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A 24-year-old man was admitted due to fever for two days. He had undergone modified Bentall operation at the age of 18. Transthoracic echocardiography (TTE) showed no findings of infective endocarditis (IE), and he was treated with a course of antibiotics. On the next day, he suffered from aphasia and right hemiplegia, and computed tomography (CT) showed left cerebral infarction due to left middle cerebral artery embolism. The emergent endovascular reperfusion was done, but mild subarachnoid hemorrhage occurred. The following day, TTE showed vegetations and aortic annular abscess, and MSSA was confirmed by blood culture. He was transferred to our institution for surgical treatment for IE. High fever continued, and inflammatory response was recurrent, because the infection was not under control. In addition, multiple systemic thromboembolisms were revealed by contrast-enhanced CT. He recovered to the level of moving his limbs slightly, but he could not speak. We did aortic homograft root replacement and coronary bypass grafting 6 days after the cerebral infarction. His postoperative course was uneventful and he was transferred to rehabilitation hospital on postoperative day 31. He reintegrated into society without neurological complications, and there are no recurrent infections and have been no structural valve deteriorations of the homograft in 5 years.
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Objective:To study the mid- and long-term outcomes of the cryopreserved homograft conduits used in the Rastelli operation and to identify the risk factors for the homograft conduit degeneration and reintervention.Methods:52 patients were followed up from 7 to 18 years, who accepted the Rastelli operation with cryopreserved homograft conduits between April 2002 and December 2013. There were 36 male and 16 female with age ranged 3 to 14 years old(median age 4 years old)and weight ranged 10 to 36 kg(median weight 14 kg). The homografts included aortic homografts implanted in 30 cases and pulmonary homografts implanted in 22 cases.The homograft conduits were divided into three groups by conduit diameter: groupⅠ(16 mm)22 cases, groupⅡ(16-20 mm)22 cases and group Ⅲ(≥20 mm)8 cases. The pathological characteristics of homografts were studied in the period of follow-up.Results:52 patinets were followed up from 7 to 18 years( median time 12 years). Over the follow up period, all homograft conduits had structural valve degeneration.The predominant pathological characteristics was stenosis of conduits. 37 patinets had received the reoperation because of the homograft degeneration. The interval between the first and reoperation is ranged 9 to 18 years( median time 12 years). Univariate analysis demonstrated young operation age(<5 years old)( P<0.001), diameter of the homograft conduit( P<0.001), high right ventricular pressure(RV/Ao P>0.5) after Rastelli operation( P=0.002)were independent risk factors for the homograft conduit degeneration. Univariate analysis demonstrated only young operation age(<5 years old)( P=0.03)was independent risk factor for the reoperation. Conclusion:In young patients, oversize homograft conduit and enlarge incision with Gore-Tex conduit may improve durability and decay the time of reintervention.
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@#Objective To evaluate the clinical outcome of valved homograft conduits (VHC) used for right ventricular outflow tract (RVOT) reconstruction in Fuwai Hospital in recent 13 years, and explore the factors influencing the long-term durability of VHC. Methods Clinical data of patients using VHC for RVOT reconstruction in Fuwai Hospital from November 2007 to October 2020 were retrospectively analyzed. The Kaplan-Meier survival curve was used to evaluate survival, VHC reintervention and VHC dysfunction. Cox proportional risk regression model was used to analyze the risk factors for VHC dysfunction. Results Finally 251 patients were enrolled, including 145 males and 106 females. The median age at surgery was 6.0 (0.3-67.0) years. Early death occurred in 5 (2.0%) patients. The follow-up was available for 239 (95.2%) patients, with the follow-up time of 0.3-160.0 (61.3±45.4) months. Five patients died during the follow-up, and the 1-year, 6-year, and 13-year survival rates were 96.6%, 95.5% and 95.5%, respectively. Eight patients received VHC reintervention during the follow-up, and freedom rates from VHC reintervention were 100.0%, 97.1% and 82.4% at 1 year, 6 years and 13 years, respectively. A total of 226 patients were followed up by echocardiography after discharge, with the follow-up time of 0.2-138.0 (48.5±40.5) months. During the follow-up, 46 (20.4%) patients developed VHC dysfunction, and freedom rates from VHC dysfunction at 1 year, 5 years, and 10 years were 92.6%, 79.6% and 59.3%, respectively. Univariate Cox regression analysis showed that age<6 years and VHC diameter<19 mm were risk factors for VHC dysfunction (P=0.029, 0.026), but multivariate regression analysis only indicated that age<6 years was an independent risk factor for VHC dysfunction (P=0.034). Conclusion The early and late outcomes of VHC used for RVOT reconstruction are satisfactory, and the long-term durability of VHC is also optimal. In addition, age<6 years is an independent risk factor for VHC dysfunction.
