| BACKGROUNDMany countries and regions have established multi center registration studies to improve the outcomes for type A aortic dissection(TAAD).However,it is unclear that actual clinical outcomes of surgical treatment for TAAD in ChinaMETHODSThis cohort study uses data from the Registry of Type A Aortic Dissection in China,a national clinical registry to investigate management of patients with Stanford type A aortic dissection.The data including surgical management and outcomes of TAAD patients including prehospital emergency care,preoperative management,surgery type and early mortality were analyzed from January 2018 and May 2021.RESULTSA total of 1166 patients with TAAD were enrolled in this study between January 2018 and May 2021,and 955(81.9%)patients had acute TAAD.The mean age of all patients was 51.3 ±12 years.The median onset time in acute TAAD was 10 hours(IQR,6-24 hours),and the median emergency room stay time was 11.89 hours(IQR,3-25.01 hours).The mean transport distance of patients with acute TAAD was 305,358.83 meters.Extended arch repair,including total arch replacement,was performed in 962 patients(82.5%),and frozen elephant trunk repair was performed in 814 patients(69.8%).The incidence of early mortality was 8%.CONCLUSIONSIn this retrospective cohort study,population of patients with TAAD in China undergoing surgery was younger,experienced a longer interval and distance from onset to arrival at hospital,received more extended aortic arch repair,and showed a relatively lower early mortality.This finding suggests more efforts should be made to promote prehospital emergency care and preoperative management of Chinese TAAD patients and longer follow-up need to be done to investigate the prognosis of extended aortic arch surgery in younger patients.BACKGROUND:It is well established that postoperative atrial fibrillation(POAF)is associated with adverse postoperative outcomes after major cardiac operations.The purpose of this study was to investigate the incidence of new-onset POAF after successful total arch repair(TAR)surgery and the association between POAF and in-hospital mortality.METHODS:All consecutive patients undergoing TAR from September,2012 to December,2019 in Fuwai hospital were enrolled(n=1280).Patients diagnosed with preoperative atrial fibrillation were excluded.POAF was diagnosed as the new-onset atrial fibrillation or flutter for more than 5 minutes based on continuous electrocardiogram monitoring.A logistic regression model was used to determine predictors of in-hospital mortality.Multivariable adjustment,inverse probability of treatment weighting(IPTW)and propensity score matching(PSM)were used to adjust for confounders.RESULTS:POAF was diagnosed in 32.3%(411/1271)of this cohort population.The occurrence of new-onset POAF was associated with age(OR=1.05,95%CI:1.04-1.06,P<0.001),male sex(OR=0.72,95%CI:0.52-0.98,P=0.035),surgery duration(OR=1.2,95%CI:1.12-1.28,P<0.001).The in-hospital mortality was significantly higher in patients with POAF than those without POAF(10.7%vs 2.4%,P<0.001).IPTW and PSM analyses confirmed the results.The increased in-hospital mortality in POAF group still existed among subgroup analysis based on different age,sex,hypertension,smoking,hypokalemia,combined with cardiac surgery,and deep hypothermic circulatory arrest.CONCLUSIONSMore careful attention should be given to POAF after TAR surgery.The incidence of POAF after TAR surgery was 32.3%and associated with increased in-hospital mortality.The elderly female patient who experienced longer operation duration was at highest risk for POAF.Objectives:Due to better postoperative convalescence and quality of life,experienced centers focus on minimally invasive surgical techniques and approaches,but this approach is not routinely performed for valve-sparing root replacement procedures.The purpose of this study was to assess the safety and feasibility of valve-sparing root replacement via partial upper sternotomy.Methods:Between January 2016 and April 2021,two hundred and sixty-nine patients underwent a valve-sparing root replacement procedure,and partial upper sternotomy was performed in 52 patients.The clinical outcomes of the partial upper sternotomy(PUS)and complete sternotomy(CS)groups,including mortality,degree of aortic insufficiency,blood loss and consumption of blood products,postoperative complications and hospitalization expenses,were compared.The Kaplan-Meier method was used to assess the degree of aortic regurgitation.Propensity score matching was performed as a sensitivity analysis.Results:There was only 1 in-hospital death(in