Objective:To examine the clinical outcomes of patients undergoing total thoracoscopic aortic-mitral double-valve replacement.Methods:This is a retrospective case series study. The clinical data of 50 patients who underwent double-valve replacement under a total thoracoscopic two-port approach from November 2021 to August 2022 in the Department of Cardiovascular Surgery, Fujian Medical University Union Hospital were retrospectively analyzed. There were 32 males and 18 females, with an age of (55.3±8.8) years (range: 21 to 62 years). Among them, 36 cases had rheumatic heart disease and 14 cases had infective endocarditis. The 3 rd intercostal space between the right anterior axillary line and the midclavicular line was selected as the main operating hole, the total thoracoscopic double-valve replacement were successfully carried out. Baseline data, intraoperative information, surgical outcomes, and postoperative complications were collected for all patients. Results:The cardiopulmonary bypass time was (168.2±30.9) minutes (range: 125 to 187 minutes), the aortic cross-clamping time was (118.8±16.5) minutes (range: 96 to 147 minutes). Five patients received bioprosthetic valves, and 45 received mechanical prosthetic valves. Postoperative mechanical ventilation lasted (9.6±3.4) hours (range: 5.1 to 14.2 hours), the ICU stay was (24.8±7.3) hours (range: 16.3 to 30.1 hours), and the postoperative hospital stay was (6.5±1.2) days (range: 5.0 to 8.0 days). Four patients received red blood cell transfusions of (2.7±0.9) units (range: 2 to 4 units), and the postoperative chest drainage volume was (222.1±56.3) ml (range: 175 to 289 ml). No deaths occurred intraoperatively or in the early postoperative period. One patient required reoperation due to bleeding in the aortic incision. Three patients had mild to moderate paravalvular leakage around the prosthetic aortic valve, with no cases of third-degree atrioventricular block or conversions to median sternotomy.Conclusions:The early outcomes of total thoracoscopic double valve replacement surgery are satisfactory, demonstrating safety and efficacy. This surgical approach expands the scope of total thoracoscopic cardiac surgery, which warrants further investigation and research.

Objective:To examine the clinical outcomes of patients undergoing total thoracoscopic aortic-mitral double-valve replacement.Methods:This is a retrospective case series study. The clinical data of 50 patients who underwent double-valve replacement under a total thoracoscopic two-port approach from November 2021 to August 2022 in the Department of Cardiovascular Surgery, Fujian Medical University Union Hospital were retrospectively analyzed. There were 32 males and 18 females, with an age of (55.3±8.8) years (range: 21 to 62 years). Among them, 36 cases had rheumatic heart disease and 14 cases had infective endocarditis. The 3 rd intercostal space between the right anterior axillary line and the midclavicular line was selected as the main operating hole, the total thoracoscopic double-valve replacement were successfully carried out. Baseline data, intraoperative information, surgical outcomes, and postoperative complications were collected for all patients. Results:The cardiopulmonary bypass time was (168.2±30.9) minutes (range: 125 to 187 minutes), the aortic cross-clamping time was (118.8±16.5) minutes (range: 96 to 147 minutes). Five patients received bioprosthetic valves, and 45 received mechanical prosthetic valves. Postoperative mechanical ventilation lasted (9.6±3.4) hours (range: 5.1 to 14.2 hours), the ICU stay was (24.8±7.3) hours (range: 16.3 to 30.1 hours), and the postoperative hospital stay was (6.5±1.2) days (range: 5.0 to 8.0 days). Four patients received red blood cell transfusions of (2.7±0.9) units (range: 2 to 4 units), and the postoperative chest drainage volume was (222.1±56.3) ml (range: 175 to 289 ml). No deaths occurred intraoperatively or in the early postoperative period. One patient required reoperation due to bleeding in the aortic incision. Three patients had mild to moderate paravalvular leakage around the prosthetic aortic valve, with no cases of third-degree atrioventricular block or conversions to median sternotomy.Conclusions:The early outcomes of total thoracoscopic double valve replacement surgery are satisfactory, demonstrating safety and efficacy. This surgical approach expands the scope of total thoracoscopic cardiac surgery, which warrants further investigation and research.

