Objective: To analyze the risk factors on acute respiratory dysfunction caused death in patients after type A aortic dissection surgery.
Methods: A total of 223 patients who received aorta replacement surgery in our hospital from 2010-01 to 2012-12 were retrospectively studied. 80 patients suffered from post-operative acute respiratory dysfunction including 61 male and 19 female with the mean age of (49.2 ± 11.6) years. Those patients were divided into 2 groups as Death group, n=18 and Survival group, n=62. We analyzed the most relevant risk factors for death, such as gender, age, histories of smoking, diabetes, hypertension, Marfan syndrome;pre-operative acute or chronic dissection, hypoxemia, mal-perfusion, LVEDD and LVEF;CPB time, aortic-clamping time;post-operative ICU retention time, mechanical ventilation time, permanent neurologic dysfunction, pulmonary infection, MACE, renal failure, hypohepatia, septicemia and wound mal-healing, et al.
Results: The early post-operative (< 3 days) respiratory dysfunction rate was 35.8% and the mortality was 22.5%(18/80). The relevant risk factors of death included female gender (P=0.019), haemorrhage (P<0.01), mechanical ventilation time (P=0.011), permanent neurologic dysfunction (P=0.013), pulmonary infection (P=0.001), MACE (P=0.022), renal failure (P<0.01), hypohepatia (P<0.01) and septicemia (P=0.001). Female gender and renal failure were the independent risk factors for respiratory dysfunction caused death in patients after type A aortic dissection surgery.
Conclusion: The occurrence and mortality were high in patients after type A aortic dissection surgery especially in those with female gender and post-operative renal failure.

Objective:To clarify whether nutritional risk screening 2002 could be used as a basis for nutritional support for liver surgery patients.Methods:Among the 243 hospitalized patients,61 patients had ≥ 3 NRS 2002 scores,and 41 of them were given nutrition support.The remaining 182 patients scored ＜ 3,and 73 of them were administrated with nutrition support.Results:The incidence of nutritional risk of hospitalized patients in liver surgery was 25 ％.Among the patients at nutritional risk group,67％ were given nutrition support.And the rates of infection related complication were nutritional supported patients significantly lower than that in the no nutrition support group (P ＜ 0.05).Conclusion:Accurate application of NRS 2002 and necessary nutrition support in liver surgery patients could improve nutritional status and clinical outcome.

Objective To detect 14 genes including fibrillin-1(FBN1) and so on mutations in 17 patients with Marfan syndrome(MFS) and family members of 2 patients and to investigate the correlation between FBN1 gene mutation and MFS.Methods Genomic DNAs were extracted from whole blood sample of 17 patients and 43 family members.After DNA samples were amplified by polymerase chain raction(PCR), we used capture panels to get target genes which would be sequenced by Illumina HiSeq2500 Analyzers(Illumina, SanDiego, USA).The target genes included ACTA2、CBS、FBN1、FBN2、MYH11、COL3A1、SMAD3、TGFBR1、TGFBR2、MYLK、MSTN、COLA2、TGFB2 and SLC2A10.The results of sequencing would be compared with multiple databases, including NCBI dbSNP, HapMap, 1000 human genome dataset and database of 100 Chinese healthy adults, to find gene mutation.Finally, these mutations would be validated using conventional Sanger sequencing methods.Results A total of 10 FBN1 mutations and 1 actin alpha2(ACTA2) mutation in 17 patients were identified, of which 8 FBN1 mutations and 1 ACTA2 mutation were novel.One FBN1 mutation was underwent family investigation and we found in this family, all patients had this mutation and others did not have it.Conclusion Missense mutation of c.7280G>A in the 59th exon of FBN1 gene is new pathogenic mutation for MFS.The other 8 novel mutations may be the pathogenic factors of MFS.

