Hybrid cardiovascular surgical procedure is an emerging concept that combines the skills and techniques of minimally invasive surgery and interventional catheterization. It allows surgeons to use interventional equipment and techniques during operations, which are traditionally used by physicians, in order to reduce the magnitude of therapeutic interventions and to increase therapeutic effectiveness. This review provides a snapshot of the main application and progress of current hybrid procedures in the field of cardiovascular surgery, including the hybrid therapy of coronary artery disease, congenital heart disease and thoracic aortic aneurysm, also discusses the precondition with which the hybrid procedure should ideally be performed.
Objective To study the mRNA expressions of protein kinase C(PKC) and nerve growth factor (NGF) in rat sciatic nerve and the number ofaxons after phorbol-12-myristate-13-acetate (PMA) was injected into silicone chamber. Methods Forty-two SD adult rats were divided into six groups depending on the time of injury (1 day, 3 days, 1 week, 2 weeks, 3 weeks and 4 weeks). A 0.5 cm nerve was cut in doublerat sciatic nerves and “T” type silicone chamber was sutured. PMA at the concentration of 1×10-9mol/L was injected discontinuously into the right side of Ttype silicone chamber(PMA group) and saline was injected into the left side(control group). Nucleic acid in situ hybridization histochemistry technique and thecomputer imagine analysis were employed to detect dynamic changes of PKC mRNA and NGF mRNA in rat sciatic nerves. The number of axons was measured. Results The expressions of PKC mRNA and NGF mRNA increased after injury, and the expressions of PKC mRNA and NGF mRNA reached the peak 2 weeks and3 weeks after injury respectively in control group. The expressions of PKC mRNA and NGF mRNA in PMA group were significantly increased than those in control group 2,3 and 4 weeks after injury(Plt;0.01).The number of axons in PMA group significantly increased than that in control group(Plt;0.01). Conclusion PKC involved inthe expression of NGF mRNA and nerve regeneration after injury. During the regenerated course, PMA can promote the expression of NGF mRNA and the number of axons after injury.
ObjectiveTo review clinical techniques and outcomes of one-stage hybrid surgery for complex Stanford type B aortic dissection (AD), and explore the feasibility of this surgery in basic-level hospitals. MethodsSeven patients with complex Stanford type B AD underwent one-stage hybrid surgery from December 2010 to March 2013 in Department of Cardiothoracic Surgery of Xiangyang Central Hospital. There were 2 males and 5 females with a mean age of 50.0±8.3 years. Preoperative computed tomography angiography (CTA)found that the distance between breach and left subclavian artery opening was less than 15 mm in 4 patients, and left subclavian artery root were involved in 3 patients. One patient had several calcification sites of the thoracic aorta and coronary arterial stenosis near the middle segment of anterior descen-ding coronary artery by about 70%. All the patients received general anesthesia and endotracheal intubation. Firstly, bypass surgery of the branches of the aortic arch was performed via neck incision in the operating room, then endovascular aortic repair (EVAR)using femoral artery incision was performed in the catheter room. The patient with coronary artery disease received concomitant stenting of the anterior descending artery. ResultsAll the patients successfully received the operation and EVAR. Postoperatively, 1 patient had mild type Ⅰ endoleaks. No death or severe complication occurred in this group. Intraoperative angiography showed that blood flow in true lumen of AD became normal, all the bypass grafts were unobs-tructed, the positioning of stent grafts was accurate, and no stent displacement was found. All the 7 patients were followed-up for 3-24 (12.0±3.6)months, and all the patients were alive and resumed normal life during follow-up. In 6 patients, CTA at 3 months, 1 year or 2 years after the operation showed no stent graft translocation, endoleak, bypass or graft obstruction. In 1 patient with typeⅠendoleaks, CTA at 3 months after the operation showed contrast agent in the false lumen, but partial thrombosis occurred, the size and scope of false lumen were smaller than preoperative values, and the true lumen significantly became larger. CTA at 6 months after the operation showed that leakage had disappeared. None of the patients had any sign of brain or limb ischemia. ConclusionOne-stage hybrid surgery is safe and effective for the treatment of complex Stanford type B AD, expands the treatment indications of EVAR, and is worthy of widely application in basic-level hospitals.
