Biomechanical Study on Contiguous Three-Level Cervical Hybrid Surgery and Anterior Cervical Discectomy and Fusion / 医用生物力学

Objective To compare the biomechanical effects of contiguous three-level cervical Hybrid surgery[anterior cervical discectomy and fusion (ACDF) + cervical disc arthroplasty ( CDA)] and three-level ACDF. Methods The finite element model of C1-T1 cervical-thoracic spine was developed based on CT data. Three models were simulated by the implantation of Prestige LP and Zero-P prostheses, including two Hybrid models (AFA, Prestige LP implanted at C3-4 and C5-6 segments and Zero-P implanted at C4-5 segment; FAF, Zero-P implanted at C3-4 and C5-6 segments and Prestige LP implanted at C4-5 segment) and three-level ACDF model(FFF). The changes in range of motion (ROM) of adjacent levels during flexion, extension, lateral bending and axial rotation, the overall ROM, as well as the intradiscal pressure ( IDP) and facet contact force ( FCF) of adjacent levels were compared. Results The ROM in adjacent levels and the overall ROM of the AFA modelwere closer to the intact model, and the maximum increases in the ROM of the adjacent levels for the FAF and FFF models were 15. 0% and 23. 4% , respectively. For AFA, FAF and FFF models, the maximum increases in the maximum IDP of adjacent levels were 19. 0% , 66. 7% , 147. 6% , and the maximum increases in FCF were 17. 4% , 55. 7% , 80. 1% , respectively. Conclusions This study provides biomechanical basis for three-level cervical Hybrid surgery in treating patients with the contiguous three-level cervical degenerative disc disease.

Minimally invasive hybrid surgery for Stanford B aortic dissection involving the aortic arch / 中华胸心血管外科杂志

Objective:To investigate the effect and safety of one-staged hybrid surgery in the treatment of complicated Stanford B aortic dissection.Methods:246 consecutive patients who underwent one-staged hybrid technique with complicated type B aortic dissection (cTBAD) between January 2014 and July 2020 were retrospectively reviewed. The perioperative mortality and morbidity of the hybrid technique was assessed and the early results of follow up were evaluated.Results:The mean age of patients was(57.1±11.2)years old, and 175 (71.1%) were male. There were 166 cases of left common carotid artery-left subclavian artery vessels bypass + TEVAR (A group), operation time(62±8)min, post-operated hospitalization(5.2±1.3)days; 62 cases of right common carotid artery-left common carotid artery vessels bypass+ left common carotid artery-left subclavian artery vessels bypass + TEVAR (B group), operation time(88±12)min, post-operated hospitalization(6.1±1.8)days; 18 cases of debranch + TEVAR, operation time(236±36)min, post-operated hospitalization(8.8±2.1)days. 246 patients underwent hybrid procedure successfully (The technique success rate was 100%). 1 patient(0.4%)with traumatic aortic dissection (with cerebral trauma) died after operation 7 days. The average follow-up period was 5 years(30.3±7.1)xmonths. 236 patients(96%) without endoleak, 10 patients(4%)with proximal endoleak, 5 patients with regular follow-up, 5 patients with surgical treatment during one year (3 patients with re-TEVAR; 2 patients with opening operation); 25 patients(10.2%)incision hematomas, all these patients settled with closely observing and conservative treatment, and all these patients without reintervention. The rate of second intervention was 2% (5/246) the patency of bridging vessel was 99.7% (343/344). There was no paraplegia and stroke during perioperative period.Conclusion:One-staged hybrid surgery has a good short-term and med-term efficacy and safety for complicated Stanford B aortic dissection.

Efficacy and safety of total aortic arch replacement in elderly patients with Stanford type A aortic dissection / 中华老年医学杂志

