Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic ...Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation(TAVI)and to analyze the ability of different tools for predicting clinical outcomes in this context.Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge.The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.Results A total of 377 patients were included(mean age of 80.4 years).Most patients were independent or mildly dependent,with an optimal cognitive status.The proportion of frailty ranged from 17.6%to 49.8%.A total of 20 patients(5.3%)died and 110/377 patients(29.2%)died or were readmitted during follow up.Overall,most components of the geriatric assessment showed an association with clinical outcomes.Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission.The association between frailty and clinical outcomes was higher for short physical performance battery(SPPB),essential frailty toolset(EFT)and the frailty index based on comprehensive geriatric assessment(IF-VIG)and lower for Fried criteria and FRAIL scale.Conclusions AS patients from this series presented a good physical performance,optimal cognitive status and a reasonably low prevalence of frailty.The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT,SPPB and the IF-VIG.展开更多
Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,m...Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.展开更多
Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAV...Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.展开更多
Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR...Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR)as an alternative therapeutic strategy for AR,particularly in patients deemed high risk for surgery.We explored the anatomical and patho-physiological disparities between AR and aortic stenosis(AS)and elucidates the technical nuances of TAVR procedures in AR pa-tients,emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume.Additionally,we discussed the safety and efficacy of TAVR compared to SAVR in AR management,drawing insights from recent case series and registry data.Notably,dedicated TAVR devices tailored for AR,such as the J-Valve and JenaValve,demonstrate promising out-comes in reducing residual AR and ensuring procedural success.Conversely,“off-label”TAVR devices,including balloon-ex-pandable and self-expandable platforms,offer feasible alternatives-particularly for large aortic annuli-with favorable device suc-cess rates and low residual AR rates.We highlighted the need for further research,including randomized trials,to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes.In conclusion,TAVR emerges as a viable option for patients with AR,particularly those facing high surgical risks or frailty,with ongoing investigations poised to refine its position in the therapeutic armamentarium.展开更多
Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LA...Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.展开更多
Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements o...Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements over last two decades,there are still significant challenges in field in terms of appropriate selection of patients as well as the valves.While there is no doubt that TAVR has now become the leading mode of treatment for severe AS patients,surgical aortic valve replacement(SAVR)still holds its value for the selective group of patients who are not ideal candidate for the minimally invasive procedure:TAVR.The dilemma is palpable in the clinical field that warrants best approach focusing on the lifetime management of these patients.In the recent metanalysis by Moradi et al,the authors provide a comprehensive insight into TAVR vs SAVR in terms of mortality,procedural complications,and post-procedure adverse events.In this editorial,we shed light on comparative analysis of both modalities to establish a middle ground.展开更多
Hepatocellular carcinoma(HCC)remains one of the most common cancers worldwide.Transcatheter arterial chemoembolization has become a common treatment modality for some patients with unresectable advanced HCC.Since the ...Hepatocellular carcinoma(HCC)remains one of the most common cancers worldwide.Transcatheter arterial chemoembolization has become a common treatment modality for some patients with unresectable advanced HCC.Since the introduction of nanomaterials in 1974,their use in various fields has evolved rapidly.In medical applications,nanomaterials can serve as carriers for the delivery of chemotherapeutic drugs to tumour tissues.Additionally,nanomaterials have potential for in vivo tumour imaging.This article covers the properties and uses of several kinds of nanomaterials,focusing on their use in transcatheter arterial chemoembolization for HCC treatment.This paper also discusses the limitations currently associated with the use of nanomaterials.展开更多
BACKGROUND Transcatheter arterial chemoembolization(TACE)is a key treatment approach for advanced invasive liver cancer(infiltrative hepatocellular carcinoma).However,its therapeutic response can be difficult to evalu...BACKGROUND Transcatheter arterial chemoembolization(TACE)is a key treatment approach for advanced invasive liver cancer(infiltrative hepatocellular carcinoma).However,its therapeutic response can be difficult to evaluate accurately using conventional two-dimensional imaging criteria due to the tumor’s diffuse and multifocal growth pattern.Volumetric imaging,especially enhanced tumor volume(ETV),offers a more comprehensive assessment.Nonetheless,bias field inhomogeneity in magnetic resonance imaging(MRI)poses challenges,potentially skewing volumetric measurements and undermining prognostic evaluation.AIM To investigate whether MRI bias field correction enhances the accuracy of volumetric assessment of infiltrative hepatocellular carcinoma treated with TACE,and to analyze how this improved measurement impacts prognostic prediction.METHODS We retrospectively collected data from 105 patients with invasive liver cancer who underwent TACE treatment at the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2024.The improved N4 bias field correction algorithm was applied to process MRI images,and the ETV before and after treatment was calculated.The ETV measurements before and after correction were compared,and their relationship with patient prognosis was analyzed.A Cox proportional hazards model