Surgical treatment for type Stanford A aortic dissection with Kommerell's diverticulum / 中华外科杂志

To examine the outcomes of surgical treatment in patients of type Stanford A aortic dissection with Kommerell's diverticulum. From January 2009 to August 2017, patients of type Stanford A aortic dissection with Kommerell's diverticulum who underwent the Sun procedure were enrolled. Patient demographic, preoperative, intraoperative, early morbidity and mortality data were collected from medical and electronic patient records. Clinical follow-up data, including late morbidity and mortality, were obtained by telephone interview with the patient. A total of 13 patients (11 males and 2 females; mean age 47 years) were included. The mean maximum diameter of Kommerell's diverticulum was (21.8±7.7) mm. The Kommerell's diverticulum was repaired by direct suture of the orifice in 3 patients, ligation of the aberrant right subclavian artery in 9 patients, and suture and ligation in 1 patient, respectively. No perioperative death occurred. One patient underwent a reexploration for bleeding. There were 2 late deaths: unknown reason in 1 patient and septic shock secondary to renal abscess in 1 patient. Reintervention was performed in one patient for a persistent type Ⅱ endoleak. The Sun procedure with femoral artery cannulation for cardiopulmonary bypass, unilateral carotid artery cannulation for selective cerebral perfusion and ligation of aberrant right subclavian artery on the right side of the trachea is an appropriate therapeutic strategy for patients of type Stanford A aortic dissection with Kommerell's diverticulum.

The research focus on short-and long-term postoperative prognosis of acute type A aortic dissection patient complicat-ed with renal malperfusion / 中华胸心血管外科杂志

Objective To find out what the exact impact of renal malperfusion on short- and long-term postoperative prognosis of ATAAD patietns. Methods 218 patients with ATAAD undergoing surgical repair from June 2009 to May 2012 . Mean age was(47.8 ±10.7) years and 170 were male(78.0％). Based on computed tomographic angiography and laboratory test, 48 patients were diagnosed with preoperative renal malperfusion(22. 0％). Clinical data were compared between two groups and risk factors for short-and long-term mortality identified using Cox regression. Results Patients with renal malperfu-sion showed significantly higher incidences of short-term mortality(22. 9％ vs 8. 3％, P =0. 023), long-term mortality (87. 0％ vs 72. 9％, P=0. 003) and postoperative acute kidney failure(20. 8％ vs 4. 1％, P<0. 001). Renal malperfusion wastheriskfactorforshort-termmortality(OR2.92,95％CI1.31-6.63,P=0.009) andlong-termmortality(OR2.56, 95％CI 1. 32-4. 94, P=0. 005). Conclusion Renal malperfusion significantly increases the postoperative risk of short-term mortality, long-term mortality and incidence of postoperative acute renal failure in patients with ATAAD.

Extra-anatomic bypass for complex aortic coarctation in adults / 中华外科杂志

<p><b>OBJECTIVE</b>To demonstrate an effective operation of extra-anatomic bypass for complex aortic coarctation in adults.</p><p><b>METHODS</b>Between July 1997 and October 2010, 51 patients underwent extra-anatomic aortic bypass. There were 39 male and 12 female patients. Mean age was (40 ± 14) years (ranging from 18 to 63 years). Operative technique of extra-anatomic bypass consisted of performing an ascending-to-descending or abdominal or femoral aorta bypass (8, 39 and 4 patients). Concomitant procedures were performed in 38 patients: 10 isolated aortic valve replacements (AVR), 11 aortic root replacements (Bentall), 4 ascending aorta replacements including 3 concomitant AVR, 5 mitral valve replacements including 3 concomitant AVR, 4 ventricular septal defect correcting with AVR, and 4 coronary artery bypass graft.</p><p><b>RESULTS</b>Mean follow-up time was (30 ± 9) months (ranging from 5 to 60 months). Two patients were reoperated for hemorrhage in descending aorta anastomosis, one of whom was dead of multiple organ failure in perioperative period. Upper-extremity blood pressure after coarctation correction with extra-anatomic aortic bypass was significantly improved (< 10 mmHg, 1 mmHg = 0.133 kPa). Arterial hypertension was well improved, except 10 patients controlled with less drug therapy. All grafts were patent without obstruction or pseudoaneurysm formation in the follow-up period evaluated by vascular ultrasound and computed tomographic angiogram.</p><p><b>CONCLUSION</b>Extra-anatomic aortic bypass is a safe and effective option for complex aortic coarctation in adults.</p>

