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@#The technique of transcatheter aortic valve implantation has become increasingly mature. Although the transapical approach has a certain degree of minimally invasive trauma, it still has the characteristics such as heart beating without cardiopulmonary bypass, and the low technical requirements of catheter guide wire. In particular, the valve path is short and coaxial, which is easy to manipulate, and pure regurgitation and stenosis can be easily operated and are not subject to the limit of peripheral artery stenosis. It is still one of China's main approaches for transcatheter aortic valve replacement. Its perioperative management still has specific features and differs from the femoral artery approach. In addition, there is little relevant literature abroad. Therefore, domestic experts in this field were organized to discuss the development of perioperative management specifications to provide reference and techniques support for developing this field in China and further improve the quality of clinical operation and perioperative management. It will provide more safe and more effective medical services to these patients.
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The end of the COVID-19 infection peak in 2022 prompts a backlog of cardiovascular surgical patients to gradually return to the hospital, resulting in a surge in cardiovascular surgeries. However, against the backdrop of the COVID-19 pandemic, the clinical practice of cardiovascular surgery faces many problems. Therefore, organized by Beijing Anzhen Hospital, experts in cardiovascular surgery and related fields have formulated hospital expert experience on perioperative treatment principles of cardiovascular surgery for patients infected with COVID-19. This article summarizes the clinical decision-making of patients requiring cardiovascular surgery after COVID-19 infection, and advises on the corresponding recommendations according to the existing evidence-based medical evidence as well as the actual clinical practice experience of relevant experts. The main content of the article includes special requirements for cardiovascular surgical treatment indications in patients with COVID-19 infection, selection of surgical timing, special requirements of preoperative, intraoperative and postoperative management, etc., which aims to provide COVID-19-infected patients with guidance on rational decision-making when receiving cardiovascular surgery.
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Objective:To examine the long-term survival outcomes and identify mortality risk factors for coronary artery bypass grafting patients who received venoarterial extracorporeal membrane oxygenation(VA-ECMO) for postcardiotomy cardiogenic shock.Methods:Data from 121 consecutive venoarterial extracorporeal membrane oxygenation-treated coronary artery bypass grafting(CABG) patients at Beijing Anzhen Hospital between June 2012 and December 2016 were analyzed. There were 84 males and 24 females. The median age was 62(55, 67) years, and the median body mass index was 25(23, 27)kg/m 2. Thirty-seven patients(34%) had left main artery disease, and 56 patients(52%) underwent off-pump CABG. According to the 3 year survival outcome after ECMO, patients were divided into survival group(35 cases) and non-survival group(73 cases). The differences of clinical indicators between the two groups were compared and analyzed. Multivariable Cox regression modeling was used to identify factors independently associated with 36 month mortality. Results:Sixty-five patients(60%) could be weaned from VA-ECMO, 49 patients(45%) survived to hospital discharge, and 35 patients(32%) survived to 3 years. The median( IQR) time on VA-ECMO support was 4(3, 5) days. The median( IQR) length of ICU stay and hospital stay duration were 8(5, 12) and 20(13, 29) days, respectively. Older age( HR=1.06, 95% CI: 1.03-1.10, P<0.001), left main coronary artery disease( HR=1.62, 95% CI: 1.00-2.60, P=0.048), and vasoactive inotropic score( HR=1.09, 95% CI: 1.03-1.17, P=0.007)were independent risk factors associated with 3-year mortality. The area under the receiver operating characteristic curve for the model, which was constructed with age≥60years, left main coronary artery disease, and vasoactive inotropic score>60, was 0.88(95% CI: 0.80-0.95). Conclusion:Long-term survival of patients who survive to discharge appears favorable. Older age, left main coronary artery disease, and vasoactive inotropic score were associated with 3-year mortality in coronary artery bypass grafting patients who received VA-ECMO.