Objective:To evaluate the efficacy and safety of total aortic arch replacement in elderly patients with Stanford type A aortic dissection(TAAD).Methods:In this retrospective study, a total of 481 TAAD patients treated with total arch replacement in our hospital from January 2016 to January 2020 were divided into three groups: aged≤59 years, 60-69 years and ≥70 years.The differences between three groups in surgical method, extracorporeal circulation time, blocking time, circulatory time, stopping time, surgical time, ventilator use time, ICU time, hospitalization time, treatment rate of continued renal replacement, fatality rate, and cause of death were statistically analyzed and compared.Results:There were statistically significant differences in the stopping time between any two groups of the three groups(all P<0.05). The older the age, the shorter the circulatory arrest time.The difference of ventilator time and ICU time between ≤59 and 60-69 years was statistically significant( P<0.01). Patients with continuous renal replacement(CRRT)were 19.0%(71/373)in ≤59 years, 23.1%(18/78)in 60~69 years, and 26.7%(8/30)over 70 years.In-hospital mortality was 35/373(9.4%)in the group of ≤59 years old, 11/78(14.1%)in the group of 60~69 years old, and 5/30(16.7%)in the group of ≥70 years old.There was no death in patients undergoing type Ⅱ hybrid surgery. Conclusions:Age is one of the important death factors after total aortic arch replacement in TAAD patients.Total aortic arch replacement is an acceptable surgical method for elderly patients with TAAD.Hybridization may reduce hospitalization death in elderly patients.

Clinical observation on the treatment of cervical degenerative diseases with Hybrid surgery / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases (CDD) and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery.@*METHODS@#From January 2015 to April 2018, 35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow up data were analyzed retrospectively. Complete imaging follow-up data were obtained from 24 patients. There were 15 males and 20 females, aged from 39 to 70(55.57±7.73) years old. The amount of bleeding was for 20 to 100 (40.29±18.39) ml, and the hospitalstay was for 4 to 28(11.03±4.63) days, and the follow-up time was(12.97±1.36) months. Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score (YT20), and Japanese Orthopaedic Association (JOA) score. The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation. Patients with or without heterotopic ossificationwere divided into two groups and their clinical effects were compared.@*RESULTS@#At the final follow up, the mean YT20 score and JOA score were significantly higher than those before operation (P <0.05), and the average improvement rate of JOA was (70.66 ±0.44)%. One year after operation, the heterotopic ossification occurred in 10 of 24 segments, with incidence of 41.70%(10/24), including 29.20% in gradeⅠand 12.50% in gradeⅡ. The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation (@*CONCLUSION@#The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases, and the cause of heterotopic ossification still needs tobe further explored.

Two staged hybrid abdominal aortic debranch procedure for thoracoabdominal aneurysm / 中华胸心血管外科杂志

Objective:To investigate the short-term effects of staged hybrid abdominal aortic debranching technique in the treatment of thoracoabdominal aorta.Methods:From January 2018 to December 2018, 22 patients with thoracoabdominal aortic aneurysms underwent surgical treatment in Nanjing Drum Tower Hospital. Among them, 12 underwent staged hybrid abdominal aortic debranching (AAD), and 10 underwent traditional thoracoabdominal aortic replacement (TAR). AAD consisted of two phases: the first phase of surgery was mid-opening, Y-type artificial blood vessels replaced the lower abdominal aorta and bilateral common iliac arteries, and the abdominal aortic branches were reconstructed at the same time: right branch artificial blood vessels-right renal artery-left renal artery, the left branch artificial blood vessel-superior mesenteric artery-common hepatic artery; the second phase was endovascular repair anchoring normal and long-term normal aorta or artificial blood vessel. The clinical effected of two methods for the treatment of thoracoabdominal aortic aneurysms were compared and analyzed.Results:The overall mortality rate was 13.6%, and the mortality rate in the TAR group increased significantly (0 vs. 30%). The main cause was dissection (91.7% vs. 90.0%, P=0.895). Crawford classification was predominantly type Ⅱ in both groups(58.3% vs. 50.0%, P=0.082). The proportion of patients with Marfan syndrome in the TAR group was higher (30% vs. 0, P=0.046). The TAR group was significantly more drained 24 h after surgery [(355.0±199.2)ml vs. (1244.0±716.1)ml, P= 0.003]. The TAR group had a higher proportion of lung infections (40% vs. 0, P= 0.018). The average cost was higher in the AAD group [(28.4±8.3) ten thousands yuan vs. (19.3±10.4) ten thousands yuan, P= 0.033]. Conclusion:The staged hybrid abdominal aortic debranching technique can effectively treat thoracoabdominal aortic aneurysms. Compared with traditional thoracoabdominal aortic replacement, the surgical trauma is smaller but more expensive.

