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
Introduction Aortic arch anomalies are congenital malformations of the position or branching of the aortic arch,or both.Double aortic arch(DAA)is a very rare malformation,affecting approximately 0.005%~0.007% of fetus...Introduction Aortic arch anomalies are congenital malformations of the position or branching of the aortic arch,or both.Double aortic arch(DAA)is a very rare malformation,affecting approximately 0.005%~0.007% of fetuses[1],and there has been no relevant literature mentioning the prenatal finding DAA in Macao till now.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
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
Bicuspid aortic valve (BAV) is a common congenital heart valve disease, often accompanied by aortic valve stenosis or regurgitation, infective endocarditis, and aortic diseases such as aortic dilation and dissection. ...Bicuspid aortic valve (BAV) is a common congenital heart valve disease, often accompanied by aortic valve stenosis or regurgitation, infective endocarditis, and aortic diseases such as aortic dilation and dissection. This article aims to review the definition, pathogenesis and genetic basis, classification methods, clinical features and current status of research and treatment and prognosis of BAV, and provide reference for the diagnosis and treatment of BAV. The content and structure of this article are as follows: The first part introduces the definition of BAV;The second part introduces the etiology and classification methods of BAV;The third part briefly describes the clinical manifestations and diagnosis of BAV;The fourth part discusses the treatment strategies and prognosis prediction of BAV;Finally, the article summarizes and looks forward to the future research directions.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
Background Hypertension is associated with an increased risk of calcific aortic valve stenosis(CAVS).However,the directionality of causation between blood pressure traits and aortic stenosis is unclear,as is the benef...Background Hypertension is associated with an increased risk of calcific aortic valve stenosis(CAVS).However,the directionality of causation between blood pressure traits and aortic stenosis is unclear,as is the benefit of antihypertensive drugs for CAVS.Methods Using genome-wide association studies(GWAS)summary statistics,we performed bidirectional two-sample univariable mendelian randomization(UVMR)to assess the causal associations of systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse pressure(PP)with CAVS.Multivariable mendelian randomization(MVMR)was conducted to evaluate the direct effect of hypertension on CAVS,adjusting for confounders.Drug target mendelian randomization(MR)and summary-level MR(SMR)were used to estimate the effects of 12 classes of antihypertensive drugs and their target genes on CAVS risk.Inverse variance weighting was the primary MR method,with sensitivity analyses to validate results.Results UVMR showed SBP,DBP,and PP have causal effects on CAVS,with no significant reverse causality.MVMR confirmed the causality between hypertension and CAVS after adjusting for confounders.Drug-target MR analyses indicated that calcium channel blockers(CCBs),loop diuretics,and thiazide diuretics via SBP lowering exerted protective effects on CAVS risk.SMR analysis showed that the CCBs target gene CACNA2D2 and ARBs target gene AGTR1 were positively associated with CAVS risk,while diuretics target genes SLC12A5 and SLC12A1 were negatively associated with aortic stenosis risk.Conclusions Hypertension has a causal relationship with CAVS.Managing SBP in hypertensive patients with CCBs may prevent CAVS.ARBs might exert protective effects on CAVS independent of blood pressure reduction.The relationship between diuretics and CAVS is complex,with opposite effects through different mechanisms.展开更多
BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic ...BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic valve complications.Longterm VSARR durability,especially in BAV patients,is debated.We hypothesize that VSARR outcomes differ between BAV and TAV patients in short-term and long-term settings.AIM To investigate short-term and long-term outcomes of VSARR in BAV vs TAV patients.METHODS This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis included observational studies comparing VSARR in adult BAV vs TAV patients.PubMed,ScienceDirect,and EMBASE were searched from inception to June 2025.Outcomes included mortality,reintervention,and procedural times.Pooled relative risk(RR)and mean differences(MD)with 95%CI were calculated.Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions;evidence certainty via GRADE.RESULTS Thirteen observational studies involving 1419 BAV and 2349 TAV patients were included.In-hospital mortality(RR=0.34,95%CI:0.10-1.14,P=0.08)and reoperation(RR=1.04,95%CI:0.64-1.69,P=0.87)showed no significant differences.All-cause mortality risk was significantly lower in BAV patients(RR=0.34,95%CI:0.13-0.86,P=0.02).Overall reintervention risk was significantly greater in BAV patients(RR=2.64,95%CI:1.96-3.55,P<0.00001).Aortic cross-clamp(MD=3.35 minutes,95%CI:-5.06 to 11.76,P=0.43)and cardiopulmonary bypass times(MD=3.96 minutes,95%CI:-10.26 to 18.18,P=0.59)showed no significant differences but substantial heterogeneity.The certainty of evidence was moderate for reintervention,low for mortality risk and in-hospital reoperation,and very low for procedural times.CONCLUSION VSARR demonstrates comparable short-term safety between BAV and TAV patients.However,BAV patients face a significantly higher long-term reintervention risk,highlighting the need for tailored strategies and further research.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
Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with ...Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.展开更多
BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous gra...BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.展开更多
The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue ...The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue disorders.There are several classifications for BAV,each with its advantages and drawbacks.The condition can lead to valvular malfunction such as regurgitation and stenosis,but is often associated with dilatation of the aortic root,the ascending aorta,the aortic arch,or a combination.Altered flow patterns due to the valve dysfunction as well as the breakdown of elastin in the aortic wall could be responsible for this development.Published surgical series are usually small and research designs vary,which makes the formulation of universal recommendations for treatment difficult.This narrative review provides data from the most recent series in this respect.Often,the condition becomes symptomatic in patients who are about 10 years younger compared to those with a diseased tricuspid aortic valve.The timing of surgery of the valve depends on the degree of its dysfunction.Repair of a dysfunctional BAV should be attempted whenever possible because of the patient’s age.The options for valve repair are summarized,including the need for the use as the effective geometric height.The use of a pericardial patch and the presence of calcified areas of the valve can be predictors for an increased need for reintervention.In those cases,a valve replacement should be preferred.If a dilatation of the ascending aorta or the aortic root is present,this should also be addressed surgically,but the threshold for such a procedure varies.Several techniques are available to treat a dilated ascending aorta and root.For the latter,remodeling and reimplantation can be applied.Depending on the patient’s characteristics,the size of the dilatation,and the affected part,the most appropriate technique should be selected.This requires surgical expertise,which can only be obtained in high-volume centers.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
Cardiac papillary fibroelastoma is a benign heart tumor that,despite its histologically benign nature,can have devastating clinical consequences.Advances in cardiac imaging have made papillary fibroelastoma the most c...Cardiac papillary fibroelastoma is a benign heart tumor that,despite its histologically benign nature,can have devastating clinical consequences.Advances in cardiac imaging have made papillary fibroelastoma the most common primary benign tumor,surpassing cardiac myxoma.These tumors predominantly occur on the surface of heart valves,with the aortic valve being the most frequently affected(44%),followed by the mitral valve(35%)and other locations.Aortic fibroelastomas are the second most common primary cardiac tumor,known for their risk of embolic complications.Surgical excision is recommended for symptomatic lesions,but the management of small and asymptomatic fibroelastomas remains uncertain,particularly in elderly patients with comorbidities.[1-3].展开更多
In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous conditi...In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous condition requires a vigilant eye.Embolic events stemming from infective endocarditis can precipitate acute coronary syndrome,adding another layer of complexity to diagnosis and treatment.展开更多
