Pub Date : 2019-09-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.09.009
Jinmou Gao, Ling-wen Kong, Hui Li, D. Du, Chang-hua Li, Jun Yang, S. Zhao
Objective To explore early diagnosis, surgical intervention and efficacy for blunt cardiac injury. Methods 43 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, preoperative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years between September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48.8%(21/43); and steering wheel injury accounted for 71.4%(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock; and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27.9%(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases; relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy(EDT) with a resuscitative rate of 42.9%(3/7). Results Overall mortality rate was 32.6%(14/43); 4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases(associated with transected aorta in 1 case); and associated injuries in 5 cases including liver trauma(3 cases), brain trauma(1 case), and cervical spinal trauma(1 case). In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 cases, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively; and other 2 restored spontaneously which were ensured by echocardiography. Postoperative complications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition. Conclusion Early diagnosis and emergent thoracotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advocated. If it is necessary, EDT should be exercised decidedly. Key words: Wounds Blunt cardiac injury Cardiac tamponade Emergent thoracotomy
{"title":"Blunt cardiac injury: experience in 43 cases treated operatively","authors":"Jinmou Gao, Ling-wen Kong, Hui Li, D. Du, Chang-hua Li, Jun Yang, S. Zhao","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.09.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.09.009","url":null,"abstract":"Objective \u0000To explore early diagnosis, surgical intervention and efficacy for blunt cardiac injury. \u0000 \u0000 \u0000Methods \u000043 patients with blunt cardiac injury treated operatively were studied retrospectively in respect of sex, age, cause of injury, preoperative diagnosis, operative time from injury, surgical procedures, and therapeutic efficacy. The study lasted for 15 years between September 2003 and August 2018. The main cause of injury is road traffic accident with a rate of 48.8%(21/43); and steering wheel injury accounted for 71.4%(15/21). Preoperative diagnosis was based on computer scaning, echocardiography in 26 cases. In remaining 17, initial judgement of cardiac wound was done because of obvious cardiac tamponade, or massive hemothorax with shock; and was proved during emergent thoracotomy. Surgical intervention was started within one hour in cases of 27.9%(12/43). Main procedures included pericardial decompression, clear off hemopericardium, and cardiorrhaphy in 36 cases; relief of pericardial herniation with strangulation of the heart in 3 cases, and repair of diaphragmatic hernia involving pericardium in 4 cases. Of all 43 cases, 7 cases underwent Emergent Department Thoracotomy(EDT) with a resuscitative rate of 42.9%(3/7). \u0000 \u0000 \u0000Results \u0000Overall mortality rate was 32.6%(14/43); 4 cases died at EDT, 5 cases intraoperatively, and 5 cases postoperatively. The cause of deaths was directly related to BCI in 9 cases(associated with transected aorta in 1 case); and associated injuries in 5 cases including liver trauma(3 cases), brain trauma(1 case), and cervical spinal trauma(1 case). In 4 of 29 survivors, intracardiac injury was proved by echocardiography postoperatively, including mitral valve in 2 cases, tricuspid in 1 case, and ventricular septum in 1 case. Of these 4 cases 2 received valvuloplasty 2 weeks and 3 months after initial operation respectively; and other 2 restored spontaneously which were ensured by echocardiography. Postoperative complications included atelectasis in 3 and infectious endocarditis in 1 respectively. They were cured . All survivors were followed up from 6 to 36 months, with a normal cardiac function and healthy condition. \u0000 \u0000 \u0000Conclusion \u0000Early diagnosis and emergent thoracotomy in time are essential to improve survival rate. Preoperative massive transfusion and pericardiocentesis are not advocated. If it is necessary, EDT should be exercised decidedly. \u0000 \u0000 \u0000Key words: \u0000Wounds Blunt cardiac injury Cardiac tamponade Emergent thoracotomy","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"40 1","pages":"541-545"},"PeriodicalIF":0.0,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73790774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.09.006
Ying Guo, Dian Xiong, Xianfeng Liu, Ye Yang, Sheng-Fu Cheng, Lai Wei
