Valvular heart disease(VHD),clinically manifested as stenosis and regurgitation of native heart valve,is one of the most prevalent cardiovascular diseases with high mortality.Heart valve replacement surgery has been r...Valvular heart disease(VHD),clinically manifested as stenosis and regurgitation of native heart valve,is one of the most prevalent cardiovascular diseases with high mortality.Heart valve replacement surgery has been recognized as golden standard for the treatment of VHD.Owing to the clinical application of transcatheter heart valve replacement technic and the excellent hemodynamic performance of bioprosthetic heart valves(BHVs),implantation of BHVs has been increasing over recent years and gradually became the preferred choice for the treatment of VHD.However,BHVs might fail within 10-15 years due to structural valvular degeneration(SVD),which was greatly associated with drawbacks of glutaraldehyde crosslinked BHVs,including cytotoxicity,calcification,component degradation,mechanical failure,thrombosis and immune response.To prolong the service life of BHVs,much effort has been devoted to overcoming the drawbacks of BHVs and reducing the risk of SVD.In this review,we summarized and analyzed the research and progress on:(i)modification strategies based on glutaraldehyde crosslinked BHVs and(ii)nonglutaraldehyde crosslinking strategies for BHVs.展开更多
Bioprosthetic heart valve(BHV)replacement has been the predo-minant treatment for severe heart valve diseases over decades.Most clinically available BHVs are crosslinked by glutaraldehyde(GLUT),while the high toxicity...Bioprosthetic heart valve(BHV)replacement has been the predo-minant treatment for severe heart valve diseases over decades.Most clinically available BHVs are crosslinked by glutaraldehyde(GLUT),while the high toxicity of residual GLUT could initiate calcification,severe thrombosis,and delayed endothelializa-tion.Here,we construed a mechanically integrating robust hydrogel-tissue hybrid to improve the performance of BHVs.In particular,recombinant humanized coilagen type Ⅲ(rhCOLⅢ),which was precisely customized with anti-coagulant and pro-endothelialization bioactivity,was first incorporated into the polyvinyl alcohol(PVA)-based hydrogel via hydrogen bond interactions.Then,tannic acid was introduced to enhance the mechanicalperfo of PVA-based hvdrogel and interfacial bonding between the hydrogel layer and bio-derived tissue due to the strong affinity for a wide range of substrates.In vitro and in vivo experimental results confirmed that the GLUT-crosslinked BHVs modified by the robust PVA-based hydrogel embedded rhCOLII and TA possessed long-term anti-coagulant,accelerated endothelialization,mild inflammatory response and anti-calcification properties.Therefore,our mechanically integrating robust hydrogel-tissue hybrid strategy showed the potential to enhance the service function and prolong the service life of the BHVs after implantation.展开更多
Background The probability of prosthesis-patient mismatch(PPM)is high in aortic valve replacement surgery for small aortic valve annulus,which increases the postoperative prosthetic valve transvalvular pressure gradie...Background The probability of prosthesis-patient mismatch(PPM)is high in aortic valve replacement surgery for small aortic valve annulus,which increases the postoperative prosthetic valve transvalvular pressure gradient.Concurrent aortic annuloplasty is a commonly applied surgical procedure,but there is currently no uniform standard or guideline on the type of prosthetic valve that should be used during surgery.Therefore,this study aimed to analyze whether there was any difference in the short-term prognosis between the choice of mechanical valves and bioprosthetic valves during aortic valve replacement surgery with concomitant aortic annuloplasty by the Nicks procedure.Methods A retrospective analysis was conducted based on the clinical data from 55 patients undergoing aortic valve replacement surgery with concomitant annuloplasty by the Nicks procedure at the Cardiac Surgery Department of Guangdong Provincial People’s Hospital from November 2021 to December 2023.In this study,all patients received aortic annuloplasty by the Nicks procedure.Among these patients,30 were in the mechanical valve group,while the other 25 were in the bioprosthetic valve group.Data including left ventricular end-diastolic/endsystolic diameters,left ventricular ejection fraction,interventricular septal thickness,left ventricular posterior wall thickness,transvalvular pressure gradient,left ventricular fractional shortening,and left ventricular mass index were collected 1 week preoperatively and 1 week and 3 months postoperatively.Information on gender,age,body surface area,types of perioperative complications,operation time,complication rates,and outcomes was also collected.Results Among the 55 patients enrolled in this study,4 died.The main causes of death included postoperative low cardiac output syndrome,severe pulmonary infection,and multi-organ dysfunction.Meanwhile,there was a statistically significant difference in left ventricular end-diastolic diameter between the mechanical valve group and the biological valve group 1 week 展开更多
