膨体聚四氟乙烯补片在腹外疝修补中的应用

目的探讨膨体聚四氟乙烯补片在成年人腹外疝手术治疗中的技术操作要点,并评价治疗效果。方法回顾性分析我院1998年至2008年,采用美国Gore公司生产的膨体聚四氟乙烯补片施行平片无张力疝修补术的859例腹外疝患者的I临床资料。其中腹股沟斜疝731例,占85．0％;腹股沟直疝86例,占10．0％;股疝13例,占1．5％;切口疝12例,腹白线疝9例,脐疝8例。结果全部病例手术成功,平均手术时间95min,手术后疼痛轻微,无明显异物感。术后平均住院时间4．6d。随访10个月-60个月,平均30个月,无复发病例。结论平片无张力疝修补术具有安全、经济、简便、复发率低的优点,疗效肯定,临床上基本可以满足各种情况下无张力疝修补手术的需要。     

Transcatheter pulmonary valve replacement using the melody valve for treatment of dysfunctional surgical bioprostheses: A multicenter study

Background

Stented bioprosthetic valves (BPVs) are commonly used for surgical pulmonary valve (PV) replacement in postoperative congenital heart disease, but develop structural failure in a time-related fashion. The Melody transcatheter PV (TPV) (Medtronic, Minneapolis, Minn) has been used to treat BPV dysfunction, but there have been few studies in this population.

层层自组装肝素/胶原复合涂层聚四氟乙烯小口径人工血管的研究

目的 观察层层自组装肝素/胶原复合涂层聚四氟乙烯小口径人工血管片的抗凝血性能和血液相容性.方法 实验分为复合人工血管片组和普通人工血管片组.采用层层静电组装的方法将带负电的肝素与带正电的胶原交替涂覆到聚四氟乙烯小口径人工血管片上,制备成复合人工血管片.参照IS010993-4及GB/TI6886标准中实验方法行血小板黏附实验、溶血实验及血浆复钙时间实验检测.结果 扫面电镜照片可以观察到普通人工血管片表面有大量血小板黏附,血小板呈扁平状贴覆在材料表面,复合血管片组表面有少量血小板贴覆(2.5±2.4比28.5±4.8,P＜0.05);普通血管片溶血率0.63％,复合血管片溶血率1.27％,均＜5％,且两者差异无统计学意义(P＞0.05);普通血管片血浆复钙时间为8.5 min,复合血管片观察至30 min未见纤维蛋白丝.结论 层层自组装肝素/胶原复合涂层聚四氟乙烯小口径人工血管片具有良好的抗凝血性能及血液相容性.     

Early and midterm outcomes of transcatheter aortic valve replacement in patients with bicuspid aortic valves

Background

Bicuspid aortic valve (BAV) stenosis has been considered a relative contraindication to transcatheter aortic valve replacement (TAVR). We compared the outcomes of TAVR in patients with BAV stenosis versus patients with trileaflet aortic valve stenosis.

Methods

From March 2012 to September 2017, 727 patients underwent TAVR. Thirty‐two patients with BAV were included in this study and compared to 96 patients with comparable risk factors (1:3) with a trileaflet aortic valve (TAV). Transesophageal echocardiography was used to estimate post‐TAVR degree of paravalvular leak (PVL).

Results

Mean ± standard deviation Society of Thoracic Surgeons risk was 6.01 ± 3.42 in the BAV group and 6.08 ± 3.76 in the TAV group (P = 0.92). Thirty‐day mortality was 4.2% (N = 4) in the TAV group and 6.25% (N = 2) in the BAV group (P = 0.63). Three (3.1%) patients in the TAV group and two (6.25%) patients in the BAV group developed a post operative stroke (P = 0.59). Following TAVR, mean aortic valve gradient significantly decreased in both TAV (42.56 ± 14.93 vs 9.27 ± 5.57, P < 0.001) and BAV (44.12 ± 11.82 vs 9.03 ± 7.29, P < 0.001) groups. No patient had a severe PVL after TAVR, and only two (2.08%) patients in the TAV group and one (3.12%) patient in the BAV group had moderate PVL (P = 1.0). Patient survival rate at 1 and 2 years was 86% in the BAV group and 90% at 1 and 2 years in the TAV group (P = 0.74).

Conclusions

TAVR in BAV disease is feasible with favorable valve performance. Immediate and mid‐term outcomes of TAVR in patients with BAV are comparable to those with TAV.     