was used to evaluate prognostic factors,with Martingale residual analysis determining the optimal cutoff value,followed by survival analysis.RESULTS Bias field correction significantly affected ETV measurements,with the corrected baseline ETV mean(505.235 cm^(3))being significantly lower than before correction(825.632 cm^(3),P<0.001).Cox analysis showed that the hazard ratio(HR)for corrected baseline ETV(HR=1.165,95%CI:1.069-1.268)was higher than before correction(HR=1.063,95%CI:1.031-1.095).Using 412 cm^(3) as the cutoff,the group with baseline ETV<415 cm^(3) had a longer median survival time compared to the≥415 cm^(3) group(18.523 months vs 8.926 months,P<0.001).The group with an ETV reduction rate≥41%had better prognosis than the<41%group(17.862 months vs 9.235 months,P=0.006).Multivariate analysis confirmed that ETV reduction rate(HR=0.412,P<0.001),Child-Pugh classification(HR=0.298,P<0.001),and Barcelona Clinic Liver Cancer stage(HR=0.578,P=0.045)were independent prognostic factors.CONCLUSION Volume imaging based on MRI bias field correction can improve the accuracy of evaluating the efficacy of TACE treatment for invasive liver cancer.The corrected ETV and its reduction rate can serve as independent indicators for predicting patient prognosis,providing important reference for developing individualized treatment strategies.展开更多
BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SA...BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.展开更多
This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter...This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.展开更多
BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invas...BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invasive techniques,such as transcatheter arterial chemoembolization(TACE)and microwave ablation(MWA).AIM To evaluate the efficacy and safety of TACE combined with MWA for large hepatic hemangiomas.METHODS This retrospective cohort study was conducted at Peking Union Medical College Hospital between January 2015 and January 2024.Eighty-two patients with hepatic hemangiomas>5 cm were divided into two groups:Observation(TACE+MWA,n=50)and control(TACE,n=32).Tumor diameter and treatment outcomes were evaluated at baseline,12 months,and>3 years.Appropriate statistical tests were chosen based on the type and distribution of the data.RESULTS At baseline,the median tumor diameter was 8.3(range:5.0-19.2)cm in the observation group and 8.5(range:5.0-20.0)cm in the control group.The median follow up duration was 44.6(95%confidence interval:36.7-52.5)months.At 12 months post-treatment,the observation group demonstrated a higher tumor reduction ratio compared to the control group(50.98%vs 23.28%,respectively;P<0.001).The objective response rate was 93.94%in the observation group,which was significantly higher than that in the control group(33.33%)(P<0.001).No recurrence occurred in the observation group,while one case occurred in the control group.Notably,no cases of hemoglobinuria or acute kidney injury were reported in the observation group.CONCLUSION Combination treatment enhances tumor shrinkage,promotes long-term tumor control,and reduces the complications associated with MWA,thereby presenting a promising alternative to surgical resection.展开更多
Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of t...Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of treatment, the success rate in left-sided IE is often limited,as nearly half of all patients eventually require surgical intervention for definitive management.^([2]) Heart failure is the main indication for surgery, but access to surgery is frequently restricted by several factors, particularly in patients with advanced age, often driven by the presence of comorbidities or hemodynamic instability.^([3,4])展开更多
BACKGROUND Transcatheter arterial chemoembolization(TACE)combined with lenvatinib is an important modality for the treatment of unresectable hepatocellular carcinoma(HCC).To date,no prognostic analysis exists for clin...BACKGROUND Transcatheter arterial chemoembolization(TACE)combined with lenvatinib is an important modality for the treatment of unresectable hepatocellular carcinoma(HCC).To date,no prognostic analysis exists for clinical predictive models of TACE combined with lenvatinib in treating advanced unresectable HCC.A model was constructed through meta-analysis,and its validation was further enhanced by the collection of external clinical data,thereby providing guidance for clinical practice.AIM To identify risk factors for unresectable HCC following TACE plus lenvatinib therapy and to construct a clinical prediction model.METHODS We searched PubMed,Web of Science,EMBASE,and Cochrane Library databases for studies on TACE plus lenvatinib for unresectable HCC.Risk factors from the meta-analysis and sensitivity analyses were used to construct a prediction model.The validation set included clinical data from 106 eligible patients at the Affiliated Hospital of North Sichuan Medical College collected by June 1,2023.RESULTS This study included 43 group studies involving 5070 patients.Tumor number,microvascular invasion,Eastern Cooperative Oncology Group performance status,Child-Pugh stage,Barcelona Clinic Liver Cancer stage,extra-hepatic metastases,alpha-fetoprotein level,and hepatitis B virus status were risk factors for overall survival and progression-free survival,while triple therapy was a protective factor for both.In the validation set,the overall survival prediction model had area under the curve values of 0.616,0.643,and 0.706 at 1 year,2 years,and 3 years,respectively,and the progression-free survival model had area under the curve values of 0.702,0.696,and 0.670 at the corresponding time points,demonstrating good model performance.Calibration curves,Kaplan-Meier survival analysis,and decision curves further validated the efficacy of the model.CONCLUSION Models based on nine variables from 43 group studies predicted the efficacy of TACE plus lenvatinib in unresectable HCC,supporting evidence-based clinical decisions and treatment strategies.展开更多