Severe tricuspid regurgitation with permanent pacemaker wire passing through the orifice of bioprosthetic tricuspid valve is extremely rare. We present a case of such kind of patient and redid bioprosthetic tricuspid ...Severe tricuspid regurgitation with permanent pacemaker wire passing through the orifice of bioprosthetic tricuspid valve is extremely rare. We present a case of such kind of patient and redid bioprosthetic tricuspid valve replacement. A hawk mouth forceps for bone surgery was used to cut off the mental ring of ruined bioprosthetic tricuspid valve and the ruined valve was removed. A new bioprosthetic tricuspid valve was implanted and the wire of permanent pacemaker was left outside the ring of bioprosthetic tricuspid valve. This method may be helpful for such kind of patient.展开更多
This paper discusses results of anatomic analogy and transmission line model for designing a sterile pulse duplication system for bioprostheses. By simulating physiological flow and pressure pulses as well as the inpu...This paper discusses results of anatomic analogy and transmission line model for designing a sterile pulse duplication system for bioprostheses. By simulating physiological flow and pressure pulses as well as the input impedance of the human arterial system Pulsatile function testing allows us to study the hydrodynamic performances and the leaflet action of each valve. This inspection enables us to identify and reject those valves exhibiting leaflet prolapse or lazy leaflet or others believed to contribute to Primary tissue failure. Consequently, the risk of valve complications is reduced展开更多
Heart valve replacement is a common cardiac surgical procedure used to treat native valvular diseases such as aortic and mitral stenosis and regurgitation. These procedures reduce the morbidity and mortality associate...Heart valve replacement is a common cardiac surgical procedure used to treat native valvular diseases such as aortic and mitral stenosis and regurgitation. These procedures reduce the morbidity and mortality associated with diseased native valves and yet come at the expense of prosthetic valve complications. Structural valve degeneration is one such complication. We present a case of a critically ill elderly man who had undergone mitral valve replacement 14 years prior to his current presentation. Only after admission through the emergency department was a transesophageal echocardiogram obtained and the diagnosis of prosthetic valve degeneration made. He subsequently underwent successful replacement of his diseased prosthetic valve.展开更多
The aim of this study was to evaluate the crosslinking effect of a naturally crosslinking reagent-procyanidins （PA）-on the materials of bioprosthetic heart valves. After fixing bovine pericardial tissues by procyani...The aim of this study was to evaluate the crosslinking effect of a naturally crosslinking reagent-procyanidins （PA）-on the materials of bioprosthetic heart valves. After fixing bovine pericardial tissues by procyanidins, crosslikng characteristics, mechanical properties, in vitro enzymatic degradation resistance, the hydrophilicity and hemolysis tests were examined. The results showed that the fixation of biological tissue with glutaraldehyde （GA） or procyanidins increased its denaturation temperature, the surface hydrophilieity and mechanical properties as well as in vitro enzymatic degradation resistance. There were no significant differences in denaturation temperature, mechanical properties, the hydrophilicity and the in vitro enzymatic degradation between the glutaraldehyde and procyanidins fixed tissues. However, the ultimate tensile strength of the procyanidins fixed tissues was significantly superior to the glutaraldehyde fixed tissues. The hemolysis tests showed that hemolysis rate of the proeyanidins fixed tissues was lower than that of the glutaraldehyde fixed tissues. This study shows that procyanidins can crosslink which bovine pericardiaa effectively without toxicity. Our results suggest that this method might be a useful approach for the preparation of bioprosthetic heart valve.展开更多
<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite expanding indications, data regarding the long-term d...<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We performed a systematic review and meta-analysis of all published studies with ≥5</span></span><span style="font-family:;" "=""></span><span style="font-family:;" "=""><span style="font-family:Verdana;">years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). </span><span style="font-family:Verdana;">Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The meta-</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male)</span><span style="font-family:Verdana;">. All TAVR procedures were performed with early</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">generations of THV. At</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33;95% CI: [1.78, 6.24], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 0%), all-cause mortality (OR 1.45;95% CI: [1.22, 1.75], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 44%) and the composite of展开更多