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Objective:To investigate the current situation of cardiopulmonary bypass(CPB) in China and analyze the causes, to guide the formulation and implementation of technology standard.Methods:The survey task force sent out a nationwide survey to obtain up-to-date information on perfusion practice by ChSECC(Chinese Society of Extracorporeal Circulation). The unit of analysis for the survey was the medical center performs CPB. The survey consisted 48 questions covering four topics of qualifications, including certification and education, policies and practices, device and equipment, techniques used.Results:There were 540 of the 714 centers for an overall response rate of 76%. According to the annual number of CPB, they were divided into 4 groups: group A(≤50 cases/year), group B(50-100 cases/year), group C(100-500 cases/year) and group D(≥500 cases/year). The response rate of center with more than group D last year was 100%. Most of the perfusionists had certification issued by ChSECC. Although there were more than 80% of group D performed regular training and assessment of perfusionist, the result was still not ideal enough. Low utilization of safety equipment was not depend on the annual operation volume in most of responding centers. Ultrafiltration and blood protection technology had high application rate in group D compared with group A and B.Conclusion:The certification rate of perfusionists are high. Lower the number of annual CPB cases, lower the proportion of regular evaluation and training, and lower rate of standards performance. No matter the amount of CPB, the application rate of safety equipment is not ideal. Higher the number of CPB cases, higher the utilization rate of CPB related technologies.
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Objective:To analyze the status of extracorporeal membrane oxygenation (ECMO) for poisoned patients in China, and prognosis, complications and risk factors for death in poisoned patients supported with ECMO.Methods:The data of adult poisoned patients registered in Chinese Society of Extracorporeal Life Support (CSECLS) database were collected. Patients were divided into the survival group and death group according to the conditions at discharge. The type of poisoning, patient prognosis, hemodynamic parameters and complications before and after ECMO were retrospectively analyzed.Results:A total of 96 poisoned patients supported with ECMO were included in the database from 2017 to 2022, including 77 adult patients. The use of ECMO for poisoning was more common in Henan Province (28 cases, 36%), Guangdong Province (11 cases, 14%) and Zhejiang Province (9 cases, 8%). The number of adult poisoned patients registered in the database increased over time from 2017 to 2022, but the survival rate showed no significant difference ( P = 0.794). Agricultural poisoning was the most common indication (43%). Veno-arterial (V-A) ECMO was used in 60 patients (78%) and venovenous (V-V) ECMO in 27 patients (22%). Thirty-two patients (42%) survived to hospital discharge. The mean duration of ECMO support was 57 (34, 123) h, the mean duration of mechanical ventilation was 88 (33, 211) h, the mean length of hospital stay was 10 (2, 21) days, and the mean length of ICU stay was 9 (2, 18) days. Multivariate analysis showed that 24-h lactic acid level was significantly associated with mortality ( OR = 0.378, 95% CI: 0.183-0.779, P = 0.008). Conclusions:ECMO can be used as a salvage strategy to treat various types of severe poisoning. Although the application of ECMO is expanded rapidly in China, it is still necessary to optimize intervention indications and treatment timing, and adopt standardized ECMO management and monitoring strategies to improve the prognosis of patients.
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Objective:To investigate the safety and the efficacy of percutaneous and surgical approach in femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) cannulation.Methods:All consecutive patients implanted with femoro-femoral VA-ECMO between January 2018 and December 2020 in Beijing Anzhen Hospital, Capital Medical University. Propensity score matching was used to compare outcomes of percutaneous and surgical groups while controlling for confounders.Results:Among the 276 patients who received femoro-femoral VA-ECMO (62 surgical and 214 percutaneous), propensity-score matching selected 52 pairs of patients with similar characteristics with mean age of(59.6±13.0)years old, in which 26 patients were female. There were a lower ECMO cannulation-associated complication (28.8% vs. 48.1%, P=0.044) and a lower hospital mortality (42.3% vs. 67.3%, P=0.010) in the percutaneous group. The circuit blood flow after ECMO initiation was similar in both groups[(3.3±0.8)L·min -1·kg -1 in percutaneous group vs. (3.2±0.7)L·min -1·kg -1 in surgical group, P=0.738]. The serum lactate was declined in both group after ECMO initiation[(5.4±5.8)mmol/L vs. (9.2±6.9)mmol/L, P<0.001 in percutaneous group; (6.3±6.2)mmol/L vs. (10.5±7.0)mmol/L, P=0.003 in surgical group]. Conclusion:Percutaneous approach is a safe and efficient technique in emoro-femoral VA-ECMO cannulation. Compared with surgical cannulation, percutaneous approach is associated with lower ECMO cannulation-associated complication and lower hospital mortality.
