Background Transcatheter aortic valve replacement （TAVR） has been performed for many elderly patients with severe aortic stenosis （AS）. The SAPIEN 3 is one of the latest balloon-expandable prosthesis. This study a...Background Transcatheter aortic valve replacement （TAVR） has been performed for many elderly patients with severe aortic stenosis （AS）. The SAPIEN 3 is one of the latest balloon-expandable prosthesis. This study aimed to investigate the early clinical outcomes after TAVR using the SAPIEN 3 in nonagenarians. Methods A total of 97 consecutive patients underwent TAVR for severe AS between De- cember 2015 and December 2016. Of these, 85 consecutive patients who underwent TAVR using the SAPIEN 3 were included. According to the age, patients were classified into age 〉 90 years group （17 patients） or age 〈 90 years group （68 patients）. The clinical outcomes in- cluding all-cause mortality and composite endpoint of early safety at 30 days were evaluated. Results The Society of Thoracic Surgeons score in age 〉 90 years group was higher than age 〈 90 years group （12.3 ±6.1% vs. 8.5 ± 5.1%, P 〈 0.01）. There was no significant difference in 30-day mortality between the two groups. However, the life-threatening bleeding and major vascular complications in age 〉 90 years group were greater than age 〈 90 years group （11.8% vs. 1.5%, P = 0.04 and 11.8% vs. 1.5%, P = 0.04, respectively）. The composite endpoint of early safety at 30 days was similar between the two groups. Multivariate logistic regression analysis showed that prior myocardial infarction was an independent predictor of the composite endpoint of early safety （odds ratio： 4.76, 95% confidence interval： 1.02-22.21, P = 0.047）. Conclusions The early mortality and safety after TAVR using the SAPIEN 3 in nonagenarians were similar and acceptable despite of higher operative risk.展开更多
Objectives Transcatheter valve-in-valve （VIV） implantation for failed bioprostheses has become an alternative to open surgery in those deemed high risk. The purpose of this study was to evaluate the effectiveness an...Objectives Transcatheter valve-in-valve （VIV） implantation for failed bioprostheses has become an alternative to open surgery in those deemed high risk. The purpose of this study was to evaluate the effectiveness and outcomes of this emerging procedure. Methods Fourty VIV procedures were performed in 38 consecutive patients （mean age 70 ± 14 years and mean Logistic EuroScore 23.6 ± 15.5%） with severe aortic （n = 19） or mitral （n = 21） bioprosthetic valve dysfunction between 2014 and 2017. Bioprosthetic failure was secondary to stenosis in 11 （27.5%）, regurgitation in 19 （47.5%）, and combined in 10 （25.0%） bioprostheses. Clinical, echocardiographic, and procedural profiles were characterized, and the short-term results of the study patients were reported. Results Successful transfemoral （n = 15）, trans-subclavian （n = 1）, or transapical （n = 3） aortic VIV using either balloon-expandable valves （Edwards Sapien XT, n = 7） or self-expandable valves （Medtronic CoreValve, n = 12）; and transapical （n = 21） mitral VIV using either Edwards Sapien XT （n = 15） or me-chanically expandable valves （Boston Scientific Lotus, n = 6） were accomplished in all 40 VIV procedures. Implantation was successful with immediate restoration of satisfactory valve function in all patients. Five patients （13.2%） died at a median follow up of 9.3 months. Most of the 33 patients alive were in good functional status with good prosthetic valve performance. Conclusions Transcatheter VIV implantation is a feasible and safe option for the management of bioprosthetic valve failure. It may offer a less invasive alternative for those high-risk patients needing repeat valve replacement.展开更多
Prosthetic valve endocarditis （PVE） after Transcatheter Aortic Valve Implantation （TAVI） has been reported to occur with an incidence of 0.3% 3.1% per patient-year and it is associated with high mortality rates. W...Prosthetic valve endocarditis （PVE） after Transcatheter Aortic Valve Implantation （TAVI） has been reported to occur with an incidence of 0.3% 3.1% per patient-year and it is associated with high mortality rates. We report a PVE occurring early, i.e., 26 days post transfemoral TAVI with the use of Edward-Sapien-XT S3 prosthesis 26 mm because of severe symptomatic aortic tory included a coronary and stenosis. His past medical his- peripheral arterial disease and a total knee replacement in 2010. Our patient, a 77-year old female, was admitted with signs of septic arthritis of the left knee and was febrile.展开更多
Objective： To observe the cardiac output （CO） in animals and patients undergone valve replacement with Jiuling bileaflet mechanical valve prosthesis. Methods： 1. Animal experiments： 6 sheep that subjected to mitr...Objective： To observe the cardiac output （CO） in animals and patients undergone valve replacement with Jiuling bileaflet mechanical valve prosthesis. Methods： 1. Animal experiments： 6 sheep that subjected to mitral replacement with a 2 I-ram-valve prosthesis were measured by open cardiac catheterization intraoperatively. Echocardiographic and open cardiac catheterization under dobutamine stress were performed on 2 sheep survival for 30 months post-operation.2. Patient measurements： CO of 14 cases of aortic valve and 10 cases of mitral valve was measured by open cardiac catheterization,and after 12 months,it was measured by echocardiography. Results： 1. Animal experiments： The mean CO of 6 sheep was 2.5 L/min intraoperatively by catheterization, and that of 2 sheep survival for 30 months post-implant was 3.0 L/min by echocardiography and 2.9 L/min by catheterization, respectively. 2. Patient measurements： The mean cardiac index of 4 patients with 21 mm valve replacement was （2.55 ± 0.27） L/min/m^2by catheterization, and was （2.84 ± 0.13） L/min/m^2 by echocardiography after 12 months. Conclusion： This study demonstrates that cardiac function on animals and patients return to normal activity after undergone the valve replacement, and the newly valve prosthesis shows excellent hemodynamic performance.展开更多
