Objective: The aim of the study was to assess the effects of aortic valve replacement (AVR) in patients with aortic stenosis (AS) or regurgitation (AR) and left ventricular (LV) dysfunction. Patients and methods: Retr...Objective: The aim of the study was to assess the effects of aortic valve replacement (AVR) in patients with aortic stenosis (AS) or regurgitation (AR) and left ventricular (LV) dysfunction. Patients and methods: Retrospective analysis identified 75 consecutive patients with left ventricular ejection fraction (LVEF) assessed by echocardiography < 40% who underwent AVR for AS (n = 40) or AR (n = 35) between 1994 and 2011. Exclusion criteria were previous myocardial infarction or concomitant valvular disorders other than aortic disease. Follow-up evaluated the New York Heart Association (NYHA) functional class, LVEF and survival rate. Results: Mean ages were respectively 56.5 ± 9.3 and 47.9 ± 11.7 years in AS and AR groups, p = 0.001. Before surgery, 88% and 75% of patients were in NYHA III-IV respectively in AS and AR. In the AS group, the mean LVEF and aortic valve area (AVA) were respectively 32.2% ± 8% and 0.65 ± 0.15 cm2. AR group had a mean LVEF of 33.8 ± 6.7% and a mean LV systolic diameter of 62 ± 8.8 mm. All patients underwent AVR under cardiopulmonary bypass. There were 5 operative deaths (12.5%) in AS group and 6 (17.6%) in AR group, p = 0.57. LVEF increased to 49% ± 14.7% and 51.2% ± 10.9% in the AS and AR groups after echocardiography control. The survival rates at 1, 5 and 10 years were respectively 94.4%, 87% and 80% in AS group and 95.2%, 93% and 89% in AR group. Conclusion: Despite higher perioperative mortality in patients with aortic valve disease (AS or AR) and LV dysfunction, long-term outcome is excellent. We, therefore, conclude that AVR can be performed and it should not be denied to patients on the basis of low EF alone.展开更多
AIM:To discuss strategies and prognosis for the emergency treatment of ruptured bleeding in primary hepatocellular carcinoma.METHODS:The retrospective analysis was performed by examining the emergency treatment experi...AIM:To discuss strategies and prognosis for the emergency treatment of ruptured bleeding in primary hepatocellular carcinoma.METHODS:The retrospective analysis was performed by examining the emergency treatment experiences of60 cases of ruptured bleeding in primary hepatocellular carcinoma.The treatment methods included surgical tumour resection,transcatheter arterial embolization(TAE)and non-surgical treatment.Univariate and multivariate analyses were performed to identify the risk factors that impacted 30-d mortality in the research groups.RESULTS:The 30-d mortality of all patients was 28.3%(n=17).The univariate analysis showed that ChildPugh C level liver function,shock,massive blood transfusion and large tumour volume were risk factors thatinfluenced 30-d mortality.The multivariate analysis showed that shock and massive blood transfusion were independent risk factors that impacted the 30-d mortality of surgical resection.As for the TAE patients,larger tumour volume was a risk factor towards prognosis.CONCLUSION:Radical resection and TAE therapy would achieve better results in carefully selected ruptured hepatocellular tumours.展开更多
文摘Objective: The aim of the study was to assess the effects of aortic valve replacement (AVR) in patients with aortic stenosis (AS) or regurgitation (AR) and left ventricular (LV) dysfunction. Patients and methods: Retrospective analysis identified 75 consecutive patients with left ventricular ejection fraction (LVEF) assessed by echocardiography < 40% who underwent AVR for AS (n = 40) or AR (n = 35) between 1994 and 2011. Exclusion criteria were previous myocardial infarction or concomitant valvular disorders other than aortic disease. Follow-up evaluated the New York Heart Association (NYHA) functional class, LVEF and survival rate. Results: Mean ages were respectively 56.5 ± 9.3 and 47.9 ± 11.7 years in AS and AR groups, p = 0.001. Before surgery, 88% and 75% of patients were in NYHA III-IV respectively in AS and AR. In the AS group, the mean LVEF and aortic valve area (AVA) were respectively 32.2% ± 8% and 0.65 ± 0.15 cm2. AR group had a mean LVEF of 33.8 ± 6.7% and a mean LV systolic diameter of 62 ± 8.8 mm. All patients underwent AVR under cardiopulmonary bypass. There were 5 operative deaths (12.5%) in AS group and 6 (17.6%) in AR group, p = 0.57. LVEF increased to 49% ± 14.7% and 51.2% ± 10.9% in the AS and AR groups after echocardiography control. The survival rates at 1, 5 and 10 years were respectively 94.4%, 87% and 80% in AS group and 95.2%, 93% and 89% in AR group. Conclusion: Despite higher perioperative mortality in patients with aortic valve disease (AS or AR) and LV dysfunction, long-term outcome is excellent. We, therefore, conclude that AVR can be performed and it should not be denied to patients on the basis of low EF alone.
文摘AIM:To discuss strategies and prognosis for the emergency treatment of ruptured bleeding in primary hepatocellular carcinoma.METHODS:The retrospective analysis was performed by examining the emergency treatment experiences of60 cases of ruptured bleeding in primary hepatocellular carcinoma.The treatment methods included surgical tumour resection,transcatheter arterial embolization(TAE)and non-surgical treatment.Univariate and multivariate analyses were performed to identify the risk factors that impacted 30-d mortality in the research groups.RESULTS:The 30-d mortality of all patients was 28.3%(n=17).The univariate analysis showed that ChildPugh C level liver function,shock,massive blood transfusion and large tumour volume were risk factors thatinfluenced 30-d mortality.The multivariate analysis showed that shock and massive blood transfusion were independent risk factors that impacted the 30-d mortality of surgical resection.As for the TAE patients,larger tumour volume was a risk factor towards prognosis.CONCLUSION:Radical resection and TAE therapy would achieve better results in carefully selected ruptured hepatocellular tumours.
