刘志刚
中国医学科学院阜外医院 普外科
OBJECTIVE:To compare the differences in nitric oxide (NO) release and endothelium-derived hyperpolarizing factor (EDHF)-mediated hyperpolarization between human radial artery (RA) and saphenous vein (SV) through direct measurement of NO and membrane potential.METHODS:RA (n = 8), SV (n = 23), and surgical prepared SV (PV, n = 9, dilatation with normal saline solution at a pressure of 100 - 600 mmHg, 1 mmHg = 0.133 kPa) segments (5 mm long) taken from patients undergoing coronary artery bypass grafting were placed in an organ chamber. The NO-sensitive electrode and intracellular glass microelectrode was used to directly measure the NO release and the membrane potential changes in response to acetylcholine (ACh) and bradykinin (BK) before and after incubation with NG-nitro-L-arginine, indomethacin, and oxyhemoglobin.RESULTS:The basal release of NO in RA [(11.9 ± 1.8) nmol/L] was significantly greater than that in SV [(9.9 ± 2.8) nmol/L, P = 0.041]. BK-induced NO release in RA was lower than that in SV [for BK 10(-7) mol/L: (25.8 ± 3.6) nmol/L vs. (43.7 ± 8.2) nmol/L, P = 0.006]. Both basal and ACh- or BK-induced NO release in PV were significantly reduced [basal release: PV (3.4 ± 1.4) nmol/L; P = 0.006 vs. RA; P = 0.002 vs. SV; stimulated release: for ACh 10(-5) mol/L: PV (4.8 ± 3.2) nmol/L; vs. RA (28.6 ± 7.9) nmol/L, P = 0.005; vs. SV (27.4 ± 3.7) nmol/L, P = 0.003; for BK 10(-7) mol/L: PV (7.0 ± 3.6) nmol/L; vs. RA (25.8 ± 3.6) nmol/L, P = 0.016; vs. SV (43.7 ± 8.2) nmol/L, P = 0.004]. EDHF-mediated hyperpolarization was greater in RA than that in SV [ACh 10(-5) mol/L: (-9.7 ± 1.9) mV vs. (-4.5 ± 1.1) mV, n = 17, P = 0.002].CONCLUSIONS:RA is superior to SV in terms of NO basal release and EDHF-mediated endothelial function. Surgical preparation and pressure dilatation may severely impair the NO-mediated endothelial function of SV, which may contribute to the poor long-term patency of SV coronary graft.
Zhonghua wai ke za zhi [Chinese journal of surgery] 2011
OBJECTIVE:Three techniques have been developed as the surgical management for patients with anomalies of ventriculoarterial connection, ventricular septal defect, and pulmonary outflow tract obstruction (stenosis): the Rastelli, Lecompte, (REV), and Nikaidoh procedures. This study was designed to compare these procedures in terms of hemodynamics of the reconstructed biventricular outflow tract, early clinical consequences, and follow-up.METHODS:Between March 2004 and September 2006, a total of 30 consecutive patients underwent double root translocation procedures (modified Nikaidoh n = 11, REV n = 7, Rastelli n = 12). In the Nikaidoh procedure, both aortic and pulmonary roots were translocated. A single-valved bovine jugular vein patch was used to repair the stenotic pulmonary artery in both Nikaidoh and REV procedures. The Senning procedure was added for those with atrioventricular discordance.RESULTS:The Nikaidoh procedure was the most time-consuming in terms of mean cardiopulmonary bypass and aortic crossclamp times. The average mechanical ventilation time was significantly shorter in the Rastelli group (63.3 +/- 89 hours) than that in the Nikaidoh group (188.7 +/- 159 hours, P = .016), but not different from that in the REV group (76.4 +/- 112.5 hours, P = .395). Two patients in the REV group and 1 in the Rastelli group died. There were no in-hospital or late deaths in the Nikaidoh group. Postoperative echocardiography demonstrated physiologic hemodynamics in the left ventricular outflow tract and normal heart function in the Nikaidoh group. Abnormal flow pattern in the left ventricular outflow tract was noted in both REV and Rastelli groups. There were no late deaths or reoperations in any group during follow-up.CONCLUSION:The modified Nikaidoh procedure is a better surgical option for transposition of the great arteries, ventricular septal defect, and pulmonary stenosis in terms of physiologic cardiac hemodynamics. Its long-term benefits need to be evaluated with a larger number of patients and longer follow-up.