Objective:To explore the influence of multidisciplinary treatment (MDT) on clinical staging and diagnosis and treatment strategies for rectal cancer.Methods:A retrospective case series study was conducted. The clinical data of 142 rectal cancer patients who underwent surgical treatment in Shanxi Provincial People's Hospital from March 2021 to December 2021 were retrospectively analyzed. According to whether to implement MDT or not, all patients were divided into MDT group (68 cases) and non-MDT group (74 cases). Relevant clinical data including patients' basic information (gender, age, etc.), TNM staging, whether to receive neoadjuvant radiotherapy and chemotherapy or not, surgical methods, R0 resection rate of both groups were compared. The implementation methods and the effects of MDT for patients were summarized.Results:There were statistically significant differences in the proportion of clinical N staging at initial diagnosis, whether to receive neoadjuvant radiotherapy and chemotherapy or not of both groups (all P < 0.05). The overall agreement rate of clinical T staging at initial diagnosis and pathological T staging was 67.6% (46/68), 50.0% (37/74), respectively in the MDT group and the non-MDT group, and the difference was statistically significant ( χ2 = 4.54, P = 0.033). The overall agreement rate of N staging at initial diagnosis and pathological N staging was 50.0% (34/68), 54.1% (40/74), respectively in the MDT group and the non-MDT group, and the difference was not statistically significant ( χ2 = 0.23, P = 0.629). The treatment rate of neoadjuvant radiotherapy and chemotherapy was 57.4% (39/68) and 4.1% (3/74), respectively in the MDT group and the non-MDT group, and the difference was statistically significant ( χ2 = 48.33, P < 0.001). The R0 resection rate in both the MDT group and non-MDT group was 100.0%, and no tumor tissue was found at the upper, lower, and circumferential margins. Conclusions:MDT could provide more accurate clinical staging and more effective diagnosis and treatment opinions for patients, and provide reliable guidance for the treatment selections.

Objective:To introduce the application of sleeve reconstruction with bovine pericardium in the reoperation of Behcet's disease with advanced aortic annulus invasion, and to report our experience and the early outcomes.Methods:From August 2012 to May 2022, 19 patients with Behcet's disease developed perivalvular leakage after previous surgery underwent aortic root replacement. They were analyzed retrospectively. Fifteen out of 19 cases underwent conventional aortic root replacement, 4 cases with advanced aortic annulus invasion underwent sleeve reconstruction with bovine pericardium. The medical records were reviewed. Demographic and perioperative data were collected, which included the aortic crossclamp time, intraoperative RBC consumption, length of ICU stay, and major postoperative complications.Postoperative follow-up was accomplished through telephone visit.Results:The median age was 39(36, 42) years old. Five were female. The median interval of diagnosis of perivalvular leak from index surgery was 5(3, 14)months. There was no perioperative death. Fifteen patients underwent conventional aortic root replacement. One patient had intraoperative ECMO impant due to low cardiac output as well as another one had IABP support. CABG was performed in 5 patients. One patient underwent permanent pacemaker implantation after surgery. The median follow-up time for the 15 patients was 55.00(29.25, 71.25)months. Two patients were lost during follow-up. One patient died of infection 3 years after surgery. One patient developed perivalvular leak. Two patient developed distal anastomotic pseudoaneurysm which need reintervention. The median follow-up time for the 4 patients with sleeve reconstruction was 5.5(5, 11.25)months. One patient underwent tracheotomy. Perivalvular leakage and pseudoaneurysm were not appreciated. Four patients were in NYHA class Ⅰ-Ⅱ.Conclusion:The sleeve reconstruction with bovine pericardium is safe and effective in reoperation treating patients with Behcet's disease and advanced aortic annulus invasion.