Objective To compare the results of invasive dual mitral and aortic valve replacement(DVR) through anterolateral minithoracotomy(RT) and partial upper hemistemotomy(PS) approaches. Methods This was a retrospective, observational, cohort study of collected data on 30 patients undergoing dual mitral and aortic valve replacement between July 2009 and March 2018 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University. There were 10 male and 20 female patients, aging from 15 to 65 years with a mean age of(45.67±12.25) years. Of these, 8 were performed through right RT and 22 through PS. SPSS 23.0 was used to analysis gender, age, left ventricle ejection fraction, New York Heart Association class, perioperative complications, total operative duration, cardiopulmonary bypass duration, aortic cross clamp time, ICU monitoring time and postoperative hospital stay of the two groups. Results Both groups successfully completed minimally invasive double-valve replacement surgery, without middle-opening thoracic surgery. Compared with PS group, patients in the RT group had longer aortic cross clamp time[(109.00±27.80)min vs.(81.23±14.10)min, P=0.026], cardiopulmonary bypass duration[(152.13±27.15)min vs.(129.55±26.36)min, P=0.049]and total operative duration[(4.81±0.77)h vs.(4.15±0.44)h, P=0.006]. In addition, the ICU monitoring time and postoperative hospital stay of patients in RT group were shorter than PS group[(24.63±11.55)h vs.(30.55±13.21)h; (5.50±0.93)day vs.(6.59±3.88)day] but there were no statistically significant(P=0.273; P=0.442). Conclusion Minimally invasive dual mitral and aortic valve replacement via RT and PS are both safe and effective. The incision of RT group is more concealed than the PS group as well as retaining sternal integrity. However, the total operative duration, cardiopulmonary bypass duration and aortic cross clamp time were longer than PS group and the requirements of the surgeon are higher. The PS group has a shorter operation time and does not change the habit of the surgeon. It is more suitable for the heart center that proposed to launch the minimally invasive dual mitral and aortic valve replacement. Key words: Dual mitral and aortic valve replacement Minimally invasive Anterolateral minithoracotomy Partial upper hemisternotomy
{"title":"The analysis of anterolateral minithoracotomy versus partial upper hemisternotomy in minimally invasive dual mitral and aortic valve replacement","authors":"Ying Guo, Dian Xiong, Xianfeng Liu, Ye Yang, Sheng-Fu Cheng, Lai Wei","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.09.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.09.006","url":null,"abstract":"Objective \u0000To compare the results of invasive dual mitral and aortic valve replacement(DVR) through anterolateral minithoracotomy(RT) and partial upper hemistemotomy(PS) approaches. \u0000 \u0000 \u0000Methods \u0000This was a retrospective, observational, cohort study of collected data on 30 patients undergoing dual mitral and aortic valve replacement between July 2009 and March 2018 at Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University. There were 10 male and 20 female patients, aging from 15 to 65 years with a mean age of(45.67±12.25) years. Of these, 8 were performed through right RT and 22 through PS. SPSS 23.0 was used to analysis gender, age, left ventricle ejection fraction, New York Heart Association class, perioperative complications, total operative duration, cardiopulmonary bypass duration, aortic cross clamp time, ICU monitoring time and postoperative hospital stay of the two groups. \u0000 \u0000 \u0000Results \u0000Both groups successfully completed minimally invasive double-valve replacement surgery, without middle-opening thoracic surgery. Compared with PS group, patients in the RT group had longer aortic cross clamp time[(109.00±27.80)min vs.(81.23±14.10)min, P=0.026], cardiopulmonary bypass duration[(152.13±27.15)min vs.(129.55±26.36)min, P=0.049]and total operative duration[(4.81±0.77)h vs.(4.15±0.44)h, P=0.006]. In addition, the ICU monitoring time and postoperative hospital stay of patients in RT group were shorter than PS group[(24.63±11.55)h vs.(30.55±13.21)h; (5.50±0.93)day vs.(6.59±3.88)day] but there were no statistically significant(P=0.273; P=0.442). \u0000 \u0000 \u0000Conclusion \u0000Minimally invasive dual mitral and aortic valve replacement via RT and PS are both safe and effective. The incision of RT group is more concealed than the PS group as well as retaining sternal integrity. However, the total operative duration, cardiopulmonary bypass duration and aortic cross clamp time were longer than PS group and the requirements of the surgeon are higher. The PS group has a shorter operation time and does not change the habit of the surgeon. It is more suitable for the heart center that proposed to launch the minimally invasive dual mitral and aortic valve replacement. \u0000 \u0000 \u0000Key words: \u0000Dual mitral and aortic valve replacement Minimally invasive Anterolateral minithoracotomy Partial upper hemisternotomy","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"2 1","pages":"530-533"},"PeriodicalIF":0.0,"publicationDate":"2019-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87333271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.08.001
B. Hou, Cuntao Yu, X. Qian, Xiaopeng Hu
