Background： Mitral valve （MV） repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for dege...Background： Mitral valve （MV） repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation （MR）. However, there has been limited infomlation regarding tile echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV. Methods： A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients （79.8%）, artificial chordae in 20 （23.8%）, and ring annuloplasty in 79 （94.1%）. Eighty-one （96.4%） of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up. Results： At a median echocardiographic follow-up of 36.0 months （interquartile range 14.3-59.4 months）, lbur patients （4.9%） developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, leli atrial diameter （LAD）, left ventricular end-diastolic diameter （LVEDD）, and let1 ventricular ejection fraction （LVEF） were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 （Z- -8.456, P 〈 0.001 ）, LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm （I - 15.131, P 〈 0.001 ）, LVEDD fiom 51.0 ± 5.0 to 43.3 ± 2.2 mm （t = 14.481, P 〈 0.001 ）, and LV EF l＇rom 67.3 ± 7.0% to 63.9 ± 5.1% （t = 4.585, P 〈 0.001 ）. Conclusion： Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up.展开更多
Background:Due to the wide variety of morphology,size,and dynamics,selecting an optimal valve size and location poses great difficulty in percutaneous pulmonary valve implantation(PPVI).This study aimed to report our ...Background:Due to the wide variety of morphology,size,and dynamics,selecting an optimal valve size and location poses great difficulty in percutaneous pulmonary valve implantation(PPVI).This study aimed to report our experience with in vitro bench testing using patient-specific three-dimensional(3D)-printed models for planning PPVI with the Venus P-valve.Methods:Patient-specific 3D soft models were generated using PolyJet printing with a compliant synthetic material in 15 patients scheduled to undergo PPVI between July 2018 and July 2020 in Central China Fuwai Hospital of Zhengzhou University.Results:3D model bench testing altered treatment strategy in all patients(100%).One patient was referred for surgery because testing revealed that even the largest Venus P-valve would not anchor properly.In the remaining 14 patients,valve size and/or implantation location was altered to avoid valve migration and/or compression coronary artery.In four patients,it was decided to change the point anchoring because of inverted cone-shaped right ventricular outflow tract(RVOT)(n=2)or risk of compression coronary artery(n=2).Concerning sizing,we found that an oversize of 2-5 mm suffices.Anchoring of the valve was dictated by the flaring of the in-and outflow portion in the pulmonary artery.PPVI was successful in all 14 patients(absence of valve migration,no coronary compression,and none-to-mild residual pulmonary regurgitation[PR]).The diameter of the Venus P-valve in the 3D simulation group was significantly smaller than that of the conventional planning group(36[2]vs.32[4],Z=-3.77,P<0.001).Conclusions:In vitro testing indicated no need to oversize the Venus P-valve to the degree recommended by the balloon-sizing technique,as 2-5 mm sufficed.展开更多
Objective:Patients with untreated severe aortic regurgitation(AR)have a high risk of mortality.Transfemoral transcatheter aortic valve replacement(TF-TAVR)is a treatment option for AR;however,the safety and efficacy o...Objective:Patients with untreated severe aortic regurgitation(AR)have a high risk of mortality.Transfemoral transcatheter aortic valve replacement(TF-TAVR)is a treatment option for AR;however,the safety and efficacy of this technique have not been sufficiently established.This study aimed to evaluate the clinical and anatomical variables correlating with device success of TF-TAVR using a self-expanding valve system for pure AR.Methods:Patients with pure native severe AR who underwent TF-TAVR using a self-expanding valve system were registered at 5 Chinese centers.The primary endpoint was device success at 1 month after TAVR.The secondary endpoint was the composite of major adverse cardiovascular events(MACE)at 6 months,including all-cause death,ischemic stroke,emergency conversion to cardiac surgery,and permanent pacemaker implantation.Echocardiography was used to analyze the left ventricular function before the TAVR procedure and