Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. How...Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety of percutaneous implantation of the device in the native aortic valve position.Methods A self expanding nitinol stent with W-model, containing porcine pericardium valves in its proximal part, was implanted in six sheep by means of a 14 French catheter through the right common iliac artery under guidance of fluoroscopy. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded. These sheep were followed up shortly after procedure with supra-aortic angiogram and left ventriculography. Additionally, one sheep was sacrificed after the procedure for anatomic evaluation.Results It was possible to replace the aortic valve in the beating heart in four sheep. The procedure failed in two sheep due to coronary orifice occlusion in one case and severe aortic valve regurgitation in the other case. One sheep was killed one hour after percutaneous aortic valve replacement for anatomic evaluation. There were no signs of damage of the aortic JntJma, or of obstruction of the coronary orifice,Conclusions Percutaneous aortic valve replacement with a W-model valved stent in the beating heart is possible. Further studies are mandatory to assess safety and efficacy of this kind of valved stent in larger sample size and by longer follow-up period.展开更多
Transcatheter mitral valve replacement(TMVR)has become an alternative to surgical mitral valve replacement for the treatment of patients with severe mitral insufficiency(MI)who are at very high or prohibitive surgical...Transcatheter mitral valve replacement(TMVR)has become an alternative to surgical mitral valve replacement for the treatment of patients with severe mitral insufficiency(MI)who are at very high or prohibitive surgical risk.[1]Because of impaired left ventricular dysfunction and previous cardiac surgery,some aged patients with degenerated bioprosthetic mitral valve and mitral regurgitation were refused to redo surgery.[2]Increasing demand are required for minimally invasive treatment of these patients.Hundreds of patients worldwide have been treated with a transcatheter mitral valve-in-ring or valve-in-valve procedure using transcatheter aortic valve.[3]However,rare case of transcatheter mitral valve-in-valve/ring replacement using transcatheter mitral valve system was reported.Here,we reported a successfully case of transcatheter mitral“valve-in-valve”replacement for the treatment of bioprosthetic mitral valve degeneration and severe regurgitation with domestic Mithos^TM valve.展开更多
Background： Compared to the Western countries, Chinese patients present a special primary disease spectrum, diverse valvular pathogenesis, and different postoperational anticoagulation strategy. This research aimed t...Background： Compared to the Western countries, Chinese patients present a special primary disease spectrum, diverse valvular pathogenesis, and different postoperational anticoagulation strategy. This research aimed to evaluate the mid- to long-term clinical performance of Hancock II bioprosthesis in the Chinese population. Methods： This study retrospectively reviewed all patients who received surgical treatments with at least one Hancock II bioprosthesis implantation from January 2004 to December 2013 at a single center in China. Totally 647 patients were included in the clinical evaluation, and 629 patients were successfully discharge, among whom 605 patients were completely fbllowed-up. The follow-up rate was 96.2%. The mean and median follow-up time was 62.0 ± 59.0 and 56.0 months, respectively, Postoperative outcomes of survival rates, reoperations and valve related morbidities were assessed. Continuous and categorical variables were compared using the t -test and Chi-square test, respectively. Survival and freedom from adverse events were calculated by using a Kaplan-Meier method. Results： The overall in-hospital mortality was 2.8% （18/647） while there were 34 deaths （5.6%, 34/605） in the tbllow-up stage after discharge. The overall survival rate was 94.6% and 82.7% at 5 years and 10 years, respectively. The cumulative survival rate of 10 years was 82.8% in AVR group, 84.4% in MVR group, and 78.4% in DVR group. The overall rate of freedom from reoperations was 95.5% at 5 years and 86.8% at 10 years. The freedom from reoperation at 10 years was 87.0%, 88.1%, and 84.0% in AVR, MVR, and DVR group, respectively. The freedom from morbidities at 10 years was： 90.3% for thromboembolism, 95.2% for hemorrhage, 97.5% for prosthesis endocarditis, 95.9% for paravalvular leak, and 94.6% for structural valve deterioration, respectively. Conclusions： Hancock II bioprosthesis exhibited a satisfactory mid- to long-term durability and promising clinical performance in the Chinese popt, lation. The occurrenc展开更多
