Objective To report our experience in living donor liver harvesting of right lobe grafts. MethodsThe data of 76 living donors of right lobe grafts hepatectomy between August 2007 and December 2008 were studied. Before operation, the graft size, remnant liver volume rate, fatty liver, middle hepatic vein type, and the level of portal hypertension of recipient were comprehensive assessed to determine whether harvested middle hepatic vein. The graft was harvested depending on the port vein and hepatic artery ischemia-line. B-ultrasound was used to definite the structure and branch of middle hepatic vein, and intraoperative cholangiography was performed to definite the structure and variation of bile duct. Donor operative time, intraoperative blood loss, postoperative hospital stay, levels of bilirubin, international normalized ratio （INR）, and ALT, and complications after operation were recorded. Results All the operations were successful. The operative time was (8.3±1.3) h, the blood loss was (325±127) ml without blood transfusion in operation. The ALT, INR, and bilirubin recovered on the 12th day. The most common complication in early post-operation was wound infection in 5 cases, 4 cases had cholestasis, 4 cases occurred cross-section bile leakage, and 11 cases occurred varying degrees of delayed gastric emptying in 4～7 d after operation, who were all alleviated by corresponding treatments. The hospital stay was 9～21 d (median: 14 d) after operation. Conclusion Preoperative evaluation of the hepatic anatomy and precise surgical procedure are crucial, which will help the development of graft harvesting and rehabilitation of donor.
Objective To research anesthetic management, pathophysiologic variation of adult-to-adult living donor liver transplantation (A-ALDLT) and to probe how to improve anesthetic quality of A-ALDLT. Methods The clinical data of 47 donors from Sep. 2005 to Jan. 2007 in West China Hospital were reviewed. Intraoperative vital signs, anesthetic management, perioperative serum levels of HGB， Alb， ALT， AST, TBIL， APTT， PT were measured， and complications were assessed. Results The physical condition of all donors were good before operations and were all in grade Ⅰaccording to ASA. Under general anesthesia of intravenous and inhalation, electrocardiogram, O2 saturation, blood pressure and body temperature were continuously monitored. A radial arterial catheter and a central venous catheter were placed. Blood lavement was utilized intraoperatively in all patients. All donors maintained stable life signs intraoperatively. The average intraoperative blood losses was （603.13±317.00） ml, and donors were transfused with autologous blood 〔(381.25±171.15) ml〕, with only 4 donors required homologous blood transfusion. HR and mean arterial blood pressure (MAP) showed no significantly variations intraoperatively (Pgt;0.05). Compared with controlled central venous pressure (CVP) before and right after hepatectomy, CVP increased significantly (P＜0.05) when intubation and abdomen-closing were carried. After hepatectomy and on the first day after operation, HGB and Alb decreased significantly (P＜0.05); ALT, AST and TBIL increased significantly (P＜0.05). Right after hepatectomy, PT increased instantly and significantly (P＜0.05); On the first day after operation, APTT began to increase significantly (P＜0.05). All donors came around completely and were extubated in the liver transplantation intensive care unit on the first day after operation. There were 3 cases (6.38%) of postoperative complication, which were biliary leakage, portal vein thrombosis and serious pleural effusion. Those 3 donors were cured after treatment. Conclusion Inhalation and intravenous general anesthesia of propofol, remifen-tanil and isoflurane can maintain stable life signs and reduce liver injury. Steady anesthesia, sufficient oxygenation and effective blood protection measures, for example, by decreasing CVP to prevent bleeding and by reclaiming autologous blood to avoid transfusing homologous blood, are keys for the safety of the donor and the prevention of complications.
In recent years, the field of cardiovascular surgery has undergone revolutionary changes and made rapid progress in various aspects, bringing more hope and possibilities for the health and well-being of patients. The constant emergence of new technologies brings new opportunities and hope, as well as constant challenges to past concepts. This article aims to provide a comprehensive overview of the latest developments in cardiovascular surgery in recent years, especially since 2023. It introduces cutting-edge knowledge and technologies in the field of cardiovascular surgery, including lifelong management of aortic valve disease, artificial valves, mitral valves, treatment options for hypertrophic obstructive cardiomyopathy, heart transplantation, left ventricular assist, coronary artery surgery, cardiac structural interventions for chronic heart failure, aortic dissection, and comprehensive surgical treatment of atrial fibrillation. It also analyzes and explores future development directions in depth, aiming to provide useful references and inspiration for cardiovascular doctors and jointly promote the continuous progress of cardiovascular surgery in China.
