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Objective:To identify the risk factors for and outcomes of preoperative hepatic dysfunction (HD) in patients who underwent surgery for the treatment of acute DeBakey type I aortic dissection (ADIAD).Methods:A retrospective study including 810 consecutive patients between January 2014 and December 2019 in Nanjing Drum Tower Hospital was performed with emergency surgical repair. All patients were divided into non-HD and HD groups according to the Model of End-Stage Liver Disease (MELD) score before surgery and their clinical parameters and clinical outcomes were collected and compared. To determine independent predictors of preoperative HD, multivariate logistic regression analyses were performed using variables with P<0.5 in the univariate analyses. Kaplan-Meier survival analyses were conducted to analyze the association between preoperative HD and postoperative long-term survival. Results:The mean age of the patients was (52.4±12.5) years. 215 patients (26.5%) were identified as the preoperative HD group. In univariate analysis, significant difference was found with respect to the postoperative complications (98.6% vs. 94.5%, P=0.011) and 30-day mortality (20.0% vs. 8.4%, P<0.001) between the two groups. Multivariate logistic analysis showed that elevated serum troponin T levels upon admission( OR=1.921, P<0.001) and preoperative cardiac tamponade ( OR=2.158, P=0.002) were independent risk factors for preoperative HD. The long-term mortality rate was not significantly affected by preoperative HD. Conclusion:Early HD before surgery was commonly observed in patients with ADIAD and was associated with increased postoperative complications and 30-Day mortality. Elevated serum troponin T levels upon admission and preoperative cardiac tamponade were identified as risk factors for preoperative HD.
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Thoracic endovascular aortic repair has served as the predominant treatment approach for patients with thoracic aortic diseases. In order to ensure the successful release of the stent as well as a good proximal anchoring effect, it is necessary to preserve or reconstruct the left subclavian supply as much as possible. With the advance of various endovascular assistive technologies, different left subclavian artery revascularization techniques have gained widespread acceptance. So far, techniques include carotid-subclavian bypass or transposition, chimney grafts, fenestrations, branched aortic devices can reconstruct the left subclavian artery and other branch vessels on the arch. This article reviewed the present situation of left subclavian artery reconstruction and the selection of surgical methods of thoracic endovascular aortic repair.
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Objective:To summarize acute type A aortic dissection(ATAAD) is relatively uncommon in dialysis patients, and repair outcomes are not fully understood.Methods:Between January 2014 and March 2020, 20 patients with ATAAD required dialysis for preoperative end-stage renal disease(ESRD) were treated by our group. There were 11 male and 9 female patients at mean age of(47.8±11.3) years. The mean duration of dialysis therapy in the total 20 patients before the onset of ATAAD was(4.5±3.9 )years, with 90%(18 cases) of these patients undergoing hemodialysis(rather than peritoneal dialysis). 17 patients were treated emergency surgically, surgical operation were performed under deep hypothermic circulatory arrest and perfused the cerebral selective cerebral perfusion, 5 cases with ascending aorta + arch fenestrated stent, 5 cases with ascending aorta+ hemi-arch replacement(2 cases with stent elephant trunk), 4 cases with ascending aorta+ arch replacement+ stent elephant trunk(1 case with coronary artery bypass grafting for left anterior descending coronary artery), 2 cases with aortic valvuloplasty + ascending aorta+ hemi-arch replacement, 1 case with Bentall+ arch fenestrated stent.Results:2 patients were died from aortic ruptured before operation, 1 patient treated medically was alive three months after admission. Cross-clamp, cardiopulmonary bypass, and circulatory arrest times of all the surgical patients were(233.8±84.4) min, (155.5±63.6)min and(28.2±10.8)min, respectively. The following complications occurred postoperative: 3 cases died in the hospital, 1 case of tracheotomy, 2 cases of cerebral infarction, 1 case of cerebral hemorrhage, 1 case of transient paraplegia, and 1 case of surgical site infection. After a mean follow-up of(11.6±14.5) months(rang, 3-61 months). the overall survival rate at 1 year and 5 years was 53% and 27% respectively.Conclusion:Dialysis patients with ATAAD should be operated on urgently and medical treatment carries high risks of aortic rupture, although in-hospital mortality is acceptable, long-term mortality is poor.
