ObjectiveTo evaluate the clinical effect of modified mini-root operation on aortic root diseases with the short and middle term follow-up results. MethodsWe retrospectively analyzed the data of thirty-one patients of modified mini-root operations between March 2008 to September 2012. There were 22 male and 9 female patients with mean age of 47.2±21.3 years(ranged from 28 to 71 years). Fifteen patients were diagnosed with acute aortic dissection(Standford A). Thirteen patients were of Marfan syndrome including 8 patients with aortic dissection and 3 patients of bi-leaflet aortic valve malformation with aortic dissection. The patients were followed up for 6 months to 50 months. Thirteen patients of mini-root operation without other procedure(mini-root operation group) were selected to compare with 8 patients of Bentall operation(Bentall operation group). Some clinical indexes were compared between the two groups. ResultsThree patients died in hospital, in which 1 died from low cardiac out-put syndrome and multiple organ failure, 1 from descending aortic aneurysm rupture, and 1 from acute cerebral infarction. Three patients suffered with acute renal insufficiency and received hemodialysis. During the follow-up, 1 patient received continuous kidney dialysis treatment, and 3 patients performed reoperation. Compared with the Bentall group, the cardiopulmonary bypass time was shorter (108.5±20.8 min vs. 138.5±19.0 min), postoperative blood transfusion volume in the first 24 h was less(661.6±135.0 ml vs. 1 381.2±517.5 ml) than those in the mini-root group. ConclusionModified mini-root technique can significantly shorten the operation time and reduce the amount of blood transfusion in the treatment of aortic root diseases. The modified mini-root technique has obvious effect on selected aortic root diseases during perioperative period.
ObjectiveTo summarize the clinical experience of aortic valve replacement surgery with minimally invasive procedure. MethodsWe retrospectively analyzed the clinical data of 72 patients underwent isolated aortic valve replacement in our hospital between January 2011 and August 2013. The patients undergoing minimally invasive procedure were as a minimally invasive group(30 patients with 18 males and 12 females at age of 60.2±13.4 years). The patients undergoings conventional procedure were as a control group(42 patients with 27 males and 15 females at age of 61.3±14.5 years). The outcomes of the two groups were compared. ResultsThere was no death and severe complication in both groups. Postoperative echocardiography showed no paravalvular leakage, no valve dysfunction in both groups. There were no significant statistically differences between the two groups in cardiopulmonary bypass time, aortic crossclamping time, ventilation time, postoperative left ventricle ejection fraction, the length of ICU stay and hospital stay (P>0.05). Blood transfusion ratio, blood transfusion volume and blood loss volume were lower in the minimally invasive group than those in the control group (P<0.05). The length of incision, chest closure time, operative duration were shorter in the minimally invasive group than those in the control group (P<0.05). ConclusionUpper median sternotomy is a safe and feasible procedure for minimally invasive aortic valve replacement surgery. Compared with conventional aortic valve replacement, its advantages include less surgical trauma, stable sternum, rapid recovery, less blood loss and blood transfusion, and cosmetic outcomes.
The implantation of a left ventricular assist device (LVAD) is an important therapeutic tool for patients with end-stage heart failure, which can either help patients transition to the heart transplantation stage or serve as destination therapy until the end of their lives. In recent years, the third generation of LVADs has evolved rapidly and several brands have been marketed both domestically and internationally. The number of LVAD implantations has been increasing and the long-term survival rate of implanted patients has been improving, so this device has a broad development perspective. This paper summarizes the current status of the development of LVAD and its problems, and is expected to be helpful to researchers who are approaching the field for the first time.
Objective To determine risk factors associated with postoperative hypoxemia after surgery for acute aortic dissection. Methods We retrospectively analyzed clinical data of 116 patients with acute aortic dissection who underwent endovascular stent-graft exclusion or open surgery in Qingdao Municipal Hospital from February 2007 to February 2012. All the 116 patients were diagnosed as acute aortic dissection by CT angiography （CTA），including 60 patients with Stanford type A aortic dissection and 56 patients with Stanford type B aortic dissection. According to whether they had postoperative hypoxemia，all the 116 patients with acute aortic dissection were divided into hypoxemia group［arterial partial pressure of oxygen （PaO2） /fraction of inspired oxygen （FiO2） ＜200 mm Hg］：33 patients including 28 males and 5 females with their age of 52.7±11.4 years； and non-hypoxemia group（PaO2/FiO2≥200 mm Hg）：83 patients including 66 males and 17 females with their age of 55.0±13.8 years. Perioperative clinical data were analyzed and compared between the two groups. Multivariate logistic regression was performed to identify risk factors of postoperative hypoxemia after surgery for acute aortic dissection. Results The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.4% （33/116）. Perioperative death occurred in 13 patients（11.2%，including 8 patients in the hypoxemia group and 5 patients in the non-hypoxemia group）. Univariate analysis showed that preoperatively the percentages of patients with body mass index（BMI） ＞ 25 kg/m2，smoking history，duration from onset to operation ＜24 h，preoperative PaO2/FiO2≤300 mm Hg，and patients undergoing open surgery in the hypoxemia group were significantly higher than those in the non-hypoxemia group（P＜0.05）. Deep hypothermic circulatory arrest（DHCA） ratio，blood transfusion in 24 hours postoperatively，mechanical ventilation time，length of ICU stay and hospital stay in the hypoxemia group were significantly higher or longer than those in the non-hypoxemia group（P＜0.05）. Logistic multivariate regression identified BMI＞25 kg/m2（RR=98.861，P=0.006），DHCA（RR=22.487，P=0.007），preoperative PaO2/FiO2≤300 mm Hg（RR=9.080，P=0.037） and blood transfusion＞6 U in 24 hours postoperatively（RR=32.813，P=0.003） as independent predictors of postoperative hypoxemia for open-surgery patients，while BMI＞25 kg/m2 （RR=24.984，P=0.036） and preoperative PaO2/FiO2 ratio≤300 mm Hg （RR=21.145，P=0.042） as independent predictors of hypoxemia for endovascular stent-graft exclusion patients. Conclusion Postoperative hypoxemia is a common complication after surgery for acute aortic dissection. Early interventions for obesity and preoperative hypoxemia，and reducing perioperative blood transfusion may decrease the incidence of postoperative hypoxemia after surgery for acute aortic dissection.