Clinical effects of type Ⅱ hybrid aortic arch repair for type A aortic dissection in elderly and non-elderly patients / 中国胸心血管外科临床杂志

@#Objective    To discuss the efficacy of type Ⅱ hybrid aortic arch repair for type A aortic dissection in patients of different age groups. Methods    We retrospectively analyzed the clinical data of 126 patients with type A aortic dissection admitted to the Fuwai Hospital between January 2016 and December 2018, including 78 (61.9%) males and 48 (38.1%) females, with an average age of 61.8±6.9 years. The patients were divided into an elderly group (≥60 years, n=82) and a non-elderly group (<60 years, n=44). The preoperative, intraoperative and postoperative data of patients in the two groups were compared. Results    The age between the elderly and non-elderly group was significantly different (65.9±4.1 years vs. 54.3±4.1 years, P<0.010), and no significant difference was found between the two groups in other preoperative baseline data. There were 6 (4.8%) patients of early death, 3 (2.4%) patients of stroke and 2 (1.6%) patients of paralysis. A total of 194 stents were implanted, and the average dimeter of the stents was 33.6±1.8 mm and the average length was 199.0±6.7 mm. The non-elderly group had shorter mechanical ventilation time (31.9±41.7 h vs. 61.0±89.2 h, P=0.043) and ICU stay time (77.8±51.4 h vs. 143.1±114.4 h, P<0.001) than the elderly group. There was no significant difference in in-hospital mortality rate, reoperation rate or survival rate between the two groups (P>0.05). Follow-up time was 1-43 (22.6±10.8) months, and 3 patients were lost. There were 104 (82.5%) patients of complete thrombus formation of false lumen in stent and endoleak was reported in 11 (9.2%) patients. Conclusion    Type Ⅱ hybrid aortic arch repair offers an alternative approach to acute type A aortic dissection with acceptable early and mid-term clinical effects. The non-elderly patients have a similar early treatment effect to the elderly patients, but have a better mid-term outcome.

Surgical treatment of thoracic aortic graft infection / 中华胸心血管外科杂志

Aortic graft infections(AGI) are uncommon complications of aortic surgery, although they carry a high mortality. Due to its special anatomical location, the thoracic aorta has less surrounding covered tissue. Once the graft infection occurs, the condition is often more dangerous. Therefore, the treatment of AGI of thoracic aorta is particularly important. This article reviews the surgical treatment of thoracic aorta graft infections.

The relationship between different time periods and the prognosis of acute type A aortic dissection surgery / 中华胸心血管外科杂志

Objective Nowadays, emergency surgery is the most important method to treat acute type A aortic dissec-tion.There are many factors that can affect the prognosis, but the relationship between time period and the prognosis of aortic dissection surgery has not been reported.Therefore, the purpose of this study was to explore the relationship between different time periods and the prognosis of acute type A aortic dissection surgery .Methods We retrospectively analyzed the characteris-tics of acute type A aortic dissection surgery in Fuwai Hospital from 2010 to 2015.All patients were divided into two groups ac-cording to different time period .Propensity matching analysis was used to compare in-hospital mortality and post-operative com-plications of these groups.Results There were 698 cases acute aortic dissection surgery during study period.321 cases were operated in the nighttime(45.98％), the others were operated during daytime(54.02％).After propensity score matching, the operation time, extracorporeal bypass time, and the aortic blocking time of nighttime group were longer than daytime group , and there was a statistical difference(P<0.01).There was a statistical difference between the two groups of postoperative con-tinuous renal replacement therapy.Nighttime group had higher incidence(15.94％ vs.5.64 ％, P<0.01).There was statis-tically significant in 30-day mortality between daytime group and nighttime group(5.26％ vs.10.53％, P=0.03).The mul-tiple-factor risk analysis of 30-day mortality in the whole group found that nighttime surgery was an independent risk factor ( OR 2.13, 95％CI 1.19-3.81, P=0.01).Conclusion For acute type A aortic dissection surgery, nighttime surgery may be the important factor for increasing 30-day mortality.For relatively stable patients, avoiding nighttime surgery may increase survival rate.

