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ABSTRACT: Systolic function of the left ventricle is vital for patients with aortic stenosis. Unfortunately, the most widely used clinical parameter, the left ventricular ejection fraction, is not sensitive enough, especially for patients with left ventricular hypertrophy. Echocardiographic strain/strain rate and twist are emerging parameters for left ventricular systolic and diastolic function evaluation. Aortic stenosis could reduce strain/strain rate while magnifying twist. Furthermore, strain/strain rate correlates well with the prognosis of patients with aortic stenosis. Most importantly the circumferential strain, strain rate and twist also play a role in differentiating cardiac compensation or decompensation. In any case, these parameters could normalize after successful surgical aortic valve replacement or transcatheter aortic valve replacement. Regardless of these advantages, clinical evidence is needed to ensure their usefulness.
Interactive cardiovascular and thoracic surgery 05/2013;
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ABSTRACT: BACKGROUND: Acute type A aortic dissection (TAAD) is a life-threatening vascular disease. Smooth muscle cells (SMCs) are the main composition of aortic media and dysfunction of SMCs may lead to acute TAAD. The aim of this work was to investigate whether the SMCs of acute TAAD could be isolated and cultured for further research. METHODS: TAAD tissues were obtained from acute TAAD patients who underwent emergent surgical treatment. A simple and economical technique of collagenase digestion method was used to isolate and culture human SMCs. Confocal laser scanning microscopy was applied to identify SMC phenotypes. Purity of isolated and cultured SMCs was analyzed with flow cytometry and fluorescence microscopy respectively. RESULTS: The purity of isolated SMCs was 78.2%, including alpha-smooth muscle cell actin positive 13.9%, calponin positive 35.0% and double positive 29.3%. For cultured SMCs, abundant expression of alpha-smooth muscle cell actin was observed universally under fluorescence microscope. Confocal laser scanning microscope testified that cultured cells were double positive of alpha-smooth muscle actin and calponin. CONCLUSIONS: This is the first report of successful culture of SMCs isolated from human acute TAAD tissues. Living human SMCs of acute TAAD provides us with a new method for studying formation of acute TAAD.
Journal of Cardiothoracic Surgery 04/2013; 8(1):83. · 1.19 Impact Factor
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ABSTRACT: BACKGROUND: This study aimed to retrospectively investigate our experience of surgical treatment for acute type A aortic dissection in patients older than 70 years. METHODS: From September 2005 to January 2012, eleven patients who were older than 70 years underwent surgical treatment for type A aortic dissection at our center and were included in this study. Total arch replacement was performed in three patients, seven patients underwent subtotal arch replacement and one with single-branched stent graft implantation. One patient underwent a valve-sparing (David) procedure while another underwent a concomitant aortic valve replacement (Wheat procedure). One patient required coronary artery bypass grafting. All operations were performed under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. RESULTS: There was one in-hospital death (9.1%) and no operative mortality within 30 days. Cardiopulmonary bypass time, myocardial ischemic time and antegrade cerebral perfusion time accounted for 151.4+/-33.5 minutes, 68.5+/-41.4 minutes and 30.3+/-12.9 minutes, respectively. Overall in-hospital duration, intensive care unit (ICU) time and mean ventilation time were 40.9+/-40.3 days, 16.5+/-22.5 days and 90.5+/-139.4 hours, respectively. New postoperative permanent neurological dysfunction and temporary neurological dysfunction were observed in one patient (9.1%) and in three patients (27.3%), respectively. Mean follow-up was 49.0+/-19.9 months and nine patients are still alive, one patient died of cancer after 24 months postoperation. CONCLUSIONS: Surgical management for acute type A dissection in patients older than 70 years is a safe alternative with acceptable risk of death and the early and late results are satisfactory.
Journal of Cardiothoracic Surgery 04/2013; 8(1):78. · 1.19 Impact Factor
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ABSTRACT: BACKGROUND: The primary experience of open triple-branched stent graft placement for acute aortic arch dissection was reported. METHODS: Between January 2011 and October 2011, 13 well-selected patients (mea age, 46+/-8.2 years; approximate range, 30~58 years) with acute aortic arch dissection underwent open triple-branched stent graft placement for total arch reconstruction. The triple-branched stent graft was a branched 1-piece graft consisting of a self-expandable nitinol stent and polyester vascular graft fabric (Yuhengjia Sci Tech Corp Ltd, Beijing, China).During hypothermic circulatory arrest, through the transverse incision of the ascending aorta, the main graft of the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta, and then each sidearm graft was positioned one by one into the aortic branch. Once the main graft and sidearm grafts were properly positioned, the restraining strings were withdrawn and then the main graft and sidearm grafts were deployed. Enhanced electric beam computed tomography was performed in each patient before discharge to evaluate the postoperative time course of the residual false lumen. RESULTS: Open triple-branched stent graft placement was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and arrest time were 138.40+/-47.75 min, 70.60+/-28.94 min and 28.60+/-12.48 min, respectively. All patients were discharged from hospital. Their computed tomographic scans postoperatively showed that all stent grafts were fully opened and not kinked, there was no blood flow surrounding the triple-branched stent graft. CONCLUSION: Open triple-branched stent graft placement is a new effective technique for total arch reconstruction in acute arch dissection.
