ObjectiveTo discuss outcomes of arch reintervention for post-repair recoarctation in children.MethodsFrom 2009 to 2019, 48 patients underwent reintervention for post-repair recoarctation in Shanghai Children’s Medical Center. Of the 48 patients, 22 patients had surgical repair, 25 patients had balloon angioplasty (BA), and 1 patient had a stent implantation. The clinical data were analyzed, and the difference in time-to-event distribution between the surgical group and the BA group was determined by a log-rank test.ResultsThe median age at reintervention was 15.0 months (range, 3.0 months-15.1 years). The median weight at reintervention was 9.8 kg (range, 3.0-58.0 kg). The time to reintervention after initial repair was 12.5 months (range, 2.0 months-7.8 years). One patient (2.1%) died in hospital and 1 patient (2.1%) experienced arrhythmia after surgical repair. One late mortality (2.1%) occurred after surgical reintervention. One patient (2.1%) experienced aortic dissection after BA. No patient died after BA. Freedom from residual coarctation or new recurrences was 66.7%, 61.3%, and 56.9%, respectively, at 1, 2, and 5 years after reintervention. Freedom from residual coarctation or new recurrences was 90.0%, 81.8%, and 70.1%, respectively, at 1, 2, and 5 years after surgical repair. Freedom from residual coarctation or new recurrences was 52.0%, 48.0%, and 48.0%, respectively, at 1, 2, and 5 years after BA. Compared with BA, surgery-based reintervention had a lower incidence of residual coarctation or recurrences (χ2=4.400, P=0.036).ConclusionReintervention for recoarctation has favorable early outcomes. Compared with balloon angioplasty, surgical repair has a more lasting effect in relieving the recoarctation.
Objective To investigate the efficacy of leaflet augmentation technique to repair the recurrent mitral valve (MV) regurgitation after mitral repair in children. Methods A retrospective analysis was conducted on the clinical data of children who underwent redo MV repair for recurrent regurgitation after initial MV repair, using a leaflet augmentation technique combined with a standardized repair strategy at Fuwai Hospital, Chinese Academy of Medical Sciences, from 2018 to 2022. The pathological features of the MV, key intraoperative procedures, and short- to mid-term follow-up outcomes were analyzed. Results A total of 24 patients (12 male, 12 female) were included, with a median age of 37.6 (range, 16.5–120.0) months. The mean interval from the initial surgery was (24.9±17.0) months. All children had severe mitral regurgitation preoperatively. The cardiopulmonary bypass time was (150.1±49.5) min, and the aortic cross-clamp time was (94.0±24.2) min. There were no early postoperative deaths. During a mean follow-up of (20.3±9.1) months, 3 (12.5%) patients developed moderate or severe mitral regurgitation (2 severe, 1 moderate). One (4.2%) patient died during follow-up, and one (4.2%) patient underwent a second MV reoperation. The left ventricular end-diastolic diameter was significantly reduced postoperatively compared to preoperatively [ (43.5±8.6) mm vs. (35.8±7.8)mm, P<0.001]. Conclusion The leaflet augmentation technique combined with a standardized repair strategy can achieve satisfactory short- to mid-term outcomes for the redo mitral repair after previous MV repair. It can be considered a safe and feasible technical option for cases with complex valvular lesions and severe pathological changes.
ObjectiveTo summarize the reoperation experience for complete atrioventricular septal defect (CAVSD) with severe left atrioventricular valve regurgitation (LAVVR) by standardized mitral repair-oriented strategy.MethodsFrom 2016 to 2019, 11 CAVSD patients underwent reoperation for severe LAVVR by standardized mitral repair-oriented strategy at Fuwai Hospital, including 5 males and 6 females with a median age of 56 (22-152) months. The pathological characteristics of severe LAVVR, key points of repair technique and mid-term follow-up results were analyzed.ResultsThe interval time between the initial surgery and this surgery was 48 (8-149) months. The aortic cross-clamp time was 54.6±21.5 min and the cardiopulmonary bypass time was 107.4±38.1 min, ventilator assistance time was 16.4±16.3 h. All patients recovered smoothly with no early or late death. The patients were followed up for 29.0±12.8 months, and the echocardiograph showed trivial to little mitral regurgitation in 5 patients, little regurgitation in 5 patients and moderate regurgitation in 1 patient. The classification (NYHA) of cardiac function was class Ⅰ in all patients.ConclusionStandardized mitral repair-oriented strategy is safe and effective in the treatment of severe LAVVR after CAVSD surgery, and the mid-term results are satisfied.