为了探究窦管交界直径呈现不同锥度角对于人工生物瓣膜性能的影响,对窦管交界不同锥度角的主动脉根部模型进行脉动流实验研究。通过三维打印方法制作窦管交界锥度角分别为0度、1度、3度和5度的4组主动脉根部模型。将人工生物瓣膜装配在...为了探究窦管交界直径呈现不同锥度角对于人工生物瓣膜性能的影响,对窦管交界不同锥度角的主动脉根部模型进行脉动流实验研究。通过三维打印方法制作窦管交界锥度角分别为0度、1度、3度和5度的4组主动脉根部模型。将人工生物瓣膜装配在主动脉根部模型上,在脉动循环模拟系统中进行不同心搏出量条件下的脉动流实验测试。心率设定为70次/分,脉动流流动速率分别为2~7 L/min。在每个脉动流流动速率条件下测试10个心动周期并将结果取平均值。实验结果显示,主动脉根部窦管交界不同锥度的模型,跨瓣压差符合国内标准,均在10 mm Hg之内;窦管交界锥度对于返流百分比存在影响,较小的窦管交界锥度有利于降低返流百分比;在心搏出量较小的情况下,较小的窦管交界锥度有利于增大有效开口面积,而在心搏出量较大的情况下,较大的窦管交界锥度有利于增大有效开口面积。实验结果表明,在临床手术过程中,对于心搏出量较低的情况,建议多考虑较小的窦管交界锥度;而对于心搏出量较高的情况,建议多考虑较大的窦管交界锥度。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
OBJECTIVE: To investigate the feasibility of endothelialization of bioprosthesis by transfer of vascular endothelial growth factor (VEGF) gene. METHODS: Bovine pericardium treated with glutaraldehyde and L-glutamic ac...OBJECTIVE: To investigate the feasibility of endothelialization of bioprosthesis by transfer of vascular endothelial growth factor (VEGF) gene. METHODS: Bovine pericardium treated with glutaraldehyde and L-glutamic acid was positioned into the pig right atrium. pcD(2)/hVEGF(121) gene (1 mg) was transferred into the right ventricular myocardium using surgical sutures Reverse transcri ption polymerase chain reaction (RT PCR) was employed to evaluate the expression of myocardial VEGF mRNA. The determination of concentrations of VEGF protein in blood from both the right atrium and peripheral vein, and histological and ultrastructural analysis of implanted bovine pericardium were completed simultaneously. RESULTS: The concentration of VEGF derived from the right atrium in pcD(2)/hVEGF(121) group was significantly higher than that in the pcD(2) group 10 days after VEGF gene transfer (P展开更多
文摘Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety of percutaneous implantation of the device in the native aortic valve position.Methods A self expanding nitinol stent with W-model, containing porcine pericardium valves in its proximal part, was implanted in six sheep by means of a 14 French catheter through the right common iliac artery under guidance of fluoroscopy. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded. These sheep were followed up shortly after procedure with supra-aortic angiogram and left ventriculography. Additionally, one sheep was sacrificed after the procedure for anatomic evaluation.Results It was possible to replace the aortic valve in the beating heart in four sheep. The procedure failed in two sheep due to coronary orifice occlusion in one case and severe aortic valve regurgitation in the other case. One sheep was killed one hour after percutaneous aortic valve replacement for anatomic evaluation. There were no signs of damage of the aortic JntJma, or of obstruction of the coronary orifice,Conclusions Percutaneous aortic valve replacement with a W-model valved stent in the beating heart is possible. Further studies are mandatory to assess safety and efficacy of this kind of valved stent in larger sample size and by longer follow-up period.
基金supported by the National Natural Science Foundation of China(81600240)the Science Foundation for Distinguished Young Scholars of Shaanxi Natural Science Basic Research Program(2018JC-015).
文摘Transcatheter mitral valve replacement(TMVR)has become an alternative to surgical mitral valve replacement for the treatment of patients with severe mitral insufficiency(MI)who are at very high or prohibitive surgical risk.[1]Because of impaired left ventricular dysfunction and previous cardiac surgery,some aged patients with degenerated bioprosthetic mitral valve and mitral regurgitation were refused to redo surgery.[2]Increasing demand are required for minimally invasive treatment of these patients.Hundreds of patients worldwide have been treated with a transcatheter mitral valve-in-ring or valve-in-valve procedure using transcatheter aortic valve.[3]However,rare case of transcatheter mitral valve-in-valve/ring replacement using transcatheter mitral valve system was reported.Here,we reported a successfully case of transcatheter mitral“valve-in-valve”replacement for the treatment of bioprosthetic mitral valve degeneration and severe regurgitation with domestic Mithos^TM valve.