Efficacy of Hybrid anterior cervical spine surgery on range of motion and curvature in the treatment of cervical degenerative diseases / 中国骨伤

OBJECTIVE@#To observe the change of cervical curvature and range of motion (ROM) on imaging at 6 months after Hybrid surgery.@*METHODS@#A total of 29 patients with cervical degenerative disease who underwent Hybrid surgery from January 2017 to July 2018 were retrospectively analyzed. Also, they all met the inclusion criteria and had complete preoperative and 6 months postoperative imaging data. There were 11 males and 18 females, aged from 34 to 76 (55.86±10.69) years, and the operation time was from 2 to 4(3.03±0.51) hours. The Cobb angle method was used to measure the changes of cervical curvature and ROM of C@*RESULTS@#There was no statistically significant difference in C@*CONCLUSION@#Hybrid surgery reconstructs the lordotic curvature of the entire cervical spine and the responsible segment, retains the ROM of the cervical replacement segment, and restores the biomechanical function of cervical spine.

Finite element analysis of lumbar interbody fusion combined with adjacent-segment semi-rigid fixation / 中国组织工程研究

BACKGROUND: The clinical occurrence of lumbar degenerative diseases is often accompanied by multi-segments lesions. To slow down the degeneration of adjacent segments after lumbar fusion, lumbar hybrid surgery has become a better choice. In the past clinical observation, WavefleX system has achieved a certain effect on single segment. Its application in lumbar hybrid surgery lacks the support of biomechanical research results. OBJECTIVE: To analyze the biomechanical effects of lumbar fusion combined with WavefleX system on adjacent segments by the finite element method. METHODS: A 64-row Siemens spiral CT machine was used to scan the lumbar spine of a stationary supine volunteer with a scanning range of T11-S1. This voluntter signed the informed consent. This study was approved by the Hospital Ethics Committee. L3-5 horizontal scanning data were imported into the Mimics medical image processing software and the Geomagic studio reverse engineering software for processing. L3-5 lumbar spine solid model was constructed in the CAD software SCDM. On the basis of L3-5 lumbar model, posterior lumbar interbody fusion model and Hybrid model were constructed respectively. Assignment and load loading were conducted in three models. The finite element analysis was carried out under the conditions of forward flexion, backward extension, lateral flexion and rotation. RESULTS AND CONCLUSION: (1) Compared with posterior lumbar interbody fusion model, the stress value of L3-4 disc in Hybrid model decreased significantly in forward flexion, backward extension, lateral flexion and rotation, and the maximum value decreased about 46% in extension. (2) Compared with posterior lumbar interbody fusion model, the range of motion of L3-4 segment in Hybrid model decreased significantly, with an average decrease of about 26%, which was smaller than that of the complete model under all conditions. (3) Under each load, the stress nephogram showed that there was an obvious stress concentration on the connecting rod of WavefleX system, and the stress at the U-shaped groove concave of the elastic system on both sides was significantly increased. (4) Displacement nephogram showed the placement of WavefleX system in Hybrid model, which made its forward bending center moved back to the elastic structure. (5) The above results show that posterior lumbar interbody fusion + WavefleX semi-rigid fixation can effectively reduce the stress of the last adjacent segment of the disc and limit the excessive activity, maintain the normal movement characteristics of the lumbar spine to a certain extent.

Emergency extracranial-intracranial bypass for complex intracranial aneurysms based on the background of hybrid surgery : A clinical analysis / 中国脑血管病杂志