Journal of Cardiothoracic Surgery 12/2012; 7(1):130. · 1.19 Impact Factor
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ABSTRACT: We report a quite rare case of giant extracardiac unruptured aneurysm of the right coronary sinus of Valsalva with no clinical findings of Marfan syndrome or Ehlers-Danlos syndrome. A 52-year-old Chinese male was diagnosed having an aneurysm of the right sinus of Valsalva and moderate aortic regurgitation, while Bentall operation was performed successfully. The patient was discharged with no complications. Pathological examination revealed conspicuously medial mucoid degeneration of the aneurismal wall and absence of medial elastic fibers. Immediate results and early follow-up were uneventful.
General Thoracic and Cardiovascular Surgery 05/2012;
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ABSTRACT: The superiority of bilateral versus unilateral antegrade cerebral perfusion (ACP) has been the subject of much debate. This study aimed to compare the two methods of cerebral perfusion.
Between September 2005 and June 2011, 263 patients (median age 51.4±10.1 years, range, 26 to 75; 200 men) underwent open aortic arch reconstruction with hypothermic circulatory arrest and bilateral or unilateral ACP. Among them, 231 patients had acute aortic dissection, 12 had subacute aortic dissection, 20 had chronic aortic dissection, 7 had Marfan syndrome, 8 had reconstruction secondary to endovascular stent graft placement for type B dissection, and 9 had bicuspid aortic valve. Our patient cohort is divided into those protected with hypothermic circulatory arrest and bilateral ACP (group A, n=128) and those with hypothermic circulatory arrest and unilateral ACP (group B, n=135).
There was no significant difference between groups A and B in cardiopulmonary bypass time, cross-clamp time, or cerebral perfusion time. Overall in-hospital mortality was 11.7% for group A and 11.1% for group B (p=0.877). Postoperative temporary and permanent neurologic dysfunction was 5.5% versus 6.7% and 12.5% versus 10.4%, respectively (group A versus group B: p=0.685, p=0.587). Intensive care unit time was 9.4±9.8 days for group A and 8.4±14.0 days for group B (p=0.972). Hospitalization was 24.3±14.6 days for group A and 23.1±21.1 days for group B (p=0.172).
Unilateral ACP with hypothermic circulatory arrest is a safe cerebral protection technique for open aortic arch reconstruction, and is not inferior to bilateral ACP with hypothermic circulatory arrest.
The Annals of thoracic surgery 05/2012; 93(6):1917-20. · 3.74 Impact Factor
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ABSTRACT: Retrograde type A aortic dissection (RTAD) is a life-threatening and underestimated complication of endovascular stent graft placement for type B dissection. Here, we retrospectively investigated our experience of surgical treatment for RTAD after endovascular stent graft placement for type B dissection. Between June 2006 and September 2011, nine patients with RTAD were transferred to our department for surgery. Total arch replacement was performed in six patients and three patients underwent subtotal arch replacement. Associated procedures consisted of ascending aorta replacement in nine patients, coronary artery bypass grafting in one patient and aortic valve plasty in two patients. All operations were performed under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion. Cardiopulmonary bypass time was 158.33 ± 29.18 min. The myocardial ischaemic time was 78.11 ± 28.30 min. The antegrade cerebral perfusion time was 38.67 ± 12.34 min. The mean ventilation time was 45.63 ± 24.74 h. A tracheotomy was necessary in one patient. The ICU time was 7.00 ± 6.80 days and the in-hospital duration was 25.33 ± 11.95 days. There was no in-hospital mortality. The mean follow-up was 34.79 ± 19.37 months and eight patients are still alive. One patient was lost to follow-up. Surgical treatment for RTAD is a safe alternative and the results are encouraging.
Interactive cardiovascular and thoracic surgery 02/2012; 14(5):538-42.
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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 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.
