Objective To evaluate the application effect of acellular dermal matrix (ADM) in immediate breast reconstruction after mammary mastectomy with prosthetic implants. Methods The clinical data of 68 patients with breast cancer undergoing immediate breast reconstruction with prosthetic implantation in our hospital were retrospectively analyzed and divided into ADM group (n=43) and non-ADM group (n=25), according to the use of ADM in the posterior space of pectoralis major muscle while prosthesis implantation or not. The size of breast prosthesis, operative time, intraoperative blood loss, drainage duration, total drainage, total hospital stay, postoperative complications, postoperative cosmetic effect and quality of life of patients were compared between the two groups. Results Patients in the ADM group showed no statistically significant difference regarding operative time, drainage duration, total drainage, hospital stay, postoperative complications and intraoperative removed gland volume with the non-ADM group (P>0.05). The average intraoperative blood loss in the ADM group was less than that of the non-ADM group, the average volume of prosthesis in the ADM group was bigger than that of the non-ADM group, the volume difference between prosthesis and removed gland in the ADM group was smaller than that of the non-ADM group, which was considered statistically significant difference (P<0.05). The subjective satisfaction and objective measurement scores of patients in the ADM group were significantly better than those of the non-ADM group, especially in the symmetry of breast, surgical scar and distance of lateral displacement of nipple (P<0.05). The postoperative quality of life in the ADM group was significantly better than that of the non-ADM group in terms of body image, sexual function and sexual interest (P<0.01). Conclusions It is safe and feasible to use ADM-assisted the immediate breast reconstruction after nipple-sparing mammary mastectomy with prosthetic implantation. As an extension of the pectoralis major muscle, ADM can enlarge the posterior space for the prosthesis implantation, making the choice of the prosthesis much more easier. The combined application of ADM can obtain a better cosmetic effect, meanwhile improving the postoperative quality of life and satisfaction of patients.
ObjectiveTo review the current development in therapy of congenital funnel chest. MethodsRecent literature concerning the development of the treatment method for congenital funnel chest was extensively reviewed and summarized. ResultsThe main therapies for congenital funnel chest are thoracoplasty (Ravitch sternum elevation procedure and minimal invasive Nuss procedure) and prosthesis implantation. The magnetic mini-mover procedure and the vacuum bell are still in the research phase. ConclusionBesides the improvement in function, the requirement in appearance after surgery is also improved in the treatment of congenital funnel chest. The minimally invasive surgery and non-invasive procedures could be expected in the future.
ObjectiveTo explore the effectiveness and safety of the improved approach of intraoperative temporary epicardial pacing lead implantation in complete video-assisted cardiac surgery. Method We included 50 cardiac patients with video-assisted cardiac surgery indications in our hospital from September 2013 to November 2013. According to approach to placing intraoperative temporary epicardial pacing lead, the patients were divided into two groups including an improved group (30 patients with 17 males and 13 females at age of 45.6±15.7 years) and a traditional group (20 patients with 12 males and 8 females at age of 44.2±17.7 years). Time of temporary epicardial pacing lead implantation, potential perioperative complications, and clinical data of intraoperation and postoperation were compared between the two groups. Result All the patients survived during perioperative period. No intraoperative bleeding, no pericardial tamponade, no infection caused by pacing wires, as well as no relevant postoperative complications occurred. Implantation time in the improved group is shorter than that in the traditional group (P<0.001). No patient had been found situations like moderate pericardial effusion, as well as pacing leads shifting during the following-up period.
ConclusionThe improved approach has shorten the implantation time, which is simpler and more effective. No patient suffers from postoperative complications during short-term following-up. But the effect in long-term following-up period is still contentious.
Objective
To explore the safety and feasibility of general anesthesia with tracheal intubation in transcatheter aortic valve implantation (TAVI), and the key points in anesthetic management.
Methods
Twenty-five patients with aortic stenosis treated by TAVI in West China Hospital of Sichuan University between September 2012 and June 2013 were included in this study. General anesthesia with tracheal intubation was chosen. We recorded and analyzed the hemodynamics, blood gas, oxygen saturation data before and after anesthesia induction, before surgery, during rapid ventricular pacing, before and after aortic valve implantation. Besides, the incidence of perioperative complications and 30-day mortality were also recorded.
Results
All the 25 patients underwent the implantation surgery successfully. Two patients had the second implantation surgery due to moderate reflux. All the subjects in this study tolerated general anesthesia well without any anesthesia-related complications. There were 19 cases of newly developed or aggravated heart blocks, 7 of permanent pace maker, 2 of perioperative hemorrhage, 2 of cerebral vascular events, and 1 death case.