Objective To investigate the efficacy of emergency extracranial-intracranial bypass for the treatment of complex intracranial aneurysms under the concept of hybrid surgery. Methods From April 2015 to May 2018,4 consecutive female inpatients with intracranial complex aneurysm treated with extracranial-intracranial bypass at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University were enrolled retrospectively. They had an acute subarachnoid hemorrhage and were diagnosed as aneurysms by DSA, including 1 case of a fusiform aneurysm of the upper trunk of the middle cerebral artery, 1 case of a vesicular aneurysm, 1 case of moyamoya disease with 2 aneurysms (in the internal carotid artery and the lenticulostriate artery) ,and 1 case of giant aneurysm of internal carotid artery. Four patients were treated with emergency superficial temporal artery-middle cerebral artery bypass and parent artery revascularization. Intraoperative DSA confirmed that the anastomosis was patent and the aneurysm was treated with one-stage treatment The preoperative Glasgow coma scale score and intracranial pressure were used to determine whether decompressive craniectomy was performed. Postoperative DSA, MR, and CT perfusion imaging and clinical follow-up showed that the Glasgow outcome scale (GOS) score increased by 1 point was improved,and no change was stable. Results Intraoperative DSA indicated that the anastomotic stoma was patent in all the 4 patients. One aneurysm was clipped again, one was trapped, and two parent arteries were occluded by balloon. One patient underwent decompressive craniectomy at the same time. No new cerebral infarction was found on MRI after operation. Hie GOS score was 5 in 2cases,4 in 1 case,and 3 in 1 case at discharge. They were followed up for 5 to 36 months after operation. No new positive signs were found. The GOS score was improved in 1 case and stabilized in 3 cases. Three cases were followed up by DSA angiography,which indicated that the bridging vessels were patent and the intracranial aneurysms disappeared. MR angiography showed tliat the bridging vessel were patent in one case. Conclusion Emcrgcncy extracranial- intracranial bypass based on the concept of hybrid surgery can be used for the treatment of complex intracranial aneurysms. It may be an effective supplement to conventional therapy.

Infección de injerto carótido-carotídeo para debranching aórtico: tratamiento con injerto autológo de vena / Infection of a carotid-carotid graft for aortic debranching: treatment with an autologous venous graft

Resumen El uso de prótesis vasculares y dispositivos endovasculares ha permitido tratar muchas patologías que antes no se intervenían dado el gran riesgo quirúrgico, como es el caso de los aneurismas de aorta torácica. Los materiales usados para estas reconstrucciones son muy resistentes y de larga duración, pero son muy sensibles a ser colonizados y presentar infección, lo que genera morbimortalidad considerable. Se presenta el caso de un paciente de 64 años con antecedente de aneurisma del arco aórtico y aorta descendente, tratado en forma extra institucional con prótesis de aorta torácica endovascular y debranchig de las ramas del arco aórtico, con injerto carótido-carotídeo y carótido-subclavio izquierdo en dacrón, por vía pretraqueal, con antecedente de intento de cubrimiento del injerto expuesto con un flap miocutáneo el cual fue fallido por necrosis; ingresó al Hospital Universitario Clínica de San Rafael, con exposición del injerto carótido-carotídeo a nivel cervical, signos locales de infección y sepsis secundaria.

Abstract The use of vascular replacements and endovascular devices has led to the treatment of many conditions that could not be operated on due to a high surgical risk, such as aortic aneurysms. The materials used for these reconstructions are very resistant and durable, but are very susceptible to being colonised and infected, which leads to a considerable morbidity and mortality. The case is presented of a 64 year-old patient with a history of an aortic arch and descending aortic aneurysm. This had been treated in another hospital with a thoracic aortic endovascular repair and debranching of the aortic arch, with carotid-carotid and left carotid-subclavian Dacron graft. The pretracheal route was used, after attempting to cover the exposed graft with a myocutaneous flap that failed due to necrosis. The patient was admitted to the Hospital Universitario Clínica de San Rafael, presenting with a carotid-carotid graft at cervical level, with local signs of infection and secondary sepsis.

Hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation / 中华胸心血管外科杂志

Objective To explore the application and effectiveness of one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation for long-standing persistent atrial fibrillation(LSPAF).Methods From Jun 2015 to Dec 2017,a cohort of 56 patients[18 female,mean age of(59.1 ±6.9) years] with long-standing persistent atrial fibrillation underwent one-staged(30 cases) or two-staged(26 cases) hybrid minimally invasive surgical and transcatheter ablation.Mean AF duration was(5.9 ± 3.0) years.Mean left atrial diameter was(45.4 ± 4.2) mm.Mean CHA2DS2-VASc score was 2.3 ± 1.2.Fourteen cases had a history of prior catheter ablation.All patients underwent continuous 24-hour or 48-hour holter monitoring at 3 months,6 months,1 year and yearly thereafter.Results All patients successfully underwent one-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation.During ablation,LSPAF was terminated in 80.0％ (24/30) with one-staged hybrid ablation and 84.6％ (22/26) with two-staged hybrid ablation.At a mean follow-up of(20.3 ± 8.2) months,89.3％ (50/56) patients maintained sinus rhythm.Among them,86.7％ (26/30) patients with one-staged hybrid ablation maintained sinus rhythm,and 92.3％ (50/56) patients with two-staged hybrid ablation maintained sinus rhythm.Six patients with recurrent AF continued to receive warfarin and amiodarone drug therapy.No death or cerebrovascular events occurred.No patient required permanent pacemaker implantation.Conclusion One-staged or two-staged hybrid minimally invasive surgical and transcatheter ablation could be safely and effectively applied to the treatment of LSPAF.The early and midterm outcomes were satisfactory.

