The technique of transcatheter aortic valve implantation has become increasingly mature. Although the transapical approach has a certain degree of minimally invasive trauma, it still has the characteristics such as heart beating without cardiopulmonary bypass, and the low technical requirements of catheter guide wire. In particular, the valve path is short and coaxial, which is easy to manipulate, and pure regurgitation and stenosis can be easily operated and are not subject to the limit of peripheral artery stenosis. It is still one of China's main approaches for transcatheter aortic valve replacement. Its perioperative management still has specific features and differs from the femoral artery approach. In addition, there is little relevant literature abroad. Therefore, domestic experts in this field were organized to discuss the development of perioperative management specifications to provide reference and techniques support for developing this field in China and further improve the quality of clinical operation and perioperative management. It will provide more safe and more effective medical services to these patients.
ObjectiveTo explore the influence of enhanced recovery after surgery (ERAS) on intestinal flora in patients with colorectal cancer.MethodsBy convenient sampling method, 60 patients with colorectal cancer were selected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University and randomly divided into ERAS group and traditional treatment group (traditional group). Among them, the perioperative clinical management was carried out according to the ERAS management and traditional treatment process in the the ERAS group and in the traditional group, respectively. The fresh fecal samples were collected within 24 h after admission and the first natural defecation after operation. The bacterial 16 Sr DNA V3–V4 region was sequenced by Illumina MiSeq sequencer, and the results were analyzed by bioinformatics.ResultsA total of 60 patients with colorectal cancer were included, 30 cases in the traditional group and 27 cases in the ERAS group (3 people temporarily withdrew from the study). There were no significant differences in the basic informations between the two groups (P>0.05). ① Before or after operation, there were no significant differences in Shannon index and Simpson index between the two groups. The difference between preoperative and postoperative comparison in the same group was also not statistically significant (P>0.05). ② Beta diversity analysis showed that there was no significant difference in community composition between the traditional group and the ERAS group before operation, and there was a clear boundary between the traditional group and the ERAS group after operation. ③ At the phylum level, compared with the preoperative abundance, the postoperative abundance Firmicutes decreased by 26.5% and 5.5% in the traditional and ERAS group, respectively; Bacteroidetes increased by 21.6% and 4.7% in the traditional and ERAS group, respectively; Proteobacteria increased by 7.2% and 2.2% in the traditional and ERAS group, respectively. At the genus level, compared with the preoperative abundance, the postoperative abundance of Bacteroides in the traditional group increased by 17.6% and in the ERAS group decreased by 1.6%; Bifidobacterium decreased by 1.8% and 1.3% in the traditional group and in the ERAS group, respectively.ConclusionsERAS does not affect species diversity of intestinal flora. Although ERAS has some damage to structure of intestinal flora, it is weaker than traditional process, so it is more conducive to reconstruction and restoration of intestinal microecological environment.
Lung transplantation has been proved to be an effective treatment after more than forty years of fast development, while more than 4000 cases of lung transplantation performed globally each year. Recently, lung transplantation in China has been advanced rapidly, and the number of transplants has increased year by year. Respiratory and Critical Care Medicine team has been recognized to play a crucial role in lung transplantation. It has an irreplaceable role and status in promoting lung transplantation, improving the preoperative evaluation of lung transplantation and the maintenance of donors, and carrying out perioperative management, as well as long-term follow-up. Lung transplantation is a systematic project, requiring the perfect cooperation and collaboration of team members and contributing to recipients’ recovery.
Giant thoracic tumor is currently one of the diagnostic and therapeutic challenges of thoracic surgery, with no established guideline or standard for diagnosis and treatment. The quality control of individualized surgical strategy and perioperative management with multi-disciplinary participation is the key to ensure the safety and improve the prognosis of patients. Based on the clinical experience of our institution and others, we hereby discussed and summarized the basic principles, surgical strategies and perioperative management of giant thoracic tumor, aiming to provide a reference of quality control.
Transcatheter mitral valve edge-to-edge repair (TEER) has become an important treatment opinion for patients with severe mitral regurgitation (MR) at high risk for surgery. The devices and procedural techniques of TEER are complex and require excellent team cooperation. However, there is still a lack of standardized clinical pathways in China. Based on the latest evidence, the expert group wrote this clinical pathway to guide and optimize TEER therapy in clinical practice. It demonstrates the following key issues of clinical concern: (1) TEER team building; (2) preoperative clinical evaluation of TEER patients; (3) imaging assessment before TEER procedure; (4) standardized procedures for TEER; (5) TEER for complex MR; (6) the standard process of perioperative comprehensive management; and (7) full life-cycle rehabilitation and follow-up. This clinical pathway might be helpful to facilitate the standardized development of TEER therapy and application, and promote the improvement of management and life quality for patients with MR.
