Objective To investigate the surgical diagnosis and treatment of chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction,so as to deepen our knowledge on chronic stenosis of mechanical prosthetic valve.Methods The clinical data of 5 patients with chronic stenosis of mechanical prosthetic valve complicated with acute dysfunction were retrospectively analyzed,and the relevant literatures were reviewed.Results Re-operation(mechanical prosthetic valve replacement) was performed once the diagnoses were confirmed.The patients recovered well;the cardiac function was obviously improved;and there were no early complications.Conclusion Chronic stenosis of mechanical prosthetic valve should be strongly suspected when they have symptoms indicating valvular stenosis.Complication of acute mechanical prosthetic valve dysfunction is not difficult to diagnose,and prompt operation is important to save the life of patients.

Objective:To summarize the results and methods of surgical treatment for type A aortic dissection with small true lumen of the descending aorta.Methods:9 patients underwent surgical treatment for type A aortic dissection with small true lumen of the descending aorta between January 2017 and December 2019 were analyzed retrospectively. There were 7 males and 2 females, mean age of (41.6±9.2) years. Acute dissection were 2 cases, and chronic dissection were 7 cases. Preoerative computed tomography was used to diagnose the dissection and evaluate the true lumen of the descending aorta. This procedure was done in all patients via a median sternotomy under hypothermic CPB with SCP. 4-branched prosthetic graft was used to replace the ascending aorta and aortic arch. The procedures involving the descending aorta: Hybrid surgery using TEVAR. Distal intimal flap fenestration. Implanting the intraoperative stent-graft or prosthetic graft at false lumen for second-step operation.Results:There was no in-hospital mortality. Stroke, Spinal cord, visceral ischemia and lower limbs malfunction were not observed. Reintervention was not found in case with acute dissection during follow-up. One patient who reveived fenestration underwent TEVAR, others with chronic dissection underwent thoracoabdominal aortic replacement 3 months after surgery.Conclusion:Hybrid or staged procedures was a suitable alternative to patients with type A aortic dissection with small true lumen of the descending aorta.

Objective More and more investigator initiated studies have been funded in China.Both institutions and investigators should take the responsibility for meeting the scientific validity,ethical requirement,feasibility and interdisciplinary management requirements during the clinial research project design and initiation.This article hereby analyzed and summarized the most common review comments on clinical research applications.Methods Summarize the problems identified during the review of Shenzhen Second People's Hospital Clinical Research Program applications.Results The most common findings in turn as follows:inappropriate sample size calculation,study design,parameters,unclear study aims,insufficient study rational.Conclusions To fund clinical research programs with significant scientific values and appropriate design,it is vital for the research management department to provide more supervision and technology support.

Objective To evaluate the effect of preoperative pulmonary artery pressure on perioperative prognosis of the recipients with end-stage heart failure undergoing heart transplantation. Methods Clinical data of 105 recipients receiving heart transplantation were retrospectively analyzed. The mean pulmonary artery pressure (mPAP) was used as the diagnostic criterion. The optimal cut-off value of mPAP for predicting perioperative prognosis of heart transplant recipients was determined. According to the optimal cut-off value of mPAP, all recipients were divided into the low mPAP group (n=66) and high mPAP group (n=39). Intraoperative indexes (cardiopulmonary bypass time, aortic occlusion time, assisted circulation time and cold ischemia time of donor heart) and postoperative indexes [intra-aortic balloon pump (IABP) support rate, IABP support time, extracorporeal membrane oxygenation (ECMO) support rate, ECMO support time, mechanical ventilation time, length of ICU stay, incidence of moderate and severe tricuspid regurgitation and perioperative mortality rate] were compared between the low and high mPAP groups. The prognosis of the two groups was compared. Results The optimal cut-off value of mPAP in predicting clinical prognosis of heart transplant recipients was 30.5 mmHg. In the high mPAP group, the ECMO support rate and perioperative mortality rate were higher than those in the low mPAP group (both P < 0.05). No significant differences were observed in the cardiopulmonary bypass time, aortic occlusion time, assisted circulation time, cold ischemia time of donor heart, IABP support rate, IABP support time, ECMO support time, mechanical ventilation time, length of ICU stay and incidence of moderate and severe tricuspid regurgitation between two groups (all P > 0.05). No significant differences were noted in the 1-, 2-, 3- and 4- survival rates between two groups (all P > 0.05). Conclusions Preoperative mPAP in patients with end-stage heart failure is intimately correlated with perioperative prognosis of heart transplant recipients. The optimal cut-off value of mPAP in predicting perioperative prognosis of heart transplant recipients is 30.5 mmHg. In the high mPAP group, perioperative ECMO support rate and perioperative mortality rate are high, which do not affect the medium and long-term prognosis of the recipients undergoing heart transplantation.