BACKGROUND For patients with unresectable hepatocellular carcinoma(HCC),both stereotactic body radiation therapy(SBRT)and transcatheter arterial chemoembolization(TACE)have demonstrated effectiveness in controlling lo...BACKGROUND For patients with unresectable hepatocellular carcinoma(HCC),both stereotactic body radiation therapy(SBRT)and transcatheter arterial chemoembolization(TACE)have demonstrated effectiveness in controlling local tumor growth.We investigated whether combining these treatments could provide better outcomes than TACE monotherapy.AIM To evaluate whether combining SBRT with TACE provides superior clinical outcomes compared to TACE alone in patients with unresectable HCC.METHODS We conducted a randomized study involving eighty patients diagnosed with unresectable HCC,classified as Barcelona Clinic Liver Cancer stage B and Child-Pugh class A.Participants were divided into two treatment arms:A control group receiving TACE alone(Group A)and an experimental group receiving sequential TACE and SBRT(Group B).The SBRT regimen consisted of 40 Gy administered in five daily fractions over one week.Primary endpoints included local control,progression-free survival(PFS),and overall survival(OS),with secondary endpoints focusing on toxicity profiles.Additional analyses explored the impact of different SBRT dose levels.RESULTS The study enrolled 88 patients from April 2021 to January 2023,with 48 assigned to Group A and 40 to Group B.Over a median follow-up period of 20 months,the combination therapy group demonstrated superior outcomes in both tumor control and disease progression metrics.Complete response rates reached 75%in Group B compared to 54.5%in Group A.The combination therapy extended median PFS to 16 months,significantly longer than the 11 months observed with TACE alone(P=0.003).Neither group had reached median OS by study conclusion.Importantly,both treatment approaches showed comparable safety profiles.CONCLUSION Our findings suggest that supplementing TACE with SBRT offers a well-tolerated and effective treatment strategy for advanced HCC patients.This combination approach achieved better tumor control and delayed disease progression compared to TACE monotherapy,while maintaining an acceptable safety profile.展开更多
BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach conce...BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain,which our meta-analysis aims to address.AIM To explore safety and efficacy outcomes for patients undergoing TAVR,comparing periprocedural continuation vs interruption of OAC therapy.METHODS A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC.Data were pooled using a random-effects model with risk ratio(RR)and their 95%confidence interval(CI)as effect measures.All statistical analyses were conducted using Review Manager with statistical significance set at P<0.05.RESULTS Four studies were included,encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8%males.A total of 733 patients underwent OAC interruption and 1080 continued.Stroke incidence was significantly lower in the OAC continuation group(RR=0.62,95%CI:0.40-0.94;P=0.03).No significant differences in major vascular complications were found between the two groups(RR=0.95,95%CI:0.77-1.16;P=0.60)and major bleeding(RR=0.90,95%CI:0.72-1.12;P=0.33).All-cause mortality was non-significant between the two groups(RR=0.83,95%CI:0.57-1.20;P=0.32).CONCLUSION Continuation of OAC significantly reduced stroke risk,whereas it showed trends toward lower bleeding and mortality that were not statistically significant.Further large-scale studies are crucial to determine clinical significance.展开更多
Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasin...Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasingly older,have comorbidities,and frailty.TAVR cardiac rehabilitation(CR)programs significantly improve both functional capacity and quality of life of patients.However,there are no guidelines on how to carry out them and few elderly patients are referred to CR.Furthermore,mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs.Multidisciplinary patient care,including comorbidities and frailty,is essential.It is necessary to ensure exquisite continuity of care during TAVR,CR,and the rest of the patient's life.Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR,given the high demand.This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.展开更多
Mitral regurgitation (MR) is a highly prevalent valvular heart disease globally,with untreated severe cases demonstrating associations with elevated morbidity,mortality,and adverse cardiovascular outcomes.[1,2]While t...Mitral regurgitation (MR) is a highly prevalent valvular heart disease globally,with untreated severe cases demonstrating associations with elevated morbidity,mortality,and adverse cardiovascular outcomes.[1,2]While transcatheter edge-toedge repair (TEER) has emerged as an alternative option for high surgical risk patients with severe MR,[3,4]severe MR of Carpentier class IIIa (characterized by restricted leaflet motion during both systole and diastole) has been considered a relative contraindication for TEER interventions due to stenosis risk and procedural complexity.[5,6]展开更多
Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to...Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.展开更多
The prevalence of mitral regurgitation(MR)is increasingly worldwide as a consequence of improved survival and ischemic heart disease.Severe MR is associated with worse prognosis,independent of left ventricular functio...The prevalence of mitral regurgitation(MR)is increasingly worldwide as a consequence of improved survival and ischemic heart disease.Severe MR is associated with worse prognosis,independent of left ventricular function and associated comorbidities.[1-3]Although surgical valve repair or replacement remains the standard treatment for patients with chronic MR,up to 50%of MR patients with symptomatic MR are not referred for surgery,mainly because of multiple comorbid conditions resulting in high surgical risk.[4]There is,therefore,a clear need for less invasive approaches for this patient group.展开更多