Objective To analyze the risk factors of postoperative acute renal injury (AKI) for acute Stanford type A aortic dissection in 137 cases.Methods From January 2010 to December 2011,137 patients with acute Stanford type A aortic dissection were received surgical operations in our hospital.There were 106 males and 31 females with their mean age of(46.8 ± 13.1)years and mean weight of (69.9 ± 18.0) kg.The postoperative acute renal injury diagnosis was according to AKIN diagnosis standard of acute kidney injury network working group in 2005.All patients were received surgical repair with cardiopulmonary bypass,including 120 patients with deep hypothermic circulatory arrest and selective cerebral perfusion.Among them,there were 54 cases with total arch replacement and 66 with right half arch replacement.The postoperative managements were include control the patients' mean arterial blood pressure at 80 to 90 mmHg (1 mmHg =0.133 kPa),supplement the blood volume timely,and correction of hypoxia and hypoproteinemia.The patients were received renal replacement therapy if still oliguria after medical treatments,or their blood creatinine raising continually more than 500 μmol/L.Results A total of 12 patients died in hospitalization with a total in-hospital mortality of 8.74％ (12/137).76 cases had AKI in the first day after operations,including 38 cases (27.7％) with stage Ⅰ and 21 cases (15.3％) with stage Ⅱ and 17 cases (12.4％) with stage Ⅲ.There were 36 patients have acute renal failure (ARF) with morbility of 26.3％ (36/137),and 34 patients among them were received renal replacement therapy.Single factor analysis showed that preoperative creatinine,total arch replacement,cardiopulmonary bypasstime,intraoperative day transfusion of concentrated red cells are risk factors of ARF.Logistic regression was used for multivariate analysis showed that total arch replacement and preoperative creatinine abnormalities are independent risk factors for postoperative AFR.Conclusion Total arch replacement and preoperative creatinine abnormalities were independent risk factors of AFR for acute type A dissection after operation.

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Objective To summarize the effect of supra-arch branches bypass combined with endovascular aortic repair for aortic diseases.Methods From January 2012 to August 2015,120 cases of thoracic aortic diseases (aortic dissection 103,aortic aneurysm 16,penetrating aortic ulcer 1) received hybrid operation in Guangdong Cardiovascular Institute.Vascular bypass was established among the brachiocephalic arteries,followed by endovascular repair through femoral artery either one-stage or two-stage.Patients were followed up for 3-24 months.Results Technical success was achieved among all the patients.Five patients died after the operation(one patient had retrograde aortic dissection,2 patients had pericardial tamponade,one patient had apnea,and one patient had respiratory and cardiac arrest.The death rate is 4.1％),4 patients had stroke,among them,symptoms were relieved in three patients,one patient was not cured.Total 92 patients were followed-up and had no symptoms of up-limb ischemia or dizziness.CT scan showed bypass graft and endovascular stent patency.6 patients had endoleak (type Ⅰ b 2 cases,type Ⅱ 3 cases,and type Ⅲ 1 case),distal aortic dissection occurred in one patient,three patients had mild contrast agent leakage around the distal endovascular stent,type A aortic dissection occurred in one patient,there were no late stage death.Conclusion Supraarch branches bypass combined with endovascular aortic repair for treating aortic disease is minimally invasive,safe,and can reduce the incidence of postoperative complications.

Objective To retrospectively analyze the surgical methods and efficacy in 70 cases of type A aortic dissection patients over 65 years old.Methods From January 2005 to May 2012,70 type A aortic dissection patients over 65 years old received surgical treatment.Among them,there were 47 males aged 65 to 78 years old with mean 71,23 females,aged 65 to 72 years old with mean 68.55 cases were acute onset,while 15 cases were chronically onset.Different surgical methods were selected depend on patients' situations.We followed up all patients after discharged from hospital to continue to observe their health situation and evaluate the therapeutic effects.Results After surgery,eight patients died in the hospital,62 patients were recovered and discharged from the hospital.The mortality rate is 11.4％.During the follow up period from 3 to 72 months,there were no dead,aneurysm rupture and others severe complications.9 cases received endovascular graft exclusion within 6 months after discharged from hospital.The survival patients were satisfactory healed with their daily living activity resumed.Conclusion For over 65 years old patients with aortic dissection,the accurate and rapid selection of surgical method could improve the survival rate and the quality of life with a lower occurrence rate of complications.

