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Community prevention for 2019 novel coronavirus (SARS-CoV-2) infection

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):237-239.

人群普遍易感新型冠状病毒（SARS-CoV-2）。有效遏制疫情扩散和蔓延，离不开全民参与早发现、报告疑似病例、管理高风险感染者等群防群控工作。依据国家卫生健康委员会和中国疾病预防控制中心等的相关发布，特为社区开展防控工作做如下推荐。

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Surgical treatment of latent infection of 2019 novel coronavirus (SARS-CoV-2) with esophageal foreign body perforation: A case report

TONG Song ; CHEN Zhuo ; WU Chuangyan ; XU Kaiying ; YANG Guanghai ; LIAO Yongde ; WANG Sihua

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):240-242.

This study reports the surgical treatment of a female patient at age of 64 years with novel coronavirus (SARS-CoV-2) latent infection complicated with esophageal foreign body perforation with no significant changes in the lung CT. The patient was confirmed as SARS-CoV-2 infection on the 4th day after surgery and then was transferred into the Department of Infectious Disease in our hospital for treatment. This case has guiding value for the operation of thoracic surgery during the outbreak of novel coronavirus pneumonia.

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Management strategy of emergency surgery combined with 2019 novel coronavirus (SARS-CoV-2) infection in cardiovascular surgery

CHEN Si ; SHI Jiawei ; XIA Jiahong ; DONG Nianguo

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):243-245.

新型冠状病毒（2019 novel coronavirus，SARS-CoV-2）感染现已被纳入《中华人民共和国传染病防护法》规定的乙类传染病，并采取甲类传染病预防控制措施。

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Chinese expert consensus of surgical treatment of congenital heart disease (2): Congenital aortic valve stenosis

Bin JIA ; Shoujun LI

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):246-250.

Congenital aortic valve stenosis in children, one of left ventricular outflow tract obstructive lesions, is difficult to operate with high risk of re-intervention. It becomes one of the difficulties in the field of children's heart disease. According to the peak gradient pressure across aortic valve, it can be divided into mild stenosis (<50 mm Hg), moderate stenosis (50-75 mm Hg) and severe stenosis (>75 mm Hg). Emergency or limited surgery is required for the patients with heart failure and patent ductus arteriosus (PDA)-dependent circulation, and patients with peak pressure gradient of 50 mm Hg or higher, or with obvious clinical symptoms should undergo surgery. The main surgical procedures include balloon aortic valve dilatation, suigical aortic valvulotomy, aortic valve reconstruction with pericardium, other aortic valvuloplasty, Ross operation and valve replacement, and aortic annulus enlargement if necessary. Heart transplantation should be considered in case of unrepairable severe lesions and poor results of valve repair. Fetal intervention remains controversial with high incidence of related complications. Aortic valve stenosis in children is a lifelong problem. To release valve stenosis appropriately and to promote children’s growth and development are the main purposes of surgery, but some children eventually need more surgeries and finally valve replacement. The long-term complications, survival rate and reintervention rate still need more attention.

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Anatomic correction for congenitally corrected transposition of the great arteries and 10-year follow-up: A retrospective cohort study

HE Xiaomin ; ZHENG Jinghao ; LUO Kai ; SUN Qi ; ZHU Zhongqun ; XU Zhiwei ; LIU Jinfen

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):255-259.

Objective To evaluate the effects of anatomic correction for congenitally corrected transposition of the great arteries (ccTGA) and 10-year follow-up. Methods From January 2008 to December 2018, 48 patients with ccTGA who underwent anatomic correction were reviewed. There were 29 males and 19 females with age of 39.2 (3-91) months. The cohort was divided into two groups: a biventricular anatomic correction group (39 patients) and a 1.5 ventricular anatomic correction group (9 patients). They were followed for in-hospital mortality, late mortality, long-term survival, freedom from reoperation, and heart function. Results There were 3 early deaths and 2 early re-intervention in the biventricular anatomic correction group, but no death and only one re-intervention in the 1.5 ventricular anatomic correction group. Compared with the biventricular anatomic correction group, the operation time, tracheal intubation and ICU time were significantly reduced or shortened in the 1.5 ventricular anatomic correction group (P<0.05). The patients were followed up for 0.5-10.4 years. Four patients were lost. Two patients died in the biventricular anatomic correction group, and two patients received re-intervention. The 1-year, 5-year and 10-year survival rate was 88.2%, 84.0%, and 84.0%, respectively. There was no death or intervention in the 1.5 ventricular anatomic correction group. The quality of life of the other patients in the medium-term follow-up was satisfactory. Only 2 patients were classified as grade Ⅲ in cardiac function, and the other patients were classified as grade Ⅰ-Ⅱ. Conclusion According to the different anatomic characteristics of ccTGA, the individualized strategy of anatomic correction can achieve satisfactory surgical results, and the medium-term quality of life was good. Especially, 1.5 ventricular anatomic correction may obtain better therapeutic effects because of its lower operative mortality and less postoperative complications.