Aortic valve preservation and root reconstruction in Marfan syndrome / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the experiences of aortic valve preservation and root reconstruction in patients with Marfan syndrome.</p><p><b>METHODS</b>From July 2003 to Dec 2007, 22 patients with Marfan syndrome were treated by aortic valve preservation and root reconstruction. There were 12 male and 10 female, the age ranged from 10 to 57 years old with a mean of (28 +/- 10) years. The operation procedures included reimplantation technique in 9 patients, remodeling technique in 8 patients, and patch technique in 2 patients. In addition, reimplantation technique + total aorta replacement in 1 patient, remodeling technique + "aortic arch replacement + stent-elephant trunk" in 1 patient, patch technique + "aortic arch replacement + stent-elephant trunk" in 1 patient. The patients were followed-up by 17 to 64 months with a mean of (46 +/- 16) months.</p><p><b>RESULTS</b>No in-hospital and follow-up period death occurred. There was one reexploration for bleeding 1 d postoperative. No valve-related complication occurred during the follow-up. At the end of follow-up, no aortic regurgitation was demonstrate in 16 patients, but mild regurgitation in 4 patients, moderate regurgitation in 1 patient and severe regurgitation in 1 patient. Two patients with moderate and severe aortic regurgitation need reoperation 1 year postoperative.</p><p><b>CONCLUSION</b>The early and mid-term results of aortic valve preservation and root reconstruction operations in Marfan syndrome were favorable.</p>

Midterm outcome of one stage total or subtotal aortic replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of one-stage total and subtotal aortic replacement for aneurysm evolving the entire aorta and show the midterm results of the operation.</p><p><b>METHODS</b>From February 2004 to July 2008, 22 patients (17 men and 5 women, age ranged from 19 to 47 years old) underwent one-stage total or subtotal aortic replacement under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. Seven patients received subtotal aortic replacement (from the aortic valve to the abdominal aorta). Fifteen patients underwent total aortic replacement (from the aortic valve to the aortic bifurcation). Patients were opened with a mid-sternotomy and a thoracoabdominal incision. First, the ascending aorta was replaced; following which the aortic arch was reconstructed. Finally, the thoracoabdominal aorta was fully replaced.</p><p><b>RESULTS</b>Thirty-day mortality was 4.5% (1/22). One patient died of multiple organ failure 11 days postoperatively. Two patients had cerebral infarction secondary to embolism. Spinal neurological deficits didn't occur. Twenty-one patients survived the operation and were followed up for 3 to 56 months (35.0 +/- 16.9 months). There was no late death. One patient received aortic valve replacement due to aortic valve regurgitation one year after David and total aortic replacement.</p><p><b>CONCLUSION</b>One-stage total and subtotal aortic replacement is an effective operation for aneurysm evolving the whole length of the aorta with acceptable mortality and morbidity. Midterm follow-up showed satisfactory results.</p>

Clinical experience of simultaneous aortic operation and coronary artery bypass grafting / 中华外科杂志

