Objective To evaluate immediate transcatheter aortic valve implantation （TAVI） results and medium-term follow-up in very elderly pa- tients with severe and symptomatic aortic stenosis （AS）. Methods This multicente...Objective To evaluate immediate transcatheter aortic valve implantation （TAVI） results and medium-term follow-up in very elderly pa- tients with severe and symptomatic aortic stenosis （AS）. Methods This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly （〉 85 years） patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rotes from any cause at two years. Results The study included 160 consecutive patients with a mean age of 87 ± 2.1 years （range from 85 to 94 years） and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 （35.6%） patients scoring 〉 20%. Procedural success rate was 97.5%, with 25 （15.6%） patients experiencing acute complications with major bleeding （the most frequent）. Global mortality rate during hospitalization was 8.8% （n = 14） and 30-day mortality rate was 10% （n = 16）. Median follow up period was 252.24± 232.17 days. During the follow-up period, 28 （17.5%） patients died （17 of them due to cardiac causes）. The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique vari- able associated with overall mortality. Conclusions TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients.展开更多
A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma(PGDLBL)by PET/CT examination,gastroscopy,biopsy and histopathological analysis at a regular physical check in April,2016.The patient r...A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma(PGDLBL)by PET/CT examination,gastroscopy,biopsy and histopathological analysis at a regular physical check in April,2016.The patient received R-CO chemotherapy(rituximab,cyclophosphamide,and vincristine)and radiotherapy subsequently,with enteral nutritional treatment through 3-cavity nasogastric tube due to development of pyloric obstruction.To satisfy patient's strong desire of eating by himself,we performed surgery of exploratory laparotomy and Roux-en-Y gastric bypass(RGB)to relieve pylorus obstruction.Postoperatively,the patient resumed oral feeding,supplemented by nasogastric tube feeding at 1350-1550 Kcal daily.He is now 94 years old with fairly well nutrition and normal communication.The outcome of 4 year follow-up suggests that nutritional treatment and palliative medicine are important for improving prognosis and life-quality of very elderly patients with end-stage tumors apart from the effective chemotherapy,radiotherapy,and surgery.展开更多
文摘Objective To evaluate immediate transcatheter aortic valve implantation （TAVI） results and medium-term follow-up in very elderly pa- tients with severe and symptomatic aortic stenosis （AS）. Methods This multicenter, observational and prospective study was carried out in three hospitals. We included consecutive very elderly （〉 85 years） patients with severe AS treated by TAVI. The primary endpoint was to evaluate death rotes from any cause at two years. Results The study included 160 consecutive patients with a mean age of 87 ± 2.1 years （range from 85 to 94 years） and a mean logistic EuroSCORE of 18.8% ± 11.2% with 57 （35.6%） patients scoring 〉 20%. Procedural success rate was 97.5%, with 25 （15.6%） patients experiencing acute complications with major bleeding （the most frequent）. Global mortality rate during hospitalization was 8.8% （n = 14） and 30-day mortality rate was 10% （n = 16）. Median follow up period was 252.24± 232.17 days. During the follow-up period, 28 （17.5%） patients died （17 of them due to cardiac causes）. The estimated two year overall and cardiac survival rates using the Kaplan-Meier method were 71% and 86.4%, respectively. Cox proportional hazard regression showed that the variable EuroSCORE ≥ 20 was the unique vari- able associated with overall mortality. Conclusions TAVI is safe and effective in a selected population of very elderly patients. Our findings support the adoption of this new procedure in this complex group of patients.
基金the Millitary Logistical Special Project for Health Care(18BJZ07)。
文摘A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma(PGDLBL)by PET/CT examination,gastroscopy,biopsy and histopathological analysis at a regular physical check in April,2016.The patient received R-CO chemotherapy(rituximab,cyclophosphamide,and vincristine)and radiotherapy subsequently,with enteral nutritional treatment through 3-cavity nasogastric tube due to development of pyloric obstruction.To satisfy patient's strong desire of eating by himself,we performed surgery of exploratory laparotomy and Roux-en-Y gastric bypass(RGB)to relieve pylorus obstruction.Postoperatively,the patient resumed oral feeding,supplemented by nasogastric tube feeding at 1350-1550 Kcal daily.He is now 94 years old with fairly well nutrition and normal communication.The outcome of 4 year follow-up suggests that nutritional treatment and palliative medicine are important for improving prognosis and life-quality of very elderly patients with end-stage tumors apart from the effective chemotherapy,radiotherapy,and surgery.