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Efficacy of different treatment strategies for congenital aortic valve disease in 85 children from a single center: A retrospective cohort study

WANG Kun ; JIA Bing

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):260-263.

Objective To analyze the early- and middle-term prognosis of various surgical methods in children with congenital aortic valve diseases, to provide reference for surgical methods in children with aortic valve stenosis or regurgitation. Methods The clinical data of 85 children with various aortic valve diseases treated in the Children’s Hospital of Fudan University from January 2005 to December 2018 were retrospectively analyzed. There were 64 males and 21 females, with an average age of 45 months ranging from 5 days to 15 years. Among them 18 patients underwent balloon aortic valvuloplasty (BAV), 8 surgical aortic valvotomy (SAV), 27 aortic valve autogenous pericardium repair, 16 mechanical arterial valve replacement and 16 Ross operation. They were followed up for 6.25±2.76 years. The re-intervention and survival status after different operations were analyzed. Results There were 3 deaths and 17 reoperations in 85 children. The 5-year survival rate of the patients with SAV, BAV, aortic valve autogenous pericardium repair, mechanical arterial valve replacement and Ross operation was 87.4%, 88.9%, 100.0%, 100.0% and 100.0%, respectively; there was no statistical difference in the early and middle-term survival rates among various operations (P>0.05). The 5-year free from re-intervention rate of the patients with SAV, BAV, aortic valve autogenous pericardium repair, mechanical arterial valve replacement and Ross operation was 44.4%, 18.4%, 100.0%, 66.9% and 80.5%, respectively; there was a statistical difference in the early and middle-term re-intervention rate among various operations (P<0.05). Conclusion The operation of congenital aortic stenosis or regurgitation needs to be performed according to the pathological changes of the valvular tissues. For children with severe lesions, SAV is recommended for the first intervention. For congenital aortic stenosis, SAV and BAV are both palliative operations which need further evaluation and re-intervention. Ross operation and mechanical arterial valve replacement have low re-intervention rate, and the middle- and long-term follow-up shows that the effect is accurate. Aortic valve autogenous pericardium repair is expected to become a method to delay or replace Ross operation and valve replacement.

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Totally thoracoscopic repair of atrial septal defect: A single-center clinical study

LAN Huai ; CHENG Yunge ; JIA Baocheng ; CHAI Yuliang

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):264-267.

Objective To summarize the experience of totally thoracoscopic cardiac surgery (TTCS) for atrial septal defect. Methods Clinical data of 442 patients undergoing TTCS for atrial septal defect from May 2008 to December 2018 in Shanghai Yodak Cardiothoracic Hospital was analyzed retrospectively. There were 149 male and 293 female patients, aged 3-74 (29.1±14.3) years. Surgical procedures were performed through 3 ports at the right chest wall. Results All the operations were completed successfully. Mean operative time was 1.5-4.6 (2.2±0.3) h. The mean extracorporeal circulation and aortic cross-clamp time was 28-118 (55.9±13.3) min and 8-78 (21.5±10.2) min, respectively. Mechanical ventilation and intensive care unit stay time was 3.5-122.0 (8.1±7.4) h and 13-141 (20.7±10.2) h, respectively. Postoperation drainage volume was 70-1 280 (251.8±131.5) mL. The hospital stay was 4-16 (7.1±1.4) d. Intraoperative and postoperative complications occurred in 15 patients (3.3%). The mean follow-up time was 1-128 (67.6±33.3) months, and during the period, there were 25 patients of atrial fibrillation, 25 patients of mild-moderate tricuspid valve incompetence, 1 patient of moderate tricuspid valve incompetence. There was no reoperation or residual shunt during the period of follow-up. And the heart function was improved. Conclusion TTCS is a feasible, safe and minimal invasive approach for patients with atrial septal defect and has good short to medium-term outcomes.

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Clinical application of 3D printed titanium chest and rib implants in chest wall reconstruction

ZHANG Hao ; HUANG Lijun ; ZHU Yifang ; YANG Sanhu ; LIU Xi ; CAO Tiesheng ; LIANG Jiahe ; GUO Yitong ; WANG Lei ; LI Xiaofei

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):268-273.

Objective In this study, three-dimensional printed (3DP) titanium implants were used for skeletal reconstructions after wide excision of chest wall. 3DP titanium implants were expected to provide a valid option with perfect anatomic fitting and personalized design in chest wall reconstruction. Methods There were 13 patients [mean age of 46 (24-78) years with 9 males and 4 females] who underwent adequate radical wide excision for tumors and chest wall reconstruction using 3DP titanium implants. Surgical data including patient demographic characteristics, perioperative clinical data and data from 1-year follow-up were collected and analyzed. Results Six patients of rib tumors, six patients of sternal tumors and one patient of sternal pyogenic osteomyelitis were finally selected for the study. The chest wall defect area was 221.0±206.0 cm2. All patients were able to maintain the integrity of the chest wall after surgery, and no abnormal breathing was found, achieving personalized and anatomical repair. Thirteen patients were successfully discharged from the hospital. Two patients developed pneumonia in the perioperative period. During the follow-up period in the first year after surgery, no implant related adverse reaction was observed, including implant rupture, implant shift, rejection reaction and allergies. One patient had wound ulcer after chemotherapy. Three patients had tumor recurrence, with the recurrence rate of 25.0%. Two patients died of tumor recurrence, with a mortality rate of 16.7%. Conclusion 3DP titanium implant is a safe and effective material for chest wall reconstruction.

