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Application of vacuum sealing drainage technique in poor healing wounds after Heart valve surgery

South China Journal of Cardiology 2013年第2期14卷 122-126页

作者：黄志锋陈华德郑少逸赖文廖路妹刘族安卞徽宁孙传伟李汉华马亮华 Deparment of Burns Surgery Guangdong General Hospital Guangdong Academy Medical Sciences Panyu Dashi People's Hospital

Background： Poor healing wounds or postoperative infection after open-heart surgery are most commonly seen, especially in secondary surgery for heart diseases, with an incidence rate of 2.2% after a valve replacement surgery. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. It becomes a really troublesome and complicated case when a poor healing occurs in midsternal incision after the Heart valve surgery and a higher medical cost may be needed. Methods From January 2009 to February 2013, 162 patients who underwent Heart valve surgery through midsternal incision approach and had a poor healing of wound were observed for prospective randomized controlled trial. The patients were randomly assigned to a vacuum sealing drainage group （n = 81） who received vacuum sealing drainage for healing of the wound or a control group （n = 81） who received traditional treating for the infected wound. Their therapeutic effects, healing time and treatment costs, etc were compared. Results Two patients from the vacuum sealing drainage group came back to hospital for repair due to dehiscence of the incision after discharge, and no patient died. Six patients from the control group came back to hospital for repair due to dehiscence of the incision after discharge, two came back to hospital for surgery due to chronic osteomyelitis, and one patient died two weeks later after surgery due to severe chest infection. Wound healing time for vacuum sealing drainage group was 14.6 ± 3.6 days, which was significantly shorter than that of the control group （21.2 ± 7.8 days, P 〈 0.05）, while the medical costs showed no significant difference between the two groups （P 〉 0.05）. Seventy-eight patients （96.29%） in the vacuum sealing drainage group showed a good healing of the wound and sternum after a six-month follow-up. Conclusion The use of vacuum sealing drainage technique in poor-healing wounds after Heart valve surgery through midster

关键词： vacuum sealing drainage Heart valve heart operation poor healing wounds

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Heart valve surgery in China :past and present

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中华外科杂志 2001年第1期39卷 20-23页

作者：张宝仁 Department of Cardiothoracic Surgery Changhai Hospital Second Mili tary Medical University Shanghai 200433 China

Heart valve surgery in China dates back to 4 to 5 decades ago. In 1954, the first closed mitral commissurotomy was successfully performed in a patient with mitral stenosis. In 1960, with the advent of transventricular dilator and by the route of left ventricle, the efficacy of mitral commissurotomy was improved. The procedure was rapidly adopted by many centers in this country［1］. In 1958, the first open heart surgery using cardiopulmonary bypass was performed in China. This was an epoch-making event, which opened up a new era in the field of cardiac surgery in China. Thereafter, in cities like Beijing and Shanghai, direct repairs of mitral lesions under CPB were made with good results. In 1965, the development of the first totally home-made ball valve prosthesis and its successful application in mitral valve replacement was another landmark in the history of Heart valve surgery in China. In 1976, aortic valve replacement with glutaraldehyde-preserved bovine pericardial valve prosthesis was carried out successfully. The next year, the first porcine aortic valve prosthesis was produced and introduced to clinical use, which greatly accelerated the progress of Heart valve surgery in China. During the last 2 decades, Heart valve surgery and its techniques have been widely applied throughout China.

关键词：中国心脏 Heart valve mitral valve replacement aortic valve cardiopulmonary bypass open heart surgery mitral stenosis cardiac surgery left ventricle clinical use up a

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A Biosurfactant-containing TSD Strategy to Modify Bovine Pericardial Bioprosthetic valves for Anticalcification

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Chinese Journal of Polymer Science 2023年第1期41卷 51-66页

作者： Cai-Yun Gao Gang Wang Lin Wang Qun-Song Wang Han-Cheng Wang Lin Yu Jian-Xiong Liu Jian-Dong Ding State Key Laboratory of Molecular Engineering of Polymers Department of Macromolecular ScienceFudan UniversityShanghai200438China R&D Center Lifetech Scientific(Shenzhen)Co.Ltd.Shenzhen518057China R&D Center Lifevalve Medical Scientific Co.Ltd.Shenzhen518057China

Bioprosthetic Heart valves(BHVs)are important for transcatheter valve replacement.Current commercial BHVs on the market are basically porcine or bovine pericardium(BP)crosslinked with glutaraldehyde(GA).Simply applying GA to BHVs can enhance mechanical stability,but cannot alleviate in vivo calcification.In this work,we developed a two-step decellularization(TSD)strategy to modify this biomacromolecular network,in which BP was post-treated,as the second step of decellularization,with a mild biosurfactant n-dodecyl-β-D-maltoside in a mixture of isopropanol and phosphate-buffered saline after the first step of traditional decellularization and GA cross-linking.The TSD-treated BP exhibited not only low cytotoxicity and excellent mechanical properties in vitro,but also low immune responses and significant anticalcification in vivo.After 60 days of subcutaneous implantation in the back of Wistar rats,the calcium content was,as quantified with an inductively coupled plasma optical emission spectrometer,only 1.1µg/mg compared to 138.6µg/mg in the control group without the post-treatment.In addition,collagen fibrils were observed with field emitting scanning electron microscopy(SEM),and the morphology and composition of the calcified sites resulting from in vivo biomineralization were studied with SEM with energy dispersive spectroscopy and also X-ray diffraction.This study proposes a facile yet effective anticalcification strategy for the modification of the bovine pericardial bioprosthetic Heart valve,a natural biomacromolecular network.

