Objective To observe the effect of reteplase on the thromboelastogram tracing of patients experiencing acute is-chemic stroke(AIS).Methods Selected 43 AIS inpatients in the Third People’s Hospital of Liaocheng from October,2013 to August,2015,who received reteplase less than 4.5 hours after the onset of syndrome of AIS.Blood samples were obtained before reteplase administration and at 0.5,1,2 and 4 hours after reteplase administration and measured by thromboelastogra-phy.Results The parameters R,K,Angle and MA of the thromboelastogram had changed after beginning administration of reteplase.The R value at 0.5 h after thrombolysis was significantly higher than that before thrombliysis,however,the R Value at 1h after thrombolysis was the most highest,and the K value.At 0.5 h after thrombolysis was the highest.At 0.5 h after thrombolysis MA and Angle values were the lowest,the differences were statistically significant (P<0.001).Conclu-sion The study suggests that the thromboelastogram is an useful tool for determining changes in the coagulation system of patients receiving reteplase.

OBJECTIVE:To probe into the cost control in PIVAS of our hospital in order to provide reference for the effective cost control.METHODS:The status quo of cost control of PIVAS was analyzed to provide corresponding countermeasures.RESULTS & CONCLUSIONS:The effective cost control can be achieved through improving cost accounting,controlling cost and reducing running cost and labour cost to promote the healthy development of PIVAS.

Objective To summarize the clinical treatment experience of blood culture-negative infective endocarditis,and to explore the surgery chance and therapeutic strategy of blood culture-negative endocarditis. Methods One hundred and sixty-six patients who were diagnosed blood culture-negative endocarditis in the Aisa Heart Hospital of Wuhan from Jul. 2008 to Dec. 2012 were recruited in the study. Broad-spectrum antibiotics including cefuroxime axetil and levofloxacin were used before the result of blood culture,and sensitive antibiotics were selected to control patient's condition when getting the result of blood culture. But broad-spectrum antibiotics were continuously used to the blood culture-negative endocarditis until stable condition. When the conditions were stable,active preparation before surgery should be carried out. Thoroughly clear the vegetation and protect the cardiorespiratory function during operating. Kata-step antibiotics were used to control patient's condition until normal temperature,as well as the number of leukocytes decreased,blood sedimentation normalized and C-reaction protein decreased. Then,the narrow-spectrum antibiotics were selected including cephalosporin until discharged from hospital,and continued treatment of antibiotics for 4 - 6 weeks. Results Five patients died after the operation,including 1 case died of low cardiac output syndrome,2 cases died of multiple organ failure,1 case died of septicemia and the 1 case died of cerebral embolism. All the other patients discharged from hospital successfully. Conclusion The patients with blood culture-negative IE should be controlled rapidly. The duration and dose of antibiotics should be enough. Active operative preparation should be taken and then surgery timely. Thus,the hospital mortality could decrease and prompt the long-term outcome.

Objective To investigate the impact of diabetes on coronary artery bypass grafting (CABG)in peroperative patients. Methods Clinical data of 692 CABG patients were collected retrospectively from Sep. 2006 to Jul. 2010. The CABG patients were divided into diabetic group (n = 276) and nondiabetic group (n = 416) according to with the status of diabetes or not before operation. Blood glucose was dynamicaly monitored and treated with insulin to control blood glucose in perioperativeperiod. The postoperative effect,perioperative complication and inhospital case fatality and their relationship with diabetes were analyzed using univariate analysis. Results No significant differences were found regarding the incision complications (5. 8%vs. 4. 3 % , P > 0. 05). The volume of blood transfusion was (890. 7 ± 520. 6) ml in the diabetes group, which was not significantly different from that of (825. 2 ±518. 4)mlin the non-diabetes group (P>0. 05). No significant difference was found on cardiac arrhythmia (13.0% vs. 13. 5%),renal function insufficient (5. 1% vs. 2.4%)and case fatality (2. 9% and 1. 9%) between the diabetes and non-diabetes group (Ps >0. 05). In the diabetes group and non-diabetes group, the duration of IABP (3.7 ± 1. 6) d vs (3.5 ± 1.6)d, use of ventilator (2. 6 ± 1.9)d vs. (2. 4±1.5)d were not sigfnificantly different (Ps >0.05). The length of hospital stay and cost were (22. 0 ±8. 8)d and (8. 11 ±2. 40) thousand RMB in the diabetes group, which were significantly higher than that of (20. 6 ±7. 6)d and (7. 63 ±2. 20) thousand RMB in the non-diabeties group (t =2. 22 and 2. 71 ,Ps <0.05) . Conclusion There are no significant differences in the operative case fatality and complications between patients with diabetes and without nondiabetes. However,diabetes increases hospital stay and expense.

