Objective To explore ability of deformation ,small deformation, orientation and in vivo half-life of erythrocytes following intraoperative autotransfusion by ZITI-3000 cell saving system (Jingjing medical facility corporation, Beijing). Methods Twenty consecutive patients undergoing scheduled off-pump coronary artery bypass grafting (CABG) were divided into two groups according to intraoperative autotransfusion, experimental group(n=10): intraoperative autotransfusion was performed; control group (n=10): intraoperative autotransfusion wasn’t used. Laser diffractometer was used to measure deformation index(DI), small deformation index[(DI)d.max], and orientation index [(DI)or.max],and chromium51 istope labeling technique was used to measure half-life of erythrocytes (51C1/2) of processed and unprocessed in vivo. Results There were no significant difference in DI, (DI)d.max, (DI)or.max and 51C1/2 in vivo between experimental group and control group. Conclusion Intraoperative autotransfusion has no significant effect on erythrocytes’s ability of DI, (DI)d.max, (DI)or.max and 51C1/2 in vivo in off-pump CABG.
Objective To compare the advantages of reconstructing the aorta by end-to-side anastomosis with extended end-to-end anastomosis for aortic coarctation （CoA） with cardiac lesions in neonates and infants. Methods There were 63 neonates and infants who underwent median full sternotomy for correction of CoA and cardiaclesions from January 2008 to July 2011 in Guangzhou Women and Children’s Medical Center. These patients were divided into two groups： extended end-to-end anastomosis was performed in 24 patients （end-to-end group, 17 males and 7 females with their mean age of 4.6±2.9 months）and end-to-side anastomosis in 39 patients （end-to-side group, 24 males and 15 females with their mean age of 3.4±2.6 months）. We compared the two groups with regard to postoperative mortality, morbidity and difference in blood pressure between the lower and upper extremities. Results The percentage of newborn patient（23.1% vs. 4.2%; χ2=3.979, P=0.045）and presence of pre-operative acidosis（15.4% vs. 0%; χ2=4.080, P=0.048）were significantly higher in end-to-side group than those in end-to-end group. There was no postoperative death in end-to-end group and 1 patient died after surgery in end-to-side group（2.6%）. The average duration of circulatory arrest in end-to-side group was significantly shorter than that in end-to-end group （18.6±2.7 min vs.23.4±3.7 min, F=14.617, P=0.000）. At the time back to cardiac intensive care unit, the percentage of patients whose difference in systolic pressure between radial and femoral artery ＜ 5 mm Hg, 5-15 mm Hg, and＞ 15 mm Hg was 20.8%, 45.8% and 33.3% respectively in end-to-end group, and 97.4%, 2.6% and 0% respectively in end-to-side group（χ2=40.380，P=0.000）. Twenty-four hours after surgery, the percentage of patients whose difference in systolic pressure between radial and femoral artery＜ 5 mm Hg, 5-15 mm Hg, and＞ 15 mm Hgwas 45.8%, 41.7% and 12.5% respectively in end-to-end group, and 100%, 0% and 0% respectively in end-to-side group （χ2=26.620, P=0.000）. All the surviving 62 patients were followed up for 2-36 months, and there was no patient with angeioma or re-stenosis needing intervention in either group during follow-up. Conclusion End-to-side anostomosis is a safe and effective method for treating CoA with cardiac lesions and eliminating residual stenosis in neonates and infants.