Aortic valve replacement(AVR)remains a major treatment option for patients with severe aortic valve disease.Clinical outcome of AVR is strongly dependent on implanted prosthetic valve size.Fluid-structure interaction(...Aortic valve replacement(AVR)remains a major treatment option for patients with severe aortic valve disease.Clinical outcome of AVR is strongly dependent on implanted prosthetic valve size.Fluid-structure interaction(FSI)aortic root models were constructed to investigate the effect of valve size on hemodynamics of the implanted bioprosthetic valve and optimize the outcome of AVR surgery.FSI models with 4 sizes of bioprosthetic valves(19(No.19),21(No.21),23(No.23)and 25 mm(No.25))were constructed.Left ventricle outflow track flow data from one patient was collected and used as model flow conditions.Anisotropic Mooney–Rivlin models were used to describe mechanical properties of aortic valve leaflets.Blood flow pressure,velocity,systolic valve orifice pressure gradient(SVOPG),systolic cross-valve pressure difference(SCVPD),geometric orifice area,and flow shear stresses from the four valve models were compared.Our results indicated that larger valves led to lower transvalvular pressure gradient,which is linked to better post AVR outcome.Peak SVOPG,mean SCVPD and maximum velocity for Valve No.25 were 48.17%,49.3%,and 44.60%lower than that from Valve No.19,respectively.Geometric orifice area from Valve No.25 was 52.03%higher than that from Valve No.19(1.87 cm2 vs.1.23 cm2).Implantation of larger valves can significantly reduce mean flow shear stress on valve leaflets.Our initial results suggested that larger valve size may lead to improved hemodynamic performance and valve cardiac function post AVR.More patient studies are needed to validate our findings.展开更多
Valvular heart disease is a pathologic process involving one or more of the four valves(aortic,pulmonary,mitral and tricuspid)of the heart typified by stenosis or regurgitation and leading to patient symptoms.The most...Valvular heart disease is a pathologic process involving one or more of the four valves(aortic,pulmonary,mitral and tricuspid)of the heart typified by stenosis or regurgitation and leading to patient symptoms.The most common causes are tissue degeneration,rheumatic fever and congenital heart diseases.Aortic valve replacement(AVR)using either mechanical or bioprosthetic(tissue)valves via open-heart surgical展开更多
Glutaraldehyde(Glut)-crosslinked porcine pericardium and bovine pericardium are mainly consisted of collagen and widely used for the preparation of heterogenous bioprosthetic heart valves(BHV),which play an important ...Glutaraldehyde(Glut)-crosslinked porcine pericardium and bovine pericardium are mainly consisted of collagen and widely used for the preparation of heterogenous bioprosthetic heart valves(BHV),which play an important role in the replacement therapy of severe valvular heart disease,while their durability is limited by degeneration due to calcification,thrombus,endothelialization difficulty and prosthetic valve endocarditis.Herein,we develop a novel BHV,namely,TPly-BP,based on natural tannic acid and polylysine to improve the durability of Glut crosslinked bovine pericardium(Glut-BP).Impressively,tannic acid and polylysine could form nanoaggregates via multiple hydrogen bonds and covalent bonds,and the introduction of nanoaggregates not only improved the mechanical properties and collagen stability but also endowed TPIy-BP with good biocompatibility and hemocompatibility.Compared to Glut-BP,TPIy-BP showed significantly reduced cytotoxicity,improved endothelial cell adhesion,a low hemolysis ratio and obviously reduced platelet adhesion.Importantly,TPly-BP exhibited great antibacterial and in vivo anti-calcification ability,which was expected to improve the in vivo durability of BHVs.These results suggested that TPly-BP would be a potential candidate for BHV.展开更多
Large abdominal cutaneous defects may occur in association with complex ventral hernias, trauma, tumor resection, necrotizing infections or septic evisceration. Soft tissue reconstruction of the abdominal wall is perf...Large abdominal cutaneous defects may occur in association with complex ventral hernias, trauma, tumor resection, necrotizing infections or septic evisceration. Soft tissue reconstruction of the abdominal wall is performed when there is insufficient adipocutaneous tissue to permit standard, primary closure. A number of reconstructive techniques are available, the choice of which is based on a number of factors, including the size and location of the defect, etiology, and timing of closure. In general, local fasciocutaneous advancement flaps and adjacent tissue rearrangement are the workhorse techniques, followed by regional myocutaneous flaps and free tissue transfers for the most complex and extensive of defects. Herein, we describe our approach to abdominal soft tissue reconstruction, indications, technical nuances, and management of complications.展开更多
