Objective To explore the feasibility and option of different surgeries for neonates with pulmonary atresia and ventricular septal defect (PA/VSD) through assessing the effect of common surgeries. Methods Fourteen neonates who underwent their first surgery in our center from July 2004 to October 2014 were included. Their basic characteristics, operation and pre- and postoperative clinical information were extracted. Follow up was conducted and the last visit was on October 10, 2016. Short- and midterm survival and total correction rate were compared among different surgeries. Results Among the 14 patients, there were 4 (28.6%) patients, 6 (42.9%) and 4 (28.6%) who underwent one-stage repair, right ventricular outflow tract (RVOT) reconstruction, and systemic to PA shunt operation respectively. The overall in-hospital mortality after the first operation was 28.6% (4/14). At last visit, no death occurred resulting the 5-year survival rate of 71.4% (10/14). The overall total correction rate for all neonates was 64.3% (9/14). Although no statistical difference was found in the mortality among the one-stage repair , RVOT reconstruction and systemic to PA shunt group(50.0% vs. 33.3% vs. 0.0%, P=0.280), the survival and hazard analysis implied better outcomes of the systemic to PA shunt palliation operation. There was no statistical difference in the total correction rate and months from the first palliative operation to correction between those who underwent RVOT reconstruction and systemic to PA shunt (75.0% vs. 50.0%, P=0.470; 32.0 months vs. 18.0 months, P=0.400). Conclusion Performing surgeries for neonates with PA/VSD is still a great challenge. However, the midterm survival rate was optimistic for the early survivors. Systematic to PA shunt seemed to be a better choice with lower mortality for the neonates with PA/VSD who need the surgery to survive.
ObjectiveTo evaluate the effectiveness of preoperative immunosuppressive therapy combined with surgical intervention. MethodsA retrospective study was conducted on Behçet's disease patients who underwent cardiac surgery at Guangdong Provincial People's Hospital from 2012 to 2021. Patients were divided into immunosuppressive group and non-immunosuppressive group based on whether they received immunosuppressive therapy before surgery. The complications and long-term survival rates of the two groups were analyzed. ResultsA total of 28 patients were included, among which 2 patients underwent reoperation, a total of 30 surgeries were performed, including 16 males (53.3%), and the confirmed age was 37 (31, 45) years old. There were 15 surgeries in the immunosuppressive group and 15 surgeries in the non-immunosuppressive group. Compared with the non-immunosuppressive group, the incidence of complications during hospitalization in the immunosuppressive group was lower (13.3% vs. 53.3%, P=0.008). One patient died in hospital, and the rest were discharged and followed up, with a median follow-up time of 38.7 (15.1, 57.3) months, and there was no statistically significant difference in long-term survival rate between the two groups (26.7% vs. 6.7%, P=0.158). There was no statistically significant difference in the cumulative incidence of complications one month (20% vs. 53%, P=0.058) and one year (27% vs. 60%, P=0.065) after surgery between the immunosuppressive group and the non-immunosuppressive group, but there was a statistically significant difference in the cumulative incidence of complications three years after surgery (47% vs. 92%, P=0.002). ConclusionSurgical treatment can save lives in Behçet's disease patients with cardiovascular diseases, but the incidence of postoperative complications is high. Timely use of immunosuppressants before cardiovascular surgery can reduce the incidence of postoperative complications.
Composite grafting techniques is a commonly used strategy in coronary artery bypass grafting,especially suits elderly patients.It is an attractive myocardial revascularization strategy when the grafts are not sufficient to achieve complete myocardial revascularization.Furthermore,composite grafting in the presence of a diseased aortic wall seems a rational approach to reduce the incidene of postoperative neurological deficit or stroke by avoiding the manipulation of atherosclerotic aorta.Also,it gained excellent short and midterm results.This review provides an overview of the various surgical techniques,outcomes,concerns and controversies associated with composite grafting.
ObjectiveTo summarize surgical experience and explore the best treatment strategy for the management of complicated mediastinitis after cardiac surgery. MethodsClinical data of 18 patients who received vascularized muscle flap transposition combined with negative pressure wound therapy (NPWT)for the treatment of complicated mediastinitis after cardiac surgery in one stage in the Department of Cardiac Surgery of Beijing Anzhen Hospital, Capital Medical University between June 2006 and December 2012 were retrospective analyzed. There were 12 male and 6 female patients with their average age of 65.5±8.2 years. The average interval between cardiac surgery and vascularized muscle flap reconstruction was 12.5±5.8 days. ResultsPostoperatively, 1 patient died of recurrent mediastinitis, sepsis and multiple organ dysfunction syndrome. Seventeen patients had an uneventful postoperative recovery and one-stage wound healing. Postoperative hospital stay was 18.6±7.2 days and wound healing time was 4.5±2.4 weeks. All the 17 patients were followed up for over 6 months, no recurrent mediastinitis was observed, and they had a good quality of life. ConclusionVascularized muscle flap transposition combined with NPWT is a simple and effective surgical strategy for the treatment of complicated mediastinitis after cardiac surgery in one-stage.
