ObjectiveTo report our clinical experience and outcomes of thoracic endovascular aortic repair (TEVAR) for acute Stanford type A dissection using ascending aorta replacement combined with implantation of a fenestrated stent-graft of the entire aortic arch through a minimally invasive technique. MethodsFrom 2016 to 2020 in our hospital, 24 patients (17 males and 7 females, aged 45-72 years) with complicated Stanford type A aortic dissection, underwent replacement of the proximal ascending aorta with TEVAR. None of the patients with dissection involved the three branches of the superior arch, and all patients were replaced with artificial blood vessels of the ascending aorta under non-hypothermic cardiopulmonary bypass, preserving the arch and the three branches above the arch, and individualized stent graft fenestration. ResultsSurgical technical success rate was 100.0%. There was no intraoperative complication or evidence of endo-leak in 1 month postoperatively. Hospital stay was 10±5 d. During postoperative follow-up, the stent was unobstructed without displacement, the preserved branch of the aortic arch was unobstructed, and the true lumen of the descending aorta was enlarged. Conclusion This hybrid technique by using TEVAR with fenestrated treatment is a minimally invasive and effective method to treat high-risk patients with acute Stanford type A aortic dissection.
ObjectiveTo compare the superiority of total arterial revascularization in patients with coronary artery disease (CAD) complicated with left ventricular dysfunction. MethodsThis retrospective study included the patients who were diagnosed with CAD with the left ventricular ejection fraction (LVEF) of ≤ 40% and underwent coronary artery bypass grafting (CABG) at our hospital from January 2016 to July 2019. The data related to perioperative and postoperative follow-up were collected. The patients were divided into two groups according to the different types of bypass vessels: a total arterialization group (TAR group) and a conventional group. A wealth of clinical data were reviewed and compared between the two groups to explore the incidence of important complications and evaluate the safety of total arterial revascularization and its protective effect on cardiac function. Results Finally 75 patients were enrolled including 52 males and 23 females with a mean age of 61.58±7.93. The operation time and the drainage volume of 24 hours after operation in the TAR group were longer or more than those in the conventional group (P<0.05), but there was no statistical difference in hospital stay, postoperative complications (such as respiratory failure, mediastinal infection, renal failure), IABP or ECMO auxiliary rate (P>0.05). After 2 years of follow-up, compared with the conventional group, the cardiac function of the TAR group was significantly improved (P<0.05), the LVEF was higher (P<0.05), the left ventricular end diastolic diameter (LVEED) was reduced (P<0.05), and the bridge stenosis rate was lower (P<0.05). Conclusion Total arterial revascularization is a safe and feasible surgical method, which is helpful to improve the cardiac function and improve the quality of life.
[Abstract]A 70-year-old woman who was admitted to the hospital for post-cardiac surgery panic attack for 4 months. Eight months ago, she was admitted to a local hospital with 7 years of post-activity panic, which worsened for 2 months, and underwent mitral valve replacement+aortic valve replacement+tricuspid valvuloplasty+modified maze procedure+left auriculotomy. Four months after the operation, mitral valve damage appeared, and transcatheter mitral valve replacement was performed in our hospital by apical approach. A case report on the treatment of this patient is presented.