In recent years，West China Hospital of Sichuan University actively participated in medical assistance and rescue in Wenchuan，Yushu and Lushan earthquakes. However，professional roles of cardiovascular surgeons in medical assistance and rescue in earthquakes remain unclear because of the particularity of cardiovascular surgery, which often affects the assembly of medical assistance and rescue teams. Thus，we need to explore the necessity for cardiovascular surgeons to join medical rescue teams within 72 hours after earthquake. In this article，medical rescue work of cardiovascular surgeons within 72 hours after 2008 “5?12” Wenchuan earthquake and 2013 “4?20” Lushan earthquake is analyzed and compared to identify professional roles of cardiovascular surgeons in medical rescue within 72 hours after earthquake. It is necessary for cardiovascular surgeons to join medical rescue teams within 72 hours after earthquake.
The incidence of cardiovascular disease remains high, and surgery is an important measure for the treatment of cardiovascular disease. However, cardiovascular surgery is complicated and difficult, and it is one of the departments with the highest rate of allogeneic blood transfusion. Allogeneic blood transfusion significantly increases the complications and mortality of patients, while autologous blood transfusion can effectively reduce allogeneic blood transfusion and adverse reactions. Autologous plateletpheresis technology is a popular autotransfusion method in recent years. This article reviews the autologous plateletpheresis technology and its clinical application in cardiovascular surgery.
Objective To analyze the characteristics of pathogens causing bloodstream infection (BSI) after cardiovascular surgery, and provide instructions for prevention and treatment of such kind of disease. Methods A retrospective investigation of clinical and pathogenic data of the patients suffering from BSI after cardiovascular surgery in West China Hospital of Sichuan University from January 2015 to December 2016 was performed. There were 61 patients with 36 males and 25 females at average age of 48.2±17.1 years. A percentage of 65.6% (40/61) of the underlying diseases was rheumatic heart disease. Results Sixty-five strains were isolated from the blood culture specimens of the 61 patients. Gram-positive bacteria, gram-negative bacteria and fungi isolates accounted for 56.9% (37/65), 35.4% (23/65), and 7.7% (5/65), respectively. Among these isolates, Streptococcus spp. was predominant (19/65, 29.2%), followed by Staphylococcus epidermidis (8/65, 12.3%), Staphylococcus aureus (6/65, 9.2%), Acinetobacter calcoaceticus- A. baumannii (5/65, 7.7%) and Escherichia coli (5/65, 7.7%). The resistance rate of Streptococcus spp. to erythromycin and clindamycin was 73.4% (14/19) and 63.2% (12/19), while its resistance to cefepime, vancomycin or linezolid was not observed. Staphylococcus spp. showed the resistance rate of 71.4% (10/14) to oxacillin. All of A. calcoaceticus-A. baumannii isolates were multidrug resistant (5/5, 100.0%), and 80.0% (4/5) of them were resistant to imipenem. The isolates producing extended spectrum beta-lactamase accounted for 80.0% (4/5) of E. coli. Conclusion Streptococcus spp. was the common pathogen causing BSI after cardiovascular surgery. Staphylococcus spp. and gram-negative bacilli show high resistance.
ObjectiveTo summarize the research progress of mixed reality (MR) technology in the field of vascular surgery.MethodWe retrieved the literatures about the application of MR technology in vascular surgery, and summarized and analyzed them.ResultsThe application of MR technology in vascular surgery could greatly improve the standardization of medical education, shorten the learning cycle, effectively shorten the operation time, and increase the benefit of patients. The application of MR in vascular surgery was still in its infancy, and it showed some attractive prospects as well as some shortcomings.ConclusionsThe application of MR technology in vascular surgery is still at the exploratory stage, but it has an attractive prospect. With the continuous improvement of registration technology and the continuous improvement of accuracy, MR technology will be more and more widely used in vascular surgery.
Abstract： Arginine vasopressin （AVP） is closely related to the pathogenesis of a variety of cardiovascular diseases and kidney diseases. Currently it is often used for the treatment of severe peripheral vasodilatory shock， and particularly beneficial for patients with refractory catecholamine-resistant vasodilatory shock. For some patients who do not have adequate AVP level in plasma after cardiovascular surgery， external low-dose AVP infusion is helpful to decrease the heart rate, and the dosage and duration of catecholamine use. Early initiation of low-dose AVP infusion may be beneficial for postoperative patients’ hemodynamic recovery without adverse complications. More randomized control trials are needed to provide evidence for rational usage， dosage and duration of AVP administration.
