Objective To evaluate the effects of 'patch-skill'in the management of refractory bleeding during the process of open heart surgery.Methods Between May 2007 to Oetober 2008,7 patients undergoing open-heart surgery experienced active bleeding.Autologous perieardial patches were used in 6 patients, and polyester patch in the other one.The patches were sutured continuously by 5-0 Prolene suture.Results The 24 hour chest tube output was less than 500 ml in all 7 cases after operation.There were no death, secondly active bleeding,or mediastinal in-faction.Conclusion The'patch-skill' can effectively control the refractory bleeding during open heart surgery.Au-tologous perieardial patehe is the first choice because it has multiple advantages.The polyester patch ean be used al-ternatively when autologous pereardiurn cannot be used (for various reasons such as edema and infection).

Objective To explore the surgical treatment for patients with aortic valve disease and ascending aorta dilatation.Methods The patients were divided into two groups according to the condition of aortic valve leaflet and surgical treatment.The changes of ascending aorta after different treatment were measured by echocardiography.Results Among tricuspid aortic valve patients,diameter of ascending aorta in patients with simple aortic valve replacement decreased by 0.471 mm averagely per year,while diameter of ascending aorta in patients with the concomitant ascending aorta angioplasty decreased 0.27 mm averagely per year.Among bicuspid aortic valve patients,diameter of ascending aorta in patients with simple aortic valve replacement increased by 2.28 mm averagely per year,while diameter of ascending aorta in patients with the concomitant ascending aorta angioplasty increased 2.923 mm averagely per year.Conclusion The patients with bicuspid aortic valve are more likely to develop ascending aorta dilatation after the operation of the aortic valve.Patients with bicuspid aortic valve should undergo ascending aorta replacement when aorta diameters are more than 40 mm.Patients with tricuspid aortic valve undergoing surgery must be very cautious.

Objective To explore the surgical treatment for patients with aortic valve disease and ascending aorta dilatation.Methods The patients were divided into two groups according to the condition of aortic valve leaflet and surgical treatment.The changes of ascending aorta after different treatment were measured by echocardiography.Results Among tricuspid aortic valve patients,diameter of ascending aorta in patients with simple aortic valve replacement decreased by 0.471 mm averagely per year,while diameter of ascending aorta in patients with the concomitant ascending aorta angioplasty decreased 0.27 mm averagely per year.Among bicuspid aortic valve patients,diameter of ascending aorta in patients with simple aortic valve replacement increased by 2.28 mm averagely per year,while diameter of ascending aorta in patients with the concomitant ascending aorta angioplasty increased 2.923 mm averagely per year.Conclusion The patients with bicuspid aortic valve are more likely to develop ascending aorta dilatation after the operation of the aortic valve.Patients with bicuspid aortic valve should undergo ascending aorta replacement when aorta diameters are more than 40 mm.Patients with tricuspid aortic valve undergoing surgery must be very cautious.

Objective To investigate the factors affecting the occurrence of new postoperative cardiac complications in patients undergoing esophageal cancer surgery with concomitant coronary heart disease. Methods Clinical data of patients who underwent esophageal cancer surgery with coronary heart disease at the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from December 2019 to June 2023 were collected. Patients were divided into two groups based on whether they experienced postoperative cardiac complications. Using the occurrence of cardiac complications as the dependent variable, a multivariate logistic regression model was established to identify related influencing factors. Results A total of 223 patients were included, comprising 148 males and 75 females, with an average age of (71.78±6.31) years (range 53-88 years). Seventy-one (31.84%) patients experienced at least one new cardiac complication postoperatively, including 2 acute coronary syndrome, 13 heart failure, and 59 new-onset postoperative arrhythmias. Univariate analysis showed that age, systemic immune-inflammation index, pulmonary infection, need for invasive mechanical ventilation due to respiratory failure, acute respiratory distress syndrome (ARDS), acute delirium, pleural effusion requiring drainage, and acute renal failure were risk factors for postoperative new-onset cardiac complications (all P<0.05). Multivariate logistic regression analysis identified age, postoperative length of hospital stay, ARDS, and systemic immune-inflammation index as independent risk factors for new cardiac complications in esophageal cancer patients with coronary heart disease. Conclusion Strengthening perioperative management of esophageal cancer patients, ranging from preoperative evaluation to postoperative complication treatment, is crucial. Particular attention should be paid to age, ARDS, and other indicators to improve postoperative prognoses in patients with coronary heart disease complicated by esophageal cancer.