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三種不同手術方式行同種異體血管主動脈根部置換的臨床效果

目的　比較 3種應用低溫保存的同種異體帶瓣管道行主動脈根部重建術式的近期和遠期效果。　方法　85例主動脈瓣膜疾病患者采用同種異體帶瓣管道行主動脈根部重建 ,其中 Freehand手術 16例 ,Miniroot手術 4 4例 ,Total aortic root手術 2 5例。　結果　 3種術式患者灌注時間、主動脈阻斷時間、呼吸機輔助時間和住 ICU時間差別均無統計學意義 (Pgt;0 .0 5 ) ;隨訪 38.9± 13.2個月 ,Miniroot手術患者主動脈瓣膜中度反流發生率低于其他 2種術式 (Plt;0 .0 5 )。　結論　用同種異體帶瓣管道行主動脈根部重建術治療主動脈瓣膜疾病 ,3種手術方式均有效 ,其中Miniroot手術術后瓣膜反流的發生率低于其它 2種術式。

急性心肌梗死合并心源性休克手術治療六例

摘要： 目的 總結急診冠狀動脈旁路移植術（CABG）救治急性心肌梗死(AMI)合并心源性休克(CS)患者的早期臨床結果和經驗，以評估手術療效。 方法 自2006年10月至2008年10月中國海洋大學附屬青島市市立醫院共對6例急性心肌梗死合并心源性休克患者施行急診CABG，其中男4例，女2例；年齡62～78歲（68.3±7.9歲）；從發生休克距開始手術時間為１～7 h（4.1±3.1 h）；冠狀動脈狹窄９０％以上病變支數１～３支（2.5±1.3支）。1例采用非體外循環（offpump CABG）技術，5例采用體外循環心臟停跳（onpump CABG）技術，心肌保護采用順行性灌注結合經冠狀靜脈竇逆行灌注心肌保護方式。 結果 每例患者平均移植血管3支(1～4支)，安裝主動脈內球囊反搏（IABP）3例。 1例患者術后第3 d死于循環衰竭合并腎功能衰竭，病死率16.67%（1/6）, 5例治愈出院。圍手術期發生呼吸功能不全2例，急性腎功能不全1例。出院3個月后隨訪，心功能分級(NYHA)Ⅲ級3例，Ⅱ級2例；1年后隨訪心功能Ⅲ級1例，Ⅱ級2例，Ⅰ級2例。 結論 急診CABG可以有效提高急性心肌梗死合并心源性休克患者的生存率。

自發性冠狀動脈夾層合并二尖瓣重度關閉不全一例

腔內隔絕術搶救Stanford B型主動脈夾層動脈瘤破裂一例

Minimally Invasive versus Conventional Aortic Valve Replacement Surgery: A Case Control Study

ObjectiveTo summarize the clinical experience of aortic valve replacement surgery with minimally invasive procedure. MethodsWe retrospectively analyzed the clinical data of 72 patients underwent isolated aortic valve replacement in our hospital between January 2011 and August 2013. The patients undergoing minimally invasive procedure were as a minimally invasive group(30 patients with 18 males and 12 females at age of 60.2±13.4 years). The patients undergoings conventional procedure were as a control group(42 patients with 27 males and 15 females at age of 61.3±14.5 years). The outcomes of the two groups were compared. ResultsThere was no death and severe complication in both groups. Postoperative echocardiography showed no paravalvular leakage, no valve dysfunction in both groups. There were no significant statistically differences between the two groups in cardiopulmonary bypass time, aortic crossclamping time, ventilation time, postoperative left ventricle ejection fraction, the length of ICU stay and hospital stay (P>0.05). Blood transfusion ratio, blood transfusion volume and blood loss volume were lower in the minimally invasive group than those in the control group (P<0.05). The length of incision, chest closure time, operative duration were shorter in the minimally invasive group than those in the control group (P<0.05). ConclusionUpper median sternotomy is a safe and feasible procedure for minimally invasive aortic valve replacement surgery. Compared with conventional aortic valve replacement, its advantages include less surgical trauma, stable sternum, rapid recovery, less blood loss and blood transfusion, and cosmetic outcomes.

Current status and future perspectives of left ventricular assist devices

The implantation of a left ventricular assist device (LVAD) is an important therapeutic tool for patients with end-stage heart failure, which can either help patients transit to the heart transplantation stage or serve as destination therapy until the end of their lives. In recent years, the third generation of LVAD has evolved rapidly and several brands have been marketed both domestically and internationally. The number of LVAD implantations has been increasing and the long-term survival rate of implanted patients has improved, so this device has a broad development perspective. This article summarizes the current status, usage standards and precautions, and common complications after implantation of LVAD, as well as looks forward to the future development of LVAD, hoping to be helpful for researchers who are new to this field.