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Objective:Analysis the protective effect of the partial femoral to femoral cardiopulmonary bypass(CPB) on thoracoabdominal aortic aneurysm repair(TAAAR).Methods:From September 2016 to August 2020, 50 cases of TAAAR under partial CPB were performed at our hospital. Thirty males and 20 females with an average age of(40.5±12.4) years old(ranging 21 to 69 years old) were involved. Partial CPB without selective organ perfusion were applied at the early stage. Since November 2019, the adjunct of perfuse the celiac and superior mesenteric artery with warm blood and irrigate the renal artery with 4℃ HTK solution was used in TAAAR, and 25 patients were operated under this adjunct.Results:The average CPB time was(116.9±35.4) min, the lowest central body temperature during the partial CPB was(34.7±0.7)℃. Total early postoperative mortality was 6%(3/50, 3 deaths in partial CPB alone group). Paraplegia occurred in 4 cases(8%), new happened postoperative hemodialysis was in 6 cases(16%). Among the hemodialysis event, 2 cases(8%, 2/25) were in the group with selective organ perfusion, and 4 cases(16%, 4/25) in the group without using the adjunct.Conclusion:Mild hypothermic partial cardiopulmonary bypass combined with selective organ perfusion have protective effects on spinal cord and abdominal organ in patients underwent TAAAR.
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Objective To investigate the incidence and risk factors of acute kidney injury(AKI) requiring continuous renal replacement treatment(CRRT) in patients with acute type A aortic dissection after Sun's operation.Methods A retrospective analysis of consecutive patients with acute type A aortic dissection underwent Sun's operation in Beijing Anzhen Hospital,Capital Medical University from January 2009 to December 2015.These patients were divided into two groups according to whether had severe postoperative AKI requiring CRRT treatment:the dialysis group(AG,65 cases) and the control group(CG,618 cases),we compared the clinical outcomes of patients in two groups and analyzed the related risk factors.Results 50 patients(7.3％) died in hospital.Compared with patients in CG group,patients in AG group had higher age,more patients with preoperative coronary heart disease,pericardial tamponade,and higher rates of intraoperative coronary artery hypass surgery or valve surgery,the results were statistically different between the two groups(P ＜0.05).The patients in AG group had a higher mortality rate in hospital(26.2％ vs.5.3％),and the difference was statistically significant(P ＜0.001).The results of multiple regression analysis suggested that the age ＞ 50 years,preoperative history of pericardial tamponade,intraoperative need for combined coronary artery bypass grafting or valve surgery,and cerebral perfusion time ＞40 min were independent risk factors for CRRT treatment of postoperative severe AKI(P ＜0.05).Conclusion The incidence of severe AKI requiring CRRT treatment in patients with acute type A aortic dissection after Sun's operation was 9.5％,and the discharge survival rate in AG group was lower than that in CG group.An important way to reduce the incidence of severe AKI requiring CRRT after sun's surgery is to shorten the intraoperative cerebral perfusion time as much as possible.