Objective To observe the effect of restrictive bare stent release on the distal end of Stanford type A aortic dissection.Methods From November 2016 to February 2018,20 patients with Stanford type A aortic dissection requiring aortic arch replacement and trunk surgery were selected for restrictive bare stent placement.Among them,there were 17 males and 3 females,aged 34-68 years old with an average age of(50.85 ± 8.49) years.The bare stent was released in the descending thoracic aorta,and the frozen elephant trunk was placed in the bare stent.The CTA of the great vessels was reviewed before discharge and the stent position and complications were observed.And compared with 42 patients with acute aortic arch replacement and stent-like nasal surgery in the acute Stanford type A aortic dissection from December 2013 to June 2015.Of the 42 patients,32 were males and 10 were females,aged 20-78 years,with an average of(49.36 ± 8.02) years.Results One patient in the bare stent group had greater resistance when the bare stent was placed,and the patient was disengaged and abandoned.The remaining 19 patients successfully completed the restrictive bare stent placement.One patient died of a large cerebral infarction during hospitalization.All 18 patients who survived and successfully placed the bare stent were followed up regularly.There was no stroke or death during the follow-up period.The computed tomography angiography of the computed tomography showed good shape and position,no displacement and type lⅢ endoleak,and no new fracture of the distal end of the elephant trunk was observed.In the conventional surgery group,2 patients died,1 patient died of large-scale cerebral infarction,and 1 patient died of perioperative myocardial infarction.No paraplegia cases.In 2 cases,a new rupture of the distal eud of the elephant trunk was performed,and the stent was placed again.Conclusion Compared with the conventional surgery group,the use of the restricted bare stent is safe,can effectively reduce the occurrence of stent-graft induced new entry and can significantly expand the diameter of the distal vessel,and the aortic remodeling effect is good.

Objective 聽 聽To investigate and evaluate the safety and efficacy of Bentall operation in the reoperation of patients with small aortic root or annulus. Methods 聽 聽Bentall procedure was performed in 24 patients with small aortic root or annulus in our hospital from September 2014 to December 2019. There were 18 males and 6 females with a mean age of 31-68 (45.70卤15.27) years. All patients had undergone a previous replacement of the aortic valve including 20 patients receiving valve replacement, 2 patients aortic root replacement with a valved conduit and 2 patients bioprothesis replacement. Results 聽 聽There was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 2 patients and no bleeding was related to the proximal anastomosis of the conduit. One patient performed pacemaker implantation for heart block after the procedure. The mean sizes of implanted aortic valve prosthesis were 22.75卤1.78 mm. A mean gradient across the aortic valve prostheses in the postoperative echocardiographic examination was 11.17卤2.24 mm Hg. Conclusion 聽 聽Bentall procedure is safe and allows a larger size of prosthesis implantation in patients with small aortic annulus or root after previous aortic valve or complete root replacement, resulting in good postoperative hemodynamic characteristics and short-term clinical results.

Objective:To summarize the experience of emergency treatment of type A aortic dissection during the prevalence of COVID-19.Methods:Retrospectively analyzed the data of 29 patients undergoing emergency surgery for type A aortic dissection during the outbreak of corona virus disease-19 ( COVID-19) in Wuhan Asian Heart Hospital from January 23 to March 31, including 25 males and 4 females aged 34-72 years with mean age (49.17±9.63) years.There were 10 cases in Wuhan and 19 cases outside the city.All patients were diagnosed and indicated for emergency surgery through online consultation before transportation.After the primary exclusion of COVID-19 by pulmonary CT scanning in the emergency department, the patients were admitted to the isolation ward. Emergency surgery was performed after emergency nucleic acid testing and preoperative examing. Postoperatives were carried to a single room in the ICU for isolation until COVID-19 was excluded, nucleic acid testing and reexamination of pulmonary CT were performed if they were fever during hospitalization.All medical personnel involved in the operation and perioperative management took three levels of protection and medical observation.Results:There were 5 cases of type A1 in the aortic root, 2 cases of type A2, 22 cases of type A3, 2 cases of simple arch, 27 cases of complex type (Sun's classification).12 cases of Bentall, 2 cases of Wheats, 15 cases of ascending aorta replacement, 14 cases of aortic valve repair, 25 cases of aortic arch replacement, 23 cases of trunk stents, 2 cases of hybridization, 6 cases of concurrent coronary artery bypass grafting, and 2 cases of tricuspid valvuloplasty.In the whole group, 1 case of COVID-19 was confirmed and 1 was suspected.The time of cardiopulmonary bypass was(224.00±21.14)min, the blocking time was(146.17±18.75)min, the postoperative ventilator assisted(65.07±10.36)h, the hospitalization time was(27.03±5.64)days, there were no hospitalized deaths, 4 cases of postoperative liver function damage, 6 cases of acute renal function damage, and 7 of pulmonary infection.None of the medical staff involved in the operation and perioperative management were infected with COVID-19.Conclusion:During the period of major infectious diseases, the admission and treatment procedures of critical and severe patients should be standardized, and the control of nosocomial infection should be strengthened. Emergency surgery is an effective means to rescue type A active vein interlayer, and the safety of protecting medical staff is guaranteed.

