So far, there have been several kinds of valvuloplasty techniques for Ebstein's anomaly. Cone reconstruction which was developed by Da Silver and his coworkers has attracted much attention from worldwide cardiac surgeons. Because this technique could reconstruct the leaflet to leaflet coapatation which permits central blood flow during diastole period. It is probably the most efficient anatomical correction method. We make a comprehensive literature retrieval concerning the Cone reconstruction for Ebstein's anomaly. Its development, key points of technique skills and prognosis evaluation are reviewed meticulously.
Significant atrioventricular valve (AVV) insufficiency has been associated with increased mortality and morbidity in patients with single ventricle. Although techniques such as annuloplasty, chordal elongation, and the use of pericardial patches can improve AVV function in many patients, a number of patients continue to have significant AVV insufficiency and may require AVV replacement. The present review made a comprehensive literature review concerning the outcome, optimal timing, key points of technique skills and prognosis evaluation.
ObjectiveTo systematically evaluate the influence of posterior mediastinal and retrosternal route on the incidence of complications in patients with esophageal carcinoma after esophagectomy. MethodsA systematic literature search for studies which were published on PubMed, EMbase, CBM, VIP was performed from database establishment to April 2014. We included randomized controlled trials and case control studies related to the influence of two routes on the incidence of complications of patients with esophagectomy. We assessed the methodology quality of included researches, and extracted data. RevMan 5.2 was used for meta-analysis. ResultsA total of 23 studies including 7 randomized controlled trials and 16 case control studies were included in this study. Meta-analysis showed that there was statistically significant difference in case control studies related to anastomotic leakage between two groups[OR=0.39, 95%CI (0.30, 0.50), P < 0.01]. However, no statistical difference in anastomotic stricture was observed between the two groups[randomized controlled trials:RR=0.80, 95%CI (0.49, 1.30), P=0.36; case control studies:OR=0.64, 95%CI (0.40, 1.03), P=0.07]. And there was no statistical difference in cardiac complications[randomized controlled trials:RR=0.70, 95%CI (0.46, 1.06), P=0.09; case control studies:OR=1.13, 95%CI (0.70, 1.81), P=0.62]. There was also no statistical difference in pulmonary complications[randomized controlled trials:RR=1.27, 95%CI(0.92, 1.75), P=0.14; case control studies:OR=0.91, 95%CI (0.66, 1.27), P=0.59]. Besides, there was also no statistical difference in postoperative mortality[randomized controlled trials:RR=0.47, 95%CI (0.19, 1.16), P=0.10; case control studies:OR=0.18, 95%CI (0.03, 1.01), P=0.05]. ConclusionFor patients with esophageal carcinoma undergoing esophagectomy and reconstruction, the incidence of anastomotic leakage was significantly lower with posterior mediastinal route than that of retrosternal route.
ObjectiveTo explore a standardized model for cardiothoracic surgery resident training program based on a combined clinical and research oriented team approach. Methods We conducted this study in a nationally ranked Class AAA hospital among the eleven residents who were accepted into the program. Throughout their training periods, clinical surgical skills were taught by one-on-one mentoring by individually assigned doctoral degree advisors, other attending surgeons and doctoral degree candidates in the program. To foster their scientific curiosity and research skills, regular didactic lectures in basic science and statistical skills by the doctoral thesis advisors, supplemented by monthly journal clubs during which trainees were required to present and discuss a previously assigned topics based on recent clinical cases within the department, thus combining acquisition of clinical skills and theory/research at the same setting. ResultsEleven physicians were selected for this training path. With respect to clinical surgical skills, 4 residents were judged to be sufficient at the end of the first cycle. The other seven residents at the end of the second cycle. One trainee won the third prize in the Medical Skill Competition in the hospital. As for scientific research skills, the team produced 11 scientific articles, one of which was accepted by the annual national conference in cardiothoracic surgery and the first author was invited to present the article. The team submitted four research projects, one won funding at the provincial competition and three within the medical school. ConclusionOur proposed standardized model of cardiothoracic surgery resident training based on a combined clinical and research oriented approach appears to be practical with moderate success. Adaptation of this model by other cardiothoracic surgery training programs in the nation will further attest to its value and functionality.
ObjectiveTo compare the complication morbidity of mechanical and hand-sewn esophagogastric anastomosis systemically. MethodsMedline (January 1960 to June 2015), EMbase (January 1980 to June 2015), Cochrane Library (January 1996 to June 2015), Web of Science (January 1980 to June 2015) and other databases were searched to identify randomized controlled trials (RCTs) about comparing the complication morbidity of hand-sewn and mechanical anastomosis. Moreover, the references were searched by search engines such as Google Scholar. Papers were screened according to the inclusion and exclusion criteria. And then the data were extracted. The quality of current meta-analysis was assessed by GRADE profiler 3.6 software. The meta-analysis was conducted using Stata 12.0 software. ResultsA total of 1 611 patients in 14 RCTs were reviewed. The results suggested that the anastomatic leakage rate of mechanical method showed no significant difference from that of hand-sewn method[RR=1.07, 95%CI (0.76, 1.51), P=0.699]. While the anastomatic stenosis rate was even higher[RR=1.59, 95%CI (1.21, 2.09), P=0.001]. ConclusionMechanical method can't reduce the anastomotic leakage rate following esophagogastrostomy, while it maybe increase the risk of anastomotic stenosis on the contrary. The patients' physical condition should be considered when surgeons make the choice.
ObjectiveTo investigate the influence of semi-mechanical and hand-sewn esophagogastric anastomoses on postoperative anastomostic complications in patients undergoing esophagectomy. MethodsA systematic, computer-aided literature search was performed in PubMed, OVID, CNKI and BioMed databases for studies which were published from database establishment to December 2013. A manual literature search was also performed. We included randomized controlled trials (RCT)and observational studies which investigated the influence of semi-mechanical and conventional hand-sewn esophagogastric anastomoses on postoperative anastomostic complications. Quality assessment and data extraction were performed, and RevMan 5.2 was used for meta-analysis. ResultsTwelve relevant studies with 1 271 patients were included (3 RCTs and 9 observational studies).No significant heterogeneity among the 12 trials was found, so fixed effects model was used for meta-analysis.There was statistical difference in the incidence of postoperative anastomotic leak between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.34, 95%CI (0.12, 0.97), P < 0.05;observational studies OR=0.40, 95%CI (0.26, 0.62), P < 0.05]. Postoperative incidence of anastomostic stricture was reported in all 12 studies. There was statistical difference in the incidence of postoperative anastomotic stricture between hand-sewn and semi-mechanical esophagogastric anastomoses[RCT RR=0.14, 95%CI (0.04, 0.47), P < 0.05;observational studies OR=0.22, 95%CI (0.15, 0.34), P < 0.000 1]. ConclusionsCompared with conventional hand-sewn anastomosis, semi-mechanical esophagogastric anastomosis can significantly reduce the incidence of postoperative anastomostic leak and stricture. Due to limited quantity and quality of included studies, more high-quality studies with larger sample size including RCT and non-randomized studies are needed to confirm these findings.