关键词： Heart valve Anticalcification Collagen In vivo biomineralization Transcatheter aortic valve implantation(TAVI) Extracellular matrix Biomacromolecular network Biosurfactant Bovine pericardium

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In vitro calcification studies on bioprosthetic and decellularized Heart valves under quasi-physiological flow conditions

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Bio-Design and Manufacturing 2021年第1期4卷 10-21页

作者： Cristian C.D’Alessandro Andreas Dimopoulos Sofia Andriopoulou Gerasimos A.T.Messaris Sotirios Korossis Petros Koutsoukos Dimosthenis Mavrilas Laboratory of Biomechanics and Biomedical Engineering Department of Mechanical Engineering and AeronauticsUniversity of PatrasPatrasGreece Department of Cardiothoracic Transplantation and Vascular SurgeryHannover Medical SchoolHannoverGermany Department of Medical Physics University Hospital of PatrasPatrasGreece Wolfson School of Mechanical Electrical and Manufacturing EngineeringLoughborough UniversityLoughboroughUK Department of Chemical Engineering University of PatrasPatrasGreece FORTH-Institute of Chemical Engineering Sciences PatrasGreece

The lifespan of biological Heart valve prostheses available in the market is limited due to structural alterations caused by calcium phosphate deposits formed from blood plasma in contact with the tissues.The objective of this work is to present a comparative methodology for the investigation of the formation of calcium phosphate deposits on bioprosthetic and tissue-engineered scaffolds in vitro and the influence of mechanical forces on tissue mineralization.Based on earlier investigations on biological mineralization at constant supersaturation,a circulatory loop simulating dynamic blood flow and physiological pressure conditions was developed.The system was appropriately adapted to evaluate the calcification potential of decellularized(DCV)and glutaraldehyde-fixed(GAV)porcine aortic valves.Results indicated that DCV calcified at higher,statistically nonsignificant,rates in comparison with GAV.This difference was attributed to the tissue surface modifications and cell debris leftovers from the decellularization process.Morphological analysis of the solids deposited after 20 h by scanning electron microscopy in combination with chemical microanalysis electron-dispersive spectroscopy identified the solid formed as octacalcium phosphate(Ca8(PO4)6H2·5H2O,OCP).OCP crystallites were preferentially deposited in high mechanical stress areas of the test tissues.Moreover,GAV tissues developed a significant transvalvular pressure gradient increase past 36 h with a calcium deposition distribution similar to the one found in explanted prostheses.In conclusion,the presented in vitro circulatory model serves as a valuable prescreening methodology for the investigation of the calcification process of bioprosthetic and tissue-engineered valves under physiological mechanical load.

关键词： Reactors Calcification Constant composition reactor Heart valve In vitro Mechanical load Tissue engineering

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心脏瓣膜替换术的应用

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西安交通大学学报(医学版) 1986年第3期 268-270页

作者：侯立业蔡澄李兆志李淳成西安医科大学第二附属医院外科学教研室西安医科大学第一附属医院外科学教研室

自1979年10月至1984年12月共为53例病人施行54个人工瓣膜替换术。其中50例二尖瓣替换,1例主动脉瓣替换,1例主动脉瓣及二尖瓣替换,1例三尖瓣替换及二尖瓣成形术。术前心功能:Ⅱ级者6例(11%),Ⅲ级者35例(66%),Ⅳ级者12例(22%)。本组术后3... 详细信息

自1979年10月至1984年12月共为53例病人施行54个人工瓣膜替换术。其中50例二尖瓣替换,1例主动脉瓣替换,1例主动脉瓣及二尖瓣替换,1例三尖瓣替换及二尖瓣成形术。术前心功能:Ⅱ级者6例(11%),Ⅲ级者35例(66%),Ⅳ级者12例(22%)。本组术后30天内死亡2例,死亡率3.7%。随访时间3个月至62个月,晚期死亡4例,死亡率为3.3%病人年。术后心功能明显改善。本文对术前准备,心肌保护及并发症作了讨论。作者认为:人工瓣膜至今尚未达到理想程度,对瓣膜替换术的病例选择应严格掌握。

关键词： Heart valve anticoagulants thromboembolism

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Emergent Technologies for Cardiovascular Surgery

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Journal of Donghua University(English Edition) 2017年第2期34卷 325-332页

作者： GUIDOIN Robert 于成龙李超婧 NUTLEY Mark 林婧张泽王璐 DOUVILLE Yvan Department of Surgery Laval University and Axe Regenerative MedicineResearch Centre CHU Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textile Donghua University Peter Lougheed Centre University of Calgary