Surgical treatment of pulmonary atresia with intact ventricular septum / 国际儿科学杂志

Pulmonary atresia with intact ventricular septum(PA/IVS) is one of the complicated cyanotic congenital heart diseases with high mortality,which needs early intervention after birth.With further understanding of the disease and the development of surgery,the operative plan of the disease is gradually changing and some fundamental changes have taken place.The hemodynamic awareness of the disease is an important factor in the selection of surgery and the improvement of prognosis.In addition,it is also important for the selection of surgery and the improvement of prognosis to evaluate the development degree of the right ventricle comprehensively and accurately.At present,it is generally believed that the most effective treatment strategy can be obtained by classifying the development degree of the right ventricle in morphology.The surgical treatment has developed from early surgical pulmonary bypass to the interventional and hybrid surgery,which greatly improves prognosis and reduces surgical trauma.Among them,the pereutaneous pulmonary valve radiofrequency perforation plus balloon dilation and PDA stent implantation can be used as the preferred treatment for PA/IVS with dysplasia of the right ventricle.Particularly,PA/IVS can be cured with the interventional surgery alone for children with mild or even moderate dysplasia of the right ventricle.Hybrid surgery that significantly reduces trauma compared with traditional surgery is also an important choice for the areas where interventional surgery is relatively outdated.This article reviews and summarizes the progress of recognition and surgical treatment of PA/IVS,in order to provide reference for the clinical diagnosis and treatment.

Comparative analysis of two hybrid technique in treating multilevel cervical spondylotic myelopathy via anterior approach / 中国骨伤

OBJECTIVE@#To compare the clinical effects and complications of two hybrid decompression techniques in treating multilevel (>=3) cervical spondylotic myelopathy(MCSM).@*METHODS@#The clinical data of 124 patients with multilevel (>=3) cervical spondylotic myelopathy treated by surgery and follow-up from January 2008 to December 2016 were retrospectively analyzed. According to the different operative methods, the patients were divided into group A and group B. Anterior cervical discectomy and fusion (ACDF) combined with anterior cervical corpectomy and fusion with preserved posterior vertebral wall (PWCF) were performed in group A; ACDF combined with anterior cervical corpectomy and fusion(ACCF) were performed in group B. There were 44 males and 16 females in group A with an average age of (60.43±7.52) years old, 46 males and 18 females in group B with an average age of (61.61±6.39) years old. No significant differences were found in gender, age between two groups. The operative time, intraoperative blood loss, hospital stay, rate of complications, postoperative Japanese Orthopaedic Association (JOA) score and improvement of cervical curvature were compared between two groups.@*RESULTS@#All the operations were successful. The follow-up time was 13 to 28(23.0±12.1) months in group A and 12 to 30(24.0±11.5) months in group B. The operative time, intraoperative blood loss, hospital stay in group B were higher than those in group A(0.05). The physiological curvature of cervical vertebra was improved significantly after operation, and there was no significant difference between two groups(>0.05).@*CONCLUSIONS@#Both surgical methods can obtain satisfactory clinical efficacy for multilevel(>=3) cervical spondylotic myelopathy, but compare with group B (ACDF combined with ACCF), group A (ACDF combined with PWCF) has shorter operation time, less trauma, less bleeding, and lower incidence of complications. ACDF combined with PWCF can be preferentially selected for the patients who corresponding to the indications.