Objective To summarize the results and methods of left subclavian artery revascularization by stented trunk fenestration for acute Stanford type A aortic dissection.Methods Clinical data of 67 patients (54 male and 13 female,mean age of (50 ± 10) years) underwent surgical treatment of left subclavian artery fenestration for acute Stanford A aortic dissection in Department of Cardiothoracic Surgery,Changhai Hospital,Second Military Medical College between September 2008 and December 2014 were analyzed retrospectively.The origin of the left subclavian artery was in the true lumen and no dissection existed near the artery's starting.There were 18 cases of Marfan's syndrome.Preoperative echocardiography showed moderate to severe aortic regurgitation in 10 cases,and mitral regurgitation in 3 cases.Electrocardiogram showed myocardial ischemia in 5 cases.Three patients had acute impaired renal function.All the patients received total arch replacement combined with stented elephant trunk implantation.Left subclavian artery revascularization was performed by stented trunk fenestration as follows:firstly,stented elephant trunk was implanted to completely cover the left subclavian artery,then part of stented trunk's polyester lining was removed which is located at the origin of left subclavian artery.Aortic root procedures included aortic valve replacement in 2 cases,Bentall procedure in 21 cases and aortic valve sparing in 44 cases.Three patients received mitral valve repair and 6 patients received coronary artery bypass grafting.Results The cardiopulmonary bypass time,cross-clamp time,and circulatory arrest time were (179 ± 32) minutes,(112 ± 25) minutes,and (26 ± 10) minutes,respectively.The in-hospital mortality was 7.5％ (5/67):2 patients died of multiple organ failure,1 patient died of acute renal failure and another 2 patients died of severe infection shock.Two patients required reexploration for root bleeding.Transient neurology dysfunction developed in 6 patients.Six patients received tracheotomy and prolonged ventilation due to pulmonary infection.All patients discharged from the hospital were followed up for 1 to 5 years.During long-term follow-up,the survival rate was 100％ and 89.8％ at 1 and 5 years,respectively.CT angiography was performed once per year after discharged.The left subclavian artery perfusion was good.No dissection or anastomosis leakage was identified in any case.Stroke and left limb ischemia did not develope.Conclusion For acute Stanford type A aortic dissection whose origin of the left subclavian artery is in the true lumen and no dissection existed near the artery's starting,the left subclavian artery revascularization by stented trunk fenestration technique during total arch replacement combined with stented elephant trunk implantation is reliable and effective.