Objective To investigate and evaluate the safety and efficacy of the aortic-mitral annular enlargement technique (double annular enlargement) in patients with small-size valve prostheses after prior valve surgery. Methods The clinical data of patients who underwent double valve annular enlargement in Wuhan Asia Heart Hospital from April 2020 to April 2022 were retrospectively analyzed. Results A total of 30 patients were collected, including 2 males and 28 females aged 9-78 (52.71±3.53) years. All patients had previous heart valve surgery, including 1 patient receiving the third heart surgery. All patients were operated on successfully and there were no postoperative in-hospital deaths. There was no postoperative bleeding which needed a secondary open-chest hemostasis, and one patient underwent permanent pacemaker implantation due to postoperative sick sinus syndrome. The mean diameter of the implanted prosthetic aortic valve was 24.23±1.60 mm, which was significantly larger than that of the preoperative aortic valve (21.03±1.90 mm, P＜0.001). The mean diameter of the implanted prosthetic mitral valve was 28.33±1.21 mm, which was significantly larger than that of the preoperative mitral valve (25.43±0.84 mm, P＜0.001). The mean peak gradient difference across the prosthetic aortic valve on postoperative echocardiography was 18.17±6.44 mm Hg, which was significantly lower than that of the preoperative aortic valve (82.57±24.48 mm Hg, P＜0.001). The mean peak gradient difference of the postoperative prosthetic mitral valve was 12.73±5.45 mm Hg, which was significantly lower than that of the preoperative mitral valve (19.43±8.97 mm Hg, P=0.003). Conclusion The double annular enlargement technique is safe and effective for reoperation in patients with a history of valve surgery with a small aortic root to obtain both a larger size prosthetic valve for a larger orifice area and stability of the mitral-aortic valve union, resulting in good postoperative hemodynamic characteristics and clinical outcomes.

Objective To investigate and evaluate the safety and effectiveness of the Chimney technique in mitral valve reoperation. Methods The clinical data of mitral valve reoperation patients who underwent Chimney surgery in Wuhan Asia Heart Hospital from 2019 to 2021 were retrospectively analyzed. Results A total of 26 patients were collected, including 7 males and 19 females, aged 27-67 (53.46±11.18) years. All patients had previous mitral valve surgery, including 23 mitral valve replacements and 3 mitral valve repairs. All patients received Chimney technique using the ideal artificial sized mitral valve, and 1 patient died of neurological complications in hospital. The cardiopulmonary bypass time and the aortic cross-clamping time were 231.11±77.05 min and 148.50±52.70 min, respectively. The mean diameter of the implanted mitral valve prosthesis was 29.08±0.68 mm, which was statistically different from pre-replacement valve prosthesis size of 26.69±0.77 mm (P＜0.001). The mean transvalvular pressure gradient of the prosthetic mitral valve measured on postoperative echocardiography was 14.77±5.34 mm Hg, which was statistically different from preoperative value of 20.92±9.83 mm Hg (P=0.005). Conclusion The Chimney technique is safe and effective for reoperation in patients with small mitral annuli, which can not only reduce the risk of reoperation, but also obtain larger prosthetic valve implants with good hemodynamic characteristics and clinical outcomes.

Objective To summarize the application of double valve ring enlargement combined with mitral Chimney technique (Chimney Commando) in the secondary valve replacement and to analyze the efficacy in the near and medium term. Methods Patients who underwent the secondary aortic valve and mitral valve (double valve) replacement by Chimney Commando in Wuhan Asia Heart Hospital from 2019 to 2022 were included, and their clinical data were retrospectively collected to analyze the safety and feasibility of this procedure in secondary valve replacement of small aortic root patients. Results A total of 49 patients (44 females and 5 males) were included. The body surface area was 1.64±0.17 m2. The time from the first operation was 13.10±5.90 years. Except for 4 patients whose first operation was valvuloplasty, the remaining 45 patients were all patients after valve replacement, 41 patients of double valves replacement, including 39 patients with mechanical valve and 2 patients with biological valve. The majority of the aortic valves were St.Jude regent 19 mm or St.Jude regent 21 mm, accounting for 30.61% and 34.69%, respectively. The mitral valves were predominantly St.Jude 25 mm mechanical valves, making up 65.31%. All patients underwent Chimney Commando double valve ring enlargement, and the mean time of aortic occlusion was 154.00±45.40 min. The mean size of the aortic valve was 23.90±1.40 mm and that of the mitral valve was 28.20±1.20 mm, and the transvalvular pressure difference across the aortic valve was 20.16±5.76 mm Hg at 6 months postoperatively. There was one death during hospitalization due to multi-organ failure. The follow-up time ranged from 1 to 24 months with a median time of 8 months. Two patients were implanted with permanent pacemakers during the follow-up period and 1 patient died due to massive stroke and malignant arrhythmia. Conclusion Chimney Commando is safe and effective in patients with secondary double valve replacement, and the postoperative prosthetic valves have good hemodynamics, and can achieve good clinical results in the near and medium term.