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@#Objective To compare the long-term durability of valved homograft conduit (VHC) in patients with Ross and non-Ross right ventricular outflow tract (RVOT) reconstruction. Methods Patients who underwent RVOT reconstruction using VHC in Fuwai Hospital from January 2008 to October 2020 were retrospectively included. Patients who received Ross RVOT reconstruction were allocated to a Ross group and patients who received non-Ross RVOT reconstruction were allocated to a non-Ross group. The survival and reintervention-free rates of the two groups were evaluated with the Kaplan-Meier survival curve and log-rank test. The propensity score matching analysis was performed on the patients who completed ultrasound follow-up in the two groups, and the VHC dysfunction-free rate was compared between the two groups. Results A total of 243 patients were enrolled, including 142 males and 101 females, with a median age of 6 years (4 months to 56 years). There were 77 patients in the ROSS group and 166 patients (168 operations) in the non-ROSS group. The cardiopulmonary bypass time in the Ross group was shorter than that in the non-Ross group (175.4±45.6 min vs. 200.1±83.5 min, P=0.003). Five patients in the non-Ross group died early after the operation. The follow-up was available in 231 patients (93.1%), with the average follow-up time of 61.7±44.4 months. During the follow-up, 5 patients in the non-Ross group died. The 12-year survival rate was 100.0% in the Ross group and 93.2% in the non-Ross group (log-rank, P=0.026). In addition, 1 patient in the Ross group and 7 patients in the non-Ross group received VHC reintervention. There was no significant difference in the reintervention-free rate between the two groups (log-rank, P=0.096). Among the 73 patients in the Ross group and 147 patients in non-Ross group who were followed up by ultrasound after discharge, 45 patients (20.5%) developed VHC dysfunction. Before matching, the long-term durability of VHC in the Ross group was better than that in non-Ross group (10-year VHC dysfunction-free rate: 66.6% vs. 37.1%, log-rank, P=0.025). After the propensity score matching, 64 patients included in each group, and there was no statistical difference in the long-term durability of VHC between the two groups (10-year VHC dysfunction-free rate: 76.3% vs. 43.0%, log-rank, P=0.065). In the subgroup analysis, the 10-year VHC dysfunction-free rate in the Ross group was higher than that in the non-Ross group (71.0% vs. 20.0%, log-rank, P=0.032) among patients aged<6 years at surgery. However, there was no significant difference in the 10-year VHC dysfunction-free rate between the two groups (53.7% vs. 56.7%, log-rank, P=0.218) among patients aged ≥6 years at surgery. Conclusion After the propensity score matching analysis, the long-term durability of VHC has no significant difference between the Ross group and non-Ross group. The long-term durability of VHC after Ross surgery is superior to that of non-Ross surgery in patients aged<6 years at surgery.