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Objective:To introduce a new method of root reconstruction for proximal repair of acute type A aortic dissection, and to retrospectively analyze its short-term efficacy.Methods:From January 2018 to October 2019, a total of 455 patients with acute Stanford type A aortic dissection received surgical treatment. Among them, 343 patients underwent double-jacket-wrapping(DJW) root reinforcement(11 patients underwent leaflet suspension), 81 patients underwent Bentall surgery, 15 Wheat operations, 12 untreated roots, and 4 David operations. Compared 343 patients who underwent double-jacket-wrapping root reconstruction and 81 patients who underwent Bentall surgery. The perioperative indicators and short-term survival of the two groups were compared.Results:No patients died intraoperatively. The 30-day mortality rate in the DJW group and the Bentall group were 10.5% and 7.4%, respectively( P=0.403); cardiopulmonary bypass time were(218.8±68.4) min and(240.2 ± 59.8), P=0.011; aortic clamp time were(150.6 ± 47.9) min and(181.3 ±45.6)min, P=0.000. There was no difference between the operation time and the deep hypothermia circulatory time between the two groups. The mean follow-up was(11.7±6.4) months. Seven and two follow-up deaths occurred in the DJW group and the Bentall group, respectively, and the cause of death was not related to the aortic root. The degree of aortic regurgitation after DJW was 0.7±0.5, which was significantly lower than that before surgery( P=0.000). Conclusion:Compared with Bentall surgery, DJW method is a safe and effective method for the repair of acute type A aortic dissection roots, which can obtain good perioperative and early curative effects.
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Objective:To evaluate the clinical effect of the pulmonary rehabilitation system based on the concept of prehabilitation for patients after cardiac surgery to wean tube and avoid related complications.Methods:From January 2018 to December 2019 in a single-center(third-class hospital in cardiac surgery intensive care unit), all adult patients hospitalized for 7 days before open-heart surgery were included. They were randomly divided into pulmonary rehabilitation group(198 cases) and control group(234 cases). To compare and analyze the clinical effects, the main observations were observed including overall outcome indicators(such as early extubation rate, ICU stay, hospitalization costs, advanced oxygen therapy support after extubation) and lung outcome related indicators(such as the occurrence of pulmonary complications, chest drainage, secondary intubation, tracheotomy, lung infection and chest tube drainage).Results:There was no statistical difference between groups in basic conditions and surgical conditions. The lung rehabilitation group significantly increased the rate of early extubation, reduced the number of advanced oxygen therapy after weaning, shortened the length of ICU stay, saved hospitalization cost, significantly reduced the occurrence of postoperative respiratory complications and improved postoperative respiratory function( P<0.05). Conclusion:During cardiac perioperation, pulmonary rehabilitation significantly can increase the rate of early extubation , shorten the length of mechanical ventilation, reduce the occurrence of secondary tracheal intubation and pulmonary complications. And it can also effectively promote the recovery of lung function and the overall recovery.
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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.
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Objective:To assess the association of time interval with surgical repair effects for patients with ventricular septal defect(VSD) following acute myocardial infarction(AMI).Methods:From January 2010 to December 2017, 14 patients with VSD induced by AMI have received surgical therapy in our department. The age of the entire group was (65.5±3.3) years with male percentage of 78.6%(11/14). VSDs were anterior apical in 10(71.4%) and posterior inferior in 4(28.6%) patients. Average size of VSD was(15.8±5.8)mm. We retrospectively reviewed the patients' clinical manifestations, surgical methods and outcomes. According to the time interval from AMI onset and operation, patients were divided into two groups, Group 1(9 cases) as more than one week and Group 2(5 cases) as less than one week. Comparing study was done and differences were analyzed.Results:All patients underwent concomitant coronary artery bypass graft surgery. The cardiopulmonary bypass time and aortic clamp time was(203.9±52.3)min and(152.4±44.8)min. The mortality rate was 14.3%(2/14), higher in Group 2 but no significant differences(20.0% vs 11.1%, P=1.000). Mechanical support(IABP and ECMO) were more common in Group 2, both in preoperative(IABP 80.0% vs 22.2%, P=0.091; ECMO 20.0% vs. 0, P=0.357) and intraoperative period(IABP 60.0% vs. 0, P=0.027; ECMO 40.0% vs. 0, P=0.110). Compared with Group 1, Group 2 revealed worse left ventricular function(LVEF 0.304±0.023 vs. 0.408±0.103, P=0.035), higher rate of urgent procedure(100% vs. 11.1%, P=0.003). No resistant shunt and death was found during follow-up. Conclusion:Surgery is an effective way to treat AMI with VSD. When the time from onset to surgery exceeds one week, the patient's hemodynamic condition is more stable and the operation is safer. Patients undergoing surgery within one week show more unstable hemodynamic status, and mechanical assistance supports can correct the hemodynamic status and improve perioperative success rate.
