ObjectiveTo investigate and evaluate the safety and efficacy of Bentall operation in the reoperation of patients with small aortic root or annulus.MethodsBentall procedure was performed in 24 patients with small aortic root or annulus in our hospital from September 2014 to December 2019. There were 18 males and 6 females with a mean age of 31-68 (45.70±15.27) years. All patients had undergone a previous replacement of the aortic valve including 20 patients receiving valve replacement, 2 patients aortic root replacement with a valved conduit and 2 patients bioprothesis replacement.ResultsThere was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 2 patients and no bleeding was related to the proximal anastomosis of the conduit. One patient performed pacemaker implantation for heart block after the procedure. The mean sizes of implanted aortic valve prosthesis were 22.75±1.78 mm. A mean gradient across the aortic valve prostheses in the postoperative echocardiographic examination was 11.17±2.24 mm Hg.ConclusionBentall procedure is safe and allows a larger size of prosthesis implantation in patients with small aortic annulus or root after previous aortic valve or complete root replacement, resulting in good postoperative hemodynamic characteristics and short-term clinical results.
Objective To analyze clinical features of reoperation patients with differentiated thyroid cancer, and to explore reason, surgical pattern and therapeutic effectiveness of reoperation. Method The clinical data of 80 patients with differentiated thyroid cancer underwent reoperation from January 2012 to June 2016 in Peking Union Medical College Hospital were analyzed retrospectively. Results ① Eighty (5.37%) patients with differentiated thyroid cancer underwent reoperation were identified from a total of 1 491 patients with thyroid cancer in our treatment team. Twenty-seven cases were males, 53 cases were females. The male to female ratio was 1∶1.96. The age was (44±13) years with a range from 14 to 66 years. The median time between reoperation and the first operation was 16.8 months with a range from 8 days to 17 years. ② Thirteen cases underwent reoperation because of uncertain frozen sections, and the reoperation style was residual lobectomy and selective lymph node dissection. Sixty-seven cases underwent reoperation because of local recurrence or metastasis, 15 of them accepted residual lobectomy and selective lymph node dissection while the other 52 accepted selective lymph node dissection. ③ The rate of residual in thyroid cancer confirmed by postoperative pathology was 18.8% (15/80). The rate of cervical lymph node metastasis was 63.8% (51/80). The temporary laryngeal recurrent nerve injury occured in 6 cases, the temporary hypocalcemia occured in 9 cases, and the lymphorrhagia occured in 2 cases. ④ The hospitalization time was (6.50±0.97) d with a range from 3 to10 d, the time of drainage tube remove was (2.41 ±0.95) d with a range from 2 to 7 d. Seventy-three cases were followed up from 3 to 58 months with (32±18) months, 4 of them underwent operation once again because of local recurrence, no distant metastasis or death happened. ⑤ The proportion of male patients in reoperation patients was significantly higher than that of the first operation patients (P<0.05). The proportion of patients aged <45 years, the average hospitalization time, the average time of drainage tube remove, and the postoperative complications rate had no significant differences between the patients with the first operation and the patients with reoperation (P>0.05). Conclusions For reoperation patients, proportion of male patients is higher. Reoperation is proper treatment for patients with residual lobe or local recurrence or metastasis for differentiated thyroid cancer. Serious complications could be avoided by suitable surgical pattern and careful dissection during operation. Residual lobectomy and selective lymph node dissection are suggested for reoperation.
Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics. Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed. Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99Tcm-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period. Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.
ObjectiveTo summarize the clinical experiences of minimally invasive cardiac surgery (MICS) for cardiac atrioventricular valve reoperation.MethodsPerioperative data of 32 patients who underwent MICS for cardiac atrioventricular valve reoperation from 2009 to 2019 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed, including 13 males and 19 females with a mean age of 51.0±12.6 years. All patients were given combined intravenous and inhalation anesthesia, and a double-lumen tube for mechanical ventilation. Cardiopulmonary bypass was established in all patients by femoral artery and venous cannulation or combined with percutaneous superior vena cava cannulation, without aortic cross-clamping. The MICS approaches included right anterolateral small incision surgery, thoracoscopic assisted small incision surgery and total thoracoscopic surgery. The clinical data of the 32 patients were compared with the perioperative indicators of 24 patients undergoing reoperation with conventional median thoracotomy during the same period.ResultsAmong them, 21 patients underwent isolated tricuspid valve replacement, 4 isolated tricuspid valvuloplasty, 1 combined tricuspid valve replacement and atrial septal defect repair and 6 combined mitral valve replacement and tricuspid valvuloplasty. Twenty-seven patients completed the operation in a beating heart, and 5 under the condition of ventricular fibrillation. Operation time (3.23±1.56 h vs. 5.46±2.13 h, P<0.001), postoperative mechanical ventilation time (9.19±5.40 h vs. 43.23±21.74 h, P<0.001), ICU stay (35.03±18.26 h vs. 79.15±22.43 h, P<0.001) and hospital stay of patients with minimally invasive surgery (9.35±6.43 d vs. 15.85±7.56 d, P=0.001) were shorter than those with median thoracotomy. And the extracorporeal circulation time was not significantly prolonged. There were 4 perioperative complications in patients with minimally invasive surgery, and 1 died in hospital after operation.ConclusionMICS for cardiac atrioventricular valve reoperation can avoid the risk of median sternotomy and separation of cardiac scar adhesion. Especially, total thoracoscopic surgery has more advantages when compared with other operations, including less trauma, less myocardial ischemia reperfusion injury, more rapid recovery and fewer postoperative complications. Total thoracoscopic surgery may be the development direction of MICS for cardiac atrioventricular valve reoperation. However we should take effective and feasible measures to solve the problems caused by cardiopulmonary bypass.