In the last decade,the number of transcatheter heart valve replacement for severe heart valve disease has increased exponentially.Although the bioprosthetic artificial heart valve(BHV)has similar fluid dynamics perfor...In the last decade,the number of transcatheter heart valve replacement for severe heart valve disease has increased exponentially.Although the bioprosthetic artificial heart valve(BHV)has similar fluid dynamics performance to the original heart valve compared with mechanical heart valve so that there is no need to take long-term anticoagulant drugs to prevent thromboembolism,transcatheter BHV replacement are still at risk for thrombosis during the first few months according to the clinical data.However,the use of antithrombotic drugs can also increase the risk of bleeding.Therefore,it is particularly important to improve the anticoagulant properties for the BHV itself.In this work,a kind of non-glutaraldehyde cross-linked BHV material with excellent antithrombotic ability has been prepared from carboxylated oxazolidine treated porcine pericardium(consisting of collagen,elastin and glycoprotein)with the further graft of the anticoagulant heparin sodium via hydrophilic modified chitosan.Along with the similar mechanical properties and collagen stability comparable to the glutaraldehyde cross-linked porcine pericardium(PP),these functional non-glutaraldehyde cross-linked PPs exhibit better biocompatibility,promoted endothelial proliferation and superior anti-calcification ability.More importantly,excellent anticoagulant activity can be observed in the hematological experiments in vivo and in vitro.In summary,these excellent performances make these functional non-glutaraldehyde cross-linked PPs great potentialities in the BHV applications.展开更多
Glutaraldehyde(Glut)-crosslinked porcine pericardium and bovine pericardium are mainly consisted of collagen and widely used for the preparation of heterogenous bioprosthetic heart valves(BHV),which play an important ...Glutaraldehyde(Glut)-crosslinked porcine pericardium and bovine pericardium are mainly consisted of collagen and widely used for the preparation of heterogenous bioprosthetic heart valves(BHV),which play an important role in the replacement therapy of severe valvular heart disease,while their durability is limited by degeneration due to calcification,thrombus,endothelialization difficulty and prosthetic valve endocarditis.Herein,we develop a novel BHV,namely,TPly-BP,based on natural tannic acid and polylysine to improve the durability of Glut crosslinked bovine pericardium(Glut-BP).Impressively,tannic acid and polylysine could form nanoaggregates via multiple hydrogen bonds and covalent bonds,and the introduction of nanoaggregates not only improved the mechanical properties and collagen stability but also endowed TPly-BP with good biocompatibility and hemocompatibility.Compared to Glut-BP,TPly-BP showed significantly reduced cytotoxicity,improved endothelial cell adhesion,a low hemolysis ratio and obviously reduced platelet adhesion.Importantly,TPly-BP exhibited great antibacterial and in vivo anti-calcification ability,which was expected to improve the in vivo durability of BHVs.These results suggested that TPly-BP would be a potential candidate for BHV.展开更多
An 80-year-old woman with a history of surgical aortic valve replacement with a 21 mm St.Jude Medical Biocor porcine aortic valve 14 years prior presented with New York Heart Association(NYHA)class III symptoms,severe...An 80-year-old woman with a history of surgical aortic valve replacement with a 21 mm St.Jude Medical Biocor porcine aortic valve 14 years prior presented with New York Heart Association(NYHA)class III symptoms,severe aortic insufficiency from a degenerated prosthesis,and a large echocardiographic mobile mass representing a highly mobile prosthetic leaflet.The patient worsened to NYHA class IV symptoms despite medical management.The So-ciety of Thoracic Surgery mortality risk score was extremely high.However,a valve-in-valve transcatheter aortic valve replacement(TAVR)was found to be a reasonable option.We used a 20 mm SAPIEN 3 Ultra valve(Edwards Lifesciences Inc.,Irvine,CA,USA)with a SENTINEL embolic protection device(Boston Scientific,Marlborough,MA,USA).During valve deployment,the echocardiographic mobile mass was visually pinned between the new TAVR valve and the surgical bioprosthetic valve.No large embolic debris was noted within the embolic protection device,and the patient remained without any new focal neurologic deficits in the perioperative period and at the 30-day follow-up.The severe aortic insufficiency resolved,and the patient clinically improved to NYHA class II symptoms.展开更多
基金supported by National Key Research and Development Programs,China(2022YFB3807305 and 2022YFB3807303)National Natural Science Foundation of China(32071357).