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Objective To analyze the risk factors and pathogen distribution of nosocomial infection in adult patients undergoing extracorporeal membrane oxygenation (ECMO) after cardiac surgery.Methods The clinical data of 325 patients who underwent ECMO support in the Department of Adult Cardiac Surgery of Beijing Anzhen Hospital from January 2012 to December 2017 were retrospectively analyzed.There were 132 patients with nosocomial infection (infected group) and 193 patients without nosocomial infection (noninfected group).Multivariate logistic analysis was used to analyze the risk factors of nosocomial infection,and the distribution of pathogens in infected patients was also analyzed.Results Among 132 infected patients,67 cases (50.76％) had respiratory infection,40 cases (30.30％) had blood infection,15 cases (11.36％) had surgical wound infection,and 10 cases (7.58％) had urinary tract infection.The case fatality rates of the infected group and non-infected group were 61.37％ (81/132) and 52.85％ (102/ 193),respectively (x2 =6.356,P ＜ 0.05).Univariate analysis showed that long operation time,application of extracorporeal circulation and long-term ECMO support were associated with nosocomial infection.Multivariate logistic regression analysis found that ECMO time (OR =5.565,95％ CI =2.868-10.799,P ＜0.01) was an independent risk factor for nosocomial infection after ECMO treatment in adult patients after cardiac surgery.Among the 132 infected patients,364 strains of pathogens were detected,of which 233 were Gram-negative bacteria,including 79 strains of Acinetobacter Baumann (33.9％) and 32 strains of K.pneumoniae (13.73％);101 strains were Gram-positive bacteria,including Streptococcus aureus (14.85％),Micrococcus (14.85％) and catarrhal bacteria (14.85％);30 strains were fungi and Candida albicans accounted for 70％ of fungi infections.Conclusion The long ECMO support time is an independent risk factor for ECMO-related hospital infections in adult patients undergoing cardiac surgery,and the pathogens are mainly Gram-negative bacteria.
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Objective@#Establish the post cardiovascular surgery SOFA score(pcvsSOFA)based on the Sequential Organ Failure Assessment(SOFA)score to evaluate the severity and prognosis of patients after cardiovascular surgery.@*Methods@#3 872 consecutive patients who underwent cardiovascular surgery and stayed in ICU more than 24 hours between July 2015 and December 2017 were retrospectively analyzed to establish a derivation cohort. Univariable and multivariable logistic regression were used to identify the predictors in the pcvsSOFA. And the validity of the new model was evaluated in the derivation cohort and validation cohort.@*Results@#Respiratory system score, coagulation system score, nervous system score and renal system score on the first day of ICU, Emergency surgery and re-surgery were risk factors and established the pcvsSOFA. The total score of pcvsSOFA was 20 point and was divided into four classes, namely class Ⅰ(pcvsSOFA-score: 1-5), class Ⅱ(pcvsSOFA-score: 6-10), class Ⅲ(pcvsSOFA-score: 11-15) and class Ⅳ(pcvsSOFA-score: 16-20)with their corresponding predicted mortality 0.9%(n=2 317), 5.7%(n=1 367), 26.8%(n=184), and 64.2%(n=4) in the derivation cohort. The area under the receiver operating characteristics curve(AUC)was 0.864(95%CI: 0.837-0.892), and the integrated discriminant improvement(IDI) was 0.035.In the validation cohort, AUC(pcvsSOFA)= 0.832(95%CI: 0.735-0.928), IDI=0.211. The AUC of SOFA, APACHE Ⅱ and SAPS Ⅱ was 0.771, 0.793 and 0.721 respectively.@*Conclusion@#Compared with the SOFA score, pcvsSOFA could be a better tool to assess the prognosis of critical patients in the early postoperative stage.