<p><b>OBJECTIVE</b>To summarized the experience of simultaneous aortic operation and coronary artery bypass.</p><p><b>METHODS</b>Between November 1997 and September 2004, thirty-six patients who underwent combined aortic operation and coronary artery bypass graft (CABG) were reviewed with a mean age of (57 +/- 12) years (range 31 to 75). Nineteen patients were suffered from aortic dissection. There were 17 patients of aortic aneurysm, 5 aortic root aneurysm, 5 ascending aortic aneurysm, 4 aortic arch aneurysm, 3 abdominal aneurysm. Preoperational coronary angiography was performed in 1 of 10 acute type A dissection patients. The coronary arteries were involved by dissection in 7 acute type A dissection patients. The artherosclerosis of coronary artery was found during operation in 2 patients. Among 7 patients with chronic type A aortic dissection, coronary angiography was performed in 2, coronary artery was involved by dissection in 2 and coronary arterosclaerosis was founded in 3. There were 2 patients with acute or chronic type B aortic dissection. The stenosis of coronary artery was confirmed by preoperative angiography in the patients with aortic aneurysm. There were 57 coronary bypass grafts, 6 of them were artery grafts, and others were venous grafts.</p><p><b>RESULTS</b>The mean cardiopulmonary bypass time was (157 +/- 54) min, and the mean aortic cross clamp time was (98 +/- 31) min. Five patients with type A aortic dissection died postoperatively, 3 from heart failure leading to multi organ system failure, 1 from cerebral hernia and one from ischemia of intestinal tract. Postoperative complication included reoperation for hemorrhage in 1 patient, respiratory failure in 1 patient.</p><p><b>CONCLUSIONS</b>Type A aortic dissection with coronary involvement or arterosclaerosis is associated with high mortality rate. Coronary artery angiography should be performed in the elder than 50 years patient with aortic aneurysm. Combined aortic aneurysm operation and CABG is a safe procedure.</p>

A New Quantitative Determination Method for the Biological Activity of Recombinant Human Ciliary Neurotrophic Factor / 中国生物工程杂志

Objective: To develop a new quantitative determination method for the biological activity of recombinant human ciliary neurotrophic factor. Methods: Dorsal root ganglions were derived from the chick embryo and dispersed into single neuron cell,The rhCNTF was added to neuron cells and incubated for 64 hours,The activity of acid phosphatase in neuron cells was determined and the biological activity of rhCNTF was analyzed quantificationally. Result: rhCNTF could promote original era dorsal root neuron cells of chick embryo surviving,the livability of neuron cells was positively related to the amount of rhCNTF added to the culture. Conclusion: A quantitative determination method for the biological activity of rhCNTF was developed by testing the activity of acid phosphatase in neuron cells. Compared with the typical ways,this method was quantificational easily,repeatable better and with much fewer disturbance factors.

Surgical treatment of Williams syndrome combined with cardiovascular disease / 中华外科杂志

<p><b>OBJECTIVE</b>To introduce the experience of diagnosis and surgical treatment of Williams syndrome combined with cardiovascular disease.</p><p><b>METHODS</b>Between October 1996 and June 2003, 8 patients of Williams syndrome with cardiovascular disease were admitted in Fuwai hospital. Seven patients underwent surgical correction. One didn't undergo surgical procedure. There were 6 male and 2 female ranging from 1.5 to 12.0 years old (medium age 6.4). Three had localized type supravalvular aortic stenosis and 5 diffused type supravalvular aortic stenosis. In them, 2 patients were combined with peripheral pulmonary stenosis. Single patch aortoplasty were performed in 6 cases, and inverted bifurcated patch aortoplasty in one patient.</p><p><b>RESULTS</b>One patient died and one patient suffered renal insufficiency. In the early postoperative period, the mean speed of flow was reduced to 1.7 m/s from 4.6 m/s, and the mean systolic pressure gradient was reduced from 91 mm Hg to 18 mm Hg. Six patients were followed up 16 to 91 months. There were 5 cases in NYHA function class I, and one in class II.</p><p><b>CONCLUSION</b>Satisfied result can be achieved in surgical treatment of Williams syndrome with supravalvular aortic stenosis, but it is not in combined with peripheral pulmonary stenosis.</p>

Surgical treatment of aortic regurgitation caused by Behcet's disease / 中国医学科学院学报