The optimal vascular blood supply throughout the body guarantees the support of normal functions to tissues and organs.Implants are now becoming a seamless extension of the body and shall accompany a higher level of fidelity between the device and the patient.As regenerative medicine is still in its infancy,the ongoing search for new and effective prosthetic alternatives continues to be essential and highly rewarding.Thanks in part to the progress of imaging and the benefits of 3D printing,previously unimagined emergent technologies are at hand.The emerging technologies of the last few decades and the near future will continue to greatly improve both the quality and quantity of patients' lives.They focus on minimally invasive technologies(keyhole surgery) and approaches for deployment of valves,stent-grafts,leadless pacemakers and adaptation of medical devices for destination therapy(assist devices and artificial hearts).In addition,specific blood conduits for the aortic valves together with the aortic arch and the pulmonary valves are considered.These breakthroughs are currently at various stages of development and acceptability.Innovative biomaterials were essential in the development of cardiovascular devices.They were and they still are the essential support for conduction prosthesis,but their place in signal prosthesis is being revisited.Any new development in medical devices has been frequently driven by surgeons and industry.The emergent technologies are introduced by pioneers.The risks and benefits of devices must be continuously reassessed during the lifetime of the implants based upon sound scientific principles of investigation,clinical experience of the users and retrieval programs.

关键词： Heart valve stent graft right ventricular outflow tract(RVOT) percutaneous valve leadless pacemakers cardiovascular emergent technologies

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Current progress on scaffolds of tissue engineering Heart valves

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Frontiers of Medicine 2008年第3期2卷 229-234页

作者： Nianguo DONG Jiawei SHI Ping HU Si CHEN Hao HONG Department of Cardiovascular Surgery Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Institute of Polymer Science&Engineering Tsinghua UniversityBeijing 100084China

Tissue engineering Heart valves(TEHV)may be the most promising valve substitute,but the study has been relatively stagnant in the recent five years due to the special position,function and mechanical property of Heart valves.It is one of the key factors to select an ideal scaffold material in the construction of TEHV.And this article will briefly review the current research and progress on the scaffolds of TEHV,especially based on Chinese works.

关键词： tissue engineering Heart valve scaffold

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Pathogenic Mineralization of Calcium Phosphate on Human Heart valves

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Journal of Wuhan University of Technology(Materials Science) 2005年第B12期20卷 150-152页

作者：王慧冯庆玲 Laboratory of Advanced Materials Department of Materials Science and Engineering Tsinghua University Beijing 100084 China

When calcium phosphate forms in soft tissues such as blood vessels and Heart valves, it causes disease. The abnormal formation of calcium phosphate is called pathogenic mineralization or pathogenic calcification. Cases of rheumatic heart disease （RHD） always occur with fibrotic and calcified tissue of Heart valve. In this article, samples taken from calcified human heart wdves were studied. The characterization was performend by scanning electronic microscope, X-ray Diffraction and transmission electron microscopy with selective diffraction patterns. It is found for the first time that calcium phosphate grains existing in the calcified human Heart valves contain octacalcium phosphate （ OCP ）.

关键词： calcification Heart valve octacalcium phosphate （OCP）

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scotch tape Encodes a Novel Transmembrane Protein Essential for Cardiac valve Development in Zebrafish

scotch tape Encodes a Novel Transmembrane Protein Essential ...

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中国的遗传学研究——遗传学进步推动中国西部经济与社会发...

作者： Qingming Yu2~*,Xu Wang1~*,Xiaojun Zhu1,and Jing-Wei Xiong1,2,3 1 Institute of Molecular Medicine.Peking University,Beijing,China 2 Department of Medicine/Nephrology,Massachusetts General Hospital and Harvard Medical School.Boston. Massachusetts,USA

Defects in cardiac valve morphogenesis are common causes of human congenital heart diseases,however the underlying cellular and molecular components remain largely unknown. The zebrafish scotch tape(sco) mutant showed severe cardiac edema,affected atrioventricular (AV) canal restriction and caused an abnormal caudal fin.Cardiac jelly,located between the endocardial and myocardial basement membranes,was almost undetectable by laminin staining, while chondroitin sulfate,a modified proteoglycan in the cardiac jelly,was present in sco mutants. High-speed movies showed no apparent endocardial invagination in the AV canal in the sco mutant heart at 72 hpf,leading to retrograde flow of blood from ventricle to atrium.The Heart valve defects were due to abnormal expression of several valve markers,including bmp4. br146/versican,tbx2b,and notch 1b.Positional cloning revealed that sco encodes a novel 540 amino acid protein with one putative transmembrane domain and three IgG domains. Overexpression of sco in the endocardium and endothelial cells,but not in the myocardium,could rescue sco mutant phenotype,supporting its primary role in the endocardium.Notch signaling was not activated in the AV canal of sco mutant hearts while it was otherwise active during normal endocardial cushion development.Abnormal expression of cell adhesion gene VE-cadherin,tight junction protein ZO1 and cell polarity protein aPKC compromised endocardial invagination of epithelial-mesenchymal transition(EMT) in the AV canal of sco mutants.Therefore,sco is an important factor for regulating endocardial and cardiac valve morphogenesis.

关键词： scotch tape Heart valve endocardium zebrafish

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