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Objective@#To research the influencing factors of postoperative atrial fibrillation(AF) in patients underwent coronary artery bypass grafting(CABG), and to explore the relationship between postoperative AF with complications and recovery.@*Methods@#From January 2017 to February 2018, 2 218 patients in Beijing Anzhen Hospital affiliated to Capital Medical University underwent simple CABG and returned to the ICU. After excluding preoperative AF and pacemaker implanted patients, a total of 1 952 patients were included in the research. According to whether there was postoperative AF, patients were divided into non-AF group [1 544 cases, male 1 017, female 527, averaged age(63.20±9.47)years old]and new-onset AF group [408 cases, male 280, female 128, averaged age(69.32±8.93) years old]. The gender, age, related medical history, cardiac function and other factors were recorded. And the postoperative laboratory test indicators, tracheal reintubation rate, tracheotomy rate, mortality, IABP and ECMO use rate, intensive care unit and hospital time were compared.@*Results@#Compared with the non-AF group, the rates of tracheal reintubation(P=0.007), tracheotomy(P=0.039), and hospital mortality(P=0.039) were higher on the new-onset AF group, and the postoperative mechanical ventilation time(P=0.010), the ICU time(P=0.037) and the hospital time(P=0.045) were longer. Multivariate regression analysis showed: advanced age(P=0.028), postoperative cardiogenic shock(P=0.033), postoperative AKI(P=0.041), postoperative CRP elevation(P=0.030), postoperative TNI elevation(P=0.028) and postoperative LAC elevation(P=0.044) were independent risk factors for postoperative new-onset AF in CABG patients.@*Conclusion@#Patients with new-onset AF after CABG have higher complication and mortality rate. It is necessary to prevent the occurrence of AF and improve the heart and vital organ function in time to reduce the mortality.
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Objective Establish the post cardiovascular surgery SOFA score( pcvsSOFA) based on the Sequential Organ Failure Assessment( SOFA) score to evaluate the severity and prognosis of patients after cardiovascular surgery. Methods 3872 consecutive patients who underwent cardiovascular surgery and stayed in ICU more than 24 hours between July 2015 and December 2017 were retrospectively analyzed to establish a derivation cohort. Univariable and multivariable logistic regression were used to identify the predictors in the pcvsSOFA. And the validity of the new model was evaluated in the derivation cohort and validation cohort. Results Respiratory system score, coagulation system score, nervous system score and renal system score on the first day of ICU, Emergency surgery and re-surgery were risk factors and established the pcvsSOFA. The total score of pcvsSOFA was 20 point and was divided into four classes, namely class Ⅰ( pcvsSOFA-score:1-5 ) , class Ⅱ( pcvsSOFA-score:6-10 ) , class Ⅲ( pcvsSOFA-score:11-15 ) and class Ⅳ( pcvsSOFA-score:16-20 ) with their corresponding predicted mortality0.9％(n=2317),5.7％(n=1367),26.8％(n=184),and64.2％(n=4) inthederivationcohort. Thearea under the receiver operating characteristics curve(AUC)was 0. 864(95％CI:0. 837-0. 892), and the integrated discriminant improvement(IDI) was 0. 035. In the validation cohort, AUC(pcvsSOFA) = 0. 832(95％CI:0. 735-0. 928), IDI=0. 211. The AUC of SOFA, APACHE Ⅱ and SAPS Ⅱ was 0. 771, 0. 793 and 0. 721 respectively. Conclusion Compared with the SOFA score, pcvsSOFA could be a better tool to assess the prognosis of critical patients in the early postoperative stage.
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Objective To research the influencing factors of postoperative atrial fibrillation( AF) in patients underwent coronary artery bypass grafting( CABG) , and to explore the relationship between postoperative AF with complications and recov-ery. Methods From January 2017 to February 2018, 2218 patients in Beijing Anzhen Hospital affiliated to Capital Medical University underwent simple CABG and returned to the ICU. After excluding preoperative AF and pacemaker implanted pa-tients, a total of 1952 patients were included in the research. According to whether there was postoperative AF, patients were dividedintonon-AFgroup[1544cases,male1017,female527,averagedage(63.20±9.47)yearsold]andnew-onsetAF group [408 cases, male 280, female 128, averaged age(69.32 ±8.93) years old]. The gender, age, related medical histo-ry, cardiac function and other factors were recorded. And the postoperative laboratory test indicators, tracheal reintubation rate, tracheotomy rate, mortality, IABP and ECMO use rate, intensive care unit and hospital time were compared. Results Compared with the non-AF group, the rates of tracheal reintubation(P=0. 007), tracheotomy(P=0. 039), and hospital mor-tality(P=0. 039) were higher on the new-onset AF group, and the postoperative mechanical ventilation time(P=0. 010), the ICU time(P=0. 037) and the hospital time(P=0. 045) were longer. Multivariate regression analysis showed: advanced age (P=0.028), postoperative cardiogenic shock(P=0.033), postoperative AKI(P=0.041), postoperative CRP elevation(P=0. 030), postoperative TNI elevation(P=0. 028) and postoperative LAC elevation(P=0. 044) were independent risk fac-tors for postoperative new-onset AF in CABG patients. Conclusion Patients with new-onset AF after CABG have higher com-plication and mortality rate. It is necessary to prevent the occurrence of AF and improve the heart and vital organ function in time to reduce the mortality.
