The incidence of cardiovascular disease remains high, and surgery is an important measure for the treatment of cardiovascular disease. However, cardiovascular surgery is complicated and difficult, and it is one of the departments with the highest rate of allogeneic blood transfusion. Allogeneic blood transfusion significantly increases the complications and mortality of patients, while autologous blood transfusion can effectively reduce allogeneic blood transfusion and adverse reactions. Autologous plateletpheresis technology is a popular autotransfusion method in recent years. This article reviews the autologous plateletpheresis technology and its clinical application in cardiovascular surgery.
3D printing technology has a promising prospect of medical use and clinical value, and may play an important role in the field of thoracic and cardiovascular surgery, such as preoperative diagnosis, surgical planning, surgical approach alternatives and organ replacement. This review focuses on the development of 3D printing technology in recent years and its use and prospect in the field of thoracic and cardiovascular surgery including surgical teaching and simulation, personalized prosthesis implantation, and artificial organ transplantation.
Open surgery is an important part of vascular surgery. For vascular surgery diseases not suitable for endovascular therapy, adjuvant methods of endovascular therapy and the ultimate means of treatment after failure, vascular graft infection, open vascular trauma, various tumors involving blood vessels, vascular reconstruction and complications of organ transplantation, iatrogenic vascular injury, and so on, open surgical procedures still need to be provided for treatment and development. This paper lists the important role that open surgery plays in supporting the treatment of vascular related diseases and the development of the discipline in surgery and internal medicine, and emphasizes that open surgery is still a necessary quality for vascular surgeons, the basis and important guarantee for the development of the discipline, and the guarantee for the timely and effective treatment of various complex and difficult vascular surgical diseases.
Objective To introduce a novel approach using parallel placement of another oxygenator in the recirculation line as oxygen supply for oxygenator failure without circulatory arrest in cardiopulmonary bypass （CPB），and confirm its outcomes in an animal experiment. Methods A traditional piglet CPB model was established. Oxygenator failure model was established by reducing fraction of inspired oxygen （FiO2） from 80% to 21% after aortic cross-clamp and cardiac arrest in CPB. Another oxygenator was then parallel placed in the recirculation line to supply 100% oxygen.Dynamic changes in partial pressure of oxygen （PaO2），mixed venous oxygen saturation （SvO2），arterial oxygen saturation（SaO2） and blood pH of blood samples from the arterial perfusion duct were monitored with different blood flow of400 ml/min，800 ml/min and 1 100 ml/min. Results When FiO2 was reduced to 21%，PaO2 decreased to 64-67 mm Hg（P＜0.001），SaO2 decreased significantly to 88%-90% （P＜0.001），SvO2 decreased to 69%-72% （P＜0.001），and blood pH decreased too，all indicating oxygenator failure. After parallel placement of another oxygenator in the recirculation line was performed，PaO2，SaO2 and SvO2 all significantly increased，as well as blood pH. When the blood flow in the recirculation line achieved 33% or above of overall arterial perfusion flow，clinical oxygen demand was generally satisfied. Conclusion Parallel placement of another oxygenator in the recirculation line may be utilized as a treatment strategy for oxygenator failure without circulatory arrest and changeover of failed oxygenator.
ObjectiveTo analyze the causes and preventions of stent graft induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for Stanford type B dissection, particularly from the standpoint of biomechanical behavior of stent graft. MethodsSINE was defined as the new tear caused by the stent graft itself, excluding those arising from natural disease progression or any iatrogenic injury from the endovascular manipulation. Twentytwo patients with SINE were retrospectively collected and analyzed out of 650 cases undergoing TEVAR for type B dissection from August 2000 to June 2008 in our center. An additional case included was referred to our center in 14 months after TEVAR performed in another hospital. ResultsTotally, there were 24 SINEs found in 23 cases, including SINE at the proximal end in 15 cases, at the distal end in 7, and at both in 1, and 6 patients died. The incidence was 3.4% ( 22/650) in our hospital, and the mortality was 26.1% (6/23). All 16 proximal SINEs was located at the greater curve of the arch and caused retrograde type A dissection. All 8 distal SINEs occurred at the dissected flap, and 5 of them caused enlarging aneurysm while 3 remained stable. All 23 cases had the endograft placed across the distal aortic arch during the primary TEVAR. ConclusionsSINE is not rare following TEVAR for type B dissection, and associates with a high substantial mortality. The stress yielded by the endograft seems to play a predominant role in its occurrence. It is of significance to take the stressinduced injury into account during both design and placement of the endograft.
