可调式免缝合人造血管与普通涤纶血管的比较

目的 观察一种末端直径可调节的新型免缝合人造血管的动物实验效果并与普通涤纶血管进行对比.方法 以猪为实验对象,实验组8只猪使用可调式免缝合人造血管,在常温阻断下行降主动脉结扎置换术;对照组6只猪使用普通涤纶人造血管,行常规降主动脉手工缝合置换术.对两组动物均进行为期3个月的术后临床、影像学、病理学和超微结构的观察.结果 两组均有1例手术死亡.与普通涤纶血管比较,使用可调式免缝合人造血管在降低手术并发症、减少手术时间、动脉阻断时间、手术出血量等方面均有明显优势(P＜0.01);而手术死亡率、近期临床效果、移植物的生物愈合和组织相容性方面与涤纶血管无明显差异.结论 新型可调式免缝合人造血管能安全、迅速地完成血管重建,符合人造血管的基本要求,具有较好的临床应用前景.     

丝涤交织人造血管的研究

目的研制新型真丝涤纶交织人造血管。方法采用38杂杂种犬,麻醉后将直径8～10mm,长度3O～50mm直型丝涤人造血管移植于胸主或腹主动脉并与聚四氟乙烯管作对照。术后按要求观察移植物通畅度、内膜生长情况、生物相容性,细胞毒反应等。结果移植血管通畅率为35／38（921％）,移植后一月可完整形成新生的内膜和外膜,细胞毒性测试表明无毒性反应。结论新型丝涤交织人造血管是一种较理想的血管代用品,值得在临床推广使用。     

近肾动脉腹主动脉下段闭塞症的手术方法探讨

目的探讨近肾动脉腹主动脉下段闭塞症（juxtarenal aortic occlusion）的手术治疗方法。方法总结自1995年以来作者收治的27例腹主动脉末端闭塞症的临床治疗，术中暂时阻断肾上主动脉（平均7min），纵行切开主动脉，迅速清理近肾主动脉病灶，缝合上段纵行切口后改为肾动脉下主动脉阻断，完成人工血管主-股动脉转流手术。结果术后22例触及股动脉和胭动脉搏动，术后7d患肢缺血症状均得以改善。手术后3月复查，患肢缺血症状消失，25例阳痿现象得到改善，彩色超声显示血管吻合口及人工血管内均未见血栓。25例获得1年以上的随访，吻合口通畅率为100％；18例获得5年以上随访，吻合口通畅率为94．4％。结论将肾上主动脉暂时阻断后纵行切开主动脉，迅速去除病灶，主动脉缝合成型，然后在肾下主动脉阻断后完成主-股动脉转流是治疗腹主动脉末端闭塞性疾病较好的手术方案。     

犬涤纶人造血管移植后不同时期的组织形态学研究

我们通过１０条犬的涤纶血管移植实验研究，连续观察分析了中口径国产涤纶人造血管移植于犬腹主动脉，术后１２周以内不同时期移植血管的组织形态学改变。结果表明２ｃｍ长国产中口径涤纶人造血管移植于腹主动脉后其新生内膜覆盖管腔内壁大约需要４周。新生内膜主要来自邻接动脉内膜的平滑肌增生爬行；内皮细胞覆盖人造血管内膜的时间较自体静脉晚得多，术后７周涤纶血管内膜尚无完整稳定的内皮细胞层；经高压蒸汽灭菌法消毒过的中口径国产涤纶人造血管不宜再次使用。     

大鼠胰十二指肠肾脏联合移植模型的实验研究

目的：为了进行胰肾联合移植基础研究，建立一种简易可靠的大鼠胰十二指肠肾脏联合移植（SPKT）模型，方法：雄性SD大鼠作同品系异体移植的供受体，受体尾静脉注射链脲霉素（STZ）50mg/kg，建立大鼠糖尿病模型，在保存液中，移植物门静脉与肾下下腔静脉作袖套式吻合；移植物肾上腹主动脉，肾上下腔静脉分别与受体肾下腹主动脉，肾下下腔静脉显微缝合吻合，移植物十二指肠与受体十二指肠端侧吻合，移植物带输尿管的膀胱片与受体膀胱吻合。结果：血管吻合时间及受体手术时间短，手术成功率为88％，移植胰腺及肾脏功能良好。结论：此模型是一种简易可靠的大鼠胰十二指肠肾脏联合移植模型。     

磁吻合技术实现犬腹主动脉快速无缝线吻合实验研究

目的:研究一种能高效完成大动脉吻合的新型血管吻合器械,利用磁性吻合技术（MCA）达到快速吻合大动脉的目的。方法:选择成年杂种犬16只,按随机数字表法分为两组：MCA组（ n=8）,利用新型磁吻合器械完成吻合;传统手工缝合（HS）组（ n=8）。比较两种方法吻合腹主动脉耗时、吻合口耐压水平、术中渗...     

