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.
ObjectiveTo investigate the feasibility and safety of hybrid coronary revascularization (HCR) in patients with multivessel coronary artery disease (MVCAD).MethodsA total of 50 patients with MVCAD who underwent HCR technique in our heart center from May 2016 to April 2019 were included in this study (a HCR group), including 38 patients who underwent two-stage HCR and 12 patients one-stop HCR. There were 39 males and 11 females, with an average age of 62.4 (46-82) years. Another 482 patients who underwent conventional median incision under off-pump coronary artery bypass grafting (OPCAB) at the same period were selected as control (an OPCAB group), including 392 males and 90 females, with an average age of 64.2 (48-84) years. The safety and feasibility of HCR were evaluated and compared with conventional OPCAB technique.ResultsThere was no perioperative death in both groups. Compared with the OPCAB, HCR was associated with shorter operation time, less chest tube drainage, lower requirement of blood transfusion, shorter mechanical ventilation time and shorter postoperative intensive care unit (ICU) stay (P<0.05). There was no statistical difference in the incidence of major adverse cardiac or cerebrovascular events during the follow-up of 6 to 36 months between the two groups.ConclusionHCR provides favorable short and mid-term outcomes for selected patients with MVCAD compared with conventional OPCAB.