Objective Retrospectively reviewed the early outcomes of one-stop hybrid technique to treat coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers (PAU). Methods This study enrolled in 23 cases (male 21, female 2) of coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers from Jan 2016 to Dec 2017 in our institute, with the mean age(67.5±7.5) years (51-79 years). Coronary artery bypass graft (CABG) surgery was performed by cardiopulmonary bypass (CPB), the procedure to treat aortic arch lesion included isolated CABG + thoracic endovascular stent graft in 2 patients, CABG + brachiocephalic arteries debranching + thoracic endovascular stent graft in 18 patients, CABG + hybrid total aortic arch replacement + thoracic endovascular stent graft in 3 patients. Results Mean CPB time was(94.3±25.7) min(55-145 min), mean aortic cross-clamp time was (61.4±19.3) min(26-97 min), intraoperative blood loss was(654.8±78.7)ml(510-900 ml), 20 patients(87.0%)needed blood transfusion therapy. Median mechanical ventilation time was 18 hours(9-249 hours), with 1 patient(4.3%)exceeded 48 hours. Median intensive care unit stay time was 2.8 days(1-23 days), with 6 patients(26.1%)exceeded 4 days. There was no in-hospital mortality. The postoperative complications included: paresis in 2 patients (8.7%), re-exploration for bleeding in 1 patient (4.3%), pleural effusion in 1 patient (4.3%), pneumothorax in 1 patient (4.3%), paraplegia、pulmonary infection、acute renal insufficiency、respiratory failure、re-intubation in 1 patient (4.3%). Conclusion The one-stop hybrid technique for treating coronary atherosclerotic disease concomitant with PAU was effective and safe. The early clinical outcome was satisfactory. Mid and long-term result need further follow-up to study. Key words: Coronary artery bypass graft; Cardiac surgical procedures; Stent; Hybrid technique
{"title":"One-stop hybrid technique to treat coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers in 23 patients","authors":"B. Hou, Cuntao Yu, X. Qian, Xiaopeng Hu","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.08.001","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.08.001","url":null,"abstract":"Objective \u0000Retrospectively reviewed the early outcomes of one-stop hybrid technique to treat coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers (PAU). \u0000 \u0000 \u0000Methods \u0000This study enrolled in 23 cases (male 21, female 2) of coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers from Jan 2016 to Dec 2017 in our institute, with the mean age(67.5±7.5) years (51-79 years). Coronary artery bypass graft (CABG) surgery was performed by cardiopulmonary bypass (CPB), the procedure to treat aortic arch lesion included isolated CABG + thoracic endovascular stent graft in 2 patients, CABG + brachiocephalic arteries debranching + thoracic endovascular stent graft in 18 patients, CABG + hybrid total aortic arch replacement + thoracic endovascular stent graft in 3 patients. \u0000 \u0000 \u0000Results \u0000Mean CPB time was(94.3±25.7) min(55-145 min), mean aortic cross-clamp time was (61.4±19.3) min(26-97 min), intraoperative blood loss was(654.8±78.7)ml(510-900 ml), 20 patients(87.0%)needed blood transfusion therapy. Median mechanical ventilation time was 18 hours(9-249 hours), with 1 patient(4.3%)exceeded 48 hours. Median intensive care unit stay time was 2.8 days(1-23 days), with 6 patients(26.1%)exceeded 4 days. There was no in-hospital mortality. The postoperative complications included: paresis in 2 patients (8.7%), re-exploration for bleeding in 1 patient (4.3%), pleural effusion in 1 patient (4.3%), pneumothorax in 1 patient (4.3%), paraplegia、pulmonary infection、acute renal insufficiency、respiratory failure、re-intubation in 1 patient (4.3%). \u0000 \u0000 \u0000Conclusion \u0000The one-stop hybrid technique for treating coronary atherosclerotic disease concomitant with PAU was effective and safe. The early clinical outcome was satisfactory. Mid and long-term result need further follow-up to study. \u0000 \u0000 \u0000Key words: \u0000Coronary artery bypass graft; Cardiac surgical procedures; Stent; Hybrid technique","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"14 1","pages":"449-453"},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75042200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.08.016
Z. Jia
Isolated mesenteric artery dissection (IMAD) is not rare. Although there are five classification methods, all of them are based on imaging findings, and all have limitations. According to patient's symptoms, signs and imaging findings, the IMAD were divided into emergency and non-emergency types, and a management flow chart of IMAD is established according to this classification. The emergency type needs surgery or endovascular treatment immediately after the diagnosis, and conservative management to non-emergency patients. Majority of IMAD patients have stable disease after conservative treatment, and only a few patients with disease progression requiring invasive intervention, and endovascular stent placement should be the first choice of those patients.