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Objective To investigate the effect of preoperative serum uric acid level on the incidence of acute kidney in-jury after off-pump coronary artery bypass grafting and to discuss whether serum uric acid level is an independent predictor of postoperative acute kidney injury.Methods A total of 631 patients undergoing off-pump coronary artery bypass grafting in Anzhen Hospital from January 2018 to June 2018 were reviewed.Patients were divided into high uric acid group(higher-than-median)and low uric acid group(lower-than-median) , based on the preoperative serum uric acid level of the patients.The de-mographic variables, comorbidities, the chelsea comorbidity index, preoperative medication, serum creatinine level and glo-merular filtration rate were compared between the two groups.Meanwhile, intraoperative operative time, infusion volume, post-operative acute kidney injury staging and the rate of frozen plasma usage , continuous renal replacement therapy and reoperation rate were observed.Results Among the 631 patients, 83(13.2％, 83/631)cases developed postoperative acute kidney inju-ry, 65(78.3％, 65/83) cases had a higher level of preoperative serum uric acid above the median(OR =3.143, 95％CI:1.850-8.798, P=0.001).After adjustment, multivariate analysis showed that elevated level of serum uric acid and BMI >30 kg/m2, the increase of preoperative serum creatinine level, the decrease of glomerular filtration rate( <60 ml/min) and higher CCI score were associated with postoperative acute kidney injury independently .Intraoperative fluid volume , diabetes and preoperative diuretic administration did not relate to the incidence of acute kidney injury after cardiac surgery .Conclusion Elevated serum uric acid level can be a strong predictor for the incidence of acute kidney injury after off-pump coronary artery bypass grafting.
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Objective To research the factors relating to hyperlactatemia and its connections to certain combinations and the motality of post CABG patients.Methods Splitting the 1 280 cases of post OPCABG surgery patient admitted to ICU of Anzhen Hospital between March 2016 and October 2016 into two groups,including a hyperlactatemia group of 511 patients [340 males and 171 females,aged (63.81 ± 9.1)years],and a none-hyperlactatemia group of 769 samples [499 males and 270 females,aged(61.72 ± 8.97) years].Recording the pre-operative characteristics such as gender,age,medical history,heart function,and post-operative characteristics such as liver and kidney function,reintubation rate,tracheotomy treatment rate,mortality rate,IABP and ECMO usage rates,ICU and hospital stay time.Results As compare to the none-hyperlactatemia group,the hyperlactatemia group has:(1) higher reintubation rate(P =0.003) and higher tracheotomy rate (P =0.035);(2) longer mechanical ventilation time (P =0.009);(3) higher mortality rate (P =0.000);(4) longer ICU stay time (P =0.039) and hospital stay time(P =0.047).Multi factor regression discovered:pre-operative IABP(P =0.040),postoperative cadiogenic shock (P =0.030),post-operative AKI (P =0.020),post-operative liver failure (P =0.039) are the independent risk factors for post-operative hyperlactatemia of CABG patient;peak lactate time ＞ 30 h (P =0.021),post-operative level 3 AKI (P =0.030),post-operative liver failure (P =0.025),post-operative cardiogenic shock (P =0.037) are the independent risk factors for mortality of CABG post-operative hyperlactatemia patient.Conclusion After CABG operation,hyperlactatemia patients had a higher mortality rate.Timely restoring heart and important organ function to remove lactate so to reduce mortality rate is advised.
