Reintervention with Transcatheter and Surgical Aortic Valves: A Systematic Review and Meta-Analysis

Background: Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. Methods: We performed a systematic review and meta-analysis of all published studies with ≥5years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. Results: The meta- analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male). All TAVR procedures were performed with early generations of THV. At a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33;95% CI: [1.78, 6.24], p < 0.001, I2 = 0%), all-cause mortality (OR 1.45;95% CI: [1.22, 1.75], p < 0.001, I2 = 44%) and the composite of reintervention and death (OR 1.47;95% CI: [1.14, 1.91], p < 0.001, I2 = 64%). Rates of myocardial infarction, transient ischemic attack, stroke, endocarditis, and the composite of endocarditis and thrombosis were similar between the groups. Conclusion: Despite comparable short and medium-term results, TAVR with early-generation THV has higher rates of reintervention and the composite of reintervention and death. Further studies employing newer definitions of structural valve deterioration and bioprosthetic valve failure are needed to assess whether technological enhancements in THV technology will improve long-term outcomes.

构建有中国特色的国际旅行健康服务体系

国际旅行医学业务在中国从无到有,其发展已经历了30余年的时间。目前我国开展旅行医学业务的实体是出入境检验检疫局,开展的旅行医学工作由政府主导,业务既包含了国际旅行卫生保健中心针对国际旅行者开展的出发前旅行医学咨询、预防接种、健康状况评估、旅行相关健康教育、回归旅行者的身体状况评估和疾病筛查,也包含了与《国际卫生条例(2005)》密切相关的出入境口岸公共卫生工作。虽然我国的国际旅行医学体系具有国外没有的优势,如政府主导、垂直管理、工作力度大、对旅行个体和其所涉及的当地人群可以通过联防联控机制和多部门合作进行快速干预,当国际关注的公共卫生事件发生时可以在口岸快速建立防线。但仍面临着对旅行医学认知不足、缺乏行业规范、专业人员短缺、与市场结合不紧密、旅行医学信息获取不及时,以及旅行医学手段局限等挑战。未来将通过加强国内外合作、增加投入、实施规范人才培养计划以及支持旅行医学研究等方式促进我国旅行医学的进一步发展。

旅行医学中健康危险因素的流行状况

在国际旅行期间,健康问题是非常常见的,并不仅限于热带病,对旅行人群而言,我们不仅要知道许多健康问题是传染性的,还必须考虑到那些非传染性疾病,诸如:环境相关性深静脉血栓或高山病等等.而旅行者本身的相关因素也在考虑之列,这主要是指旅行者旅行前即存在的不良健康状况的恶化问题.

生物恐怖:威胁和解决(英文)

Robert Steffen, Scientist, WHO Project Improving public health preparedness on diseases associated with biological warfare; Co-chair, Swiss B Committee: University of Zurich, Switzerland. The goal of any emergency preparedness and response planning is to keep it an emergency and to avert a disaster.