BACKGROUND Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD),significantly impacting long-term survival.Accurate ...BACKGROUND Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD),significantly impacting long-term survival.Accurate risk prediction is essential for optimized clinical management.AIM To develop and validate a logistic regression-based risk prediction model for aortic adverse remodeling following TEVAR in patients with TBAD.METHODS This retrospective observational cohort study analyzed 140 TBAD patients undergoing TEVAR at a tertiary center(2019–2024).Based on European guidelines,patients were categorized into adverse remodeling(aortic growth rate>2.9 mm/year,n=45)and favorable remodeling groups(n=95).Comprehensive variables(clinical/imaging/surgical)were analyzed using multivariable logistic regression to develop a predictive model.Model performance was assessed via receiver operating characteristic-area under the curve(AUC)and Hosmer-Lemeshow tests.RESULTS Multivariable analysis identified several strong independent predictors of negative aortic remodeling.Larger false lumen diameter at the primary entry tear[odds ratio(OR):1.561,95%CI:1.197–2.035;P=0.001]and patency of the false lumen(OR:5.639,95%CI:4.372-8.181;P=0.004)were significant risk factors.False lumen involvement extending to the thoracoabdominal aorta was identified as the strongest predictor,significantly increasing the risk of adverse remodeling(OR:11.751,95%CI:9.841-15.612;P=0.001).Conversely,false lumen involvement confined to the thoracic aorta demonstrated a significant protective effect(OR:0.925,95%CI:0.614–0.831;P=0.015).The prediction model exhibited excellent discrimination(AUC=0.968)and calibration(Hosmer-Lemeshow P=0.824).CONCLUSION This validated risk prediction model identifies aortic adverse remodeling with high accuracy using routinely available clinical parameters.False lumen involvement thoracoabdominal aorta is the strongest predictor(11.751-fold increased risk).The tool enables preoperative risk stratification to guide tailored TEVAR strategies and improve long-term outcomes.展开更多
BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on pri...BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.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
Aneurysms and dissections represent some of the most serious cardiovascular diseases.The prevailing theory posits that mechanical overloading of the vessel wall is the underlying cause.Inspired by Barkhordarian et al,...Aneurysms and dissections represent some of the most serious cardiovascular diseases.The prevailing theory posits that mechanical overloading of the vessel wall is the underlying cause.Inspired by Barkhordarian et al,the authors present matrix metalloproteinases(MMPs)and their inhibitors in immunohistological analyses as contributing factors in the pathophysiology of aortic aneurysms(AA).Data analysis of MMP-1,MMP-9,tissue inhibitors of metalloproteinases(TIMPs),including TIMP-1 and TIMP-2 expression reveals a varied distribution between the adventitia and media and a non-uniform expression of the investigated markers.These elements,as key components of the extracellular matrix(ECM),indicate that the formation of AA is not solely driven by endoluminal pressure loading of the aortic wall.Instead,degenerative processes within ECM elements contribute significantly.Importantly,AA do not necessarily imply dissection.Tissue destruction,allowing blood flow entry,arises from reduced oxygen supply to the media,primarily due to incomplete capillarization or neocapillarization.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
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Introduction Aortic arch anomalies are congenital malformations of the position or branching of the aortic arch,or both.Double aortic arch(DAA)is a very rare malformation,affecting approximately 0.005%~0.007% of fetuses[1],and there has been no relevant literature mentioning the prenatal finding DAA in Macao till now.
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.
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Bicuspid aortic valve (BAV) is a common congenital heart valve disease, often accompanied by aortic valve stenosis or regurgitation, infective endocarditis, and aortic diseases such as aortic dilation and dissection. This article aims to review the definition, pathogenesis and genetic basis, classification methods, clinical features and current status of research and treatment and prognosis of BAV, and provide reference for the diagnosis and treatment of BAV. The content and structure of this article are as follows: The first part introduces the definition of BAV;The second part introduces the etiology and classification methods of BAV;The third part briefly describes the clinical manifestations and diagnosis of BAV;The fourth part discusses the treatment strategies and prognosis prediction of BAV;Finally, the article summarizes and looks forward to the future research directions.