Objective To compare the postoperative outcomes of modified single-patch technique and one-and-a-half-patch technique for complete atrioventricular septal defect (CAVSD) with a large ventricular component (>1 cm). Methods We retrospectively reviewed clinical data of 79 CAVSD patients with a large ventricular component (>1 cm) in Shanghai Children's Medical Center from January 2005 through January 2016. There were 37 males, 42 females with a median age of 8 months (range, 1.5 months to 10.2 years). Among the patients, 45 patients (20 males, 25 females) with a median age of 6 months(range, 1.5 months to 10.2 years) received modified single patch technique and 34 patients (17 males, 17 females) with a median age of 5.3 months (range, 2.5 months to 8.3 years) underwent one-and-a-half-patch (1.5-patch) technique. All the patients complicated with complex malformation such as double outlet of right ventricular, single ventricle, and transposition of great arteries were excluded. Results The mortality and reoperation rate in modified single-patch group were higher than those of the one-and-a-half-patch group. There were 2 postoperative early deaths in the modified single-patch group (4.4%). Among them, one patient died of postoperative valvular regurgitation and heart pump failure. The other one died of respiratory failure caused by severe pneumonia. There were 3 reoperations. Two patients performed valve plastic surgery because of valve regurgitation and one patient because of residual ventricular septal defect. There was no death and reoperation in the one-and-a-half-patch technique group. No left ventricular outflow tract obstruction and atrioventricular block in both groups were developed. Conclusion The 1.5-patch technique is an attractive clinical option in CAVSD patients with a large ventricular component.
ObjectiveTo summarize the clinical outcomes and experience of surgical treatment for patients with complete atrioventricular septal defect (CAVSD) above the optimal age for surgery.MethodsWe retrospectively reviewed clinical data of 163 simple type CAVSD patients less than 7 years who underwent operations in Fuwai Hospital from 2002 to 2013. The patients were divided into a normal group (n=84, including 37 males and 16 females with an average age of 7.6±2.7 months) and an over-age group (n=79, including 30 males and 49 females with an average age of 34.6±19.6 months) according to whether the age was more than 1 year.ResultsThe average aortic cross clamp time (88.3±24.4 min vs. 106.1±35.4 min, P<0.001) and cardiopulmonary bypass time (123.6±31.1 min vs. 142.6±47.1 min, P=0.003) were statistically different between the two groups. During the follow-up period (the normal group 53.3±43.9 months, the over-age group 57.2±48.2 months), there was no statistical difference in all-cause mortality (10.7% vs. 8.9%, P=0.691), the incidence of moderate or severe left atrioventricular valve regurgitation (16.7% vs. 21.5%, P=0.430) and reintervention rate (3.6% vs. 0.0%, P=0.266) between the two groups. No left ventricular outflow tract obstruction and complete atrioventricular block occurred in both groups.ConclusionFor CAVSD children above the optimal age, rational surgical treatments can also achieve satisfying results.
Objective To explore prognostic factors of unplanned reoperation in Department of General Surgery. Methods The clinical data of 85 patients with unplanned reoperations who treated in the Northern District of the Shanghai Ninth People’s Hospital from January 2014 to May 2017 were retrospectively collected. The risk factors such as preoperative basic information, surgical related information, and postoperative information for death of unplanned reoperations were analyzed. Results There were 72 cured patients and 12 deaths in the 85 patients. The univariate analysis results showed that the age was older (P<0.05), the operative time was longer (P<0.05) in the patients with death as compared with the cured patients; the with basic diseases, selective operation, high grade of ASA, preoperative hemoglobin <90 g/L, admission to ICU after unplanned reoperations, postoperative complications, and multiple reoperations were correlated with the mortality of unplanned reoperations (P<0.05). The multivariate analysis results showed that the elderly patients, preoperative hemoglobin <90 g/L, and postoperative complications were the independent prognostic factors (P<0.05). The satisfaction of patients at discharge in the death group was significantly lower than that in the survival group (P<0.05). Conclusion Ederly patient, preoperative hemoglobin <90 g/L, and postoperative complications are independent prognostic factors of unplanned reoperations in Department of General Surgery.
