Prior reconstruction of an isolated left vertebral artery for Stanford type A aortic dissection.

Although isolated left vertebral artery is a supra-aortic trunk variant, it is not so rare. It may pose additional difficulties during total arch replacement surgeries. The aim of this study was to present our experience with prior reconstruction of isolated left vertebral artery by isolated left vertebral artery-left common carotid artery during total arch replacement combined with stented elephant trunk implantation.

Thoracoscope-assisted Right Vertical Infra-axillary Mini-incision for Cardiac Surgery.

BACKGROUND: The thoracoscope and minimally invasive techniques have been effectively used in cardiac surgery. METHODS: The study included 27 consecutive patients (aged 24.8±17.6 years), who underwent cardiac surgery from January 2012 to July 2013. Six patients were diagnosed with mitral valve stenosis (MS), 17 patients with atrial septal defects (ADSs), and four with ventricular septal defects (VSDs). All the patients underwent thoracoscope-assisted right vertical infra-axillary mini-incision (TARVAI). RESULTS: The procedure was successfully performed in all patients. For the patients with ASDs or VSDs, the times for cardiopulmonary bypass, aortic cross-clamping, operating (skin-to-skin), ventilation, ICU stay, postoperative hospital stay were 63±25 min, 28.1±15.5 min, 167.1±35.7 min, 5.2±2.7 h, 25.3±10.5 h, 8.7±3.6 days, and for the patients with MS, these were 143.3±25.2 min, 88.2±15.4 min, 236.5±48.5 min, 7.3±1.5 h, 36.7±9.1 h, and 13.5±4.4 days, respectively. The median postoperative drainage (total) for the ASD/VSD and MS patients was 136.3±54.5 ml and 203.8±94.4 ml, respectively. CONCLUSIONS: In our institution, the TARVAI approach is feasible and safe in cardiac surgery. It may be particularly useful in young patients with simple congenital heart disease and mitral valve disease.

Anti-inflammatory and anti-proliferative effects of CBS3830 in arterialized vein grafts in rats.

OBJECTIVE: To investigated whether CBS3830, a highly selectively inhibitor of p38MAPK, could ameliorate inflammation and intimal hyperplasia in arterialized vein grafts (AVGs). METHODS: Sixty male Sprague-Dawley rats underwent a reversed right jugular vein to common carotid artery interposition graft and were randomly treatment with vehicle (control) or single-dose (3 mg/kg, preoperative) or double-dose (3 mg/kg, preoperative and 4 d postoperative) CBS3830. Twenty rats underwent sham operation. The levels of tumor necrosis factor-α (TNF-α), interleukin-1ß (IL-1ß), and interleukin-6 (IL-6) were determined by ELISA. Vein grafts were analyzed by intimal/medial morphometry, proliferating cell nuclear antigen (PCNA) expression, and p38MAPK phosphorylation. RESULTS: TNF-α, IL-1ß, and IL-6 gradually increased then slowly decreased in AVG rats. However, at 4 d and 7 d, TNF-α levels decreased by 37.5% and 29.5% (p = 0.003, 0.05, respectively) in the single-dose CBS3830 group, and by 37.6% and 32.5%, respectively (both p = 0.003) in the double-dose group compared with those of control. IL-1ß levels significantly reduced at 4 d and 14 d in both dosage groups. IL-6 levels significantly reduced at 7 d in both groups. Intima and medial thickening were significantly reduced in both dosage treated groups at 7, 14, and 28 d (all p = 0.000) compared to the controls. Further study showed CBS3830 inhibited p38MAPK phosphorylation and decreased PCNA expression. CONCLUSIONS: CBS3830 significantly decreases inflammation and intimal hyperplasia in AVGs.

p38 MAPK inhibitor, CBS3830 limits vascular remodelling in arterialised vein grafts.

OBJECTIVE: Following bypass surgery vein grafts undergo a remodelling process that can lead to restenosis and ultimately vein graft failure. Signalling through mitogen activated protein kinases (MAPKs) is a key mechanism involved in vein graft failure. Here, we investigated whether CBS3830 (c-a-i-r biosciences GmbH, Tübingen, Germany), a new highly selectively inhibitor of p38 MAPK, has a significant effect on inhibiting intimal, medial and adventitial hyperplasia. METHODS: Sixty specific pathogen free Sprague Dawley male rats were randomly divided into three groups. The control group with a reversed right jugular vein, which is common to carotid artery interposition graft, was compared with sham-operated, and CBS3830 treated animals. Intimal, medial and adventitia morphometric examinations and expression of proliferating cell nuclear antigen (PCNA) were analysed after one, two and four weeks for vein grafts. RESULTS: Intimal, medial and adventitia thickening in CBS3830 group were significantly lower than in the control group at each time point. Moreover, CBS3830 significantly reduced the phosphorylation of p38 MAPK and PCNA expression compared to the control. CONCLUSION: On the basis of the present work, intima, media and adventitia of saphenous vein grafts undergo vascular remodelling after surgery. The new, highly selective p38 MAPK inhibitor, CBS3830, ameliorates intimal, medial, and adventitial remodelling by varying degrees.

Right vertical infra-axillary mini-incision for repair of simple congenital heart defects: a matched-pair analysis.

OBJECTIVES: To evaluate the efficacy and safety of the right vertical infra-axillary mini-incision (RVAI) used for the repair of simple congenital heart defects. METHODS: We performed a retrospective 1:1 matched-pair analysis on the patients with simple congenital heart defects who were operated on from February 2003 to October 2010. All the recruited patients were treated through either RVAI (RVAI group) or median sternotomy incision (MSI group). In order to balance the major prognostic factors between the two groups, the MSI group was selected by a pair-matched case-control methodology and matched for heart defects, the year of surgery, body weight and patching. RESULTS: A total of 104 patients were included. The demographics and preoperative clinical characteristics of the patients in the RVAI group (n = 52) and in the MSI one (n = 52) were similar. There were no operative or late mortalities and no special care in the intensive care unit (ICU) or rehospitalization. The mean duration time of surgical operation (skin-to-skin) was 147 ± 21 min (range from 100 to 190 min) in the RVAI group and 174 ± 35 min (range from 120 to 270 min) in the MSI one (P < 0.001), respectively. No significant difference was found between the two groups in the consuming time for cardiopulmonary bypass, aortic cross-clamp, postoperative ventilation, ICU stay, postoperative hospital stay and drainage. No significant residual defects were found in patients of both groups. No asymmetrical development of the breast, thoracic deformity or scoliosis has been found during the follow-up. All the patients or the parents of young children (100%) in the RVAI group and 34 patients or the parents of young children (65.4%) in the MSI one were satisfied with the cosmetic results (P < 0.001). CONCLUSIONS: The RVAI surgical approach to simple congenital heart defects was a safe procedure and could be performed with excellent cosmetic and clinical outcomes. It provided a good alternative to the standard MSI for simple congenital heart defects.