孟强
中国医学科学院阜外医院 普外科
OBJECTIVE:Existing simulators for off-pump coronary artery (CA) bypass grafting training are unable to provide cardiac surgery residents all necessary skills they need entering the operation room. In this study, we introduced a secure and high-fidelity live animal model to supplement the in vitro simulators for off-pump CA bypass grafting training.DESIGN:The left internal thoracic artery (ITA) of 3 Chinese miniature pigs was grafted to the left anterior descending CA using an end-to-side anastomosis. The free segment of the ITA was fixed on the ventricle surface, making it a simulative CA beating in synchrony with the heart. A total of 6 to 8 training anastomoses were made on each ITA.SETTING:Animal Experiment Center in Fuwai Hospital.PARTICIPANTS:In total, 19 resident surgeons with at least 3 years of cardiac surgery work experience were trained using the new model. Their performances were recorded and reviewed.RESULTS:Simulative coronary arteries were successfully constructed in all 3 animals with no adverse event observed. A total of 19 anastomoses were then completed, 1 pig of 7 anastomoses and the other 2 animals of 6 anastomoses. Time consumption for the anastomosis was 782 ± 107 seconds. Anastomotic leakage was observed in 10/19 procedures. The most frequency site (7/10) was at the toe of the anastomosis. Further, the most common cause was uneven spacing or small margin of the stitches or both. Emergencies occurred during the training process included hypotension (7 procedures), tachyarrhythmia (4 procedures), and low blood oxygen saturation (1 procedure).CONCLUSIONS:This study demonstrated the safety and feasibility of our new live pig model in training resident surgeons. The simulative arteries can be easily accomplished and were long enough to place at least 6 anastomoses. Both on lumen diameter and motion status, they were proven to be a good substitution of the CA.
Journal of surgical education 2016
OBJECTIVE:To review the results of the valve-sparing operation (David procedure) in patients with aortic root disease.METHODS:Twenty-nine patients with aortic root disease, 20 males and 9 females, aged 39 +/- 17 (10-64), 10 being of heart functional class I, 15 of class II, and 4 of class III, and 15 with gentle, 9 with moderate, and 5 with severe aortic insufficiency underwent David procedure, one undergoing the aortic valve-sparing reimplantation (David I), 25 undergoing aortic valve-sparing remodeling (David II), and 3 undergoing a new modified aortic valve-sparing operation. After the operation the patients were followed up for 29 +/- 15 months (5-74 months).RESULTS:No intra-operative death was found. The mean extracorporeal circulation time was 126 min +/- 25 min, and the aortic crossclamp time was 87 min +/- 22 min. All patients recovered to heart functional class I. Post-operatively 11 patients showed no normal, eight gently and two moderate aortic regurgitation.CONCLUSION:The valve-sparing operation is an ideal operation to the aortic root aneurysm with more or less normal aortic leaflets and valvular ring normal.
Zhonghua yi xue za zhi 2005
OBJECTIVE:To introduce the experience of diagnosis and surgical treatment of Williams syndrome combined with cardiovascular disease.METHODS:Between October 1996 and June 2003, 8 patients of Williams syndrome with cardiovascular disease were admitted in Fuwai hospital. Seven patients underwent surgical correction. One didn't undergo surgical procedure. There were 6 male and 2 female ranging from 1.5 to 12.0 years old (medium age 6.4). Three had localized type supravalvular aortic stenosis and 5 diffused type supravalvular aortic stenosis. In them, 2 patients were combined with peripheral pulmonary stenosis. Single patch aortoplasty were performed in 6 cases, and inverted bifurcated patch aortoplasty in one patient.RESULTS:One patient died and one patient suffered renal insufficiency. In the early postoperative period, the mean speed of flow was reduced to 1.7 m/s from 4.6 m/s, and the mean systolic pressure gradient was reduced from 91 mm Hg to 18 mm Hg. Six patients were followed up 16 to 91 months. There were 5 cases in NYHA function class I, and one in class II.CONCLUSION:Satisfied result can be achieved in surgical treatment of Williams syndrome with supravalvular aortic stenosis, but it is not in combined with peripheral pulmonary stenosis.
Zhonghua wai ke za zhi [Chinese journal of surgery] 2005
OBJECTIVE:To summarize the experience of surgical treatment of aorta-pulmonary window.METHODS:Between January 1980 and August 2000, 18 patients suffering from aorta-pulmonary window, 11 males and 7 females, with a mean age of 6.5 years (2 approximately 14 years), underwent surgical treatment. Eleven cases were type I, 3 were type II and 4 were type III. Sixteen patients underwent surgical repair under cardiopulmonary bypass at moderate hypothermic temperatures. Deep hypothermic circulatory arrest was used in 2 of them. Closed surgical ligation under cardiopulmonary bypass at normal thermic temperature was performed on 1 case. External division and ligation under general anesthesia through left thorax was performed on 1 case. Thirteen patients underwent surgical repair through the anterior wall of aorta. Surgical repair was performed through the anterior wall of pulmonary artery in 3 cases. Other associated malformations were repaired simultaneously.RESULTS:Three patients died during the peri-operative period. Fifteen patients who survived the operation were followed up for 108 months on average. One patient was noted to have residue shunt on aorta pulmonary window. The other patients showed alleviation of symptoms and improvement of life quality.CONCLUSION:Early diagnosis, suitable surgical procedure and prevention and treatment of postoperative complications are the key factors for treatment of aorta pulmonary window.
Zhonghua yi xue za zhi 2002