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 National Natural Science Foundation of China(82170375,U23A20395)1.3.5 project for disciplines of excellence from West China Hospital of Sichuan University(ZYGD23021,23HXF-H009)Sichuan Science and Technology Program 2023NSFSC1645。
文摘Background Hypertension is associated with an increased risk of calcific aortic valve stenosis(CAVS).However,the directionality of causation between blood pressure traits and aortic stenosis is unclear,as is the benefit of antihypertensive drugs for CAVS.Methods Using genome-wide association studies(GWAS)summary statistics,we performed bidirectional two-sample univariable mendelian randomization(UVMR)to assess the causal associations of systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse pressure(PP)with CAVS.Multivariable mendelian randomization(MVMR)was conducted to evaluate the direct effect of hypertension on CAVS,adjusting for confounders.Drug target mendelian randomization(MR)and summary-level MR(SMR)were used to estimate the effects of 12 classes of antihypertensive drugs and their target genes on CAVS risk.Inverse variance weighting was the primary MR method,with sensitivity analyses to validate results.Results UVMR showed SBP,DBP,and PP have causal effects on CAVS,with no significant reverse causality.MVMR confirmed the causality between hypertension and CAVS after adjusting for confounders.Drug-target MR analyses indicated that calcium channel blockers(CCBs),loop diuretics,and thiazide diuretics via SBP lowering exerted protective effects on CAVS risk.SMR analysis showed that the CCBs target gene CACNA2D2 and ARBs target gene AGTR1 were positively associated with CAVS risk,while diuretics target genes SLC12A5 and SLC12A1 were negatively associated with aortic stenosis risk.Conclusions Hypertension has a causal relationship with CAVS.Managing SBP in hypertensive patients with CCBs may prevent CAVS.ARBs might exert protective effects on CAVS independent of blood pressure reduction.The relationship between diuretics and CAVS is complex,with opposite effects through different mechanisms.
文摘BACKGROUND Aortic root dilation,linked to bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV),risks aneurysm and dissection.Valve-sparing aortic root replacement(VSARR)preserves native valves,avoiding prosthetic valve complications.Longterm VSARR durability,especially in BAV patients,is debated.We hypothesize that VSARR outcomes differ between BAV and TAV patients in short-term and long-term settings.AIM To investigate short-term and long-term outcomes of VSARR in BAV vs TAV patients.METHODS This Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant meta-analysis included observational studies comparing VSARR in adult BAV vs TAV patients.PubMed,ScienceDirect,and EMBASE were searched from inception to June 2025.Outcomes included mortality,reintervention,and procedural times.Pooled relative risk(RR)and mean differences(MD)with 95%CI were calculated.Risk of bias was assessed using Risk of Bias in Non-randomized Studies of Interventions;evidence certainty via GRADE.RESULTS Thirteen observational studies involving 1419 BAV and 2349 TAV patients were included.In-hospital mortality(RR=0.34,95%CI:0.10-1.14,P=0.08)and reoperation(RR=1.04,95%CI:0.64-1.69,P=0.87)showed no significant differences.All-cause mortality risk was significantly lower in BAV patients(RR=0.34,95%CI:0.13-0.86,P=0.02).Overall reintervention risk was significantly greater in BAV patients(RR=2.64,95%CI:1.96-3.55,P<0.00001).Aortic cross-clamp(MD=3.35 minutes,95%CI:-5.06 to 11.76,P=0.43)and cardiopulmonary bypass times(MD=3.96 minutes,95%CI:-10.26 to 18.18,P=0.59)showed no significant differences but substantial heterogeneity.The certainty of evidence was moderate for reintervention,low for mortality risk and in-hospital reoperation,and very low for procedural times.CONCLUSION VSARR demonstrates comparable short-term safety between BAV and TAV patients.However,BAV patients face a significantly higher long-term reintervention risk,highlighting the need for tailored strategies and further research.
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Aortic stenosis(AS)is the most common valvular heart disease,with a prevalence of over 4%among octogenarians.[1]The prevalence of autopsy-confirmed wild-type transthyretin cardiac amyloidosis(ATTRwt-CA)increases with age,accounting for 25%of patients aged 85 years and older in Europe and 12%of patients older than 80 years in Japan.[2,3]Recent studies have reported that ATTRwt-CA coexists in 11%-16%of older patients with AS undergoing transcatheter aortic valve replacement(TAVR).[1,4,5]In a metaanalysis by Ho et al.,[6]the prevalence rates of cardiac amyloidosis,predominantly ATTRwt-CA,in patients with AS and those referred for TAVR or surgical aortic valve replacement(SAVR)were 14.4%and 15.2%,respectively.Conversely,the prevalence of AS in patients with cardiac amyloidosis is 8.7%.Owing to the high surgical risk in patients with both AS and ATTRwt-CA,TAVR may be preferred over SAVR.
