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.
Working Group on Extracorporeal Life Support, National Center for Cardiovascular Quality Improvement developed guidelines on patient blood management for adult cardiovascular surgery under cardiopulmonary bypass, aiming to standardize patient blood management in adult cardiovascular surgery under cardiopulmonary bypass, reduce blood resource consumption, and improve patients outcomes. Forty-eight domestic experts participated in the development of the guidelines. Based on prior investigation and the PICO (patient, intervention, control, outcome) principles, thirteen clinical questions from four aspects were selected, including priming and fluid management during cardiopulmonary bypass, anticoagulation and monitoring during cardiopulmonary bypass, peri-cardiopulmonary bypass blood product infusion, and autologous blood infusion. Systemic reviews to the thirteen questions were performed through literature search. Recommendations were drafted using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. After five rounds of experts discussions between 2023 and 2024, 19 recommendations were finally formed.
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 investigate the clinical application of fresh autologous pericardial patch transplantation in cardiovascular surgery. MethodFrom January 2008 to December 2014, we used fresh autologous pericardial patch as a repair material in surgical treatment of congenital heart disease, valvular and vascular malformation. A total of 239 patients were included (130 males, 109 females), with a mean age of 0.40±13.80 years ranging from 0.25-69.00 years, including 180 infants. ResultThe time of intensive care unit (ICU) stay was 3-15 days and the time of ventilator-assisted breathing was 4-100 hours. Postoperative atelectasis and pleural effusion occured in 8 patients and was cured successfully by closed thoracic drainage and anti-infection therapy. Nine patients died within 30 days after surgery, including 3 deaths caused by low cardiac output syndrome and acute renal failure, 5 deaths caused by multiple organ failure, and 1 death caused by malignant arrhythmia. All patients had no infective endocarditis, thrombosis, hemolysis, blood vessel stenosis, or calcification of pericardial patch. The cause of death was associated with the primary lesion, but not with transplanted pericardium. We followed up 198 patients for 3-64 months. During follow-up, echocardiography showed no patch graft vegetation, thrombosis, perforation or calcification. ConclusionThe fresh autologous pericardium is a good material for repairing cardiac defects.
Committee of Minimally Invasive Cardiovascular Surgery (CMICS) annually investigates the minimally invasive cardiovascular surgery performed by departments of cardiovascular surgery of all hospitals in China of last year, and makes classification and summary according to the operation amount of minimally invasive surgery, regional and hospital distribution, and publishes it on the theme report of China Minimally Invasive Cardiovascular Surgery Conference (CMC). In 2021, CMICS published the 2018-2019 annual data of Chinese cardiovascular surgery in the form of a white paper for the first time in the Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, which attracted great attention from peers. In this statistical report, CMICS will focus on the volume of minimally invasive cardiovascular surgery, regional and hospital distribution in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region, and Taiwan Province) in the 2020—2021 for your reference.
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.
Hybrid cardiovascular surgical procedure is an emerging concept that combines the skills and techniques of minimally invasive surgery and interventional catheterization. It allows surgeons to use interventional equipment and techniques during operations, which are traditionally used by physicians, in order to reduce the magnitude of therapeutic interventions and to increase therapeutic effectiveness. This review provides a snapshot of the main application and progress of current hybrid procedures in the field of cardiovascular surgery, including the hybrid therapy of coronary artery disease, congenital heart disease and thoracic aortic aneurysm, also discusses the precondition with which the hybrid procedure should ideally be performed.
Objective To summarize treatment experience and evaluate clinical outcomes of surgical therapy for Stanford type A aortic dissection （AD）. Methods Clinical data of 48 patients with Stanford type A AD who underwent surgical treatment in General Hospital of Lanzhou Military Region from October 2006 to March 2013 were retrospectively analyzed. There were 41 males and 7 females with their age of 26-72 （47.6±9.2） years. There were 43 patients with acute Stanford type A AD （interval between symptom onset and diagnosis＜14 days） and 5 patients with chronic AD. There were 19 patients with moderate to severe aortic insufficiency and 6 patients with Marfan symdrome but good aortic valve function，who all received Bentall procedure，total arch replacement and stented elephant trunk implantation. There were 8 patients with AD involving the aortic root but good aortic valve function who underwent modified David procedure，total arch replacement and stented elephant trunk implantation. There were 10 patients with AD involving the ascending aorta who received ascending aorta replacement，total arch replacement and stented elephant trunk implantation. There were 5 patients with AD involving partial aortic arch who underwent ascending aorta and hemiarch replacement. Patients were followed up in the 3rd，6th and 12th month after discharge then once every year. Follow-up evaluation included general patient conditions，blood pressure control，chest pain recurrence，mobility and computerized tomography arteriography （CTA）. ResultsCardiopulmonary bypass time was 121-500 （191.4±50.6） minutes，aortic cross-clamp time was 58-212 （112.3±31.7） minutes，and circulatory arrest and selective cerebral perfusion time was 26-56 （34.8±8.7） minutes. Postoperative mechanicalventilation time was 32-250 （76.2±35.6） hours，and ICU stay was 3-20 （7.1±3.4） days. Thoracic drainage within 24 hours postoperatively was 680-1 600 （1 092.5±236.3） ml. Seven patients （14.5%） died perioperatively including 2 patients with multiple organ dysfunction syndrome，2 patients with low cardiac output syndrome，1 patient with renal failure，1patient with delayed refractory hemorrhage，and 1 patient with coma. Twenty patients had other postoperative complicationsand were cured or improved after treatment. A total of 38 patients ［92.7% （38/41）］ were followed up for 3-48 （13.0±8.9） months，and 3 patients were lost during follow-up. During follow-up，there were 36 patients alive and 2 patients who died of other chronic diseases. There was no AD-related death during follow-up. None of the patients required reoperation for AD or false-lumen expansion. CTA at 6th month after discharge showed no anastomotic leakage，graft distortion or obstruction.Conclusion According to aortic intimal tear locations，ascending aorta diameter and AD involving scopes，appropriate surgical strategies，timing and organ protection are the key strategies to achieve optimal surgical results for Stanford type A AD. Combined axillary and femoral artery perfusion and increased lowest intraoperative temperature are good methods for satisfactory surgical outcomes of Stanford type A AD.
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.
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.