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>

Edge-to-edge chordal transfer repair for anterior leaflet prolapse of mitral valve in 21 patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Repair of anterior mitral leaflet (AML) prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.</p><p><b>METHODS</b>Between January 2002 and June 2009, the operation of chordal transfer based on the "edge-to-edge" technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet. After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.</p><p><b>RESULTS</b>All patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association (NYHA) functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve: the cross-sectional area of the mitral valve was 3.3 - 4.8 cm(2) (mean (3.78 ± 0.52) cm(2)), the mean regurgitation area was (0.45 ± 0.22) cm(2). At the same time, both dimension of left atrium and left ventricle reduced significantly (left atrium diameter: pre-operation (48.26 ± 11.12) mm, post-operation (37.57 ± 9.56) mm, P < 0.05; the end-diastolic diameter of the left ventricle: pre-operation (61.43 ± 8.24) mm, post-operation (42.35 ± 10.79) mm, P < 0.01).</p><p><b>CONCLUSION</b>"Edge-to-edge" chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.</p>

The early and middle-long term clinical results of surgical treatment for ventricular septal rupture / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the way of promoting the efficacy of surgical treatment for ventricular septal rupture (VSR) after acute myocardium infarction in terms of perioperative and long term survival.</p><p><b>METHODS</b>The clinic data of 37 VSR cases underwent surgical treatment from October 1994 to October 2007 were analyzed retrospectively. There were 24 male and 13 female, and the age was (63.4 +/- 7.6) years old. The whole group was divided into the VSR repair plus revascularization group (group A, 26 cases) and simple VSR repair group (group B, 11 cases).</p><p><b>RESULTS</b>There were 4 operative deaths in group A (15.4%), 7 deaths in group B (63.6%), P = 0.006. With the follow-up of (34.0 +/- 29.8) months ranged from 2 to 103 months of the 26 operational survivors, there were 5 late deaths, of which 2 deaths in group A and 3 deaths in group B. According to the Kaplan-Meier survival curve, the actuarial survival rate at 6 to 8 year was (64.3 +/- 21.0)% for group A and the actuarial survival rate at 4 year was (25.0 +/- 21.7)% for group B, P = 0.011. Of the 21 mid-long term survivors, 17 cases were in NYHA class I to II and 4 cases in NYHA class III to IV. There were 4 cases suffered from VSR recurrence. According to Logistic regression, the risk factors for the early death were not adoptive of revascularization, cardiogenic shock and emergency surgical procedure, while the risk factors for late death were not adoptive of revascularization and low cardiac output after the procedures.</p><p><b>CONCLUSIONS</b>VSR repair plus revascularization could improve the perioperative and mid-long term survival for the surgical treatment of VSR. The appropriate timing and procedures of the surgical operation are very important to promote perioperative survival and to prevent VSR recurrence.</p>

Prognosis of patients with chronic thromboembolic pulmonary hypertension receiving conservative or operative treatments according to a new clinical classification scheme / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy of conservative or pulmonary thromboendarterectomy (PTE) therapy for chronic thromboembolic pulmonary hypertension (CTEPH) patients according to a new clinical classification scheme.</p><p><b>METHODS</b>This retrospective study analyzed 63 cases of CTEPH admitted to our hospital from February 1995 to October 2007 and 45 cases were treated surgically (Group A) and 18 cases received conservative therapy (Group B). Results were analyzed using Fisher exact test and t test according to San Diego medical center quartering classification scheme and Anzhen Hospital modified bifurcate classification scheme.</p><p><b>RESULTS</b>There were 6 operational deaths in Group A and 2 deaths during hospital stay in Group B. During follow-ups (mean 3.6 +/- 2.5 years), there were 4 deaths in Group A and 9 deaths in Group B. the totality survival rate is significantly higher in Group A than that in Group B (P < 0.05). For patients with San Diego Type I CTEPH, survival rate was significantly higher in Group A compared with Group B (P = 0.009) and was similar for patients with type II and III and IV CTEPH between the two groups (P = 0.338, 0.455, 0.800). Survival rate was significantly higher in Group A than that in Group B for patients with Anzhen central type CTEPH (P = 0.009), but was similar between the two groups for patients with Anzhen peripheral type CTEPH (P = 0.125). The Kaplan-Meier survival curve 5 years survival rate in the Group A was (91.7 +/- 8.0)% for Anzhen central type and (76.0 +/- 8.5)% for Anzhen peripheral type (P = 0.04), and the 5 years Kaplan-Meier survival rate in the Group B was (42.9 +/- 18.7)% for Anzhen central type and (56.2 +/- 10.8)% for Anzhen peripheral type (P = 0.851).</p><p><b>CONCLUSION</b>Anzhen Hospital modified bifurcate classification scheme is a simple and effective classification to predict the prognosis and choose treatment method of CTEPH.</p>

