Abstract： Objective To evaluate clinical outcomes of endoscopic vein harvesting （EVH）for coronary artery bypass grafting（CABG） in diabetic patients. Methods In this prospective non-randomized control study, patients with type 2 diabetes who underwent CABG from December 2010 to Febuary 2012 in West China Hospital were enrolled. Based on different vein graft harvesting technique, these patients were divided into two groups: an EVH group and a conventional vein harvesting（CVH）group. Perioperative complications were compared between the two groups. Interventional or CT coronary angiogram was used to evaluate bypass graft patency during follow-up. Results A total of 51 patients with type 2 diabetes were enrolled in this study with 24 patients in the EVH group and 27 patients in the CVH group. There was no statistical difference in age, weight, and comorbidities between the two groups. There was no statistical difference in cardiopulmonary bypass time and aortic cross-clamping time between the two groups （67.2±9.8 min versus 68.3±14.5 min, P＞0.05; 62.4±11.3 min versus 65.2±10.3 min, P＞ 0.05）. The vein graft harvesting time （35.6±6.4 min versus 45.2±11.4 min, P＜ 0.05）and rate of delayed leg wound healing（0.0% with 0/24 versus 18.5% with 5/27, P＜0.05） of the EVH group were significantly shorter or lower than those of CVH group.There was no statistical difference in major postoperative complications with respect to venous graft failure rate and chest pain during short term follow-up（9.1 months in the CVH group and 9.4 months in the EVH group） between the two groups. Conclusion EVH is a safe, effective, minimally invasive and quick vein graft harvesting technique for CABG in diabetic patients.
Transesophageal echocardiogram (TEE) can promote the quality of cardiac surgery and reduce peri-operative complications, and thus has been gradually accepted by cardiac surgeons. Through an esophageal probe, TEE can clearly visualize the internal structure of the heart without interrupting surgical procedure. As a newly developed technology which breaks the limitations tied to the traditional two-dimensional TEE, the realtime threedimensional transesophageal echocardiogram (RT3D-TEE) has the advantages of showing threedimensional structure of the heart and providing full range of anatomical information of the heart. Furthermore, it can precisely analyze the anatomical structure of the abnormal heart valves and provide assessment of the change of heart volume. Relying on its unique imaging property, it can largely facilitate preoperative decision-making and provide realtime intraoperative guidance as well as accurate postoperative evaluation. It has now been successfully applied in various types of cardiac surgical procedures including valve repair surgery, congenital heart defect intervention, cardiac mass removal as well as heart function evaluation. In this article, we will review the applications of RT3D-TEE in cardiac surgery, and try to form a basis for its further clinical application.
Echocardiography is an important imaging technique in transcatheter edge-to-edge mithal valve repair (TEER). During the operation, mitral leaflets capture and clamping have the highest requirements for ultrasound image quality and should be performed under the guidance of high-quality commissural view. However, standard commissural view cannot be obtained in some patients due to cardiac enlargement, transposition or limited esophageal acoustic window. In this condition, the optimal view can be obtained by Multivue technology. This paper reports a case of successful mitral valve TEER under the real-time guidance of Multivue technology, and summarizes the key points of this technology.
Transcatheter left ventricular assist pump (LVAP) is widely used in cardiogenic shock, post-circulatory hypoperfusion syndrome and high-risk percutaneous coronary intervention (PCI), and its application scenarios cover various complex environments such as ICU, operating room, emergency department and catheterization room. It is important to quickly and accurately implant the transcatheter LVAP and monitor its position in real time. This paper reported 2 male patients with high-risk PCI, aged 47 and 45 years old, both with triple coronary artery disease and reduced ejection fraction (<35%). The domestically produced transcatheter LVAP was implanted using an echocardiography guidance technology system, and PCI treatment was performed under the assistance of the interventional pump. The operation was smooth, and the interventional pump assisted for 1 h in 2 patients, and the pump was successfully removed. There were no obvious complications related to the pump and PCI after the operation, and the patients were discharged smoothly.