ObjectiveTo understand the current progress of diagnosis and treatment of accidental gallbladder cancer.MethodThe relevant literatures about diagnosis and treatment of accidental gallbladder cancer and gallbladder cancer were analyzed and summarized.ResultsDue to the lack of specific symptoms and signs in most patients with accidental gallbladder cancer at the early stage, appropriate imaging examinations and tumor marker examinations could improve the preoperative diagnosis rate. The radical resection was the most effective method for accidental gallbladder cancer, but there were still some controversies about the scope of resection according to different tumor stages, the choice of laparoscopic cholecystectomy or open cholecystectomy, and the timing of reoperation. The postoperative adjuvant therapy could improve the prognosis of patients, but most patients didn’t receive adjuvant therapy after surgery.ConclusionsMost patients with accidental gallbladder cancer are in the early stage, and most of them could obtain radical resection. If the first operation fails to achieve radical resection or postoperative pathological examination to confirm the diagnosis, comprehensive evaluation of the tumor stage and the patient’s general condition should be performed, and remedial treatment should be taken as soon as possible.
ObjectiveTo investigate and evaluate the safety and efficacy of Bentall operation in the reoperation of patients with small aortic root or annulus.MethodsBentall procedure was performed in 24 patients with small aortic root or annulus in our hospital from September 2014 to December 2019. There were 18 males and 6 females with a mean age of 31-68 (45.70±15.27) years. All patients had undergone a previous replacement of the aortic valve including 20 patients receiving valve replacement, 2 patients aortic root replacement with a valved conduit and 2 patients bioprothesis replacement.ResultsThere was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 2 patients and no bleeding was related to the proximal anastomosis of the conduit. One patient performed pacemaker implantation for heart block after the procedure. The mean sizes of implanted aortic valve prosthesis were 22.75±1.78 mm. A mean gradient across the aortic valve prostheses in the postoperative echocardiographic examination was 11.17±2.24 mm Hg.ConclusionBentall procedure is safe and allows a larger size of prosthesis implantation in patients with small aortic annulus or root after previous aortic valve or complete root replacement, resulting in good postoperative hemodynamic characteristics and short-term clinical results.
ObjectiveTo summarize the surgical strategy of reoperative aortic root replacement after prior aortic valve replacement (AVR), and analyze the early and mid-term outcomes.MethodsFrom April 2013 to January 2020, 75 patients with prior AVR underwent reoperative aortic root replacement in Fuwai Hospital. There were 54 males and 21 females with a mean age of 56.4±12.7 years. An emergent operation was performed in 14 patients and an elective operation in 61 patients. The indications were aortic root aneurysm in 38 patients, aortic dissection involving aortic root in 30 patients, root false aneurysm in 2 patients, prosthesis valve endocarditis with root abscess in 2 patients, and Behçet's disease with root destruction in 3 patients. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test.ResultsThe operative procedures included prosthesis-sparing root replacement in 45 patients, Bentall procedure in 26 patients, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/75). A composite of adverse events occurred in 5 patients, including operative death (n=1), stroke (n=1), and acute renal injury necessitating hemodialysis (n=3). The follow-up was available for all 74 survivors, with the mean follow-up time of 0.5-92.0 (30.3±25.0) months. Four late deaths occurred during the follow-up. The survival rate at 1 year, 3 years and 6 years was 97.2%, 91.4% and 84.4%, respectively. Aortic events developed in 2 patients. The rate of freedom from aortic events at 1 year, 3 years, and 6 years was 98.7%, 95.0% and 87.7%, respectively. There was no difference in rate of survival or freedom from aortic events between the elective patients and the emergent patients.ConclusionReoperative aortic root replacement after prior AVR can be performed to treat the root pathologies after AVR, with acceptable early and mid-term outcomes.
ObjectiveTo summarize the clinical outcomes and experience of surgical treatment for patients with complete atrioventricular septal defect (CAVSD) above the optimal age for surgery.MethodsWe retrospectively reviewed clinical data of 163 simple type CAVSD patients less than 7 years who underwent operations in Fuwai Hospital from 2002 to 2013. The patients were divided into a normal group (n=84, including 37 males and 16 females with an average age of 7.6±2.7 months) and an over-age group (n=79, including 30 males and 49 females with an average age of 34.6±19.6 months) according to whether the age was more than 1 year.ResultsThe average aortic cross clamp time (88.3±24.4 min vs. 106.1±35.4 min, P<0.001) and cardiopulmonary bypass time (123.6±31.1 min vs. 142.6±47.1 min, P=0.003) were statistically different between the two groups. During the follow-up period (the normal group 53.3±43.9 months, the over-age group 57.2±48.2 months), there was no statistical difference in all-cause mortality (10.7% vs. 8.9%, P=0.691), the incidence of moderate or severe left atrioventricular valve regurgitation (16.7% vs. 21.5%, P=0.430) and reintervention rate (3.6% vs. 0.0%, P=0.266) between the two groups. No left ventricular outflow tract obstruction and complete atrioventricular block occurred in both groups.ConclusionFor CAVSD children above the optimal age, rational surgical treatments can also achieve satisfying results.