{"title":"Classification and management progress of isolated mesenteric artery dissection","authors":"Z. Jia","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.08.016","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.08.016","url":null,"abstract":"Isolated mesenteric artery dissection (IMAD) is not rare. Although there are five classification methods, all of them are based on imaging findings, and all have limitations. According to patient's symptoms, signs and imaging findings, the IMAD were divided into emergency and non-emergency types, and a management flow chart of IMAD is established according to this classification. The emergency type needs surgery or endovascular treatment immediately after the diagnosis, and conservative management to non-emergency patients. Majority of IMAD patients have stable disease after conservative treatment, and only a few patients with disease progression requiring invasive intervention, and endovascular stent placement should be the first choice of those patients.","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"6 1","pages":"509-512"},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86194113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Safety and feasibility of lung resection after immunotherapy for unresectable lung tumors","authors":"Y. Xuan, B. Cao, Baojun Chen, Xiao-feng He, Yong Zhou, M. Shi, Tao Wang","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.08.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.08.013","url":null,"abstract":"转移性肺癌或中央型肺癌常见，患者通常无法实施一期手术切除。回顾2014年1月至2017年12月治疗的所有肺癌患者临床资料，从中选择已发生转移的或无法一期手术切除的患者，选择接受免疫治疗后6个月内接受肺叶切除术的患者，采集患者所有临床资料并统计分析。最终12例患者入组，主要诊断为肺癌6例，转移性黑色素瘤4例。使用的免疫治疗药物主要为尼鲁单抗4例、派姆单抗4例和伊匹单抗2例。所有患者接受末次药物治疗至手术平均时间71天(6～178天)。7例实施肺叶切除术。术中发现8例免疫治疗后有肿瘤残余，R0切除11例。手术平均173 min(45～380 min)。术后4例患者出现并发症。术后2年整体生存率及无病生存率分别为75.0%及41.7%。转移性肺癌或无法手术切除的肺癌患者，接受免疫治疗后若怀疑仍有肿瘤残留，可实施肺切除术，安全有效且R0切除率很高。手术操作可能困难，但发生严重并发症概率低，术后短期随访结果满意。","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"44 1","pages":"502-504"},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77919306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.08.004
Y. Ge, Chengnan Li, Yuge Xia, Fucheng Xiao, Haiou Hu, T. Zheng, Jun Zheng, Yong-min Liu, Junming Zhu, Li-Zhong Sun
Objective To explore the risk factors of renal replacement therapy for acute Stanford A aortic dissection patients with acute renal injury (AKI) after Sun's operation. Methods From January 2016 to October 2017, 144 patients with Stanford A aortic dissection who underwent Sun's procedure were enrolled in the study. Univariate analysis and logistic regression analysis were used to analyze the risk factors of continuous renal replacement therapy (CRRT). Variables with statistical difference from univariate analysis were included in multivariate logistic regression analysis. Results 8 patients (5.55%) died in hospital. 16 patients (11.11%) needed CRRT for AKI. 5 of them (31.25%) died in hospital. Of the 11 surviving patients, 5 had complete recovery of renal function within 2 weeks after operation and stopped renal replacement therapy. The remaining 6 patients recovered their renal function within 3 months and stopped renal replacement therapy. Univariate analysis showed that there were significant differences in preoperative age, creatinine clearance, peripheral white blood cell count, D-dimer, myoglobin, double renal arteries in false lumen, aortic cross clamp time and red blood cell transfusions between the two groups. The above risk factors were included in multivariate logistic regression. The results showed that double renal arteries in false lumen (OR=24.64, P=0.002), serum creatinine clearance <85 ml/min (OR=4.99, P=0.02) and red blood cell transfusions (OR=1.17, P<0.001) were independent risk factors. Conclusion Double renal arteries in false lumen, serum creatinine clearance< 85ml/min and red blood cell transfusions were independent risk factors for CRRT after Sun's procedure for acute Stanford A aortic dissection. For high-risk patients with double renal arteries in false lumen, and markedly decreased creatinine clearance before operation, red blood cell transfusions should be reduced as much as possible to reduce the risk of AKI after operation. Key words: A-Aortic dissection; Sun's procedure; Renal replacement therapy