Conclusioins
General anesthesia with tracheal intubation can be utilized safely in patients undergoing TAVI. TAVI is a challenging technique in need of precise collaborations of multi-disciplines, in which anesthetists should play more as a leader in evaluation and decision-making during the surgery.
Abstract In order to have more selective sources of skin flaps to repair soft tissue defects, the prefabricated flap combining with skin expander was tried. Implanted the dorsal thoracic artery and vein with a muscle bundle of latissimus dorsi into the lateral thoracic wall subdermally andset a skin expander subcutaneously. Injected saline into the expander to inflate the flap gradually. In a month, an axial flap with the dorsal thoracic vesselswas prepared. the flap was transferred to the defect by vascular anastomosis technique. This method was applied in two cases, one to the left ankle, another to the left side of the neck. The sizes of the two flaps were 20cm×14cmand 22cm×15cm respectively. After operation, the flaps were alive completely. The advantages included selective source of vascular pedicle, thinpliable flap with enough blood supply, and direct closure of the donor site without skin graft.
ObjectiveTo observe the morphological characteristic by implanting domestic porous tantalum in rabbit patellar tendon and to evaluate biocompatibility features so as to provide experimental basis for porous tantalum used as interface fixation between tendon and bone.
MethodsA total of 48 adult New Zealand white rabbits, male or female, weighing 2.5-3.0 kg, were selected. Porous tantalum flake (5 mm×5 mm×2 mm) was implanted in the left patellar tendon (experimental group) and the same size porous titanium flake in the right patellar tendon (control group). The animals were sacrificed at 2, 4, 8, and 12 weeks after implantation, then the specimens were harvested for gross observation, HE staining, scanning electron microscope (SEM) observation, and hard slices observation.
ResultsNo animal died after operation. Porous tantalum was bonded closely with host tendon and no inflammatory reaction was found. Loose and thick fibrous capsule was observed at the beginning and became density and thinner in the end by microscope, showing significant difference between different time points in 2 groups (P<0.05), but no significant difference was found between 2 groups at different time points (P>0.05). The SEM observation showed that fibrous tissue attached to the surface and inner walls of porous tantalum at early stage, and extended on the material to reach confluence at late period, but the experimental group was more than the control group. Hard slices observation showed that the collagen fibrils were seen on porous tantalum interface with host tendon, and blood vessels grew into the pores. The control group and the experimental group showed no significant difference.
ConclusionThe domestic porous tantalum has good biocompatibility. Connection and integration can be established between tendon and porous tantalum, and therefore it could be used in reconstruction of tendon-bone fixation device.
ObjectiveTo summarize the indication and surgical experiences of valve replacement, high-risk factors and long-term results for aortic regurgitation and large left ventricle.
MethodsWe retrospectively analyzed the clinical data of 42 patients with aortic regurgitation and left ventricle end-diastolic diameter (LVEDD) ≥70 mm and left ventricle end-systolic diameter (LVESD) ≥ 50 mm in our hospital from March 2004 through December 2012. There were 38 males and 4 females,aged 16-73 (45.86±14.99) years. The patients underwent aortic valve replacement, who were evaluated by echocardiography at pre-operation, pre-discharge and early follow-up. The follow up period was 12-132 months.
ResultsEarly death occurred in one patient. And five patients died during the follow-up. One week after surgery in 41 patients, LVEDD (62.00±13.21 mm), LVESD (50.71±14.02 mm), indexed LVEDD (35.23±8.58 mm/m2), indexed LVESD (28.92±9.08 mm/m2), LVEF (46.41%±12.49%), were significantly smaller than those before the operation (P<0.01). Heart function grades, preoperative EF, LVEDD and indexed LVEDD were the predictors for left ventricular function recovery. One-year, 5-year, 10-year survival rate was 92.9%, 90.2%, 83.8%, respectively.
ConclusionMost of patients with aortic regurgitation and large left ventricle still have indications for surgical treatment, but severe left ventricular dysfunction and ventricular arrhythmia are high risk factors for long-term survival.