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This paper analyzed the current status of standardized training for specialists in China using American "milestone concept" and its competency training and assessment system for specialists as references. To achieve the goal of training high-standard and homogeneous cardiothoracic surgeons, a "milestone plan" focusing on the cultivation of diagnosis and treatment capacity of specialists, their mastery ability of medical knowledge, communication ability, professional ability, system-based clinical practice ability, practice-based learning ability and the ability of pursuing improvement was explored. In addition, daily assessment and summary assessment were carried out by means of self-evaluation, superior evaluation and peer evaluation. At the end, training of six core competencies and multi-dimensional evaluation system for cardiothoracic surgeons were constructed, which provided significant references to the construction of training and assessment system for specialists in China.
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Objective@#To analyze the treatment results of cardiac rupture in patients with acute myocardial infarction (AMI) .@*Method@#Clinical data of 6 with cardiac rupture after AMI, who were hospitalized in our hospital from June 2015 to June 2017, were retrospectively analyzed,and the clinical manifestations, methods of treatment and outcomes were investigated.@*Results@#Cardiac function classification was Killip class Ⅱin all patients. There were 3 massive anterior wall myocardial infarction, 2 anterior wall myocardial infarction,and 1 inferior myocardial infarction. There were 4 patients with ventricular septal defect, 1 patient with rupture of papillary muscle,and 1 patient with left ventricular free wall rupture.All patients received continuous infusion of vasoactive medicines and treated with intra-aortic balloon pump(IABP), 2 patients (1 patient accepted operative treatment,and 1 patient received conservative treatment) were treated with extracorporeal membrane oxygenation (ECMO), mechanical ventilation,and continuous renal replacement therapy(CRRT).Three patients received surgical repair,1 case was supported by IABP, 1 case supported by ECMO,CRRT,and IABP,and 1 case did not use IABP or ECMO post operation. All 3 surgically treated patients recovered successfully and were discharged from hospital.Meanwhile, in the other 3 patients treated conservatively, 2 patients died in the hospital and 1 patient was discharged according to own will.@*Conclusion@#On the basis of vasoactive medicines and IABP, surgery repair is a feasible option for cardiac rupture patients secondary to AMI,and ECMO may improve the perioperative state in these patients.
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Objective To summarize the surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion.Methods From January 2010 to November 2015,307 patients of acute Stanford A aortic dissection underwent operation were included.The mean age was (51.3 ± 13.0) years,ranged from 22 to 83.The BMI was (25.4 ± 3.7) kg/m2 and 239 (77.9％) were men.There were 210 (71.2％) with hypertension,9 (2.9％) with Marian syndrome,and 44 (14.3％) with cardiac tamponade.Coronary malperfusion was confirmed in 43(14.0％) patients with 34 in right coronary artery,5 in left coronary artery,and 4 in both.There were 26 type A,8 type B,9 type C in Neri system.We performed coronary ostia repair in 12 patients,Bentall in 16,coronary artery bypass grafting(CABG) in 9,and Bentall plus CABG in 6.CABG was also performed in 1 Bentall,1 aortic valve repair,and 5 ascending aorta replacement in 264 patients without coronary malperfusion.Results The rate of CABG,cardiopulmonary bypass(CPB) time,aorta cross-clamp time were significantly higher in patients with coronary malperfusion(P ＜0.01).The in-hospital mortality was 32.6％ in patients with coronary malperfusion and 14.4％ in patients without coronary malperfusion.Thus,coronary malperfusion significantly increased in-hospital mortality(P ＜0.01).The mean follow-up time was(19.2 ± 18.0) months with a 95％ follow-up rate.The total follow-up survival rate is 97.5％ and the rate of patients with coronary malperfusion is 100％.Multivariate logistic regression analysis shows that cardiac tamponade(OR =4.8,P ＜0.01) and CPB time(OR =1.0,P ＜0.01) was the independent risk factor of post-operation inhospital mortality of acute Stanford A aortic dissection.Conclusion Acute Stanford A aortic dissection with coronary malperfusion has a significantly high in-hospital mortality with the indeed need of revascularization of coronary arteries rapidly.The treatment strategy depends on the specific clinical condition.