during follow-up.Multivariable logistic regression and Cox regression analyses were performed to find relevant independent risk factors.Results:Between September 2019 and February 2022,79 patients with AR were enrolled in the study.At 1 month,device success was achieved in 60(75.9%)patients.By 6 months,29(36.7%)patients had MACE.Echocardiography revealed improved left ventricular function after TAVR.Multivariate regression analysis demonstrated that the Society of Thoracic Surgeons risk score(odds ratio 0.760,95%confidence interval(Cl):0.584-0.989;P=0.041)and annulus perimeter(odds ratio 0.888,95%Cl:0.796-0.992;P=0.035)were 2 predictors of device success.Moreover,annulus perimeter(<80.2mm),but not Society of Thoracic Surgeons risk score,was associated with a significant reduction in MACE at 6 months(hazard ratio 2.223,95%Cl:1.060-4.659;P=0.028).Conclusions:TF-TAVR using a self-expanding valve system appears to be a safe and feasible treatment for patients with pure native severe AR,particularly those with a less enlarged annulus.展开更多
Chronic ischemic mitral valve regurgitation is a result of disturbed left ventricular geometry secondary to myocardial ischemia in the absence of intrinsic mitral valve pathology. It is a common complication after myo...Chronic ischemic mitral valve regurgitation is a result of disturbed left ventricular geometry secondary to myocardial ischemia in the absence of intrinsic mitral valve pathology. It is a common complication after myocardial infarction, and patients who have ischemic mitral regurgitation(IMR) have a worse prognosis compared to patients who have ischemic heart disease alone, and this is directly related to the severity of IMR. Medical therapy has limited efficacy, and surgical options including various repair techniques and valve replacement had been tried with variable success. Still there is intense debate among surgeons whether to interfere with moderate degree IMR at the time of coronary artery revascularization.展开更多
Background:Mitral valve perforation refers to the occurrence of cracks or openings in the structure of the mitral valve,allowing blood to escape through these gaps.Typically,this is caused by infective endocarditis an...Background:Mitral valve perforation refers to the occurrence of cracks or openings in the structure of the mitral valve,allowing blood to escape through these gaps.Typically,this is caused by infective endocarditis and the most common site is the anterior leaflet.However,it is crucial to explore other potential causes of valve damage,particularly when conventional risk factors are not apparent.Case presentation:We present a case of a middle-aged male patient who developed mitral valve perforation because of aortic valve regurgitation in the absence of infective endocarditis.Conclusion:Exploring such rare cases contributes to a deeper understanding of valvular diseases and enhances clinical decision making for effective management.展开更多
目的探讨重度三尖瓣反流(TR)患者行经导管三尖瓣置换术(TTVR)的围术期预后效果。方法对2020年9月至2022年8月空军军医大学西京医院心血管外科手术风险高危的重度及以上TR患者(10例)进行回顾性分析。在全身麻醉下,所有患者均行经心房手...目的探讨重度三尖瓣反流(TR)患者行经导管三尖瓣置换术(TTVR)的围术期预后效果。方法对2020年9月至2022年8月空军军医大学西京医院心血管外科手术风险高危的重度及以上TR患者(10例)进行回顾性分析。在全身麻醉下,所有患者均行经心房手术入路,术中经食管超声心动图(TEE)和X射线引导下植入LuX-Valve。收集患者的术前、出院前以及术后6个月随访的临床资料进行分析。结果10例患者均成功植入LuX-Valve。手术时间140.0(120.0,172.5)min,ICU住院时间3.0(2.0,3.5)d。植入后,9例患者术中TEE无/微量瓣周漏,1例患者轻度瓣周漏,所有患者未发生其他围术期并发症。6个月随访结果显示,纽约心脏协会心功能Ⅱ级患者数量多于术前(8 vs 0,P<0.01),三尖瓣环平面收缩位移显著改善[16.4(14.1,18.0)mm vs 12.5(11.5,15.0)mm,P<0.01]。此外,患者6 min步行距离[360.0(315.0,390.0)m vs 212.5(165.0,255.0)m]以及堪萨斯城心肌病问卷评分[62(60,65)分vs 31(27,37)分]均较术前明显提高(P<0.01)。结论本研究初步证实使用LuX-Valve进行TTVR治疗严重TR患者是一种可行且相对安全的方法,临床结果可靠。然而,由于该手术难度较大,因此需要加强病情观察和严密监护。展开更多
Background Pulmonary regurgitation leads to progressive right ventricular dysfunction, susceptibility to arrhythmias,and sudden cardiac death. Percutaneous valve replacement has been developed in recent years, providi...Background Pulmonary regurgitation leads to progressive right ventricular dysfunction, susceptibility to arrhythmias,and sudden cardiac death. Percutaneous valve replacement has been developed in recent years, providing patients with an alternative option. Percutaneous pulmonary valve replacement has been recently introduced into clinical practice. The goal of this study was to evaluate the feasibility of percutaneous valve stent insertion