国产带膜支架治疗腹主动脉瘤的可行性研究

我们自1997年11月开始着手国产带膜支架及输送系统的研制工作,现报道动物实验及对腹主动脉痛的近期治疗效果。一、材料与方法1．动物模型的制作10条健康成年杂种犬,体重20kg以上。静脉麻醉（硫贲妥钠20mg／kg体重）;手术阻断肾动脉下方至骼动脉分叉一段主动脉,并暂时阻断各分支;梭形切除主动脉前、侧壁0．5cmX3cm左右;分别以带腹膜的腹直肌后鞘、Dacron人造血管等材料用6－0Prolene线将其与主动脉窗口作连续外翻缝合;解除血管阻断,测量人造动脉瘤颈部、瘤体及主动脉直径,动脉瘤上下颈部距肾动脉、骼动脉分叉的距离及动脉瘤的长度…     

复杂动脉导管未闭的外科治疗

在近１０多年中，作者单位收治复杂动脉导管未闭６９例，其中窗型９例、动脉瘤型１３例、粗大动脉导管１５例、假性动脉瘤３例、动脉导管钙化３例、动脉导管再通５例、有导管炎史５例、合并重度肺动脉高压１６例。单纯结扎导管５１例、加垫卷或垫片结扎导管９例、左心转流下切断导管缝合５例、对导管或主动脉破裂出血，采用补片修补结扎导管２例、带环涤纶人造血管套入胸主动脉内结扎２例。术后早期死亡２例（２．９％）。随访５个月～１６年，手术效果满意，杂音均消失。作者认为，良好的手术效果取决于对困难动脉导管未闭不同类型，采用了不同的手术方法，强调对破裂的动脉导管或主动脉进行补片修补或带环涤纶人造血管套入胸主动脉内结扎术，操作简便，安全可靠。     

单边内翻套入缝合法吻合兔颈动脉的实验研究

目的：探寻一种新的安全、快捷的小血管吻合方法。方法成年新西兰白兔45只，一侧颈动脉行单边内翻套入缝合法为实验组，另一侧行常规对端缝合法为对照组，比较两组的血管吻合时间、血管通畅率，术后1周，2周行血管吻合口的大体观察、组织学及扫描电镜观察。结果血管吻合时间：实验组为（12±2） min，对照组（16±2） min，差异有显著性（P＜0.05），实验组明显低于对照组。术后两组的血管即刻通畅率均为100%，近期通畅率均为98%，两组间差异无显著性（P＞0.05）。组织学及扫描电镜观察示两组血管吻合口愈合过程及时间相似。结论单边内翻套入缝合法吻合小血管快捷、简单，效果可靠。     

人造血管旁路术后移植物感染的外科治疗

为评价人造血管旁路术后移植物感染外科治疗的临床疗效,作者对１９８５年～１９９５年上海中山医院收诊的２５０例人造血管旁路术后发生移植物感染的８例进行分析。临床表现为移植物外露伴创口溢脓、大出血、移植物和／或远端肢体动脉搏动消失、远端肢体坏疽。移植物感染率３．２％。外科治疗包括：（１）移植物去除、清创引流术;（２）移植物去除、清创引流加截肢术;（３）移植物去除、清创引流加近远端动脉人造血管重建术;（４）单纯清创引流术。结果显示,８例中６例痊愈,２例因吻合口破裂出血死亡。作者认为移植物感染的危险因素有：（１）糖尿病;（２）继发血肿;（３）同一部位多次手术。外科积极处理较保守治疗愈后更好。     