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Objective To evaluate the safety and feasibility of extra-anatomic bypass in the treatment of complex aorta coarctation concomitant with cardiac lesions,multiple stenosis of aorta or severe stenosis.Methods Complex aorta coarctation include a combination of heart disease (valve disease,coronary artery disease,ect.),or multiple constrictive lesions of the thoracic abdominal aorta or an aneurysm due to constriction of the arch,which are all difficult by interventional surgery or open thoracotomy surgery.From October 2016 to October 2017,6 patients with complex aorta coarctation have received surgical therapy in our department,including 3 males and 3 females,with the average age(50.0-± 17.9) years old.One-staged extra-anatomic bypass was used to establish an ascending aorta to the distal aorta bypass,4 patients underwent median thoracotomy and bypass surgery with thoracic aorta from the posterior inferior pericardium,1 patient underwent bypass surgery with abdominal aorta through thoracoabdominal incision,and 1 patient underwent bypass surgery with bilateral femoral artery from bilateral inguinal incision and guiding with laparoscopic through peritoneal cavity.Among them,3 patients underwent valve surgery in the same period,and 1 patient underwent coronary artery bypass surgery.Results No patient died.The mean cardiopulmonary bypass time was 273.8 minutes and the average aorta blocking time was 216.0 minutes.Pulse pressure of extremities blood pressure was significantly reduced compared with preoperative,and the clinical symptoms were significantly alleviation.During follow-up,6 patients presented with patent artificial blood vessels and alleviated symptoms.Conclusion Extra-anatomic bypass is a safe and effective method for the treatment of complex vasoconstriction without increasing the risk of surgery.
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Objective To evaluate the optimal management of cardiac surgery during pregnancy,in the second or third trimester,and the maternal and fetal outcomes in pregnant patients after surgery.Methods Six pregnant women with heart diseases were identified,who underwent cardiac surgery with cardiopulmonary bypass.Surgery was performed using cardiopulmonary bypass at mild hypothermia/normothermia,with pulsatile perfusion.Natural progesterone(20 mg)was added in priming solution,monitoring uterine contractions and heart rate changes.The mode of surgeries included mitral valve replacement+tricuspid valve plastic in three cases,aortic and mitral valve replacement+tricuspid valve plastic in one,left ventricular myxomatomy in one,left ventricular septal myectomy+artificial aortic valvular vegetations dissection+tricuspid valve plastic in one.Results The cardiopulmonary bypass and cross clamp time averaged 169 minutes(range,96~419 minutes)and 113 minutes(range,56~296 minutes),respectively.Five patients were alive.One maternal and fetal death occurred 6 h after surgery caused by heart failure and pulmonary edema.The other 5 patients terminated pregnancies after heart surgeries,one underwent with cesarean section 3 d after surgery in second trimester,two of whom with induction of labor,and two full-term labor(one with cesarean section,one with normal delivery).Two newborns were alive with no malformation.Conclusion Cardiopulmonary bypass can be used safely with satisfactory maternal and fetal outcomes in pregnant patients with heart disease undergoing cardiac surgery.
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Objective To analyse of 150 cases of type A aortic dissection anatomic parameter and the relationship between anatomic parameter and clinic date and prognosis.Methods We identified 150 cases of type A aortic dissection who were diagnosed clearly.All patients were divided into groups by gender and surgical approaches.General clinic data and radiological data were recorded.Survival rate was evaluated by follow up 3 months after surgery.Results The aortic root diameter of group aortic root replacement was(53.25±13.17)mm,group aortic root sparing was (49.08±6.94)mm,there was significant difference between the two group(P0.05).There were gender differences between type A dissection parameters of descending aorta,the start diameter of male and female's descending aorta were (41.09±8.86)mm and(37.44±5.60)mm,respectively.The descending aorta in parallel to the pulmonary artery diameter were(34.31±0.59)mm and(31.11±0.88)mm,respectively.Descending aorta diameter of the diaphragm were(31.45±6.50)mm and(28.46±5.20)mm,respectively(all P>0.05).Conclusion In patients who suffer from type A aortic dissection,Parameter of aortic root is one of factors which determine surgical approach to aortic root.When treating descending aorta,surgeon should consider the influence of gender.Our study provided data references for selection and design of endovascular stent-graft.