ObjectiveTo summarize the surgical strategy of reoperative aortic root replacement after prior aortic valve replacement (AVR), and analyze the early and mid-term outcomes.MethodsFrom April 2013 to January 2020, 75 patients with prior AVR underwent reoperative aortic root replacement in Fuwai Hospital. There were 54 males and 21 females with a mean age of 56.4±12.7 years. An emergent operation was performed in 14 patients and an elective operation in 61 patients. The indications were aortic root aneurysm in 38 patients, aortic dissection involving aortic root in 30 patients, root false aneurysm in 2 patients, prosthesis valve endocarditis with root abscess in 2 patients, and Behçet's disease with root destruction in 3 patients. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test.ResultsThe operative procedures included prosthesis-sparing root replacement in 45 patients, Bentall procedure in 26 patients, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/75). A composite of adverse events occurred in 5 patients, including operative death (n=1), stroke (n=1), and acute renal injury necessitating hemodialysis (n=3). The follow-up was available for all 74 survivors, with the mean follow-up time of 0.5-92.0 (30.3±25.0) months. Four late deaths occurred during the follow-up. The survival rate at 1 year, 3 years and 6 years was 97.2%, 91.4% and 84.4%, respectively. Aortic events developed in 2 patients. The rate of freedom from aortic events at 1 year, 3 years, and 6 years was 98.7%, 95.0% and 87.7%, respectively. There was no difference in rate of survival or freedom from aortic events between the elective patients and the emergent patients.ConclusionReoperative aortic root replacement after prior AVR can be performed to treat the root pathologies after AVR, with acceptable early and mid-term outcomes.
ObjectiveTo evaluate the clinical outcomes of pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF) after re-PVR surgery.MethodsPubMed, EMbase, the Cochrane Controlled Trials Register databases, CNKI, CBM disc and VIP datebases were searched, and study eligibility and data abstraction were determined independently and in duplicate. Literature searches from database establishment to December 2018. The heterogeneity and data were analyzed by the software of Stata 11.0.ResultsOf 4 831 studies identified, 26 studies met eligibility criteria, and invovled with a total of 3 613 patients. The combined 30-day mortality for PVR was 2.2% (95% CI 1.5%-3.1%) and follow-up mortality was 3.4% (95% CI 2.4%-4.9%), re-PVR rate was 6.8% (95% CI 5.1%-9.2%), and the rate of intervention was 11.4% (95% CI 8.0%-16.4%). Subgroup analysis showed that the patient's age range may be a heterogeneous source of mortality during the follow-up period, and there was no statistical heterogeneity for adult patients (P=0.63, I2=0%), with a lower incidence than those including adolescents patients. The type of valve was likely to be a source of retrospective PVR. There was no statistical heterogeneity in bioprosthetic valves and allograft lobes (P=0.24, I2=25%). And the incidence of re-PVR was lower than that of the mechanical valve patients. Heart function classification (NYHA) of patients with TOF after PVR was statistically improved (P<0.05). Electrocardiogram QRS change was not statistically differently (P>0.05). Postoperative MRI findings showed a decrease in RVEDV, an increase in RVEF, a decrease in RV/LV ratio, and a decrease in pulmonary valve (all P<0.05). Funnel map monitoring, Begg test and Egger's test both indicated that there was no publication bias.ConclusionsAccording to the results of the analysis, PVR after TOF surgery is a more mature surgery, the clinical effect was significant, with lower early and long-term mortality. The long-term mortality rate of adolescent patients undergoing PVR is higher than that of adult patients. Long-term outocme of re-PVR or re-intervention is still the main problem affecting the effect of the operation. Indications for surgery and choice of valve need further investigation.
Objective To investigate and evaluate the safety and effectiveness of the Chimney technique in mitral valve reoperation. Methods The clinical data of mitral valve reoperation patients who underwent Chimney surgery in Wuhan Asia Heart Hospital from 2019 to 2021 were retrospectively analyzed. Results A total of 26 patients were collected, including 7 males and 19 females, aged 27-67 (53.46±11.18) years. All patients had previous mitral valve surgery, including 23 mitral valve replacements and 3 mitral valve repairs. All patients received Chimney technique using the ideal artificial sized mitral valve, and 1 patient died of neurological complications in hospital. The cardiopulmonary bypass time and the aortic cross-clamping time were 231.11±77.05 min and 148.50±52.70 min, respectively. The mean diameter of the implanted mitral valve prosthesis was 29.08±0.68 mm, which was statistically different from pre-replacement valve prosthesis size of 26.69±0.77 mm (P＜0.001). The mean transvalvular pressure gradient of the prosthetic mitral valve measured on postoperative echocardiography was 14.77±5.34 mm Hg, which was statistically different from preoperative value of 20.92±9.83 mm Hg (P=0.005). Conclusion The Chimney technique is safe and effective for reoperation in patients with small mitral annuli, which can not only reduce the risk of reoperation, but also obtain larger prosthetic valve implants with good hemodynamic characteristics and clinical outcomes.