Repair of anterior leaflet mitral valve prolapse: the comparison between chordal replacement and chordal shortening / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the relative merits between chordal shortening and artificial chordae to repair the anterior leaflet prolapses (ALP).</p><p><b>METHODS</b>The clinic data of 50 cases underwent repair of ALP from March 1990 to March 2008 were analyzed retrospectively. There were 29 male and 21 female patients with a mean age of (42.6 +/- 11.3) years old. There were 23 patients in chordal shortening group and 27 patients in artificial chordae group.</p><p><b>RESULTS</b>There were 3 operative deaths in chordal shortening group (13.0%), and 1 death in artificial chordae group (3.7%, P = 0.199). With a mean follow-up of (5.8 +/- 4.8) years and a total follow-up of 278 patient-years, there were 3 late deaths respectively in each group. According the Kaplan-Meier survival curve, the actuarial survival rate at 5-8 years was 70.0% +/- 18.2% for chordal shortening group and 86.8% +/- 9.2% for artificial chordae group (chi(2) = 8.17, P = 0.046). There were 5 reoperations, of which 4 in chordal shortening group and 1 in artificial chordae group. According to the Kaplan-Meier freedom from reoperation curve, the freedom from reoperation at 5 years was 83.3% +/- 15.2% for chordal shortening group and 100% for artificial chordae group (chi(2) = 12.06, P = 0.007). The COX proportional hazard regressions revealed that chordal-shortening technique was the independent risk predictor for the late cardiac event after ALP surgical repair.</p><p><b>CONCLUSION</b>Artificial chordae techniques has a relative superiority to chordal shortening for repair of mitral valve ALP.</p>

The clinical analysis of 54 cases for the surgical treatment of pulmonary embolism / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the results of surgical procedures for pulmonary embolism.</p><p><b>METHODS</b>Fifty-four patients of pulmonary embolism received surgical treatment from October 1994 to June 2007, of which 9 were acute pulmonary embolism underwent pulmonary embolectomy and 45 patients were chronic thromboembolic pulmonary hypertension (CTEPH) underwent pulmonary thromboendarterectomy.</p><p><b>RESULTS</b>The mortality rate was 44.4% in acute pulmonary embolism group and 13.3% in CTEPH group (P < 0. 05). Thirteen patients had residual pulmonary hypertension and 23 patients had severe pulmonary reperfusion injury postoperatively. The pulmonary artery systolic pressure changed from (89.4 +/- 36.3) mm Hg (1 mm Hg =0.133 kPa) preoperative to (55.6 +/- 22.4) mm Hg postoperative. The pulmonary vascular resistance changed from (89. 7 +/- 56.7) kPa L(-1) S(-1) preoperative to (38.9 +/- 31.1) kPa L(-1) S(-1) postoperative. The arterial partial pressure of oxygen changed from (52. 3 +/- 6.7 ) mm Hg preoperative to (87.6 +/- 6.5) mm Hg postoperative. The arterial oxygen saturation changed from (88.9 +/- 4.5)% preoperative to (95.3 +/- 2.8 )% postoperative (P < 0.05). With the follow-up of (41.8 +/- 36.4) months, there were 4 patients died. According to NYHA, there were 28 patients for class I , 10 patients for class II and 2 patients for class III. According to Kaplan-Meier survival curve, the 3-year, 4-year, 5-year and 8-year survival rate were (97.1 +/- 2.8 )%, (94.0 +/- 4.1)%, (90.8 +/- 5.2)% and (85.0 +/- 7.3)% respectively. Linear rate of bleeding and thromboembolic related to anticoagulation were 0. 63% patient-years and 0. 62% patient-years respectively.</p><p><b>CONCLUSIONS</b>The operational mortality of acute pulmonary embolism is significantly higher than CTEPH, and the mid-long term survival rate is agreeable and the complication rate related to anticoagulation is relatively low.</p>

Combined endocardial and epicardial radiofrequency modified Maze procedure in the treatment of atrial fibrillation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of the combined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure for the treatment of atrial fibrillation (AF).</p><p><b>METHODS</b>During a period of 3 years, 295 patients with AF having concomitant cardiac surgery underwent the procedure. Patients underwent either the endocardial and epicardial group (n=185) or the endocardial group (n=110) radiofrequency ablation. There were 124 males, 171 females with a mean age of (52 +/- 11) year old. Mean duration of preoperative AF was 36 +/- 43 months. And about 90.8 percent valve pathology was rheumatic. Valve operation was performed in 289 patients, coronary artery bypass graft surgery in 19 patients and congenital heart disease operation in 6 patients respectively. Follow-up for the whole patients ranged from 3 to 47 months (mean 28 +/- 5 months).</p><p><b>RESULTS</b>Ten patients died postoperatively (3.4%). Four patients died of low cardiac output, five patients died of multisystem and organ failure, one patient died of cerebral hernia. There were 2 patients died of nerves system complication during follow-up. At the end of the procedure 228 patients (77.3%) were sinus rhythm, including 78 patients (70.9%) in endocardial group while 150 patients (81.1%) in endocardial and epicardial group (P<0.05). At late follow-up, 191 of 259 patients (73.7%) were in stable sinus rhythm. Sinus rhythm was present in 64 patients (66.0%) in endocardial group while 127 patients (78.4%) in endocardial and epicardial group (P<0.05). Histopathology of the endocardial group revealed foci coagulative necrosis was limited to the endocardial side. While endocardial and epicardial ablation had full-thickness alteration of atrial tissue besides ill defined borders and inflammatory cell infiltration.</p><p><b>CONCLUSIONS</b>Combined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure was performed safely and efficiently. And it restored sinus rhythm better than endocardial ablation only.</p>