Objective    To review and analyze the clinical manifestations of common aortitis in cardiac surgery. Methods    We screened 41 552 patients who were hospitalized in the Department of Cardiac Surgery of Zhongshan Hospital, Fudan University from 2010 to 2020, analyzed the patients' clinical data, and classified according to the type of diseases. Then we summarized all their clinical manifestations. Results    In our center 145 patients were operated for aortitis diseases, including 75 males and 70 females, with the age of 24-76 (45.6±11.3) years. There were 61 patients of Takayasu's arteritis, 51 patients of Behcet's disease, 8 patients of syphilitic aortitis, 8 patients of systemic lupus erythematosus, 2 patients of Kawasaki disease, 4 patients of ankylosing spondylitis, 10 patients of dry syndrome, and 1 patient of scleroderma. Conclusion    Aortitis is not uncommon in cardiac surgery, and awareness of the disease should be enhanced. So that we can distinguish various types of aortitis and to make proper management to improve patients' prognosis.

Objective:To explore the risk factors of early delayed recovery after right ventricular-extrapulmonary arterial(RV-PA)conduit reconstruction.Methods:From 2017 to 2021, the children with RV-PA conduit reconstruction, who were treated in our hospital were retrospectively analyzed.The demographic data and peri-operative clinical data of the patients were collected for statistical analysis.Results:Fifty-five patients were included in the study.The patients were sequenced by the length of ICU stay.The time at the 75th percentile was defined as the critical value for grouping.According to the ICU stay time of the children, they were divided into normal recovery group(ICU stay ≤7 days, n=40)and delayed recovery group(ICU stay>7 days, n=15).The mechanical ventilator time in the whole group was 24(0, 1 408)h, and the ICU stay time was 4(1, 67)d.Six cases required extracorporeal membrane oxygenation (ECMO) support, and two cases died.In the multivariate Logistic regression analysis of two groups, long cardiopulmonary bypass(CPB) time( OR=1.034, 95% CI 1.009-1.061, P=0.009)and poor right ventricular function( OR=9.536, 95% CI 1.010-90.037, P=0.049)were independent risk factors for early delayed recovery. Conclusion:The risk of RV-PA conduit reconstruction is high.The proportion of ECMO support is increased.The mortality rate is higher.Right heart dysfunction and prolonged CPB time are risk factors for delayed postoperative recovery.

Immunotherapy for gastric cancer has recently received attention. As a result, the guidelines for diagnosis and treatment of advanced gastric cancer have been revised. Many clinical studies have begun to pay attention to perioperative immunotherapy for gastric cancer. This article discusses the perioperative treatment of gastric cancer in the new era of immunity to contribute to the hot issues in this field.

Anastomotic leakage is one of the common and serious complications after colorectal cancer surgery, and it should be detected, prevented and treated as soon as possible. In recent years, the causes, diagnosis and treatment of postoperative anastomotic leakage of colorectal cancer have always been the focus of clinical attention, and relevant reports and prediction indicators continue to emerge. This article reviews the current situation and progress of biomarkers for predicting postoperative anastomotic leakage of colorectal cancer, in order to provide theoretical basis for early clinical detection and treatment of anastomotic leakage.

Objective    To discuss the feasibility of establishment of animal model of "functional" bicuspid aortic valve with swine and observe its effect on the wall shear stress inside the aorta. Methods    Four common Shanghai White Swine with body weight between 50 kg to 55 kg were selected. Under general anesthesia and cardiopulmonary bypass, the aortic transverse incision approach was used, continuous suture with 6-0 polypropylene to align the left and right coronary valve leaflets to create a bicuspid valve morphology. After the operation, echocardiography was used to observe the aortic valve morphology and the hemodynamic changes of the aortic valve orifice. The effect on the wall shear stress inside the aorta was studied with 4D-Flow magnetic resonance imaging (MRI). Results    A total of 4 swine "functional" bicuspid aortic valve models were established, with a success rate of 100.0%. Echocardiography showed that the blood flow velocity of the aortic valve orifice was faster than that before the operation (0.96 m/s vs. 1.80 m/s). 4D-Flow MRI showed abnormally increased wall shear stress and blood flow velocity in the aorta of the animal models. After the surgery, in model animals, the maximal wall shear stress inside the ascending aorta was greater than 1.36 Pa, and the maximum blood flow velocity was greater than 1.4 m/s. Conclusion    Establishment of the animal model of "functional" bicuspid aortic valve in swine is feasible, scientific and reliable. It can be used in researches on evaluating the pathophysiological changes.

