This article reviews the progress of biomechanical studies on anterior cervical fusion and nonfusion surgery in recent years. The similarities and differences between animal and human cervical spines as well as the major three biomechanical test methods are introduced. Major progresses of biomechanical evaluation in anterior cervical fusion and nonfusion devices, hybrid surgery, coupled motion and biomechanical parameters, such as the instant center of rotation, are classified and summarized. Future development of loading method, multilevel hybrid surgery and coupling character are also discussed.
Objective To discusses the feasibilities of the hybrid surgical treatment of Stanford type B aortic dissection. Methods From August 2011 to August 2015 a total of 14 cases of complex Stanford type B aortic dissection patients had been completed hybrid surgery. Among them 11 cases of men and 3 cases of women, aged 22 to 62, an average of 44±7.2 years old. Twelve cases with dissecting aneurysm involving the aortic arch and its three vascular branch. There were 2 cases of patients after TEVER, occurred new dissection or pseudoaneurysms, and had hybrid surgery by traditional thoracotomy; 3 cases involving carotid artery were received neck-neck hybrid surgery, and 7 cases involving left subclavian artery were received neck-lock hybrid surgery. Two cases of dissecting aneurysm involving the iliac artery to thrombosis that result in lower limb ischemia, then femoral to femoral artery hybrid surgery were performed. Results All the patients were successfully completed the operation of covered stent implantation and hybrid surgery. Intraoperative angiography showed that the position of the stent was accurate, the interlayer isolation was successful, there was no obvious leakage and displacement of the stent, the true lumen blood flow of the aortic dissection was returned to normal, and bypass blood and target blood vessels were unobstructed. Fourteen patients were followed-up for a period of 3 to 36 months, with an average of (24.0±8.2) months. In 1 month after operation, pleural effusion occurred in 1 case, there was 1 case of cerebral stroke in two days after surgery, incision hematoma occurred in 1 case in 10 days after surgery, and the other patients had no postoperative death and severe complications. All 14 patients were followed-up and returned to normal life. Conclusion The hybrid operations can increase the success rate of TEVAR in complex Stanford type B aortic dissection patients, and early and mid-term results are satisfactory.
ObjectiveTo explore the single-center experience of hybrid therapy in treatment of Stanford type A aortic dissection, and to make a comparison of the clinical results of this hybrid therapy with total arch replacement surgery in the same period.MethodsFrom March 2017 to April 2020, 272 patients with Stanford type A aortic dissection underwent surgical treatment in our center, including 147 patients (126 males and 21 females) who received the aortic arch surgery. Among them, 106 patients underwent replacement of ascending aorta+aortic arch+stent trunk (total arch replacement group), while 41 patients underwent one-stop compound total arch type Ⅱ hybrid surgery (compound total arch replacement group). We tried to identify whether hybrid surgery really simplified total arch replacement surgery of the aortic dissection by comparing the operative mortality, postoperative complication rate, operative time, extracorporeal circulation time, etc.ResultsThere was no statistical difference in preoperative clinical data or death rate between the two groups. However, blood transfusion (6.74±7.35 U vs. 4.65±6.87 U, P<0.05), postoperative respiratory insufficiency [16 (15.09%) vs. 2 (4.88%), P<0.05], and apoplexy [3 (2.83%) vs. 0, P<0.05], paraplegia [2 (1.89%) vs. 0, P<0.05], in the compound total arch replacement group was significantly better than those of the total arch replacement group. The compound total arch replacement group did not shorten the total operation time, but it was significantly better in terms of extracorporeal circulation time (175.50±55.70 min vs. 129.70±48.80 min, P<0.05), aortic block time (103.10±23.70 min vs. 49.70±30.10 min, P<0.05), and the time of stopping the circulation or avoiding stopping the circulation (32.10±7.20 min vs. 0 min, P<0.05). The postoperative mechanical ventilation time was shorter in the compound total arch group (62.60±31.70 h vs. 41.30±32.60 h, P<0.05), and the time of staying in ICU (124.50±61.50 h vs. 63.40±71.20 h, P<0.05) and the postoperative hospital stay (13.50±11.20 d vs. 9.20±7.20 d, P<0.05) were significantly shorter than those in the total replacement group. A total of 138 patients were followed up for 6-38 (15.8±6.4) months. There was no statistical difference in one-year mortality or three-year mortality (P>0.05).ConclusionHybrid surgery shortens extracorporeal circulation time, while reduces or avoids the time of deep hypothermia circulatory arrest, the incidence of complications and the time of hospital stay. In conclusions, hybrid surgery simplifies the arch management of acute Stanford type A aortic dissection.
Objective To analyze the clinical effect of hybrid surgery on complex type B aortic dissection in 5 years. Methods A retrospective analysis of 47 patients with complex type B aortic dissection in the Central Hospital of Wuhan affiliated to Tongji Medical College of Huazhong University of Science and Technology from 2014 to 2017 was conducted, including 42 males and 5 females with an average age of 54.9±11.2 years. Twenty-one patients underwent the left common carotid artery to the left subclavian artery bypass (a bypass group), and 26 patients underwent the left common carotid artery to the left subclavian artery transposition (a transposition group). Results All patients accepted hybrid surgery successfully. There was no statistical difference in arterial occlusion time or intraoperative blood loss between the two groups (P＞0.05). The 5-year follow-up rate was 100.0% (47/47). During the follow-up period, 12 (25.5%) patients developed complications, including 5 (10.6%) patients of endoleak, 5 (10.6%) patients of hoarseness, 2 (4.3%) patients of stroke/dizziness. There was no patient of left upper limb weakness, paraplegia or retrograde aotic dissection. The reconstructed left subclavian artery remained patent in 46 (97.9%) patients. The overall 5-year survival rate was 100.0%. Conclusion The long-term therapeutic outcome of hybrid surgery for the treatment of complex type B aortic dissection is satisfying. In 5 years, the rebuilt left subclavian artery has a remarkable patency rate. Endoleak and hoarseness are the most common surgical complications.