This study aimed to evaluate the feasibility,safety,and efficacy of a noveltranscatheter suture closure system(HaloStitch^(®))for patent foramen ovale(PFO)closure in a swine model.Methods:Thirteen swine underwent...This study aimed to evaluate the feasibility,safety,and efficacy of a noveltranscatheter suture closure system(HaloStitch^(®))for patent foramen ovale(PFO)closure in a swine model.Methods:Thirteen swine underwentexperimental PF0 model creation.All animals received implantationof the transcatheter suture closure system to evaluate procedural success.Comprehensive follow-up over sixmonths included serial ultrasound imaging,histopathological analysis,and gross anatomical exaninationof cardiac specimens.Results:Successful HaloStitch^(®)device implantation was adhieved in 11 of 13 swine.Gross anatomical examination confirrned secure positioning of all sutures in the atrial septum,with noredundancy or thrombus formation.Postoperative ultrasound demonstrated stable suture and staplepositions throughout follow-up,with no evidence of suture breakage,displacement,or thrombus.Stapleswere clearly visualized under ultrasound imaging,Both the atrial septal defect orifice diameter and residualseptal shunt flow velocity decreased significantly during the observation period.Histopathological analysisrevealed partially organized thrombi at the implant head and fibrous connective tissue encapsulation withlocalized inflammatory cell infiltration surrounding the polymer material.Conclsions:The transcathetersuture closure system(HaloStitch^(®))demonstrated feasibility,safety,and biocompatib ility for PFO closure ina swine model,supporting its potential for clinical translation.展开更多
文摘Background There is scarce data about comparisons between geriatric assessment tools in patients with aortic stenosis(AS).We aimed to describe the geriatric profile of patients with AS undergoing transcatheter aortic valve implantation(TAVI)and to analyze the ability of different tools for predicting clinical outcomes in this context.Methods This was a single center retrospective registry including patients with AS undergoing TAVI and surviving to hospital discharge.The primary endpoint was all-cause mortality or need for urgent readmission one year after TAVI.Results A total of 377 patients were included(mean age of 80.4 years).Most patients were independent or mildly dependent,with an optimal cognitive status.The proportion of frailty ranged from 17.6%to 49.8%.A total of 20 patients(5.3%)died and 110/377 patients(29.2%)died or were readmitted during follow up.Overall,most components of the geriatric assessment showed an association with clinical outcomes.Disability for instrumental activities showed a significant association with mortality and a strong association with the rate of mortality or readmission.The association between frailty and clinical outcomes was higher for short physical performance battery(SPPB),essential frailty toolset(EFT)and the frailty index based on comprehensive geriatric assessment(IF-VIG)and lower for Fried criteria and FRAIL scale.Conclusions AS patients from this series presented a good physical performance,optimal cognitive status and a reasonably low prevalence of frailty.The best predictive ability was observed for disability for instrumental activities and frailty as measured by the EFT,SPPB and the IF-VIG.
文摘Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.
文摘Particularly commendable is the important work of Calvo,et al.[1]in comparing geriatric assessment tools to predict mortality and readmissions in elderly patients undergoing transcatheter aortic valve implantation(TAVI).Their efforts underscore the growing importance of frailty assessment in cardiovascular risk stratification.We would like to respectfully highlight several areas that,if addressed in future studies(Figure 1),could further enhance the utility and inclusivity of these assessments.
文摘Aortic regurgitation(AR)poses distinct challenges in interventional cardiology,necessitating novel approaches for treatment.This editorial examined the evolving landscape of transcatheter aortic valve replacement(TAVR)as an alternative therapeutic strategy for AR,particularly in patients deemed high risk for surgery.We explored the anatomical and patho-physiological disparities between AR and aortic stenosis(AS)and elucidates the technical nuances of TAVR procedures in AR pa-tients,emphasizing the need for precise prosthesis positioning and considerations for excessive stroke volume.Additionally,we discussed the safety and efficacy of TAVR compared to SAVR in AR management,drawing insights from recent case series and registry data.Notably,dedicated TAVR devices tailored for AR,such as the J-Valve and JenaValve,demonstrate promising out-comes in reducing residual AR and ensuring procedural success.Conversely,“off-label”TAVR devices,including balloon-ex-pandable and self-expandable platforms,offer feasible alternatives-particularly for large aortic annuli-with favorable device suc-cess rates and low residual AR rates.We highlighted the need for further research,including randomized trials,to delineate the definitive role of TAVR in AR treatment and to address remaining questions regarding device selection and long-term outcomes.In conclusion,TAVR emerges as a viable option for patients with AR,particularly those facing high surgical risks or frailty,with ongoing investigations poised to refine its position in the therapeutic armamentarium.
文摘Background Transcatheter left atrial appendage occlusion(LAAO)has become a suitable alternative to anticoagulation in patients with atrial fibrillation(AF).However,outcomes among patients age>75 years undergoing LAAO are lacking.Methods We included 723 consecutive patients with AF undergoing LAAO from August 2015 to March 2020.Patient data including clinical,laboratory,procedural characteristics,medications and outcomes were collected.The primary composite outcome was major adverse cardiac events(MACE)including mortality,stroke,bleeding and readmissions at 60-days.Results Mean age was 75±8 years and 434(60%)were males.Median CHA2DS2-VASc score was 4(IQR:4,5)points and median HASBLED score was 4(IQR:3,4)points.Composite MACE outcome was significantly higher among patients age>75 years in both unadjusted(17.1%vs.11.5%,P=0.03)and adjusted(Odds Ratio=1.59,95%CI:1.02-2.46,P=0.04)analysis.Composite MACE was primarily driven by higher all-cause mortality(1.3%vs.0,P=0.04)among patients age>75 years.The secondary outcome of procedural success was also lower among patients age>75 years(92.2%vs.96.2%,P=0.02).The occurrence of stroke(P=0.38),major bleeding(P=0.29)and readmissions(P=0.15)did not differ between patients age>75 years and less than 75years.Conclusion Patients age>75 years undergoing LAAO have worse outcomes primarily driven by higher all-cause mortality and are less likely to achieve procedural success.Future prospective studies evaluating these findings are warranted.
