Risk Factors for Acute Renal Failure after Thoracoabdominal Aortic Aneurysm Surgery / 中国医学科学院学报

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

Early and Midterm Results of Thoracoabdominal Aortic Aneurysm Repair in Patients with Marfan Syndrome / 中国医学科学院学报

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

Reoperation on aortic disease in patients with previous aortic valve surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases. This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.</p><p><b>METHODS</b>Forty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012, and the mean interval time of re-intervention to aortic disease was 6 years ((6.0 ± 3.8) years). The secondary aortic surgery included aortic root replacement (14 cases), ascending aorta replacement (10 cases), aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases), and total thoracoabdominal aorta replacement (2 cases). All these patients have received outpatient re-exams or follow-up by phone calls.</p><p><b>RESULTS</b>After the initial aortic valve replacement, patients suffered from aortic dissection (25 cases, 53%), ascending aortic aneurysm (12 cases, 26%) or aortic root aneurysm (10 cases, 21%). Diameter in ascending aorta increased (5.2 ± 7.1) mm per year and aortic sinus (3.3 ± 3.1) mm per year. The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P < 0.05). All 47 patients have received reoperation on aorta. One patient died in operating room because aortic dissection seriously involved right coronary artery. Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction. All patients were followed up, the mean survival time was (97.25 ± 17.63) months, 95% confidence interval was 55.24-73.33 months. Eight cases were died during follow-up and five-year survival rate was 83%.</p><p><b>CONCLUSION</b>To reduce the aortic adverse events after first aortic valve surgery, it is necessary to actively treat and strictly follow-up patients with previous aortic operation especially patients with Marfan syndrome and rheumatic heart disease.</p>

Magnetic resonance imaging of children with fecal incontinence after anoplasty for anorectal malformation and its clinical significance / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To study the development of pelvic floor muscle, morphology and location of rectum and anal canal as well as morphology of spinal cord and sacrum based on pelvic magnetic resonance imaging(MRI) of children with fecal incontinence after anoplasty for anorectal malformation and to provide information on management of fecal incontinence.</p><p><b>METHODS</b>Clinical and MRI data of 34 children with fecal incontinence after anoplasty for anorectal malformation in the Second Hospital of Shangdong University from September 2009 to December 2011 were analyzed retrospectively. There were 21 males and 13 females with the age of 3 to 14 years old. All the children underwent MRI detection. The morphology of external anal sphincter, puborectalis, ani levator, rectum and anal canal as well as the development of spinal cord and sacrum were observed using 1.5T MR scanner, including routine axial view, coronal view and sagittal view.</p><p><b>RESULTS</b>MRI revealed that dysplasia of external anal sphincter, puborectalis and anilavatory were found in 18, 23 and 27 children, respectively. MRI also showed ectopia of rectum(n=6), dilation of rectum(n=12), increased anorectal angle(n=11), fat tissue around the anal canal(n=5), tethered cord syndrome(n=2), Currarino syndrome(n=2), sacrum dysplasia(n=11); and rectourethral fistula(n=2). The above MRI findings were confirmed by operation and clinical practice.</p><p><b>CONCLUSIONS</b>MRI can provide clear morphology of external anal sphincter, puborectalis and ani lavatory, and location of rectum and anal canal as well as the development of spinal cord and sacrum. MRI is a valuable method to evaluate the children with fecal incontinence after anoplasty.</p>

Risk analysis for hospital mortality after operations for type A aortic dissection / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the risk factors for hospital mortality after operations for type A aortic dissection.</p><p><b>METHODS</b>Totally 766 consecutive patients (586 male and 180 female patient, aged (45±12) years, ranging from 16 to 78 years), who underwent surgery for type A aortic dissection from January 2001 to December 2010, were studied retrospectively. Preoperative and operation related clinic factors were analyzed by univariate analysis, followed by Logistic regression model, to identify the risk factors of hospital mortality.</p><p><b>RESULTS</b>Overall, 37 patients (4.8%) died during hospitalization. On univariate analysis, significant risk factors for hospital mortality were male, acute status, renal dysfunction, cardiac dysfunction, cardiopulmonary bypass time, duration of operation, volume of blood transfusion, re-operation for bleeding (χ2=4.008-27.093, P<0.05). On Logistic regression model, independent risk factors were acute status (OR=2.784, 95%CI: 1.166-6.649, P=0.021), renal dysfunction (OR=6.285, 95%CI: 1.738 - 22.723, P=0.005), cardiac dysfunction (OR=3.052, 95%CI: 1.083-8.606, P=0.035), re-operation for bleeding (OR=3.690, 95%CI: 1.262-10.791, P=0.017), volume of blood transfusion (OR=1.033, 95%CI: 1.008-1.058, P=0.010). Additionally, male (OR=0.387, 95%CI: 0.177-0.848, P=0.018) was protective factor, and alternatively, female was indeed one of the independent risk factors for hospital mortality.</p><p><b>CONCLUSION</b>Female, acute status, renal dysfunction, cardiac dysfunction, re-operation for bleeding, volume of blood transfusion were independent risk factors for hospital mortality after operations for type A aortic dissection.</p>