<p><b>OBJECTIVE</b>To summarize operational effect with surgical treatment of aortic regurgitation caused by Behcet's disease and discuss relevant surgical techniques for treatment of these conditions.</p><p><b>METHODS</b>Eight patients with aortic regurgitation secondary to Behcet's disease and received surgery between April 1997 and August 2003 were retrospetively analyzed. Among them, two patients had their aortic valves replaced in other hospital before admitted to our hospital where one undertook aortic valve replacement (AVR), and the other undertook aortic root replacement (ARR). In six patients who were initially treated in our hospital, the surgical procedures for aortic regurgitation included AVR in three patients and ARR operation in other three patients in whom Bentall-type operation was conducted in two patients and Cabrol-type operation in one.</p><p><b>RESULTS</b>One patient died during hospital stay. The follow-up periods ranged from 3 months to 36 months. In five patients with prosthetic valve detachment or suture detachment, redo homograft replacement was required in one patient and redo AVR in 3, one patient had redo AVR twice, and the remaining one patient had no surgery at present. Three patients primarily operated by ARR operation have no complications.</p><p><b>CONCLUSIONS</b>The rate of prosthetic valve detachment is high in patients with Behcet's disease. ARR should be a first-line therapy for operation promised these patients.</p>

Clinical application of total or subtotal aortic replacement on the one stage / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the experience of the application of total and subtotal aortic replacement on the one stage in the treatment of the patients with extensive aortic aneurysm and chronic Stanford type A dissecting aneurysm.</p><p><b>METHODS</b>From February to November 2004, 8 patients (7 male and 1 female; ranging from 23 to 47 years old) underwent one-stage total or subtotal aortic replacement under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. Two patients received subtotal aortic replacement (from the aortic valve to the abdominal aorta). Six patients underwent total aortic replacement (from the aortic valve to the aortic bifurcation), of which 3 patients had aortic valve replacement. Patients were with mid-sternotomy and thoracoabdominal incision. The ascending aorta was firstly replaced, following which the aortic arch was reconstructed. Finally, the thoracoabdominal aorta was fully replaced.</p><p><b>RESULTS</b>There was no operative or early postoperative death. One patient had cerebral infarction secondary to embolism. Spinal neurological deficits didn't occur. All 8 patients were alive and had good functional status 2 to 12 months after operation.</p><p><b>CONCLUSION</b>The patients performed with one-stage total and subtotal aortic replacement achieves good results. It can eliminate the risk of remnant aneurysm rupture in staged total aortic replacement.</p>

Dexterously use four branch vessel prosthesis on aortic surgery / 中华外科杂志

<p><b>OBJECTIVE</b>To review the experience of various positions aortic replacement by four branch prosthesis vessel.</p><p><b>METHODS</b>From August 2003 to May 2005, we finished aortic procedures with four branch prosthesis vessel for 142 patients, aged (44 +/- 12) (22-78) years, weighted (72 +/- 20) kg (49-130 kg). We performed ascending aorta and total aortic arch replacement for 85 cases during right axillary artery cannulation for cardiopulmonary bypass and selected antegrade cerebral perfusion. 38 patients underwent one-stage total thoracoabdominal aortic replacement during deep hypothermic bypass and subsection circulatory arrest. 8 patients underwent one-stage total or subtotal aortic replacement during deep hypothermic bypass and selected antegrade cerebral perfusion and subsection circulatory arrest. We performed totally aortic arch replacement without utilizing cardiopulmonary bypass and hypothermic for 11 cases.</p><p><b>RESULTS</b>The mortality was 4.2%. Cerebral complications occurred in 16 (11.3%). 2 patients suffered from permanence spinal cord dysfunction. 4 patients suffered from temporary spinal cord dysfunction.</p><p><b>CONCLUSION</b>The four branch vessel prosthesis can be used on aortic surgery dexterously. The approach may shorten she time of aortic arrest and arterial construction.</p>

