Objective To study the clinical characteristics, therapy strategies and the outcomes of female patients with acute aortic dissection during late pregnancy and puerperal period. Methods We retrospectively analyzed the clinical data of 7 patients with acute aortic dissection during late pregnancy and puerperal period in Shanghai Changhai Hospital between August 2012 and June 2017. Five of the 7 patients were late stage pregnancy, 2 were puerperal period (1 at the postpartum night, 1 in 18 days after delivery). There were 6 patients of Stanford type A aortic dissection (85.7%), and 1 patient of type B aortic dissection (14.3%). The age of the patients ranged from 26 to 34 (30.8±3.1) years. Cardiac ultrasonography of patients with type A showed that the maximum diameter of the ascending aortas was 4.2–5.7 (4.7±0.6) cm, of which 2 patients were aneurysm of aortic sinus, 3 patients were with Marfan syndrome. Bentall procedure was conducted in 1 patient, Bentall+Sun’s surgery in 2 patients, ascending aorta replacement+Sun’s+coronary artery bypass grafting surgery in 1 patient, aortic root remodeling+ascending aorta replacement+Sun’s surgery in 2 patients. One patient with Stanford type B acute aortic dissection was performed with thoracic endovascular aortic repair (TEVAR) after cesarean section. Results Aortic blocking time ranged from 51 to 129 (85.5±22.9) min. Cardiopulmonary bypass time was 75–196 (159.0±44.0) min. Moderate hypothermic circulation arrest with selective cerebral perfusion time was 20–30 (23.8±3.5) min. All maternal and fetuses survived. The infant whose mother received aortic repair in early stage and then received cesarean section was diagnosed with cerebral palsy. Maternal and fetuses were followed up for 9 months to 4 years. During the follow up period, all the fetuses grew well except the cerebral palsy one, and all maternal recovered well. The patient who received aortic repair in the early stage, had a sigmoid rupture during cesarean section and was treated with sigmoid colostomy. Another patient with Stanford type A dissection was diagnosed as left renal vein entrapment syndrome after 2 years. Conclusion Type A aortic dissection is more common in late pregnancy and puerperal patients. And Marfan syndrome is a high-risk factor for acute aortic dissection in pregnancy women. Early and appropriate surgical treatment strategy based on the type of aortic dissection and gestational age are the key points to achieve good outcomes both for maternal and fetus.
Objective Historically, perioperative hemoglobin monitoring has relied on calculated saturation, using blood gas devices that measure plasma hematocrit (Hct). Co-oximetry, which measures total hemoglobin (tHb), yields a more comprehensive assessment of hemodilution. The purpose of this study was to examine the association of tHb measurement by co-oximetry and Hct, using conductivity with red blood cell (RBC) transfusion, length of stay (LOS) and inpatient costs in patients having major cardiac surgery. Methods A retrospective study was conducted on patients who underwent coronary artery bypass graft (CABG) and/or valve replacement (VR) procedures from January 2014 to June 2016, using MedAssets discharge data. The patient population was sub-divided by the measurement modality (tHb and Hct), using detailed billing records and Current Procedural Terminology coding. Cost was calculated using hospital-specific cost-to-charge ratios. Multivariable logistic regression was performed to identify significant drivers of RBC transfusion and resource utilization. Results The study population included 18 169 cardiovascular surgery patients. Hct-monitored patients accounted for 66% of the population and were more likely to have dual CABG and VR procedures (10.4% vs. 8.9%, P=0.006 9). After controlling for patient and hospital characteristics, as well as patient comorbidities, Hct-monitored patients had significantly higher RBC transfusion risk (OR=1.26, 95%CI 1.15-1.38,P<0.000 1), longer LOS (IRR=1.08, P<0.000 1) and higher costs (IRR=1.15, P<0.000 1) than tHb-monitored patients. RBC transfusions were a significant driver of LOS (IRR=1.25, P<0.000 1) and cost (IRR=1.22, P<0.000 1). Conclusion tHb monitoring during cardiovascular surgery could offer a significant reduction in RBC transfusion, length of stay and hospital cost compared to Hct monitoring.
Patients with cardiac diseases undergoing non-cardiac surgery have high risk and mortality. Management of these kind of patients is complicated and difficult. Appropriate use of circulation monitoring is good for clinical decision making and prognosis improvement. This article reviews the circulation monitoring technologies for patients with cardiac diseases undergoing non-cardiac surgeries from pressure monitoring, haemodynamics monitoring and cardiac structure and function monitoring. To choose suitable circulation monitor individually according to advantages, disadvantages and interference factors of every technology, the comorbidities and surgical characteristics can provide references for clinical decision making.