Objective To summarize the results and methods of left subclavian artery revascularization by stented trunk fenestration for acute Stanford type A aortic dissection.Methods Clinical data of 67 patients (54 male and 13 female,mean age of (50 ± 10) years) underwent surgical treatment of left subclavian artery fenestration for acute Stanford A aortic dissection in Department of Cardiothoracic Surgery,Changhai Hospital,Second Military Medical College between September 2008 and December 2014 were analyzed retrospectively.The origin of the left subclavian artery was in the true lumen and no dissection existed near the artery's starting.There were 18 cases of Marfan's syndrome.Preoperative echocardiography showed moderate to severe aortic regurgitation in 10 cases,and mitral regurgitation in 3 cases.Electrocardiogram showed myocardial ischemia in 5 cases.Three patients had acute impaired renal function.All the patients received total arch replacement combined with stented elephant trunk implantation.Left subclavian artery revascularization was performed by stented trunk fenestration as follows:firstly,stented elephant trunk was implanted to completely cover the left subclavian artery,then part of stented trunk's polyester lining was removed which is located at the origin of left subclavian artery.Aortic root procedures included aortic valve replacement in 2 cases,Bentall procedure in 21 cases and aortic valve sparing in 44 cases.Three patients received mitral valve repair and 6 patients received coronary artery bypass grafting.Results The cardiopulmonary bypass time,cross-clamp time,and circulatory arrest time were (179 ± 32) minutes,(112 ± 25) minutes,and (26 ± 10) minutes,respectively.The in-hospital mortality was 7.5％ (5/67):2 patients died of multiple organ failure,1 patient died of acute renal failure and another 2 patients died of severe infection shock.Two patients required reexploration for root bleeding.Transient neurology dysfunction developed in 6 patients.Six patients received tracheotomy and prolonged ventilation due to pulmonary infection.All patients discharged from the hospital were followed up for 1 to 5 years.During long-term follow-up,the survival rate was 100％ and 89.8％ at 1 and 5 years,respectively.CT angiography was performed once per year after discharged.The left subclavian artery perfusion was good.No dissection or anastomosis leakage was identified in any case.Stroke and left limb ischemia did not develope.Conclusion For acute Stanford type A aortic dissection whose origin of the left subclavian artery is in the true lumen and no dissection existed near the artery's starting,the left subclavian artery revascularization by stented trunk fenestration technique during total arch replacement combined with stented elephant trunk implantation is reliable and effective.

Objective:To explore the clinical outcomes of recipients with refractory heart failure requiring an insertion of mechanical circulation support(MCS)device prior to heart transplantation(HT).Methods:From March 2017 to December 2021, retrospective review is performed for clinical data of 7 recipients with refractory heart failure requiring a bridging placement of MCS.There are 2 males and 5 females with an average age of(39.0±16.3)years(7~56 years)and an average weight of(57.6±19.9)kg(7~56 kg).The primary diseases of recipients are dilated cardiomyopathy(4 cases)severe viral myocarditis(2 cases)and ischemic cardiomyopathy(1 case).All of them develope acute decompensation of congestive heart failure.Before implanting MCS, two or more inotropic drugs are offered at maximal doses ages or IABP device, 6 cases required cardio-pulmonary resuscitation treatment and another patient for Heartcon assistance.All the patients bridge to heart transplatation.Results:Adjuvant therapy of MCS was offered for(20.0±11.5)d(7~34 d).Emergency HT is performed.Two post-HT deaths occurr due to multiple organ failure(1 case)and severe infection(1 case).The remainders recover smoothly during a follow-up period of(6~24 months).Conclusions:MCS device is recommended as a bridging too for HT recipients with refractory heart failure.It is imperative to improve clinical outcomes with MCS support before an onset of multiple organ dysfunction.Despite a perioperative mortality, long-term prognosis is generally satisfactory.