文摘Background Transcatheter aortic valve replacement （TAVR） has been performed for many elderly patients with severe aortic stenosis （AS）. The SAPIEN 3 is one of the latest balloon-expandable prosthesis. This study aimed to investigate the early clinical outcomes after TAVR using the SAPIEN 3 in nonagenarians. Methods A total of 97 consecutive patients underwent TAVR for severe AS between De- cember 2015 and December 2016. Of these, 85 consecutive patients who underwent TAVR using the SAPIEN 3 were included. According to the age, patients were classified into age 〉 90 years group （17 patients） or age 〈 90 years group （68 patients）. The clinical outcomes in- cluding all-cause mortality and composite endpoint of early safety at 30 days were evaluated. Results The Society of Thoracic Surgeons score in age 〉 90 years group was higher than age 〈 90 years group （12.3 ±6.1% vs. 8.5 ± 5.1%, P 〈 0.01）. There was no significant difference in 30-day mortality between the two groups. However, the life-threatening bleeding and major vascular complications in age 〉 90 years group were greater than age 〈 90 years group （11.8% vs. 1.5%, P = 0.04 and 11.8% vs. 1.5%, P = 0.04, respectively）. The composite endpoint of early safety at 30 days was similar between the two groups. Multivariate logistic regression analysis showed that prior myocardial infarction was an independent predictor of the composite endpoint of early safety （odds ratio： 4.76, 95% confidence interval： 1.02-22.21, P = 0.047）. Conclusions The early mortality and safety after TAVR using the SAPIEN 3 in nonagenarians were similar and acceptable despite of higher operative risk.
文摘Objectives Transcatheter valve-in-valve （VIV） implantation for failed bioprostheses has become an alternative to open surgery in those deemed high risk. The purpose of this study was to evaluate the effectiveness and outcomes of this emerging procedure. Methods Fourty VIV procedures were performed in 38 consecutive patients （mean age 70 ± 14 years and mean Logistic EuroScore 23.6 ± 15.5%） with severe aortic （n = 19） or mitral （n = 21） bioprosthetic valve dysfunction between 2014 and 2017. Bioprosthetic failure was secondary to stenosis in 11 （27.5%）, regurgitation in 19 （47.5%）, and combined in 10 （25.0%） bioprostheses. Clinical, echocardiographic, and procedural profiles were characterized, and the short-term results of the study patients were reported. Results Successful transfemoral （n = 15）, trans-subclavian （n = 1）, or transapical （n = 3） aortic VIV using either balloon-expandable valves （Edwards Sapien XT, n = 7） or self-expandable valves （Medtronic CoreValve, n = 12）; and transapical （n = 21） mitral VIV using either Edwards Sapien XT （n = 15） or me-chanically expandable valves （Boston Scientific Lotus, n = 6） were accomplished in all 40 VIV procedures. Implantation was successful with immediate restoration of satisfactory valve function in all patients. Five patients （13.2%） died at a median follow up of 9.3 months. Most of the 33 patients alive were in good functional status with good prosthetic valve performance. Conclusions Transcatheter VIV implantation is a feasible and safe option for the management of bioprosthetic valve failure. It may offer a less invasive alternative for those high-risk patients needing repeat valve replacement.
文摘Prosthetic valve endocarditis （PVE） after Transcatheter Aortic Valve Implantation （TAVI） has been reported to occur with an incidence of 0.3% 3.1% per patient-year and it is associated with high mortality rates. We report a PVE occurring early, i.e., 26 days post transfemoral TAVI with the use of Edward-Sapien-XT S3 prosthesis 26 mm because of severe symptomatic aortic tory included a coronary and stenosis. His past medical his- peripheral arterial disease and a total knee replacement in 2010. Our patient, a 77-year old female, was admitted with signs of septic arthritis of the left knee and was febrile.
文摘Objective： To observe the cardiac output （CO） in animals and patients undergone valve replacement with Jiuling bileaflet mechanical valve prosthesis. Methods： 1. Animal experiments： 6 sheep that subjected to mitral replacement with a 2 I-ram-valve prosthesis were measured by open cardiac catheterization intraoperatively. Echocardiographic and open cardiac catheterization under dobutamine stress were performed on 2 sheep survival for 30 months post-operation.2. Patient measurements： CO of 14 cases of aortic valve and 10 cases of mitral valve was measured by open cardiac catheterization,and after 12 months,it was measured by echocardiography. Results： 1. Animal experiments： The mean CO of 6 sheep was 2.5 L/min intraoperatively by catheterization, and that of 2 sheep survival for 30 months post-implant was 3.0 L/min by echocardiography and 2.9 L/min by catheterization, respectively. 2. Patient measurements： The mean cardiac index of 4 patients with 21 mm valve replacement was （2.55 ± 0.27） L/min/m^2by catheterization, and was （2.84 ± 0.13） L/min/m^2 by echocardiography after 12 months. Conclusion： This study demonstrates that cardiac function on animals and patients return to normal activity after undergone the valve replacement, and the newly valve prosthesis shows excellent hemodynamic performance.