文摘Transcatheter aortic valve replacement(TAVR)has emerged as an established standard of care for patients with severe aortic stenosis(AS),irrespective of their surgical risk.However,despite the continuous advancements over last two decades,there are still significant challenges in field in terms of appropriate selection of patients as well as the valves.While there is no doubt that TAVR has now become the leading mode of treatment for severe AS patients,surgical aortic valve replacement(SAVR)still holds its value for the selective group of patients who are not ideal candidate for the minimally invasive procedure:TAVR.The dilemma is palpable in the clinical field that warrants best approach focusing on the lifetime management of these patients.In the recent metanalysis by Moradi et al,the authors provide a comprehensive insight into TAVR vs SAVR in terms of mortality,procedural complications,and post-procedure adverse events.In this editorial,we shed light on comparative analysis of both modalities to establish a middle ground.
文摘Hepatocellular carcinoma(HCC)remains one of the most common cancers worldwide.Transcatheter arterial chemoembolization has become a common treatment modality for some patients with unresectable advanced HCC.Since the introduction of nanomaterials in 1974,their use in various fields has evolved rapidly.In medical applications,nanomaterials can serve as carriers for the delivery of chemotherapeutic drugs to tumour tissues.Additionally,nanomaterials have potential for in vivo tumour imaging.This article covers the properties and uses of several kinds of nanomaterials,focusing on their use in transcatheter arterial chemoembolization for HCC treatment.This paper also discusses the limitations currently associated with the use of nanomaterials.
文摘BACKGROUND Transcatheter arterial chemoembolization(TACE)is a key treatment approach for advanced invasive liver cancer(infiltrative hepatocellular carcinoma).However,its therapeutic response can be difficult to evaluate accurately using conventional two-dimensional imaging criteria due to the tumor’s diffuse and multifocal growth pattern.Volumetric imaging,especially enhanced tumor volume(ETV),offers a more comprehensive assessment.Nonetheless,bias field inhomogeneity in magnetic resonance imaging(MRI)poses challenges,potentially skewing volumetric measurements and undermining prognostic evaluation.AIM To investigate whether MRI bias field correction enhances the accuracy of volumetric assessment of infiltrative hepatocellular carcinoma treated with TACE,and to analyze how this improved measurement impacts prognostic prediction.METHODS We retrospectively collected data from 105 patients with invasive liver cancer who underwent TACE treatment at the Affiliated Hospital of Xuzhou Medical University from January 2020 to January 2024.The improved N4 bias field correction algorithm was applied to process MRI images,and the ETV before and after treatment was calculated.The ETV measurements before and after correction were compared,and their relationship with patient prognosis was analyzed.A Cox proportional hazards model was used to evaluate prognostic factors,with Martingale residual analysis determining the optimal cutoff value,followed by survival analysis.RESULTS Bias field correction significantly affected ETV measurements,with the corrected baseline ETV mean(505.235 cm^(3))being significantly lower than before correction(825.632 cm^(3),P<0.001).Cox analysis showed that the hazard ratio(HR)for corrected baseline ETV(HR=1.165,95%CI:1.069-1.268)was higher than before correction(HR=1.063,95%CI:1.031-1.095).Using 412 cm^(3) as the cutoff,the group with baseline ETV<415 cm^(3) had a longer median survival time compared to the≥415 cm^(3) group(18.523 months vs 8.926 months,P<0.001).The group with an ETV reduction rate≥41%had better prognosis than the<41%group(17.862 months vs 9.235 months,P=0.006).Multivariate analysis confirmed that ETV reduction rate(HR=0.412,P<0.001),Child-Pugh classification(HR=0.298,P<0.001),and Barcelona Clinic Liver Cancer stage(HR=0.578,P=0.045)were independent prognostic factors.CONCLUSION Volume imaging based on MRI bias field correction can improve the accuracy of evaluating the efficacy of TACE treatment for invasive liver cancer.The corrected ETV and its reduction rate can serve as independent indicators for predicting patient prognosis,providing important reference for developing individualized treatment strategies.