Outcome of surgery for sinus of Valsalva aneurysm with discrete membranous subaortic stenosis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly, and SVA with discrete membranous subaortic stenosis is even rarer. The aim of the study was to make sure the incidence of SVA with discrete membraneous subaortic stenosis in SVA and their surgical results. We retrospectively analyzed 234 patients receiving surgical repair of SVA and reported the incidence of ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis. We also reported seven cases of SVA combined with discrete membranous subaortic stenosis and their surgical results.</p><p><b>METHODS</b>Between January 1999 and December 2009, seven patients of SVA with discrete membranous subaortic stenosis underwent surgical repair of SVA and resection of subaortic discrete membrane. There were six male and one female patients. The mean age was (33.71 ± 13.25) years (range 16 - 52 years). Associated cardiovascular lesions were aortic regurgitation (n = 7), ventricular septal defect (n = 5), coarctation of aorta (n = 1), bicuspid aortic valve (n = 1), patent ductus arteriosus (n = 1), and aortic valve stenosis (n = 1). The aortic valve was replaced in four patients and valvuloplasty was done in three. The other co-existing anomalies were corrected at the same time. All the seven patients were followed up from 18 to 125 months (mean (63.14 ± 39.54) months). Among 234 SVA patients who underwent surgical repair, the number of cases with coexisting ventricular septal defect, aortic regurgitation, and discrete membranous subaortic stenosis was 129, 108, and 7, respectively.</p><p><b>RESULTS</b>There was neither early death after operation nor late death during the follow-up period. All the seven patients were in the New York Heart Association (NYHA) functional classes I and II. There was no recurrence of discrete subaortic membrane during the follow-up period. The incidence of ventricular septal defect, aortic valve incompetence, and discrete membranous subaortic stenosis among 234 SVA patients was 55.13%, 46.15%, and 2.99%, respectively.</p><p><b>CONCLUSIONS</b>Surgical repair of SVA with discrete membranous subaortic stenosis showed good mid-term results. Resection of discrete subaortic membrane should be done actively while repairing SVAs. Long-term results need to be followed up.</p>

Stented elephant trunk and femoral artery bypass grafting surgery for extended aneurysmal dilation of Stanford A aortic dissection or aortic aneurysm / 中华外科杂志

<p><b>OBJECTIVES</b>To summarize the clinical experience of stented elephant trunk with femoral artery bypass grafting procedure to treat severe aneurysmal dilation of Stanford A aortic dissection or aortic aneurysm. To study the surgical indication and surgical strategy of chronic Stanford A aortic dissection and aneurysmal dilation, also to summarize the early follow-up results.</p><p><b>METHODS</b>From February 2006 to November 2011, 19 patients with Stanford A aortic dissection or aortic aneurysm with extented aneurysmal dilation (megaaorta) received stented elephant trunk with femoral artery bypass grafting procedure. There were 3 acute cases and 16 chronic cases with 14 male patients and 5 female patients. Average age of this group was (42 ± 8) years and average body weight was (70 ± 15) kg. One patient was aortic aneurysm and all the other were Stanford A aortic dissection. Eight patients were Mafan's syndrome. Ascending aorta replacement or Bentall's operation was done first and total arch replacement and stented elephant trunk operation was done under deep hypothermia and circulatory arrest. After the patient was weaned from cardiopulmonary bypass, bypass from ascending aorta to femoral artery was done subcutaneously using the 10 mm graft in the same femoral incision.</p><p><b>RESULTS</b>There was no operative mortality. One patient had chylothorax which recovered with medical treatment and one patient got paraplegia after surgery. The cardiopulmonary bypass time was (176 ± 42) minutes, aortic cross clamping time was (88 ± 25) minutes and deep hypothermia and low flow rate time was (23 ± 8) minutes. The blood pressure of the lower extremities were normal after operation. Follow-up time was (22 ± 19) months. All patients survived. False lumen closure rate at the stent level was 100%. CT scan at 3 to 6 months after operation showed no obvious dilation of the descending aorta. Two patient successfully received second stage operation of total (subtotal) thoracoabdominal aorta replacement.</p><p><b>CONCLUSIONS</b>Stented elephant trunk and aorta to femoral artery bypass is a safe procedure to treat aortic dissection or aortic aneurysm with extended aneurysmal dilation. This procedure can effectively increase the blood supply of the lower extremities due to small true lumen of the descending aorta, and may decrease the speed of dilation of the false lumen. It is also a practical procedure to lay the foundation for the second stage operation of normothemia thoracoabdominal aorta replacement.</p>

Surgical repair of ruptured sinus of Valsalva aneurysm to right atrium / 中华外科杂志

<p><b>OBJECTIVES</b>To summarize the experience of surgical repair of ruptured sinus of Valsalva aneurysm to right atrium and to compare the difference between through right atrium repair and transaortic combined with right atrium approach.</p><p><b>METHODS</b>Between January 2004 and December 2009, 53 patients with ruptured sinus of Valsalva aneurysm to right atrium underwent surgical repair. There were 35 male and 18 female, aged from 15 to 63 with a mean of (33 ± 9) years. Repair through right atrium had undergone in 40 patients (group I), while transaortic combined with right atrium approach in 13 patients (group II). Surgical results between the two group and group were compared in cardiopulmonary bypass time, clamp aorta time, mechanical ventilation time, ICU time and postoperative stay time.</p><p><b>RESULTS</b>There were no significant differences between two groups in cardiopulmonary bypass time [(86 ± 29) min vs. (96 ± 30) min], clamp aorta time [(59 ± 29) min vs. (71 ± 25) min], mechanical ventilation time [(9 ± 4) h vs. (16 ± 23) h], ICU time [(35 ± 23) h vs. (35 ± 23) h], postoperative stay time [(7.1 ± 0.9) d vs. (7.7 ± 2.8) d] (P > 0.05). Follow-up was performed from 1 to 64 months, with a mean of (32 ± 21) months. There was no death during follow up. One needed operation due to severe aortic valve regurgitation. One combined with coronary artery disease used medication. Heart function (NYHF) of the other patients were I and II degree during follow up.</p><p><b>CONCLUSIONS</b>Surgical repair of ruptured sinus of Valsalva aneurysm to right atrium shows good result. There is no significant difference between through right atrium repair and transaortic combined with right atrium approach.</p>