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Objective:To explore expression of miR-146b in peripheral blood serum and aortic wall tissues in patients with acute Stanford type A aortic dissection (TAAD),and to discuss the significance and underlying mechanisms.Methods:The subjects were divided into a control group (excluded relative aortic diseases) (n=23) and a TAAD group (n=27).The miR-146b levels of serum and aortic wall tissues were detected by quantitative real-time PCR (qRT-PCR).Serum miR-146b and aortic wall tissues miR-146b were compared among different risk TAAD groups.The correlations between miR-146b and severity of aortic dissection were analyzed.MiR-146b related target genes were predicted by the DIANA LAB-TarBase 6.0 and TargetScan.Results:The expression levels of miR-146b in the serum and aortic wall tissues in the TAAD group were significantly elevated compared with those in the control group (P＜0.001).Compared with the mild risk group,the miR-146b levels of serum and aortic wall tissues were significantly higher in the moderate risk and severe risk groups (P＜0.05).The expression of miR-146b was positively correlated with the risk severity of TAAD patients (r=0.862,0.872;P＜0.05).Nuclear factor kappa B1 (NF-κB1),tumor necrosis factor receptor-associated factor 6 (TRAF6),matrix metalloproteinase 16 (MMP16) and actin alpha 2 (ACTA2) were miR-146b related target genes.Conclusion:The upregulation of miR-146b in peripheral blood serum and aortic wall tissues may contribute to the pathogenesis of TAAD and the severity of this disease.
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Objective@#To explore the plasma chemokines expressions and related clinical implication in patients with Stanford type A aortic dissection (AD).@*Methods@#We retrospectively analyzed the data of 65 patients with Stanford type A aortic dissection, hypertensive patients and 11 healthy subjects admitted in our department from October 2013 to December 2014, they were divided into four groups: NH-CON group (11 healthy subjects), H-AD group (29 AD patients with hypertension), NH-AD group (21 AD patients without hypertension), and H-CON group (14 hypertension patients). Four plasma samples from AD patients and 4 plasma samples from healthy subjects were collected randomly with random numbers table, and the levels of different chemokines were examined by protein array analysis. Then, plasma levels of chemokines including macrophage inflammatory protein 1β(MIP-1β), epithelial neutrophil activating peptide 78(ENA-78), interleukin 16(IL-16), interferon inducible protein 10(IP-10) and FMS-like tyrosine kinase 3(Flt-3) ligand were analyzed by luminex. Pearson analysis was used to determine the correlations between the chemokines and serum C reactive protein (CRP) levels.@*Results@#Plasma levels of MIP-1β(34.0(29.3, 47.2) ng/L vs. 51.0(28.2, 80.7) ng/L, P<0.05) and ENA-78(110.5(59.1, 161.4) ng/L vs. 475.7(299.3, 837.3) ng/L, P<0.05) were significantly lower in H-AD group, while plasma IL-16 level was significantly higher in H-AD group(54.7(16.3, 187.8) ng/L vs. 17.5(11.9, 20.8) ng/L, P<0.05) than in H-CON group. Plasma levels of MIP-1β(48.3(26.4, 62.1) ng/L, P<0.05) were significantly lower in H-AD patients than in NH-AD patients. Plasma level of ENA-78 was significantly lower in NH-AD group than in NH-CON group (95.0(58.0, 155.0) ng/L vs. 257.7(85.2, 397.8) ng/L, P<0.05). The levels of IP-10 and Flt-3 ligand were similar among the 4 groups (all P>0.05). Pearson analysis showed that there were no correlation between MIP-1β(r2=0.01, P>0.05), ENA-78(r2=0.02, P>0.05), IL-16(r2=0.02, P>0.05), IP-10(r2=0.00, P>0.05), Flt-3 ligand(r2=0.02, P>0.05) and CRP levels in patients with Stanford type A aortic dissection.@*Conclusions@#Lower plasma levels of MIP-1β and ENA-78 and higher plasma levels of IL-16 may associate with the occurrence and development of type A aortic dissection, but their concentrations are not correlated with serum CRP levels. There is no significant change on plasma levels of IP-10 and Flt-3 in the Stanford type A aortic dissection patients.