The Journal of thoracic and cardiovascular surgery 2008
OBJECTIVES:To eliminate the residual false lumen in the descending thoracic aorta and improve long-term outcomes of surgical intervention for Stanford type A aortic dissection, we performed the skeletonized "elephant trunk" procedure in the ascending aorta and aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for both acute and chronic type A aortic dissection, and the short-term results were compared.METHODS:Between April 2003 and November 2004, 60 consecutive patients (mean age, 53 +/- 16.7; approximate range, 28-78 years) with acute (n = 36) or chronic (n = 24) type A aortic dissection underwent this procedure. Right axillary artery cannulation was used for cardiopulmonary bypass and selected cerebral perfusion. The stented graft, a 10-cm-long woven Dacron graft with a self-expandable stent, was implanted through the aortic arch during hypothermic circulatory arrest. Enhanced electric beam computed tomography was performed in each patient before discharge, 3 months after the operation, and once each year thereafter to evaluate the postoperative time course of the residual false lumen.RESULTS:Cardiopulmonary bypass time was 166 +/- 38 minutes, and average selective cerebral perfusion and lower body arrest time was 30 +/- 15 minutes. The in-hospital mortality was 3.3% (2/60). Thrombus obliteration of the residual false lumen in the descending thoracic aorta was observed in 92% and 85% of the acute and chronic aortic dissections, respectively, 3 months postoperatively. There was no late death during follow-up.CONCLUSIONS:The skeletonized elephant trunk procedure is an effective way of closing the residual false lumen of the descending aorta and might contribute to better long-term outcomes for both acute and chronic type A aortic dissection.
The Journal of thoracic and cardiovascular surgery 2006
We reviewed the perfusion experiences of 60 cases with a modified technique of selected cerebral perfusion (SCP) under deep hypothermic circulatory arrest (DHCA) during ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta for acute and chronic type A aortic dissection. Right auxiliary artery cannulation was routinely used for cardiopulmonary bypass (CPB) and SCP in this procedure. Generally, this technique requires two main pumps for two arterial lines before we applied the modified technique; one for CPB and the other for SCP. In order to simplify the circuit of the extracorporeal circuit (ECC) to operate easily, the arterial line was separated into two branches with a Y-connector on the operating table, one for axillary artery perfusion and the other for graft perfusion connected to the ECC set-up. This method is easy for the perfusionist to install and convenient for the surgeon. This is a safe and simple to use modified technique for SCP under DHCA during ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta.
Perfusion 2006
BACKGROUND:The goal of total aortic resection surgery is to correct the extensive or multiple sites of aortic pathology, which involves the entire length of the vessel. This study describes our experience in this operation at Fuwai Cardiovascular Hospital.METHODS:From February 2004 to October 2005, thirteen patients with Marfan syndrome underwent one-stage total or subtotal aortic replacement for aortic dissection or aortic aneurysms. Four patients received subtotal aortic replacement (ascending aorta to the abdominal aorta). Nine patients underwent total aortic replacement (ascending aorta to the aortic bifurcation). Operations were performed under circulatory arrest with profound hypothermia. Patients were opened with a mid-sternotomy and a thoracoabdominal incision. Extracorporeal circulation was instituted with two arterial cannulae and a single venous cannula in the right atrium. During cooling, the ascending aorta or aortic root was replaced. At the nasopharyngeal temperature of 20 degrees C, the aortic arch was replaced with selective antegrade cerebral perfusion. After brain reperfusion, staged aortic occlusions allowed for replacement of descending thoracic and abdominal aorta. Intercostal, visceral, and renal arteries were anastomosed to the graft.RESULTS:There was no operative or early postoperative death. One case of postoperative complication was noted for cerebral infarction secondary to embolism. Spinal neurologic deficits did not occur. At the last follow-up, ranging from 4 to 24 months postoperatively, all 13 patients were alive and had good functional status.CONCLUSIONS:One-stage total or subtotal aortic replacement for treatment of extensive aortic disease is feasible with acceptable surgical risks and satisfactory results. It can eliminate the risk of remnant aortic aneurysm rupture in staged total aortic replacement.
The Annals of thoracic surgery 2006