Evaluation of an aortic stapler for an open aortic anastomosis

Open repair for aortic pathology requires clamping of the aorta. Aortic clamp time is an important predictor of outcome following open aortic reconstruction. In an attempt to decrease aortic clamp time, an aortic stapler was developed. The purpose of this clinical study was to evaluate the performance of the aortic stapler in the creation of a sutureless aorta-graft anastomosis. A single-center, intention to treat study was performed. Data were prospectively collected and retrospectively analyzed. The study protocol was approved by the institutional review board and all patients gave informed consent. Ten patients were analyzed. Patients with infrarenal abdominal aortic aneurysms and aorto-iliac occlusive disease who were candidates for elective, open aortic repair were included. All proximal anastomoses were completed in an end-to-end fashion using the aortic stapler. Time to complete the anastomosis (defined as time required to achieve anastomotic integrity and hemostasis) was the primary endpoint. Secondary endpoints were patency and anastomotic complications (pseudoaneurysm, hematoma, fistula) as diagnosed by duplex evaluation at one month follow-up. The aortic stapler was successfully used in all cases. Open aortic staplers of 14, 16, and 18 mm diameters were used in the procedures. Either woven dacron tube grafts or a bifurcated prosthesis were mounted on the staplers. In all cases only the proximal anastomosis was performed using the open aortic stapler. The distal anastomosis was sutured in a conventional manner using a continuous prolene suture. There were no stapler related deaths or anastomotic complications observed. The aortic stapler was successfully used in all cases. The mean time to complete the stapled proximal anastomosis was 10.2 min (7-18 ). The mean number of additional sutures required with the aortic stapler was 1.20 (0-6). Mean total aortic clamping time was 50.1 min (22-66). Duplex and CT imaging obtained at one-month confirmed the integrity of the proximal anastomosis as well as the patency of the vascular grafts. The aortic stapler can create a uniform staple line between a vascular prosthesis and the aortic wall. It is a simple, safe, rapid and reliable means for creation of a sutureless, end-to-end anastomosis in patients with aortic pathology, however, more patients and longer follow-up are required prior to concluding superiority to conventional suturing.     

Sutureless videoendoscopic thoracic aorta to iliac artery bypass: the easiest approach to occlusive aorto-iliac diseases.

OBJECTIVE: We designed an animal study to determine the feasibility of videoendoscopic thoracic aorta to iliac artery bypass using a sutureless anastomotic device for proximal anastomosis construction. METHODS: In 12 pigs the descending thoracic aorta was exposed using the thoracoscopic technique. A 4 mm PTFE thin wall graft was used as conduit. The proximal anastomosis was constructed using a mechanical device for sutureless anastomosis inserted through the camera port incision. The prosthesis was passed through the diaphragm in the retroperitoneal space and the distal anastomosis was done with running suture. RESULTS: The operation was successfully completed in 11 animals. One animal died due to hemorrage during anastomosis construction. Mean graft flow was 144 ml/min (range 88-167 mmHg). The angiogram showed no graft kinking or stenosis. Total operative time was 58 min (range 47-68 min). CONCLUSIONS: This approach allows quick and excellent exposure of the entire descending thoracic aorta. The use of the sutureless device to perform the proximal anastomosis dramatically reduces the technical demands of this procedure and could avoid an aortic clamp.     

Chirurgischer Aortenklappenersatz

Conventional, i.e. surgical, aortic valve replacement represents one of the most standardized procedures in cardiac surgery. In the year 2011 a total of 11,668 isolated aortic valve replacements were performed in Germany, a volume equal to that of the previous year. Partial sternotomy was applied in approximately 15 % of all procedures and biological valves were the predominantly used prosthesis type (approximately 84 %). Mechanical prostheses, homografts and autografts were used in the minority of cases, while aortic valve reconstruction was applied in a marginal proportion of cases. Innovations in the field of aortic valve surgery concern the surgical access and the design of modern biological prostheses. Although first described in the 1960s, sutureless valves are currently experiencing a considerable renaissance. This article provides a brief overview on current guidelines, operative techniques and moreover focuses particularly on the spectrum of prosthesis types that are currently used for surgical replacement of aortic valves.     

Video-assisted replacement or bypass grafting of the descending thoracic aorta with a new sutureless vascular prosthesis: an experimental study.