文摘BACKGROUND The management of severe symptomatic aortic stenosis has been revolutionized by transcatheter aortic valve replacement(TAVR),offering a minimally invasive alternative to surgical aortic valve replacement(SAVR).However,the compara-tive safety and efficacy of these interventions remain subjects of ongoing investigation.AIM To compare the clinical outcomes and safety of TAVR vs SAVR in patients with severe symptomatic aortic stenosis.METHODS A systematic review and meta-analysis were conducted according to PRISMA guidelines.Randomized controlled trials(RCTs)comparing TAVR and SAVR were identified from databases including PubMed,Scopus,and Web of Science up to May 31,2024.Data were extracted on clinical outcomes,including mortality,procedural compli-cations,and post-procedure adverse events.Risk ratios(RRs)with 95%CIs were calculated using a random-effects model.RESULTS A total of 10 RCTs were included.TAVR demonstrated a significantly lower risk of acute kidney injury(RR:0.33;95%CI:0.25–0.44),major bleeding(RR:0.37;95%CI:0.30–0.46),and new-onset atrial fibrillation(RR:0.44;95%CI:0.34–0.57)compared to SAVR.However,TAVR was associated with higher risks of new permanent pacemaker implantation(RR:3.49;95%CI:2.77–4.39),major vascular complications(RR:2.47;95%CI:1.91–3.21),and paraval-vular leaks(RR:4.15;95%CI:3.14–5.48).Mortality at 30 days was comparable(RR:0.95;95%CI:0.78–1.15),but long-term mortality was slightly higher with TAVR in some analyses(RR:1.23;95%CI:1.01–1.49).Rates of stroke(RR:0.97;95%CI:0.81–1.17)and myocardial infarction(RR:0.91;95%CI:0.67–1.24)were similar between the groups.CONCLUSION TAVR offers a less invasive option with significant benefits in reducing acute kidney injury,major bleeding,and new-onset atrial fibrillation,making it particularly advantageous for high-risk surgical candidates.However,higher risks of permanent pacemaker implantation,vascular complications,and paravalvular leaks highlight the need for individualized patient selection and shared decision-making to optimize outcomes.
基金Supported by National High Level Hospital Clinical Research Funding Project,No.BJ-2023-206.
文摘This narrative review examines osteosarcopenia,characterized by the concurrent loss of muscle mass and bone density,as a pivotal marker of frailty in older adults.Its implications for patients undergoing transcatheter aortic valve replacement(TAVR)for severe aortic stenosis remain underexplored.This review examines the association between osteosarcopenia and adverse clinical outcomes in older adults undergoing TAVR,with an emphasis on mortality.It also evaluates the integration of osteosarcopenia into pre-procedural risk assessments.Contemporary studies were reviewed,focusing on older adults undergoing TAVR.Key parameters included pre-procedural assessments of muscle mass(psoas cross-sectional area)and bone density(lumbar trabecular attenuation)using computed tomography.Clinical correlations with frailty indices,nutritional deficiencies,functional disability and mortality were analyzed.Studies including the FRAILTY-AVR cohort indicate that osteosarcopenia affects 15%-20% of TAVR patients and independently predicts 1-year mortality.Combined deficits in muscle and bone health are associated with elevated risks of post-TAVR complications,prolonged hospitalizations,and worsening disability compared to isolated sarcopenia or osteoporosis(P<0.05).Incorporating osteosarcopenia into risk stratification models could enhance predictive accuracy for adverse outcomes.Osteosarcopenia serves as a critical biomarker for frailty and should be routinely assessed in pre-TAVR evaluations.Targeted interventions,such as resistance training and nutritional optimization,may mitigate its impact and improve clinical outcomes.Early identification facilitates personalized management strategies,enhancing survival and quality of life in this high-risk cohort.
基金Supported by the Peking Union Medical College Hospital Central High-Level Hospital Clinical Research Project,No.2022-PUMCH-B-069。
文摘BACKGROUND Hepatic hemangiomas represent the most prevalent benign liver tumors.Surgical management of large symptomatic hepatic hemangiomas remains controversial and there is an increasing interest in minimally invasive techniques,such as transcatheter arterial chemoembolization(TACE)and microwave ablation(MWA).AIM To evaluate the efficacy and safety of TACE combined with MWA for large hepatic hemangiomas.METHODS This retrospective cohort study was conducted at Peking Union Medical College Hospital between January 2015 and January 2024.Eighty-two patients with hepatic hemangiomas>5 cm were divided into two groups:Observation(TACE+MWA,n=50)and control(TACE,n=32).Tumor diameter and treatment outcomes were evaluated at baseline,12 months,and>3 years.Appropriate statistical tests were chosen based on the type and distribution of the data.RESULTS At baseline,the median tumor diameter was 8.3(range:5.0-19.2)cm in the observation group and 8.5(range:5.0-20.0)cm in the control group.The median follow up duration was 44.6(95%confidence interval:36.7-52.5)months.At 12 months post-treatment,the observation group demonstrated a higher tumor reduction ratio compared to the control group(50.98%vs 23.28%,respectively;P<0.001).The objective response rate was 93.94%in the observation group,which was significantly higher than that in the control group(33.33%)(P<0.001).No recurrence occurred in the observation group,while one case occurred in the control group.Notably,no cases of hemoglobinuria or acute kidney injury were reported in the observation group.CONCLUSION Combination treatment enhances tumor shrinkage,promotes long-term tumor control,and reduces the complications associated with MWA,thereby presenting a promising alternative to surgical resection.