to correct the pulmonary regurgitation in sheep using a cup-shaped valve stent.Methods Pulmonary regurgitation was created by percutaneous cylindrical stent insertion in native pulmonary annulus of 8 sheep. One month after the initial procedure, the sheep with previous cylindrical stent implanted underwent the same implantation procedure of pulmonary valve stent. The valve stent consisted of a cup-shaped stent and pericardial valves.Hemodynamic assessments of the bioprosthetic pulmonary valve were obtained by echocardiography at immediately post-implant and at 2 months follow up.Results Successful transcatheter cylindrical stent insertion was performed in 7 sheep but failed in 1 sheep because the cylindrical stent was released to right ventricle outflow tract. After one month the 7 sheep with pulmonary regurgitation underwent valve stent implantation successfully. Echocardiography confirmed the stents were in desired position during the follow-up. No evidence of pulmonary valve insufficiency occurred in any animals. Echocardiography showed all heart function markers were normal.Conclusions Percutaneous cylindrical stent insertion to induce significant pulmonary regurgitation in sheep was feasible, simple and reproducible. Percutaneous pulmonary valve stent implantation can reduce pulmonary regurgitation in a sheep model. Further development of animal model and clinical trials are warranted.展开更多
Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitr...Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.展开更多
Background:Ventricular septal defect(VSD)is the most common congenital heart disease.Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD.However,there is a limit data ...Background:Ventricular septal defect(VSD)is the most common congenital heart disease.Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD.However,there is a limit data for outlet VSD,especially impact to the aortic valve leaflet after transcatheter closure.This study aims to assess the outcomes of transcatheter closure of the outlet-type ventricular septal defect(OVSD)after 1 postoperative year.Methods:A retrospective study was performed including 50 patients who underwent transcatheter(n=25)and surgical(n=25)OVSD closure during the exact time frame at two medical centres.Results:The median age and body weight of patients in the transcatheter group were significantly higher than those of patients in the surgical group(7.0 vs.2.8 years;27.0 vs.11.4 kg;p<0.01).The defect size in the surgical group was significantly larger than that in the transcatheter group(5.0 vs.3.0 mm;p<0.01).All OVSD patients have successful transcatheter closure(100%)as effective as surgical closure.Less than small residual shunt was present 20%and 8%immediately after the procedure in the transcatheter and surgical groups(p=0.50),which decreased to 12%and 4%at the 1-year follow-up(p=0.61),respectively.No incidence of complete atrioventricular block and other complications was observed in both groups,and no significant differences were noted in the new onset or worsening of the aortic regurgitation in both groups(p=1.0).Conclusions:Transcatheter treatment could be effectively and safely achieved for OVSD closure at 1-year follow-up.展开更多
文摘Background： Mitral valve （MV） repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation （MR）. However, there has been limited infomlation regarding tile echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV. Methods： A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients （79.8%）, artificial chordae in 20 （23.8%）, and ring annuloplasty in 79 （94.1%）. Eighty-one （96.4%） of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up. Results： At a median echocardiographic follow-up of 36.0 months （interquartile range 14.3-59.4 months）, lbur patients （4.9%） developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, leli atrial diameter （LAD）, left ventricular end-diastolic diameter （LVEDD）, and let1 ventricular ejection fraction （LVEF） were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 （Z- -8.456, P 〈 0.001 ）, LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm （I - 15.131, P 〈 0.001 ）, LVEDD fiom 51.0 ± 5.0 to 43.3 ± 2.2 mm （t = 14.481, P 〈 0.001 ）, and LV EF l＇rom 67.3 ± 7.0% to 63.9 ± 5.1% （t = 4.585, P 〈 0.001 ）. Conclusion： Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up.