Objective To investigate the effect of ligustrazine on autophagy-related proteins Beclin 1,LC3 and P62 after spinal cord ischemia-reperfusion injury.Methods A total of 48 SD rats were randomly divided into sham operation group,model group,ligustrazine group and 3-MA group.The rats were intraperitoneally injected with ligustrazine injection 0.16 mg/kg in the Ligustrazine group,the rats were intraperitoneally injected with 3-methyladenine injection 0.015 mg/kg in the inhibitor group,and the rats were intraperitoneally injected with normal saline of equal volume in the sham operation group and model group.Spinal cord ischemia-reperfusion model was established in all groups except sham-operated group after administration.After molding behavioral scores were scored after 3 and 6 hours of ischemia,and the expression of Beclin 1,LC3 and P62 was detected by immunohis-tochemistry.Results After 3 and 6 hours,compared with the model group,the behavioral score (3 h:2.33 ± 0.58 vs.0.67 ± 0.58,6 h:3.33 ± 0.58 vs.1.33 ± 0.58) of the rats in ligustrazine group significantly increased (P＜0.05).Compared with the model group,the expression of Beclinl (3 h:348.00×104± 0.27×104 vs.659.00×104± 0.11×104;6 h:38.00×104± 0.19×104 vs.557.00×104± 0.26×104),LC3 (3 h:357.00×104± 0.48×104 vs.686.00×104± 0.33×104'6 h:334.00×104± 0.51×104 vs.673.00×104 ± 0.22×104),P62 (3 h:357.00×104 ± 0.48×104 vs.830.00×104 ± 0.48×104;6 h:315.00×104 ± 0.12× 104 vs.591.00× 104± 0.36× 104) in ligustrazine group were significantly decreased (P＜0.05).Conclusions The ligustrazine may regulate autophagy in two directions and protect nerve cells.

Objective To examine the results of surgical treatment for endograft infection after thoracic endovascular aortic repair (TEAVR). Methods Clinical data of 7 patients underwent surgical treatment for endograft infection after TEAVR at Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University between January 2016 and December 2018 were analyzed retrospectively. There were 6 males and 1 female, aging (51.5±16.7) years (range: 25 to 68 years). The origin of the aortic disease was descending aortic aneurysm in 5 cases, and Stanford B aortic dissection in 2 cases. Abdominal aorta below the level of the diaphragm was not involved in all patients. Two patients received "chimney technology" for left subclavian artery procedures. Time to infection was 5(3) months (M(QR)) (range: 1 to 24 months). Aortic endograft infection was diagnosed with a combination of microbiology (positive blood cultures, except one with mycotic), radiological evidence and clinical evidence of sepsis. Two patients suffered from aorto‐esophageal fistula received emergency surgery, others were treated with elective surgery. Extra‐anatomic prosthetic graft bypass was used for reconstruction of aorta, infected endogarft and aorta was removed, sac drainage was performed. Aorto‐esophageal fistula was procedured according to the degree of lesions. All patients received antibiotics with specialist advice for 6 to 8 weeks. Results One patient died due to septic shock. In the follow‐time (range: 6 to 24 months), 1 patient suffered from thoracic infection in 3 months after surgery, an other patient got iliac abscess after a month. Conclusions Endograft infection after TEAVR is high risk but may be curative. Appropriate selection of patients for infected endograft explantation could get a satisfied results.

Objective To examine the results of surgical treatment for endograft infection after thoracic endovascular aortic repair (TEAVR). Methods Clinical data of 7 patients underwent surgical treatment for endograft infection after TEAVR at Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University between January 2016 and December 2018 were analyzed retrospectively. There were 6 males and 1 female, aging (51.5±16.7) years (range: 25 to 68 years). The origin of the aortic disease was descending aortic aneurysm in 5 cases, and Stanford B aortic dissection in 2 cases. Abdominal aorta below the level of the diaphragm was not involved in all patients. Two patients received "chimney technology" for left subclavian artery procedures. Time to infection was 5(3) months (M(QR)) (range: 1 to 24 months). Aortic endograft infection was diagnosed with a combination of microbiology (positive blood cultures, except one with mycotic), radiological evidence and clinical evidence of sepsis. Two patients suffered from aorto‐esophageal fistula received emergency surgery, others were treated with elective surgery. Extra‐anatomic prosthetic graft bypass was used for reconstruction of aorta, infected endogarft and aorta was removed, sac drainage was performed. Aorto‐esophageal fistula was procedured according to the degree of lesions. All patients received antibiotics with specialist advice for 6 to 8 weeks. Results One patient died due to septic shock. In the follow‐time (range: 6 to 24 months), 1 patient suffered from thoracic infection in 3 months after surgery, an other patient got iliac abscess after a month. Conclusions Endograft infection after TEAVR is high risk but may be curative. Appropriate selection of patients for infected endograft explantation could get a satisfied results.