Chun-sheng Wang

Fudan University, Shanghai, Shanghai Shi, China

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Publications (5)3.9 Total impact

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    ABSTRACT: To review the results for minimally invasive aortic valve replacement (AVR) through a 5 cm right anterolateral thoracotomy. From July 2009 to September 2011, 101 consecutive patients with isolated aortic valve disease (degenerative in 37 patients, rheumatic in 21 patients, congenital in 37 patients, endocarditic in 3 patients and aorta-arteritis in 1 patients) underwent AVR through the right anterolateral thoracotomy approach in the third intercostal space with a groin incision for femoral connection of cardiopulmonary bypass. The mean age was 45.7 years (ranging from 17 to 71 years). Sixty patients were male. Operations were successfully performed in all but 1 patient (1.0%) who required intraoperative conversion to full sternotomy. Mean duration of cardiopulmonary bypass time and aortic cross-clamp time was (88 ± 24) minutes and (55 ± 18) minutes, respectively. Thirty-day mortality was 1.0% (1/101), this patient was found difficult in weaning off cardiopulmonary bypass and exhibited severe coronary artery plaque, although bypass graft was carried out immediately, the patient died of severe low cardiac output syndrome finally. No blood products were needed in 83.2% patients. Follow-up was performed in all patients at an average of (16 ± 7) months postoperatively. A good recovery was obtained in all patients except one who died of multiple organ failure caused by massive cerebral infarction 38 days after surgery. Minimally invasive aortic valve replacement though the right anterolateral thoracotomy approach is safe and feasible, with good cosmetic results and rapid postoperative recovery. It is worthy of clinical elective application.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 03/2013; 51(3):252-5.
  • Zhao-Hua Yang, Li-Min Xia, Lai Wei, Chun-Sheng Wang
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    ABSTRACT: Endovascular treatment has emerged as a less traumatic alternative treatment for several diseases of the thoracic aorta. However, the complications of the endovascular management of ascending aortic dissections are still high. We present a case of two iatrogenic complications after endovascular repair (EVAR) of type A (ascending) aortic dissection. Retrograde aortic dissection at the proximal part of the aortic endovascular graft and a guidewire-induced iatrogenic left ventricular pseudoaneurysm were presented in this patient after the stent-grafting procedure. Fourteen months later, surgical replacement of the ascending aorta and proximal arch was performed and the left ventricular pseudoaneurysm was treated successfully by linear closure. The patient recovered uneventfully. Although aortic endovascular grafting is apparently less traumatic, indications and potential complications related to the stent graft should be considered with great care.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 08/2012; 42(5):894-6. DOI:10.1093/ejcts/ezs384 · 2.81 Impact Factor
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    ABSTRACT: To compared outcomes of robotic mitral valve repair with those of standard sternotomy, and right anterolateral thoracotomy. From August 2010 to July 2011, 70 patients with degenerative mitral valve disease and posterior leaflet prolapsed scheduled for elective isolated mitral valve repair were prospectively unrandomized to undergo mitral valve operation by standard sternotomy (n = 30), right anterolateral thoracotomy (n = 30), or a robotic approach (n = 10). There were 49 male and 21 female patients, aging from 16 to 70 years with a mean of 53.4 years. Outcomes of the three groups were compared. Mitral valve repair was achieved in all patients except 1 patient in the standard group. There were no in-hospital deaths. The median operation time [(300 ± 41) min, (184 ± 20) min and (169 ± 22) min, F = 112.5, P < 0.01], cardiopulmonary bypass time [(139 ± 26) min, (82 ± 20) min and (69 ± 23) min, F = 36.8, P < 0.01], aortic cross-clamping time [(93 ± 23) min, (47 ± 10) min and (38 ± 8) min, F = 75.0, P < 0.01] were longer for robotic than standard sternotomy and right anterolateral thoracotomy. The robotic group had shortest time of mechanical ventilation time [(4.9 ± 2.1) h, (5.3 ± 4.5) h and (14.1 ± 10.2) h, F = 13.2, P < 0.01], ICU time [(15.1 ± 2.1) h, (16.4 ± 5.4) h and (28.7 ± 16.1) h, F = 