Heart transplantation remains the most effective treatment for patients with end-stage heart failure. Over the past decade, significant advancements have been made in the field of heart transplant surgery. However, the enormous demand from heart failure patients and the severe shortage of available donor hearts continue to be major obstacles to the widespread application of heart transplantation. With the development of donor heart recovery, preservation, and evaluation techniques, the use of extended criteria donors and donation after circulatory death has increased. These technological advancements have expanded the safe ischemic time and geographic range for donor heart procurement, significantly enlarging the donor pool and driving a rapid increase in heart transplant cases. Concurrently, many new techniques have emerged in heart transplant surgery and perioperative management, particularly the rapid advancements in mechanical circulatory support and artificial intelligence, which hold the potential to revolutionize the field. This article reviews and discusses the current status and major surgical advancements in adult heart transplantation in the United States, aiming to provide insights and stimulate ongoing exploration and innovation in this field.
目的 探讨和分析反流性食管炎与幽门螺杆菌感染之间的关系。 方法 回顾性分析2009年1月－2011年11月间胃镜确诊为反流性食管炎334例，所有患者均行快速尿素酶试验；其中反流性食管炎合并消化性渍疡57例，慢性非萎缩性胃炎102例。 结果 反流性食管炎的幽门螺杆菌感染率为21.6% ，在幽门螺杆菌感染阳性的患者中最多见并发消化性溃疡，而在幽门螺杆菌感染阴性的患者中最多见并发慢性非萎缩性胃炎，解剖结构和动力障碍性疾病绝大多数并发于幽门螺杆菌阴性患者。A和B级反流性食管炎的幽门螺杆菌感染阴性的患者多于幽门螺杆菌感染阳性的患者。在A级反流性食管炎中幽门螺杆菌感染率28.0%，B级为8.4%，C+D级为0.0%。 结论 反流性食管炎中幽门螺杆菌感染率低，幽门螺杆菌阳性的反流性食管炎多并发于消化性溃疡，提示幽门螺旋杆菌对反流性食管炎发病有一定保护作用。
ObjectiveTo investigate the therapeutic effect, safety and effectiveness of multiple valvular surgery through right anterolateral intercostal thoracotomy, as well as the mid-term follow-up results and surgeon's learning curve.MethodsThe clinical data of 154 patients with multiple valvular disease were performed minimally invasive cardiac surgery in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University, from 2015 to 2019 were retrospectively analyzed. There were 103 males and 51 females, aged 23-68 years. Closed cardiopulmonary bypass was established through femoral artery and femoral vein, and the thoracic cavity was entered through a 6 cm transverse incision in the fourth intercostal space on the right side of sternum. Baseline and perioperative characteristics and postoperative outcomes were reviewed.ResultsThere was no perioperative death. The average cardiopulmonary bypass time was 159.3±39.4 min, and the aortic clamping time was 102.3±20.3 min. One patient underwent thoracotomy during the operation, and two patients underwent second thoracotomy for hemostasis. During the follow-up period of 10-55 months, 1 patient died, 2 patients developed mild perivalvular regurgitation, 6 patients developed moderate tricuspid regurgitation, and no serious cardiovascular events occurred in the rest of the patients.ConclusionOur findings demonstrate that multiple valvular surgery through right anterolateral intercostal thoracotomy is safe, and in an acceptable risk of complication. The early and middle follow-up results are satisfactory. The minimally invasive cardiac surgery can also meet the requirements of cosmetology, and is conducive to the recovery of patients' mental and physical health. This method is worthy of application in medical centers with rich experience in routine cardiac surgery.