{"title":"Risk factors of renal replacement therapy after Sun’s procedure for acute Stanford A aortic dissection","authors":"Y. Ge, Chengnan Li, Yuge Xia, Fucheng Xiao, Haiou Hu, T. Zheng, Jun Zheng, Yong-min Liu, Junming Zhu, Li-Zhong Sun","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.08.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.08.004","url":null,"abstract":"Objective \u0000To explore the risk factors of renal replacement therapy for acute Stanford A aortic dissection patients with acute renal injury (AKI) after Sun's operation. \u0000 \u0000 \u0000Methods \u0000From January 2016 to October 2017, 144 patients with Stanford A aortic dissection who underwent Sun's procedure were enrolled in the study. Univariate analysis and logistic regression analysis were used to analyze the risk factors of continuous renal replacement therapy (CRRT). Variables with statistical difference from univariate analysis were included in multivariate logistic regression analysis. \u0000 \u0000 \u0000Results \u00008 patients (5.55%) died in hospital. 16 patients (11.11%) needed CRRT for AKI. 5 of them (31.25%) died in hospital. Of the 11 surviving patients, 5 had complete recovery of renal function within 2 weeks after operation and stopped renal replacement therapy. The remaining 6 patients recovered their renal function within 3 months and stopped renal replacement therapy. Univariate analysis showed that there were significant differences in preoperative age, creatinine clearance, peripheral white blood cell count, D-dimer, myoglobin, double renal arteries in false lumen, aortic cross clamp time and red blood cell transfusions between the two groups. The above risk factors were included in multivariate logistic regression. The results showed that double renal arteries in false lumen (OR=24.64, P=0.002), serum creatinine clearance <85 ml/min (OR=4.99, P=0.02) and red blood cell transfusions (OR=1.17, P<0.001) were independent risk factors. \u0000 \u0000 \u0000Conclusion \u0000Double renal arteries in false lumen, serum creatinine clearance< 85ml/min and red blood cell transfusions were independent risk factors for CRRT after Sun's procedure for acute Stanford A aortic dissection. For high-risk patients with double renal arteries in false lumen, and markedly decreased creatinine clearance before operation, red blood cell transfusions should be reduced as much as possible to reduce the risk of AKI after operation. \u0000 \u0000 \u0000Key words: \u0000A-Aortic dissection; Sun's procedure; Renal replacement therapy","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"185 1","pages":"462-465"},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76135017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.08.002
Jian-rong Li, Jun Zheng, Yong-min Liu, Shang-dong Xu, Yu Li, Li-Zhong Sun
Objective To review the outcomes of the frozen elephant trunk implantation in patients with pseudoaneurysms of the distal aortic arch and descending aorta. Methods From March 2009 to December 2017, patients with pseudoaneurysms of the distal aortic arch and descending aorta who underwent the frozen elephant trunk implantation were enrolled. Patient demographic, preoperative, intraoperative, early morbidity and mortality data were collected from medical and electronic patient records. Clinical follow-up data, including late morbidity and mortality, were obtained by telephone interview with the patient. Results A total of 14 patients were included, 13 males and 1 females, aged( 41.0±14.7) years. Early mortality rate was 7.14% (1/14). The cause of death was rupture of the distal descending thoracic aorta. The early complications included reexploration for bleeding in 1 patient and pericardial window for delayed pericardial effusion in 1 patient. The mean follow-up was(32.3±22.3) months. There was 1 late death from severe pulmonary infection. Conclusion The frozen elephant trunk implantation is an appropriate therapeutic strategy for patients with pseudoaneurysms of the distal aortic arch and descending aorta. Key words: Aorta; Aortic aneurysm; Frozen elephant trunk implantation
{"title":"Frozen elephant trunk implantation for pseudoaneurysms of the distal aortic arch and descending aorta","authors":"Jian-rong Li, Jun Zheng, Yong-min Liu, Shang-dong Xu, Yu Li, Li-Zhong Sun","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.08.