Objective To systematically review the efficacy, safety and economic value of hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) for Chinese patients with multivessel coronary artery disease. Methods We searched PubMed, WanFang Data, CNKI, Web of Science and The Cochrane Library (Issue 2, 2016) to collect case-control studies about HCR versus CABG for Chinese patients with coronary multivessel disease from the January 1996 to April 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then meta-analysis was performed by using RevMan 5.1 software. Results A total of 9 studies, involving 1 231 patients were included. The results of meta-analysis showed that: compared with the CABG groups, HCR group had lower length of ICU stay (MD=–25.84, 95% CI –42.55 to –9.13,P=0.002) and intubation time (MD=–4.06, 95% CI –6.43 to –1.69,P=0.000 8). However, there were no significant differences between both groups in the length of hospital stay (MD=–0.64, 95% CI –2.53 to 1.25,P=0.51), the incidence of atrial fibrillation (OR=1.41, 95% CI 0.86 to 2.30,P=0.17) and renal failure (OR=1.56, 95% CI 0.89 to 2.74,P=0.12). No significant differences were found between both groups in mortality (OR=0.36, 95% CI 0.12 to 1.11,P=0.07), the incidence of myocardial infarction (OR=0.32, 95% CI 0.06 to 1.85,P=0.20) and the incidence of target vessel revascularization (OR=1.16, 95% CI 0.48 to 2.76,P=0.74). But the incidence of the stroke (OR=0.35, 95% CI 0.14 to 0.91,P=0.03) and MACCEs (OR=0.37, 95% CI 0.20 to 0.70,P=0.002) of the HCR group were lower than those of the patients of the CABG group. Conclusion The current evidence shows that, compared with the CABG groups, HCR had lower incidence of stroke and MACCEs, however, the safety and efficacy were not significantly different between both groups. Due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion.
Objective Using molecular biology method to detect and genotype human papilloma virus (HPV) in women taking physical examination in West China Hospital, Sichuan University, to explore the infection status and genotype distribution of HPV in normal women in Chengdu area, and to provide basis for early effective prevention and control of cervical cancer and domestic research and development of HPV vaccine. Methods Flow fluorescent hybridization technique was used to detect and genotype HPV-DNA in 25 148 healthy women taking physical examination in West China Hospital, Sichuan University between May 1st, 2018 and May 31st, 2019. The overall positive HPV infection rate, HPV genotype distribution, and characteristics of HPV infections were analyzed and calculated, and the HPV infection rates of different age groups were calculated and compared by chi-square test using SPSS 17.0 software. Results The overall positive rate of HPV infection was 12.19% (3 066/25 148). The high-risk HPV genotypes infection rate was 8.69% (2 186/25 148), and the top five subtypes with the highest infection rates were HPV52, HPV53, HPV58, HPV16, and HPV39. The low-risk HPV genotypes infection rate was 4.66% (1 171/25 148), and the top five subtypes with the highest infection rates were HPV61, HPV81, HPV43, HPV44, and HPV6. Single subtype infections were the main infections with a proportion of 81.74% (2 506/3 066), and the most common multiple infections were double infections which accounted for 13.96% (428/3 066). In different age groups, the HPV infection rate of group 60-69 was the highest (12.87%), while that of group 70-89 was the lowest (10.88%), but the difference among different age groups was not statistically significant (χ2=4.035, P=0.544). Conclusion According to the results of this study in women taking physical examination in West China Hospital, Sichuan University, we suggest adding HPV52, HPV53, and HPV58 which have the highest infection rate in high-risk HPV subtypes to the evaluation of domestic HPV vaccine screening and the cervical cancer prevention and control system.
The conventional total arch replacement (cTAR) with frozen elephant trunk implantation is commonly regarded as the gold standard for aortic pathologies involving ascending aorta and proximal aortic arch. By combining open supra-aortic vessels debranching and emerging endovascular technologies, hybrid arch repair (HAR) has been increasingly performed as a promising alternative in risky patients with comorbidities and frailties. Nevertheless, the advantages or disadvantages of hybrid arch procedures and cTAR in terms of survival and related outcomes remain controversial. This study is aimed to briefly review the role and results of HAR in the management of aortic arch pathology in comparison of contemporary cTAR.