American College of Cardiology (ACC) issued the updated expert consensus decision pathway on the management of mitral regurgitation in April 2020. The whole process in caring patients with mitral valve regurgitation from patient evaluation to treatment choice was discussed in the consensus. The main change from the 2017 version is the confirmation of the effect of transcatheter mitral valve repair on secondary mitral regurgitation. It standardized the process in this field. In this paper, we aimed to introduce the focus update of this consensus.
Committee of Minimally Invasive Cardiovascular Surgery (CMICS) annually investigates the minimally invasive cardiovascular surgery performed by departments of cardiovascular surgery of all hospitals in China of last year, and makes classification and summary according to the operation amount of minimally invasive surgery, regional and hospital distribution, and publishes it on the theme report of China Minimally Invasive Cardiovascular Surgery Conference (CMC). In 2021, CMICS published the 2018-2019 annual data of Chinese cardiovascular surgery in the form of a white paper for the first time in the Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, which attracted great attention from peers. In this statistical report, CMICS will focus on the volume of minimally invasive cardiovascular surgery, regional and hospital distribution in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region, and Taiwan Province) in the 2020—2021 for your reference.
Recently, real world studies (RWS) have received increasing attentions. Such studies typically involve patient information, and their results may have potentially significant impact on patient well-being and safety. When reviewing the protocol of real world studies, ethical issues should be carefully considered and assessed. This paper discussed three issues, including the overview of bioethics and its application to classic clinical trials, key features of RWS, and medical ethical considerations on RWS.
Objective To approach the questions of donation after cardiac death （DCD） and transplantation through analyzing the DCD cases in this hospital. Methods The organs were obtained from 4 DCD from 2010 to 2011 in this hospital， the clinical data of DCD were analyzed retrospectively. Results Seven renal transplantations and 3 liver transplantations were performed. Donor warm ischemic time was 10-40 min. The liver and left kidney of the first DCD donator （Maastricht categoryⅣ） were eliminated through biopsy. One patient exhibited delayed graft function of kidney from the first DCD，the nephrectomy had to be done on day 7 after operation due to renal allograft rupture. Nine patients received 3 livers and 6 kidneys from the other 3 DCD donators （Maastricht categoryⅢ），whose patients were alive with excellent graft function. Conclusions The use of controlled DCD （Maastricht categoryⅢ） might be an effective way to increase the number of organs available for transplantation because that it might obtain satisfactory transplant outcomes and acceptable postoperative complications. The widespread implementation of controlled DCD in China should be encouraged.
Objective To share clinical experience of minimally invasive technique in surgical treatment of cardiac tumors. Methods Clinical data of 50 patients with cardiac tumors who underwent surgical teatment in Zhongshan Hospital of Fudan University from January 2011 to September 2014 were analyzed retrospectively. There were 18 males and 32 females aged from 32 to 65 years (mean age 47 years). Cardiac tumors were located in the left atrium in 44 (88%) patients and right atrium in 6 (12%) patients. Results There was no in-hospital death. All patients recovered well without any complications. Mean total operating, cardiopulmonary bypass and aortic cross-clamp time was 148±45 min, 56±23 min, 26±16 min, respectively. The average time to extubation was 5±3 hours and the median length of stay in the intensive care unit (ICU) and in the hospital was 9±6 hours and 5±3 days, respectively. All patients were followed up for 1 to 44 months without tumor recurrence except one. Conclusion Minimally invasive technique in surgical treatment of cardiac tumors via right anterolateral thoracotomy is a safe and feasible method with good cosmetic results and rapid postoperative recovery, and is worthy of clinical selective application for treatment of benign cardiac tumor.