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Objective To study the long-term follow-up results of Ross surgery.Methods Between October 1994 and February 2009,58 consecutive patients underwent a Ross procedure at our institution.The right ventricular outflow tract was repaired with a cryopreserved pulmonary homograft.All patients were scheduled for a yearly study thereafter that ended at the time of death or at closure of the follow-up visit.Mean follow-up was (12.6 ± 5.8) years (range:4.5 to 18.2 years).Results There were two early deaths (3 ％)and one late death (2％).Acturial survival at 16 years was (94.8 ± 3.1) ％.One patient required reoperation 1.5 years after his first Ross operation.Of the 55 survival patients,42 patients(76％) were in NYHA functional class Ⅰ and 13 patients(24％) were in NYHA functional class Ⅱ.Grade 1 or grade 2 autograft regurgitation was observed in seven patients(12％) at one year after the surgery.The sinus of Valsalva diameters were all ＜ 40 mm in these seven patients.Mter surgery,freedom from hemodynamically relevant autograft regurgitation was(87.9 ± 2.8) ％ at 16 years,whose left ventricular function was significantly improved and left ventricular end-diastolic diameter recovered to normal over the long term.None of the patients required reoperation due to pulmonary homograft failure.Conclusion The Ross procedure can be safely performed in patients with aortic valve disease.To date,mortality,morbidity,and reoperation relates are very low.Reasons for these superior results may include the following:diameter of the aortic valve annulus matching that of the pulmonary valve and patients were monitored with antihypertensive medications to keep systolic blood pressure under 120mmHg(1 mmHg =0.133kPa) to delay pressure lesions to the pulmonary autograft.
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Objective To investigate the effect of lung recruitment maneuver on alveolar collapse after fiber support bronchoscopy,and to evaluate its clinical value.Methods Since April 2014 and April 2017 in underwent deep hypothermia and stop of 60 cases of hypoxemia in patients with postoperative aortic circulation as the research object,according to the random number distribution method.The average score of the two groups,each group with 30 cases in each.The control group was treated with conventional fiber bronchoscopy and end expiratory positive pressure ventilation in the treatment,observation group patients on the basis of the application of lung recruitment method to carry on the treatment.Observation compared two groups of patients with lung recruitment maneuver and respiration and circulation of the parameter variations and mechanical ventilation in time.Results Two groups of patients with treatment of the parameters,the difference was not statistically significant (P ＞0.05);after treatment,observation group of patients with oxygen synthetic index and mechanical ventilation time and the control group was significant difference compared with statistical significance(P ＜ 0.05);and two groups of patients with arterial carbon dioxide into change of pressure and tidal volume before and after the treatment were not significant,no statistical significance(P ＞ 0.05).Two groups of patients with the circulatory system index tends to be stable,no significant change (P ＞0.05).Conclusion The use of bronchoscopy in patients with aortic dissection after the examination of hypoxia,application of lung recruitment maneuver method for treatment,can improve the patient's oxygenation index,reduce the time of mechanical ventilation in patients with.
