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Extracorporeal Membrane Oxygenation after Cardiac Surgery: A Clinical Analysis of 27 Adult Patients

ObjectiveTo summarize the experience of applying extracorporeal membrane oxygenation (ECMO) after cardiac surgery in adult patient. MethodsWe retrospectively analyzed the clinical data of 27 patients underwent ECMO from December 2011 to October 2013. There were 15 males and 12 females at the mean age of 51±11 years ranging from 41 to 73 years. Vein-artery perfusion was performed in all 27 patients. ResultsAll 27 patients underwent ECMO. The mean time of using ECMO was 81.2±36.4 hours ranging from 48.0-192.0 hours. The mean time of hospital stay was 307.8±97.0 hours ranging from 168.0-480.0 hours. The rate of weaning from ECMO was 77.8% (21/27). The rate of discharge was 51.9% (14/27). The rate of perioperative mortality was 44.4% (12/27). ConclusionEffective monitoring with other supportive equipments is helpful to promote the result of ECMO.

原发性心脏肿瘤的外科治疗

目的 总结原发性心脏肿瘤的外科治疗经验，以提高手术疗效。 方法 回顾性分析1980年6月至2008年12月中国医科大学附属第一医院收治的263例原发性心脏肿瘤患者的临床资料，其中男90例，女173例；年龄10～79岁（41±13岁）。良性肿瘤241例，其中良性粘液瘤240例，纤维瘤1例；恶性肿瘤22例，其中恶性粘液瘤7例，恶性间皮瘤4例，血管肉瘤5例，横纹肌肉瘤1例，肺动脉内膜肉瘤1例，平滑肌肉瘤1例，炎症性恶性纤维组织细胞瘤1例，恶性淋巴瘤1例，滑膜肉瘤1例。手术完整摘除肿瘤252例（恶性肿瘤11例），局部切除肿瘤5例（均为恶性肿瘤），开胸探查取病理活组织检查6例（均为恶性肿瘤）。同期行冠状动脉旁路移植术（CABG）5例，二尖瓣置换术5例，二尖瓣成形术4例，三尖瓣成形术9例，三尖瓣生物瓣置换术1例，主动脉根部及肺动脉成形术1例，肺动脉瓣置换术1例，肺动脉主干及左右肺动脉人工血管加肺动脉瓣置换术1例，肺动脉切开取栓术1例，经股动脉取瘤栓术5例。 结果 围术期死亡7例（良性粘液瘤6例、恶性粘液瘤1例），其中术中不能停体外循环2例，术后发生低心排血量、心室颤动3例，呼吸、循环衰竭1例，大面积脑出血1例；其余患者无并发症发生。随访247例（良性肿瘤229例，恶性肿瘤18例），随访时间3个月～28年，失访9例（良性肿瘤6例、恶性肿瘤3例）。随访期间良性粘液瘤复发4例，均再次手术治疗；良性肿瘤患者死亡13例（心源性猝死6例、脑卒中2例、肺癌1例、不明原因4例），其余216例均生存。随访期间恶性肿瘤患者死亡15例，术后生存时间为1～4年，死于肿瘤复发或转移11例，心力衰竭和恶病质各2例。 结论 原发性心脏肿瘤一经确诊应尽早手术治疗，良性肿瘤手术效果好，恶性肿瘤术中应尽量切除肿瘤。

无名动脉插管简化支架“象鼻”手术治疗DeBakey Ⅰ型主动脉夹层

心脏恶液质瓣膜病患者的外科治疗

80岁以上老年患者行非体外循环冠状动脉旁路移植术16例

Hypothermia Continuous Renal Replacement Therapy for Severe Heart Failure after Cardiac Surgery

目的探讨亚低温联合持续肾脏替代治疗（CRRT）对心脏外科术后重症心力衰竭的临床效果 方法回顾性分析我中心2009年2月至2013年12月行心脏外科术后重症心力衰竭38例患者的临床资料，其中男18例、女20例，年龄55～74岁，虽应用大剂量血管活性药物及主动脉内球囊反搏（IABP）辅助循环，心力衰竭无改善，采用CRRT及亚低温联合治疗。监测患者在联合治疗前后心脏指数（CI）值、混合静脉血氧饱和度（SvO2）、尿量、肌酐（Cr）及乳酸（Lac）的变化。 结果亚低温联合CRRT治疗后，患者CI较治疗前明显改善[（2.3± 0.7）L/（min· m2）vs.（1.8± 0.2）L/（min· m2）]，SvO2升高（62%± 5%vs.50%± 4%），乳酸明显降低[（8.6± 2.3）mmol/L vs.（3.0± 1.1）mmol/L]，尿量明显增加[（2.5± 0.9）ml/h vs.（1.0± 0.7）ml/h]，Cr明显下降[（140± 19）mmol/L vs.（292± 24）mmol/L]。 结论亚低温联合CRRT治疗心脏外科术后重症心力衰竭能有效改善循环功能，且操作简单易行。

左主干完全闭塞的外科治疗

目的 探讨冠状动脉左主干完全闭塞的外科治疗方法，总结其临床经验。 方法 1998年3月～2006年11月我院共收治6例冠状动脉左主干完全闭塞患者，在体外循环心脏不停跳下行冠状动脉旁路移植术（CABG），观察体外循环时间、术后呼吸机辅助时间、ICU时间、住院时间、围术期以及随访情况。 结果 体外循环时间为88.2±15.5min，术后呼吸机辅助时间14.2±4.6h，住ICU时间3.3±0.8d，住院时间18.0±2.7d，无围术期心肌梗死发生。6例均随访，随访时间29.0±19.2个月,心绞痛症状均消失，无1例死亡。超声心动图检查提示左心室收缩功能得到不同程度的改善。 结论 冠状动脉左主干完全闭塞患者施行体外循环心脏不停跳CABG，可以取得良好的临床疗效。

