62岁男性患者，发现右心室肿物1天。既往有骨肉瘤病史。超声心动图示右心室心腔内及右心室壁占位性病变。2019年2月在全麻低温体外循环下行右心室肿物切除术＋三尖瓣生物瓣膜置换术＋心外膜临时起搏导线缝置术。术后病理检查示间叶源性恶性肿瘤，考虑心脏转移性骨肉瘤。术后随访1年，患者心功能良好，心腔内未见肿瘤复发，右心室壁占位无明显变化。

Aim The aim of this study was to investigate the effect of the modified extracorporeal circulation perfusion method during surgery for acute Stanford type A aortic dissection in patients who underwent stented elephant trunk implantation and arch replacement. Method A total of 69 patients with acute Stanford type A aortic dissection who underwent stented elephant trunk implantation and arch replacement were retrospectively analysed from 2017 to 2018. According to the perfusion method of extracorporeal circulation, patients were divided into a routine perfusion (RP) group and a modified perfusion (MP) group. Clinical data were collected, including the time of extracorporeal circulation and deep hypothermic circulatory arrest, incidence of acute kidney injury and neurological complications, and comparisons between the two groups were conducted by using independent sample t-tests for normally distributed qualitative data, the Mann-Whitney U-test for skewed qualitative data, and the chi square test or Fisher's exact test for categorical data. Results There were 55 (80%) males and 14 (20%) females in the entire cohort, and the mean +/- standard deviation age was 50.4+/-9.0 years. Atotal of 53 (77%) patients were included in the RP group, and 16 (23%) were included in the MP group. Patients in the MP group were older (55.5+/-7.8 vs 48.8+/-8.9 years), and the difference was significant (p=0.008). Compared with the RP group, the time of extracorporeal circulation (218.0 [44.7] vs 246.0 [58.0] min; p=0.005) and deep hypothermic circulatory arrest (4.0 [2.0] vs 25.0 [10.0] min; p<0.001) was shorter, and the incidence of postoperative acute kidney injury (n=6 [37.5%] vs n=36 [67.9%]; p=0.029) was lower in the MP group; the differences were significant. Six (6) patients died in the RP group; no patients died in the MP group. The total in-hospital mortality rate was 8.7%. Conclusions The modified extracorporeal circulation perfusion method is feasible, with satisfactory results.

The present study aimed to clarify the influence of long non-coding RNA small nuclear host gene 16 (lncRNA SNHG16) on cardiomyocyte proliferation following ischemia/reperfusion injury (IRI) and the potential mechanism. An IRI model in mice was established by performing ligation of the anterior descending coronary artery (LAD). Primary cardiomyocytes were isolated from newborn mice and subjected to H2O2 treatment to mimic in vitro IRI. Relative levels of SNHG16 and miRNA-770-5p in both in vivo and in vitro IRI models were examined. The regulatory effects of SNHG16 and miRNA-770-5p on the proliferative ability of H2O2-treated cardiomyocytes were assessed by Cell Counting Kit-8 (CCK-8) and 5-ethynyl-2'-deoxyuridine (EdU) assay. The binding relationship between SNHG16 and miRNA-770-5p was verified through dual-luciferase reporter gene assay. It is found that SNHG16 was time-dependently downregulated in the IRI models. Overexpression of SNHG16 enhanced the proliferative ability of the cardiomyocytes. miRNA-770-5p was found to be a direct target of SNHG16. Moreover, SNHG16 was able to negatively regulate the miRNA-770-5p level. Overexpression of miRNA-770-5p partially reversed the role of SNHG16 on accelerating cardiomyocyte proliferation. Collectively, SNHG16 accelerates the proliferative ability of cardiomyocytes following IRI by negatively regulating miRNA-770-5p.

达芬奇机器人技术自应用于心血管外科领域后,已经获得了长足的发展,中国心血管外科团队在其中起到了举足轻重的作用.达芬奇机器人技术在中国正逐步推广,并应用到各学科手术当中.本综述简要介绍了达芬奇机器人的诞生与组成,在心外科手术中的应用以及达芬奇手术的基本要点.

目的 比较达芬奇机器人辅助下二尖瓣手术与常规二尖瓣手术的临床效果,以明确达芬奇机器人技术的优点及不足.方法 2014年11月-2017年12月,我科共行达芬奇机器人辅助下二尖瓣手术82例(达芬奇组),同期行常规二尖瓣手术246例(常规组),将两组病人的临床治疗情况进行对比分析.结果 两组均无院内死亡.达芬奇组病人手术时间、体外循环时间、升主动脉阻断时间较常规组延长(P＜0.05);重症监护室治疗时间、拔除气管插管时间、术后住院天数较常规组缩短(P＜0.05);术中出血量、术后1个月射血分数与常规组比较差异无显著性(P＞0.05).结论 达芬奇机器人技术可安全、有效地应用于二尖瓣手术当中,并且能明显缩短病人重症监护室治疗时间、拔除气管插管时间和术后住院天数,但其手术、体外循环和升主动脉阻断时间较传统手术延长.

Objective To investigate the results of the surgical treatment in the patients with Stanford type A aortic dissection.Methods Aretrospective study was performed on 88 cases of patients who were admitted and underwent surgery of the Stanford type A aortic dissection from January 2011 to March 2016.The preoperative data,in vitro circulation data,perioperative blood transfusion volume,mechanical ventilation time,ICU hospitalization time,total hospitalization time and postoperative complications were analyzed.Results In the total 88 cases,16 cases were operated by the means of the none-total arch replacement without the deep hypothermic circulatory arrest (7 cases with the ascending aorta replacement and Bentall surgery in 9 cases),and the rest of the 72 cases were operated by the total arch replacement (ascending aorta replacement + Sun's surgery in 40 cases,Bentall + Sun's surgery in 31 cases,David + Sun's surgery in 1 case).Compared with the patients of non-total arch replacement group,patients of total arch replacement group were with low intraoperative nasopharyngeal temperature and anal temperature,long time of extracorporeal circulation and the ascending aorta blocking,large amount of intraoperative red blood cells,plasma and platelet transfusion,long time of the breathing machine ventilation and ICU length of hospital stay,large amount of postoperative red blood cells,plasma and platelet transfusion,high incidence rate of postoperative neurological complications,and the differences were statistically significant(P ＜ 0.05).The autologous blood transfusion volume,the total length of hospital stay,postoperative acute kidney injury,hypoxemia,the application of continuous renal replacement therapy and secondary tracheal intubation and tracheostomy and mortality rate in the total arch replacement group were higher than those in the non-total arch replacement group,there was no statistically significant difference between the two groups(P ＞ 0.05).During the follow-up,2 patients(12.5％) were re-operated by the means of total arch replacement and descending aorta stent implantation because of the aortic dissection in the aortic arch in the none-total arch replacement group,there was no secondary surgery in the total arch replacement group,and the difference was statistically significant (P ＜ 0.05).Conclusion The surgical treatment effect of the Stanford A type aortic dissection is satisfactory although the disease is complicated,the condition is severe,the operation risk is large and the in-hospital mortality is high.Intraoperative brain protection is of particular importance,and selection of surgical methods should be considered.