Objective:To investigate the application value of mesocolon approach in transanal total mesorectal excision (TaTME).Methods:The retrospective cohort study was conducted. The clinicopathological data of 61 patients with middle or low rectal cancer who were admitted to the Nanchong Central Hospital of North Sichuan Medical College from January to December in 2018 were collected. There were 41 males and 20 females, aged from 43 to 81 years, with an average age of 62 years. Of the 61 patients, 30 patients undergoing TaTME with the conventional approach were allocated into traditional approach group, and 31 patients undergoing TaTME with mesocolon approach were allocated into mesocolon approach group. Observation indicators: (1) surgical situations; (2) postoperative recovery; (3) follow-up. Follow-up was conducted by outpatient examination and telephone interview once every 3 months to detect local recurrence and metastasis of tumors in patients up to June 2019. Measurement data with normal distribution were expressed as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were expressed as M (range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups were analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was analyzed using the Mann-Whitney U test. Results:(1) Surgical situations: patients in the two groups underwent TaTME successfully, without conversion to laparotomy. The transabdominal operation time, volume of intraoperative blood loss, length of distal margin from surgical specimen, length of proximal margin from surgical specimen, cases with complete mesentery or with nearly complete mesentery ( the integrity of mesentery ), positive rate of circumferential margin, positive rate of distal margin, and the number of lymph node dissected of the traditional approach group were (126±56)minutes, 41.0 mL (range, 17.5-71.4 mL), 1.3 cm (range, 0.8-2.0 cm), (10.0±5.0)cm, 10, 20, 3.3%(1/30), 0, 13.7 (range, 9.0-17.0), respectively, versus (101±30)minutes, 44.0 mL (range, 25.0-67.5 mL), 1.6 cm (range, 1.1-2.2 cm), (12.0±3.0)cm, 23, 8, 6.5%(2/31), 0, 13.0 (range, 10.9-17.3) of the mesocolon approach group. There were significant differences in the transabdominal operation time, length of proximal margin from surgical specimen, and the integrity of mesentery between the two groups ( t=2.133, -2.286, χ2=10.250, P<0.05). There was no significant difference in the volume of intraoperative blood loss, length of distal margin from surgical specimen, or the number of lymph node dissected between the two groups ( Z=-0.662, -1.107, 0.304, P>0.05). There was also no significant difference in the positive rate of circumferential margin or positive rate of distal margin between the two groups ( P>0.05). (2) Postoperative recovery: the time to first anal flatus of the traditional approach group was 51 hours (range, 48-64 hours). There were 3 patients with complications in the traditional approach group. One patient in the traditional approach group had postoperative anastomotic fistula of Clavien-Dindo classification Ⅱ, and was cured after conservative treatment including sufficient drainage, parenteral nutrition and anti-infective treatment. One patient had chylous fistula of Clavien-Dindo classification Ⅱ, and was cured after conservative treatment. One patient had pulmonary infection of Clavien-Dindo classification Ⅳa, and was cured after treatment in ICU. The duration of postoperative hospital stay of the traditional approach group was (11.3±4.5)days. The time to first anal flatus of the mesocolon approach group was 59 hours (range, 49-70 hours). One patient in the mesocolon approach group had paralytic ileus of Clavien-Dindo classification Ⅰ, and was cured after conservative treatment. The duration of postoperative hospital stay of the mesocolon approach group was (9.6±1.8)days. There was no significant difference in the time to first anal flatus or duration of postoperative hospital stay between the two groups ( Z=-0.554, t=1.884, P>0.05). There was no significant difference in the complications between the two groups ( P>0.05). (3) Follow-up: 61 patients were followed up for 6-18 months, with a median time of 12 months. There was no local recurrence or metastasis of tumors in patients during the follow-up. Conclusion:The mesocolon approach is safe and feasible in TaTME, which abides by the principle of radical resection, and can decrease the difficulty of mesocolon excision, shorten the time of transabdominal operation, increase the length of proximal margin from tumor specimen, improve the integrity of mesentery.