The application of modified classification of the aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the indication, optimal operative procedures, plan and the estimation of the prognosis depending on the subtype of aortic dissection defined by the extension and extent of dissection.</p><p><b>METHODS</b>The outcome of 708 patients with aortic dissection between January 1994 and December 2004 was analyzed. Among them 477 patients suffered from Stanford type A aortic dissection were treated. Type A dissection can be classified into 3 subtypes based on the pathological change of the aortic root. Type A1 (No pathological change type): 212 patients underwent ascending aorta replacements; Type A2 (mild pathological change type): 63 patients underwent ascending aortic replacement with concomitant aortic valve and valsalva sinus plasty and David procedure was performed in 9 patients; Type A3 (severe pathological change type): 193 patients underwent Bentall procedure. The method of aortic arch repair was determined by the pathological type of distal aorta. Total aortic arch replacement was performed in 78 patients with complex type (type C). There hundred and ninety-nine patients with simple type (type S) underwent partial aortic arch replacement. 231 patients suffered from Stanford type B aortic dissection. Type B dissection can be classified into 3 subtypes based on dilated extension of proximal descending aorta. Type B1 (no dilation was confined in the proximal of thoracic descending aorta): endoluminal stent graft repair was performed in 103 patients. Replacement of the partial proximal thoracic descending aorta and replacement combined with stented elephant trunk procedure were performed in 32 and 12 patients respectively; Type B2 (aneurysm in thoracic descending aorta): 32 patients underwent the part proximal thoracic descending aorta replacement combined with aorta plasty. 21 patients underwent the replacement of entire thoracic descending aorta; Type B3 (aneurysm in thoracic descending and abdominal aorta): thoracoabdominal aortic replacement was operated in 31 patients with deep hypothermia circulatory arrest; Type BC (complex type): 44 patients were performed the operation with the use of deep hypothermia circulatory arrest because their left subclavian arteries or distal aortic arch were affected by the dissection; Type BS (simple type): 103 patients were underwent endoluminal stent graft repair. In the 60 patients, the operations were performed by using the technique which preserved blood was transfused back by pump via the femoral artery. Femoro-femoral bypass was performed in 24 patients.</p><p><b>RESULTS</b>Type A: the operative mortality was 4.6% (27/477), and the hospital morbidity was 14.5% (69/477). Type B: the hospital mortality of endoluminal stent graft repair was 1.9% (2/103). 9.7% (10/103) had mild leakage from proximal communications. The morbidity was 2.9% (3/103) in stent group. The mortality was 3.1% (4/128), and the hospital morbidity was 18.8% (24/128) in the operative group.</p><p><b>CONCLUSION</b>The subtype of aortic dissection is much useful in determining the optimal procedure, operative indication and plan, estimating the prognosis.</p>

Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To improve the long term outcomes of the surgery for Stanford type A aortic dissection, we performed ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for acute and chronic type A aortic dissection.</p><p><b>METHODS</b>From April 2003 to March 2004, 40 consecutive patients with acute or chronic Stanford type A aortic dissection underwent this procedure. Right axillary artery cannulation was routinely used for cardiopulmonary bypass and selected cerebral perfusion. The stented elephant trunk was implanted through the aortic arch under hypothermic circulatory arrest. The stented elephant trunk was a 10 cm long self expandable graft. Enhanced electric beam computed tomography (EBCT) was performed in each patient before discharge, three month after surgery, and once each year after discharge to evaluate the postoperative time course of the residual false lumen.</p><p><b>RESULTS</b>Cardiopulmonary bypass time was (166 +/- 38) min, average cross clamp time was (107 +/- 28) min, and average selective cerebral perfusion and lower body arrest time was (30 +/- 15) min. The in-hospital mortality was 5% (2/40). One patient died of multi-organ failure postoperatively and another died of cerebral infarction 2 month after surgery. One suffered from spinal cord injury perioperatively. There was no late death during follow up.</p><p><b>CONCLUSION</b>Ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective way in closing the residual false lumen of the descending aorta and might contribute to the better long term outcomes of type A aortic dissection. Our half mortality of 2 patients suffering acute renal failure suggests that this group may be candidates for medical or delayed surgical intervention. Conversely, our 5% mortality rate for those renal intact patients warrant aggressive and expeditious surgical treatment.</p>