文摘Background： Compared to the Western countries, Chinese patients present a special primary disease spectrum, diverse valvular pathogenesis, and different postoperational anticoagulation strategy. This research aimed to evaluate the mid- to long-term clinical performance of Hancock II bioprosthesis in the Chinese population. Methods： This study retrospectively reviewed all patients who received surgical treatments with at least one Hancock II bioprosthesis implantation from January 2004 to December 2013 at a single center in China. Totally 647 patients were included in the clinical evaluation, and 629 patients were successfully discharge, among whom 605 patients were completely fbllowed-up. The follow-up rate was 96.2%. The mean and median follow-up time was 62.0 ± 59.0 and 56.0 months, respectively, Postoperative outcomes of survival rates, reoperations and valve related morbidities were assessed. Continuous and categorical variables were compared using the t -test and Chi-square test, respectively. Survival and freedom from adverse events were calculated by using a Kaplan-Meier method. Results： The overall in-hospital mortality was 2.8% （18/647） while there were 34 deaths （5.6%, 34/605） in the tbllow-up stage after discharge. The overall survival rate was 94.6% and 82.7% at 5 years and 10 years, respectively. The cumulative survival rate of 10 years was 82.8% in AVR group, 84.4% in MVR group, and 78.4% in DVR group. The overall rate of freedom from reoperations was 95.5% at 5 years and 86.8% at 10 years. The freedom from reoperation at 10 years was 87.0%, 88.1%, and 84.0% in AVR, MVR, and DVR group, respectively. The freedom from morbidities at 10 years was： 90.3% for thromboembolism, 95.2% for hemorrhage, 97.5% for prosthesis endocarditis, 95.9% for paravalvular leak, and 94.6% for structural valve deterioration, respectively. Conclusions： Hancock II bioprosthesis exhibited a satisfactory mid- to long-term durability and promising clinical performance in the Chinese popt, lation. The occurrenc
文摘为了探究窦管交界直径呈现不同锥度角对于人工生物瓣膜性能的影响,对窦管交界不同锥度角的主动脉根部模型进行脉动流实验研究。通过三维打印方法制作窦管交界锥度角分别为0度、1度、3度和5度的4组主动脉根部模型。将人工生物瓣膜装配在主动脉根部模型上,在脉动循环模拟系统中进行不同心搏出量条件下的脉动流实验测试。心率设定为70次/分,脉动流流动速率分别为2~7 L/min。在每个脉动流流动速率条件下测试10个心动周期并将结果取平均值。实验结果显示,主动脉根部窦管交界不同锥度的模型,跨瓣压差符合国内标准,均在10 mm Hg之内;窦管交界锥度对于返流百分比存在影响,较小的窦管交界锥度有利于降低返流百分比;在心搏出量较小的情况下,较小的窦管交界锥度有利于增大有效开口面积,而在心搏出量较大的情况下,较大的窦管交界锥度有利于增大有效开口面积。实验结果表明,在临床手术过程中,对于心搏出量较低的情况,建议多考虑较小的窦管交界锥度;而对于心搏出量较高的情况,建议多考虑较大的窦管交界锥度。
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.
基金agrantfromtheEducationAssociationofJiangsuProvince ,China (No .98JKB32 0 0 0 8)
文摘OBJECTIVE: To investigate the feasibility of endothelialization of bioprosthesis by transfer of vascular endothelial growth factor (VEGF) gene. METHODS: Bovine pericardium treated with glutaraldehyde and L-glutamic acid was positioned into the pig right atrium. pcD(2)/hVEGF(121) gene (1 mg) was transferred into the right ventricular myocardium using surgical sutures Reverse transcri ption polymerase chain reaction (RT PCR) was employed to evaluate the expression of myocardial VEGF mRNA. The determination of concentrations of VEGF protein in blood from both the right atrium and peripheral vein, and histological and ultrastructural analysis of implanted bovine pericardium were completed simultaneously. RESULTS: The concentration of VEGF derived from the right atrium in pcD(2)/hVEGF(121) group was significantly higher than that in the pcD(2) group 10 days after VEGF gene transfer (P