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Objective@#To discuss the perioperative and follow-up results of different surgical methods for acute Stanford type A aortic dissection patients and analyzed the results.@*Methods@#The clinic data of 351 acute Stanford type A aortic dissection patients received surgical therapy at Department of Thoracic and Cardiovascular Surgery, Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital from January 2008 to December 2015 were analyzed retrospectively. There were 272 male and 79 female patients, aging from 22 to 83 years with a mean age of (52±13) years. According to root size, aortic valve structure and the status of dissection involvement, these patients were devided into three major groups: 218 cases with root reconstruction using Dacron felts, 34 cases with root reconstruction concomitant with aortic valve resuspension repair and 99 cases in with Bentall procedure. Proper shape based on the status of dissection involvement of Dacron patch was cut and put between the middle and outerlayer of aorta, then inside the inner layerone band Dacron felt was sutured with the aorta and the new middle layer with Dacron patch as mentioned above. In some cases the prolapsed aortic valve was re-suspended to the aortic cusp. Clinical outcomes among the 3 procedures were compared by χ2 test, Fisher′s exact test, t test and analysis of variance.@*Results@#Cardiopulmonary bypass, cross-clamp, and circulatory arrest times of all the patients were (250±78), (171±70) and (31±10) minutes, respectively. The 30-day mortality was 9.2%(33/351), while no difference among the 3 procedures (9.6%, 8.8% and 9.1%). In the average follow-up time of (26.0±23.0) months (range from 0.5 to 90.0 months), survival rates were similar among the 3 procedures (77.7%, 77.4% and 77.8%). Only one patient received redo Bentall procedure because of severe aortic regurgitation and dilated aortic root (diameter of 50 mm).@*Conclusions@#The indication of root management of acute Stanford type A aortic dissection is based on the diameter of aortic root, structure of aortic leaflets, and the dissection involvement. For most acute Stanford type A aortic dissection patients, aortic root reconstruction is a feasible and safe method.
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@#Objective To identify the predictors for readmission in the ICU among cardiac surgery patients. Methods We conducted a retrospective cohort study of 2 799 consecutive patients under cardiac surgery, who were divided into two groups including a readmission group (47 patients, 27 males and 20 females at age of 62.0±14.4 years) and a non readmission group (2 752 patients, 1 478 males and 1 274 females at age of 55.0±13.9 years) in our hospital between January 2014 and October 2016. Results The incidence of ICU readmission was 1.68% (47/2 799). Respiratory disorders were the main reason for readmission (38.3%).Readmitted patients had a significantly higher in-hospital mortality compared to those requiring no readmission (23.4% vs. 4.6%，P<0.001). Logistic regression analysis revealed that pre-operative renal dysfunction (OR=5.243, 95%CI 1.190 to 23.093, P=0.029), the length of stay in the ICU (OR=1.002, 95%CI 1.001 to 1.004, P=0.049), B-type natriuretic peptide (BNP) in the first postoperative day (OR=1.000, 95%CI 1.000 to 1.001, P=0.038), acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in the first 24 hours of admission to the ICU (OR=1.171, 95%CI 1.088 to1.259, P<0.001), and the drainage on the day of surgery (OR=1.001, 95%CI1.001 to 1.002, P<0.001) were the independent risk factors for readmission to the cardiac surgery ICU. Conclusion The early identification of high risk patients for readmission in the cardiac surgery ICU could encourage both more efficient healthcare planning and resources allocation.
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Objective To analyze the effect of the false lumenstatus of different methods in a single center.Methods From January 2010 to December 2015,391 cases of acute Stanford A aortic dissection were treated in our center.139 cases(of which 108 malesand 31 females) were finally selected after excluding the cases who died during hospitalization,whose perioperative clinical data were incomplete,follow-up information were incomplete,and DeBakey type Ⅱ aortic dissection and the cases with descending aorta dilatation.The average age was(50.3 ± 11.6) years(22-76 years).According to the methods for aortic arch and descending aorta,139 cases were divided into 5 groups:24 cases in AR(including ascending aorta replacement,ascending aorta + hemi-arch replacement and ascending aorta + island-arch replacement),9 cases in AR + SET (including ascending aorta + hemi-arch replacement + stent elephant trunk and ascending aorta + island-arch replacement + stent elephant trunk),42 cases in Arch + SET(ascending aorta + arch replacement + stent elephant trunk),22 cases in AR + TBS (ascending aorta + triple branched stent) and 42 cases in AR + FS(ascending aorta + arch fenestrated stent).Statistical analysis the size of true lemen and the status of false lumen among these five groups in the level of aortic arch,the distal end of stent,diaphragm,celiac artery,renal artery and iliacartery postoperatively.Results Different levels of descending aorta in each group have showed arying degrees of true lumen open and thrombosisof false lumen during follow-up period.Among them,cases with aortic arch treatment and stent implantation have showed higher ratio of thrombosis of false lumen.Effects of different stents were similar,which all promoted the process of thrombosis of false lumen.Conclusion Three methods for aortrc arch and desc ending aorta repair including Cronus (R),triple branched stent and arch fenstrafed stent had similar clinical aortic false lumen closure rate.Three methods had similar long term effect.
