Objective:To evaluate the application effect of predictive nursing on patients undergoing heart valve surgery with extracorporeal circulation(ECC).Methods:92 ECC patients admitted to the hospital between July 2021 and...Objective:To evaluate the application effect of predictive nursing on patients undergoing heart valve surgery with extracorporeal circulation(ECC).Methods:92 ECC patients admitted to the hospital between July 2021 and July 2023 were selected and grouped by random number table method;the observation group practiced predictive nursing,while the reference group practiced conventional nursing.The cardiopulmonary rehabilitation and other indexes were compared between the groups.Results:The postoperative rehabilitation time of the observation group was shorter than that of the reference group,the treatment compliance was higher than that of the reference group,the cardiopulmonary function indexes were all better than that of the reference group,and the complication rate was lower than that of the reference group(P<0.05).Conclusion:The implementation of predictive nursing for ECC patients can promote postoperative rehabilitation,improve patients’treatment compliance,and enhance the cardiopulmonary rehabilitation effect,and nursing safety is high.展开更多
Although surgical aortic valve replacement is the standard therapy for severe aortic stenosis(AS),about one third of patients are considered inoperable due to unacceptable surgical risk.Under medical treatment alone t...Although surgical aortic valve replacement is the standard therapy for severe aortic stenosis(AS),about one third of patients are considered inoperable due to unacceptable surgical risk.Under medical treatment alone these patients have a very poor prognosis with a mortality rate of 50%at 2 years.Transcatheter aortic valve implantation(TAVI)has been used in these patients,and has shown robust results in the only randomized clinical trial of severe AS treatment performed so far.In this review,we will focus on the two commercially available systems:Edwards SAPIEN valve and CoreValve Revalving system.Both systems have demonstrated success rates of over 90%with 30-d mortality rates below 10%in the most recent transfemoral TAVI studies.Moreover,long-term studies have shown that the valves have good haemodynamic performance.Some studies are currently exploring the non-inferiority of TAVI procedures vs conventional surgery in high-risk patients,and long-term clinical results of the percutaneous valves.In this article we review the current status of TAVI including selection of patients,a comparison of available prostheses,results and complications of the procedure,clinical outcomes,and future perspectives.展开更多
Right ventricular outflow tract(RVOT)obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot,pulmonary atresia/stenosis and other conotruncal abnormalities etc.After surgic...Right ventricular outflow tract(RVOT)obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot,pulmonary atresia/stenosis and other conotruncal abnormalities etc.After surgical repair,these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit.There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction.Surgical pulmonic valve replacement(SPVR)has been the mainstay for these patients and is considered standard of care.Transcatheter pulmonic valve implantation(TPVI)was first reported in 2000 and has made strides as a comparable alternative to SPVR,being approved in the United States in 2010.We provide a comprehensive review in this space–indications for TPVI,detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI.TPVI has been shown to have favorable medium-term outcomes free of reinterventions especially after the adoption of the practice of pre-stenting the RVOT.Procedural mortality and complications are uncommon.With more experience,recognition of risk of dreaded outcomes like coronary compression has improved.Also,conduit rupture is increasingly being managed with transcatheter tools.Questions over endocarditis risk still prevail in the TPVI population.Head-to-head comparisons to SPVR are still limited but available data suggests equivalence.We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.展开更多
背景:退行性二尖瓣关闭不全的病例有逐渐增加的趋势,而单纯二尖瓣环扩张引起的二尖瓣关闭不全是退行性二尖瓣关闭不全的一种类型,国内尚无关于此类二尖瓣关闭不全的外科治疗的临床研究报告。目的:观察单纯瓣环置入修复单纯二尖瓣环扩张...背景:退行性二尖瓣关闭不全的病例有逐渐增加的趋势,而单纯二尖瓣环扩张引起的二尖瓣关闭不全是退行性二尖瓣关闭不全的一种类型,国内尚无关于此类二尖瓣关闭不全的外科治疗的临床研究报告。目的:观察单纯瓣环置入修复单纯二尖瓣环扩张引起的二尖瓣关闭不全早中期生物相容性的反应。方法:单纯二尖瓣瓣环扩张致二尖瓣关闭不全患者48例,均行二尖瓣人工瓣环置入修复,其中使用Carpentier-Edwards生理环23例、SJMTM刚性鞍形成形环25例。出院后随访,采用超声心动图观察心功能和二尖瓣反流程度等变化,并比较两种瓣环与宿主生物相容性有无差别。结果与结论:围术期无死亡,均治愈出院。48例均获随访,随访率100%,随访时间3个月至4年,无死亡病例。NYHA心功能分级Ⅰ级32例,Ⅱ级16例。与术前比较,随访期超声心动图显示左心房内径、左心室舒张末期内径、左心室收缩末期内径、肺动脉收缩压和反流速面积/左房面积均明显减少(P<0.01),左室射血分数明显增加(P<0.01)。跨瓣压差均<3 mm Hg。二尖瓣无明显返流36例,微量返流10例,轻度反流2例。未出现成形环断裂、成形环撕脱及溶血现象。Carpentier-Edwards生理环组和SJMTM刚性鞍形成形环组比较,上述各指标差异无显著性意义(P>0.05)。结果提示对于因单纯二尖瓣环扩张引起的退行性二尖瓣关闭不全,通过正确的置入技巧、选择合适的人工瓣环,应用人工瓣环置入有与宿主生物较好的生物相容性反应,置入后的瓣膜替代功能良好。展开更多
文摘Objective:To evaluate the application effect of predictive nursing on patients undergoing heart valve surgery with extracorporeal circulation(ECC).Methods:92 ECC patients admitted to the hospital between July 2021 and July 2023 were selected and grouped by random number table method;the observation group practiced predictive nursing,while the reference group practiced conventional nursing.The cardiopulmonary rehabilitation and other indexes were compared between the groups.Results:The postoperative rehabilitation time of the observation group was shorter than that of the reference group,the treatment compliance was higher than that of the reference group,the cardiopulmonary function indexes were all better than that of the reference group,and the complication rate was lower than that of the reference group(P<0.05).Conclusion:The implementation of predictive nursing for ECC patients can promote postoperative rehabilitation,improve patients’treatment compliance,and enhance the cardiopulmonary rehabilitation effect,and nursing safety is high.
