Bentall procedure for reoperation in the small aortic root or annulus / 中国胸心血管外科临床杂志

@#Objective 聽 聽To investigate and evaluate the safety and efficacy of Bentall operation in the reoperation of patients with small aortic root or annulus. Methods 聽 聽Bentall procedure was performed in 24 patients with small aortic root or annulus in our hospital from September 2014 to December 2019. There were 18 males and 6 females with a mean age of 31-68 (45.70卤15.27) years. All patients had undergone a previous replacement of the aortic valve including 20 patients receiving valve replacement, 2 patients aortic root replacement with a valved conduit and 2 patients bioprothesis replacement. Results 聽 聽There was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 2 patients and no bleeding was related to the proximal anastomosis of the conduit. One patient performed pacemaker implantation for heart block after the procedure. The mean sizes of implanted aortic valve prosthesis were 22.75卤1.78 mm. A mean gradient across the aortic valve prostheses in the postoperative echocardiographic examination was 11.17卤2.24 mm Hg. Conclusion 聽 聽Bentall procedure is safe and allows a larger size of prosthesis implantation in patients with small aortic annulus or root after previous aortic valve or complete root replacement, resulting in good postoperative hemodynamic characteristics and short-term clinical results.

Emergency surgical analysis of 29 patients with type A aortic dissection during COVID-19 epidemic / 中华胸心血管外科杂志

Objective:To summarize the experience of emergency treatment of type A aortic dissection during the prevalence of COVID-19.Methods:Retrospectively analyzed the data of 29 patients undergoing emergency surgery for type A aortic dissection during the outbreak of corona virus disease-19 ( COVID-19) in Wuhan Asian Heart Hospital from January 23 to March 31, including 25 males and 4 females aged 34-72 years with mean age (49.17±9.63) years.There were 10 cases in Wuhan and 19 cases outside the city.All patients were diagnosed and indicated for emergency surgery through online consultation before transportation.After the primary exclusion of COVID-19 by pulmonary CT scanning in the emergency department, the patients were admitted to the isolation ward. Emergency surgery was performed after emergency nucleic acid testing and preoperative examing. Postoperatives were carried to a single room in the ICU for isolation until COVID-19 was excluded, nucleic acid testing and reexamination of pulmonary CT were performed if they were fever during hospitalization.All medical personnel involved in the operation and perioperative management took three levels of protection and medical observation.Results:There were 5 cases of type A1 in the aortic root, 2 cases of type A2, 22 cases of type A3, 2 cases of simple arch, 27 cases of complex type (Sun's classification).12 cases of Bentall, 2 cases of Wheats, 15 cases of ascending aorta replacement, 14 cases of aortic valve repair, 25 cases of aortic arch replacement, 23 cases of trunk stents, 2 cases of hybridization, 6 cases of concurrent coronary artery bypass grafting, and 2 cases of tricuspid valvuloplasty.In the whole group, 1 case of COVID-19 was confirmed and 1 was suspected.The time of cardiopulmonary bypass was(224.00±21.14)min, the blocking time was(146.17±18.75)min, the postoperative ventilator assisted(65.07±10.36)h, the hospitalization time was(27.03±5.64)days, there were no hospitalized deaths, 4 cases of postoperative liver function damage, 6 cases of acute renal function damage, and 7 of pulmonary infection.None of the medical staff involved in the operation and perioperative management were infected with COVID-19.Conclusion:During the period of major infectious diseases, the admission and treatment procedures of critical and severe patients should be standardized, and the control of nosocomial infection should be strengthened. Emergency surgery is an effective means to rescue type A active vein interlayer, and the safety of protecting medical staff is guaranteed.

Evaluation of the efficacy of restricted bare stent in the treatment of acute stanford A aortic dissection / 中华胸心血管外科杂志

Objective To observe the effect of restrictive bare stent release on the distal end of Stanford type A aortic dissection.Methods From November 2016 to February 2018,20 patients with Stanford type A aortic dissection requiring aortic arch replacement and trunk surgery were selected for restrictive bare stent placement.Among them,there were 17 males and 3 females,aged 34-68 years old with an average age of(50.85 ± 8.49) years.The bare stent was released in the descending thoracic aorta,and the frozen elephant trunk was placed in the bare stent.The CTA of the great vessels was reviewed before discharge and the stent position and complications were observed.And compared with 42 patients with acute aortic arch replacement and stent-like nasal surgery in the acute Stanford type A aortic dissection from December 2013 to June 2015.Of the 42 patients,32 were males and 10 were females,aged 20-78 years,with an average of(49.36 ± 8.02) years.Results One patient in the bare stent group had greater resistance when the bare stent was placed,and the patient was disengaged and abandoned.The remaining 19 patients successfully completed the restrictive bare stent placement.One patient died of a large cerebral infarction during hospitalization.All 18 patients who survived and successfully placed the bare stent were followed up regularly.There was no stroke or death during the follow-up period.The computed tomography angiography of the computed tomography showed good shape and position,no displacement and type lⅢ endoleak,and no new fracture of the distal end of the elephant trunk was observed.In the conventional surgery group,2 patients died,1 patient died of large-scale cerebral infarction,and 1 patient died of perioperative myocardial infarction.No paraplegia cases.In 2 cases,a new rupture of the distal eud of the elephant trunk was performed,and the stent was placed again.Conclusion Compared with the conventional surgery group,the use of the restricted bare stent is safe,can effectively reduce the occurrence of stent-graft induced new entry and can significantly expand the diameter of the distal vessel,and the aortic remodeling effect is good.