Correlation between of aortic dissection onset and climate change / 中华外科杂志

Objective@#To explore the relationship between the incidence of aortic dissection and climate change.@*Methods@#The characteristics of 345 acute aortic dissection patients came from Beijing in Department of Vascular Surgery, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College from January 2005 to December 2015 were analyzed, retrospectively. There were 266 male and 79 female patients with a mean age of (49±12) years. There were 209 cases of Stanford type A aortic dissection, and 136 cases of type B. According to Fuwai aortic dissection classification: type A 8 cases, type B 95 cases, type Cp 13 cases, type Ct 187 cases, type Cd 40 cases, type D 2 cases. Meanwhile, monthly maximum temperature, minimum temperature, average temperature, average pressure, amount of rainfall, sunshine, relative humidity and other meteorological data were collected. Rank-sum test was used to analyze the difference of onset of aortic dissection in different seasons and months. Generalized additive models were implied to explore climate change and the onset of aortic dissection.@*Results@#The onset of aortic dissection was related to season. Winter had higher morbidity compared to summer (M(QR): 3(2) vs. 2(2), Z=1.97, P=0.05). The occurrence of aortic dissection was associated with month.December had the largest quantity, July had the least (2(3) vs. 2(1), Z=2.42, P=0.02). The mean temperature was statistically significant for indicating the change of aortic dissection onset. It meaned that onset probability was increased with the decrease of temperature (RR=1.01, 95%CI: 1.00 to 1.02, P=0.04).@*Conclusions@#The onset of aortic dissection had something to do with season and month. The incidence of aortic dissection increases with temperature decreases.

The reconstruction of left subclavian artery in thoracic endovascular aortic repair for aortic arch disease / 中华胸心血管外科杂志

Objective This study was designed to evaluate the prognosis of the reconstruction of left subclavian artery (LSA)in thoracic endovascular aortic repair(TEVAR)for patients with aortic arch disease.Methods From January 2010 to August 2016,55 patients with aortic arch disease(left vertebral artery dominance)who had undergone TEVAR including LSA covered in Fuwai Hospital were enrolled.28 patients received concomitant reconstruction of LSA.The study endpoints includ-ed: postoperative death, reoperation, stroke and aorta-related adverse events.Results Follow-up data were obtained from all patients.The mean follow-up time was(30.0 ±17.5)months.All patients were diagnosed with left vertebral artery dominance by preoperative computerized tomography of aorta.The preoperative diameter of left vertebral artery was(4.88 ±0.85)mm while the right vertebral artery was(3.00 ±0.75)mm.There were no in-hospital deaths,reoperations and aorta-related adverse events.Three patients died and 2 patients experienced Type Ⅳ endoleak during the follow up.Conclusion The mid-term prognosis of the reconstruction of left subclavian artery in thoracic endovascular aortic repair for patients with aortic arch disease are good and long-term follow-up is necessary.

Exercise capacity and quality of life after total cavopulmonary connection at adults / 中华胸心血管外科杂志

Objective The aim of this study was to evaluate the clinical and phychology profile after total cavopulmonary connection procedure and to identify the significant determinants of quality of life.Methods Data from 21 patients underwent total cavopulmonary connection procedure from January 2008 to December 2015 were retrospectively analyzed.Patients under went echocardiography aud cardiopulmonary exercise testing.Used ST-36 questionnaire to perceived health status.The NT-ProBNP levels was test.Results 21 patients aged between 19 to 36 years(mean 26.6 years) were enrolled.The mean follow-up time was(44.2 ± 29.9) months.The mean EF was (59.4 ± 6.2) ％,and the peak oxygen uptake was (19.9 ± 3.6) ml · kg-1 · min-1,perceut predict value was(52.5 ± 8.9) ％.SF-36 score was well.Independent risk for impaired exercise capacity was interval time from surgery.Conclusion The exercise capacity of total cavopulmonary connection patients was impaired.Identify more predict factors of the quality of these patients need further study.

Exercise capacity and quality of life after total cavopulmonary connection at adults / 中华胸心血管外科杂志

Objective The aim of this study was to evaluate the clinical and phychology profile after total cavopulmonary connection procedure and to identify the significant determinants of quality of life.Methods Data from 21 patients underwent total cavopulmonary connection procedure from January 2008 to December 2015 were retrospectively analyzed.Patients under went echocardiography aud cardiopulmonary exercise testing.Used ST-36 questionnaire to perceived health status.The NT-ProBNP levels was test.Results 21 patients aged between 19 to 36 years(mean 26.6 years) were enrolled.The mean follow-up time was(44.2 ± 29.9) months.The mean EF was (59.4 ± 6.2) ％,and the peak oxygen uptake was (19.9 ± 3.6) ml · kg-1 · min-1,perceut predict value was(52.5 ± 8.9) ％.SF-36 score was well.Independent risk for impaired exercise capacity was interval time from surgery.Conclusion The exercise capacity of total cavopulmonary connection patients was impaired.Identify more predict factors of the quality of these patients need further study.