基金Henan Province health science and technology innovation talents training project(No.YXKC 2020047)
文摘Background:Due to the wide variety of morphology,size,and dynamics,selecting an optimal valve size and location poses great difficulty in percutaneous pulmonary valve implantation(PPVI).This study aimed to report our experience with in vitro bench testing using patient-specific three-dimensional(3D)-printed models for planning PPVI with the Venus P-valve.Methods:Patient-specific 3D soft models were generated using PolyJet printing with a compliant synthetic material in 15 patients scheduled to undergo PPVI between July 2018 and July 2020 in Central China Fuwai Hospital of Zhengzhou University.Results:3D model bench testing altered treatment strategy in all patients(100%).One patient was referred for surgery because testing revealed that even the largest Venus P-valve would not anchor properly.In the remaining 14 patients,valve size and/or implantation location was altered to avoid valve migration and/or compression coronary artery.In four patients,it was decided to change the point anchoring because of inverted cone-shaped right ventricular outflow tract(RVOT)(n=2)or risk of compression coronary artery(n=2).Concerning sizing,we found that an oversize of 2-5 mm suffices.Anchoring of the valve was dictated by the flaring of the in-and outflow portion in the pulmonary artery.PPVI was successful in all 14 patients(absence of valve migration,no coronary compression,and none-to-mild residual pulmonary regurgitation[PR]).The diameter of the Venus P-valve in the 3D simulation group was significantly smaller than that of the conventional planning group(36[2]vs.32[4],Z=-3.77,P<0.001).Conclusions:In vitro testing indicated no need to oversize the Venus P-valve to the degree recommended by the balloon-sizing technique,as 2-5 mm sufficed.
基金supported by the National Natural Science Foundation of China(81970307,82100357,and 82270344)jointly supported by Six Talent Peaks Project of Jiangsu Province(2019-WSN-156)+2 种基金Jiangsu Health Committee(H2019077)Nanjing Health Committee(JQX22007)National Key R&D Program of China(2020YFC2008100).
文摘Objective:Patients with untreated severe aortic regurgitation(AR)have a high risk of mortality.Transfemoral transcatheter aortic valve replacement(TF-TAVR)is a treatment option for AR;however,the safety and efficacy of this technique have not been sufficiently established.This study aimed to evaluate the clinical and anatomical variables correlating with device success of TF-TAVR using a self-expanding valve system for pure AR.Methods:Patients with pure native severe AR who underwent TF-TAVR using a self-expanding valve system were registered at 5 Chinese centers.The primary endpoint was device success at 1 month after TAVR.The secondary endpoint was the composite of major adverse cardiovascular events(MACE)at 6 months,including all-cause death,ischemic stroke,emergency conversion to cardiac surgery,and permanent pacemaker implantation.Echocardiography was used to analyze the left ventricular function before the TAVR procedure and during follow-up.Multivariable logistic regression and Cox regression analyses were performed to find relevant independent risk factors.Results:Between September 2019 and February 2022,79 patients with AR were enrolled in the study.At 1 month,device success was achieved in 60(75.9%)patients.By 6 months,29(36.7%)patients had MACE.Echocardiography revealed improved left ventricular function after TAVR.Multivariate regression analysis demonstrated that the Society of Thoracic Surgeons risk score(odds ratio 0.760,95%confidence interval(Cl):0.584-0.989;P=0.041)and annulus perimeter(odds ratio 0.888,95%Cl:0.796-0.992;P=0.035)were 2 predictors of device success.Moreover,annulus perimeter(<80.2mm),but not Society of Thoracic Surgeons risk score,was associated with a significant reduction in MACE at 6 months(hazard ratio 2.223,95%Cl:1.060-4.659;P=0.028).Conclusions:TF-TAVR using a self-expanding valve system appears to be a safe and feasible treatment for patients with pure native severe AR,particularly those with a less enlarged annulus.
