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.
目的 分析75岁以上高龄冠心病患者行冠状动脉旁路移植术（CABG）的治疗效果和临床经验。 方法回顾性分析山东省潍坊市人民医院和青岛市市立医院自2005年1月至2014年1月109例75岁以上行CABG术患者的临床资料。其中，男63例、女46例，平均年龄（78.1±4.2）岁，均为多支血管病变。术前心功能分级（NYHA） Ⅳ级23例、Ⅲ级57例、Ⅱ级29例。术中行非体外循环CABG （OPCABG） 92例，体外循环下行CABG （on pump CABG）术9例，体外循环辅助心脏不停跳下CABG （on pump beating heart CABG） 术8例。 结果 平均移植血管（2.5±1.4）支，围术期死亡4例，死亡率3.7%。其中，低心排血量综合征死亡1例，心律失常心室颤动死亡1例，肾衰和胃肠道并发症导致多器官衰竭死亡2例。术后主要并发症为心律失常、低心排血量综合征和肺部感染。105例生存患者95例获得随访，随访6～90 （45±26）个月，随访率90.5%。随访期间心源性死亡1例，非心源性死亡4例。患者心功能分级（NYHA）Ⅰ级81例，Ⅱ级18例，Ⅲ级2例，心绞痛消失。 结论 75岁以上冠心病患者行冠状动脉旁路移植术可改善患者症状，缓解心绞痛，提高生活质量，具有良好的近中期效果。
Objective To identify the predictors of prolonged stay in the intensive care unit (ICU) in patients undergoing surgery for acute aortic dissection type A. Methods We retrospectively analyzed the clinical data of 80 patients who underwent surgery for acute aortic dissection type A in Qingdao Municipal Hospital from December 2009 through December 2013. The mean age of the patients was 48.9±12.5 years, including 54 males (67.5%) and 26 females (32.5%). The patients were divided into two groups based on their stay time in the ICU. Prolonged length of ICU stay was defined as 5 days or longer time in the ICU postoperatively. There were 67 patients with length of ICU stay shorter than 5 days, 13 patients with length of ICU stay 5 days or longer time. Univariate and multivariate analysis (logistic regression) were used to identify the predictive risk factors. Results The length of ICU stay was 63.2±17.4 hours and 206.9±25.4 hours separately. Overall in-hospital mortality was 3.0% and 15.4% respectively in the two groups. In univariate analyses, there were statistically significant differences with respect to the age, the European system for cardiac operative risk evaluation (EuroSCORE), the preoperative D-dimmer level, total cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA), inotropes and occurrence of postoperative stroke, acute renal failure and acute respiratory failure, ICU stay duration and hospital stay duration between the patients with length of ICU stay shorter than 5 days and longer than 5 days. Multivariate logistic analysis showed that CPB time, occurrence of postoperative stroke, acute renal failure, or acute respiratory failure were independent predictors for prolonged ICU stay. Conclusion The incidence of prolonged ICU stay is high after surgery for acute aortic dissection type A. It can be predicted by CPB time, occurrence of postoperative stroke, acute renal failure, and acute respiratory failure were independent predictors for prolonged ICU stay. For patients with these risk factors, more perioperative care strategies are needed in order to shorten the ICU stay 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.