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.08.002","url":null,"abstract":"Objective \u0000To review the outcomes of the frozen elephant trunk implantation in patients with pseudoaneurysms of the distal aortic arch and descending aorta. \u0000 \u0000 \u0000Methods \u0000From March 2009 to December 2017, patients with pseudoaneurysms of the distal aortic arch and descending aorta who underwent the frozen elephant trunk implantation were enrolled. Patient demographic, preoperative, intraoperative, early morbidity and mortality data were collected from medical and electronic patient records. Clinical follow-up data, including late morbidity and mortality, were obtained by telephone interview with the patient. \u0000 \u0000 \u0000Results \u0000A total of 14 patients were included, 13 males and 1 females, aged( 41.0±14.7) years. Early mortality rate was 7.14% (1/14). The cause of death was rupture of the distal descending thoracic aorta. The early complications included reexploration for bleeding in 1 patient and pericardial window for delayed pericardial effusion in 1 patient. The mean follow-up was(32.3±22.3) months. There was 1 late death from severe pulmonary infection. \u0000 \u0000 \u0000Conclusion \u0000The frozen elephant trunk implantation is an appropriate therapeutic strategy for patients with pseudoaneurysms of the distal aortic arch and descending aorta. \u0000 \u0000 \u0000Key words: \u0000Aorta; Aortic aneurysm; Frozen elephant trunk implantation","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"95 1","pages":"454-457"},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76216634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.08.012
Jiaqi Zhang, Lei Liu, Guige Wang, Wen-liang Bai, Cheng Huang, Yeye Chen, Shanqing Li
Objective To analysis the clinicopathological features of skip N2 metastasis in NSCLC in our clinical center, therefore guide for clinical decision making for NSCLC patients. Methods A total of 120 NSCLC patients with N2 metastasis treated by surgery were enrolled from January 2017 to May 2018, of which 55 were males and 65 were females. The mean age of them were (58.36±11.34) years old. 36 patients had skip N2 metastasis, accounting for 30% of patients with N2 metastasis. 48 patients had a history of smoking or a definitive history of second-hand smoke exposure, compared with other 72 patients. Collected pre- and post-operation clinical data of those patients, and carried out relevant statistical analysis. Results Among the NSCLC with skip N2 metastasis, it occulted more frequently in right lower lobe and peripheral lung cancer. The main pathological type was adenocarcinoma with acinar subtype. The most cases of skip N2 metastasis were characterized by single N2 station metastasis. Age of patients showed a significant difference between the two groups(P=0.049). Gender, smoking history, T staging of lung cancer, pathological type and involvement of pulmonary membrane showed no statistic difference between the two groups(P>0.05). Conclusion Patient with skip N2 metastasis seemed to be elder, and the lesions of those patients were more likely to be lung adenocarcinoma in the right lower lobe and peripheral lung cancer, often involved single N2 station. The lung cancer in right upper lobe often skipped to level R2+ R4, which in right middle lobe often skipped to levels R2+ R4 and 7, in right and left lower lobes skipped to level 7, in the left upper lobe often skipped to level 5. Key words: Non-small cell lung cancer; Skip metastasis; Clinicopathological features
{"title":"Investigating the characteristics of skip N2 metastasis in NSCLC","authors":"Jiaqi Zhang, Lei Liu, Guige Wang, Wen-liang Bai, Cheng Huang, Yeye Chen, Shanqing Li","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.08.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.08.012","url":null,"abstract":"Objective \u0000To analysis the clinicopathological features of skip N2 metastasis in NSCLC in our clinical center, therefore guide for clinical decision making for NSCLC patients. \u0000 \u0000 \u0000Methods \u0000A total of 120 NSCLC patients with N2 metastasis treated by surgery were enrolled from January 2017 to May 2018, of which 55 were males and 65 were females. The mean age of them were (58.36±11.34) years old. 36 patients had skip N2 metastasis, accounting for 30% of patients with N2 metastasis. 48 patients had a history of smoking or a definitive history of second-hand smoke exposure, compared with other 72 patients. Collected pre- and post-operation clinical data of those patients, and carried out relevant statistical analysis. \u0000 \u0000 \u0000Results \u0000Among the NSCLC with skip N2 metastasis, it occulted more frequently in right lower lobe and peripheral lung cancer. The main pathological type was adenocarcinoma with acinar subtype. The most cases of skip N2 metastasis were characterized by single N2 station metastasis. Age of patients showed a significant difference between the two groups(P=0.049). Gender, smoking history, T staging of lung cancer, pathological type and involvement of pulmonary membrane showed no statistic difference between the two groups(P>0.05). \u0000 \u0000 \u0000Conclusion \u0000Patient with skip N2 metastasis seemed to be elder, and the