文摘Chronic ischemic mitral valve regurgitation is a result of disturbed left ventricular geometry secondary to myocardial ischemia in the absence of intrinsic mitral valve pathology. It is a common complication after myocardial infarction, and patients who have ischemic mitral regurgitation(IMR) have a worse prognosis compared to patients who have ischemic heart disease alone, and this is directly related to the severity of IMR. Medical therapy has limited efficacy, and surgical options including various repair techniques and valve replacement had been tried with variable success. Still there is intense debate among surgeons whether to interfere with moderate degree IMR at the time of coronary artery revascularization.
文摘Background:Mitral valve perforation refers to the occurrence of cracks or openings in the structure of the mitral valve,allowing blood to escape through these gaps.Typically,this is caused by infective endocarditis and the most common site is the anterior leaflet.However,it is crucial to explore other potential causes of valve damage,particularly when conventional risk factors are not apparent.Case presentation:We present a case of a middle-aged male patient who developed mitral valve perforation because of aortic valve regurgitation in the absence of infective endocarditis.Conclusion:Exploring such rare cases contributes to a deeper understanding of valvular diseases and enhances clinical decision making for effective management.
文摘目的探讨重度三尖瓣反流(TR)患者行经导管三尖瓣置换术(TTVR)的围术期预后效果。方法对2020年9月至2022年8月空军军医大学西京医院心血管外科手术风险高危的重度及以上TR患者(10例)进行回顾性分析。在全身麻醉下,所有患者均行经心房手术入路,术中经食管超声心动图(TEE)和X射线引导下植入LuX-Valve。收集患者的术前、出院前以及术后6个月随访的临床资料进行分析。结果10例患者均成功植入LuX-Valve。手术时间140.0(120.0,172.5)min,ICU住院时间3.0(2.0,3.5)d。植入后,9例患者术中TEE无/微量瓣周漏,1例患者轻度瓣周漏,所有患者未发生其他围术期并发症。6个月随访结果显示,纽约心脏协会心功能Ⅱ级患者数量多于术前(8 vs 0,P<0.01),三尖瓣环平面收缩位移显著改善[16.4(14.1,18.0)mm vs 12.5(11.5,15.0)mm,P<0.01]。此外,患者6 min步行距离[360.0(315.0,390.0)m vs 212.5(165.0,255.0)m]以及堪萨斯城心肌病问卷评分[62(60,65)分vs 31(27,37)分]均较术前明显提高(P<0.01)。结论本研究初步证实使用LuX-Valve进行TTVR治疗严重TR患者是一种可行且相对安全的方法,临床结果可靠。然而,由于该手术难度较大,因此需要加强病情观察和严密监护。
文摘Background Pulmonary regurgitation leads to progressive right ventricular dysfunction, susceptibility to arrhythmias,and sudden cardiac death. Percutaneous valve replacement has been developed in recent years, providing patients with an alternative option. Percutaneous pulmonary valve replacement has been recently introduced into clinical practice. The goal of this study was to evaluate the feasibility of percutaneous valve stent insertion to correct the pulmonary regurgitation in sheep using a cup-shaped valve stent.Methods Pulmonary regurgitation was created by percutaneous cylindrical stent insertion in native pulmonary annulus of 8 sheep. One month after the initial procedure, the sheep with previous cylindrical stent implanted underwent the same implantation procedure of pulmonary valve stent. The valve stent consisted of a cup-shaped stent and pericardial valves.Hemodynamic assessments of the bioprosthetic pulmonary valve were obtained by echocardiography at immediately post-implant and at 2 months follow up.Results Successful transcatheter cylindrical stent insertion was performed in 7 sheep but failed in 1 sheep because the cylindrical stent was released to right ventricle outflow tract. After one month the 7 sheep with pulmonary regurgitation underwent valve stent implantation successfully. Echocardiography confirmed the stents were in desired position during the follow-up. No evidence of pulmonary valve insufficiency occurred in any animals. Echocardiography showed all heart function markers were normal.Conclusions Percutaneous cylindrical stent insertion to induce significant pulmonary regurgitation in sheep was feasible, simple and reproducible. Percutaneous pulmonary valve stent implantation can reduce pulmonary regurgitation in a sheep model. Further development of animal model and clinical trials are warranted.