ObjectiveTo analyze the causes and preventions of stent graft induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for Stanford type B dissection, particularly from the standpoint of biomechanical behavior of stent graft. MethodsSINE was defined as the new tear caused by the stent graft itself, excluding those arising from natural disease progression or any iatrogenic injury from the endovascular manipulation. Twentytwo patients with SINE were retrospectively collected and analyzed out of 650 cases undergoing TEVAR for type B dissection from August 2000 to June 2008 in our center. An additional case included was referred to our center in 14 months after TEVAR performed in another hospital. ResultsTotally, there were 24 SINEs found in 23 cases, including SINE at the proximal end in 15 cases, at the distal end in 7, and at both in 1, and 6 patients died. The incidence was 3.4% ( 22/650) in our hospital, and the mortality was 26.1% (6/23). All 16 proximal SINEs was located at the greater curve of the arch and caused retrograde type A dissection. All 8 distal SINEs occurred at the dissected flap, and 5 of them caused enlarging aneurysm while 3 remained stable. All 23 cases had the endograft placed across the distal aortic arch during the primary TEVAR. ConclusionsSINE is not rare following TEVAR for type B dissection, and associates with a high substantial mortality. The stress yielded by the endograft seems to play a predominant role in its occurrence. It is of significance to take the stressinduced injury into account during both design and placement of the endograft.
Facing the increasing cardiovascular disease burden and prevailing population risk factors, the cardiovascular surgery in China was also encountering challenges including imbalances in discipline development, significant divergencies in healthcare quality, lacking of clinical guidelines and domestic critical evidence. The concept of quality control and improvement has been practiced and tested in many disease specialties. Quality improvement programs are urgently needed in China to promote the universal cardiovascular surgery healthcare quality.
Objective To investigate the protective effect of autologous platelet separation on blood in surgery for Standford type A aortic dissection. Methods A total of 180 patients with Standford type A aortic dissection undergoing elective major vascular surgery in our hospital from July 2014 to March 2016 were enrolled. There were 123 males and 57 females with age ranging from 19 to 68 years and weight of 50-85 kg. The patients were randomly divided into two groups. Patients in group A (n=92, 65 males, 27 females, mean age of 45±21 years) received intraoperative autologous blood recovery; while those in group B (n=88, 58 males, 30 females, mean age of 43±24 years) received autologous platelet rich plasma (APRP) and intraoperative autologous blood recovery. The whole process of platelet separation was completed before heparinization. The relevant indicators of blood coagulation function before the induction of anesthesia (T1), before heparinization (T2), immediately postoperatively (T3) and 1 h (T4), 24 h (T5) postoperatively were measured. Cardiopulmonary bypass, aortic cross-clamping time, drainage volume at postoperative 1 h, 24 h and allogeneic blood transfusion volume were recorded. Results The whole blood volume of group B in the platelet separation in emergency was 1 305±110 ml, and collected platelet rich plasma was 275±30 ml, platelet counts (630±220)×109/L, accounting for 25%±5% of platelets of whole blood, and platelet separation time was 32±9 min. Compared with group A, platelet count at postoperative 1 h in group B was significantly higher; drainage volume at postoperative 1 h, 24 h, allogeneic red blood cells, plasma transfusion volume and allogeneic platelet infusion rate decreased significantly (P<0.05). Group B had less postoperative complications (P<0.05). Conclusion Preoperative autologous plateletpheresis combined with intraoperative autologous blood recovery can significantly improve the coagulation function of patients with vascular surgery, and reduce the amount of allogeneic blood transfusion and postoperative bleeding.
Open surgery is an important part of vascular surgery. For vascular surgery diseases not suitable for endovascular therapy, adjuvant methods of endovascular therapy and the ultimate means of treatment after failure, vascular graft infection, open vascular trauma, various tumors involving blood vessels, vascular reconstruction and complications of organ transplantation, iatrogenic vascular injury, and so on, open surgical procedures still need to be provided for treatment and development. This paper lists the important role that open surgery plays in supporting the treatment of vascular related diseases and the development of the discipline in surgery and internal medicine, and emphasizes that open surgery is still a necessary quality for vascular surgeons, the basis and important guarantee for the development of the discipline, and the guarantee for the timely and effective treatment of various complex and difficult vascular surgical diseases.
In 2022, many excellent clinical studies emerged in the field of cardiovascular surgery. Selecting papers published in The New England Journal of Medicine and other top medicine and cardiology journals, this review focused on the research progress on 7 topics in the field of cardiovascular surgery: coronary artery surgery, vascular surgery, valvular surgery, structural heart disease, congenital heart disease, heart transplantation, perioperative management, and special population.