ObjectiveTo explore the feasibility of CORFLO feeding tube in enternal nutrition after video-assisted thoracoscopic Ivor Lewis esophagogastrectomy for esophageal cancer and cardiac adenocarcinoma. MethodsA total of 107 patients with esophageal cancer and cardiac adenocarcinoma undergoing video-assisted thoracoscopic Ivor Lewis esophagectomy or resection of cardiac adenocarcinoma in our department between October 2014 and January 2016 were enrolled, among whom 10 patients received jejunostomy and 97 patients (60 males, 37 females, median age of 66 years, range, 47-75 years) received the insertion of CORFLO feeding tubes. ResultsIn 97 cases with insertion of feeding tubes, median insertion time was 7 (3-11) min and median depth was 83 (75-90) cm. The first-attempt success rate during the operation was 77.3% (75/97), and the second attempt at the bedside postoperatively was successful in 8 cases. The overall success rate was 85.6% (83/97). Insertion was successful in 77 esophageal cancer patients and 6 cardiac adenocarcinoma patients. Conclusion Blind insertion of CORFLO feeding tube in video-assisted thoracoscopic Ivor Lewis esophagogastrectomy for esophageal cancer and cardiac adenocarcinoma is feasible and safe. This noninvasive method is simple, effective and repeatable.
ObjectiveTo investigate clinical outcomes of aortic valve replacement (AVR)for surgical treatment of patients with severe aortic stenosis (AS)and left ventricular dysfunction (LVD). MethodsClinical data of 29 patients with severe AS and LVD (left ventricular ejection fraction (LVEF) < 0.50)who underwent AVR in Changhai Hospital between January 2000 and December 2011 were retrospectively analyzed. Patients with mitral stenosis were excluded from this study. There were 22 male and 7 female patients with their age of 14-76 (56.3±12.9)years. Preoperative and postoperative clinical and echocardiographic findings were compared to assess AVR effects. Possible risk factors affecting postoperative recovery of left ventricular function were analyzed according to postoperative LVEF changes. ResultsOne patient died within 30 days after AVR. In the other 28 patients, postoperative aortic pressure gradient (APG)decreased from 97.6±25.1 mm Hg to 25.0±9.7 mm Hg, while LVEF increased from 41%±6% to 56%±11%. Postoperative left ventricular end-diastolic/systolic diameter/volume all significantly improved (all P < 0.001). ConclusionsAVR is an effective treatment for patients with severe AS and LVD. Left ventricular function improves significantly in most patients after AVR. Patients with a less dilated left ventricle may have a better LVEF recovery.
ObjectiveTo analyze the reason and prevention of late bioprosthetic heart valve thrombosis (LBVT). MethodsBioprosthetic heart valves were implanted in 580 patients between January 2001 and July 2013 in Changhai Hospital, and only found one case of LBVT (0.2%). Reoperation was performed for a 67-year-old male patient 3 years after bioprosthetic aortic valve replacement due to severe aortic valve stenosis. Retrospectively analyzed the clinical data and reviewed the literature between January 1989 and December 2013 in Pubmed. ResultsNo risk factor for thrombosis was revealed in this patient. Pathology revealed valve thrombosis and collagen and elastic fibers fragmentation and disruption in valve leaflets. In literature review, 20 articles and 47 cases were brought in. The morbidity of LBVT was 0.2%-1.0%. At least 18 patients had high risk factors, and 15 of the 18 patients discontinued anticoagulation after 3 months. However, at least 10 patients had no high risk factors. Forty-four of the 47 patients received stented porcine valve replacement, only one patient received stented bovine pericardial valve replacement. ConclusionsLBVT is a rare but serious complication after bioprosthetic valve replacement, the causes of which include the feature of the patients and the bioprosthetic valves. Bovine pericardial valves could be superior to porcine valves in preventing LBVT. Postoperative long-time aspirin therapy is recommended for patients without high risk factors. Patients with any high risk factors should prolong anticoagulation.