lesions of those patients were more likely to be lung adenocarcinoma in the right lower lobe and peripheral lung cancer, often involved single N2 station. The lung cancer in right upper lobe often skipped to level R2+ R4, which in right middle lobe often skipped to levels R2+ R4 and 7, in right and left lower lobes skipped to level 7, in the left upper lobe often skipped to level 5. \u0000 \u0000 \u0000Key words: \u0000Non-small cell lung cancer; Skip metastasis; Clinicopathological features","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"61 4 1","pages":"497-501"},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83251716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-08-25DOI: 10.3760/CMA.J.ISSN.1001-4497.2019.08.003
Yongfu Xie, Q. Lu
Objective To evaluate the long-term clinical effect of Thoracic endovascular aortic repair (TEVAR) for traumatic Type B aortic dissection, and to provide a reference for the next stage treatment. Methods Twenty-one patients with traumatic Stanford type B aortic dissection treated in our center from December 1999 to June 2012 were retrospectively analyzed for the treatment effectiveness and follow-up results. The average age of 21 Traumatic Type B aortic dissection patients was 42.7 years (range: 19 to 67 years). Men accounted for 85.7% (18/21). 80.9% (17/21) of the dissection were caused by car accident, 4 were due to falling accident from high places. There were 7 cases of hypertension, 4 cases of diabetes, 4 cases of hyperlipidemia, 2 cases of chronic ischemic heart disease, 14 cases of pneumothorax, 8 cases of rib fracture, 3 cases of craniocerebral trauma / neuropsychiatric symptoms, and 1 patient with shock. The median time from onset to treatment was 5 days (range: 1-73 days). There were 16 cases (≤14 days) in the acute phase, 2 cases (15-60 days) in the subacute phase, and 3 cases (> 60 days) in the chronic phase. There was no patient in super acute phase in the study group (0-24 hour). Results The perioperative mortality was 9.52% (2/21) for the patients traumatic type B aortic dissection, 4.76% (1/21) for those with postoperative endoleaks; 2-year and 5-year survival rates were 90.48% and 85.71%. Conclusion Intracavitary treatment of traumatic Stanford B type aortic dissection is effective and has good long-term clinical benefit, which provides a guidance for future clinical treatment of traumatic type B aortic dissection. Key words: Type B aortic dissection; Thoracic endovascular aortic repair; Trauma
{"title":"The beneficial enlightenment of thoracic endovascular aortic repair for traumatic type B aortic dissection with long-term follow-up of single center","authors":"Yongfu Xie, Q. Lu","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.08.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.08.003","url":null,"abstract":"Objective \u0000To evaluate the long-term clinical effect of Thoracic endovascular aortic repair (TEVAR) for traumatic Type B aortic dissection, and to provide a reference for the next stage treatment. \u0000 \u0000 \u0000Methods \u0000Twenty-one patients with traumatic Stanford type B aortic dissection treated in our center from December 1999 to June 2012 were retrospectively analyzed for the treatment effectiveness and follow-up results. The average age of 21 Traumatic Type B aortic dissection patients was 42.7 years (range: 19 to 67 years). Men accounted for 85.7% (18/21). 80.9% (17/21) of the dissection were caused by car accident, 4 were due to falling accident from high places. There were 7 cases of hypertension, 4 cases of diabetes, 4 cases of hyperlipidemia, 2 cases of chronic ischemic heart disease, 14 cases of pneumothorax, 8 cases of rib fracture, 3 cases of craniocerebral trauma / neuropsychiatric symptoms, and 1 patient with shock. The median time from onset to treatment was 5 days (range: 1-73 days). There were 16 cases (≤14 days) in the acute phase, 2 cases (15-60 days) in the subacute phase, and 3 cases (> 60 days) in the chronic phase. There was no patient in super acute phase in the study group (0-24 hour). \u0000 \u0000 \u0000Results \u0000The perioperative mortality was 9.52% (2/21) for the patients traumatic type B aortic dissection, 4.76% (1/21) for those with postoperative endoleaks; 2-year and 5-year survival rates were 90.48% and 85.71%. \u0000 \u0000 \u0000Conclusion \u0000Intracavitary treatment of traumatic Stanford B type aortic dissection is effective and has good long-term clinical benefit, which provides a guidance for future clinical treatment of traumatic type B aortic dissection. \u0000 \u0000 \u0000Key words: \u0000Type B aortic dissection; Thoracic endovascular aortic