Objective To analyze the use of modified pericardial oblique sinus approach in surgical repair for total anomalous pulmonary venous connection in neonates. Methods Between May 2005 and December 2015, 67 consecutive neonates with supracardiac or infracardiac type total anomalous pulmonary venous connection who underwent surgical repair in our institute were included in this study. The patients are divided into three groups according to the different approaches including a sulcus approach group (6 patients), a superior approach group (14 patients), and a modified pericardial oblique sinus approach group (47 patients). There were 53 males and 14 females at median age of 12.5 (7.0, 20.5) d. Results The time of cardiopulmonary bypass [88 (80.0, 107.0) min vs. 135 (121.0, 157.0) min, P<0.05] and aortic cross clamping of the modified pericardial oblique sinus approach group was significantly shorter than that of the sulcus approach group [45 (39.0, 53.0) min vs. 80 (73.0, 85.0) min, P<0.05]. Perioperative mortality (2.1% vs. 28.6%, P<0.05) was significantly lower in the modified pericardial oblique sinus approach group than that in the superior approach group. The long-term mortality (4.3% vs. 60.0%, P<0.05) was significantly lower in the modified pericardial oblique sinus approach group than that in the sulcus approach group or the superior approach group . The rate of pulmonary venous stenosis was significantly lower in the modified pericardial oblique sinus approach group than that in the sulcus approach group (2.1% vs. 50.0%, P<0.05) or superior approach group (2.1% vs. 35.7%, P<0.05). Conclusions In surgical correction of neonatal supracardiac and infracardiac total anomalous pulmonary venous, compared with the traditional surgical approach, the modified pericardial oblique sinus pathway can provide excellent surgical space and has a good surgical prognosis.
Objective To evaluate possibility and reliability of the technique of artificial pulmonary valve reconstruction in right ventricular outflow tract reconstruction. Methods We retrospectively analyzed the clinical data of 35 patients with artificial pulmonary valve reconstruction of right ventricular outflow tract reconstruction surgery in our hospital between February 2012 and December 2016. There were 35 patients with 19 males and 16 females at age of 10 years ranged 5 months to 42 years and body weight of 26 (8–62) kg. There were 21 patients with artificial moncusp valve, 6 patients with bicuspid technology, 8 patients with comprehensive forming method. Results Average extracorporeal circulation time was 75–251 (120±37) min. Aorta blocking time was 32–185 (72±28) min. ICU stay time was 14–225 (59±51) hours. Breathing machine auxiliary time was 6–68 (24±18) hours. There were 3 early postoperative deaths. There was no death during the long term following-up time. Thirty-two patients survived with heart function of class Ⅰ in 20 patients, class Ⅱ in 10 patients, class Ⅲ in 2 patients. Conclusion In right ventricular outflow tract reconstruction using the technique of artificial pulmonary valve reconstruction in the operation, it can reduce early postoperative right ventricular volume load. To smooth out perioperative patients, the surgical technique is simple, cheap, safe, but long-term follow-up still needs further observation.
ObjectiveTo investigate if the ratio of pulmonary valve annulus, which is the proportion of pulmonary valvular annulus size to total size of aortic valvular annulus and pulmonary valvular annulus, can better guide the choice of surgical approach than the value of z.MethodsA retrospective analysis was made for 254 patients who underwent total correction of tetralogy of Fallot in Guangdong General Hospital between January 2016 and January 2018. There were 154 males and 100 females with an average age of 14.60±18.76 years. The patients were categorized into two groups, a transannular patch group (TAP, n=164) and a non-TAP group (n=90). The sizes of pulmonary and aortic valvular annulus were evaluated in each group, and the cutoff value of proportion of pulmonary valvular annulus for TAP was calculated.ResultsBoth proportion of pulmonary valvular annulus and z-scores were smaller in the TAP group than those in the non-TAP group (0.29±0.06 vs. 0.36±0.06, P<0.001; –4.04±2.13 vs. –2.06±1.84, P<0.001, respectively). In receiver operating characteristics analyses, proportion of pulmonary valvular annulus and the z-score cutoff values were 0.353 (area under the curve 0.781, 95%CI 0.725–0.831) and –2.13 (area under the curve 0.766, 95%CI 0.709–0.817), respectively, demonstrating that the proportion of pulmonary valvular annulus was a more powerful diagnostic tool as a predictor of TAP.ConclusionOur results suggest that the proportion of pulmonary valvular annulus is an effective predictor for TAP and can be easily applied to clinical practice.