文摘Valvular heart disease(VHD),clinically manifested as stenosis and regurgitation of native heart valve,is one of the most prevalent cardiovascular diseases with high mortality.Heart valve replacement surgery has been recognized as golden standard for the treatment of VHD.Owing to the clinical application of transcatheter heart valve replacement technic and the excellent hemodynamic performance of bioprosthetic heart valves(BHVs),implantation of BHVs has been increasing over recent years and gradually became the preferred choice for the treatment of VHD.However,BHVs might fail within 10-15 years due to structural valvular degeneration(SVD),which was greatly associated with drawbacks of glutaraldehyde crosslinked BHVs,including cytotoxicity,calcification,component degradation,mechanical failure,thrombosis and immune response.To prolong the service life of BHVs,much effort has been devoted to overcoming the drawbacks of BHVs and reducing the risk of SVD.In this review,we summarized and analyzed the research and progress on:(i)modification strategies based on glutaraldehyde crosslinked BHVs and(ii)nonglutaraldehyde crosslinking strategies for BHVs.
基金supported by National Key Research and Development Programs(2022YFB3807303 and 2022YFB3807305),National Natural Science Foundation of China(32101107)and CAMS InnovationFundforMedical Sciences(2021-12M-5-013)。
文摘Bioprosthetic heart valve(BHV)replacement has been the predo-minant treatment for severe heart valve diseases over decades.Most clinically available BHVs are crosslinked by glutaraldehyde(GLUT),while the high toxicity of residual GLUT could initiate calcification,severe thrombosis,and delayed endothelializa-tion.Here,we construed a mechanically integrating robust hydrogel-tissue hybrid to improve the performance of BHVs.In particular,recombinant humanized coilagen type Ⅲ(rhCOLⅢ),which was precisely customized with anti-coagulant and pro-endothelialization bioactivity,was first incorporated into the polyvinyl alcohol(PVA)-based hydrogel via hydrogen bond interactions.Then,tannic acid was introduced to enhance the mechanicalperfo of PVA-based hvdrogel and interfacial bonding between the hydrogel layer and bio-derived tissue due to the strong affinity for a wide range of substrates.In vitro and in vivo experimental results confirmed that the GLUT-crosslinked BHVs modified by the robust PVA-based hydrogel embedded rhCOLII and TA possessed long-term anti-coagulant,accelerated endothelialization,mild inflammatory response and anti-calcification properties.Therefore,our mechanically integrating robust hydrogel-tissue hybrid strategy showed the potential to enhance the service function and prolong the service life of the BHVs after implantation.
文摘Background The probability of prosthesis-patient mismatch(PPM)is high in aortic valve replacement surgery for small aortic valve annulus,which increases the postoperative prosthetic valve transvalvular pressure gradient.Concurrent aortic annuloplasty is a commonly applied surgical procedure,but there is currently no uniform standard or guideline on the type of prosthetic valve that should be used during surgery.Therefore,this study aimed to analyze whether there was any difference in the short-term prognosis between the choice of mechanical valves and bioprosthetic valves during aortic valve replacement surgery with concomitant aortic annuloplasty by the Nicks procedure.Methods A retrospective analysis was conducted based on the clinical data from 55 patients undergoing aortic valve replacement surgery with concomitant annuloplasty by the Nicks procedure at the Cardiac Surgery Department of Guangdong Provincial People’s Hospital from November 2021 to December 2023.In this study,all patients received aortic annuloplasty by the Nicks procedure.Among these patients,30 were in the mechanical valve group,while the other 25 were in the bioprosthetic valve group.Data including left ventricular end-diastolic/endsystolic diameters,left ventricular ejection fraction,interventricular septal thickness,left ventricular posterior wall thickness,transvalvular pressure gradient,left ventricular fractional shortening,and left ventricular mass index were collected 1 week preoperatively and 1 week and 3 months postoperatively.Information on gender,age,body surface area,types of perioperative complications,operation time,complication rates,and outcomes was also collected.Results Among the 55 patients enrolled in this study,4 died.The main causes of death included postoperative low cardiac output syndrome,severe pulmonary infection,and multi-organ dysfunction.Meanwhile,there was a statistically significant difference in left ventricular end-diastolic diameter between the mechanical valve group and the biological valve group 1 week
文摘Severe tricuspid regurgitation with permanent pacemaker wire passing through the orifice of bioprosthetic tricuspid valve is extremely rare. We present a case of such kind of patient and redid bioprosthetic tricuspid valve replacement. A hawk mouth forceps for bone surgery was used to cut off the mental ring of ruined bioprosthetic tricuspid valve and the ruined valve was removed. A new bioprosthetic tricuspid valve was implanted and the wire of permanent pacemaker was left outside the ring of bioprosthetic tricuspid valve. This method may be helpful for such kind of patient.