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Short-term effects of Da Vinci robot Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease

KANG Poming ; TAO Shaolin ; TAN Qunyou ; JIANG Bin ; WU Licheng ; FANG Chunshu ; LI Qingyuan ; WANG Ruwen

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):274-278.

Objective To investigate the short-term effects of Da Vinci robot-assisted Nissen fundoplication in the treatment of refractory gastroesophageal reflux disease (rGERD), and to evaluate the safety and efficacy of its surgical treatment. Methods A total of 40 patients with rGERD treated by Da Vinci robot-assisted surgery from October 2016 to November 2019 in our hospital were collected. There were 23 males and 17 females at age of 34-76 (61±23) years. The related clinical data were retrospectively analyzed, and the operation skills of Da Vinci robot-assisted Nissen fundoplication with rGERD were summarized. Results There was no perioperative death or serious complication such as esophagogastric fistula. Postoperative reflux symptoms were significantly improved. DeMeester scores after surgery (39.79±35.01 points vs. 2.61±2.40 points, P=0.029), lower esophageal sphincter pressure (8.74±7.21 mm Hg vs. 24.56±8.76 mm Hg, P=0.020), integrated relaxation pressure (7.29±7.21 mm Hg vs. 16.49±9.99 mm Hg, P=0.023), distal contractile integral (600.49 ± 665.30 mm Hg·s·m vs. 510.99 ± 580.60 mm Hg·s·m, P=0.042), GERD-Q scale score (12.98±2.39 points vs. 7.59±1.11 points, P=0.033) were significantly improved compared with those before surgery. Postoperative dysphagia was found in 2 patients. And dysphagia was alleviated after diet adjustment and other treatments. Conclusion Da Vinci robot-assisted Nissen fundoplication is a safe and effective treatment for rGERD.

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Da Vinci robot-assisted surgery versus video-assisted thoracoscopic surgery for resection of mediastinal tumors: A retrospective cohort study

ZENG Liping ; WANG Zhitian ; HE Zhehao ; ZHU Linhai ; WANG Luming ; ZHANG Chong ; HU Jian

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery.2020;27(03):279-283.

Objective To summarize the experience of minimally invasive anterior mediastinal tumor resection in our center, and compare the Da Vinci robotic and video-assisted thoracoscopic approaches in the treatment of mediastinal tumor. Methods A retrospective cohort study was conducted to continuously enroll 102 patients who underwent minimally invasive mediastinal tumor resection between September 2014 and November 2019 by the single medical group in our department. They were divided into two groups: a robotic group (n=47, 23 males and 24 females, average age of 52 years) and a thoracoscopic group (n=55, 29 males and 26 females, average age of 53 years). The operation time, intraoperative blood loss, postoperative thoracic drainage volume, postoperative thoracic drainage time, postoperative hospital stay, hospitalization expense and other clinical data of two groups were compared and analyzed. Results All the patients successfully completed the surgery and recovered from hospital, with no perioperative death. Myasthenia gravis occurred in 4 patients of the robotic group and 5 of the thoracoscopic group. The tumor size was 2.5 (0.8-8.7) cm in the robotic group and 3.0 (0.8-7.7) cm in the thoracoscopic group. Operation time was 62 (30-132) min in the robotic group and 60 (29-118) min in the thoracoscopic group. Intraoperative bleeding volume was 20 (2-50) mL in the robotic group and 20 (5-100) mL in the thoracoscopic group. The postoperative drainage volume was 240 (20-14 130) mL in the robotic group and 295 (20-1 070) mL in the thoracoscopic group. The postoperative drainage time was 2 (1-15) days in the robotic group and 2 (1-5) days in the thoracoscopic group. There was no significant difference between the two groups in the above parameters and postoperative complications (P>0.05). The postoperative hospital stay were 3 (2-18) days in the robotic group and 4 (2-14) in the thoracoscopic group (P=0.014). The hospitalization cost was 67 489 (26 486-89 570) yuan in the robotic group and 27 917 (16 817-67 603) yuan in the thoracoscopic group (P=0.000). Conclusion Compared with the video-assisted thoracoscopic surgery, Da Vinci robot-assisted surgery owns the same efficacy and safety in the treatment of mediastinal tumor, with shorter postoperative hospital stay, but higher cost.

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