Objective To investigate the application of sequential noninvasive ventilation (NIV) in weaning patients off mechanical ventilation after coronary artery bypass grafting (CABG). Methods From July 2007 to July 2009, 52 patients who underwent CABG with mechanical ventilation for no less than 24 hours and P/F Ratio lower than 150 mm Hg were divided into two groups with random number table. In the sequential NIV group (SNIV group), there were 19 patients including 16 males and 3 females whose ages were 69.26±8.10 years. In the prolonged mechanical ventilation group (PMV group), there were 33 patients including 28 males and 5 females whose ages were 70.06±7.09 years. Clinical data of these two groups were compared and the influence of NIV on the circulation and respiration of the patients were observed. Results The SNIV group weaned off mechanical ventilation earlier than the PMV group (26.46±3.66 h vs. 38.65±9.12 h, P=0.013). The SNIV group held shorter total ventilation time (29.26±21.56 h vs.54.45±86.57 h,P=0.016), ICU stay time (2.44±2.99 d vs. 4.89±7.42 d, P=0.028) and postoperative hospital time (10.82±4.31 d vs. 14.01±19.30 d, P=0.039) than the PMV group. Furthermore, the SNIV group had lower pneumonia rate (5.26% vs. 30.30%, P=0.033) and total postoperative complication rate (10.53% vs.45.45%, P=0.030) than the PMV group. However, there was no significant difference (Pgt;0.05) between the two groups in the successful weaning rate, repeated tracheal intubation rate, tracheotomy rate and mortality 30 days after operation. After NIV, SNIV group had no significant change in heart rate, central vein 〖CM(1585mm〗pressure, pulmonary arterial pressure and pulmonary arterial wedge pressure than the baseline value, while systolic pressure (129.66±19.11 mm Hg vs. 119.01±20.31 mm Hg, P=0.031), cardiacindex ［3.01±0.30 L/(min.m2) vs. 2.78±0.36 L/(min.m2), P=0.043］ and P/F Ratio (205.95±27.40 mm Hg vs. 141.33±9.98 mm Hg, P=0.001) were obviously elevated. Conclusion Sequential NIV is a effective and safe method to wean CABG patients off mechanical ventilation.
ObjectiveTo evaluate the effects of modified left ventricular reconstruction (LVR) and linear repair (LR) to post-infarct left ventricular aneurysm (LVA) and summarize the surgical experience of LVA. MethodsFrom May 2004 to December 2011, 47 patients were admitted in the Department of Cardiovascular Surgery, Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University. There were 25 patients underwent LVR (group LVR, including 21 males and 4 females), 18 patients underwent LR (group LR, including 14 males and 4 females) and 4 patients underwent directly sutured (including 3 males and 1 female). Among them, 42 patients underwent coronary artery bypass grafting (CABG). During 6-24 months'follow-up, left ventricular ejection fraction (LVEF), quality of life and activity were measured. ResultsPostoperative LVEF was significantly higher than preoperative LVEF in group LVR(49.2%±13.6% vs. 32.5%±12.9%, P < 0.05) and group LR (47.5%±11.6% vs. 36.9%±11.6%, P < 0.05). One patient died in LR group (5.5%) and 1 died in LVR group (4.0%), no death occurred in directly sutured surgery. Total mortality was 4.2%. ConclusionLVR and LR are both effective treatment for LVA. Personalized treatment can receive satisfactory short-and long-term outcomes.