Objective To explore the effect of preoperative hypothyroidism on postoperative cognition dysfunction (POCD) in elderly patients after on-pump cardiac surgery. Methods Patients who were no younger than 50 years and scheduled to have on-pump cardiac surgeries were selected in West China Hospital from March 2016 to December 2017. Based on hormone levels, patients were divided into two groups: a hypo group (hypothyroidism group, thyroid stimulating hormone (TSH) >4.2 mU/L or free triiodothyronine 3 (FT3) <3.60 pmol/L or FT4 <12.0 pmol/L) and an eu group (euthyroidism group, normal TSH, FT3 and FT4). The mini-mental state examination (MMSE) test and a battery of neuropsychological tests were used by a fixed researcher to assess cognitive function on 1 day before operation and 7 days after operation. Primer outcome was the incidence of POCD. Secondary outcomes were the incidence of cognitive degradation, scores or time cost in every aspect of cognitive function. Results No matter cognitive function was assessed by MMSE or a battery of neuropsychological tests, the incidence of POCD in the hypo group was higher than that of the eu group. The statistical significance existed when using MMSE (55.56% vs. 26.67%, P=0.014) but was absent when using a battery of neuropsychological tests (55.56% vs. 44.44%, P=0.361). The incidence of cognitive deterioration in the hypo group was higher than that in the eu group in verbal fluency test (48.15% vs. 20.00%, P=0.012). The cognitive deterioration incidence between the hypo group and the eu group was not statistically different in the other aspects of cognitive function. There was no statistical difference about scores or time cost between the hypo group and the eu group in all the aspects of cognitive function before surgery. After surgery, the scores between the hypo group and the eu group was statistically different in verbal fluency test (26.26±6.55 vs. 30.23±8.00, P=0.023) while was not statistically significant in other aspects of cognitive function. Conclusion The incidence of POCD is high in the elderly patients complicated with hypothyroidism after on-pump cardiac surgery and words reserve, fluency, and classification of cognitive function are significantly impacted by hypothyroidism over than other domains, which indicates hypothyroidism may have close relationship with POCD in this kind of patients.
Minimally invasive cardiac surgeries are the trend in the future. Among them, robotic cardiac surgery is the latest iteration with several key-hole incision, 3-dimentional visualization, and articulated instrumentation of 7 degree of ergonomic freedom for those complex procedures in the heart. In particular, robotic mitral valve surgery, as well as coronary artery bypass grafting, has evolved over the last decade and become the preferred method at certain specialized centers worldwide because of excellent results. Other cardiac procedures are in various stages of evolution. Stepwise innovation of robotic technology will continue to make robotic operations simpler, more efficient, and less invasive, which will encourage more surgeons to take up this technology and extend the benefits of robotic surgery to a larger patient population.
ObjectiveTo summarize the experience of totally thoracoscopic cardiac surgery (TTCS) for atrial septal defect.MethodsClinical data of 442 patients undergoing TTCS for atrial septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 149 male and 293 female patients, aged 3-74 (29.1±14.3) years. Surgical procedures were performed through 3 ports at the right chest wall.ResultsAll the operations were completed successfully. Mean operative time was 1.5-4.6 (2.2±0.3) h. The mean extracorporeal circulation and aortic cross-clamp time was 28-118 (55.9±13.3) min and 8-78 (21.5±10.2) min, respectively. Mechanical ventilation and intensive care unit stay time was 3.5-122.0 (8.1±7.4) h and 13-141 (20.7±10.2) h, respectively. Postoperation drainage volume was 70-1 280 (251.8±131.5) mL. The hospital stay was 4-16 (7.1±1.4) d. Intraoperative and postoperative complications occurred in 15 patients (3.3%). The mean follow-up time was 1-128 (67.6±33.3) months, and during the period, there were 25 patients of atrial fibrillation, 25 patients of mild-moderate tricuspid valve incompetence, 1 patient of moderate tricuspid valve incompetence. There was no reoperation or residual shunt during the period of follow-up. And the heart function was improved.ConclusionTTCS is a feasible, safe and minimal invasive approach for patients with atrial septal defect and has good short to medium-term outcomes.