Surgical Therapy for Valve Diseases Combined with Coronary Heart Diseases in Patients Over or Below 70 Years Old

Surgical Therapy for Valve Diseases Combined with Coronary Heart Diseases in Patients Over or Below 70 Years Old YU Lei, GU Tianxiang, SHI Enyi, XIU Zongyi, FANG Qin, ZHANG Yuhai. (Department of Cardiac Surgery, The No. 1 Hospital of China Medical University, Shenyang 110001, P.R. China)Corresponding author: GU Tianxiang, Email: cmugtx@sina.comAbstract： Objective To summarize the experiences of valve replacement combined with coronary artery bypass grafting (CABG) in senile patients by comparing clinical outcomes of valve diseases combined with coronary heart diseases in patients over or below 70 years old. Methods We retrospectively analyzed the clinical data of 49 patients who received valve replacement combined with CABG in our department from May 1999 to December 2007. Based on the age, the patients were divided into ≥70 years group (17 cases) with its patients at or above 70 years old and lt;70 years group (32 cases) with its patients younger than 70. The percentage of chronic obstructive pulmonary diseases (COPD) before surgery in ≥70 years group was higher than that in lt;70 years group(Plt;0.05). No significant difference was found in the other relevant factors between the two groups. The clinical index of patients in the two groups were compared and analyzed. Results There were significant differences between the two groups in such factors as the percentage of biovalve use (82.4% vs. 12.5%, χ2=23.311, P=0.000), the time of mechanic ventilation (34.5±29.3 h vs. 18.0±16.1 h, t=-2.542,P=0.014), the time of ICU stay (4.4±1.5 d vs. 3.3±0.7 d, t=-3.522, P=0.001), the time of hospital stay (21.4±7.7 d vs. 18.1±1.8 d, t=-2.319, P=0.025), the percentage of IABP use (29.4% vs. 6.3%, χ2=4.862, P=0.037), the percentage of pulmonary function failure (35.3% vs. 6.3%, χ2=6.859, P=0.009), the percentage of acute renal failure (23.5% vs. 3.1%, χ2=5.051, P=0.025), and the percentage of cerebrovascular accident (11.8% vs. 0.0%, χ2=3.933, P=0.048). There was no significant difference between the two groups in factors like the anastomosis of distal graft (2.5±3.1 vs. 2.4±14, t=0.301, P=0.758), the time of aortic occlusion (89.3±25.4 min vs. 88.5±31.0 min, t=0.108,P=0.913), the time of cardiopulmonary bypass (144.6±44.8 min vs. 138.3±52.9 min, t=0.164, P=0.871) and the mortality (5.9% vs. 6.3%, χ2=0.002,P=0.959). The perioperative myocardial infarction rate was zero in both groups. ≥70 years group patients were followed up for 2 months to 9 years with only 1 case missing. One patient who had undergone mechanic valve replacement died of cerebral hemorrhage 1.5 years after operation. Two died of heart failure and lung cancer 3 months and 6 years after operation respectively. For all the others, the cardiac function was at class Ⅰ to Ⅱ and their life quality was significantly improved. The follow up time of lt;70 years group was 1 month to 6 years and 5 cases were missing. Four patients who had undergone mechanic valve replacement died of complications in relation to anticoagulation treatment. One died of severe low cardiac output. Another died of traffic accident. Conclusion Surgery operation and effective perioperative treatment are key elements in improving surgery successful rate and decreasing mortality in patients with valve and coronary artery diseases. Valve replacement combined with CABG is safe for patients older than 70 years old.

主动脉缩窄合并冠心病一例

Minimally Invasive Mitral Valve Replacement Combined with Atrial Fibrillation Radiofrequency Ablation via Right Minithoracotomy

ObjectiveTo summarize clinical advantages and outcomes of minimally invasive mitral valve replacement (MVR) combined with atrial fibrillation (AF) radiofrequency ablation via right minithoracotomy. MethodsEight patients with mitral valve disease and AF who received surgical therapy in the First Hospital of China Medical University between October 2009 and October 2012 were included in the study. There were 4 males and 4 females with their age of 34-67 (52.4±17.5) years. All the patients underwent minimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy. Clinical outcomes were summarized. ResultsThere was no in-hospital death or conversion to conventional sternotomy in this group. Two patients received biological valve replacement and 6 patients received mechanical prosthesis. Operation time was 207.9±18.1 minutes, cardiopulmonary bypass time was 81.7±23.9 minutes, and chest drainage amount was 126.7±34.5 ml. AF recurred in 1 patient on the 3rd postoperative day. All the patients were in sinus rhythm at discharge. These patients were followed up for 18.3±7.4 months. During follow-up, 1 patient had AF recurrence. Seven patients were in NYHA class Ⅰ, and 1 patients was in NYHA class Ⅱ. ConclusionMinimally invasive MVR combined with AF radiofrequency ablation via right minithoracotomy can achieve satisfactory clinical results and esthetic appearance, and is a good choice for patients with mitral valve disease and AF.