目的 总结冠心病行不停跳冠状动脉旁路移植术（OPCAB）中，右冠状动脉突发急性缺血事件的处理经验。 方法 2010 年 5 月至 2015 年 5 月我院共行 OPCAB 1 568 例，术中出现右冠状动脉急性缺血事件 22 例，其中男 16 例、女 6 例，年龄（66.5±9.7）岁。 结果 11 例患者于紧急右冠状动脉旁路移植术后、开放桥血管后 ST 段可以逐渐恢复正常，右心功能恢复，心律失常明显减少或消失。2 例患者右冠状动脉旁路移植后仍有右心功能不全表现，但经积极药物处理以及主动脉内球囊反搏（IABP）应用后逐步脱离危险期。1 例患者术后循环仍不稳定，最终于术后 2 d 死亡。总死亡率 4.5%。发生围术期心肌梗死 6 例，全组患者 IABP 应用 3 例。 结论 OPCAB 术中右冠状动脉突发缺血事件更多表现为心律失常，发生率虽低，但在无杂交手术室的情况下能够及时判断并正确处理右冠状动脉突发急性缺血事件至关重要，对患者术后及预后都有较积极的影响。
ObjectiveTo explore the single-center experience of hybrid therapy in treatment of Stanford type A aortic dissection, and to make a comparison of the clinical results of this hybrid therapy with total arch replacement surgery in the same period.MethodsFrom March 2017 to April 2020, 272 patients with Stanford type A aortic dissection underwent surgical treatment in our center, including 147 patients (126 males and 21 females) who received the aortic arch surgery. Among them, 106 patients underwent replacement of ascending aorta+aortic arch+stent trunk (total arch replacement group), while 41 patients underwent one-stop compound total arch type Ⅱ hybrid surgery (compound total arch replacement group). We tried to identify whether hybrid surgery really simplified total arch replacement surgery of the aortic dissection by comparing the operative mortality, postoperative complication rate, operative time, extracorporeal circulation time, etc.ResultsThere was no statistical difference in preoperative clinical data or death rate between the two groups. However, blood transfusion (6.74±7.35 U vs. 4.65±6.87 U, P<0.05), postoperative respiratory insufficiency [16 (15.09%) vs. 2 (4.88%), P<0.05], and apoplexy [3 (2.83%) vs. 0, P<0.05], paraplegia [2 (1.89%) vs. 0, P<0.05], in the compound total arch replacement group was significantly better than those of the total arch replacement group. The compound total arch replacement group did not shorten the total operation time, but it was significantly better in terms of extracorporeal circulation time (175.50±55.70 min vs. 129.70±48.80 min, P<0.05), aortic block time (103.10±23.70 min vs. 49.70±30.10 min, P<0.05), and the time of stopping the circulation or avoiding stopping the circulation (32.10±7.20 min vs. 0 min, P<0.05). The postoperative mechanical ventilation time was shorter in the compound total arch group (62.60±31.70 h vs. 41.30±32.60 h, P<0.05), and the time of staying in ICU (124.50±61.50 h vs. 63.40±71.20 h, P<0.05) and the postoperative hospital stay (13.50±11.20 d vs. 9.20±7.20 d, P<0.05) were significantly shorter than those in the total replacement group. A total of 138 patients were followed up for 6-38 (15.8±6.4) months. There was no statistical difference in one-year mortality or three-year mortality (P>0.05).ConclusionHybrid surgery shortens extracorporeal circulation time, while reduces or avoids the time of deep hypothermia circulatory arrest, the incidence of complications and the time of hospital stay. In conclusions, hybrid surgery simplifies the arch management of acute Stanford type A aortic dissection.
Abstract: Objective To evaluate surgical strategies for the treatment of acute Stanford type A aortic dissection with involvement of the aortic root. Methods From January 2005 to December 2010, 62 consecutive patients underwent emergency surgical intervention for acute Stanford type A aortic dissection with involvement of the aortic root in Renji Hospital Affiliated to Medical School of Shanghai Jiaotong University. According to different methods for the management of proximal aortic dissection, these patients were divided into 3 groups: group A, aortic valve commissural suspension＋supracommissural replacement of the ascending aorta （SCR）,including 28 patients （20 males and 8 females，mean age 45.2±15.6 years）; group B, partial sinus remodeling+ascending aortic replacement, including 10 patients （7 males and 3 females，mean age 44.6±14.9 years）；group C, Bentall procedure,including 24 patients （17 males and 7 females，mean age 46.2±15.6 years）. Clinical outcomes were compared among the three groups. Results Six patients died peri-operatively and in-hospital mortality was 9.67% （6/62）. Fifty-four patients were followed up, and the mean follow-up time was 27.3±15.7 months. During follow up, 2 patients died, one for lung cancer and the other for unknown reason. One patient in group A underwent CT scan 6 months after surgery which showed aortic root pseudo-aneurysm. Cardiopulmonary bypass time and aortic cross-clamping time of group C were significantly longer than those of group A and group B （274±97 min vs. 194±65 min, 210±77 min, t=22.482, 30.419, P=0.002， 0.122；150±56 min vs. 97±33 min, 105±46 min, t=12.630, 17.089, P=0.000，0.034）. There was no statistical difference in mortality （t=1.352，P=0.516）, incidence of postoperative reexploration for bleeding, acute renal failure and neurological complication （t=0.855, 0.342, 2.281; P=0.652, 0.863, 0.320） among the three groups. Conclusion For patients with acute aortic dissection involving the aortic root, aortic valve commissural suspension+SCR，partial sinus remodeling＋ascending aortic replacement and Bentall procedure may be considered the surgical treatment of choice with respective advantages and disadvantages. Satisfactory clinical outcomes can be achieveed if surgical indications and procedures are properly employed.
