Chun-sheng Wang

Fudan University, Shanghai, Shanghai Shi, China

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Publications (11)6.38 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. · 2.40 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.
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    ABSTRACT: To analyze the peri-operative risk factors of mortality in patients with aortic dissection (AD). Between January 2003 and June 2008, 361 AD patients at our hospital were enrolled. Their demographics, history, clinical characteristics and laboratory examinations were retrospectively analyzed. Twenty pre-operative variables were analyzed to identify the predictors of perioperative mortality of AD patients by the analyses of univariate and multivariate logistic regression. The analysis of univariate logistic regression showed that history of hypertension [odds ratio (OR) 0.465, 95% confidence interval (CI) 0.229 - 0.947, P = 0.035], Stanford type A (OR 2.758, 95%CI 1.054 - 7.213 P = 0.039), acute course (OR 7.897, 95%CI 1.874 - 33.275 P = 0.005), neurological symptoms (OR 0.275, 95%CI 0.140 - 0.541, P < 0.001) and operation or not (OR 8.206, 95%CI 4.205 - 16.012, P < 0.001) had a higher mortality in AD patients. The multivariate analysis revealed that acute course (OR 8.178, 95%CI 1.796 - 37.242, P = 0.007), Stanford type A (OR 3.236, 95%CI 1.104-9.487 P = 0.032), neurological symptoms (OR 0.350, 95%CI 0.159 - 0.770, P = 0.009) and operation or not (OR 9.429, 95%CI 4.456 - 19.952, P < 0.001) were significant independent predictors of perioperative mortality in AD patients. History of hypertension, acute course, Stanford A and positive neurological symptoms are the independent predictors of perioperative mortality in AD patients. Operation or not is a determinant of patient outcome.
    Zhonghua yi xue za zhi 11/2010; 90(42):2994-8.
  • 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. · 0.94 Impact Factor
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    ABSTRACT: The roles of inositol-1,4,5-trisphosphate receptors (IP3Rs) in arrhythmia are not fully understood, especially in human beings. Recently, the reported upregulated expression of IP3Rs in atrial myocytes of atrial fibrillation (AF) subjects suggested that IP3Rs might be associated with AF. To directly understand the roles of IP3Rs in AF, we have investigated the IP3R-dependent Ca2+ events as well as the cross-talk between IP3Rs and ryanodine receptors (RyRs) in permeabilized atrial myocytes of AF and normal sinus rhythm (NSR) patients by Ca2+ imaging. In the presence of tetracaine, IP(3)R-dependent Ca2+ events in AF atrial myocytes showed increased frequency, delayed termination and broadened width, compared with NSR myocytes. Moreover, when RyRs were not inhibited, IP3 or adenophostin induced an outburst of RyR-dependent spontaneous Ca2+ sparks with the altered spatial-temporal characteristics. The activation of IP3Rs also enhanced Ca2+ waves. These effects on RyR-dependent Ca2+ signaling were significantly stronger in AF myocytes than in NSR cells and were completely blocked by 2-aminoethoxydiphenyl borate. Thus, our results suggested not only an enhanced activity of IP3Rs but also an elevated cross-talk between IP3R- and RyR-mediated Ca2+ signaling in atrial myocytes of human AF patients, a reflection of altered function of IP3Rs in AF.
    Cardiology 08/2009; 114(3):180-91. · 1.52 Impact Factor
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    ABSTRACT: To investigate the clinical profile of myocardial infarction (MI) due to retrograde aortic dissection of aortic root and the relevant predictors of in-hospital death. The clinical data of 207 consecutive patients with type A aortic dissection (AD), who were hospitalized and underwent operation between December 2003 and October 2007, were analyzed retrospectively. Eight of the 207 patients were diagnosed as with MI due to retrograde aortic dissection of aortic root, 6 males and 2 females, aged (49 +/- 14). Surgical repair of the aorta and coronary revascularization was implanted: ascending aorta replacement in 2 cases, hemi-arch replacement in 5 cases, arch replacement in 1 case; coronary artery bypass grafting in 5 cases, and coronary repair in 3 cases. In-hospital death occurred in 4 of the 8 patients (50%) who all had preoperative renal insufficiency and developed acute renal failure (ARF) after surgery. Univariate analysis identified preoperative renal insufficiency an independent predictor of in-hospital death (The preoperative serum creatinine (sCr) level of the surviving patients was (80 +/- 30) micromol/L, significantly lower than that of the deceased patients [(176 +/- 67) micromol/L, P = 0.02]. There were no significant differences in other parameters between the surviving and deceased groups. MI due to type A AD is associated with high operative mortality. Preoperative renal insufficiency attributes to development of ARF after surgery and the unfavorable outcome. Renal function before surgery is essential for risk stratification in this lethal condition.