11.6, P < 0.01], postoperative hospital stay time [(4.6 ± 1.0) d, (5.7 ± 1.7) d and (8.8 ± 5.1) d, F = 8.0, P < 0.01] with the lowest of drainage [(192 ± 200) ml, (215 ± 163) ml and (405 ± 239) ml, F = 7.1, P < 0.01] and ratio of the patients needed blood transfusion (0, 20.0% and 66.7%, χ(2) = 22.7, P < 0.01). Patients were followed up 6 to 17 months, with 100% completed. No patients died during follow-ups, and no moderate or more mitral regurgitation was observed. The robotic group had the shortest time of return to normal activities compared with the other two groups [(2.4 ± 0.7) weeks, (4.2 ± 1.2) weeks and (8.2 ± 1.8) weeks, F = 83.0, P < 0.01]. This study shows mitral valve repair via the right anterolateral thoracotomy and a robotic approach is safe and feasible, with good cosmetic results and rapid postoperative recovery, and is worthy of clinical selective application.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 07/2012; 50(7):637-41.
  • Hai-Yan Luo, Ke-Jian Hu, Jin-Yuan Zhou, Chun-Sheng Wang
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    ABSTRACT: Retrospectively to analyze the risk factors of postoperative respiratory dysfunction (RD) in 196 patients with type A dissection operated on with cerebral perfusion and a lower body hypothermia circulatory arrest (HCA) and to investigate the method of the lung protection. From January 2005 to April 2008, 196 patients with type A dissection underwent surgical repair with cerebral perfusion and HCA. There were 142 male patients and 54 female patients, with ages from 17 to 78 years. Antegrade selective cerebral perfusion (SCP) through the axillary artery was performed for 168 patients and retrograde cerebral perfusion (RCP) from the superior vena cava for 28 patients. All the factors underwent univariate and multivariate analysis. Mean cardiopulmonary bypass (CPB) duration was (186+/-56) minutes and mean cerebral perfusion time was (35+/-15) minutes; mean HCA time was (39+/-14) minutes. Postoperative RD was detected in 26 patients (13.3%). Multivariate analysis showed that the longer duration of circulatory arrest (CA), P=0.008, OR=1.048, and the higher temperature in the bladder during CA, P=0.002, OR=1.614, were independent risk factors of postoperative RD. There was a higher mortality (23.1%, P=0.025) in patients with postoperative RD when compared with the other patients. The longer duration of CA and the higher temperature in the bladder during CA were found to be the independent risk factors of postoperative RD after type A aortic dissection surgery. Attention should be paid to lung protection for these patients and the adjunct of continuing descending aortic perfusion and cerebral perfusion should be a safe and feasible procedure and it would be valuable to perform a prospective trial.
    Perfusion 09/2009; 24(3):199-202. DOI:10.1177/0267659109346671 · 1.08 Impact Factor
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    ABSTRACT: To evaluate the risk factors of postoperative renal failure (RF) in the patients with type A dissection of aorta operated on with cerebral perfusion and deep hypothermia circulatory arrest (DHCA). From January 2004 to October 2007, 157 patients with type A dissection of aorta underwent surgical procedures with cerebral perfusion and DHCA. There were 115 male patients and 42 female patients with the age from 17 to 76 years old. Antegrade selective cerebral perfusion through axillary artery was performed for 129 patients and retrograde cerebral perfusion from superior cava vein was performed for 28 patients. All the factors underwent univariate and multivariate analysis. Mean cardiopulmonary bypass duration was (188.0 +/- 10.8) min and mean cerebral perfusion time was (36.0 +/- 3.1) min. Fifteen patients died in hospital and the hospital mortality was 9.6%. Permanent neurological dysfunction (PND) occurred in 8 patients (5.1%). Postoperative RF was observed in 20 patients (12.8%). Multivariate analysis showed the preoperative renal dysfunction (P = 0.042, OR = 4.41) and over seventy-year-old patients (P = 0.049, OR = 4.94) were found to be the risk factors of postoperative RF. There was a higher incidence of death (45%, P = 0.001) and PND (25%, P = 0.009) in the patients of postoperative RF when compared with the other patients. The preoperative renal dysfunction and elderly patients were found to be the risk factors of postoperative RF after type A dissection of aorta surgery.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 08/2008; 46(14):1070-2.