ObjectiveTo explore risk factors and prognosis of unplanned reoperation in patients with malignant tumors of digestive tract. MethodsThe clinical data of patients with malignant tumors of digestive tract underwent unplanned reoperation who treated in the Department of General Surgery, the Northern District of the Shanghai Ninth People’s Hospital from January 2014 to December 2017 were retrospectively collected, and each operation was matched in a ratio of 1∶3 as a case-conontrol study object. The risk factors and prognosis of unplanned reoperation were analyzed by the basic information, surgical related informations, and postoperative relevant informations. ResultsThere were 33 cases of unplanned reoperation in the 588 patients with malignant tumors of digestive tract treated surgically, 8 cases died after the unplanned reoperation. The analysis results showed that the basic diseases, history of previous abdominal surgery, preoperative anemia, the first operative time >4 h and intraoperative blood loss ≥400 mL were the independent risk factors of the unplanned reoperations (P<0.050); the basic diseases, unplanned preoperative hemoglobin <90 g/L and intraoperative blood loss ≥400 mL were the independent factors of death for patients with unplanned reoperation (P<0.050). ConclusionsEffective intervention on independent risk factors associated with unplanned reoperation in patients with digestive tract malignant tumors can reduce incidence of unplanned reoperation in future and improve prognosis.
ObjectiveTo explore the effect of LeCompte maneuver on in-hospital mortality and mid-to-long term reintervention after single-stage arterial switch operation in children with side-by-side Taussig-Bing anomaly. Methods Clinical data of patients diagnosed with side-by-side Taussig-Bing anomaly and undergoing single-stage arterial switch operation in Shanghai Children’s Medical Center from 2006 to 2017 were retrospectively analyzed. Patients were divided into two groups based on whether LeCompte maneuver was performed: a LeCompte maneuver group and a non LeCompte maneuver group. The clinical data of two groups were compared. ResultsFinally 92 patients were collected. LeCompte maneuver was performed in 32 out of 92 patients with a median age of 65.0 days and an average weight of 4.3 kg, among whom 24 (75.0%) were male. Fifteen (46.9%) patients received concomitant aortic arch repair while 12 (37.5%) patients were associated with coronary artery malformation. LeCompte maneuver was not performed in 60 patients with a median age of 81.0 days and an average weight of 4.8 kg, among whom 45 (75.0%) were male. Twenty-two (36.7%) patients received concomitant aortic arch repair while 35 (58.3%) patients were associated with coronary artery malformation. The average cardiopulmonary bypass duration of the LeCompte maneuver group showed no statistical difference from the non LeCompte maneuver group (179.0±60.0 min vs. 203.0±74.0 min, P=0.093). The in-hospital mortality of the two groups were 6 (18.8%) and 7 (11.7%), respectively, which also showed no statistical difference (P=0.364). The median follow-up period was 4.1 (1.6, 7.5) years for 79 patients with 8 lost to follow-up, and no death was observed. Kaplan-Meier curve and log-rank test showed no statistical difference in overall mid-to-long term reintervention rate (P=0.850) as well as right ventricular outflow tract and pulmonary artery reintervention rate (P=0.240) with or without LeCompte maneuver. ConclusionWhether or not to perform LeCompte maneuver shows no statistical impact on in-hospital mortality and mid-to-long term reintervention rate of single-stage arterial switch operation for side-by-side Taussig-Bing anomaly.
Objective To compare the postoperative outcomes of modified single-patch technique and one-and-a-half-patch technique for complete atrioventricular septal defect (CAVSD) with a large ventricular component (>1 cm). Methods We retrospectively reviewed clinical data of 79 CAVSD patients with a large ventricular component (>1 cm) in Shanghai Children's Medical Center from January 2005 through January 2016. There were 37 males, 42 females with a median age of 8 months (range, 1.5 months to 10.2 years). Among the patients, 45 patients (20 males, 25 females) with a median age of 6 months(range, 1.5 months to 10.2 years) received modified single patch technique and 34 patients (17 males, 17 females) with a median age of 5.3 months (range, 2.5 months to 8.3 years) underwent one-and-a-half-patch (1.5-patch) technique. All the patients complicated with complex malformation such as double outlet of right ventricular, single ventricle, and transposition of great arteries were excluded. Results The mortality and reoperation rate in modified single-patch group were higher than those of the one-and-a-half-patch group. There were 2 postoperative early deaths in the modified single-patch group (4.4%). Among them, one patient died of postoperative valvular regurgitation and heart pump failure. The other one died of respiratory failure caused by severe pneumonia. There were 3 reoperations. Two patients performed valve plastic surgery because of valve regurgitation and one patient because of residual ventricular septal defect. There was no death and reoperation in the one-and-a-half-patch technique group. No left ventricular outflow tract obstruction and atrioventricular block in both groups were developed. Conclusion The 1.5-patch technique is an attractive clinical option in CAVSD patients with a large ventricular component.