PURPOSE: The feasibility of the video-assisted insertion of a new sutureless vascular prosthesis was studied. METHODS: Seven sheep, weighing 25 to 35 kg, were operated on under general anesthesia. The animals were intubated with a single-lumen endotracheal tube and placed in the right lateral decubitus position. A thoracoscope was introduced in the 11th intercostal space, and a minithoracotomy (4 to 5 cm) was performed in the seventh intercostal space. After retraction of the lung, a short segment (10 cm) of the descending thoracic aorta was exposed. Our prosthesis was made of Dacron and was specifically designed to be inserted without a suture. After systemic heparinization, the aorta was cross-clamped with two vascular clamps introduced into the thoracic cavity through two 5-mm thoracic incisions. The aorta was either replaced (five cases) or bypass grafted (two cases). At the completion of the procedure, blood pressure was pharmacologically increased (5 mg intravenous bolus of epinephrine), and each anastomosis was checked for bleeding. All animals were killed, and the prosthesis was retrieved for macroscopic examination. RESULTS: The procedure was completed in each case without extension of the minithoracotomy. Insertion of the prosthesis was easy and fast, and completion of each anastomosis required 10 to 15 minutes. A 3- to 4-mm space between each clip was sufficient for proper attachment. All procedures were performed in less than 120 minutes. No bleeding was observed at the level of each anastomosis, even when a sustained high blood pressure was induced. The proper insertion of the prosthesis and the absence of any anastomotic stenosis was confirmed by means of macroscopic examination. CONCLUSION: Video-thoracoscopic replacement or bypass grafting of the descending thoracic aorta was easy with this new sutureless vascular prosthesis. Minimally invasive vascular surgery might be facilitated with such a prosthesis. However, long-term animal studies are required before human implantation can be undertaken.     

Replacement of the thoracic aorta with intraluminal sutureless prosthesis.

A survey of the collective experience reveals that between 1976 and 1990, a sutureless intraluminal prosthesis was used to replace the ascending thoracic aorta, arch, and descending thoracic aorta in 122, 14, and 81 patients, respectively. During these 217 operations, at least 364 of the 434 anastomoses were performed by sutureless fixation. The underlying disease processes consisted of acute and chronic dissections; atherosclerotic, Marfan's, and mycotic aneurysms; and intraoperative disruptions of the ascending aorta. The data in the literature suggest that sutureless fixation shortens aortic cross-clamp time and reduces blood loss. Early graft-related complications were few and probably can be further reduced by improving surgical techniques. The incidence of paraplegia and renal failure after descending aortic grafting was identical at 2.5%. The operative mortality rate for ascending aortic, arch, and descending aortic replacement was 13.1%, 42.9%, and 14.8%, respectively. Long-term follow-up of 143 patients revealed satisfactory graft function with three possible device-related deaths and no other known complications attributable to the prosthesis. There are, however, anecdotal references to late complications from the intraluminal prosthesis. Most of these relate to faulty implantation techniques, but some could be due to flaws inherent in the concept of sutureless grafting. The collective experience suggests that grafting of the thoracic aorta is less hazardous with the sutureless than with the conventional sutured anastomosis technique. The implications of the anecdotal accounts about late complications remain to be determined.     

Sutureless thoracic aorta to femoral artery bypass with robotic videoendoscopic approach: a fast track procedure

This study was undertaken to determine the feasibility of robotic videoendoscopic thoracic aorta to femoral artery bypass. In six pigs, three ports were inserted in the fourth, eighth and tenth left intercostal spaces. Lung retraction was obtained by insufflating CO2. The ZEUS robotic surgical system and the AESOP system were used to perform aortic dissection and to position the camera via voice control. A length of 5 cm of descending thoracic aorta was exposed. A 4mm polytetrafluoroethylene (PTFE) graft was used as conduit. The proximal anastomosis was constructed using a prototype of sutureless aortic connector. Left femoral artery was exposed and an endograsp was passed to create a retroperitoneal tunnel. The prosthesis was then anastomosed to the left femoral artery. CO2 insufflating pressure was 9+/-1 mmHg. The operation was completed in three animals while the other three died. In two animals, the death was due to aortic injury during aortic exposure and in one complications of anesthesia. Total operative time was 48+/-15 min. Robotic videoendoscopic descending thoracic aorta to femoral artery bypass is a technically feasible operation in a pig model. The use of the sutureless device to perform the proximal anastomosis dramatically reduces the technical demand of this procedure.     

Angiographic results after the use of a sutureless aortic connector for proximal vein graft anastomoses

The sutureless aortic connector system was recently developed to create anastomoses between the aorta and saphenous vein grafts for coronary artery bypass grafting. Ten consecutive patients scheduled for coronary artery bypass grafting were studied; in each patient one proximal anastomosis was performed using the aortic connector and another was sutured in the conventional manner to serve as the patient‘s own control. One graft in the sutured group had a significant stenosis and one of the grafts in which the aortic connector was used, was occluded. In this limited study the use of the sutureless connector system for proximal anastomosis shows satisfactory early graft patency (90%).     