文摘Infective endocarditis(IE) remains a severe and life-t hreatening disease, with rising incidence and a particularly high mortality rate, especially among elderly patients.^([1]) While antibiotics are the mainstay of treatment, the success rate in left-sided IE is often limited,as nearly half of all patients eventually require surgical intervention for definitive management.^([2]) Heart failure is the main indication for surgery, but access to surgery is frequently restricted by several factors, particularly in patients with advanced age, often driven by the presence of comorbidities or hemodynamic instability.^([3,4])
文摘BACKGROUND Transcatheter arterial chemoembolization(TACE)combined with lenvatinib is an important modality for the treatment of unresectable hepatocellular carcinoma(HCC).To date,no prognostic analysis exists for clinical predictive models of TACE combined with lenvatinib in treating advanced unresectable HCC.A model was constructed through meta-analysis,and its validation was further enhanced by the collection of external clinical data,thereby providing guidance for clinical practice.AIM To identify risk factors for unresectable HCC following TACE plus lenvatinib therapy and to construct a clinical prediction model.METHODS We searched PubMed,Web of Science,EMBASE,and Cochrane Library databases for studies on TACE plus lenvatinib for unresectable HCC.Risk factors from the meta-analysis and sensitivity analyses were used to construct a prediction model.The validation set included clinical data from 106 eligible patients at the Affiliated Hospital of North Sichuan Medical College collected by June 1,2023.RESULTS This study included 43 group studies involving 5070 patients.Tumor number,microvascular invasion,Eastern Cooperative Oncology Group performance status,Child-Pugh stage,Barcelona Clinic Liver Cancer stage,extra-hepatic metastases,alpha-fetoprotein level,and hepatitis B virus status were risk factors for overall survival and progression-free survival,while triple therapy was a protective factor for both.In the validation set,the overall survival prediction model had area under the curve values of 0.616,0.643,and 0.706 at 1 year,2 years,and 3 years,respectively,and the progression-free survival model had area under the curve values of 0.702,0.696,and 0.670 at the corresponding time points,demonstrating good model performance.Calibration curves,Kaplan-Meier survival analysis,and decision curves further validated the efficacy of the model.CONCLUSION Models based on nine variables from 43 group studies predicted the efficacy of TACE plus lenvatinib in unresectable HCC,supporting evidence-based clinical decisions and treatment strategies.
文摘BACKGROUND For patients with unresectable hepatocellular carcinoma(HCC),both stereotactic body radiation therapy(SBRT)and transcatheter arterial chemoembolization(TACE)have demonstrated effectiveness in controlling local tumor growth.We investigated whether combining these treatments could provide better outcomes than TACE monotherapy.AIM To evaluate whether combining SBRT with TACE provides superior clinical outcomes compared to TACE alone in patients with unresectable HCC.METHODS We conducted a randomized study involving eighty patients diagnosed with unresectable HCC,classified as Barcelona Clinic Liver Cancer stage B and Child-Pugh class A.Participants were divided into two treatment arms:A control group receiving TACE alone(Group A)and an experimental group receiving sequential TACE and SBRT(Group B).The SBRT regimen consisted of 40 Gy administered in five daily fractions over one week.Primary endpoints included local control,progression-free survival(PFS),and overall survival(OS),with secondary endpoints focusing on toxicity profiles.Additional analyses explored the impact of different SBRT dose levels.RESULTS The study enrolled 88 patients from April 2021 to January 2023,with 48 assigned to Group A and 40 to Group B.Over a median follow-up period of 20 months,the combination therapy group demonstrated superior outcomes in both tumor control and disease progression metrics.Complete response rates reached 75%in Group B compared to 54.5%in Group A.The combination therapy extended median PFS to 16 months,significantly longer than the 11 months observed with TACE alone(P=0.003).Neither group had reached median OS by study conclusion.Importantly,both treatment approaches showed comparable safety profiles.CONCLUSION Our findings suggest that supplementing TACE with SBRT offers a well-tolerated and effective treatment strategy for advanced HCC patients.This combination approach achieved better tumor control and delayed disease progression compared to TACE monotherapy,while maintaining an acceptable safety profile.
文摘BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement(TAVR)have an indication for oral anticoagulation(OAC),primarily due to underlying atrial fibrillation.The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain,which our meta-analysis aims to address.AIM To explore safety and efficacy outcomes for patients undergoing TAVR,comparing periprocedural continuation vs interruption of OAC therapy.METHODS A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC.Data were pooled using a random-effects model with risk ratio(RR)and their 95%confidence interval(CI)as effect measures.All statistical analyses were conducted using Review Manager with statistical significance set at P<0.05.RESULTS Four studies were included,encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8%males.A total of 733 patients underwent OAC interruption and 1080 continued.Stroke incidence was significantly lower in the OAC continuation group(RR=0.62,95%CI:0.40-0.94;P=0.03).No significant differences in major vascular complications were found between the two groups(RR=0.95,95%CI:0.77-1.16;P=0.60)and major bleeding(RR=0.90,95%CI:0.72-1.12;P=0.33).All-cause mortality was non-significant between the two groups(RR=0.83,95%CI:0.57-1.20;P=0.32).CONCLUSION Continuation of OAC significantly reduced stroke risk,whereas it showed trends toward lower bleeding and mortality that were not statistically significant.Further large-scale studies are crucial to determine clinical significance.
文摘Severe aortic stenosis has increased exponentially as a result of the aging of the population.Transcatheter aortic valve replacement(TAVR)procedures increase by 20%-30%per year in Spain.Referred patients are increasingly older,have comorbidities,and frailty.TAVR cardiac rehabilitation(CR)programs significantly improve both functional capacity and quality of life of patients.However,there are no guidelines on how to carry out them and few elderly patients are referred to CR.Furthermore,mortality in women who undergo TAVR is higher than in men and even fewer are referred to CR programs.Multidisciplinary patient care,including comorbidities and frailty,is essential.It is necessary to ensure exquisite continuity of care during TAVR,CR,and the rest of the patient's life.Telerehabilitation could be an option in some lower-risk patients to include more patients in CR programs after TAVR,given the high demand.This article reviews the evidence on why CR should be performed in post-TAVR patients and proposes a practical and novel approach to the care process and the recommended aspects and components of the CR program.