文摘This paper discusses results of anatomic analogy and transmission line model for designing a sterile pulse duplication system for bioprostheses. By simulating physiological flow and pressure pulses as well as the input impedance of the human arterial system Pulsatile function testing allows us to study the hydrodynamic performances and the leaflet action of each valve. This inspection enables us to identify and reject those valves exhibiting leaflet prolapse or lazy leaflet or others believed to contribute to Primary tissue failure. Consequently, the risk of valve complications is reduced
文摘Heart valve replacement is a common cardiac surgical procedure used to treat native valvular diseases such as aortic and mitral stenosis and regurgitation. These procedures reduce the morbidity and mortality associated with diseased native valves and yet come at the expense of prosthetic valve complications. Structural valve degeneration is one such complication. We present a case of a critically ill elderly man who had undergone mitral valve replacement 14 years prior to his current presentation. Only after admission through the emergency department was a transesophageal echocardiogram obtained and the diagnosis of prosthetic valve degeneration made. He subsequently underwent successful replacement of his diseased prosthetic valve.
基金National High Technology Research and Development Program (836 Program)grant number:2007AA02Z444+1 种基金National BasicResearch Program of Chinagrant number:2009CB930000
文摘The aim of this study was to evaluate the crosslinking effect of a naturally crosslinking reagent-procyanidins （PA）-on the materials of bioprosthetic heart valves. After fixing bovine pericardial tissues by procyanidins, crosslikng characteristics, mechanical properties, in vitro enzymatic degradation resistance, the hydrophilicity and hemolysis tests were examined. The results showed that the fixation of biological tissue with glutaraldehyde （GA） or procyanidins increased its denaturation temperature, the surface hydrophilieity and mechanical properties as well as in vitro enzymatic degradation resistance. There were no significant differences in denaturation temperature, mechanical properties, the hydrophilicity and the in vitro enzymatic degradation between the glutaraldehyde and procyanidins fixed tissues. However, the ultimate tensile strength of the procyanidins fixed tissues was significantly superior to the glutaraldehyde fixed tissues. The hemolysis tests showed that hemolysis rate of the proeyanidins fixed tissues was lower than that of the glutaraldehyde fixed tissues. This study shows that procyanidins can crosslink which bovine pericardiaa effectively without toxicity. Our results suggest that this method might be a useful approach for the preparation of bioprosthetic heart valve.
文摘<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We performed a systematic review and meta-analysis of all published studies with ≥5</span></span><span style="font-family:;" "=""></span><span style="font-family:;" "=""><span style="font-family:Verdana;">years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). </span><span style="font-family:Verdana;">Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The meta-</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male)</span><span style="font-family:Verdana;">. All TAVR procedures were performed with early</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">generations of THV. At</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33;95% CI: [1.78, 6.24], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 0%), all-cause mortality (OR 1.45;95% CI: [1.22, 1.75], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 44%) and the composite of
基金The research was supported in part by National Sciences Foundation of China Grants 11672001,81571691 and 81771844.
