Objective To explore the short- and mid-term efficacy of Castor single branch aortic stent combined with subclavian artery bypass grafting for the aortic arch lesions. Methods A retrospective analysis of the clinical data of patients with proximal anchor zone insufficiency aortic arch lesions treated with Castor stent combined with subclavian artery bypass grafting at the Department of Cardiac Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from August 2020 to November 2023 was performed. Results A total of 22 patients were included, including 19 males and 3 females, with an average age of (56±16) years. There were 18 patients of aortic dissection and 4 patients of aortic arch tumors. The success rate of surgical technique was 100.0%, and the average postoperative hospital stay for patients was (10±4) days. The median follow-up time was 20 months. During the follow-up period, there were no major complications such as endoleak, paraplegia, cerebral infarction, and renal insufficiency, and all patients had no readmissions. Conclusion For proximal anchor zone insufficiency aortic arch lesions, the treatment method of using a Castor stent branch placed in the left common carotid artery can effectively extend the anchor zone, avoid the huge trauma of open chest surgery, and achieve a good short- and mid-term efficacy.

Thoracic endovascular aortic repair has served as the predominant treatment approach for patients with thoracic aortic diseases. In order to ensure the successful release of the stent as well as a good proximal anchoring effect, it is necessary to preserve or reconstruct the left subclavian supply as much as possible. With the advance of various endovascular assistive technologies, different left subclavian artery revascularization techniques have gained widespread acceptance. So far, techniques include carotid-subclavian bypass or transposition, chimney grafts, fenestrations, branched aortic devices can reconstruct the left subclavian artery and other branch vessels on the arch. This article reviewed the present situation of left subclavian artery reconstruction and the selection of surgical methods of thoracic endovascular aortic repair.

Objective:To investigate the short-term effects of staged hybrid abdominal aortic debranching technique in the treatment of thoracoabdominal aorta.Methods:From January 2018 to December 2018, 22 patients with thoracoabdominal aortic aneurysms underwent surgical treatment in Nanjing Drum Tower Hospital. Among them, 12 underwent staged hybrid abdominal aortic debranching (AAD), and 10 underwent traditional thoracoabdominal aortic replacement (TAR). AAD consisted of two phases: the first phase of surgery was mid-opening, Y-type artificial blood vessels replaced the lower abdominal aorta and bilateral common iliac arteries, and the abdominal aortic branches were reconstructed at the same time: right branch artificial blood vessels-right renal artery-left renal artery, the left branch artificial blood vessel-superior mesenteric artery-common hepatic artery; the second phase was endovascular repair anchoring normal and long-term normal aorta or artificial blood vessel. The clinical effected of two methods for the treatment of thoracoabdominal aortic aneurysms were compared and analyzed.Results:The overall mortality rate was 13.6%, and the mortality rate in the TAR group increased significantly (0 vs. 30%). The main cause was dissection (91.7% vs. 90.0%, P=0.895). Crawford classification was predominantly type Ⅱ in both groups(58.3% vs. 50.0%, P=0.082). The proportion of patients with Marfan syndrome in the TAR group was higher (30% vs. 0, P=0.046). The TAR group was significantly more drained 24 h after surgery [(355.0±199.2)ml vs. (1244.0±716.1)ml, P= 0.003]. The TAR group had a higher proportion of lung infections (40% vs. 0, P= 0.018). The average cost was higher in the AAD group [(28.4±8.3) ten thousands yuan vs. (19.3±10.4) ten thousands yuan, P= 0.033]. Conclusion:The staged hybrid abdominal aortic debranching technique can effectively treat thoracoabdominal aortic aneurysms. Compared with traditional thoracoabdominal aortic replacement, the surgical trauma is smaller but more expensive.

Objective:To introduce a new method of root reconstruction for proximal repair of acute type A aortic dissection, and to retrospectively analyze its short-term efficacy.Methods:From January 2018 to October 2019, a total of 455 patients with acute Stanford type A aortic dissection received surgical treatment. Among them, 343 patients underwent double-jacket-wrapping(DJW) root reinforcement(11 patients underwent leaflet suspension), 81 patients underwent Bentall surgery, 15 Wheat operations, 12 untreated roots, and 4 David operations. Compared 343 patients who underwent double-jacket-wrapping root reconstruction and 81 patients who underwent Bentall surgery. The perioperative indicators and short-term survival of the two groups were compared.Results:No patients died intraoperatively. The 30-day mortality rate in the DJW group and the Bentall group were 10.5% and 7.4%, respectively( P=0.403); cardiopulmonary bypass time were(218.8±68.4) min and(240.2 ± 59.8), P=0.011; aortic clamp time were(150.6 ± 47.9) min and(181.3 ±45.6)min, P=0.000. There was no difference between the operation time and the deep hypothermia circulatory time between the two groups. The mean follow-up was(11.7±6.4) months. Seven and two follow-up deaths occurred in the DJW group and the Bentall group, respectively, and the cause of death was not related to the aortic root. The degree of aortic regurgitation after DJW was 0.7±0.5, which was significantly lower than that before surgery( P=0.000). Conclusion:Compared with Bentall surgery, DJW method is a safe and effective method for the repair of acute type A aortic dissection roots, which can obtain good perioperative and early curative effects.

