Objective To summarize the experience of great saphenous vein (GSV) harvesting using multiple interrupted cutaneous incisions and retrospectively compare the clinical results with those using traditional single long incision. Methods One hundred and forty-nine patients for initial elective coronary artery bypass grafting underwent GSV harvesting by either interrupted incisions (Group A, n=108) between August 2004 to October 2005 or traditional technique (Group B, n=41) between February 2004 and July 2004, respectively. The Length of GSV harvested, total incision length, time of harvesting, and complication rate were compared between the two groups. Results There were no statistical differences in the age, sex, length of GSV harvested, and macroscopic GSV quality between the two groups. Short- or long-term complications relating to the quality of venous grafts occurred in neither groups. As compared with the Group B, the Group A presented significantly longer time for GSV harvesting (49.3?6.6 min vs 29.1?5.4 min; t=17.490, P=0.000), shorter incision length (17.8?3.2 cm vs 43.1?4.9 cm; t=-36.878, P=0.000), and lower wound-related complication rate [9.3% (10/108) vs 22.0% (9/41); ?2=4.303, P=0.038]. The time for donor site manipulation was slightly increased in the Group A (62.4?8.7 min vs 59.8?6.9 min; t=1.718, P=0.088). Conclusions GSV harvesting using multiple interrupted incisions requires more complicated and difficult techniques than using a single long incision, but it is less invasive and produces superior patient satisfaction and better cosmetic outcomes.

Objective To summarize the treatment of 10 aortic coarctation cases ,who receive the surgery from ascending aorta to thoracic descending aorta with the prosthetic graft, discuss the valuable and appliable of this method. Methods Cardiac surgery, Chinese Acdemy of Medical Sciences, Peking Union Medical College Hospital department treated 10 patients who got the aortic coarctation from Jan. 2006 to Dec. 2015 Seven male patients and 3 cases of female patients consist of the sample, aged from 14 to 35 years old, the median age was 27. One cases consolidated aortic valve deformity and aortic root expansion, the others were simple aortic coarctation. Their upper limbs blood pressure was 20 mmHg higher compared with the low limb. Meanwhile, there was no sign of surgery contraindication. Ten cases received this operation under cardiopulmonary bypass situation. And the patient who consolidate aortic valve deformity and aortic root expansion receive the Bentall surgery at the same time. Results There was no death during perioperative time, no spinal cord ischemic and other serious complications. Those patients went back to outpatient department after discharging from hospital 3 to 6 months. The differential pressure between upperlimbs and low limbs were less than 20 mmHg, and the CTA results indicated no aneurysms. Conclusion Using artificial blood vessels to make a graft from the ascending aorta to the descending aorta is an effective method for treatment of thoracic aorta.

Objective To establish an assay for detecting α2-macroglobulin activity in Cohn fraction Ⅳ.Methodsα2-M reacted with trypsin to form α2-M-trypsin complex.After the chromogenic substrate Na-benzoyl-DL-arginine 4-nitroanilide hydrochloride ( BAPNA) was added, absorption at 410 nm was detected with the microplate reader .α2-M activity in Cohn fractionⅣwas quantitatively detected according to the established standard curve of plasma α2-M activity. Result Several critical parameters in this assay were optimized .A standard curve of plasma α2-M activity was established . According to this standard curve ,α2-M activity in Cohn fraction Ⅳsample was detected to be 1.578 PU/ml.Conclusion Using normal human plasma as the reference material , theα2-M activity in Cohn fractionⅣcan be detected through chro-mogenic substrate assay.This study provides a simple method to detect α2-M activity during the purification process of α2-M from Cohn fraction Ⅳ.

