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.

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

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

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.

65mmHg. Sufficient blood products might be indicated when there was excessive oozing. Anticoagulant was not necessary. Two patients died of perioperative myocardial infarction and one of allergic shock to protamine. An incidence of postoperative complications as low as 2 2% (5/225) was obtained. Five patients were found to have various postoperative complications, which were completely cured. All the rest patients were uneventful, and they were discharged after (3 0?2 6) days of stay in the ICU and (8 2?1 5) days after the operation. Therefore, it is our belief that comprehensive and careful postoperative management is essential to achieve excellent results.

To review the experience in surgical management of cor triatriatum, fourteen patients underwent open heart surgery under hypothermic cardiopulmonary bypass (CPB) from 1986 to 2001 for their cor triatiatum were studied retrospectively. The mean age of the patients was 6 6 years, with a range of 1 to 26 years. Eight patients were men and six were women. Eleven cases were diagnosed by two dimensioned echo cardiography with colour Dopplar imaging. Eleven patients with complete cor triatriatum were operate on enlarging ASD, resecting the fiboromuscular membrane and patching ASD and one patient with incomplete cor triatriatum were operated on through similar techniques and the associated abnormalities were corrected at a time. Nine patients were followed up after surgery from 5 months to 15 years, no patient died and had salutary results. It suggested that two dimensional echo cardiography with colour Doppler imaging can diagnose this condition accurately, surgical treatment of cor triatriatum was satisfactory in longterm follow up.

To introduce the experience in application of intra aortic balloon pump (IABP) in coronary artery bypass grafting (CABG), 506 consecutive CABG performed from March 1997 to October 2001 including 19 cases who needed IABP support were retrospectively studied. IABP was inserted through femoral artery when blood circulation failed to maintain normal even though cardiopulmonary bypass had been weaned off and inotropic agents administered. The overall rate of using IABP was 2 4%. IABP was not needed in off pump CABG. Sixteen patients smoothly resuscitated from low output syndrome, but two died of perioperative myocardial infarction (PMI) and one of allergic shock to protamine, resulting in a mortality rate of 15 8%. Two patients (10 5%) were respectively insulted by external iliac artery rupture and thromboembolism of dorsal pedis artery but cured completely. The complication rate was 10 5%. The mean duration of using IABP was 25 3?5 6 hours. The authors hold that IABP should be used without hesitation when indicated and good early outcome and low incidence of complication can always be obtained.

Objective To summarize the experience in diagnosis and surgical treatment of double-chambered right ventricle (DCRV). Methods From 1990 to 2001, 95 patients with DCRV received surgical correction, including 56 males and 39 females, with an age ranging from 1 to 48. 82 cases had other cardiac abnormalities, 56 of whom had ventricular septal defect (VSD). Right atrium incision was made in 8 patients, right ventricular infundibular incision in 30, and both right atriotomy and ventriculotomy in 57. Results Muscular ring was found in 61 patients, and muscular shelf in 34. No death occurred. Preoperatively, 15 patients and 3 patients were misdiagnosed by echocardiography as VSD and pulmonary stenosis, respectively. The diagnosis was corrected during operation. Conclusions DCRV was often found to be complicated with other cardiac disorders. Echocardiography was the main diagnotic method, but the misdiagnosis was not uncommon. So it was very important to make surgical exploration, especially on tricuspid valve and pulmonary valve during intraventricular operations. Right ventricular infundibular incision was convenient and dependable.

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 summarize the clinical experience of coronary angiography before coronary artery grafting (CABG) with concomitant valvular surgery in patients with valvlar disease. Methods From April 2000 to May 2005, two hundred and eleven patients over 50 years old (mean age 60 3.5) with valvlar diseases were studied retrospectively. Coronary angiography was utilized for patients who were found to have risk factors for atherosclerosis. Coronary stenosis over 50% of its calibre was considered positive, and 75% stenosis (including LMCA stenosis more than 50%) was used as the indication for coronary artery bypass surgery. Results Coronary angiography was employed in 128 patients and 30 cases (23.4%) had coronary artery stenosis exceeding 50%. CABG was concomitantly performed during cardiac valvular surgery in 24 patients. In-hospital mortality in patients with valve surgery alone was 0.5%, which was significantly lower compared with patients with valve surgery combined with CABG group (4.2%)(P