ObjectiveTo summarize clinical outcomes of different end-to-end anastomotic methods for surgical treatment of acute Stanford type A aortic dissection (AD). MethodsBetween January 2012 and May 2013, 95 patients with acute Stanford type A AD received surgical treatment in Nanjing Hospital Affiliated to Nanjing Medical University. According to different end-to-end anastomotic methods, 72 patients were divided into 3 groups (23 patients undergoing Bentall procedure were excluded from this study). In group A, there were 23 patients including 18 males and 5 females with their age of 48.67±9.23 years, who received 'sandwich' anastomotic technique strengthening both the inner and outer layers of the aortic wall. In group B, there were 11 patients including 8 males and 3 females with their age of 48.00±9.17 years, who received pericardium strengthening only inner layer of the aortic wall. In group C, there were 38 patients including 29 males and 9 females with their age of 49.20±8.57 years, who received artificial graft that was anastomosed directly to the aortic wall without any reinforcement. Postoperative outcomes were compared among the 3 groups. ResultsEight patients (11.11%)died postoperatively including 1 patient in group A (1/23, 4.35%)and 7 patients in group C (7/38, 18.42%). One patient in group A died of persistent wound errhysis and later disseminated intravascular coagulation. Three patients in group C died of persistent anastomotic incision errhysis and circulatory failure. Four patients in group C died of postopera-tive severe tricuspid regurgitation, secondary severe low cardiac output syndrome and multiple organ dysfunction syndrome. Severe postoperative complications included renal failure in 5 patients, respiratory failure in 7 patients, severe cerebral infarction and paralysis in 1 patient, paresis in 3 patients, delayed recovery of consciousness in 2 patients, and ischemic necrosis of the lower limb in 1 patient. Postoperative thoracic drainage amount in group C was significantly larger than that of the other 2 groups, and there was no statistical difference in thoracic drainage amount between group A and group B. Sixty-four patients were followed up for 1 to 6 months, and there was no late death during follow-up. Among the 5 patients with postoperative renal failure, only 1 patient needed regular hemodialysis, and renal function of the other 4 patients returned to normal. One patient with cerebral infarction recovered partial limb function and was able to walk with crutches. All the 3 patients with paresis recovered their limb function. ConclusionsAnastomotic quality of end-to-end anastomosis is of crucial importance for surgical treatment of acute Stanford type A AD. Appropriate reinforcement methods can be chosen according to individual intraoperative findings. 'sandwich' anastomotic technique can significantly reduce incision errhysis, prevent acute myocardial infarction caused by aortic anastomotic tear, and decrease postoperative mortality. If coronary ostia are involved in AD, concomitant coronary artery bypass grafting is needed.
ObjectiveTo summarize clinical experience and outcomes of modified Bentall procedure for the treatment of Stanford type A3 aortic dissection (AD). MethodsFifty-four patients with Stanford type A3 AD underwent aortic root replacement in Nanjing Hospital Affiliated to Nanjing Medical University from January 2004 to June 2013. There were 41 male and 13 female patients with their age of 21-73 years. According to different surgical methods, all the 54 patients were divided into 2 groups. In group A, there were 36 patients who received conventional Bentall procedure. In group B, there were 18 patients who received modified Bentall procedure ('gate' anastomosis of the coronary ostia for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia). Postoperative outcomes were compared between the 2 groups. ResultsThere was no statistical difference in age or gender between the 2 groups. Mean diameter of the aortic root of group A was significantly larger than that of group B (52.11±3.62 mm vs. 40.72±2.67 mm, P=0.000). There was no statistical difference in operation time, cardiopulmonary bypass time, intraoperative circulation arrest time, postoperative thoracic drainage or length of ICU stay between the 2 groups (P > 0.05). Four patients died postoperatively including 2 patients with uncontrollable bleeding, 1 patient with abdominal AD rupture and 1 patient with acute pulmonary embolism. There was no statistical difference in in-hospital mortality between group A and group B[5.56% (2/36)vs. 11.11% (2/18), P=0.462]. Forty-eight patients were followed up for 3 months, and 2 patients were lost during follow-up. Forty-eight patients received computed tomography angiography without false aneurysm formation in the aortic root, coronary ostial aneurysm or stenosis. ConclusionModified Bentall procedure ('gate' anastomosis of the coronary ostia)is simple and effective for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia.
Congestive heart failure is a complication of myocardial infarction threatening human health. Although the pharmacotherapy is effective, it is still a worldwide challenge to thoroughly repair the injured myocardium induced by myocardial infarction. It has been demonstrated that mesenchymal stem cells (MSCs) can repair infarcted myocardium. Much evidence shows that MSCs can generate new myocardial cells in both human and animals' hearts. This review aims at discussing the therapeutic progress of the congestive heart failure treated with MSCs.