The quality control of lung transplantation involves many aspects, such as team building, selection of recipients, preoperative diagnosis and evaluation of recipients, maintenance of brain-dead donors, evaluation and acquisition of donors, surgical operation, postoperative management and postoperative follow-up. Precision management is the core concept of operation quality control. Only by normalizing the operation quality control of lung transplantation to provide basic guarantee for multi-team cooperation and development of lung transplantation management in the future, building a complete lung transplantation database to excavate data resources and improve the quality of transplantation, and comprehensively building a Chinese lung transplantation quality control system with multi-team participation and cooperation, can we improve the overall level of surgical diagnosis and treatment of lung transplantation in China.
Objective To investigate the feasibility and effectiveness of antibiotic bone cement directly inducing skin regeneration technology in the repairing of wound in the lateral toe flap donor area. MethodsBetween June 2020 and February 2023, antibiotic bone cement directly inducing skin regeneration technology was used to repair lateral toe flap donor area in 10 patients with a total of 11 wounds, including 7 males and 3 females. The patients’ age ranged from 21 to 63 years, with an average of 40.6 years. There were 3 cases of the distal segment of the thumb, 2 cases of the distal segment of the index finger, 1 case of the middle segment of the index and middle fingers, 1 case of the distal segment of the middle finger, and 3 cases of the distal segment of the ring finger. The size of the skin defect of the hand ranged from 2.4 cm×1.8 cm to 4.3 cm×3.4 cm. The disease duration ranged from 1 to 15 days, with an average of 6.9 days. The flap donor sites were located at fibular side of the great toe in 5 sites, tibial side of the second toe in 5 sites, and tibial side of the third toe in 1 site. The skin flap donor site wounds could not be directly sutured, with 2 cases having exposed tendons, all of which were covered with antibiotic bone cement. ResultsAll patients were followed up 6 months to 2 years, with an average of 14.7 months. All the 11 flaps survived and had good appearance. The wound healing time was 40-72 days, with an average of 51.7 days. There was no hypertrophic scar in the donor site, which was similar to the color of the surrounding normal skin; the appearance of the foot was good, and wearing shoes and walking of the donor foot were not affected. ConclusionIt is a feasible method to repair the wound in the lateral foot flap donor area with the antibiotic bone cement directly inducing skin regeneration technology. The wound heals spontaneously, the operation is simple, and there is no second donor site injury.
Objective To investigate the dynamic changes of postoperative liver reserve function and laboratory liver function as well as liver volume regeneration, and their potential relationship with short-term clinical outcomes after adult-to-adult living donor liver transplantation (LDLT). Methods The data of 30 recipients underwent LDLT were prospectively collected. The plasma clearance (K) by indocyanine green (ICG) excretive test, liver function test by laboratory methods, liver volume by CT and shortterm (lt;3 months) complications were analyzed. Results The graft recipient body weight ratio (GRBW) was 0.63%-1.43%. The hepatic volume of the recipients in the operation was (638±103) ml, which was smaller than that day 7, 30, and 90 after operation (Plt;0.001), but the hepatic volume at subsequent time point was not different from that at the former time point (Pgt;0.05). The KICG values of recipients among the day 3 〔(0.177±0.056)/min〕, 7 〔(0.183±0.061)/min〕, 30 〔(0.200±0.049)/min〕, and 90 〔(0.209±0.050)/min〕 after operation gradually increased, which was respectively higher than that of recipients before operation (P=0.006, P=0.002, Plt;0.001, and Plt;0.001). Compared with the baseline KICG 〔(0.228±0.036)/min〕 of the donors, the KICG of recipients showed significant variation on day 3 and 7 after operation (P=0.004 and P=0.015), and the KICG of recipients on day 30 and 90 after operation approached the baseline KICG (P=0.355 and P=0.915). The recipients were divided into good liver function group (n=23) and poor liver function group (n=7) according to total serum bilirubin on day 14 after operation. The KICG significantly dropped compared with the recipients of good liver function group on day 3 after operation (P=0.001). Conclusions The liver volume regenerates dramatically on day 7 after operation for the recipients. The ICG excretivetest shows that volume recovery occurs much more gradually than the recovery of function in the recipients. The ICG excretive test is a more reliable indicator of graft function and subsequent graft outcome early after LDLT.