Repair of tricuspid valve with pulmonary valve replacement in repaired tetralogy of fallot

Objectives: We aimed to investigate the outcome of tricuspid valve repair (TVR) performed concomitantly with pulmonary valve replacement in repaired tetralogy of Fallot (TOF) patients. Design: This retrospective study included all patients who underwent pulmonary vale replacement from 2000 to 2016 after TOF correction. TVR patient data were compared to those of patients who underwent pulmonary vale replacement alone. Results: Thirty-eight patients were enrolled. The degree of tricuspid regurgitation was significantly decreased after operation in the TVR group. Tricuspid valve annulus and annuloectasia before operation did not vary between groups (21.1?±?6.3 and 41.4% in no TVR vs. 21.3?±?4.8 and 52.6% in TVR). However pre-operative right ventricular volumes were larger in the TVR group. Normal tricuspid valve coaptation (body to body) was observed less frequently in the TVR group than in the other group (52.6% vs. 93.1%, p < .001). Pre-operative tricuspid regurgitation had a linear correlation with right ventricular volume, but not with tricuspid annulus size. Conclusion: Tricuspid annulus diameter decreased significantly regardless of TVR. Abnormal coaptations were observed more in patients group and the degree of pre-operative tricuspid regurgitation was linearly correlated with right ventricular volume rather than tricuspid annulus size.     

Long-term outcomes of expanded polytetrafluoroethylene conduits with bulging sinuses and a fan-shaped valve in right ventricular outflow tract reconstruction

Objective

Various types of conduits are available for right ventricular outflow tract (RVOT) reconstruction. We have developed an expanded polytetrafluoroethylene (ePTFE) conduit with bulging sinuses and a fan-shaped ePTFE valve. This study summarized the results of a multicenter study evaluating the valved ePTFE conduit.

A polyurethane vascular access graft and a hybrid polytetrafluoroethylene graft as an arteriovenous fistula for hemodialysis: comparison with an expanded polytetrafluoroethylene graft

AIM: We evaluated a polyurethane vascular access graft (TVAG), a hybrid polytetrafluoroethylene graft (hPTFEG), and an expanded polytetrafluoroethylene graft (ePTFEG) for postoperative complications and graft patency in their use as prosthetic devices of vascular access for hemodialysis. METHODS: Between August 1993 and October 2001, we treated 200 patients in whom A-V fistulas were placed by the same surgeon. These were divided into the following four groups according to the type of blood access: 27 cases of ePTFEG, 23 cases of TVAG, 22 cases of hPTFEG, and 128 cases of an autogenous A-V fistula. We calculated the cumulative patency rates by the Kaplan-Meier method, including primary (problem-free) and secondary (revised or functional) patency rates. RESULTS: The hPTFEG group experienced few thromboses. The absence of perigraft edema in the TVAG group permitted the early use of the TVAG within a few postoperative days for hemodialysis. Among the three graft groups, the primary patency was the best in the hPTFEG group (94.7% at 1 year and 86.1% at 2 years), with a significant difference versus the ePTFEG group. In regard to secondary patency, hPTFEG had an excellent patency of 100% at 1 year and 90.9% at 2 years, and TVAG had a comparable patency with that of ePTFEG. CONCLUSION: The hPTFEG was considered superior to ePTFEG in terms of being complication-free and had the excellent 2 year secondary patency of 90.9%. TVAG, with a patency equal to that of ePTFEG, could be used immediately after implantation due to the absence of limb edema.     

国产膨体聚四氟乙烯在整形美容外科中的应用

目的评估国产膨体聚四氟乙烯(ePTFE)在整形美容外科中的临床效果. 方法采用国产ePTFE,以进口ePTFE作为对照,根据不同需要分别置于额部、颞部、鼻部、颏部、鼻基底及上颌部,矫正面部软组织缺损及凹陷畸形,比较2组术后伤口愈合、不良反应及临床效果. 结果试验组16例18个部位,术后随访6～9个月,其中1例(鼻部)因埋置过浅、过于接近切口继发感染而取出;1例(颏部)伤口愈合不良,假体外露,经换药后术后2周Ⅱ期愈合;其余病例临床观察未见明显过敏反应、炎症反应及排异反应,外形保持良好,满意率94.4%(17/18).对照组10例12个部位,术后随访6～9个月,1例(鼻部)假体外露取出,其余病例未出现异常情况,满意率为91.7%(11/12).2组在伤口愈合情况(χ2=1.109,P=0.574)、不良反应(P=1.000)和临床疗效(P=1.000)等方面均无显著性差异. 结论国产ePTFE具有良好的组织相容性,适合充填软组织,可作为安全而廉价的替代产品.     

Transcatheter aortic valve replacement as a bridge to surgical aortic valve replacement in a younger patient with extremely high surgical risk

A 50‐year‐old man with decompensated aortic stenosis displayed significantly reduced ejection fraction, an ascending aortic aneurysm (55 mm in diameter), and bilateral giant bullae, and was evaluated as having extremely high surgical risk. Therefore, as a bridge to definitive treatment, he simultaneously underwent transcatheter aortic valve replacement (TAVR) and upper left lung lobectomy. His heart function recovered 6 months later and he underwent surgical aortic valve replacement (SAVR) and graft replacement of the ascending aorta. TAVR may serve as a bridge procedure before SAVR for aortic stenosis in younger patients with high surgical risk.     

