The minimally invasive approach is the direction of cardiac surgery.With the development of telemanipulation and computer technology,the minimally robotic surgery has become reality.As the one of the most minimally invasive cardiac surgery,the robotic surgical system provides cardiac surgeons with less invasive manner and dexterity manipulation.Robotic cardiac surgery is an evolutionary process and has resulted in a substantial increased attention to surgeons and patients.This review is to introduce the recent clinical application of robotic technology in cardiac surgery.

0.05; at 14 d,28 d, the thickness and area of the intiam in group S were smaller than those in group NS,P

Objective To investigate the effect of non-restrictive external stent on both cell proliferation of rabbit vein grafts and prevention from hyperplasia of the grafts' neointima. Methods 36 New Zealand white rabbits were randomly divided into two groups, each animal was subjected to a reversed autologous venous graft between external jugular vein and common carotid artery. In stenting group (group S), the vein grafts were surrounded by a 6 mm in diameter non-restrictive stent, and in non-stenting group (group NS), there is no stent to support the vein grafts. The grafts were harvested 1 week (1W), 2 weeks (2W) and 4 weeks (4W) after surgery, respectively. The sections were stained with hematoxylin and eosin stain, ?-smooth muscle actin (?-SMA) and proliferating cell nuclear antigen (PCNA) immunocytochemistry stain. PCNA index was calculated in intima, media and adventitia, respectively. Results (1) HE staining: From 1W to 4W, the hyperplasia of intima and media appeared gradually in both group S and group NS, nevertheless such hyperplasia in group S was lessintense than in group NS. (2) ?-SMA staining: Almost all cells in media were positive, but few cells were positive in intima of both groups at 1W; the thickness of intima of both groups increased gradually, and almost all cells except endothelial cells were positive in intima in both groups, though the thickness of intima of group S was smaller than in group NS at 2W and 4W. (3) PCNA index: the index of intima in both two groups peaked at 2W, and the index of intima in group S was less than in group NS at 2W and 4W, P

Fractures of the femoral head (FFH) are mainly seen in young adults,and the majority mechanism is due to dashboard injury in crushing vehicles.FFH can be present with or without posterior dislocation of the hip joint.Except for periarticular pain and hip dysfunction,the typical signs include flexion,adduction and internal rotation of the hip and shortening of involved limb.CT and MRI get their popularity as diagnostic methods for FFH.An emergency open reduction should be indicated in the scenario of failed closed reduction in FFH with posterior dislocation,of FFH with femoral neck fractures,of unmatched head and acetabulum following closed reduction and of deteriorating sciatic nerve damage.Pipkin as well as Brumback classification is still the most popularly used methods,which have great significance for establishment of surgical strategy and prediction of prognosis.More and more clinical evidences show conservative care of FFH should only be indicated for non-displaced fractures or displacement less than 2 mm.These cases must meet the following criteria simultaneously,including stable hip joint,concentric head and acetabulum,no free fractured fragments in the joint space and no labrum entrapment.Operative care is naturally the treatment of choice.Surgical approaches for FFH are hot topics in recent years.In previous control studies to compare Kocher-Langenbeck (K-L) and Smith-Peterson (S-P) approach,it is revealed less operative time,less blood loss and better operative field you can get in S-P approach,however,the incidence of ectopic ossification is higher.Ganz approach,which is characterized by osteotomy of great trochanter,hip capsulotomy and surgical dislocation of the hip,is a novel pattern for operative care of FFH.Ganz approach can show the entire femoral head,while can not damage medial femoral circumflex artery (MFCA) and induce iatrogenic osteonecrosis of the femoral head (ONFH).Various screws are the main implants for the fixation of fractured femoral head.Osteoarthritis and ONFH are two principal complications following FFH,which not only closely associate with severity and mechanism of primary injury,but also correlate with reduction quality and iatrogenic factors.Artificial hip joint replacement is a rational choice for extremely comminuted femoral head and these FFH in the elderly.

Objective To observe the distribution of different ventricular myocardial band segment's in different echocardiogram sectiones. Methods 5 swine hearts, 5 ox hearts and 5 sheep hearts were dissect to the ventricular myocardial band structure by the standard anatomy method. After the demarcation line of each segment of ventricular myocardial band was defined, they were dyed with different colors and then were recovered into the state before dissecting. At last, they were cut open according to different echocardiogram sectiones. Results With relative stabile anatomy methods, all hearts presented to be a unique integrate myocardial band,with two loops, the basic loop and apical loop, and four segments. At different echocardiogram sectiones, the left ventricle is formed by three muscular strata, while the right ventricle is formed by only one muscular strata. Conclusion The distribution of different ventricular myocardial band segments in different echocanliogram sectiones is significantly different.

Objective To compare the economic outcome between on-pump and off-pump coronary artery bypass grafting (CABG). Methods Six hundred seventy-nine patients were divided into on-pump and off-pump groups. Twelve variables with respect to costs were obtained for each group during hospital stay. Results There was no significant difference in total mean cost between two groups. For off-pump patient, the costs of medication, operation, blood transfusion, bed occupancy, and nursery were significantly less than those of on-pump CABG surgery was (P0.05). Conclusion Costs of OPCAB are not significantly lower than on-pump CABG due to higher material costs.