Sutureless intraluminal graft for repair of abdominal aortic aneurysm

A series of seven patients undergoing elective repair of abdominal aortic aneurysms using sutureless intraluminal aortic prostheses for infrarenal tube grafts was reviewed. Follow-up was five to seven months. There was no morbidity related to the graft and one late mortality. In the uncomplicated cases, the average total operative time was two hours 14 minutes with no bank blood transfusions. The overall average operative time was two hours 41 minutes with an average operative transfusion of 0.28 units and total transfusions of 1.70 units of bank blood per case. Based on this experience and the observation that operative time and blood loss are major determinants of mortality with emergency abdominal aortic aneurysm repairs, we believe that use of sutureless intraluminal prostheses in suitable cases of leaking or ruptured abdominal aortic aneurysms has the potential to markedly improve survival.     

Differences in reconstruction of the anatomy with modern adjustable compared to second-generation shoulder prosthesis

Reconstruction of the anatomy of the proximal humerus is a prerequisite to achieving good long-term clinical results after shoulder arthroplasty. Modern, adjustable prostheses have greater flexibility of inclination, retroversion, and medial and dorsal offset in comparison with older prostheses. Such improvements should allow for better reconstruction of the centre of rotation compared to older prostheses. Reconstruction of the humeral head centre was assessed in 106 modern adjustable (Affinis) and 47 second-generation prostheses. All reconstructions were compared both to the preoperative state and the unoperated shoulder. To describe the pre- and postoperative states, the geometry and position of the humeral head in relation to the glenoid were analysed on patient radiographs. Applying the defined parameters, modern adjustable prostheses showed better reconstruction than second generation prostheses. Parameter values measured in reconstructions using fourth generation prostheses were comparable to those of the unoperated shoulder, but differed significantly from the preoperative state. Second generation prostheses, in contrast, only show non-specific differences in parameter values. This suggests that an approximate reconstruction of normal anatomy can be achieved using a modern fourth generation prosthesis. Reconstruction of the complex anatomy of the proximal humerus is significantly better with modern adjustable prostheses compared to second generation prostheses. Improved clinical outcome can therefore be predicted in a functional and intact rotator cuff. The advantage of using modern prostheses systems over older models is clearly demonstrated in this study.     

First clinical experience and 1-year follow-up with the sutureless 3F-Enable aortic valve prosthesis.

BACKGROUND: Aortic valve replacement (AVR) with extracorporeal circulation (ECC) is currently the treatment of choice for symptomatic aortic stenosis. However, patients with multiple high-risk comorbid conditions may benefit from reduced ECC time and thus, reduced myocardial ischemia, by the use of sutureless AVR. We describe the initial experience and 1-year results of our first 3F-Enable AVR implants. METHODS: Between 09/05 and 12/05, six patients (age 74+/-1.8 years; three females) with symptomatic aortic stenosis (NYHA III) underwent AVR with an equine pericardial and nitinol-stented sutureless prosthesis. For additional safety up to three stay sutures were placed. Echocardiography was performed preoperatively, intraoperatively, at 6- and 12-month follow-up. Clinical data, adverse events and patient outcome were recorded prospectively. RESULTS: Prosthesis sizes were 27 mm (n=3), 25 mm (n=1), 23 mm (n=1) and 21 mm (n=1). ECC time was 87+/-32 min; aortic clamp time was 56+/-24 min. Prosthesis deployment time was 148 +/- 173 s. There were no intraoperative deaths or complications. At 12-month follow-up mean pressure gradients (MPG) were 6.8+/-3.5 mmHg and aortic valve area (AVA) was 2.2 +/- 0.5 cm(2). One patient underwent successful redo AVR after 8 months due to severe paravalvular leakage (PVL), and one patient died due to lung cancer 10 months after surgery. At 12 months follow-up four out of six patients are alive and asymptotic (NYHA I) with the 3F-Enable aortic valve prosthesis, however, one patient showed mild paravalvular leakage. CONCLUSIONS: These first 1-year follow-up data suggest the feasibility of this new concept of sutureless aortic valve implantation. However, severe aortic insufficiency at 8 months and paravalvular leakage at 1-year follow-up should prompt further procedural and device enhancements.