High-Porosity expanded polytetrafluoroethylene grafts with omentum wrap for portal vein replacement: Intermediate results

The purpose of this study was to examine the intermediate (6-month) patency and healing characteristics of high-porosity expanded polytetrafluoroethylene (ePTFE) grafts with and without omentum wrap in a dog portal vein replacement model, compared with short-term (1-month) results. The grafts, either wrapped by omentum or not, were placed as portal vein replacements in 22 mongrel dogs. After 1 and 6 months, the grafts were retrieved and examined for patency and subjected to pathology study. Although the short-term patency rate in all grafts was 100%, regardless of the presence or absence of omentum wrap, the intermediate patency of high-porosity ePTFE without omentum wrap was very poor (20%). On the other hand, high-porosity ePTFE with omentum wrap had an intermediate patency rate of 100%. At 6 months, the high-porosity ePTFE grafts with omentum wrap were completely healed. The pseudointima was entirely replaced by thin fibrous tissue, with complete endothelial-like cell coverage throughout the graft. This result suggests that high-porosity ePTFE with omentum wrap could be a suitable prosthetic alternative to autogenous vein graft in portal vein reconstruction.     

Congenital bicuspid pulmonary valve. An uncommon impede for Ross procedure

We report a case of successful heterograft aortic valve replacement following an impede Ross procedure in a 48-year-old man presenting with a congenital bicuspid pulmonary valve. The patient was admitted for aortic valve stenosis that required an aortic valve replacement (AVR). Owing to his young age and reluctance to long-term anticoagulation therapy, it was decided to do an AVR by pulmonary autograft. During surgery, the anatomical unsuitability of the graft was discovered leading to the procedure’s readjustment.     

Management of aortic valve disease during pregnancy: A review

Cardiovascular disease represents a significant portion of pregnancy‐related complications and is associated with high rates of morbidity and mortality in this cohort. Cardiac valvulopathy, and aortic valve pathologies, in particular, pose a significant challenge to women who are pregnant and to the health care professionals who look after them. Depending on the type and severity of aortic valve pathology, pregnancy may exacerbate or accelerate the progression of valvulopathy sequelae because of the hemodynamic changes that occur from conception, throughout gestation, up to Labor and postpartum. Management of such patients ranges from basic conservative measures such as bed‐rest, extending to high‐risk emergency open heart surgery. This nonstructured review aims to highlight the current evidence available relating to the management of aortic valve disease in pregnancy, with a key focus on cases which requires intervention beyond that of medical therapy. In conclusion, the management of aortic valvulopathy in pregnancy is a challenging field with only a small amount of clinical experience and retrospective study supporting evidence‐based decisions in this field. A greater understanding of the most recent advances is recommended to support decision making in this specialist field of clinical medicine.     

Structural valve deterioration of bioprosthetic aortic valves: An underestimated complication

Objectives

Structural valve deterioration (SVD) remains a major bioprosthesis-related complication, as recently described for the Mitroflow valve (models LX and 12A) (LivaNova, London, United Kingdom). The real incidence of the SVD risk remains unclear, often due to methodologic pitfalls by systematically using the Kaplan-Meier estimator and/or the Cox model. In this report, we propose for the first time a precise statistical modeling of this issue.

Transfemoral aortic valve replacement with the SAPIEN XT valve: step-by-step

Transcatheter aortic valve replacement (TAVR) has become an attractive alternative for patients with severe aortic stenosis at high surgical risk. We describe a step-by-step approach to performing TAVR with the SAPIEN XT valve.     

吸入一氧化氮对心瓣膜置换术后肺动脉高压患者血流动力学的影响

目的：观察吸入一氧化氮（ＮＯ）对心瓣膜置换术后肺动脉高压患者血流动力学的影响。方法：选择９例心瓣膜置换术后伴肺动脉高压的病人，吸入ＮＯ０．００３％，观察三个时象点：吸入ＮＯ前；开始吸入ＮＯ后１５分钟；停止吸入ＮＯ后１５分钟。结果：吸入ＮＯ能显著降低肺动脉压和肺循环阻力指数（Ｐ＜０．０１），停止吸入ＮＯ１５分钟后，肺动脉压和肺循环阻力指数恢复到原有水平。在整个观察过程中，心率、平均动脉压、中心静脉压、肺动脉楔压、体循环阻力指数和心脏指数均无显著变化（Ｐ＞０．０５）。结论：吸入ＮＯ具有选择性肺血管扩张作用，是治疗心瓣膜置换术后肺动脉高压的较理想药物。     

A rare case of quadruple valve surgery with bioprosthetic pulmonary valve replacement in an octogenarian for degenerative valvular disease: Technical aspects

Quadruple valve surgery represents a complex and rare surgical procedure, requiring a systematic and standardized approach. In this intervention, pulmonary valve replacement (PVR) in patients without pre‐existing congenital heart disease represents a challenge and no large data have been reported yet. We hereby report a case of bioprosthetic PVR in an octogenarian within a quadruple valve procedure, illustrating our preferred technique of PVR with bioprosthetic implantation and right ventricular outflow tract reconstruction.