Objective To evaluate the clinical effectiveness of valve-sparing aortic root replacement (VSARR) in the treatment of patients with dilated aortic root after operation for tetralogy of Fallot (TOF). Methods A retrospective analysis was conducted on clinical data of TOF patients with aortic root dilation who underwent VSARR in our hospital from 2016 to 2022. Results Finally 14 patients were collected, including 8 males and 6 females, with a median age of 22 years ranging from 12-48 years. Among them, 5 patients had severe aortic valve regurgitation, 4 moderate regurgitation, and 5 mild or no regurgitation. Six patients had sinus of valsalva dilation, and 8 significant dilation of the ascending aorta. One patient had residual shunt due to ventricular septal defect, and 9 severe pulmonary valve regurgitation. The David procedure was performed in 10 patients, Yacoub procedure in 2 patients, and Florida sleeve in 2 patients. There was no perioperative mortality in the group. The median follow-up time was 2.9 years (ranging from 0.4 to 6.0 years). One patient had mild aortic valve regurgitation, and the rest had minimal or no regurgitation. One patient had mild stenosis of the left ventricular outflow tract, and the rest patients had no obvious stenosis. Conclusion VSARR is a satisfactory treatment for aortic root dilation in patients with TOF, with no significant increase in the incidence of left ventricular outflow tract stenosis or aortic regurgitation during mid-term follow-up.
ObjectiveTo evaluate the safety and efficacy of total arterial off-pump coronary artery bypass grafting (OPCABG) using a left internal thoracic artery (LITA) combined with bilateral radial arteries (RAs). MethodsWe retrospectively analyzed the clinical data of patients with severe multi-vessel coronary artery disease who underwent total arterial OPCABG with a LITA and bilateral RAs at Sichuan Provincial People’s Hospital from November 2020 to April 2023. Results A total of 24 patients were included, comprising 23 males and 1 female, with a mean age of (53.63±4.33) years. The New York Heart Association (NYHA) functional class was Ⅱ to Ⅲ. The mean number of distal anastomoses was 3.17±0.38. A Y-graft was constructed in 12 patients and sequential grafting was performed in 4 patients. Concomitant procedures included coronary endarterectomy in 1 patient, intra-aortic balloon pump (IABP) implantation in 10 patients, and thymoma resection in 1 patient. The mean operative time was (308.13±30.39) min, mechanical ventilation time was (15.42±7.42) h, ICU stay was (46.08±27.32) h, and postoperative hospital stay was (11.71±1.90) d. There were no in-hospital deaths. Postoperative complications included one patient of acute renal failure and one patient of cerebral infarction. Pre-discharge color Doppler echocardiography revealed that the left ventricular end-diastolic diameter was significantly smaller than before surgery (P<0.05), while the left ventricular ejection fraction and fractional shortening were significantly higher (P<0.05). Coronary computed tomography angiography (CTA) showed that all arterial grafts were patent. During a mean follow-up of (14.58±8.75) months, no patients experienced angina recurrence or mortality. Repeat coronary CTA or angiography in 16 patients one year postoperatively confirmed that all arterial grafts remained patent. Conclusion Total arterial OPCABG using a LITA and bilateral RAs is a safe and effective treatment for patients with severe multi-vessel coronary artery disease. For high-risk patients, intraoperative IABP support is recommended.
Objective To analyze the perioperative management strategies and early postoperative outcomes of adult patients with tetralogy of Fallot (TOF) undergoing corrective surgery. Methods A retrospective analysis was conducted on adult patients who underwent corrective surgery for TOF in Sichuan Provincial People's Hospital between June 2016 and May 2026. Demographic characteristics, concomitant intracardiac anomalies, pulmonary valve management strategies, cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times, intensive care unit (ICU) stay, mechanical ventilation duration, postoperative right-sided pressure parameters, perioperative complications, and in-hospital outcomes were collected and analyzed. Results A total of 30 patients were enrolled, including 17 (56.7%) males and 13 (43.3%) females , with a mean age of (31.1\begin{document}$ \pm $\end{document}9.7) years. Preoperatively, the proportions of patients with New York Heart Association (NYHA) functional classⅠ, Ⅱ, Ⅲ, and Ⅳ were 6.7%, 46.7%, 36.7%, and 10.0%, respectively. The majority of patients presented with hypoxemia and compensatory polycythemia. Intraoperatively, 19 patients (63.3%) underwent pulmonary valve replacement (PVR), and 11 (36.7%) received pulmonary valvuloplasty. The median CPB time was 143.5 (132.5, 159.8) min, and the mean ACC time was (100.0±8.8) min. Postoperatively, the right ventricular systolic pressure was (41.0\begin{document}$ \pm $\end{document}3.8) mm Hg, the ratio of right ventricular to systemic systolic pressure was (37.9%±3.3%), and the right ventricular-pulmonary artery (RV-PA) systolic pressure gradient was 14.0 (12.0, 17.0) mm Hg. Postoperative arrhythmia occurred in 9 patients (30.0%). One patient (3.3%) died perioperatively due to multiple organ dysfunction syndrome secondary to severe pulmonary infection, yielding an in-hospital survival rate of 96.7%. Conclusion Adult TOF patients present with complex pathophysiologic features and require surgical and perioperative management distinct from those for pediatric patients. Appropriate pulmonary valve management and effective control of postoperative right heart pressure load contribute to favorable early outcomes. Nevertheless, vigilant surveillance for complications and sustained long-term follow-up remain essential.