Mini-root Technique for Aortic Root Diseases: A Mid-term Follow-up Study

ObjectiveTo evaluate the clinical effect of modified mini-root operation on aortic root diseases with the short and middle term follow-up results. MethodsWe retrospectively analyzed the data of thirty-one patients of modified mini-root operations between March 2008 to September 2012. There were 22 male and 9 female patients with mean age of 47.2±21.3 years(ranged from 28 to 71 years). Fifteen patients were diagnosed with acute aortic dissection(Standford A). Thirteen patients were of Marfan syndrome including 8 patients with aortic dissection and 3 patients of bi-leaflet aortic valve malformation with aortic dissection. The patients were followed up for 6 months to 50 months. Thirteen patients of mini-root operation without other procedure(mini-root operation group) were selected to compare with 8 patients of Bentall operation(Bentall operation group). Some clinical indexes were compared between the two groups. ResultsThree patients died in hospital, in which 1 died from low cardiac out-put syndrome and multiple organ failure, 1 from descending aortic aneurysm rupture, and 1 from acute cerebral infarction. Three patients suffered with acute renal insufficiency and received hemodialysis. During the follow-up, 1 patient received continuous kidney dialysis treatment, and 3 patients performed reoperation. Compared with the Bentall group, the cardiopulmonary bypass time was shorter (108.5±20.8 min vs. 138.5±19.0 min), postoperative blood transfusion volume in the first 24 h was less(661.6±135.0 ml vs. 1 381.2±517.5 ml) than those in the mini-root group. ConclusionModified mini-root technique can significantly shorten the operation time and reduce the amount of blood transfusion in the treatment of aortic root diseases. The modified mini-root technique has obvious effect on selected aortic root diseases during perioperative period.

Risk Factors for Hypoxemia after Surgery for Acute Aortic Dissection

Objective To determine risk factors associated with postoperative hypoxemia after surgery for acute aortic dissection. Methods We retrospectively analyzed clinical data of 116 patients with acute aortic dissection who underwent endovascular stent-graft exclusion or open surgery in Qingdao Municipal Hospital from February 2007 to February　2012. All the 116 patients were diagnosed as acute aortic dissection by CT angiography （CTA），including 60 patients with Stanford type A aortic dissection and 56 patients with Stanford type B aortic dissection. According to whether they had postoperative hypoxemia，all the 116 patients with acute aortic dissection were divided into hypoxemia group［arterial　partial pressure of oxygen （PaO2） /fraction of inspired oxygen （FiO2） ＜200 mm Hg］：33 patients including 28 males and 5 females with their age of 52.7±11.4 years； and non-hypoxemia group（PaO2/FiO2≥200 mm Hg）：83 patients including　66 males and 17 females with their age of 55.0±13.8 years. Perioperative clinical data were analyzed and compared　between the two groups. Multivariate logistic regression was performed to identify risk factors of postoperative hypoxemia after surgery for acute aortic dissection. Results The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.4% （33/116）. Perioperative death occurred in 13 patients（11.2%，including 8 patients in the hypoxemia group and 5 patients in the non-hypoxemia group）. Univariate analysis showed that preoperatively the percentages of　patients with body mass index（BMI） ＞ 25 kg/m2，smoking history，duration from onset to operation ＜24 h，preoperative　PaO2/FiO2≤300 mm Hg，and patients undergoing open surgery in the hypoxemia group were significantly higher than those　in the non-hypoxemia group（P＜0.05）. Deep hypothermic circulatory arrest（DHCA） ratio，blood transfusion in 24 hours　postoperatively，mechanical ventilation time，length of ICU stay and hospital stay in the hypoxemia group were significantly　higher or longer than those in the non-hypoxemia group（P＜0.05）. Logistic multivariate regression identified BMI＞25 kg/m2（RR=98.861，P=0.006），DHCA（RR=22.487，P=0.007），preoperative PaO2/FiO2≤300 mm Hg（RR=9.080，P=0.037） and blood transfusion＞6 U in 24 hours postoperatively（RR=32.813，P=0.003） as independent　predictors of postoperative hypoxemia for open-surgery patients，while BMI＞25 kg/m2 （RR=24.984，P=0.036） and preoperative PaO2/FiO2 ratio≤300 mm Hg （RR=21.145，P=0.042） as independent predictors of hypoxemia for endovascular stent-graft exclusion patients. Conclusion Postoperative hypoxemia is a common complication after surgery for acute aortic dissection. Early interventions for obesity and preoperative hypoxemia，and reducing perioperative blood transfusion may decrease the incidence of postoperative hypoxemia after surgery for acute aortic dissection.