Objective To discuss the key points of anesthesia for patients undergoing transcatheter aortic valve implantation (TAVI) surgery. Methods We retrospectively collected and analyzed the data of 70 patients who underwent TAVI in the Department of Cardiovascular Surgery, West China Hospital from March 2014 to October 2015. There were 39 males and 31 females with an average age of 73.7±4.5 years. The perioperative preparation and anesthesia points of TAVI were summarized. Results All of the 70 included patients were aged and at high risk severe comorbidities such as ischemic heart disease and stroke. The aortic stenosis and regurgitation occurred in 39 and 31 patients respectively. No patients died during the surgery. The total success rate was 95.7%. Conclusion TAVI is a complex procedure for high risk patients and need more attention during anesthesia. The successful conduction of the procedure requires the whole team to prepare carefully and cooperate closely.
The heart valve prosthesis must have excellent hydrodynamic performance which is usually tested in vitro, not in vivo. This paper comprehensively introduced the principles and methods of hydrodynamic performance in vitro testing, helping clinicians to understand valve performance parameters, evaluate valve applicability, and reduce clinical risk of the valve prosthesis. In vitro testing not only serves as the "gold standard" for valve prosthesis assessment, but also provides detailed data for design and optimization of the prosthesis. ISO 5840 defines the items and methods for valve in vitro testing, which consists of three parts: (1) pulsatile flow testing, which reproduces the pulsating flow of the valve prosthesis after implantation in the human body; (2) steady flow testing, which assesses valve forward flow resistance; (3) durability testing, which evaluates the durability of the valve prosthesis and determines the expected failure mode. In addition, the paper presented the differences between atrioventricular and aortic valve testing, the method of mitral valve testing, the differences between transcatheter and surgical valve testing, and the method of valve flow visualization.
Mitral regurgitation (MR) is the most common valvular heart disease, however, majority of patients are not suitable for open heart surgery due to comorbidity such as organ and heart dysfunction. Transcatheter edge-to-edge mitral valve repair has become an effective treatment option for high-risk patients with MR. Two patients were enrolled in this study inlcuding one 60-year degenerative mitral regurgitation patient and one 72-year functional mitral regurgitation patient. Transcatheter repair procedure was successfully done for the two patients without postoperative complication.
ObjectiveTo investigate the anesthesia management of transcatheter ultrasound-guided percutaneous interventional therapy for pediatric patients with congenital heart disease at a mobile surgical platform. Methods From March to July 2023, 13 patients in remote areas underwent interventional surgery on the mobile truck operating platform. The patients undergoing general anesthesia using non-tracheal intubation were collected. ResultsFinally, 8 patients received monitored anesthesia care (MAC) with local anesthesia-assisted sedation and analgesia drugs under the supervision of anesthesiologists (general anesthesia using non-tracheal intubation), due to the patients having difficulty cooperating with the surgery (young age, nervous mood, and crying), including 5 males and 3 females with an average age of 6.95±3.29 years and an average weight of 19.50±6.04 kg. There were 6 patients diagnosed with atrial septal defect, 1 patient with residual shunt after patent ductus arteriosus ligation, and 1 patient with severe pulmonary stenosis by transthoracic ultrasonography. The surgical process was smooth, analgesia was perfect, anesthesia and surgical effect were satisfactory, postoperative recovery was satisfactory, and there were no surgical or anesthesia complications. The anesthesia time was 41.53±8.62 min, the operation time was 39.88±8.52 min, and the recovery time was 41.50±14.56 min. Conclusion Transthoracic ultrasound-guided interventional surgery is a minimally invasive approach for congenital heart disease, offering the advantages of zero radiation exposure. Non-tracheal general anesthesia preserved spontaneous breathing can be safely and effectively administered to pediatric patients who cannot cooperate in mobile operating platform.