Minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure: a series of 60 cases / 中华外科杂志

Objective: To examine the short-term curative effect with minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure. Methods: The clinical data of 60 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure from August 2021 to August 2022 at Department of Cardiovascular Surgery, Zhejiang Provincial People's Hospital were retrospectively analyzed. There were 31 males and 29 females, with the age (M (IQR)) of 54.0(22.3) years (range: 15 to 71 years). The echocardiography confirmed the diagnosis of moderate mitral regurgitation in 30 patients, and severe mitral regurgitation in 13 patients. Systolic anterior motion (SAM) was present preoperatively in 54 patients. All 60 patients underwent transaortic modified Morrow procedure through a right infra-axillary thoracotomy using femorofemoral cardiopulmonary bypass. Surgical procedures mainly included transverse aortic incision, exposure of left ventricular outflow tract (LVOT), septal myectomy, and correction of the abnormal mitral valve and subvalvular structures. Results: All 60 patients underwent the programmatic procedures successfully without conversion to full sternotomy. The cardiopulmonary bypass time was (142.0±32.1) minutes (range: 89 to 240 minutes), while the cross-clamp time was (95.0±23.5) minutes (range: 50 to 162 minutes). The patients had a postoperative peak LVOT gradient of 7.0 (5.0) mmHg (range: 0 to 38 mmHg) (1 mmHg=0.133 kPa). A total of 57 patients were extubated on the operating table. The drainage volume in the first 24 h was (175.9±57.0) ml (range: 60 to 327 ml). The length of intensive care unit stay was 21.0 (5.8)h (range: 8 to 120 h) and postoperative hospital stay was 8 (5) days (range: 5 to 19 days). The postoperative septal thickness was 11 (2) mm (range: 8 to 14 mm). All patients had no iatrogenic ventricular septal perforation or postoperative residual SAM. The patients were followed up for 4 (9) months (range: 1 to 15 months), and none of them needed cardiac surgery again due to valve dysfunction or increased peak LVOT gradient during follow-up. Conclusion: Using a video-assisted thoracoscopic transaortic modified Morrow procedure through a right infra-axillary minithoracotomy can provide good visualization of the LVOT and hypertrophic ventricular septum, ensure optimal exposure of the mitral valve in the presence of complex mitral subvalvular structures, so that allows satisfactory short-term surgical results.

Establishment of a rat model of craniocerebral blast injury induced by cabin explosion / 解放军医学杂志

Objective To establish a rat model of craniocerebral blast injury caused by the shock wave of cabin explosion.Methods Fifty male adult Sprague-Dawley rats were randomly divided into 5 groups (10 each):3g,5g,8g TNT with vest groups,5g TNT without vest group and control group.Uncased explosives of different equivalent were suspended in the cabin center.After anesthesia,with exception of control group,the rats were placed in prone position about 31 cm below the explosive,facing the explosive with or without vest.After the explosion,the survived rats were observed,serological and pathological examinations were performed at 3h,1d and 3d after the explosion.Results In terms of tissue damage and mortality,compared with the control group,no obvious injury formed in rats of the 3g TNT with vest group,and all of them survived;Rats in 5g TNT with vest group showed mild lung injury,brain tissue edema,enlarged blood vessel,patchy hemorrhage on the brain surface,and with a mortality of 30％;Rats in 8g TNT with vest group showed serious organ damage with a mortality of 80％;Rats in 5g TNT without vest group suffered from severe lung injury,almost all died right after the explosion.Therefore,rats in 5g TNT with vest group were more in line with the experimental needs.Further serum and pathologic examinations showed that the brain water content increased,the serum neuron specific enolase (NSE) and S-100β protein also increased markedly,and necrotic or apoptotic changes happened in the cortex and hippocampus neurons.Conclusion A stable animal model of craniocerebral blast injury may be established with rats in the case of chest and abdomen protected and then exposed to 5g TNT explosion in cabin.

Acute renal failure following operation in patients with acute type A aortic dissection: An analysis of risk factors / 第二军医大学学报

Objective To identify the risk factors of acute renal failure following operation in patients with acute type A aortic dissection (AAAD). Methods The clinical data of 266 consecutive patients undergoing operation for AAAD between Jan. 2002 and Mar. 2013 were retrospectively analyzed. The patients were divided into two groups according to the presence of postoperative acute renal failure. The general data were compared between the two groups. Univariate and multivariate conditional logistic regression analysiswere used to determine the independent risk factors of postoperative acute renal failure. Results Eighteen (6. 77%) patients had acute renal failure in our study. The incidence rates of preoperative cardiac dysfunction (NYHA II-IV) (P = 0. 024), renal insufficiency (P = 0. 002), cardiopulmonary bypass time (CPBT)≥190 min (P = 0. 000), aortic cross-clamp time≥90 min (P = 0. 015), postoperative re-operation for bleeding (P = 0. 004), brain damage (P = 0. 013), acute respiratory dysfunction (P = 0. 000) and perioperative erythrocyte transfusions (P = 0. 015) were significantly different between the two groups preoperatively. Multivariate conditional logistic regression analysis showed that preoperative renal insufficiency (0R=6.978, 95% Cl: 1.874-25.997), CPBT≥190 min (0R= 5. 663, 95% Cl: 1.621-19.781), perioperative erythrocyte transfusions (0R=1.071, 95% CI: 1. 030-1. 113)and postoperative acute respiratory dysfunction (0R= 4. 853, 95% Cl: 1. 467-16. 053)were independent risk factors for postoperative acute renal failure. Conclusion Renal failure is a severe complication caused by many risk factors after operation in AAAD patients. The patients should be monitored closely early after operation; the risks of acute renal failure should be assessed and individualized intervention should be given to improve hospital mortality and prognosis.