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Objective To evaluate the impact of cerebrospinal fluid drain(CSFD) on the incidence of acute spinal cord injury(SCI) following extensive TAAA repair.Methods From February 2009 to July 2016,153 patients underwent extensive TAAA repairs with a consistent strategy of normal thermia,non-circulatory bypass,sequential aortic cross clamping,aortic-lilac bypass,and intercostal artery reconstruction.The repairs were performed with preoperative CSFD (n =78) or without CSFD (n =75).In the former group,CSFD was inserted after the patient has been anaesthetized and continued for 72 hours after surgery.The target CSF pressure was 10 mmHg or less.Results The mean age of patients was (38 ± 10) years and 108 (70.6％) were male.There were 87 (53.8％) patients with previous aortic surgeries and 33 (22％) with Marfan syndrome.The two groups had similar risk factors for paraplegia.Aortic clamp time,operation time and number of reattached intercostal arteries were similar in both groups.In-hospital mortality rates were 1.3％ (one patient) and 6.7％ (five patients) for CSFD and the group without CSFD,respectively (P =0.086).Ten patients (13.3 ％) in the group without CSFD had paraplegia develop.In contrast,only two patients in the CSFD group(2.6％) had postoperative paraplegia(P =0.013).Stepwise logistic regression analysis identified CSFD had spinal cord protection,P =0.026;OR =0.171;95％ CI:0.036-0.809).No patients occurred CSF catheter related complications.Conclusion This randomized clinical trial showed that preoperative CSFD placement could be an effective strategy in preventing SCI following extensive aortic aneurysm repair.Care should be taken to prevent complications related to overdrainage.
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Objective To evaluate risk factors of in-hospital mortality during extracorporeal membrane oxygenation(ECMO) support for those with refractory cardiogenic shock after aortic surgery.Methods Retrospective analyses were conducted for 35 patients using ECMO after aortic surgery at Beijing Anzhen Hospital,Capital Medical University from September 2009 to March 2016.Demographic characteristics,diagnosis,ECMO related data,including ECMO indication,operation,clinical parameters before and 24 hours during ECMO were collected to set up a database.The patients were divided into survival group and non-survival group according to the prognosis.The risk factors of mortality in hospital after ECMO were analyzed by multivariate logistic regression analysis regression.Results There were 35 adult patients who had received ECMO support with 32 male and 3female.All patients received veno-arterial ECMO (V-A ECMO).ECMO was successfully weaned in 22 patients (62.9％),and 18 patients(51.4％) survived.Multivariate logistic regression analysis revealed that high lactic acid levels at 12 hours after ECMO(OR =1.445;95％ CI:1.026-2.034) and multiple organ dysfunction syndrome(MODS,OR =10.412;95％ CI:2.246-70.798)(P ＜ 0.05) were independent risk factors of in-hospital mortality in adult patients undergoing ECMO after aortic surgery.Conclusion High lactic acid levels at 12 hours after ECMO and MODS were very important factors of patients undergoing ECMO after aortic surgery.The proper identification and management shall improve the prognosis of patients.
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Objective This study aims to analyze midterm survival and to assess the midterm mortality following acute kidney failure (AKF) of patients undergoing surgical treatment of acute type A aortic dissection.Methods Clinical data of the patients who underwent Sun's procedure from February 2009 to March 2015 were collected.Patients with preoperative dialysis were excluded.Data including preoperative cardiovascular diseases,serum creatinine leve1 and CPB time were gathered.The patients were divided into the group of AKF and the group of non-AKF accounting to require dialysis.The group of AKF was follow-up by phone.Midterm mortality was studied with Cox analysis and midterm survival was estimated by Kaplan-Meier analysis.Results 524 patients underwent aortic surgeries which AKF was occurred in 51 (51/524,9.7％) patients.Hospital mortality was 23.5％ (12/51) in AKF group which seven death were strokes,three death were lower-extremity ischemia and two death were low cardio output.There were 2 patients dead with multi organ failure and paraplegia in first year.One reoperation patient because of anastomotic fistula was dead in fifth year.Only diabetes was independently associated with midterm mortality.Midterm survival for patients with AKF was 56％ during a median follow-up of 30.5 months.Survival was equal between the subgroups of Cr ＞ 200 mol/L and Cr ＜ 200 mol/L(P =0.741).Conclusion AKF after acute aortic dissection was a severe complication and the incidence was 9.7％.In patients with AKF,diabetes was associated with increased mortality across follow-up.Five years survival was 56％ not effected by preoperative Cr.