Objective To explore a method to culture human aortic valvular interstitial cells and identify the phenotypes,to establish the cell model which would be used to study aortic valve diseases in vitro.Methods Normal aortic valves of the patient with acute Stanford A aortic dissection in Peking Union Medical College Hospital were preserved during the surgical operation.Human aortic valvular interstitial cells were isolated and amplified in vitro by modified collagenase digestion method.The cell phenotype was identified by the immunofluorescent staining.Results Human aortic valvular interstitial cells could be successfully isolated and amplified in vitro by modified collagenase digestion method,identified by positive staining of Vimention and α-SMA.Conclusions The cell model of human aortic valvular interstitial ceils could be successfully established in vitro by modified collagenase digestion method.The cell phenotype identification proved to meet the experimental requirements.So it could provide cellular foundations for the study of pathogenesis of degenerative aortic valve disease.

Objective To investigate the feasibility of treating ischemic heart disease with transplantation of marrow mesenchymal stem cells.Methods Marrow mesenchymal stem cells were collected from New Zealand rabbit's sternum and cultured.A myocardial infarction model was created by ligation of the distal left anterior descending artery in New Zealand rabbit.MSCs were injected into the region of myocardial infarction.The size of the myocardial infarction area was measured by PET and the cardiac function was assessed by measuring the pressure change of left ventricle(dp/dt).Results The size of the myocardial infarction area diminished and the cardiac function was improved after the transplantation of marrow mesenchymal stem cells.Conclusion Transplantation marrow mesenchymal stem cells may improve cardiac function of ischemic heart disease in animal model of New Zealand rabbit.

Objective Renal tumor and gynecological tumor invading into inferior vena cava and extending to the right cardiac cavities is quite uncommon,we report the experience of diagnosis and surgical treatment of intravenous tumor embolus extending through inferior vena cava into the right cardiac cavities.Methods From Junuary 2001 to May 2008,4 patients with intravenous tumor embolus extending through inferior vena cava into right cardiac cavity were treated in PUMC Hospital.Three cases were leiomyomatosis.Two patients' operation was performed by stages,firstly removed tumer in the right cardiac cavities using cardiopulmonary bypass under mid-hypothermia,and,postoperatively 3～4 weeks,total abdominal hysterectomy with bilateral salpingo-oophorectomy including the tumor mass was performed.The other patient's tumor was resected at one time.One case is renal clear cell carcinoma,The urologist performed abdominal nephrectomy and then cardiac surgeon resected tumor embolus using cardiopulmonary bypass under deep hypothermic total circulatory.Results The four patients were uneventful recovery,there was no death or any serious perioperative complications.Following up of 3 months to 4 years showed no tumor recurrence after the operation.Conclusion Confirmed diagnosis,the tumor embolus extending through inferior vena cava into the right cardiac cavities should be suspected among patients with renal cell carcinoma and multiple hysteromyoma are all critical for the treatment.Successful therapy for intravenous tumor embolus is dependent on totalone or two-stage surgical excision of the tumor and multi-department cooperation and combined therapy.

Objective To systemically assess impact on postoperative outcomes after red blood cell transfusion(RBCT) in coronary artery bypass graft surgey.Methods A meta-analysis was performed on the comparison and synthesis of findings from included studies published from January 1980 to January 2014.Pooled odds ratio(OR) and 95 ％ confidence interval(CI) were calculated using RevManS.3 software.Sensitivity analysis was conducted and possible publication bias was tested as well.Results Seven retrospective studies including 71 228 patients(33 872 RBCT cases,37 356 control cases) were eligible for inclusion.The pooled analysis revealed difference in the 30-day mortality OR =1.85 (95％ CI:1.35-2.54),1-year mortality OR =2.02 (95 ％ CI:1.44-2.84),shock OR =2.92 (95 ％ CI:1.96-4.35),renal dysfunction OR =7.67 (95 ％ CI:1.44-40.94),mediastinitis OR =2.26 (95 ％ CI:1.72-2.97),and myocardial infarction OR =3.53 (95 ％ CI:2.89-4.29).Conclusion Perioperative RBCT can incresase the risk of postoperative mortality and complications in coronary artery bypass graft surgey.High-quality randomized case cohort studies are still needed for the further proof of the risk.

