow-up and five-year survival rate was 87.5 %.One patient was reoperation with total thoracic abdominal aorta replacement,five-year free from reoperation was 85.7%.Conclusion The retrograde type A dissection after thoracic endovascular repair were closely related with proximal bare mental stent,part of cases were silent symptom,the clinical fellow with aortic enhanced computed tomography were necessary to detect the serious complication.Operation scheme was safely and effectively,aortic arch replacement plus elephant trunk procedure was the preferred method to repair retrograde aortic dissection.

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