Objective To determine the anti-apoptosis effects of heme oxygenase-1 (HO-1) on lung injury after cardiopulmonary bypass (CPB), and to investigate its probable mechanisms. Methods A total of 144 male Wistar rats with wight of 250-350 g were divided into 3 groups: group A (control group), group B (cobalt protoporphyrin, CoPP), and group C [CoPP and zinc protoporphyrin (ZnPP)] randomly. A modified rat model of CPB-induced lung injury was established. And then the lung tissues were taken at different times for the relevant indicators test: before CPB (T0), immediately after CPB (T1), 2 h after CPB (T2), 6 h after CPB (T3), 12 h after CPB (T4), and 24 h after CPB (T5). The expression of HO-1 and Bcl-2 protein in each group was tested by immunohistochemistry, and cell apoptosis by TUNEL. Results The HO-1 protein expression in group B was significantly higher than that in groups A and C at any given time point, so was the HO-1 activity (P<0.05). There was no significant difference in Bcl-2 expression of lung tissue before CPB among each group (P>0.05). The Bcl-2 protein reduced gradually after CPB. The expressions of Bcl-2 protein in group B at all time points after bypass were significantly higher than that in groups A and C (P<0.05). The apoptosis index (AI) showed no significant difference before CPB in each group (P>0.05), and increased gradually after CPB. AI in group B at any time point after bypass was lower than that in groups A and C (P<0.05). The HE staining results showed that the damage of lung tissue in group B obviously reduced compared with groups A and C. Conclusion CoPP can induce a large amount of HO-1 expression in the lung tissue, and it is still highly expressed after CPB. So it plays an important role in anti-apoptosis through the up-regulation of Bcl-2 protein expression.
ObjectiveTo identify the predictors of postoperative acute kidney injury in patients undergoing surgery for Stanford type A acute aortic dissection. MethodsA total of 220 patients who underwent surgery for type A acute aortic dissection in Qingdao Municipal Hospital from September 2010 to September 2017 were divided into two groups including a group A and a group B based on whether acute kidney injury occurred or not after surgery. There were 40 patients with 29 males and 11 females with the mean age of 54.6±9.2 years in the group A, 180 patients with 133 males and 47 females with the mean age of 48.5±7.9 years in the group B. Univariate and multivariate analyses (logistic regression) were used to identify the predictive risk factors.ResultsOverall in-hospital mortality was 5.5%. In univariate analysis, there were statistically significant differences with respect to the age, preoperative creatinine, preoperative white blood cell, the European system for cardiac operative risk evaluation (EuroSCORE), total cardiopulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA) time, arch replacement, red blood cell transfusion intraoperative and in 24 hours postoperatively, postoperative mechanical ventilation time, ICU stay duration, hospital stay duration and in hospital mortality. Multivariate logistic analysis showed that preoperative creatinine, preoperative white blood cell, CPB time, and red blood cell transfusion intraoperative and in 24 hours postoperatively were the independent predictors for postoperative acute kidney injury.ConclusionThe incidence of acute kidney injury is high after surgery for acute Stanford type A aortic dissection. It can be predicted based on above factors, for patients with these risk factors, more perioperative care strategies are needed in order to induce the incidence of acute kidney injury.
ObjectiveTo explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and aortic dissection (AD).MethodsFifty three patients with AD diagnosed by CTA in our hospital from January 2016 to January 2018 were selected. All the patients with AD were scored by the STOP-BANG questionnaire. The patients who scored more than or equal to 3 received polysomnography (PSG) after surgical or conservative treatment, and according to whether the sleep apnea-hypopnea index was higher than or equal to 5. Fifty-three patients were divided into an OSAHS group and a non OSAHS group.ResultsThere were 18 patients with 17 males and 1 female at average age of 43.3±8.4 years in the OSAHS group, and 35 patients with 23 males and 12 females at average age of 56.6±12.9 years in the non OSAHS group. There was no statistical difference between the two groups in the Stanford classification of aortic dissection, the time of onset, personal history, the history of diabetes, coronary heart disease and hyperlipidemia, or post-treatment systolic/diastolic blood pressure before sleep (P>0.05). The age of patients in the OSAHS group was significantly less than that in the non OSAHS group (P<0.01), the proportion of men/women (P=0.021), weight (P<0.01), height (P=0.028), body mass index (P<0.01), and post-treatment systolic/diastolic blood pressure after waking up (P=0.028,P=0.044) in the OSAHS group were significantly higher than those in the non OSAHS group. In the OSAHS group, the proportion of previous hypertension was significantly higher than that in the non OSAHS group (P=0.042).ConclusionAD patients combined with OSAHS are mostly male patients. The number of young and high-fat people is significantly more than that in the non OSAHS group. OSAHS may be one of the risk factors for young, high-fat men with AD.