ObjectiveTo discuss the feasibility of establishment of animal model of "functional" bicuspid aortic valve with swine and observe its effect on the wall shear stress inside the aorta. MethodsFour common Shanghai White Swine with body weight between 50 kg to 55 kg were selected. Under general anesthesia and cardiopulmonary bypass, the aortic transverse incision approach was used, continuous suture with 6-0 polypropylene to align the left and right coronary valve leaflets to create a bicuspid valve morphology. After the operation, echocardiography was used to observe the aortic valve morphology and the hemodynamic changes of the aortic valve orifice. The effect on the wall shear stress inside the aorta was studied with 4D-Flow magnetic resonance imaging (MRI). ResultsA total of 4 swine "functional" bicuspid aortic valve models were established, with a success rate of 100.0%. Echocardiography showed that the blood flow velocity of the aortic valve orifice was faster than that before the operation (0.96 m/s vs. 1.80 m/s). 4D-Flow MRI showed abnormally increased wall shear stress and blood flow velocity in the aorta of the animal models. After the surgery, in model animals, the maximal wall shear stress inside the ascending aorta was greater than 1.36 Pa, and the maximum blood flow velocity was greater than 1.4 m/s. ConclusionEstablishment of the animal model of "functional" bicuspid aortic valve in swine is feasible, scientific and reliable. It can be used in researches on evaluating the pathophysiological changes.
The minimally invasive cardiovascular surgery developed rapidly in last decades. In order to promote the development of minimally invasive cardiovascular surgery in China, the Chinese Minimally Invasive Cardiovascular Surgery Committee (CMICS) has gradually standardized the collection and report of the data of Chinese minimally invasive cardiovascular surgery since its establishment. The total operation volume of minimally invasive cardiovascular surgery in China has achieved substantial growth with a remarkable popularization of concepts of minimally invasive medicine in 2019. The data of Chinese minimally invasive cardiovascular surgery in 2019 was reported as a paper for the first time, which may provide reference to cardiovascular surgeons and related professionals.
ObjectiveTo investigate the effect of recipient hepatic artery reconstruction site selection on early ischemic-type biliary lesion (ITBL) after liver transplantation. Methods The clinical data of 656 cadaver liver transplantation were collected retrospectively from January 2015 to January 2020 in the Liver Transplantation Center of West China Hospital of Sichuan University and the Institute of Organ Transplantation of Tongji Hospital Affiliated to Huazhong University of Science and Technology. Patients were divided into two groups according to the reconstruction sites of recipient arteries. The distal group was anastomosed at left hepatic artery, right hepatic artery or proper hepatic artery. The proximal group was anastomosed at the gastroduodenal artery, the common hepatic artery or the common hepatic artery-gastroduodenal artery bifurcation. To investigate the differences in the incidence of early postoperative complications between the two groups and the factors influencing the development of ITBL within one year after transplantation. Results Of 656 patients, 262 were in the distal group and 394 were in the proximal group. The incidence of hepatic artery thrombosis was lower in the proximal group than that in the distal group (χ²=5.675, P=0.017), while the differences in the incidences of ITBL-related graft failure and rejection-related graft failure were not statistically significant when compared (all P>0.05). Multivariate logistic regression results showed that hepatic artery thrombosis [OR=4.453, 95%CI (1.318, 15.050), P=0.016] and cold ischemia time >6 h [OR=1.844, 95%CI (1.014, 3.353), P=0.045] were risk factors for early postoperative ITBL in the liver transplant patients, while different hepatic artery reconstruction categories were not risk factors for ITBL [OR=1.166, 95% CI (0.630, 2.157), P=0.625]. Conclusion Hepatic artery anastomosis reconstruction with the recipient common hepatic artery, gastroduodenal artery, and Carrel flap at the common hepatic artery-gastroduodenal artery bifurcation can somewhat reduce the difficulty of anastomosis and does not increase the risk of postoperative ITBL.
Mitral valve replacement is one of the most common heart valve surgeries in China. In recent years, with the increase in degenerative valve diseases, older patients, and the progress of anti-calcification technology of biological valves, the proportion of mitral valve biological valve replacement has been increasing year by year. After the damage of traditional mitral valve biological valves, re-operation of valve replacement with thoracotomy is required. However, the adhesion between the heart and sternum, as well as the damage caused by cardiopulmonary bypass and cardiac arrest, can cause significant trauma to elderly patients and those with multiple organ dysfunction, leading to increased mortality and complication rates. In recent years, interventional valve surgery, especially transcatheter valve-in-valve surgery, has developed rapidly. This procedure can correct the damaged mitral valve function without stopping the heart, but there are still many differences between its technical process and conventional aortic valve replacement surgery. Therefore, organizing and writing multicenter expert recommendations on the technical process of transcatheter valve-in-valve surgery for damaged mitral valve biological valves is of great significance for the training and promotion of this technology.