Objective To summarize treatment experience and evaluate clinical outcomes of surgical therapy for Stanford type A aortic dissection （AD）. Methods Clinical data of 48 patients with Stanford type A AD who underwent surgical treatment in General Hospital of Lanzhou Military Region from October 2006 to March 2013 were retrospectively analyzed. There were 41 males and 7 females with their age of 26-72 （47.6±9.2） years. There were 43 patients with acute Stanford type A AD （interval between symptom onset and diagnosis＜14 days） and 5 patients with chronic AD. There were 19 patients with moderate to severe aortic insufficiency and 6 patients with Marfan symdrome but good aortic valve function，who all received Bentall procedure，total arch replacement and stented elephant trunk implantation. There were 8 patients with AD involving the aortic root but good aortic valve function who underwent modified David procedure，total arch replacement and stented elephant trunk implantation. There were 10 patients with AD involving the ascending aorta who received ascending aorta replacement，total arch replacement and stented elephant trunk implantation. There were 5 patients with AD involving partial aortic arch who underwent ascending aorta and hemiarch replacement. Patients were followed up in the 3rd，6th and 12th month after discharge then once every year. Follow-up evaluation included general patient conditions，blood pressure control，chest pain recurrence，mobility and computerized tomography arteriography （CTA）. ResultsCardiopulmonary bypass time was 121-500 （191.4±50.6） minutes，aortic cross-clamp time was 58-212 （112.3±31.7） minutes，and circulatory arrest and selective cerebral perfusion time was 26-56 （34.8±8.7） minutes. Postoperative mechanicalventilation time was 32-250 （76.2±35.6） hours，and ICU stay was 3-20 （7.1±3.4） days. Thoracic drainage within 24 hours postoperatively was 680-1 600 （1 092.5±236.3） ml. Seven patients （14.5%） died perioperatively including 2 patients with multiple organ dysfunction syndrome，2 patients with low cardiac output syndrome，1 patient with renal failure，1patient with delayed refractory hemorrhage，and 1 patient with coma. Twenty patients had other postoperative complicationsand were cured or improved after treatment. A total of 38 patients ［92.7% （38/41）］ were followed up for 3-48 （13.0±8.9） months，and 3 patients were lost during follow-up. During follow-up，there were 36 patients alive and 2 patients who died of other chronic diseases. There was no AD-related death during follow-up. None of the patients required reoperation for AD or false-lumen expansion. CTA at 6th month after discharge showed no anastomotic leakage，graft distortion or obstruction.Conclusion According to aortic intimal tear locations，ascending aorta diameter and AD involving scopes，appropriate surgical strategies，timing and organ protection are the key strategies to achieve optimal surgical results for Stanford type A AD. Combined axillary and femoral artery perfusion and increased lowest intraoperative temperature are good methods for satisfactory surgical outcomes of Stanford type A AD.
