Aortic stenosis is the most common native valve disease, affecting up to 5% of the elderly population. Surgical aortic valve replacement reduces symptoms and improves survival, and is the definitive therapy in patient...Aortic stenosis is the most common native valve disease, affecting up to 5% of the elderly population. Surgical aortic valve replacement reduces symptoms and improves survival, and is the definitive therapy in patients with symptomatic severe aortic stenosis. However, despite the good results of classic surgery, risk is markedly increased in elderly patients with co-morbidities. Transcatheter aortic valve replacement （TAVR） allows implantation of a prosthetic heart valve within the diseased native aortic valve without the need for open heart surgery and cardiopulmonary bypass, offering a new therapeutic option to elderly patients considered at high surgical risk or with contraindications to surgery. To date, several multicenter registries and a randomized trial have confirmed the safety and efficacy of TAVR in those patients. In this chapter, we review the background and clinical applications of TAVR in elderly patients.展开更多
Native heart valve leaflets with layered fibrous structures show anisotropic characteristics,allowing them to withstand complex mechanical loading for long-term cardiac cycles.Herein,two types of silk fibroin(SF)fiber...Native heart valve leaflets with layered fibrous structures show anisotropic characteristics,allowing them to withstand complex mechanical loading for long-term cardiac cycles.Herein,two types of silk fibroin(SF)fiber membranes with anisotropic(ASF)and isotropic(ISF)properties were prepared by electrospinning,and were further combined with poly(ethylene glycol)diacrylate(PEGDA)hydrogels to serve as polymeric heart valve(PHV)substitutes(PEGDA-ASF and PEGDA-ISF).The uniaxial tensile tests showed obvious anisotropy of PEGDA-ASF with elastic moduli of 10.95±1.09 and3.55±0.32 MPa,respectively,along the directions parallel and perpendicular to the fiber alignment,while PEGDA-ISF possessed isotropic property with elastic moduli of 4.54±0.43 MPa.The PHVs from both PEGDA-ASF and PEGDA-ISF presented appropriate hydrodynamic properties from pulse duplicator tests according to the ISO 5840-3 standard.However,finite element analysis(FEA)revealed the anisotropic PEGDA-ASF valve showed a lower maximum principle stress value(2.20 MPa)in commissures during diastole compared with that from the isotropic PEGDA-ISF valve(2.37 MPa).In the fully open state,the bending area of the PEGDA-ASF valve appeared in the belly portion and near the attachment line like native valves,however,which was close to free edges for the PEGDA-ISF valve.The Gauss curvature analysis also indicated that the anisotropic PEGDA-ASF valve can produce appropriate surface morphology by dynamically adjusting the movement of bending area during the opening process.Hence,anisotropy of PHVs with bio-inspired layered fibrous struc-tures played important roles in mechanical and hydrodynamic behavior mimicking native heart valves.展开更多
文摘Aortic stenosis is the most common native valve disease, affecting up to 5% of the elderly population. Surgical aortic valve replacement reduces symptoms and improves survival, and is the definitive therapy in patients with symptomatic severe aortic stenosis. However, despite the good results of classic surgery, risk is markedly increased in elderly patients with co-morbidities. Transcatheter aortic valve replacement （TAVR） allows implantation of a prosthetic heart valve within the diseased native aortic valve without the need for open heart surgery and cardiopulmonary bypass, offering a new therapeutic option to elderly patients considered at high surgical risk or with contraindications to surgery. To date, several multicenter registries and a randomized trial have confirmed the safety and efficacy of TAVR in those patients. In this chapter, we review the background and clinical applications of TAVR in elderly patients.
基金supported by the National Natural Science Foundation of China (31300788)the Hundred-Talent Program from Chinese Academy of Sciences
文摘Native heart valve leaflets with layered fibrous structures show anisotropic characteristics,allowing them to withstand complex mechanical loading for long-term cardiac cycles.Herein,two types of silk fibroin(SF)fiber membranes with anisotropic(ASF)and isotropic(ISF)properties were prepared by electrospinning,and were further combined with poly(ethylene glycol)diacrylate(PEGDA)hydrogels to serve as polymeric heart valve(PHV)substitutes(PEGDA-ASF and PEGDA-ISF).The uniaxial tensile tests showed obvious anisotropy of PEGDA-ASF with elastic moduli of 10.95±1.09 and3.55±0.32 MPa,respectively,along the directions parallel and perpendicular to the fiber alignment,while PEGDA-ISF possessed isotropic property with elastic moduli of 4.54±0.43 MPa.The PHVs from both PEGDA-ASF and PEGDA-ISF presented appropriate hydrodynamic properties from pulse duplicator tests according to the ISO 5840-3 standard.However,finite element analysis(FEA)revealed the anisotropic PEGDA-ASF valve showed a lower maximum principle stress value(2.20 MPa)in commissures during diastole compared with that from the isotropic PEGDA-ISF valve(2.37 MPa).In the fully open state,the bending area of the PEGDA-ASF valve appeared in the belly portion and near the attachment line like native valves,however,which was close to free edges for the PEGDA-ISF valve.The Gauss curvature analysis also indicated that the anisotropic PEGDA-ASF valve can produce appropriate surface morphology by dynamically adjusting the movement of bending area during the opening process.Hence,anisotropy of PHVs with bio-inspired layered fibrous struc-tures played important roles in mechanical and hydrodynamic behavior mimicking native heart valves.