ObjectiveTo describe our experiences of application of off-pump coronary artery bypass grafting surgery (OPCABG) in coronary artery disease (CAD) patients with dilated left ventricle.MethodsA retrospective analysis of 303 patients with dilated left ventricle [left ventricular end-diastolic diameter (LVEDD)> 60 mm] who underwent OPCABG from January 2008 to December 2018 at a single center was conducted. There were 205 males and 98 females at age of 45-87 (66.9±9.3) years.ResultsThe mean pulmonary artery pressure in 90 patients was more than 25 mm Hg. Sixteen patients underwent OPCABG with emergent transition of extracorporeal circulation (CPB). Twenty-one patients underwent OPCABG with CPB at the beginning of CABG. Thirty-five patients underwent intra-aortic balloon counterpulsation (IABP). Four patients died during in-hospital time with the experience of emergent transition of CPB. Six months after operation, LVEDD and left ventricular ejection fraction (LVEF) were improved.ConclusionOPCABG is a safe and effective alternative for CAD patients with dilated left ventricle. However, for patients with higher pulmonary pressure and a spherical left ventricle after cardiac reshaping, there is a high risk of emergent transition of CPB during OPCABG; for this kind of patients, it is necessary to start CPB at the beginning of OPCABG.
ObjectiveTo analyze the safety and follow-up results of on-pump coronary artery bypass grafting (CABG) for the treatment of multivessel diseases via left anterolateral minithoracotomy.MethodsFrom January 2018 to March 2020, a total of 30 patients including 18 males and 12 females with an average age of 61.3±7.5 years having multivessel coronary heart diseases were treated in our hospital with on-pump CABG via left anterolateral minithoracotomy. Among them, 14 patients had three-vessel diseases and 16 patients had two-vessel diseases.ResultsThere were 29 internal mammary artery-to-left anterior descending bypass grafts harvested in total while the rest were saphenous-vein bypass grafts. The average number of bypass vessels was 2.3±0.5. There was no perioperative death in the whole group, one patient underwent rethoracotomy due to hemorrhage, and one patient suffered acute renal insufficiency. The average time of postoperative tracheal intubation was 16.0±5.8 hours, and the postoperative ICU stay was 30.1±11.5 hours. Twenty five patients were followed up, including coronary CT angiography examinations at 6 months and 1 year after operation. Proximal anastomotic stenosis in one patient and distal anastomosis occlusion in one patient occurred.ConclusionOn-pump CABG via left anterolateral minithoracotomy is safe for appropriately selected patients.
ObjectiveTo evaluate the perioperative, short- and mid-term results of total artery bypass grafting and saphenous vein bypass grafting in three-vessel coronary heart disease patients complicated with diabetes.MethodsRetrospective analysis was performed on 46 patients (a TAR group) including 36 males and 10 females with an average age of 65.1±11.3 years who underwent total artery bypass grafting in Renji Hospital affiliated to Shanghai Jiao Tong University Medical College from 2005 to 2014. A total of 46 patients with age and gender matched admitted during the same period were selected as a control group (NCR group), in which left internal mammary artery and great saphenous vein were used as grafting vessels. Preoperative, perioperative, and postoperative (1 year and 5 years) data of the two groups were analyzed.ResultsIn terms of perioperative data, the TAR group was inferior to the NCR group in operation time, postoperative 24 h drainage volume and postoperative 24 h blood transfusion volume. However, there was no difference between the two groups in terms of perioperative mortality, ICU stay, etc. One year after surgery, there was no difference in angina pectoris recurrence, recurrent myocardial infarction or grafting vessel patency rate between the two groups. Five years after the operation, the TAR group was superior to the NCR group in angina recurrence, myocardial infarction, and grafting vessels patency rate.ConclusionFor patients with three-vessel coronary heart disease complicated with diabetes, total arterial bypass grafting can achieve better mid-term effect, although it can prolong the operation time and increase the amount of drainage and blood transfusion 24 h after operation.