Objective To investigate the protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection. Methods A total of 180 patients with Standford type A aortic dissection undergoing elective major vascular surgery in our hospital from July 2014 to March 2016 were enrolled. There were 123 males and 57 females with age ranging from 19 to 68 years and weight of 50-85 kg. The patients were randomly divided into two groups. Patients in group A (n=92, 65 males, 27 females, mean age of 45±21 years) received intraoperative autologous blood recovery; while those in group B (n=88, 58 males, 30 females, mean age of 43±24 years) received autologous platelet rich plasma (APRP) and intraoperative autologous blood recovery. The whole process of platelet separation was completed before heparinization. The relevant indicators of blood coagulation function before the induction of anesthesia (T1), before heparinization (T2), immediately postoperatively (T3) and 1 h (T4), 24 h (T5) postoperatively were measured. Cardiopulmonary bypass, aortic cross-clamping time, drainage volume at postoperative 1 h, 24 h and allogeneic blood transfusion volume were recorded. Results The whole blood volume of group B in the platelet separation in emergency was 1 305±110 ml, and collected platelet rich plasma was 275±30 ml, platelet counts (630±220)×109/L, accounting for 25%±5% of platelets of whole blood, and platelet separation time was 32±9 min. Compared with group A, platelet count at postoperative 1 h in group B was significantly higher; drainage volume at postoperative 1 h, 24 h, allogeneic red blood cells, plasma transfusion volume and allogeneic platelet infusion rate decreased significantly (P<0.05). Group B had less postoperative complications (P<0.05). Conclusion Preoperative autologous plateletpheresis combined with intraoperative autologous blood recovery can significantly improve the coagulation function of patients with vascular surgery, and reduce the amount of allogeneic blood transfusion and postoperative bleeding.
Facing the increasing cardiovascular disease burden and prevailing population risk factors, the cardiovascular surgery in China was also encountering challenges including imbalances in discipline development, significant divergencies in healthcare quality, lacking of clinical guidelines and domestic critical evidence. The concept of quality control and improvement has been practiced and tested in many disease specialties. Quality improvement programs are urgently needed in China to promote the universal cardiovascular surgery healthcare quality.
Abstract： Objective To evaluate the incidence and prognosis of postoperative acute kidney injury （AKI） in patients after cardiovascular surgery， and analyse the value of AKI criteria and classification using the Acute Kidney Injury Network （AKIN） definition to predict their in-hospital mortality. Methods A total of 1 056 adult patients undergoing cardiovascular surgery in Renji Hospital of School of Medicine， Shanghai Jiaotong University from Jan. 2004 to Jun. 2007 were included in this study. AKI criteria and classification under AKIN definition were used to evaluate the incidence and in-hospital mortality of AKI patients. Univariate and multivariate analyses were used to evaluate preoperative， intraoperative， and postoperative risk factors related to AKI. Results Among the 1 056 patients， 328 patients（31.06%） had AKI. In-hospital mortality of AKI patients was significantly higher than that of non-AKI patients （11.59% vs. 0.69%， P＜0.05）. Multivariate logistic regression analysis suggested that advanced age （OR=1.40 per decade）， preoperative hyperuricemia（OR=1.97）， preoperative left ventricular failure （OR=2.53）， combined CABG and valvular surgery （OR=2.79）， prolonged operation time （OR=1.43 per hour）， postoperative hypovolemia （OR=11.08） were independent risk factors of AKI after cardiovascular surgery. The area under the ROC curve of AKIN classification to predict in-hospital mortality was 0.865 （95% CI 0.801-0.929）. Conclusion Higher AKIN classification is related to higher in-hospital mortality after cardiovascular surgery. Advanced age， preoperative hyperuricemia， preoperative left ventricular failure， combined CABG and valvular surgery， prolonged operation time， postoperative hypovolemia are independent risk factors of AKI after cardiovascular surgery. AKIN classification can effectively predict in-hospital mortality in patients after cardiovascular surgery， which provides evidence to take effective preventive and interventive measures for high-risk patients as early as possible.
ObjectiveTo summarize the research progress of mixed reality (MR) technology in the field of vascular surgery.MethodWe retrieved the literatures about the application of MR technology in vascular surgery, and summarized and analyzed them.ResultsThe application of MR technology in vascular surgery could greatly improve the standardization of medical education, shorten the learning cycle, effectively shorten the operation time, and increase the benefit of patients. The application of MR in vascular surgery was still in its infancy, and it showed some attractive prospects as well as some shortcomings.ConclusionsThe application of MR technology in vascular surgery is still at the exploratory stage, but it has an attractive prospect. With the continuous improvement of registration technology and the continuous improvement of accuracy, MR technology will be more and more widely used in vascular surgery.