Mapeo y ablación por radiofrecuencia a cielo abierto: un caso de taquicardia ventricular refractaria en anomalía de Ebstein / Open-heart mapping and radiofrequency ablation: a case of refractory ventricular tachycardia in Ebstein's anomaly

Resumen La anomalía de Ebstein es una enfermedad congénita, caracterizada por el desplazamiento y la adherencia de la válvula tricúspide. Las valvas septal y posterior se implantan en posiciones más inferiores, causando insuficiencia tricuspídea, esta condición de forma progresiva genera dilatación y deterioro de la función sistólica ventricular derecha. Comúnmente se asocia a otras entidades, principalmente, a la comunicación interauricular y las arritmias mediadas por vías accesorias. La muerte súbita ocurre en estadios avanzados, usualmente relacionados con episodios de taquicardia ventricular. Este reporte describe un caso de anomalía de Ebstein y tormenta arrítmica, que se sometió a ablación del sustrato arrítmico endo y epicárdico en la porción atrializada del ventrículo derecho, que presentó como complicación intraprocedimiento la perforación del ventrículo, el taponamiento cardiaco y la necesidad urgente de la reparación quirúrgica, realizándose en el intraoperatorio una segunda ablación por radiofrecuencia a cielo abierto con el objetivo de eliminar los potenciales tardíos y los fragmentados remanentes en el área de bajo voltaje de la escara. Veintidós semanas después de la ablación se implantó un cardiodesfibrilador subcutáneo para prevención secundaria de la muerte súbita; en el seguimiento a 14 meses no hubo terapias apropiadas del dispositivo.

Abstract Ebstein's anomaly is a congenital disease characterised by the displacement and adherence of the tricuspid valve. Septal and posterior valves are implanted in lower positions, thus causing tricuspid insufficiency. This condition gradually generates dilation and deterioration of the right ventricular systolic function. It is commonly associated to other conditions, mainly atrial septal defect and accessory pathway arrhythmias. Sudden death occurs in the advanced stages, usually related to episodes of ventricular tachycardia. This report describes a case of Ebstein's anomaly and arrhythmic storm who underwent ablation of the arrhythmic endo- and epicardial substract in the atrialized portion of the right ventricle, that developed as an intrasurgical complication the perforation of the ventricle, cardiac tamponade and urgent need of surgical repair. During the surgery a second open-heart radiofrequency ablation was conducted with the goal of eliminating potentially late and fragmented remnants in the low voltage area of the scars. Twenty two weeks after the ablation a subcutaneous cardioverterdefibrillator was implanted for secondary prevention of sudden death; in the follow-up after 14 months there were no appropriate therapies of the device.

Early outcomes of two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease / 中国胸心血管外科临床杂志

@#Objective    To observe the short-term efficacy and the incidence of adverse cardiovascular events in patients aged over 80 years with multivessel coronary artery disease following two-stage Hybrid surgery. Methods    We retrospectively analysed the clinical data of 67 patients aged over 80 years with multivessel coronary artery disease undergoing surgery in our hospital. The were 44 males and 23 females with an anverage age of 82.4±2.1 years. According to the operation pattern, the patients were divided into two groups: a two-stage Hybrid surgery group (n=29, 19 males, 10 females, aged 83.2±3.1 years) and a traditional thoracotomy group (n=38, 25 males, 13 females, aged 83.3±3.4 years). We compared the clinical results of perioperation between the two groups. Results    Conpared with the traditional thoracotomy group, the two-stage Hybrid surgery group had shorter postoperative duration of mechanical ventilation (6.7±2.2 h vs. 18.2±3.4 h) and hospitalization stay (15.7±3.0 d vs. 20.7±5.6 d) and had less volume of chest drainage during the first 24 h after surgery (176.5±32.3 ml vs. 443.8±51.5 ml). The incidence of adverse cardiovascular events in the two-stage Hybrid surgery group was significantly lower than that in the traditional thoracotomy group (6.9% vs. 23.1%, P<0.05). Conclusion    The two-stage Hybrid surgery in patients aged over 80 years with multivessel coronary artery disease can significantly decrease the postoperative incidence of adverse cardiovascular events, shorten the postoperative duration of mechanical ventilation and hospitalization stay, reduce the volume of chest drainage during the first 24 h after surgery and improve prognosis of surgery for the elderly patients.