    Zhonghua yi xue za zhi 01/2009; 88(48):3425-7.
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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.
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    ABSTRACT: Many alterations in sarcoplasmic reticulum Ca(2+) handling proteins in atrial myocytes have been associated with atrial fibrillation (AF) in clinical patients, whereas the functional consequences of these alterations mostly remain unclear. To know whether or not ryanodine receptor (RyR)-mediated intracellular Ca(2+) events in AF atrial myocytes are affected by protein alterations, we investigated spontaneous Ca(2+) sparks and Ca(2+) waves in intact and permeabilized atrial myocytes of AF patients (n(patients) = 21) and normal sinus rhythm (NSR) patients (n(patients) = 22) by laser scanning confocal microscopy. It was found that the frequency, amplitude and rise time of Ca(2+) sparks were comparable between AF and NSR groups, while full width and full duration at half maximum intensity significantly increased in the AF group. Along with these changes, the frequency of small and global Ca(2+) waves increased in AF atrial myocytes. Our results clearly indicated that the spatiotemporal properties but not the frequency of Ca(2+) sparks were affected in AF atrial myocytes. In addition, the frequency of Ca(2+) waves increased. This profile of the alterations in RyR-mediated Ca(2+) events in AF atrial myocytes was different from previous studies. The underlying mechanisms, as well as possible reasons for this discrepancy, were discussed.
    Cardiology 04/2008; 111(2):102-10. · 1.52 Impact Factor
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    ABSTRACT: To summarize the clinical experience on 56 patients undergoing orthotopic heart transplantation. Between May 2000 and December 2003 56 patients, 47 with cardiomyopathy, 2 with end-stage valvular heart disease, 2 with end-stage ischemic heart disease, 2 with primary malignant cardiac tumor, 1 with complicated congenital heart disease, 1 with muscular dystrophy cardiomyopathy, and 1 with refractory malignant ventricular arrhythmias, underwent orthotopic heart transplantation in the Transplantation Center of Fudan University. The operative procedures included 19 conventional Stanford orthotopic cardiac transplantation in 19 cases and bicaval anastomotic cardiac transplantation in 37 cases. Postoperatively, the patients were prescribed with cyclosporine A + corticosteroids + MMF or FK506 + corticosteroids + MMF as anti-rejection therapy. One patient undergoing his fifth operation died of bleeding 3 days after operation. All survivors were followed-up for 12.4 months on average. Five patients died within 1 year postoperatively with a one-year survival rate of 91%. One patient died of allograft vasculopathy 38 months after operation. Other patients enjoyed heart function recovering to class I-II (NYHA). With proper recipient selection, excellent donor heart conservation, bicaval anastomotic technique, and efficient postoperative surveillance and treatment, heart transplantion may produce satisfying mid-term results.
    Zhonghua yi xue za zhi 11/2004; 84(19):1589-91.
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    ABSTRACT: To explore and sum up the characteristics of infection after cardiac transplantation and to discuss the prophylaxis and management. From May 2000 to April 2003, 36 patients received orthotopic heart transplantation, the clinical data were observed and analyzed. Infection occurred in 2 (6%) cases, both belonged to lung infection caused by human cytomegalovirus. The 2 cases were cured by ganciclovir intravenously. Good prophylactic method may decrease post cardiac transplantation infection significantly. It is very important to early diagnose and treat infection.
    Zhonghua wai ke za zhi [Chinese journal of surgery] 02/2004; 42(2):75-6.