Clinical analysis in 34 cases of paravalvular leakage after valve replacement / 中华外科杂志

<p><b>OBJECTIVE</b>To study the treatment of paravalvular leakage (PVL) after cardiac valve replacement retrospectively.</p><p><b>METHODS</b>Between 1993 and 2005, 34 patients with PVL were observed, including aortic PVL in 6 patients and mitral valve PVL in 28 patients. Twenty-five patients with severe anemia and/or heart failure were reoperated, 9 patients without severe clinical symptoms and signs had treated conservatively. Repair of PVL was carried out in 14 patients, and the other 10 patients were performed prosthetic valve replacement.</p><p><b>RESULTS</b>Of 9 patients who had treated conservatively, 1 patients died of septic shock, and 1 patient died of heart failure. During 6 - 72 months follow-up, of the seven survivals, 2 patients died of heart failure. And the other 5 patients were in NYHA class II. Echocardiography demonstrated no obvious enlargement of the PVL and diameter of the heart. Among the 25 patients who were reoperated, the overall operative mortality was 12% (3 patients). Twenty-one survivals were in NYHA class II during the follow-up of 4 - 132 months. While a mitral valve PVL and a aortic valve PVL were diagnosed among them after the reoperation 4 years and 6 months respectively.</p><p><b>CONCLUSIONS</b>Patients with PVL and no severe symptoms can be treated conservatively and followed up. A more aggressive surgical treatment is recommended for patients with PVL and severe anemia and/or heart failure.</p>

Left atrial plication for left atrium associated with mitral valve disease / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of left atrial plication (LAP) in patients with giant left atrium (GLA) associated with mitral valve disease.</p><p><b>METHODS</b>Twenty-three patients with left atrial diameter (LAD) over 8.0 cm were enrolled. All cases underwent valve replacement and LAP between November 1993 and November 2004 were studied retrospectively. According to New York Heart Association (NYHA) classification, 15 belonged to class III, 8 to class IV. Mitral valve replacements were performed in 18 patients (mechanical valve in 17 and biological valve in 1), double value replacement in 5, tricuspid valve plasty (TVP) in 15, atrial fibrillation radiofrequency ablation in 2.</p><p><b>RESULTS</b>Low output syndrome happened in 3, respiratory failure in 2. The early death was in 3 cases (operative mortality 13%). The causes of death were: heart failure in 2 cases and stroke in 1. LAD was decreased significantly in patients after operation.</p><p><b>CONCLUSIONS</b>LAP has considerably beneficial effects on improvement of postoperative respiratory and cardiac function, reducing operative mortality. Atrial fibrillation radiofrequency ablation is effective in patients with GLA associated with valve disease. It may be recommended for patients with GLA during mitral valve surgery, especially for patients with LAD > 8.0 cm.</p>

Surgical management for Stanford A aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize the surgical experience for Stanford A aortic dissection.</p><p><b>METHODS</b>Sixty-eight patients with Stanford A aortic dissection underwent surgery from March 1998 to October 2004, acute aortic dissection in 45 cases, chronic aortic dissection in 23 cases. The operation were performed by using moderate hypothermic cardiopulmonary bypass in 53 cases, deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) in 11 cases; DHCA with antegrade selective cerebral perfusion (SCP) in 4 cases. Surgical procedures included ascending aortic grafting in 7 cases, ascending and hemiarch grafting in 6, ascending and total arch grafting in 3, ascending and total arch grafting with Frozen elephant trunk procedure in 4. Concomitant procedures included Bentall procedure in 34 cases, Wheat procedure in 12 cases, aortic valvuloplasty in 2 cases, mitral valvuloplasty in 1 cases. Urgent surgery was in 39 cases (emergency surgery in 19).</p><p><b>RESULTS</b>Operative mortality was 7% (urgent surgery mortality was 8%, elective surgery mortality was 7%). Fifty-eight cases were followed up for (37 +/- 22) months. Actuarial survival of 58 cases at 1, 3 and 5 years was 100%, 95% and 86% respectively.</p><p><b>CONCLUSION</b>The choice of surgical procedures depend on the location of intimal tear for Stanford A aortic dissection. Proper surgical indication, technique and brain protections are the key factors of Stanford A aortic dissection surgery.</p>