文摘Although surgical aortic valve replacement is the standard therapy for severe aortic stenosis(AS),about one third of patients are considered inoperable due to unacceptable surgical risk.Under medical treatment alone these patients have a very poor prognosis with a mortality rate of 50%at 2 years.Transcatheter aortic valve implantation(TAVI)has been used in these patients,and has shown robust results in the only randomized clinical trial of severe AS treatment performed so far.In this review,we will focus on the two commercially available systems:Edwards SAPIEN valve and CoreValve Revalving system.Both systems have demonstrated success rates of over 90%with 30-d mortality rates below 10%in the most recent transfemoral TAVI studies.Moreover,long-term studies have shown that the valves have good haemodynamic performance.Some studies are currently exploring the non-inferiority of TAVI procedures vs conventional surgery in high-risk patients,and long-term clinical results of the percutaneous valves.In this article we review the current status of TAVI including selection of patients,a comparison of available prostheses,results and complications of the procedure,clinical outcomes,and future perspectives.
文摘Right ventricular outflow tract(RVOT)obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot,pulmonary atresia/stenosis and other conotruncal abnormalities etc.After surgical repair,these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit.There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction.Surgical pulmonic valve replacement(SPVR)has been the mainstay for these patients and is considered standard of care.Transcatheter pulmonic valve implantation(TPVI)was first reported in 2000 and has made strides as a comparable alternative to SPVR,being approved in the United States in 2010.We provide a comprehensive review in this space–indications for TPVI,detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI.TPVI has been shown to have favorable medium-term outcomes free of reinterventions especially after the adoption of the practice of pre-stenting the RVOT.Procedural mortality and complications are uncommon.With more experience,recognition of risk of dreaded outcomes like coronary compression has improved.Also,conduit rupture is increasingly being managed with transcatheter tools.Questions over endocarditis risk still prevail in the TPVI population.Head-to-head comparisons to SPVR are still limited but available data suggests equivalence.We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.
文摘背景:退行性二尖瓣关闭不全的病例有逐渐增加的趋势,而单纯二尖瓣环扩张引起的二尖瓣关闭不全是退行性二尖瓣关闭不全的一种类型,国内尚无关于此类二尖瓣关闭不全的外科治疗的临床研究报告。目的:观察单纯瓣环置入修复单纯二尖瓣环扩张引起的二尖瓣关闭不全早中期生物相容性的反应。方法:单纯二尖瓣瓣环扩张致二尖瓣关闭不全患者48例,均行二尖瓣人工瓣环置入修复,其中使用Carpentier-Edwards生理环23例、SJMTM刚性鞍形成形环25例。出院后随访,采用超声心动图观察心功能和二尖瓣反流程度等变化,并比较两种瓣环与宿主生物相容性有无差别。结果与结论:围术期无死亡,均治愈出院。48例均获随访,随访率100%,随访时间3个月至4年,无死亡病例。NYHA心功能分级Ⅰ级32例,Ⅱ级16例。与术前比较,随访期超声心动图显示左心房内径、左心室舒张末期内径、左心室收缩末期内径、肺动脉收缩压和反流速面积/左房面积均明显减少(P<0.01),左室射血分数明显增加(P<0.01)。跨瓣压差均<3 mm Hg。二尖瓣无明显返流36例,微量返流10例,轻度反流2例。未出现成形环断裂、成形环撕脱及溶血现象。Carpentier-Edwards生理环组和SJMTM刚性鞍形成形环组比较,上述各指标差异无显著性意义(P>0.05)。结果提示对于因单纯二尖瓣环扩张引起的退行性二尖瓣关闭不全,通过正确的置入技巧、选择合适的人工瓣环,应用人工瓣环置入有与宿主生物较好的生物相容性反应,置入后的瓣膜替代功能良好。