Objective To investigate the early safety and efficacy of transapical transcatheter aortic valve implantation (TAVI) for high-risk elderly patients with pure aortic valve insufficiency. Methods A prospective multicenter clinical study of domestic J-valveTM TAVI for high-risk native non-calcified aortic valve insufficiency was conducted from April 2014 to May 2018, and the early postoperative results were analyzed. A total of 82 patients were enrolled, including 62 patients from West China Hospital, Sichuan University, 16 patients from Zhongshan Hospital, Fudan University, and 4 patients from Beijing Fuwai Hospital, National Center for Cardiovascular Diseases. There were 55 males and 27 females. The age was 61-90 (73.8±6.3) years. The logistic EuroSCORE was 10.0%-44.4% (17.5%±8.1%). All patients underwent TAVI using J-ValveTM system. Clinical evaluation and echocardiography were performed preoperatively and 1 month postoperatively. Multislice spiral CT was reviewed before discharge. Results Three patients were transferred to thoracotomy for cardiopulmonary bypass operation, and 1 patient had decreased cardiac function due to leakage of the valve 1 week after surgery. The overall technical and procedural success rate was 95.1% and 93.9%, respectively. During hospitalization, 1 patient died of moderate pericyclosis complicated with multiple organ failure, and 1 patient died of pulmonary infection. Six (7.6%) patients received pacemaker implantation due to new onset Ⅲ° atrioventricular block. Echocardiographic follow-up showed paravalvular leak was observed in the few of patients, mild paravalvular leak was in 13 patients on the 30th day. Two patients showed moderate paravalvular leak. Left ventricular end-diastolic volume decreased from 197.7±66.8 mL (pre-TAVI) to 147.2±53.3 mL (30-day post-TAVI) (P<0.05). Mean pressure gradient was 9.5±4.1 mm Hg (30-day post-TAVI). Conclusion This multicenter study demonstrates that TAVI with the J-Valve system for the treatment of pure aortic regurgitation is associated with sustained clinical and functional cardiovascular benefits in high-risk patients with symptomatic aortic regurgitation early-term follow-up. Our results further support that TAVI with the specific designed J-Valve system is an acceptable alternative therapy for high-risk patients with pure AR. Our result demonstrates good early-term durability and preserved hemodynamic function. The procedure appears to offer an adequate and lasting resolution for selected patients with pure aortic regurgitation.
Objective To report our experience with enhanced recovery after surgery (ERAS) protocol in patients undergoing transapical transcatheter aortic valve implantation (TAVI) and to determine perioperative predictors for ERAS failure. Methods Between May 2018 and January 2019, 80 patients undergoing TAVI in our hospital were recruited. Among them, 40 patients (24 males, 16 females, aged 73.0±5.0 years) successfully received ERAS, defined as successful extubation in operating room (an ERAS group) and the other 40 patients (28 males, 12 females, aged 73.0±7.0 years, a non-ERAS group) failed to perform ERAS. Results Compared with the non-ERAS group, patients in the ERAS group were associated with a significantly lower incidence of postoperative complications (30.0% vs. 52.5%, P=0.04), shorter postoperative ICU stay (2.2±0.4 d vs. 4.0±4.8 d, P=0.00) and hospital stay (7.0±2.3 d vs. 9.5±4.8 d, P=0.00), and less medical cost (311±20 thousand yuan vs. 347±80 thousand yuan, P=0.00). Independent predictors of ERAS failure were poor preoperative heart function and elevated B-type natriuretic peptides. Conclusion ERAS protocol is feasible and effective in patients undergoing TAVI. Poor preoperative heart function is an independent predictor of failure in early extubation which, in turn, is associated with prolonged ICU and hospital stay and dramatic worsening of patient outcomes.
The purpose of this study was to explore the feasibility of dual-source computed tomography (DSCT) high-pitch scan mode in the preoperative evaluation of severe aortic stenosis (AS) referred to transcatheter aortic valve implantation (TAVI). Thirty patients with severe AS referred for TAVI underwent cervico-femoral artery joint DSCT angiography. Measurement and calculation of contrast, contrast noise ratio (CNR) and noise of aorta and access vessels were performed. The intra-and inter-observer reproducibilities for assessing aortic root and access vessels were evaluated. Evaluation of shape and plagues of aorta and access vessels was performed. The contrast, CNR and noise of aorta and access vessels were 348.2~457.9 HU, 12.2~30.3 HU and 19.1~48.1 HU, respectively. There were good intra-and inter-observer reproducibilities in assessing aortic root and access vessels by DSCT (mean difference:-0.73~0.79 mm, r=0.90~0.98, P < 0.001; mean difference:-0.70~0.73 mm, r=0.90~0.96, P < 0.001). In the 30 patients, the diameters of external iliac artery, femeral artery or subclavian artery were less than 7 mm in 5 cases (16.7%), marked calcification in bilateral common iliac arteries in 1 case (3.3%) and marked soft plaque in left common iliac artery in 1 case (3.3%). DSCT high-pitch scan mode was feasible in the preoperative evaluation of aorta and access vessels in patients with AS referred for TAVI.
