Objective To compare the clinical efficacies among three surgical approaches of small inci-sion in the lower segment of the sternum,small incision in the right axilla and thoracoscopic 3 incisions for re-pairing adult giant atrial septal defects(ASD).Methods The medical records of 112 patients with giant ASD undergoing surgical repair in this hospital from January 2018 to January 2024 were retrospectively analyzed.According to the different surgical approaches,the patients were divided into the group A(n=35,small inci-sion in the lower part of the sternum),group B(n=37,small incision in the right axilla)and group C(n=40,thoracoscopic 3 incisions).The general data,operation time,cardiopulmonary bypass time,blood transfusion volume,incision length,postoperative VAS score,postoperative mechanical ventilation time,ICU stay time,postoperative hospitalization duration,hospitalization cost and postoperative complications occurrence rates were compared among the various groups.Results There were no statistically significant differences in the operation time,cardiopulmonary bypass time,blood transfusion volume,postoperative mechanical ventilation time,ICU stay time and postoperative hospitalization duration among 3 groups(P＞0.05).The hospitalization cost in the group C was higher than that in the groups A and group B,the postoperative VAS score in the group B was higher than that in the group A and C,the incision size in the group C was shorter than that in the group A and group B,and the differences were statistically significant(P＜0.05).All patients were suc-cessfully repaired.The incidence rate of postoperative pulmonary infection in the group A and group C was lower than that in the group B,and the difference was statistically significant(P＜0.05).Conclusion All three surgical approaches could safely and effectively repair adult giant ASD.Different surgical approaches should be selected based on the specific conditions of the patients.

Objective To analyze warfarin anticoagulation therapy for patients after heart valve replacement,and to explore an optimal intensity of warfarin anticoagulation.Methods The administration method,international normalized ratio (INR) monitoring of 265 patients who received warfarin anticoagulation therapy after heart valve replacement were analyzed retrospectively.The patients were divided into three groups according to different valve prostheses:aortic valve replacement (AVR) group (37 cases),mitral valve replacement (MVR) group (165 cases) and double valve replacement (DVR) group (63 cases).Each group was divided into two subgroups according to their INR levels (INR 1.5-2.0,INR 2.1-2.5).The occurrence of bleeding and thromboembolic events in these subgroups were compared.Results A total of 265 cases were visited,and followed up for 4 months to 6 years.The dose of warfarin was 0.625-7.500 (2.5 ± 1.4) mg/d.The incidence of anticoagulation adverse events was 23 cases.The incidence of bleeding events was 6.79％ (18/265),which was higher than that of thromboembolic events (1.89％,5/265),and there was significant difference (P ＜ 0.05).Four cases of the hemiplegia sequelae occurred and 2 cases died.The incidence of bleeing events in patients with INR1.5-2.0 in AVR group,MVR group and DVR group were 0 (0/20),3.57％ (3/84),2.70％ (1/37),in patients with INR 2.1-2.5 were 1/17,11.11％ (9/81),15.38％ (4/26),and there were significant differences (P ＜ 0.05).There were no significant differences in the incidence of thromboembolic events between INR 1.5-2.0 and INR 2.1-2.5 in AVR group,MVR group and DVR group (P ＞ 0.05).Conclusions After heart valve replacement,the anticoagulation therapy with warfarin is effective and safe to maintain the low intensity anticoagulation (INR1.5-2.0).AVR and MVR/DVR may benefit from a treatment strategy with levels ranging from 1.5-1.8 and 1.8-2.0,and the anticoagulation therapy of individuation should be formulated according to different conditions.