Objective To evaluate the prevalence and impact of coronary artery disease (CAD) in aged patients with Stanford type B aortic dissection(AD).Methods From January 2008 to December 2011,CAG was routinely performed before aortography and thoracic aortic repair(TEVAR) to determine the prevalence of concomitant CAD in 200 consecutive Stanford type B AD patients who were older than 50 years.All patients received 1 year follow-up.Adverse events were compared between patients with and without concomitant CAD.Data analysis by SPSS 17.0 statistical software,using Student t test,Chi-square test and Fisher exact test.Results CAG showed 53 patients (26.5％) had CAD.Multivariate logistic regression analysis showed that male gender(OR =4.415,95％ CI:1.131-17.237,P =0.033) and age (OR =1.061,95％ CI:1.017-1.108,P =0.006) were independent predictors of Stanford type BAD coexisted with CAD.Age was also independent predictor of multi-vessel disease(MVD) and/or left main disease(LMD) (OR =1.096,95％ CI:1.009-1.191,P =0.023).At 30-day follow-up,there was no difference in the incidence of adverse events between patients with and without concomitant CAD.Patients with concomitant CAD showed higher incidence of myocardial infarction[3 (5.66％) vs.0(0),P =0.018] and stroke [4 (7.55 ％) vs.1 (0.68 ％),P =0.018].Conclusion The prevalence of CAD in aged patients with Stanford type BAD is relatively high.Concomitant CAD is associated with higher risk of cardio-cerebrovascular ischemic events while dose not increase the risk of adverse aorta related events.

Objective: To evaluate the mitral, aortic and tricuspid valve replacement for rheumatic heart disease. Methods: From June 1990 to June 2001, 941 patients underwent valve replacement. Among them, 24 patients underwent simultaneously mitral, aortic and tricuspid valve replacement. There were 17 females and 7 males, with mean age of 36 years (ranged from 18 to 59 years). Eight patients had previous closed mitral valvotomy. Eleven patients complicated with left atrium thrombus, 16 with hapotomeglia, and 8 with ascites. The X ray results showed that the C/T ratio was 0.66 to 0.91. The heart function (NYHA) was class III in 9, and class IV in 15. All patients had combined mitral, aortic valve lesions associated with severe tricuspid valve regurgitation. Results: One patient died postoperatively with an operative mortality of 4.2%. 23 patients followed up from 20 to 36 months (mean, 26.4 months). There was no thrombolism and anticoagulant related hemorrhage. The echocardiography demonstrated the diameter of left atrium right ventricle, and LVDd significantly decreased after operation. The heart function was also significantly improved. Conclusion: The combination of mitral, aortic and tricuspid valve replacement could achieve a satisfactory result with low mortality and better recovery of heart function.

BACKGROUND:Searching for a porous three-dimensional (3D) scaffold holding good porosity, mechanical property and biocompatibility has become a hot spot, in which, 3D printing technology also plays apart. OBJECTIVE:To prepare silk fibroin/col agen scaffolds using 3D printing technology and detect its performance. METHODS:Silk fibroin/col agen scaffolds were constructed using 3D printing technology, and the silk fibroin/col agen mass ratio was 4:2 (group A) and 4:4 (group B), respectively. The porosity, water absorption expansion rate, mechanical properties and pore size of the composite scaffolds were detected. The passage 3 rat bone marrow mesenchymal stem cel s were seeded onto the two scaffolds. The cel proliferation was detected using MTT assay at 13 days of culture, and the cel morphology was observed by hematoxylin-eosin staining and scanning electron microscope at 14 days of culture. RESULTS AND CONCLUSION:The porosity, pore size, and water absorption expansion rate of group A were significantly larger than those of group B (P<0.05), while the elasticity modulus showed no significant difference between groups. Bone marrow mesenchymal stem cel s on the two scaffolds increased gradual y with time, especial y in the group A (P<0.05). Abundant cel s distributed evenly in the group A, while few cel s distributed unevenly in the group B. These results suggest that the 3D printed scaffolds composed by silk fibroin/col agen mass ratio of 4:2 holds good physicochemical performance and cytocompatibility.