文摘Background: Functional mitral regurgitation (FMR) is an increasing burden as population ages. Mitral valve repair (MVr) is the preferred surgical treatment of FMR despite limited evidence supporting its efficacy. Mitral valve replacement (MVR) is the alternative procedure typically reserved for patients who are at higher risk or refractory to MVr. The present study aims to determine which of the two procedures is more effective in the surgical treatment of FMR. Methods: 344 charts of FMR patients who received either MVr (n = 263) or MVR (n = 81) from 2004-2016 at our institution were reviewed. Treatment efficacy was assessed based on heart failure (HF)-readmission and survival rates within 5 years from discharge. Propensity score approach with inverse probability weighting and Cox regression models were employed to evaluate procedural impact on survival and rehospitalizations, respectively. Follow-up echocardiographic data from the original cohort was assessed for differences in metrics between procedural groups at >6 months (MVr: n = 75;MVR: n = 23) and 1 year (MVr: n = 75;MVR: n = 18) post-op. Results: MVR patients had a lower risk of being readmitted for HF within 5 years compared to the MVr group (HR-adj (95% CI): 0.60 (0.41 - 0.88), p = 0.008). MVR patients also had a higher overall risk of death (HR-adj (95% CI): 1.82 (1.05 - 3.16), p = 0.034) but this was borderline significantly different at 5 years cut-off (p = 0.057). Conclusions: Higher HF readmission in MVr patients than in sicker, higher surgical-risk MVR patients reflects the inadequacy of MVr to treat FMR. Novel approaches to MVR may be necessary to adequately manage FMR.
文摘Background:Ventricular septal defect(VSD)is the most common congenital heart disease.Transcatheter VSD closure is an effective treatment for patients with muscular and perimembranous VSD.However,there is a limit data for outlet VSD,especially impact to the aortic valve leaflet after transcatheter closure.This study aims to assess the outcomes of transcatheter closure of the outlet-type ventricular septal defect(OVSD)after 1 postoperative year.Methods:A retrospective study was performed including 50 patients who underwent transcatheter(n=25)and surgical(n=25)OVSD closure during the exact time frame at two medical centres.Results:The median age and body weight of patients in the transcatheter group were significantly higher than those of patients in the surgical group(7.0 vs.2.8 years;27.0 vs.11.4 kg;p<0.01).The defect size in the surgical group was significantly larger than that in the transcatheter group(5.0 vs.3.0 mm;p<0.01).All OVSD patients have successful transcatheter closure(100%)as effective as surgical closure.Less than small residual shunt was present 20%and 8%immediately after the procedure in the transcatheter and surgical groups(p=0.50),which decreased to 12%and 4%at the 1-year follow-up(p=0.61),respectively.No incidence of complete atrioventricular block and other complications was observed in both groups,and no significant differences were noted in the new onset or worsening of the aortic regurgitation in both groups(p=1.0).Conclusions:Transcatheter treatment could be effectively and safely achieved for OVSD closure at 1-year follow-up.