随着人口的老龄化，越来越多的有症状或无症状的冠心病患者需接受非心脏外科手术。接受非心脏外科手术而死亡的患者大约有50%是由于心脏并发症所致［1］。围手术期发生的心脏并发症大约5%～10%为心肌梗死，主要发生于术后头3天，其病死率很高，可达32%～69%［2，3］。术后发生心肌梗死或不稳定型心绞痛的患者发生心血管问题的几率增加20倍［4］。因此，如何评估非心脏外科手术患者的心脏危险性，如何预防围手术期心脏并发症的发生，已成为外科医生十分关注的一个问题。
【摘要】 目的 探讨活动期感染性心内膜炎（infectiue endocarditis，IE）患者心脏手术的最佳时期。 方法 回顾分析1999年9月-2009年9月行外科治疗的92例IE患者的临床资料。IE诊断标准为修订的Duke标准。采用SPSS 12.0软件包，分析了年龄、性别、是否是院内感染IE、合并症（糖尿病、慢性阻塞性肿疾病、癌症）、病原菌、手术时间等因素与手术并发症及6个月病死率的关系。 结果 56例患者在确诊为IE后7 d内手术，36例患者在确诊7 d后，并抗生素治疗完成后手术。葡萄球菌为主要感染菌株，与栓塞、脓肿及感染性休克显著相关。最常见的手术指征是重度的瓣膜关闭不全合并心功能不全。6个月的病死率为12%。早期手术与晚期手术比较，病死率增高。单因素分析显示，与6个月病死率相关的因素包括葡萄球菌感染和感染性休克。多因素分析显示感染性休克为6个月内死亡的预测因子。感染性休克的患者尽管行了早期手术，病死率仍为67%。严重瓣膜关闭不全的患者，若未出现心衰，无手术（早期或晚期）死亡。 结论 手术患者的预后由是否发生过感染性休克决定。晚期手术组患者结果好于早期手术组，但结果的差异可能并不是手术的时期不同，而是感染性心内膜炎的严重程度不同造成的。对于有重度瓣膜返流但无心衰的患者，早期手术可能在缩短住院时间，预防心衰发生上有帮助。【Abstract】 Objective To discuss the optimal time of cardiac operations in patients with infective endocarditis (IE). Methods We analyzed the clinical data of 92 patients with IE diagnosed by the modified Duke criteria between September 1999 and September 2009. SPSS 12.0 was used to analyze predictors of 6-month mortality, including age, sex, nosocomial origin of infection, comorbid conditions (diabetes, chromic obstructive pulmonary disease, cancer), the causative microorganisms, the timing of cardiac operation, and the complications. Results Fifty-six patients underwent operation within the first 7 days after diagnosis of infective endocarditis, and 36 received operation at the completion of antibiotic treatment 7 days after the diagnosis. Staphylococci predominated and were significantly associated with embolism, abscess, and septic shock. The most frequent indication for operation was severe regurgitation with heart failure. The 6-month mortality was 12%. Early operation showed an increased mortality compared with late operation. Univariate analysis showed that factors associated with 6-month mortality included staphylococci infection and septic shock. Multivariate analysis revealed that septic shock was a predictor of 6-month mortality. Despite early operation for patients with septic shock, 67% of them died. No death occurred to patients with severe regurgitation but without heart failure after undergoing (early or late) operations. Conclusions The prognosis for surgically treated patients is determined by the occurrence of septic shock. The outcome in patients undergoing late operations is favorable compared with patients undergoing early operations. This difference is probably not due to the timing of the surgical intervention but to the severity of infective endocarditis. In patients with severe regurgitation without heart failure, early operation may offer benefits in shortening the length of hospitalization and preventing development of heart failure.
Objective To investigate the effect of applying intraoperative epicardial echocardiography (IEE) on preoperative monitoring and evaluating the clinical result of cardiac surgery. Methods We retrospectively analyzed the clinical data of 248 patients treated in the Affiliated 105 Hospital of People’s Liberation Army and the First Affiliated Hospital of Anhui Medical University from June 2008 to May 2015. There were 108 males and 140 females. The age ranged from 7 months to 71 years. There were 113 patients diagnosed with the congenital heart disease (CHD) at the mean age of 11.89±14.74 years. There were 135 patients diagnosed with valvular heart disease at the mean age of 47.20±14.57 years. All patients underwent IEE during operation. Results In 113 patients with CHD, we found new deformities and corrected preoperative diagnosis before cardiopulmonary bypass (CPB) and we identified surgical complications after CPB by IEE. Other deformities and left atrial thrombus were found in 135 patients with valvular heart disease by IEE before CPB. After CPB, paravalvular leak and mitral regurgitation were found, therefore we took action immediately. Conclusions IEE can improve the preoperative diagnosis and reduce perioperative complications, which has value of application during cardiac surgery.
ObjectiveTo analyze the clinical effects of staged repair for severe tetralogy of Fallot (TOF), and to investigate a better individual treatment of TOF. MethodsWe retrospectively analyzed the clinical data of 110 children with TOF in our hospital from January 2009 through December 2014. The patients were divided into a severe TOF group (Group A, n=23) and a mild TOF group (Group B, n=87). In the group A, all 23 patients underwent staged surgery (modified Blalock-Taussig and radical operation of TOF). In the Group B, all 87 patients only received a radical operation of TOF. The patients' preoperative and postoperative arterial oxygen saturation, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), the results of perioperation and follow-up were compared. ResultsIn the group A, there was no death after modified Blalock-Taussig (MBT). The median interval time between MBTs and radical operation was 9 months (ranged from 6.3 to 25.3 months). Compared with that before MBTs, the McGoon ratio and LVEDVI were significantly increased at the time of radical operation. And the pulmonary artery development and left ventricle volume reached the standard of radical operation of TOF (P < 0.01). After the radical operation, one patient died for pneumonia in the early postoperation period. In the group B, three patients died for low cardiac output syndrome during perioperation. There was no significant difference between the group A and the group B in in-hospital mortality, length of hospital stay, intensive care unit (ICU) stay, ventilation time, cardiopulmonary bypass time, aortic cross-clamp time, rate of using trans-annular repair path, or drainage of pleural fluid. ConclusionStaged repair of severe TOF is safe and effective for children, who are not suitable for one-stage radical operation. Severe TOF received staged repair can achieve the similar outcomes with that of mild TOF underwent one-stage radical operation.