Objective To explore the feasibility of harvesting free thinned innervated anterolateral thigh (ALT) perforator flap for repairing the donor defect after wrap-around flap transfer. Methods Between May 2011 and December 2013, free thinned innervated ALT perforator flap was used to repair the donor defects after wrap-around flap transfer in 9 patients. There were 8 males and 1 female, with a mean age of 31.2 years (range, 19-42 years). The interval time between injury and admission was 3-12 hours (mean, 6.5 hours). Injury causes included machine crush injury (4 cases), traffic accident injury (3 cases), and twisting injury (2 cases). The wrap-around flaps were transferred to reconstruct thumb defects. And the size of donor site defect ranged from 3 cm×2 cm to 8 cm×5 cm. A branch of the lateral femoral cutaneous nerve was carried to make innervated ALT perforator flap for donor site repair. The size of innervated ALT perforator flap ranged from 3.0 cm×2.0 cm to 8.5 cm×5.0 cm. The thickness of innervated ALT perforator flap before defatting ranged from 2.0 to 4.5 cm (mean, 3.2 cm); the thickness after defatting ranged from 0.4 to 0.6 cm (mean, 0.5 cm). The defect at the anterolateral thigh was primarily closed in all cases. Results All reconstructed thumbs and ALT perforator flaps survived. All patients were followed up 6-30 months (mean, 15.8 months). The ALT perforator flaps had good appearance and color, with no further flap revision or defatting procedures. The static two-point discrimination was 8-15 mm (mean, 10.5 mm). All patients could walk and run normally without postoperative skin erosions or ulcerations. Conclusion The free thinned innervated ALT perforator flap is pliable and thin. It is suitable for repairing the donor site defects after wrap-around flap transfer for thumb reconstruction.
Objective To review the vascular anatomy of the donor and the reci pient for the l iving kidney transplantation. Methods The recent l iterature about the vessels of donor and reci pient in cl inical appl ications was extensively reviewed. Results The pertinent vascular anatomy of the donor and recipient was essential for the screening of the proper candidates, surgical planning and long-term outcome. Early branching and accessory renal artery of the donor were particularly important to deciding the side of nephrectomy, surgical technique and anastomosing pattern, and their injuries were the most frequent factor of the conversion from laparoscopic to open surgery. With increase of laparoscopic nephrectomy indonors, accurate venous anatomy was paid more and more attention to because venous bleeding could also lead to conversion to open nephrectomy. Multidetector CT (MDCT) could supplant the conventional excretory urography and renal catheter angiography and could accurately depict the donors’ vessels, vascular variations. In addition, MDCT can excellently evaluate the status of donor kidney, collecting system and other pertinent anatomy details. Conclusion Accurate master of related vascular anatomy can facil iate operation plan and success of operation and can contribute to the rapid development of living donor kidney transplantation. MDCT has become the choice of preoperative one-stop image assessment for living renal donors.
Objective To discuss the criteria of recipient selection，surgical approach，and complications and its theray by using of pediatric donation after cardiac death liver graft in adult recipient. Methods The clinical data of one case of pediatric donation after cardiac death liver to adult recipient was analyzed retrospectively and the literatures were reviewed. Results A 6-year-old girl pronounced brain death due to drowning and on the basis of cardiopulmonary criteria donated the organ．The liver graft weight was 598 g and the warm ischemic time was 10 min. The liver donor was transplanted to a 64-year-old woman，the graft to recipient weight ratio was 1.09%，the graft volume/estimated standard liver volume was 61.8%．The classic orthotopic liver transplantation without bypass was underwent，the postoperative recovery was smooth after the liver transplantation．The CT scan showed that the liver graft volume was 1 003cm3 on day 14 after operation．The patient was discharged on 45 d after orthotopic liver transplantation and the liver function was normal when followed-up 3 months after the operation. Conclusions Pediatric donation after cardiac death liver graft can be successfully utilized to adult recipient．Recipient selection and surgical approach should be decided by conditions of both donor and graft．
Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. MethodsThe Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and China Biology Medicine from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. The data were extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were conducted by the Stata 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4% (95%CI 2% to 5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5% to 9%). Besides, compared with recipients from SARS-CoV-2-negative donors, the pooled odds ratio (OR) value of death of SARS-CoV-2-positive donors was 0.68 (95%CI 0.38 to 1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27 to 0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37 to 0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors (SMD=–0.03, 95%CI –0.22 to 0.15, Z=0.36, P=0.720). Conclusion The application of heart from SARS-CoV-2-positive donor for transplantation is safe and feasible. However, further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.