自2014版美国心脏病学会(American College of Cardiology,ACC)/美国心脏协会(American Heart Association,AHA)心脏瓣膜病患者管理指南发布以来,心脏瓣膜病的治疗领域又取得了一些重要进展。此次更新的内容主要涉及主动脉瓣狭窄治疗方...自2014版美国心脏病学会(American College of Cardiology,ACC)/美国心脏协会(American Heart Association,AHA)心脏瓣膜病患者管理指南发布以来,心脏瓣膜病的治疗领域又取得了一些重要进展。此次更新的内容主要涉及主动脉瓣狭窄治疗方式的选择、二尖瓣反流的干预策略、人工瓣膜类型的选择以及生物瓣的抗栓治疗策略。该文对2017年ACC/AHA指南更新的主要内容进行了总结和解读,并在此基础上对心脏瓣膜病治疗领域的未来发展趋势进行了展望。展开更多
As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to ...As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population.Recent years have brought a progression of surgical treatments toward less invasive strategies.This has given rise to percutaneous approaches for the correction of valvular heart disease.Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation.We review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.展开更多
Background:The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement(TAVR)for symptomatic severe aortic stenosis(AS),and the impact of sizing strategi...Background:The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement(TAVR)for symptomatic severe aortic stenosis(AS),and the impact of sizing strategies and related procedural outcomes.Methods:Patients with severe AS who underwent TAVR were consecutively enrolled from 2012 to 2019.The anatomy and morphology of the aortic root were assessed."Downsize"strategy was preformed when patients had complex morphology.The clinical outcomes of patients who performed downsize strategy were compared with those received annular sizing strategy.The primary outcome was device success rate,and secondary outcomes included Valve Academic Research Consortium-3 clinical outcomes variables based on 1-year follow-up.Results:A total of 293 patients were enrolled.Among them,95 patients(32.4%)had bicuspid aortic valve.The calcium volume(Hounsfield Unit-850)of aortic root was 449.90(243.15-782.15)mm3.Calcium is distributed mostly on the leaflet level.Downsize strategy was performed in 204 patients(69.6%).Compared with the patients who performed annular sizing strategy,those received downsize strategy achieved a similar device success rate(82.0%[73]vs.83.3%[170],P=0.79).Aortic valve gradients(downsize strategy group vs.annular sizing group,11.28 mmHg vs.11.88 mmHg,P=0.64)and percentages of patients with moderate or severe paravalvular regurgitation 2.0%(4/204)vs.4.5%(4/89),P=0.21were similar in the two groups at 30 days after TAVR.These echocardiographic results were sustainable for one year.Conclusions:Chinese TAVR patients have more prevalent bicuspid morphology and large calcium volume of aortic root.Calcium is distributed mostly on the leaflet level.Compare with annular sizing strategy,downsize strategy provided a non-inferior device success rate and transcatheter heart valve hemodynamic performance in self-expanding TAVR procedure.展开更多
文摘自2014版美国心脏病学会(American College of Cardiology,ACC)/美国心脏协会(American Heart Association,AHA)心脏瓣膜病患者管理指南发布以来,心脏瓣膜病的治疗领域又取得了一些重要进展。此次更新的内容主要涉及主动脉瓣狭窄治疗方式的选择、二尖瓣反流的干预策略、人工瓣膜类型的选择以及生物瓣的抗栓治疗策略。该文对2017年ACC/AHA指南更新的主要内容进行了总结和解读,并在此基础上对心脏瓣膜病治疗领域的未来发展趋势进行了展望。
文摘As life expectancy increases,valvular heart disease is becoming more common.Management of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly population.Recent years have brought a progression of surgical treatments toward less invasive strategies.This has given rise to percutaneous approaches for the correction of valvular heart disease.Percutaneous mitral valve repair using the MitraClip system (Abbott Vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral regurgitation.We review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.
基金National Key Research&Development Program of China(No.2020YFC2008100)Project of Capital Clinical Treatment Technology Research and Translation Application(No.Z201100005520068)。
文摘Background:The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement(TAVR)for symptomatic severe aortic stenosis(AS),and the impact of sizing strategies and related procedural outcomes.Methods:Patients with severe AS who underwent TAVR were consecutively enrolled from 2012 to 2019.The anatomy and morphology of the aortic root were assessed."Downsize"strategy was preformed when patients had complex morphology.The clinical outcomes of patients who performed downsize strategy were compared with those received annular sizing strategy.The primary outcome was device success rate,and secondary outcomes included Valve Academic Research Consortium-3 clinical outcomes variables based on 1-year follow-up.Results:A total of 293 patients were enrolled.Among them,95 patients(32.4%)had bicuspid aortic valve.The calcium volume(Hounsfield Unit-850)of aortic root was 449.90(243.15-782.15)mm3.Calcium is distributed mostly on the leaflet level.Downsize strategy was performed in 204 patients(69.6%).Compared with the patients who performed annular sizing strategy,those received downsize strategy achieved a similar device success rate(82.0%[73]vs.83.3%[170],P=0.79).Aortic valve gradients(downsize strategy group vs.annular sizing group,11.28 mmHg vs.11.88 mmHg,P=0.64)and percentages of patients with moderate or severe paravalvular regurgitation 2.0%(4/204)vs.4.5%(4/89),P=0.21were similar in the two groups at 30 days after TAVR.These echocardiographic results were sustainable for one year.Conclusions:Chinese TAVR patients have more prevalent bicuspid morphology and large calcium volume of aortic root.Calcium is distributed mostly on the leaflet level.Compare with annular sizing strategy,downsize strategy provided a non-inferior device success rate and transcatheter heart valve hemodynamic performance in self-expanding TAVR procedure.