ObjectiveTo explore the short- and mid-term efficacy of Castor single branch aortic stent combined with subclavian artery bypass grafting for the aortic arch lesions. MethodsA retrospective analysis of the clinical data of patients with proximal anchor zone insufficiency aortic arch lesions treated with Castor stent combined with carotid-subclavian bypass at the Department of Cardiac Surgery, Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from August 2020 to November 2023 was performed. ResultsA total of 22 patients were included, including 19 males and 3 females, with an average age of 56±16 years. There were 18 patients of aortic dissection and 4 patients of aortic arch tumors. The success rate of surgical technique was 100.0%, and the average postoperative hospital stay for patients was 10±4 days. The median follow-up time was 20 months. During the follow-up period, there were no major complications such as endoleak, paraplegia, cerebral infarction, renal insufficiency, etc., and all patients had no readmissions. ConclusionFor proximal anchor zone insufficiency aortic arch lesions, the treatment method of using a Castor stent branch placed in the left common carotid artery can effectively extend the anchor zone, avoid the huge trauma of open chest surgery, and achieve good short- and mid-term efficacy.
ObjectiveTo explore the efficacy and safety of hybrid surgery in the treatment of thoracoabdominal aortic aneurysm (TAAA). MethodsTwenty patients who were diagnosed with TAAA (including chronic thoracoabdominal aortic dissection aneurysm) and underwent hybrid surgery in Vascular Surgery, West China Hospital, Sichuan University were enrolled between January 2015 and December 2022. All the patients underwent retrograde reconstruction for visceral arteries in the open surgery. Additionally, one-stage or two-stage endovascular aortic repair with covered stents was performed. The patients’ clinical baseline information was collected. Moreover, the patients received clinical follow-up and imaging examinations postoperatively, whose informationwas collected. ResultsOne patient developed paraplegia and acute renal failure 16 days postoperatively in the hospital, and subsequently died in the hospital due to septic shock. Another patient underwent exploratory laparotomy for hemostasis due to anastomotic bleeding in the hospital. The other patients did not experience serious complications perioperatively. Nineteen patients were discharged from the hospital with long-term follow-up ranging from 10 to 144 months (median time: 48 months), and all of them had a long-term survival. No patients were observed with paraplegia, myocardial infarction, stroke, or rupture of aneurysm. None of the patients received reintervention during the follow-up, except for one patient who underwent ultrasound-guided puncture and suctionin the aneurysmallumen. ConclusionHybrid surgery is an effective treatment for TAAA with favorable short- and long-term safety and efficacy.
ObjectiveTo compare the clinical efficacy of TypeⅡhybrid and Sun’s surgery in treating acute Stanford A aortic dissection. MethodsA retrospective analysis was conducted on the clinical data of patients with acute Stanford A aortic dissection who were treated at the Central Hospital of Wuhan affiliated to Tongji Medical College, Huazhong University of Science and Technology from 2016 to 2022. According to the surgical method, patients were divided into a typeⅡhybrid group and a Sun’s surgery group, and the clinical efficacy of the two groups was compared. ResultsA total of 52 patients were included, with 22 in the typeⅡhybrid group and 30 in the Sun’s surgery group. The typeⅡhybrid group consisted of 18 males and 4 females, with an average age of (58.18±6.00) years, while the Sun’s surgery group consisted of 22 males and 8 females, with an average age of (53.03±11.89) years. All surgeries were successfully completed. There were 4 (13.3%) perioperative deaths in the Sun’s surgery group, including 2 patients of multiple organ failure, 1 patient of paraplegia, and 1 patient of uncontrollable postoperative bleeding. There was 1 (4.5%) perioperative death in the typeⅡ hybrid surgery group, who was suspected of acute coronary syndrome and took a loading dose of dual antiplatelet drugs preoperatively. The patient underwent secondary thoracotomy for hemostasis, was re-cannulated during the operation, and finally died of circulatory failure after implantation of intra-aortic balloon pumping. There was no statistical difference in perioperative mortality between the two groups (P=0.381). Compared with the Sun’s surgery group, the typeⅡhybrid surgery group had shorter cardiopulmonary bypass time [153.00 (135.00, 185.25) min vs. 182.50 (166.50, 196.75) min, P=0.013], aortic cross-clamp time [77.00 (70.50, 92.00) min vs. 102.50 (93.50-109.75) min, P<0.001], postoperative ICU stay [4.0 (2.83, 6.00) days vs. 8.0 (6.38, 11.78) days, P<0.001], postoperative ventilator support time [72.00 (29.50, 93.25) h vs. 87.65 (39.13, 139.13) h, P=0.138], intraoperative blood loss [(1586.82±209.41) mL vs. (1806±292.62) mL, P=0.004], postoperative 24 h drainage volume [612.50 (507.50, 762.50) mL vs. 687.50 (518.75, 993.75) mL, P=0.409], and postoperative hospital stay [18.00 (13.00, 20.25) days vs. 22.00 (17.00, 29.25) days, P=0.013]. There was no statistically significant difference in the incidence of other early postoperative complications such as secondary thoracotomy for hemostasis, tracheotomy, renal dysfunction requiring dialysis, stroke, and paraplegia between the two groups (P>0.05). ConclusionFor patients with acute Stanford A aortic dissection, typeⅡhybrid surgery is safe and effective; compared with traditional Sun’s surgery, typeⅡ hybrid surgery has relatively less trauma, lower incidence of complications, satisfactory short-term results, and further research is needed on long-term prognosis.