Inferior vena caval (IVC) tumor thrombus with cardiac extension is a very rare phenomenon,which proliferates fast and could be very challenging to the surgery.This paper was designed to investigate the clinical value of transesophageal echocardiography (TEE) for the surgical resection of IVC tumor thrombus extending into right cardiac cavities.Six cases from our medical institute,preoperatively diagnosed as IVC tumor thrombus with cardiac extension and scheduled for the surgical resection,were retrospectively analyzed.In addition to real-time and dynamic monitoring,comprehensive TEE exams were performed for all the patients respectively after anesthesia induction,namely before tumor resection and after tumor resection.Cardiac extension was defined by the preoperative finding of cardiac mass originated from IVC tumor thrombus by transthoracic echocardiography,computerized tomography or CT angiography.In all the cases,intraoperative TEE provided an accurate and excellent view of the IVC tumor thrombus.For case three,the IVC tumor thrombus was found at the IVC entrance to right atrium without further cardiac extension; for case five,the IVC tumor thrombus proliferated into right atrium but the extended cardiac mass was very slim and flexible and the tricuspid valve was untouched; for case four,the IVC tumor thrombus extended into right atrium and even cross the tricuspid valve but the extended cardiac mass was also very slim and flexible.Based on the TEE-provided information,the originally scheduled surgical decision was modified and the surgical resection was performed without cardiopulmonary bypass (CPB).For the other three cases,the intraoperative TEE showed similar results to preoperative findings.The huge IVC tumor thrombus extended into the right heart,presented almost no flexibility and dramatically compromised the intracardiac blood flow.For the three cases,CPB support was indispensable for the tumor resection.The full TEE exam after tumor resection in all the six patients displayed clear surgical resection without tumor residuals,but in those three patients suffered with severely compromised cardiac extension,severe tricuspid regurgitation was noticed.All the six patients were closely monitored until discharged,and no TEE-related complications were observed.This paper reports about TEE' s utilization in a series of consecutive patients undergoing surgical resection of IVC tumor thrombus with cardiac extension.In addition to its safety and effectiveness,TEE can provide valuable information for surgical decision making,surgical intervention assessment and anesthesiamanagement strategies.

Objective To study the clinical features of intraductal papillary mucinous neoplasm of the biliary tract (BT-IPMN) and to analyse the diagnostic and surgical patterns.Method The data of 19 patients with BT-IPMN admitted from Jun.2012 to Jul.2016 were retrospectively analyzed.Results These 19 (2.3％) patients with BT-IPMN came from 815 patients with biliary tract tumors who were treated in our institution.There were 9 males and 10 females.The male to female ratio was 1.0∶ 1.1.The mean age was 60.6 ± 12.9 years with a range from 25 to 78 years.Jaundice (in 10 patients) and abdominal discomfort (in 6 patients) were the most common presenting symptoms.Bile duct dilatation and intraluminal mass were typical preoperative imaging findings.All these 19 patients were diagnosed to have BT-IPMN histopathologically.18 patients underwent surgery in our hospital.Left lateral hepatic sectionectomy or left hepatectomy was performed in 8 patients,pancreaticoduodenectomy in 6,local excision of bile duct and cholangiojejunostomy in 3 and central hepatectomy in 1.The average operating time was 280 minutes and the average amount of intra-operative bleeding was 515 ml.Fourteen patients underwent regional lymph node dissection and 3 positive lymph nodes were detected out of 94 resected lymph nodes.Sixteen patients were followed up from 1 to 51 months with a mean of (25.7 ± 19.5) months.Fourteen of these patients were still surviving.Two patients died 3 and 17 months after operation due to the tumor.Conclusions Intraductal papillary mucinous neoplasm of the biliary tract was very rare.Early diagnosis was not easy.There was a low percentage of lymphatic metastasis.Surgery was the first choice of treatment and complete resection of BT-IPMN was associated with good long-term survival.