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)can be performed through multiple access sites with the preferred approach being transfemoral.In patients with severe peripheral arterial disease and previous grafts,the safety of transfemoral access via direct graft puncture,especially when performed twice within a short period,remains unclear compared to alternative access methods.We present a case demonstrating the safety and efficacy of direct graft puncture for transfemoral access during balloon aortic valvuloplasty(BAV)and TAVR.CASE SUMMARY An 82-year-old man presented with dyspnea on exertion.Echocardiogram was significant for severe aortic stenosis.Following a heart team discussion,the patient was scheduled for a balloon valvuloplasty followed by staged TAVR.Based on pre-TAVR computed tomography angiogram,the aortobifemoral graft was deemed as an appropriate access site.Micropuncture needle was used to access the right femoral artery graft,and the sheath was upscaled to 10 Fr.He underwent successful intervention to ostial left anterior descending and left circumflex arteries,and BAV with 22 mm Vida BAV balloon.Hemostasis was achieved using Perclose.For TAVR,an 8 Fr sheath was inserted via the right femoral bypass graft.The arteriotomy was pre-closed with two Perclose ProGlides and access was upsized to 18F Gore DrySeal.A 5Fr sheath was used for left femoral bypass graft access.Patient underwent successful TAVR with 29 mm CoreValve.Hemostasis was successfully achieved using 2 Perclose for right access site and one Perclose for left side with no postoperative bleeding complications.CONCLUSION BAV and TAVR are feasible and safe through a direct puncture of the aortofemoral bypass graft with successful hemostasis using Perclose.
文摘The presence of a bicuspid aortic valve(BAV)is the most common congenital heart anomaly,which can remain asymptomatic for decades,if it is not a part of a syndrome,such as Turner syndrome or genetic connective tissue disorders.There are several classifications for BAV,each with its advantages and drawbacks.The condition can lead to valvular malfunction such as regurgitation and stenosis,but is often associated with dilatation of the aortic root,the ascending aorta,the aortic arch,or a combination.Altered flow patterns due to the valve dysfunction as well as the breakdown of elastin in the aortic wall could be responsible for this development.Published surgical series are usually small and research designs vary,which makes the formulation of universal recommendations for treatment difficult.This narrative review provides data from the most recent series in this respect.Often,the condition becomes symptomatic in patients who are about 10 years younger compared to those with a diseased tricuspid aortic valve.The timing of surgery of the valve depends on the degree of its dysfunction.Repair of a dysfunctional BAV should be attempted whenever possible because of the patient’s age.The options for valve repair are summarized,including the need for the use as the effective geometric height.The use of a pericardial patch and the presence of calcified areas of the valve can be predictors for an increased need for reintervention.In those cases,a valve replacement should be preferred.If a dilatation of the ascending aorta or the aortic root is present,this should also be addressed surgically,but the threshold for such a procedure varies.Several techniques are available to treat a dilated ascending aorta and root.For the latter,remodeling and reimplantation can be applied.Depending on the patient’s characteristics,the size of the dilatation,and the affected part,the most appropriate technique should be selected.This requires surgical expertise,which can only be obtained in high-volume centers.
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Cardiac papillary fibroelastoma is a benign heart tumor that,despite its histologically benign nature,can have devastating clinical consequences.Advances in cardiac imaging have made papillary fibroelastoma the most common primary benign tumor,surpassing cardiac myxoma.These tumors predominantly occur on the surface of heart valves,with the aortic valve being the most frequently affected(44%),followed by the mitral valve(35%)and other locations.Aortic fibroelastomas are the second most common primary cardiac tumor,known for their risk of embolic complications.Surgical excision is recommended for symptomatic lesions,but the management of small and asymptomatic fibroelastomas remains uncertain,particularly in elderly patients with comorbidities.[1-3].
文摘In the realm of medical rarity,the convergence of infective endocarditis with the development of an aortic root abscess stands as a formidable challenge,often bearing a grim prognosis.Recognizing this perilous condition requires a vigilant eye.Embolic events stemming from infective endocarditis can precipitate acute coronary syndrome,adding another layer of complexity to diagnosis and treatment.
基金Supported by Zhangjiajie"Xiao He(Young Talent)"Project,No.2024XHRC03Jishou University School-Level Research Project.