Objective To introduce the strategy of perioperative blood glucose control and the early outcome in diabetic and non-diabetic patients undergone coronary artery bypass grafting (CABG). Methods A total of 1019 CABG were performed and the patients were divided into diabetic and non-diabetic groups (n=211, 808, respectively). The demography was comparable between the two groups with the exception that the percentage of preoperative myocardial infarction was significantly higher in diabetic group than that in non-diabetic group. Off-pump and conventional CABG were routinely performed and the left internal mammary artery (IMA) and great saphenous vein (GSV) were used as conduit. Perioperative blood glucose was controlled according to the close supervision. The aim of preoperative 6mmol/L and postoperative 8mmol/L was achieved by means of oral medication or subcutaneous injection of insulin, which was complimented by continuous pump infusion of regular insulin to optimize the glucose level. Results 99.2% patients were discharged. The overall perioperative mortality was 0.8% and the percentage was 1.4% and 0.6% respectively in diabetic and non-diabetic group with significant difference(P0.05), respectively. Cerebral infarction occurred in 1.4% diabetic patients and in 0.5% non-diabetic patients(P

Objective To investigate the therapeutic efficacy of surgical treatment of myocardial bridge. Methods Fifteen patients with myocardial bridge had been treated in our hospital from January 1999 to October 2006. Thirteen patients who had typical angina had been treated regularly by medication, but their symptom remission was not satisfactory. One patient suffered from acute myocardial infarction, and another 1 patient complained of palpitation and syncope. All the patients were given surgical treatment. Surgical strategies included minimally invasive off-pump surgery in 9 patients (supraarterial myotomy in 3 patients, coronary artery bypass grafting in 2, and coronary artery bypass grafting with supraarterial myotomy in 4) and on-pump surgery in 6 patients (coronary artery bypass grafting with supraarterial myotomy in 5 patients and supraarterial myotomy in 1). Results All the operations were successfully completed. The operative duration of off-pump and on-pump surgery was 2.8?1.9 h and 3.5?1.7 h, respectively. The extracorporeal circulation time was 59?37 min. No surgery related death or complications occurred. At 3 months after operation, all the patients were free from symptoms, and electrocardiogram returned to normal in 11 patients. During a follow-up for 0.5~7 years (1.9?1.2 years), recurrent palpitation was seen in 1 patient and others reported no angina. Conclusions Surgical treatment of myocardial bridge has good immediate and long-term results.

Objective To introduce the clinical experience of Bentall procedure with composite tissue valve conduit. Methods Five patients were diagnosed as severe aortic regurgitation with dilatation of Valsava sinus and sinotubular junction and ascending aorta. Mean age of patients was (55.8?9.4) years (range 47～67). After median sternotomy , cardiopulmonary bypass was established using a single two-stage venous cannula. Temperature was brought to 28℃. After the ascending aorta was occluded, an aortotomy was made and aortic valve was excised. Aorta was removed from sinuses of Valsalva except for generous buttons around coronary ostia. After sizing the aortic annulus, an appropriate-size tissue valve and woven dacron conduit (3 mm greater in diameter than the tissue valve) were chosen to build a composite conduit. It was attached to annulus of aortic valve with pledget-reinforced horizontal mattress stitches to replace the aortic valve and ascending aorta as an en bloc procedure (Bentall procedure). In 2 cases, Coronary artery bypass grafting was performed with greater saphenous vein anastomosed distally to left anterior descending artery and proximately to conduit. Results All cases recovered uneventfully and they were discharged without any postoperative complications. Echocardiography was repeated before discharge. Mean aortic pressure gradient was (18.3?7.6) mmHg. Left ventricular dimension was significantly reduced [(58.8?6.3)mm vs. (43.7?3.1)mm]after operations(P0.05). Follow-up was 2 to 8 months. Conclusion With composite tissue valve conduit, Bentall procedure to replace the aortic valve and ascending aorta as an en bloc procedure is feasible and safe for the elderly patients. A long-term follow-up for the function and structure of tissue valve is needed.

Objective By dissected and decomposed the boiled rabbits' hearts to study the space courser of ventricular myocardial band of the normal heart architecture. Methods 10 rabbit hearts were boiled and dissected as described by Torrent-Guasp. All myocardial bands were decomposed and tagged, then recovered to the state when they hadn't been dissected, and then X-ray photos were taken. Results The myocardial band twists on itself extends from the origin of the pulmonary artery to the root of the aorta. This defines two turns in a helical fashion and delimitates two cavities, the right and left ventricles. The reciprocal fiber angle within descending and ascending segments of the apical loop was about 90?. The interventricular septum is formed by three muscular strata: right segment, descending segment and ascending segment. Conclusion Our study shows that the reciprocal fiber angle within descending and ascending segments of the apical loop is about 90? and the interventricular septum is formed by three muscular strata.