文摘Aortic valve replacement(AVR)remains a major treatment option for patients with severe aortic valve disease.Clinical outcome of AVR is strongly dependent on implanted prosthetic valve size.Fluid-structure interaction(FSI)aortic root models were constructed to investigate the effect of valve size on hemodynamics of the implanted bioprosthetic valve and optimize the outcome of AVR surgery.FSI models with 4 sizes of bioprosthetic valves(19(No.19),21(No.21),23(No.23)and 25 mm(No.25))were constructed.Left ventricle outflow track flow data from one patient was collected and used as model flow conditions.Anisotropic Mooney–Rivlin models were used to describe mechanical properties of aortic valve leaflets.Blood flow pressure,velocity,systolic valve orifice pressure gradient(SVOPG),systolic cross-valve pressure difference(SCVPD),geometric orifice area,and flow shear stresses from the four valve models were compared.Our results indicated that larger valves led to lower transvalvular pressure gradient,which is linked to better post AVR outcome.Peak SVOPG,mean SCVPD and maximum velocity for Valve No.25 were 48.17%,49.3%,and 44.60%lower than that from Valve No.19,respectively.Geometric orifice area from Valve No.25 was 52.03%higher than that from Valve No.19(1.87 cm2 vs.1.23 cm2).Implantation of larger valves can significantly reduce mean flow shear stress on valve leaflets.Our initial results suggested that larger valve size may lead to improved hemodynamic performance and valve cardiac function post AVR.More patient studies are needed to validate our findings.
基金supported by the Department of Anesthesiology and Pain Medicine,University of California Davis Health
文摘Valvular heart disease is a pathologic process involving one or more of the four valves(aortic,pulmonary,mitral and tricuspid)of the heart typified by stenosis or regurgitation and leading to patient symptoms.The most common causes are tissue degeneration,rheumatic fever and congenital heart diseases.Aortic valve replacement(AVR)using either mechanical or bioprosthetic(tissue)valves via open-heart surgical
基金supported by the National Natural Science Foundation of China(81970325 and 82170375)Key Research and Development Support Project of Science&Technology Department of Chengdu(2021-YF08-00121-GX)+3 种基金Post-Doctor Research Project,West China Hospital,Sichuan University(Grant No.20HXBH164 and 20HXBH105)Chinese Medical Association Cardiovascular Branch(CSC)Clinical Research Special Fund Project(CSCF2020B04)West China Hospital"1.3.5"Discipline of Excellence Project-"Percutaneous transcatheter aortic valve implantation""Mechanisms of aortic stenosis and the clinical applications"(ZYGD20002).
文摘Glutaraldehyde(Glut)-crosslinked porcine pericardium and bovine pericardium are mainly consisted of collagen and widely used for the preparation of heterogenous bioprosthetic heart valves(BHV),which play an important role in the replacement therapy of severe valvular heart disease,while their durability is limited by degeneration due to calcification,thrombus,endothelialization difficulty and prosthetic valve endocarditis.Herein,we develop a novel BHV,namely,TPly-BP,based on natural tannic acid and polylysine to improve the durability of Glut crosslinked bovine pericardium(Glut-BP).Impressively,tannic acid and polylysine could form nanoaggregates via multiple hydrogen bonds and covalent bonds,and the introduction of nanoaggregates not only improved the mechanical properties and collagen stability but also endowed TPIy-BP with good biocompatibility and hemocompatibility.Compared to Glut-BP,TPIy-BP showed significantly reduced cytotoxicity,improved endothelial cell adhesion,a low hemolysis ratio and obviously reduced platelet adhesion.Importantly,TPly-BP exhibited great antibacterial and in vivo anti-calcification ability,which was expected to improve the in vivo durability of BHVs.These results suggested that TPly-BP would be a potential candidate for BHV.
文摘Large abdominal cutaneous defects may occur in association with complex ventral hernias, trauma, tumor resection, necrotizing infections or septic evisceration. Soft tissue reconstruction of the abdominal wall is performed when there is insufficient adipocutaneous tissue to permit standard, primary closure. A number of reconstructive techniques are available, the choice of which is based on a number of factors, including the size and location of the defect, etiology, and timing of closure. In general, local fasciocutaneous advancement flaps and adjacent tissue rearrangement are the workhorse techniques, followed by regional myocutaneous flaps and free tissue transfers for the most complex and extensive of defects. Herein, we describe our approach to abdominal soft tissue reconstruction, indications, technical nuances, and management of complications.
基金National Key Research and Development Programs(2020YFC1107802)the National Natural Science Foundation of China(32071357)the Sichuan Science and Technology Program(2021YFH0011),Sichuan Province Major Science and Technology Special Projects(2018SZDZX0011),the National 111 project of Introducing Talents of Discipline to Universities(No.B16033).We would be grateful to the help of VENUS Medtech Inc.(Hangzhou,China)for providing the fresh porcine pericardium.