With the widespread adoption of antiretroviral therapy, vast improvements in the life expectancy of individuals infected with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) were seen, and the liver disease of this population has become a leading cause of mortality. Although liver transplantation is as an effective treatment for end-stage liver disease, it remains in its nascent stage for the patients with HIV/AIDS in China, lacking standardized protocols and substantial clinical experience. Therefore, a “Multicenter expert consensus on perioperative management of liver transplantation in patients with human immunodeficiency virus infection” was formulated. This expert consensus aims to standardize and optimize the diagnosis and treatment process for liver transplantation in HIV-infected patients, providing systematic guidance for this procedure in China and fostering multidisciplinary collaboration and development in the field. This expert consensus clearly delineates the indications and contraindications for liver transplantation in HIV-infected patients, emphasizing comprehensive preoperative evaluations of both donors and recipients. These evaluations include infection control measures, immune function monitoring, and management of comorbidities. In terms of surgical procedures, strategies to prevent occupational exposure and intraoperative guidelines are outlined. Postoperatively, the focus is on antiviral therapy, individualized immunosuppression management, and vigilant monitoring of complications to ensure patient recovery and long-term survival. The long-term follow-up management prioritizes regular assessments of liver function, immune status, and HIV-related indicators to adjust treatment plans and enhance patient survival rates and quality of life. With the continuous enrichment of clinical experience and the progress of clinical research, this consensus will be continuously updated.
We update the "2021 expert consensus on clinical pathway for transcatheter aortic valve replacement in China" using the Delphi method. By searching for evidence related to the clinical pathways of transcatheter aortic valve replacement (TAVR) in PubMed, CIKI, and Wanfang Database over the past four years, 35 core viewpoints were proposed in four directions: TAVR team composition and clinical evaluation, perioperative imaging assessment, surgical process, and perioperative and postoperative long-term management of patients. The specific updates include: refining the responsibilities and composition of the TAVR team, clarifying the steps and content of clinical evaluation; emphasizing the core position of CT in perioperative imaging assessment, and introducing the application of new technologies such as artificial intelligence, numerical simulation, and 3D printing; optimizing the TAVR surgical process, including anesthesia selection, access establishment, valve selection and release, and others; and proposing management strategies for special types of patients (such as emergency TAVR, simplified TAVR, pure aortic regurgitation, combined coronary heart disease and atrial fibrillation). In addition, the consensus also emphasizes the importance of postoperative follow-up and rehabilitation, and provides detailed antithrombotic and rehabilitation guidance. The update of this consensus will further promote the standardized development of TAVR technology in China and improve clinical treatment effects.
ObjectiveTo optimize the perioperative management experiences for breast cancer patients undergoing direct-to-implant-based breast reconstruction, and provide reference for clinical practice. Methods A comprehensive review of recent domestic and international literature was conducted to systematically summarize the key points of perioperative management for direct-to-implant-based breast reconstruction, including preoperative health education, intraoperative strategies, and postoperative management measures, along with an introduction to the clinical experiences of West China Hospital of Sichuan University. ResultsStandardized perioperative management can effectively reduce the incidence of complications and achieve excellent cosmetic outcomes and quality of life after operation. Pre-operative management includes proactive health education to alleviate patients’ anxiety and improve treatment compliance, as well as comprehensive assessment by surgeons of the patient’s physical condition and reconstructive expectations to select the most appropriate implant. Intra-operative management consists of strict aseptic technique, minimizing implant exposure, preserving blood supply to the nipple-areola complex (e.g., by using minimally invasive techniques and indocyanine green angiography), and meticulous hemostasis. Post-operative management encompasses multimodal analgesia, individualized drain management (such as early removal or retaining a small amount of fluid to optimize contour), infection prevention and control (including topical and systemic antibiotics, ultrasound-guided minimally invasive drainage), guidance on rehabilitation exercises (early activity restriction followed by gradual recovery), and regular follow-up to evaluate aesthetic results and monitor for complications. ConclusionEstablishing a standardized, multidisciplinary perioperative management framework markedly enhances surgical safety and patient satisfaction, thereby providing a replicable benchmark for direct-to-implant-based breast reconstruction across diverse clinical settings.
ObjectiveTo summarize the recent research progress of artificial intelligence (AI) for perioperative management of colorectal cancer (CRC), and to explore its clinical application value and future development direction. MethodThe relevant research on AI in the perioperative management of CRC surgery from China National Knowledge Infrastructure, Wanfang, PubMed, and Google Scholar databases in the past 5 years was retrieved and reviewed. ResultsCurrently, AI had been applied throughout the entire process related to CRC surgery. Preoperatively, AI-assisted analysis of CT or MRI images facilitated precise tumor staging assessment, prediction of neoadjuvant therapy response, and surgical planning optimization. Intraoperatively, real-time endoscopic vision integrated with AI enabled tumor localization, tracking, and tissue identification accuracy, enhancing procedural safety. Postoperatively, AI-supported rehabilitation protocols optimized early mobilization, enabled continuous complication monitoring, and refined follow-up management, providing personalized intervention strategies for early clinical intervention to improve patient outcomes. ConclusionsCurrent research demonstrates promising outcomes of AI applications in CRC perioperative management, yet reveals a significant imbalance in research focus with predominant investigations concentrated on preoperative assistance. Notably, postoperative domains, including fall prevention, medication error detection, complication mitigation, adjuvant therapy decision support, psychosocial support, recurrence surveillance, and survival follow-up, exhibit marked deficiencies in AI exploration and clinical translation, constituting a critical weakness in establishing comprehensive intelligent support throughout the perioperative continuum. Future research must extend beyond addressing intraoperative AI challenges to prioritize AI-augmented prediction of short-/long-term complications, optimization of personalized rehabilitation pathways, precision adjuvant therapy decision support, intelligent follow-up systems, and applications enhancing postoperative quality of life and long-term survival outcomes.