Objective:To assess the association of time interval with surgical repair effects for patients with ventricular septal defect(VSD) following acute myocardial infarction(AMI).Methods:From January 2010 to December 2017, 14 patients with VSD induced by AMI have received surgical therapy in our department. The age of the entire group was (65.5±3.3) years with male percentage of 78.6%(11/14). VSDs were anterior apical in 10(71.4%) and posterior inferior in 4(28.6%) patients. Average size of VSD was(15.8±5.8)mm. We retrospectively reviewed the patients' clinical manifestations, surgical methods and outcomes. According to the time interval from AMI onset and operation, patients were divided into two groups, Group 1(9 cases) as more than one week and Group 2(5 cases) as less than one week. Comparing study was done and differences were analyzed.Results:All patients underwent concomitant coronary artery bypass graft surgery. The cardiopulmonary bypass time and aortic clamp time was(203.9±52.3)min and(152.4±44.8)min. The mortality rate was 14.3%(2/14), higher in Group 2 but no significant differences(20.0% vs 11.1%, P=1.000). Mechanical support(IABP and ECMO) were more common in Group 2, both in preoperative(IABP 80.0% vs 22.2%, P=0.091; ECMO 20.0% vs. 0, P=0.357) and intraoperative period(IABP 60.0% vs. 0, P=0.027; ECMO 40.0% vs. 0, P=0.110). Compared with Group 1, Group 2 revealed worse left ventricular function(LVEF 0.304±0.023 vs. 0.408±0.103, P=0.035), higher rate of urgent procedure(100% vs. 11.1%, P=0.003). No resistant shunt and death was found during follow-up. Conclusion:Surgery is an effective way to treat AMI with VSD. When the time from onset to surgery exceeds one week, the patient's hemodynamic condition is more stable and the operation is safer. Patients undergoing surgery within one week show more unstable hemodynamic status, and mechanical assistance supports can correct the hemodynamic status and improve perioperative success rate.

This paper analyzed the current status of standardized training for specialists in China using American "milestone concept" and its competency training and assessment system for specialists as references. To achieve the goal of training high-standard and homogeneous cardiothoracic surgeons, a "milestone plan" focusing on the cultivation of diagnosis and treatment capacity of specialists, their mastery ability of medical knowledge, communication ability, professional ability, system-based clinical practice ability, practice-based learning ability and the ability of pursuing improvement was explored. In addition, daily assessment and summary assessment were carried out by means of self-evaluation, superior evaluation and peer evaluation. At the end, training of six core competencies and multi-dimensional evaluation system for cardiothoracic surgeons were constructed, which provided significant references to the construction of training and assessment system for specialists in China.

Objective To evaluate the safety and feasibility of extra-anatomic bypass in the treatment of complex aorta coarctation concomitant with cardiac lesions,multiple stenosis of aorta or severe stenosis.Methods Complex aorta coarctation include a combination of heart disease (valve disease,coronary artery disease,ect.),or multiple constrictive lesions of the thoracic abdominal aorta or an aneurysm due to constriction of the arch,which are all difficult by interventional surgery or open thoracotomy surgery.From October 2016 to October 2017,6 patients with complex aorta coarctation have received surgical therapy in our department,including 3 males and 3 females,with the average age(50.0-± 17.9) years old.One-staged extra-anatomic bypass was used to establish an ascending aorta to the distal aorta bypass,4 patients underwent median thoracotomy and bypass surgery with thoracic aorta from the posterior inferior pericardium,1 patient underwent bypass surgery with abdominal aorta through thoracoabdominal incision,and 1 patient underwent bypass surgery with bilateral femoral artery from bilateral inguinal incision and guiding with laparoscopic through peritoneal cavity.Among them,3 patients underwent valve surgery in the same period,and 1 patient underwent coronary artery bypass surgery.Results No patient died.The mean cardiopulmonary bypass time was 273.8 minutes and the average aorta blocking time was 216.0 minutes.Pulse pressure of extremities blood pressure was significantly reduced compared with preoperative,and the clinical symptoms were significantly alleviation.During follow-up,6 patients presented with patent artificial blood vessels and alleviated symptoms.Conclusion Extra-anatomic bypass is a safe and effective method for the treatment of complex vasoconstriction without increasing the risk of surgery.

