Treatment of thoracoabdominal aortic aneurysm by prosthetic vessel replacement under left heart bypass / 中南大学学报(医学版)

OBJECTIVES@#Thoracoabdominal aortic aneurysm (TAAA) prosthetic vessel replacement is one of the most complex operations in the field of cardiovascular surgery. The key to success of this operation is to prevent and avoid ischemia of important organs while repairing TAAA. This study aims to summarize and analyze the effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA.@*METHODS@#Data of 15 patients with TAAA who underwent prosthetic vessel replacement under left heart bypass in Xiangya Hospital of Central South University were retrospectively analyzed. According to Crawford classification, there were 2 cases of type I, 8 cases of type II, 3 cases of type III, and 2 cases of type V. There were 14 cases of selective operation and 1 case of emergency operation. All operations were performed under left heart bypass, and cerebrospinal fluid drainage was performed before operation. Left heart bypass was established by intubation of left inferior pulmonary vein and distal abdominal aorta or left femoral artery. The thoracoabdominal aorta was replaced segment by segment. After aortic dissection, the kidneys were perfused with cold crystalloid renal protective solution, and the celiac trunk and superior mesenteric artery were perfused with warm blood.@*RESULTS@#One patient with TAAA after aortic dissection of type A died. During the operation, straight blood vessels were used to repair TAAA, and the celiac artery branches were trimmed into island shape and anastomosed with prosthetic vessels. After the operation, massive bleeding occurred at the anastomotic stoma, then anaphylactic reaction occurred during massive blood transfusion, resulting in death. One patient suffered from paraplegia due to ischemic injury of spinal cord. The other patients recovered well and were discharged. The postoperative ventilation time was (16.5±13.8) h and the postoperative hospital stay was (10±4) d. The amount of red blood cell transfusion was (13±9) U. The patients were followed up for 2 months to 2 years, and the recovery was satisfactory.@*CONCLUSIONS@#The effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA is good, which is worthy of clinical promotion.

Treatment strategies for congenital heart disease in infants with severe pneumonia / 中南大学学报(医学版)

To observe the results of different treatment of congenital heart disease (CHD) complicated with severe pneumonia in infants.
 Methods: A total of 27 infants with CHD and severe pneumonia were admitted to the Department of Pediatrics, Xiangya Hospital from January 2014 to December 2014, of whom 18 were male and 9 were female. The average age was 2.0-19.0(5.9±4.3) months, with an average body weight of 3.3-10.0 (5.8±1.8) kg. Infants were treated with a strategy of complete control of the lung infection before surgery (internal medicine group). From January 2015 to December 2015, 29 infants with same condition were admitted, of whom 15 were males and 14 females. The average age was 2.0-27.0 (6.1±3.9) months, with an average body weight of 3.1-8.0 (4.8±1.0) kg. Infants were treated with a strategy of combined treatment (combined treatment group), in which early surgical treatment were performed after a short time antibiotics and supportive treatment.
 Results: One nosocomial death in internal medicine group, with an average hospital stay for 3-26 (11±6) d. Further surgeries were performed in 5 patients after discharge with no surgical death. The mean preoperative hospital stay in combined treatment group was 1-21 (10±6) d. The mean total hospital stay for combined treatment group was 14-48 (24±9) d and the mean postoperative hospital stay was 6-35 (14±7) d. One patient died soon after surgery in combined treatment group. Thirty-day follow-up found that no other patient died in combined treatment group, and 6 patients died in internal medicine group. The 30-day mortality was 3.4% in combined treatment group and 22.2% in internal medicine group (P<0.01).
 Conclusion: Infant congenital heart disease complicated with severe pneumonia requires early surgical treatment, which contributed to the control of pulmonary infection and reduce mortality.