文摘BACKGROUND Aortic adverse remodeling remains a critical complication following thoracic endovascular aortic repair(TEVAR)for Stanford type B aortic dissection(TBAD),significantly impacting long-term survival.Accurate risk prediction is essential for optimized clinical management.AIM To develop and validate a logistic regression-based risk prediction model for aortic adverse remodeling following TEVAR in patients with TBAD.METHODS This retrospective observational cohort study analyzed 140 TBAD patients undergoing TEVAR at a tertiary center(2019–2024).Based on European guidelines,patients were categorized into adverse remodeling(aortic growth rate>2.9 mm/year,n=45)and favorable remodeling groups(n=95).Comprehensive variables(clinical/imaging/surgical)were analyzed using multivariable logistic regression to develop a predictive model.Model performance was assessed via receiver operating characteristic-area under the curve(AUC)and Hosmer-Lemeshow tests.RESULTS Multivariable analysis identified several strong independent predictors of negative aortic remodeling.Larger false lumen diameter at the primary entry tear[odds ratio(OR):1.561,95%CI:1.197–2.035;P=0.001]and patency of the false lumen(OR:5.639,95%CI:4.372-8.181;P=0.004)were significant risk factors.False lumen involvement extending to the thoracoabdominal aorta was identified as the strongest predictor,significantly increasing the risk of adverse remodeling(OR:11.751,95%CI:9.841-15.612;P=0.001).Conversely,false lumen involvement confined to the thoracic aorta demonstrated a significant protective effect(OR:0.925,95%CI:0.614–0.831;P=0.015).The prediction model exhibited excellent discrimination(AUC=0.968)and calibration(Hosmer-Lemeshow P=0.824).CONCLUSION This validated risk prediction model identifies aortic adverse remodeling with high accuracy using routinely available clinical parameters.False lumen involvement thoracoabdominal aorta is the strongest predictor(11.751-fold increased risk).The tool enables preoperative risk stratification to guide tailored TEVAR strategies and improve long-term outcomes.
文摘BACKGROUND Sex disparities in clinical outcomes following thoracic endovascular aortic repair(TEVAR)for acute complicated type B aortic dissection(TBAD)are not well understood.AIM To evaluates the impact of sex on primary and secondary outcomes by comparing male and female cohorts undergoing TEVAR.METHODS A systematic search of PubMed,EMBASE,Cochrane Library,and ScienceDirect identified five studies involving 2572 patients(1153 males and 1419 females).The primary outcome was hospital mortality.Secondary outcomes included reintervention rates,acute kidney injury(AKI),ischemic stroke,limb ischemia,and spinal cord ischemia.Odds ratios(OR)with 95%confidence intervals(CI)were calculated using a random-effects model.Heterogeneity was assessed using the I²statistic.RESULTS The primary outcome showed no significant difference between males and females for hospital mortality(OR:1.13,95%CI:0.81-1.59,P=0.47,I2=0).Among secondary outcomes,males had a significantly higher risk of AKI(OR:1.55,95%CI:1.21-2.00,P=0.0006,I²=0).No differences were observed for reintervention rates,ischemic stroke,limb ischemia,or spinal cord ischemia.CONCLUSION Male patients undergoing TEVAR for complicated TBAD are at increased risk of AKI but show comparable outcomes to females for mortality,ischemic events,reintervention,and other complications.Future research should explore mechanisms and strategies to optimize outcomes.
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Aneurysms and dissections represent some of the most serious cardiovascular diseases.The prevailing theory posits that mechanical overloading of the vessel wall is the underlying cause.Inspired by Barkhordarian et al,the authors present matrix metalloproteinases(MMPs)and their inhibitors in immunohistological analyses as contributing factors in the pathophysiology of aortic aneurysms(AA).Data analysis of MMP-1,MMP-9,tissue inhibitors of metalloproteinases(TIMPs),including TIMP-1 and TIMP-2 expression reveals a varied distribution between the adventitia and media and a non-uniform expression of the investigated markers.These elements,as key components of the extracellular matrix(ECM),indicate that the formation of AA is not solely driven by endoluminal pressure loading of the aortic wall.Instead,degenerative processes within ECM elements contribute significantly.Importantly,AA do not necessarily imply dissection.Tissue destruction,allowing blood flow entry,arises from reduced oxygen supply to the media,primarily due to incomplete capillarization or neocapillarization.
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.