the CS group,p=1)and no postoperative moderate to severe aortic insufficiency in either group.The blood loss and consumption of blood products in the PUS group were also lower than in the CS group,especially for plasma use.Regarding the need for re-exploration because of bleeding,acute kidney injury,pericardial pleural effusion,drainage volume within the first 24 hours,mechanical ventilation time and arrhythmia,the 2 groups were comparable.Patients in the CS group showed a longer ICU time(74.20±47.21 vs.50.94±30.16 h,p=0.001)and higher hospitalization expenses(135649.52±29992.21 vs.123380.15±27062.82yuan,p<0.001).None of the patients died or reoperated during the follow-up.Freedom from moderate or severe aortic insufficiency remained comparable after matching(p=0.97).Conclusions:Minimally invasive valve-sparing aortic replacement via partial upper sternotomy can be safely performed in selected patients.Objective:It is very important to select the correct size of graft in valve sparing root replacement(VSRR)procedure.At present,there are many methods to select the graft.The traditional methods need complex measurement and calculation,and do not consider the matching between graft and aortic leaflets.Therefore,we propose a simple and easy calculation method to help us select the appropriate graft in VSRR procedure and use this size to determine the free margin length,so as to ensure that the graft matches its own anatomical structure.Methods:From January to June 2021,18 patients who underwent reimplantation VSRR were included in this study.All patients used this measurement and calculation method to select graft.Our measurement and calculation method is that the geometric height(gH)of three aortic sinuses during operation were measured.Based on the minimum geometric height of the three leaflets,minus 2-3mm from this height,and double the value is the diameter of the graft(d)(d=(gH-(2～3))*2).Then the aortic valve leaflet underwent cusp plication so that the free margin length(FML)of the plicated aortic leaflet is equal to the diameter of the artificial vessel plus 3-5mm(FML=d+(3～5)).The degree of aortic regurgitation was measured by ultrasound before operation and after discharge.The primary end points were all-cause death and re intervention of aortic valve.Results:The mean age of 18 patients undergoing VSRR procedure was 50.1 ± 11.9 years,and 15 patients was male(83.3%),BMI was 26.19 ± 2.46.One patient was diagnosed with Marfan’s syndrome(5.6%),and one patient was diagnosed bicuspid aortic valve(5.6%).All 18 cases had preoperative aortic regurgitation(100%),including 4 mild(22.2%),9 moderate(50%)and 5 severe(27.8%).During the operation,7 patients were treated with 30mm(38.9%),10 patients with 28mm(55.6%),and 1 patient with 26mm graft(5.6%).Only 4 patients had mild aortic regurgitation after operation(before discharge).There was no death and reoperation within 3 months after discharge;There was no progression in the degree of aortic regurgitation.Conclusions:The new measurement and calculation method of graft size and aorticvalve free margin length determined based on aortic valve geometric height is simple and satisfactory,which can ensure that the selected graft matches the patient.Objective:Aortic root replacement with aortic valve preservation(David operation)is an internationally recognized valve preservation operation.The purpose of this study is to try to overcome the defects of existing aortic graft and design a new fully bionic aortic sinus artificial blood vessel,which has good sinus morphology,mechanical elasticity,compliance,structural stability and histocompatibility.Methods and results:We extracted the computed tomography imaging information of people with normal aortic root structure for mold construction,imported the imaging data of the research object into software repair modeling,if the model surface is rough,we can use freeform software for smoothing,and finally export the model file for 3D printing.Use 3D printing technology to make molds.According to the mold,the three-layer structure based on polyurethane material is made,and the full bionic aortic sinus artificial blood vessel is obtained.Conclusion:Based on the anatomical and imaging data of aortic root in normal people and polyurethane synthetic materials independently developed in China,some studies have made a fully bionic three-layer sinus artificial blood vessel.At present,in order to overcome the technical difficulties,in the next step,in vitro experiments and animal experiments will be carried out to provide a basis for the next clinical trial. |
PDF Full Text Request