Thromboelastographic Dynamic Monitoring and Clinical Application in Patients Experiencing Acute Ischemic Stroke and Receiving Reteplase / 现代检验医学杂志

Objective To observe the effect of reteplase on the thromboelastogram tracing of patients experiencing acute is-chemic stroke(AIS).Methods Selected 43 AIS inpatients in the Third People’s Hospital of Liaocheng from October,2013 to August,2015,who received reteplase less than 4.5 hours after the onset of syndrome of AIS.Blood samples were obtained before reteplase administration and at 0.5,1,2 and 4 hours after reteplase administration and measured by thromboelastogra-phy.Results The parameters R,K,Angle and MA of the thromboelastogram had changed after beginning administration of reteplase.The R value at 0.5 h after thrombolysis was significantly higher than that before thrombliysis,however,the R Value at 1h after thrombolysis was the most highest,and the K value.At 0.5 h after thrombolysis was the highest.At 0.5 h after thrombolysis MA and Angle values were the lowest,the differences were statistically significant (P<0.001).Conclu-sion The study suggests that the thromboelastogram is an useful tool for determining changes in the coagulation system of patients receiving reteplase.

Clinical therapy for blood culture-negative infective endocarditis / 中国综合临床

Objective To summarize the clinical treatment experience of blood culture-negative infective endocarditis,and to explore the surgery chance and therapeutic strategy of blood culture-negative endocarditis. Methods One hundred and sixty-six patients who were diagnosed blood culture-negative endocarditis in the Aisa Heart Hospital of Wuhan from Jul. 2008 to Dec. 2012 were recruited in the study. Broad-spectrum antibiotics including cefuroxime axetil and levofloxacin were used before the result of blood culture,and sensitive antibiotics were selected to control patient's condition when getting the result of blood culture. But broad-spectrum antibiotics were continuously used to the blood culture-negative endocarditis until stable condition. When the conditions were stable,active preparation before surgery should be carried out. Thoroughly clear the vegetation and protect the cardiorespiratory function during operating. Kata-step antibiotics were used to control patient's condition until normal temperature,as well as the number of leukocytes decreased,blood sedimentation normalized and C-reaction protein decreased. Then,the narrow-spectrum antibiotics were selected including cephalosporin until discharged from hospital,and continued treatment of antibiotics for 4 - 6 weeks. Results Five patients died after the operation,including 1 case died of low cardiac output syndrome,2 cases died of multiple organ failure,1 case died of septicemia and the 1 case died of cerebral embolism. All the other patients discharged from hospital successfully. Conclusion The patients with blood culture-negative IE should be controlled rapidly. The duration and dose of antibiotics should be enough. Active operative preparation should be taken and then surgery timely. Thus,the hospital mortality could decrease and prompt the long-term outcome.

Influence of diabetes on off-pump coronary artery bypass grafting / 中国综合临床

Objective To investigate the impact of diabetes on coronary artery bypass grafting (CABG)in peroperative patients. Methods Clinical data of 692 CABG patients were collected retrospectively from Sep. 2006 to Jul. 2010. The CABG patients were divided into diabetic group (n = 276) and nondiabetic group (n = 416) according to with the status of diabetes or not before operation. Blood glucose was dynamicaly monitored and treated with insulin to control blood glucose in perioperativeperiod. The postoperative effect,perioperative complication and inhospital case fatality and their relationship with diabetes were analyzed using univariate analysis. Results No significant differences were found regarding the incision complications (5. 8%vs. 4. 3 % , P > 0. 05). The volume of blood transfusion was (890. 7 ± 520. 6) ml in the diabetes group, which was not significantly different from that of (825. 2 ±518. 4)mlin the non-diabetes group (P>0. 05). No significant difference was found on cardiac arrhythmia (13.0% vs. 13. 5%),renal function insufficient (5. 1% vs. 2.4%)and case fatality (2. 9% and 1. 9%) between the diabetes and non-diabetes group (Ps >0. 05). In the diabetes group and non-diabetes group, the duration of IABP (3.7 ± 1. 6) d vs (3.5 ± 1.6)d, use of ventilator (2. 6 ± 1.9)d vs. (2. 4±1.5)d were not sigfnificantly different (Ps >0.05). The length of hospital stay and cost were (22. 0 ±8. 8)d and (8. 11 ±2. 40) thousand RMB in the diabetes group, which were significantly higher than that of (20. 6 ±7. 6)d and (7. 63 ±2. 20) thousand RMB in the non-diabeties group (t =2. 22 and 2. 71 ,Ps <0.05) . Conclusion There are no significant differences in the operative case fatality and complications between patients with diabetes and without nondiabetes. However,diabetes increases hospital stay and expense.