文摘In the last decade,the number of transcatheter heart valve replacement for severe heart valve disease has increased exponentially.Although the bioprosthetic artificial heart valve(BHV)has similar fluid dynamics performance to the original heart valve compared with mechanical heart valve so that there is no need to take long-term anticoagulant drugs to prevent thromboembolism,transcatheter BHV replacement are still at risk for thrombosis during the first few months according to the clinical data.However,the use of antithrombotic drugs can also increase the risk of bleeding.Therefore,it is particularly important to improve the anticoagulant properties for the BHV itself.In this work,a kind of non-glutaraldehyde cross-linked BHV material with excellent antithrombotic ability has been prepared from carboxylated oxazolidine treated porcine pericardium(consisting of collagen,elastin and glycoprotein)with the further graft of the anticoagulant heparin sodium via hydrophilic modified chitosan.Along with the similar mechanical properties and collagen stability comparable to the glutaraldehyde cross-linked porcine pericardium(PP),these functional non-glutaraldehyde cross-linked PPs exhibit better biocompatibility,promoted endothelial proliferation and superior anti-calcification ability.More importantly,excellent anticoagulant activity can be observed in the hematological experiments in vivo and in vitro.In summary,these excellent performances make these functional non-glutaraldehyde cross-linked PPs great potentialities in the BHV applications.
基金the National Natural Science Foundation of China(81970325 and 82170375)Key Research and Develop-ment Support Project of Science&Technology Department of Chengdu(2021-YF08-00121-GX)+2 种基金Post-Doctor Research Project,West China Hospital,Sichuan University(Grant No.20HXBH164 and 20HXBH105)Chinese Medical Association Cardiovascular Branch(CSC)Clinical Research Special Fund Project(CSCF2020B04)West China Hospital“1·3·5”Discipline of Excellence Project-“Percutaneous transcatheter aortic valve implantation”and“Mechanisms of aortic stenosis and the clinical applications”(ZYGD20002).
文摘Glutaraldehyde(Glut)-crosslinked porcine pericardium and bovine pericardium are mainly consisted of collagen and widely used for the preparation of heterogenous bioprosthetic heart valves(BHV),which play an important role in the replacement therapy of severe valvular heart disease,while their durability is limited by degeneration due to calcification,thrombus,endothelialization difficulty and prosthetic valve endocarditis.Herein,we develop a novel BHV,namely,TPly-BP,based on natural tannic acid and polylysine to improve the durability of Glut crosslinked bovine pericardium(Glut-BP).Impressively,tannic acid and polylysine could form nanoaggregates via multiple hydrogen bonds and covalent bonds,and the introduction of nanoaggregates not only improved the mechanical properties and collagen stability but also endowed TPly-BP with good biocompatibility and hemocompatibility.Compared to Glut-BP,TPly-BP showed significantly reduced cytotoxicity,improved endothelial cell adhesion,a low hemolysis ratio and obviously reduced platelet adhesion.Importantly,TPly-BP exhibited great antibacterial and in vivo anti-calcification ability,which was expected to improve the in vivo durability of BHVs.These results suggested that TPly-BP would be a potential candidate for BHV.
文摘An 80-year-old woman with a history of surgical aortic valve replacement with a 21 mm St.Jude Medical Biocor porcine aortic valve 14 years prior presented with New York Heart Association(NYHA)class III symptoms,severe aortic insufficiency from a degenerated prosthesis,and a large echocardiographic mobile mass representing a highly mobile prosthetic leaflet.The patient worsened to NYHA class IV symptoms despite medical management.The So-ciety of Thoracic Surgery mortality risk score was extremely high.However,a valve-in-valve transcatheter aortic valve replacement(TAVR)was found to be a reasonable option.We used a 20 mm SAPIEN 3 Ultra valve(Edwards Lifesciences Inc.,Irvine,CA,USA)with a SENTINEL embolic protection device(Boston Scientific,Marlborough,MA,USA).During valve deployment,the echocardiographic mobile mass was visually pinned between the new TAVR valve and the surgical bioprosthetic valve.No large embolic debris was noted within the embolic protection device,and the patient remained without any new focal neurologic deficits in the perioperative period and at the 30-day follow-up.The severe aortic insufficiency resolved,and the patient clinically improved to NYHA class II symptoms.