基金supported by the 1·3·5 Project for Disciplines of Excellence from West China Hospital of Sichuan University(ZYGD23021&23HXFH009)Sichuan Science and Technology Program(No.2025ZNSFSC1698)the Sichuan Provincial Cadre Health Research Program(ZH2024-103).
文摘Mitral regurgitation (MR) is a highly prevalent valvular heart disease globally,with untreated severe cases demonstrating associations with elevated morbidity,mortality,and adverse cardiovascular outcomes.[1,2]While transcatheter edge-toedge repair (TEER) has emerged as an alternative option for high surgical risk patients with severe MR,[3,4]severe MR of Carpentier class IIIa (characterized by restricted leaflet motion during both systole and diastole) has been considered a relative contraindication for TEER interventions due to stenosis risk and procedural complexity.[5,6]
基金supported by grants from Guangzhou Sci-ence and Technology Bureau City-University(College)Joint Fund-ing Project(2023A03J0224)2024 Guangzhou Basic and Applied Basic Research Scheme(Project for Maiden Voyage)(SL2023A04J00258)。
文摘Background:Transcatheter arterial chemoembolization(TACE)combined with ablation has better clinical outcomes than monotherapy in patients with hepatocellular carcinoma(HCC).However,prolonged time intervals can lead to recanalization and neoangiogenesis,which may interfere with the synergistic effects of combination therapy.This study aimed to investigate whether TACE simultaneously combined with microwave ablation(MWA)is more effective than sequential therapy in patients with HCC.Methods:A total of 129 HCC patients who underwent TACE combined with MWA were included in this study.Based on the time interval between the first combination therapy of TACE and MWA,patients were divided into the simultaneous and sequential groups.Propensity score matching(PSM)was performed to reduce bias between the groups.Overall survival(OS),time-to-progression(TTP),tumor response,and liver function were compared.Results:Before PSM,the simultaneous group had a higher tumor load.Following PSM,36 and 40 patients remained in the simultaneous and sequential groups,respectively.The median TTP and OS were 12.9 vs.10.6 months(P=0.262)and 44.0 vs.26.5 months(P=0.313)for the simultaneous and sequential groups,respectively.After 4–8 weeks,there were 16 complete responders and 17 partial responders in the simultaneous group and 15 and 22 patients in the sequential group,respectively(P=0.504).The median complete response duration was 11.3 and 9.2 months for the simultaneous and sequential groups,respectively(P=0.882).These results did not differ in BCLC stratified subgroups.Patients with small tumor sizes(≤5 cm),tumor nodules≤3,well-defined boundaries,and early-stage tumors were more likely to achieve complete response(all P<0.05).After 4–8 weeks,the liver function was significantly improved compared to that before or one day after treatment.Conclusions:TACE simultaneously combined with MWA is safe and effective but not superior to sequential therapy.
基金supported by the Cultivation of Scientific Research Project of Changhai Hospital,Shanghai,China(No.2021JCMS20)Major Topics of the Health Commission of Jiangsu Province(ZD2021020).
文摘The prevalence of mitral regurgitation(MR)is increasingly worldwide as a consequence of improved survival and ischemic heart disease.Severe MR is associated with worse prognosis,independent of left ventricular function and associated comorbidities.[1-3]Although surgical valve repair or replacement remains the standard treatment for patients with chronic MR,up to 50%of MR patients with symptomatic MR are not referred for surgery,mainly because of multiple comorbid conditions resulting in high surgical risk.[4]There is,therefore,a clear need for less invasive approaches for this patient group.
基金supported by grants from National High-Level Hospital Clinical Research Funding(2023-GSP-RC-04).
文摘This study aimed to evaluate the feasibility,safety,and efficacy of a noveltranscatheter suture closure system(HaloStitch^(®))for patent foramen ovale(PFO)closure in a swine model.Methods:Thirteen swine underwentexperimental PF0 model creation.All animals received implantationof the transcatheter suture closure system to evaluate procedural success.Comprehensive follow-up over sixmonths included serial ultrasound imaging,histopathological analysis,and gross anatomical exaninationof cardiac specimens.Results:Successful HaloStitch^(®)device implantation was adhieved in 11 of 13 swine.Gross anatomical examination confirrned secure positioning of all sutures in the atrial septum,with noredundancy or thrombus formation.Postoperative ultrasound demonstrated stable suture and staplepositions throughout follow-up,with no evidence of suture breakage,displacement,or thrombus.Stapleswere clearly visualized under ultrasound imaging,Both the atrial septal defect orifice diameter and residualseptal shunt flow velocity decreased significantly during the observation period.Histopathological analysisrevealed partially organized thrombi at the implant head and fibrous connective tissue encapsulation withlocalized inflammatory cell infiltration surrounding the polymer material.Conclsions:The transcathetersuture closure system(HaloStitch^(®))demonstrated feasibility,safety,and biocompatib ility for PFO closure ina swine model,supporting its potential for clinical translation.
