Risk profile and outcomes of aortic valve replacement in octogenarians

AIM: To investigate the patient characteristics, relationship between the Logistic EuroSCORE (LES) and the observed outcomes in octogenarians who underwent surgical aortic valve replacement (AVR). METHODS: Two hundred and seventy three octogenarians underwent AVR between 1996 and 2008 at Bristol Royal Inf irmary. Demographics, acute outcomes,length of hospital stay and mortality were obtained. The LES was calculated to characterize the predicted operative risk. Two groups were def ined: LES ≥ 15 (n = 80) and LES < 15 (n = 193). RESULTS: In patients with LES ≥ 15, 30 d mortality was 14% (95% CI: 7%-23%) compared with 4% (95% CI: 2%-8%) in the LES < 15 group (P < 0.007). Despite the increase in number of operations from 1996 to 2008, the average LES did not change. Only 5% of patients had prior bypass surgery. The LES identifi ed a low risk quartile of patients with a very low mortality (4%, n = 8, P < 0.007) at 30 d. The overall surgical results for octogenarians were excellent. The low risk group had an excellent outcome and the high risk group had a poor outcome after surgical AVR. CONCLUSION: It may be better treated with transcatheter aortic valve implantation.

包裹支架转移治疗基因到猪冠状动脉的实验研究

【目的】寻找一种有效转送治疗基因到扩张冠状动脉的靶部位的运载工具,用于预防冠状动脉损伤后再狭窄。【方法】治疗组用高分子聚合物phosphorylocholine(PC)包裹不锈钢丝的包裹支架,对照组用非包裹支架。①体外研究:经用复制缺陷的重组腺病毒β-Gal(1x109pfu/ml)处理后,将支架植入刚获得的新鲜猪冠状动脉内,植入了支架的冠状动脉分别用一种液体冲洗,共分成5组,每组5例,1组无冲洗、2组生理盐水、3组造影剂、4组血液、5组培养液。对照组用生理盐水冲洗。然后培养48h后固定,X-Gal染色,进行组织学分析。②在体研究:支架经用复制缺陷的重组腺病毒RvdTIMP3处理后,植入猪的冠状动脉,7d后处死猪,取血标本作血液学检验。心脏、脑、肺、肝、脾组织、部分冠状动脉靶部位置入液氮保存,作PCR分析。【结果】①体外包裹支架传移率分别为:无冲洗组6.9%±3.7%,生理盐水组6.6%±3.6%,培养液组7.2%±2.5%,造影剂组7.4%±1.9%,血液组16.2%±9.3%。对照组1.9%±0.5%,与生理盐水冲洗的治疗组比较差异有显著性,P=0.025。②仅治疗组在治疗部位的冠状动脉及远端血管组织中有TIMP3出现,其他器官组织中均未发现有TIMP3。【结论】经PC包裹的支架可有效地输送含有治疗基因的腺病毒到冠状动脉靶部位,液体的冲洗对传移率无明显影响,这?

植入携带有治疗性腺病毒的包裹支架对猪冠状动脉再狭窄的预防作用

目的寻找一种有效转送治疗基因到所扩张冠状动扩脉的靶部位的方法,以预防冠状动脉损伤后再狭窄。方法大白猪14只,随机分治疗组(包裹支架)和对照组(非包裹支架),每组7只,治疗组用高分子聚合物phosphorylocholine包裹不锈钢丝的包裹支架,对照组用非包裹支架,经复制缺陷的重组腺病毒RadTIMP-3处理后,植入猪的冠状动脉,4周后,行冠状动脉造影,取新鲜的心脏用福尔马林固定,进行组织形态分析。结果治疗组的血管腔内径平均值为(2.32±0.185) mm, 而非包裹支架的对照组平均直径为(1.79±0.31) mm,治疗组显著高于对照组,P=0.014。TiMP-3治疗组冠状动脉内膜的厚度为(0.34±0.17) mm,对照组为(0.81±0.32) mm,显著高于治疗组,P= 0.0059。结论经PC包裹支架输送含有TIMP-3基因的腺病毒到冠状动脉,可有效地抑制内膜平滑肌细胞的增生,减轻再狭窄。