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Background: The mitral valve apparatus, consisting of the mitral valve leaflets and commissures and subvalvular apparatus- papillary muscles and chordae tendinae; is one of the most complex and intricately designedstructures present in the human body and therefore the understanding of anatomical variations of papillarymuscles becomes important for surgical interventional procedures, in response to the increasing incidence ofvalvular heart defects. The aim of the cadaveric analysis was to identify the disparity in the morphometry of thepapillary muscles of the mitral valve complex. Therefore this study was taken up with an effort to extend theconcepts previously presented as well as to overcome deficiencies in the knowledge of gross architecture andpositional nomenclature of the papillary muscles.Materials and methods: Fifty formalinized cadaveric hearts were the material for study. Papillary muscles of leftventricle were classified according to a system developed by Berdajs et al., (2005), by precisely measuringshapes lengths and widths.Results: The significant outcome of this study indicates that no two papillary muscles out of the 50 specimenshad the same size, shape or position. All the hearts had two distinct groups of muscles – anterolateral andposteromedial. Specific analysis of each group revealed data regarding the muscles. In the antero-lateral groupof the specimens, the maximum height and width of the muscles was 37.40mm and 17.06mm respectively and inthe postero-lateral group, 33.86 and 26.90mm respectively. Conical shaped muscles were the most commonlyfound muscles owing to the minimum obstruction posed by them to blood flow.Implication: Better understanding of morphological variations can help cardiothoracic surgeons to customizesurgical procedures according to the papillary muscle pattern of the individual patient
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Objective To explore the clinical application of irradiated homograft costal cartilage (IHCC) granule transplantation for the pyriform aperture sunken and deformity in the facial contour.Methods From August 2016 to November 2017,a total of 29 female patients were received IHCC transplantation to the face contour.The standardized photos were taken before and after the operation and then survey of patient satisfaction was conducted.Results In a total of 29 patients,the postoperative 21 patients were satisfied with the IHCC transplantation.After the operation,5 cases were slightly highlighted and obvious bundles could be touched in the deep.At the early stage of operation,the cartilage particles were smoothed by means of manipulation.3 cases were not satisfied with full effect postoperatively and satisfied after secondary transplantation.Conclusions The IHCC granule transplantation for pyriform aperture sunken and deformity can increase the overall sense of facial coordination and anti-aging,and is a safe and effective treatment.
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Patients with Behçet disease often develop postoperative valve detachment and pseudoaneurysm as a potentially fatal complication following aortic valve surgery, necessitating re-operation in a few cases. A 37-year-old man underwent 5 aortic valve and aortic root surgeries for the management of valve detachment after initial aortic valve replacement. Evaluation during the course of his disease revealed incomplete Behçet disease. He presented with high fever and Staphylococcus epidermidis bacteremia during the introduction of immunosuppressive therapy with infliximab. Contrast computed tomography revealed a pseudoaneurysm around the aortic root, and an aortic root replacement was performed using an aortic homograft after administration of a 6-week course of vancomycin. The patient is being observed at our outpatient clinic and has demonstrated no complications after 5 years from his last surgery.
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Aortic root surgical anatomy and knowledge of the various homograft implantation techniques is of paramount importance to the attending anesthesiologist for echocardiographic correlation, estimation and accurately predicting aortic annular dimensions for the valve replacement in a case of diseased homograft.
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In recent years, the use of transcatheter aortic valve replacement (TAVR) has extended beyond the treatment of native aortic valve stenosis in patients with high surgical risk. TAVR is increasingly being performed for bioprosthetic aortic valve failure, i.e., the valve‑in‑valve (VIV) procedure. Establishing the success of a VIV procedure can be challenging in these cases. Furthermore, the limited availability of prostheses sizes further complicates the management of these patients. We present an unusual case of a repeat TAVR in a patient who previously had a VIV procedure in an aortic homograft.
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BACKGROUND: The advantages of using a homograft in valve replacement surgery are the excellent hemodynamic profile, low risk of thromboembolism, and low risk of prosthetic valve infection. The aim of this study was to evaluate the long-term outcomes of homograft implantation in the aortic valve position. METHODS: This is a retrospective study of 33 patients (>20 years old) who underwent aortic valve replacement or root replacement with homografts between April 1995 and May 2015. Valves were collected within 24 hours from explanted hearts of heart transplant recipients (<60 years) and organ donors who were not suitable for heart transplantation. The median follow-up duration was 35.6 months (range, 0 to 168 months). RESULTS: Aortic homografts were used in all patients. The 30-day mortality rate was 9.1%. The 1- and 5-year survival rates were 80.0%±7.3% and 60.8%±10.1%, respectively. The 1-, 5-, and 10-year freedom from reoperation rates were 92.3%±5.2%, 68.9%±10.2%, and 50.3%±13.6%, respectively. The 1-, 5-, and 10-year freedom from significant aortic dysfunction rates were 91.7%±8.0%, 41.7%±14.2%, and 25.0%±12.5%, respectively. CONCLUSION: Homografts had the advantages of a good hemodynamic profile and low risk of thromboembolic events, and with good outcomes in cases of aortitis.