Effects of Hybrid surgery on load transfer pattern of cervical spine / 医用生物力学

Objective To investigate the pattern of load transfer in cervical spine treated with Hybrid surgery using total disc replacement (TDR) and spinal fusion, so as to deepen the understanding of Hybrid surgery from the biomechanical view. Methods A finite element model of cervical spine C3-7 (INTACT model) was built to simulate three types of fusion surgeries at C4-6 degenerative segments: upper TDR combined with lower bone graft fusion (TDR45 model), upper fusion combined with lower TDR (TDR56 model), two-level fusion (Fusion456 model). Results In all surgical models, mobility of the fused levels was almost lost, while mobility of the TDR levels increased. Under the axial load of 160 N, the entire cervical motion was less than 4° in the INTACT model, while the motion in the TDR45 model and TDR56 model increased to 8.2° and 8.9°, respectively. In the TDR56 model, the force transferred through the C5 vertebra decreased by 20%, while the force transferred through the facet joint force was 3.8 times larger than that of the INTACT model. The facet contact force in the TDR45 model increased by 50%. The maximal stress in the INTACT model was 0.8 MPa, while the facet contact force in the TDR45 model and TDR56 model were almost 2 times as that in the INTACT model. Conclusions Due to the increased mobility at the TDR levels, the cervical curvature after Hybrid surgery changes greatly under the axial load. The alteration of spinal alignment will result in a decrease in anterior vertebral section force at the operative level, as well as an increase in facet joint force and facet cartilage stress.

Clinic analysis of Hybrid Surgery to treat multi segmental anterior cervical spondylotic myelopathy / 天津医药

Objective To investigate the effect of corpectomy decompression by subtotal vertebrectomy and fusion of adjacent segmental artificial disc replacement through anterior intervertenral spance (Hybrid Surgery) in the anteriorcervical spondylotic myelopathy treatment . Methods Hybrid Surgery were operated on 18 patients who suffered from anterior cervi?cal spondylotic myelopathy . Follow up of 1-50 months. Patient’s conditions were assessed according to the Japanese Associ?ation for Department of orthopedics assessment score (JOA score) before and after operation. Effects of Hybrid operation were assessed by the improvement of JOA score, Odom’s follow-up grade and cervical mobility . Results The JOA scores of all 18 operated patients were improved from 10.6 ± 1.7 before operation to 13.5 ± 2.4 after operation. And the difference is statistically significant (t=1.314, P 0.05). Conclusion Hybrid Surgery of anterior cervical decompression and fusion can both improve the nerve function and preserve cervical mobility.

The Comparative Analysis between Surgical Thrombectomy and Hybrid Treatment in Salvage Operation / 대한혈관외과학회지

PURPOSE: Salvage operation is performed to improve the functional deficit of vascular access. This study is planned to evaluate the utility of the hybrid surgery through a comparative analysis between the results of surgical thrombectomy and those of hybrid surgery, combining surgical methods and endovascular treatments. METHODS: From January 2007 to December 2008, surgical thrombectomy had been done to 55 patients, whereas hybrid surgery had been done to 111 patients from January 2009 to December 2011. We have done a comparative analysis on the patency rate after the salvage operation for each group, retrospectively. Medical records were reviewed for patient information and radiographic data was used for checking the stenosis site in the hybrid surgery group. RESULTS: There were no statistically significant differences between the two groups, including age, gender, diabetes status, hypertension, and vascular access site or type. The primary patency rate was significantly higher in arteriovenous fistulas (65%) compared with arteriovenous grafts group (55%), at 12 months (P<0.01). At one year after the salvage operation, the secondary patency rate was higher in the hybrid surgery group compared to the surgical thrombectomy group (43.8% vs. 23.7%, P<0.01). CONCLUSION: This study shows that hybrid surgery combining surgical methods and endovascular treatments can be more useful for the salvaging of thrombosed vascular access than performing only surgical thrombectomy.