Cardiogenic shock (CS) describes a physiological state of end-organ hypoperfusion characterized by reduced cardiac output in the presence of adequate intravascular volume. Mortality still remains exceptionally high. Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has become the preferred device for short-term hemodynamic support in patients with CS. ECMO provides the highest cardiac output, complete cardiopulmonary support. In addition, the device has portable characteristics, more familiar to medical personnel. VA ECMO provides cardiopulmonary support for patients in profound CS as a bridge to myocardial recovery. This review provides an overview of VA ECMO in salvage of CS, emphasizing the indications, management and further direction.
Objective To analyze the clinical efficacy of totally thoracoscopic surgery and conventional thoracotomy in repair of ventricular septal defect (VSD). Methods We retrospectively reviewed the clinical data of 50 VSD patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2017. According to the surgical pattern, they were divided into two groups: a totally thoracoscopic surgery group (21 patients, 13 males, 8 females, aged 38.36±10.02 years), and a thoracotomy group (29 patients, 18 males, 11 females, aged 42.36±13.02 years). The operation time, hospital stay, ventilator-assisted time and thoracic drainage were compared between the two groups. Results There was no death in two groups. In the thoracoscopic group the duration of cardiopulmonary bypass (CPB) time and the aortic clamping time were longer than those of the thoracotomy group (P<0.05), but postoperative drainage, patients with postoperative use of blood products and postoperative hospital stay were less (P<0.05). There was no statistically significant difference between the two groups in operation time, postoperative ventilator-assisted time or duration of ICU stay. Conclusion Compared with the conventional thoracotomy, totally thoracoscopic VSD repair with less trauma, quicker recovery and less blood use, is safe and reliable and can be used as a preferred surgical intervention.
Objective To investigate clinical diagnosis，timing of surgery and perioperative therapeutic strategies for blood culture-negative infective endocarditis （IE）. Methods Clinical data of 240 IE patients who were admitted tWuhan Asia Heart Hospital between July 2008 and July 2012 were retrospectively analyzed. According to their blood cultureresults，all the patients were divided into blood culture-negative group and blood culture-positive group. In the blood culture-negative group，there were 158 patients including 88 male and 70 female patients with their age of 51.3±10.1 years. In the blood culture-positive group，there were 82 patients including 45 male and 37 female patients with their age of 48.9±9.8 years. All the patients underwent surgical treatment，and the surgical procedures included complete vegetations excision，debridement of infected valves，removal of necrotic tissue around the annulus，and concomitant heart valve replacement or intracardiac repair. Postoperatively，all the patients received routine monitoring in ICU，cardiac glycosides，diuretics，other symptomatic treatment and adequate dosages of antibiotics for 4-6 weeks. Results Four patients died postoperatively in this study including 1 patient for low cardiac output syndrome and 3 patients for multiple organ dysfunction syndrome，1 patient in the blood culture-positive group and 3 patients in the blood culture-negative group respectively. There was no statistical difference in surgical mortality between the 2 groups （χ2=0.15，P=0.70）. All the other patients were discharged successfully and followed up for 6 to 36 months with the median follow-up time of 22 months. During follow-up, 2 patients died including 1 patient for cerebral infarction 2 years after surgery and another patient for cerebral hemorrhage 3 yearsafter surgery. Conclusion Patients with blood culture-negative IE should receive adequate dosage and duration of broad-spectrum antibiotics to control the infection rapidly, and aggressive surgical therapy to decrease in-hospital mortality and improve their quality of life and prognosis.
ObjectiveTo investigate the negative emotions of patients before cardiac surgery in West China Hospital in order to analyze the related factors.MethodsThe Huaxi emotional-distress index (HEI), a screening tool for mood disorders developed by the Mental Health Center of West China Hospital, was used for preoperative psychological evaluation of 1 968 adult patients hospitalized in cardiac surgery from March 2016 to July 2014. There were 835 males and 1 133 females at age of 49±13 years.Results Fifty-one patients (2.6%) had negative emotions, among whom 6 patients were screened for suicide risk. After intervention, none of them had serious consequences caused by adverse emotions, such as automatic discharge from hospital, avoidance of surgery and suicide.ConclusionThis study found that most of the cardiac surgery patients in West China Hospital have good psychological status before surgery, and a few suffered from negative emotions. “Huaxi emotional-distress index” is simple, effective and worth promoting.