Objective To summarize the surgical treatment strategy of acute Stanford A aortic dissection with coronary malperfusion.Methods From January 2010 to November 2015,307 patients of acute Stanford A aortic dissection underwent operation were included.The mean age was (51.3 ± 13.0) years,ranged from 22 to 83.The BMI was (25.4 ± 3.7) kg/m2 and 239 (77.9％) were men.There were 210 (71.2％) with hypertension,9 (2.9％) with Marian syndrome,and 44 (14.3％) with cardiac tamponade.Coronary malperfusion was confirmed in 43(14.0％) patients with 34 in right coronary artery,5 in left coronary artery,and 4 in both.There were 26 type A,8 type B,9 type C in Neri system.We performed coronary ostia repair in 12 patients,Bentall in 16,coronary artery bypass grafting(CABG) in 9,and Bentall plus CABG in 6.CABG was also performed in 1 Bentall,1 aortic valve repair,and 5 ascending aorta replacement in 264 patients without coronary malperfusion.Results The rate of CABG,cardiopulmonary bypass(CPB) time,aorta cross-clamp time were significantly higher in patients with coronary malperfusion(P ＜0.01).The in-hospital mortality was 32.6％ in patients with coronary malperfusion and 14.4％ in patients without coronary malperfusion.Thus,coronary malperfusion significantly increased in-hospital mortality(P ＜0.01).The mean follow-up time was(19.2 ± 18.0) months with a 95％ follow-up rate.The total follow-up survival rate is 97.5％ and the rate of patients with coronary malperfusion is 100％.Multivariate logistic regression analysis shows that cardiac tamponade(OR =4.8,P ＜0.01) and CPB time(OR =1.0,P ＜0.01) was the independent risk factor of post-operation inhospital mortality of acute Stanford A aortic dissection.Conclusion Acute Stanford A aortic dissection with coronary malperfusion has a significantly high in-hospital mortality with the indeed need of revascularization of coronary arteries rapidly.The treatment strategy depends on the specific clinical condition.

Objective To analyze early-and mid-term outcomes of aortic valve repair(AVr) for patients with aortic re gurgitation(AR).Methods From April 2010 to December2013,94 patients underwent elective aortic valve repair(AVr) for aortic regurgitation(AR).There were 36 male and 58 female,and the mean age was(51.3 ± 18.0) (6-75)years.There were 2 patients(2.1％) with severe AR,88 patients (93.6 ％) with moderate AR,and 4 patients (4.3％) with mild AR.The total number of the aortic valve lesions were 110,including 31 for annnlar dilatation,1 for leaflets fenestrations,1 for leaflets vcgctation,61 for leaflets prolapses,11 for leaflets calcification or thickness,and 4 for commissure fusion.We performed the annuloplasty for 32 patients including commissure plicature for 20 patiengs,subcommissural annuloplasty for 11 patients,valve-sparing aortic root replacement for 1 patient,and the valvuloplasty for 78 patients,including leaflets plicature for 2 patients,commissure suspension for 59 patients,leaflets shaving for 11 patients,commissure resection for 4 patients,leaflet patch repair for 1 patient,and leaflets vegetation msection for 1 patient.The concomitant procedures include coronary artery bypass grafting for 18 patients,mitral valve replacement/repair for 72,tricuspid valve replacement/repair for 75,congenital heart disease correction for 27,and ascending aorta plasty for 9.Results There was no case with aorta re-erossclamp,or aortic valve replacement due to AVr failure.In-hospital mortality was 4.25％ (4/94).Postoperative echocardiography showed 75 patients (79.8％)with none AR,13 (13.8％) with mild regurgitation,and 6 (6.4％) with moderate regurgitation.There was no severe AR post operative.AR gradient reduced in 94.7 ％ (89/94) of patients.The mean follow-up period was (30.6 ± 10.4) months,and the overall survival and the freedom of re operation for aortic valve were 100％.Conclusion There was good early-and mid-term outcomes of aortic valve repair for patients with aortic regurgitation.