repair; Trauma","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"11 1","pages":"458-461"},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88735685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the early diagnosis of non-central small cell lung cancer. Methods 141 patients wereselected from July 1999 to June 2017, who were diagnosed with small cell lung cancer (stage N2 and N3). They were divided into two groups according to the approach of obtaining histopathological tissuefor diagnosis.49 cases in the experimental group were obtained by EBUS-TBNA, 92 cases in the control group were done by video assisted thoracic surgery (40 cases, 43.5%), mediastinoscopy (1 case, 1.1%), and open procedure (51 case, 55.4%). Survival outcome, time of waiting for the treatment and lengthof stay were analyzed. Results There were109 males, 32 females, the range of age is from 16 to 79 years old[(56.21±11.48)years]. 62 lesions located in the upper lobe, 12 in the middle lobe, 56 in the lower lobe, 11 in the middle-lower/-upper lobes. Considering the T stage, there are 7 cases of T1, 61 cases of T2, 45 cases of T3, and 26cases of T4, 2 patients with Tx stage.Compared with conventional approach, EBUS-TBNA saved 10.78 days from admission to the time of receiving treatment [(4.62±0.66)days vs. (15.40±1.61)days, P<0.05], and saved 18.13 days of length of stay [(5.30±0.76)days vs. (23.43±2.44)days, P<0.05]. 5-year survival rate was 31.0% for traditional group and 27.5% for EBUS-TBNA group, there was no significant difference between two groups(P=0.308). Conclusion EBUS-TBNA couldsave the waiting days from admission to the time of receiving treatment, and also shorten the total length of stay. EBUS-TBNA was more efficient than conventional approaches (VATS, mediastinoscopy or open procedure) for diagnosing non-central small cell lung cancer with enlarged mediastinal lymph nodes. Key words: Small cell lung cancer; Diagnosis, fenl; EBUS-TBNA
{"title":"Analysis of endobronchial ultrasound-guided transbronchial needle aspiration’s efficiency in the early diagnosis of non-central small cell lung cancer","authors":"Qianli Ma, Huanshun Wen, Tong Bao, Hongxiang Feng, Zhen-rong Zhang, Deruo Liu","doi":"10.3760/CMA.J.ISSN.1001-4497.2019.08.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1001-4497.2019.08.009","url":null,"abstract":"Objective \u0000To evaluate the value of endobronchial ultrasound-guided transbronchial needle aspiration in the early diagnosis of non-central small cell lung cancer. \u0000 \u0000 \u0000Methods \u0000141 patients wereselected from July 1999 to June 2017, who were diagnosed with small cell lung cancer (stage N2 and N3). They were divided into two groups according to the approach of obtaining histopathological tissuefor diagnosis.49 cases in the experimental group were obtained by EBUS-TBNA, 92 cases in the control group were done by video assisted thoracic surgery (40 cases, 43.5%), mediastinoscopy (1 case, 1.1%), and open procedure (51 case, 55.4%). Survival outcome, time of waiting for the treatment and lengthof stay were analyzed. \u0000 \u0000 \u0000Results \u0000There were109 males, 32 females, the range of age is from 16 to 79 years old[(56.21±11.48)years]. 62 lesions located in the upper lobe, 12 in the middle lobe, 56 in the lower lobe, 11 in the middle-lower/-upper lobes. Considering the T stage, there are 7 cases of T1, 61 cases of T2, 45 cases of T3, and 26cases of T4, 2 patients with Tx stage.Compared with conventional approach, EBUS-TBNA saved 10.78 days from admission to the time of receiving treatment [(4.62±0.66)days vs. (15.40±1.61)days, P<0.05], and saved 18.13 days of length of stay [(5.30±0.76)days vs. (23.43±2.44)days, P<0.05]. 5-year survival rate was 31.0% for traditional group and 27.5% for EBUS-TBNA group, there was no significant difference between two groups(P=0.308). \u0000 \u0000 \u0000Conclusion \u0000EBUS-TBNA couldsave the waiting days from admission to the time of receiving treatment, and also shorten the total length of stay. EBUS-TBNA was more efficient than conventional approaches (VATS, mediastinoscopy or open procedure) for diagnosing non-central small cell lung cancer with enlarged mediastinal lymph nodes. \u0000 \u0000 \u0000Key words: \u0000Small cell lung cancer; Diagnosis, fenl; EBUS-TBNA","PeriodicalId":10181,"journal":{"name":"Chinese Journal of Thoracic and Cardiovaescular Surgery","volume":"39 1","pages":"484-488"},"PeriodicalIF":0.0,"publicationDate":"2019-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79368765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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