Hybrid surgery versus percutaneous mechanical thrombectomy for the thrombosed hemodialysis autogenous arteriovenous fistulas / 대한외과학회지

PURPOSE: For the successful treatment of thrombosed autogenous arteriovenous fistula (AVF), we designed and performed a hybrid surgery. Its clinical outcomes were compared with those of percutaneous mechanical thrombectomy, retrospectively. METHODS: Forty cases of thrombosed autogenous AVFs underwent hybrid surgery, whereas 19 cases received percutaneous mechanical thrombectomy. Hybrid surgery consisted of surgical thrombectomy, balloon angioplasty and/or additional surgical angioplasty. Percutaneous mechanical thrombectomy included catheter-introduced thrombus aspiration, balloon angioplasty and/or stenting. Procedure related outcomes such as technical success rates and primary patency rates were analyzed, retrospectively. RESULTS: There were no statistically significant differences between the two groups in terms of demographic data of the patients including age, gender, diabetes status, and frequency of antiplatelet use, as well as the characteristics of thrombosed autogenous AVFs such as access age, site, type, and length of time between thrombosis and AVF creation (P > 0.05). Technical success rates (92.5% vs. 68.4%, P = 0.005, respectively) and primary patency rates (85.9% vs. 36.8% at 6 months, 81.1% vs. 26.3% at 12 months, 81.1% vs.21.1% at 18 and 24 months respectively, log-rank test, (P < 0.001) were significantly higher in the hybrid surgery group. In terms of cost analysis, supply cost was not different (P = 0.065), but total cost was statistically lower in the hybrid surgery group (P = 0.019). CONCLUSION: Hybrid surgery showed better technical success rates and patency rates in the salvaging of thrombosed autogenous AVFs than in percutaneous mechanical thrombectomy.

Hybrid Surgery for Supra-renal Abdominal Aortic Aneurysm: A case report / 대한흉부외과학회지

A 70-year old male with dilated cardiomyopathy was admitted to our hospital because of a renal stone, and a supra-renal abdominal aortic aneurysm was detected during work-up. We performed a hybrid surgery using an endovascular stent because of his co-morbidities. The operation consisted of removal of the renal stone, de-branching of the visceral artery and both renal arteries from the abdominal aorta, reperfusion of the de-branched arteries with retrograde bypass surgery using two Y-graft from the left external iliac artery, and deployment of stent graft in the abdominal aorta. Therefore, we report a case of hybrid surgery for supra-renal abdominal aortic aneurysm.

Operation-effect analysis of surgical repair combined with collateral embolization for cyanotic congenital heart disease with major aortopulmonary collateral arteries / 中华胸心血管外科杂志

Objective To evaluate the operation-effect of surgical repair combined with collateral embolization for cyanotic congenital heart disease with major aortopulmonary collateral arteries (MAPCAs) and optimal time of the associated operation. Methods We retrospectively reviewed the clinical data of 151 patients with cyanotic congenital heart disease and MAPCAs from 1992 to Nov of 2009. Two hundred and fifty two MAPCAs were embolized. One hundred and thirty two patients were performed one-stage surgical correction, another 19 patients received palliative operation and 7 patients received staging surgical repair after palliative operation. Results All patients received combined therapy of MAPCAs embolization and surgical repair with total in-hospital mortality of 7.3%. There was no death in 6 cases of preoperative interventional embolization, 2 death in 6 cases of postoperative embolization before July 2007 and none after July 2007. Simultaneous hybrid procedures (4.3%) had lower in-hospital mortality than intraoperative embolization before July 2007 (21.1%). There were significant differences regarding the duration of respirator usage, duration of ICU and postoperative hospital stay, as well as the cost of hospitalization for the preoperative, intraoperative and postoperative embolization groups ( P = 0.000, 0.000 and 0.000, respectively). Patients had a shorter duration of ICU and hospital stay after July 2007 ( P = 0.002, 0.002 ). The duration of ICU and hospital stay in simultaneous hybrid procedures was shorter than those of intraoperative embolization before July 2007 (5.37 days vs. 8.38 days, P=0.079 and 13.01 days vs. 18.74 days, P=0.059, respectively). Conclusion The surgical volume of the associated opertaion increased rapidly since the establishment of hybrid operating room. Simultaneous hybrid surgery significantly reduced the operative mortality, shortened the duration of ICU and hospital stay, and improved the operation-effect. Preoperative and intraoperative embolization could alleviate operative injury, reduce respirator usage, shorten the duration of PICU and hospital stay. Therefore, the cost of hospitalization was reduced. Postoperative embolization was a good compensate procedure for decreasing operative complications.