Background: The treatment of superior vena cava syndrome caused by invasive thymoma is challenging. This paper aims to explore the application of preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA) for total superior vena cava reconstruction.Methods: Total superior vena cava reconstruction guided by preoperative 3D-CTBA in the treatment of superior vena cava syndrome offers more accurate surgical evaluation and more effective procedure of multidisciplinary team (MDT), assists radical dissection and vascular reconstruction as planed in the way of "Step by Step". It also makes the follow-up procedure more effective.Results: High-quality thoracic computed tomography (CT) image is essential. A medical team ensures procedural success with 3D-CTBA. Using this approach, five patients have been treated successfully. The average operative length was 324 minutes and the average blood loss was 190 mL. There was no surgical mortality. Five patients are alive.Conclusions: Total superior vena cava reconstruction guided by preoperative 3D-CTBA is an effective technology for radical resection of mediastinal lesions combined with artificial vascular replacement.Meanwhile, 3D-CTBA improves the efficiency of MDT and surgical planning. It contributes to alleviate symptoms of SVCS and improve the quality of postoperative life.
Objectives: The partial upper sternotomy (PUS) approach is acceptable for aortic valve replacement, and even aortic root operation. However, the efficiency of PUS for extensive arch repair of acute type A aortic dissection (AAAD) in older adult patients has not been well investigated.Methods: Between January 2012 and December 2019, 222 older adult patients (≥65 years) diagnosed with AAAD went through extensive arch repair, among which 127 received PUS, and 95 underwent full sternotomy (FS). Logistic regression analysis was used to identify risk factors for early death, and negative binomial regression analysis was applied to explore risk factors related to post-operative ventilator-supporting time and intensive care unit stay time. Results: Total early mortality was 8.1% (18/222 patients). The PUS group had shorter Cardiopulmonary bypass time (133.0 vs.155.0 minutes, P<0.001), cross-clamp time (44.0 vs. 61.0 minutes, P<0.001) and shorter selective cerebral perfusion time (11.0 vs. 21.0 minutes, P<0.001) than the FS group. Left ventricle ejection fraction (LVEF)<50% (odds ratio [OR], 17.05; 95% confidence interval [CI] 1.87-155.63; P=0.012) and malperfusion syndromes (OR, 65.83; 95% CI 11.53-375.86; P<0.001) were related to early death. In the multivariate model, the PUS approach contributed to shorter ventilator-supporting time (incidence rate ratio [IRR], 0.76; 95% CI 0.64-0.91; P=0.003) , when compared with the FS group. Conclusions: The early results of emergency extensive arch repair of AAAD via PUS in older adult patients were satisfactory. However, the long-term results remain to be investigated.
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