Heparin-induced thrombocytopenia in patients undergoing cardiac surgery / 中南大学学报(医学版)

OBJECTIVE@#To investigate the incidence for heparin-induced thrombocytopenia (HIT) in patients undergoing cardiac surgery and to evaluate the risk factors for the generation of HIT-antibody.
@*METHODS@#A total of 315 patients undergoing cardiac surgery in the Department of Cardiothoracic Surgery, Xiangya Hospital between December, 2013 and July, 2014 were enrolled for this study. Among them, 120, 154 and 41 were for surgery of congenital heart defect, valve and coronary artery bypass graft, respectively. There were 170 male patients and 69 patients were under 18 years old. Platelet counts, HIT-antibody and concentration of platelet factor 4 (PF4) were tested before and after the surgery. Diagnosis of HIT was based on "4Ts" (Pretest Clinical Scoring System). 
@*RESULTS@#HIT was diagnosed in 11 patients (3.5%, 11/315). And thromboembolic events occurred in 2 of 11 patients with HIT. The positive ratio for HIT-antibody was 36.5% (115/315). The coronary artery disease patients had a higher incidence of HIT than that of either the valve disease or the congenital heart defect (17.1%, 7/41 versus 1.9%, 3/154 or 0.8%, 1/120; P<0.05). The congenital heart defect patients had a higher positive ratio for HIT-antibody than that of both the valve disease and the coronary artery disease. The valve disease patients had a higher positive ratio for HIT-antibody than that of the coronary artery disease (51.7%, 62/120 versus 30.5%, 47/154 versus 14.6%, 6/41; P<0.05). Major postoperative complications occurred more frequently in HIT patients (36.4%, 4/11 versus 10.5%, 32/304; P<0.05). Age was a risk factor for HIT (P=0.030, OR=1.083, 95% CI 1.008-1.163). Cardiopulmonary bypass (CPB) (P=0.037, OR=3.113, 95% CI 1.071-9.050) and age (P<0.001, OR=0.970, 95% CI 0.959-0.982) were risk factors for HIT-antibody.
@*CONCLUSION@#The incidence of HIT is low during cardiac surgery, but HIT is a highly risk factor for the major postoperative complications. More attentions should be paid to these severe complications and the risk factors for HIT.

REV procedure for complex congenital heart diseases / 中南大学学报(医学版)

OBJECTIVE@#To introduce REV procedure in patients with transposition of the great arteries (TGA) with a ventricular septal defect (VSD) and pulmonary stenosis (PS).@*METHODS@#From May 2012 to June 2012, 4 patients with TGA were admitted for surgery. Two patients with VSD underwent SWITCH operation. REV procedure was used for the other two patients with PS. The Senning procedure was also used for the patient with atrioventricular discordance.@*RESULTS@#There was no in-hospital mortality. Shortest cardiopulmonary bypass time and aortic crossclamp time were found in simple REV procedure patient. Postoperative echocardiography demonstrated physiologic hemodynamics in the left ventricular outflow tract and normal heart function. All the patients were in excellent clinical condition during follow-up.@*CONCLUSION@#REV procedure is a good choice for transposition of great arteries associated with ventricular septal defect and obstruction of the pulmonary outflow tract.

Telephone follow-up of 1635 post-surgery lung cancer patients and retrospective study of lung cancer prognosis / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the telephone follow-up of surgery patients with lung cancer and to analyze the prognosis factors.@*METHODS@#From October 2011 to January 2012, 1635 post-surgery lung cancer patients from January 2002 to August 2011 were followed up by telephone interview. The data from follow-up and clinical characteristics were collected and analyzed. Among these patients, 116 patients with complete and reliable clinical data were further analyzed to determine the effective factors of lung cancer metastasis and long-term survival.@*RESULTS@#The average response rate in the follow-up was 36.1%, and the response rate was related to the interval time after the operations. The shorter the interval, the higher the response rate. The response rate in female patients was higher than that in male patients (P<0.001).The response rate was higher in patients younger than 40 (56 %) than that in the patients aged between 50-59 and over 60 (39% and 24% respectively, P<0.001). There was no statistical difference between patients from urban and rural areas (P=0.844). In the 116 patients with complete and reliable clinical data, statistical analysis confirmed that the metastasis and high lymph node staging were factors to increase patients' risk of death (with odd ratio 0.212 and 1.818 respectively, P<0.001). The adenocarcinoma grade, high lymph node staging and advanced age were related to the metastasis risk (odds ratio 2.353, 2.181 and 2.908, respectively).@*CONCLUSION@#Time, gender and age are the influencing factors in the telephone follow-up. Metastasis, lymph node metastasis, pathologic type and age are related to the lung cancer prognosis in the small-scale sample.