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Objective Acute Stanford type A aortic dissection(aTAAD) is often misdiagnosed as acute coronary syndrome(ACS), anti-platelet therapy for ACS will influence the timing and outcome of aTAAD.We reviewed the surgical outcome of these misdiagnosed aTAAD patients.Methods From January 2011 to October 2015, 309 aTAAD patients have received surgical therapy in our department, among them 15 patients had misdiagnosed as ACS and taken oral anti-platelet therapy, 9 male and 6 female, the average age was(60.6±8.7) years.Retrospectively reviewed the data of perioperative and follow-up period.Results 5 patients took orally aspirin, 10 took aspirin and clopidogrel.2 patients had received operation 7 days after stopping the agents, 3 days for 3 patients, 1 day for 1 patient, and the other 5 patients received emergency operation without stopping the agents.The cardiopulmonary bypass time was(259.7±64.8) minutes, aortic cross-clamp time was(181.0±51.7) minutes, and selective cerebral perfusion and lower body arrest time was(34.9±8.1) minutes.There were 2 in-hospital deaths due to circulation failure(mortality 13.3%).The average drainage volume in the first 24 hours after operation was(800.7±598.8)ml.During a mean follow-up period of(20.6±17.4) months, one patient had suddenly death.Conclusion aTAAD misdiagnosed as ACS was not rare, anti-platelet therapy will increase the risk of bleeding.The decision of operation time rely on considering balance between the rupture risk of aortic dissection and the hemorrhage risk of anti-platelet therapy.Emergency operation for these patients will increase the bleeding and transfusion.
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Objective@#To estimate the prevalence and the risk factors of preoperative coronary angiography (CAG) confirmed coronary stenosis in patients with degenerative valvular heart disease.@*Methods@#A total of 491 patients who underwent screening CAG before valvular surgery due to degenerative valvular heart disease were enrolled from January 2011 to September 2014 in our hospital, and clinical data were analyzed. According to CAG results, patients were divided into positive CAG result (PCAG) group or negative CAG (NCAG) group. Positive CAG result was defined as stenosis ≥50% of the diameter of the left main coronary artery or stenosis ≥70% of the diameter of left anterior descending, left circumflex artery, and right coronary artery.Risk factors of positive CAG result were analyzed by multivariable logistic regression analysis, and Bootstrap method was used to verify the results.@*Results@#There were 47(9.57%)degenerative valvular heart disease patients with PCAG. Patients were older ((68.0±7.6)years vs.(62.6±7.1)years, P<0.001) and the prevalence of typical angina was significantly higher (14.89%(7/47)vs. 2.03%(9/444), P<0.001)in PCAG group than in NCAG group. Multivariable logistic regression analysis showed that age (OR=1.118, 95%CI 1.067-1.172, P<0.001), typical angina (OR=8.970, 95%CI 2.963-27.154, P<0.001), and serum concentration of apolipoprotein B (OR=20.311, 95%CI 4.774-86.416, P<0.001) were the independent risk factors of PCAG in degenerative valvular heart disease patients. Bootstrap method revealed satisfactory repeatability of multivariable logistic regression analysis results (age: OR=1.118, 95%CI 1.068-1.178, P=0.001; typical angina: OR=8.970, 95%CI 2.338-35.891, P=0.001; serum concentration of apolipoprotein B: OR=20.311, 95%CI 4.639-91.977, P=0.001).@*Conclusions@#A low prevalence of PCAG before valvular surgery is observed in degenerative valvular heart disease patients in this patient cohort. Age, typical angina, and serum concentration of apolipoprotein B are independent risk factors of PCAG in this patient cohort.