A Clinical Analysis of Thirty-Five Patients Undergoing Aortic Reoperation

Abstract Introduction: At present, there are few reports regarding the issue of aortic reoperation due to its complexity and high risk and individual differences among patients. Methods: From November 2016 to December 2017, the data from 35 cases of aortic reoperation at our institution, out of 212 consecutive aortic repairs, were reviewed. We retrospectively summarized and analyzed their surgical indications, operative data, time interval from previous aortic repair, and outcomes. The time intervals until reoperation were analyzed for differences. Results: Patients' mean age was 40.9±14.5 years, and 25 of them were men (71.4%). The indications for reoperation were aortic valvular problem (14.3%), aneurysmal dilatation (25.7%), pseudoaneurysm formation due to anastomotic leakage (43.2%), and aortic dissection (17.1%). For patients who had underwent primarily emergency operations due to aortic dissection, the time interval until reoperation (4.8±3.2 years) was significantly shorter than that of the whole group (5.5±3.6 years, P<0.01). Among the 35 reoperations, Sun's procedure was selected for 16 patients (45.7%) with total aortic arch reconstruction. The average follow-up was 12 months (range 9-15 months). Hospital mortality was 5.7% (two patients). Among the hospital survivors there were no cases of death, rupture of residual dissection, paraplegia, or central nervous system complications during the follow-up period. Conclusion: Patients with acute aortic dissection required repeat surgery significantly earlier compared to other diseases. As to reoperation strategy, we recommend Sun's procedure as the choice for extended arch reconstruction since minimal effect on overall mortality and complication rates were found.

The reduction of coagulation factor activity R before surgery increases the risk of postoperative neurological complications in patients with acute type A aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To analyze the risk factors for neurological complications after emergency surgery of acute type A aortic dissection. Methods    The clinical data of 51 patients with acute Stanford type A aortic dissection who were admitted to Shanghai Delta Hospital from October 2018 to May 2019 were retrospectively analyzed. There were 37 males (72.5%) and 14 females (27.5%), aged 29-85 (55.1±12.3) years. The patients were divided into two groups, including a N1 group (n=12, patients with postoperative neurological insufficiency) and a N0 group (n=39, patients without postoperative neurological insufficiency). The clinical data of the two groups were compared and analyzed. Results    There were statistical differences in age (62.6±11.2 years vs. 51.7±11.4 years, P=0.003), preoperative D-dimer (21.7±9.2 μg/L vs.10.8±10.7 μg/L, P=0.001), tracheal intubation time (78.7±104.0 min vs. 19.6±31.8 min, P=0.003), ICU stay time (204.1±154.8 min vs. 110.8±139.9 min, P=0.037) and preoperative coagulation factor activity R (4.0±1.5 vs. 5.1±1.6, P=0.022). Preoperative coagulation factor activity R was the independent risk factor for neurological insufficiency after emergency (OR=2.013, 95%CI 1.008-4.021, P=0.047). Conclusion    For patients with pre-emergent acute aortic dissection who are older (over 62.6-64.5 years), with reduced coagulation factor R (less than 4.0), it is recommended to take more active brain protection measures to reduce the occurrence of postoperative neurological complications in patients with acute aortic dissection, and further improve the quality of life.

The Effect of Hypoxic Preconditioning on the Biological Function of Bone Marrow-Derived Endothelial Progenitor Cells / 天津医药

Objective To investigate the effect of hypoxic preconditioning on the biological function of bone mar-row-derived endothelial progenitor cells (BM-EPCs). Methods Mononuclear cells were collected by density gradient cen-trifugation from the bone marrow of rats. The isolated cells were cultivated in dishes coated with the vitronectin from rat plas-ma,filled with the endothelial cell basal medium-2. Cells were then cultured under the conventional culture conditions (37℃and 5%CO2). The cultured cells were divided into control group and hypoxia training group after four-day culture. Cells of the control group were cultured in previous conditions for another three days. However, cells of the hypoxia training groups were cultured in previous conditions for 0, 1 and 2 days,and then under the hypoxic condition (1%O2+5%CO2+94%N2) for another 72 hours, 48 hours and 24 hours, respectively. After seven days,cells in all of groups were collected for the following study. The immunofluorescence labeling and cell analyzer were used to indentify BM-EPCs. The tube formation of BM-EPCs was tested by Matrigel assay. Annexin V/PI antiapoptotic assay was used to detect the apoptotic rate of BM-EPCs. Results The early apoptotic rate of BM-EPCs was increased obviously with extended hypoxia. There was no significant dif-ference in the early apoptotic rate of BM-EPCs between control group (0.89±0.20)%and hypoxic 24-h group (1.33±0.07)%(P>0.05). There was significant increase in the early apoptotic rate of BM-EPCs in hypoxic 48-h group (3.25±0.12)%and hypoxic 72-h group (7.48 ± 1.53)%(P<0.05). Compare with control group, the tube formation ability was significantly in-creased in hypoxic 24-h group (P<0.01), but the tube formation ability was significantly decreased in hypoxic 48-h group and hypoxic 72-h group (P<0.01). Conclusion After hypoxic preconditioning for 24 hours, the apoptotic rate was not obvi-ous in BM-EPCs, but the tube formation ability was markedly increased.

The Role of SDF-1α/CXCR4 Signal Pathway in the Therapeutic Effects of Hypoxic Preconditioning of Endothelial Progenitor Cell Transplantation on Ischemia Heart Disease / 天津医药

Objective To investigate the role of stromal cell-derived factor-1α(SDF-1α)/CXCR4 signal pathway in the therapeutic effects of hypoxic preconditioning endothelial progenitor cell (HEPC) transplantation on acute myocardial in-farction Methods Bone marrow endothelial progenitor cells (EPCs) were isolated from syngeneic adult male Wistar rats. EPCs were cultured under normoxic condition for 4 days and 1%O2+5%CO2+94%N2 condition for 3 days. The effect of HEP-Cs on the migration ability of 100μg/L SDF-1αwas observed. Western blot assay was used to detect the expression of CX-CR4, the solo receptor of SDF-1α on cells surface. Then, 26 syngeneic adult male Wistar rats were randomized into 3 groups:control group (n=8),EPCs group (n=9) and HEPCs group (n=9). The acute myocardium infarction animal model was established. At infarction, the rats received 5-points peri-infarct intramyocardial injections of PBS 200μL, 2×106 EPCs and 2 × 106 HEPCs. After 4 weeks, the haemodynamics parameters of cardiac function were analyzed by echocardiography. Results Compare with EPCs, the migration ability of HEPCs towards SDF-1α was increased significantly. The result of Western blot analysis showed an increased CXCR4 expression on the cell surface. After 4 weeks of transplantation, the left ventricular end systolic diameter and ejection fraction (EF%) were much improved in HEPCs group than those of EPCs group and control group (P＜0.05). Compare with control group, the left ventricular end-diastolic diameter was significantly im-proved in EPCs and HEPCs groups (P＜0.05). There was no significant difference in the improvement of the left ventricular end-diastolic diameter between HEPCs and EPCs groups (P>0.05). Conclusion SDF-1α/CXCR4 pathway was up-regu-lated by HEPCs, which showed the therapeutic effects via EPCs. The adjustment of SDF-1α/CXCR4 signaling pathway is an effective method for the treatment of ischemic heart diseases.