Objective: To study early results of hand made fresh (autologous/homologous) pericardial valved conduit in achieving right ventricle to pulmonary artery continuity. Method: Between November 2014 and September 2015, 19...Objective: To study early results of hand made fresh (autologous/homologous) pericardial valved conduit in achieving right ventricle to pulmonary artery continuity. Method: Between November 2014 and September 2015, 19 cases, with diagnosis of Tetralogy of Fallot with Pulmonary stenosis (PS) or Pulmonary atresia (PA) underwent intracardiac repair and Right Ventricular Outflow Tract (RVOT) reconstruction with hand made fresh [autologous (n = 2)/ homologous (n = 17)] pericardial valved conduit. Mean age of the patients at time of surgery was 6.37 years (range 3 months to 18 years), mean weight was 18.52 kilograms (range 6 kg to 40 kg) and mean size of the conduit was 20.7 mm (range 16 mm to 24 mm). Results: All patients had a smooth post-operative course, with mean ICU (Intensive Care Unit) stay of 3.6 days (range 3 days to 6 days) and mean post-operative hospital stay 8.5 days (range 7 days to 16 days). Intra-operative and Post-operative echocardiography revealed moderate Pulmonary regurgitation (PR) in one patient, mild PR in 5 patients and no or trace PR in 13 patients. No patient has developed conduit stenosis or calcification till now. Conclusion: Autologous or homologous pericardial valved conduit provides good early results and is especially suitable for developing world because of zero cost. Long term usefulness of such option remains to be confirmed in terms of dilation, calcification and freedom from intervention.展开更多
Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. How...Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety of percutaneous implantation of the device in the native aortic valve position.Methods A self expanding nitinol stent with W-model, containing porcine pericardium valves in its proximal part, was implanted in six sheep by means of a 14 French catheter through the right common iliac artery under guidance of fluoroscopy. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded. These sheep were followed up shortly after procedure with supra-aortic angiogram and left ventriculography. Additionally, one sheep was sacrificed after the procedure for anatomic evaluation.Results It was possible to replace the aortic valve in the beating heart in four sheep. The procedure failed in two sheep due to coronary orifice occlusion in one case and severe aortic valve regurgitation in the other case. One sheep was killed one hour after percutaneous aortic valve replacement for anatomic evaluation. There were no signs of damage of the aortic JntJma, or of obstruction of the coronary orifice,Conclusions Percutaneous aortic valve replacement with a W-model valved stent in the beating heart is possible. Further studies are mandatory to assess safety and efficacy of this kind of valved stent in larger sample size and by longer follow-up period.展开更多
Background The prognosis of tetralogy of Fallot with absent pulmonary valve (TOF/APV) without operation is poor. We evaluated the surgical outcome of TOF/APV in a single center. Methods Twenty-two TOF/APV patients und...Background The prognosis of tetralogy of Fallot with absent pulmonary valve (TOF/APV) without operation is poor. We evaluated the surgical outcome of TOF/APV in a single center. Methods Twenty-two TOF/APV patients underwent complete surgical correction in our hospital. Right ventricular outflow tract reconstruction was performed using bovine jugular vein (BJV)-valved conduit implantation (n=10), homograft-valved conduit implantation (n=2), or monocusp-valve patch (n=10). Health-related quality of life (QOL) was evaluated during follow-up. Results The overall survival at 5 and 10 years was 86.4±7.3% (confidence interval 69.4–97.2%). The survival rates were significantly different between patients with and without bronchial stenosis (40 and 100%, P=0.0003, log-rank test). The survival of patients aged>6 months was higher than those≤6 months (100 vs. 40%, P=0.0003, log-rank test). Patients with BJV-valved conduits had higher systolic gradients from the right ventricle to the pulmonary artery (RV–PA) compared to those with monocusp-valve patches. BJV-valved conduit implantation was a risk factor for post-operative pulmonary-valve stenosis. The QOL score for patients with BJV-valved conduits was lower than those with monocusp-valve patches (P<0.05). No reoperation was performed during follow-up. Conclusions Bronchial stenosis and lower age (≤6 months) were the main factors influencing post-operative survival. The use of a BJV-valved conduit was a main reason for RV–PA restenosis;thus, the use of a BJV-valved conduit may increase the need for repeat intervention and decrease the post-operative quality of life.展开更多
Background The application of pulmonary valved conduit to reconstruct the continuity between right ventricles and pulmonary artery is one of the major surgeries.This study aimed to establish an in vivo model of in sit...Background The application of pulmonary valved conduit to reconstruct the continuity between right ventricles and pulmonary artery is one of the major surgeries.This study aimed to establish an in vivo model of in situ implantation using pulmonary valved conduit in large animals under off-pump condition to validate the long-term effects of artificial pulmonary valved conduit.Methods Domesticate juvenile male sheep and tissue-engineered poorine pulmonary valved conduit were used for the experiment：30 sheep,weighing （15±3） kg （range 13 to 17 kg） were randomly divided into two groups which were all operated under general anesthesia by off-pump surgery （group 1） and left thoracotomy （group 2）.Two different off-pump surgical methods were used to perform cannulation in sheep pulmonary artery to replace part of sheep pulmonary artery with pulmonary valved conduit which will work together with sheep pulmonary artery and valves.During the experiments,animal survival,complication rates,operating time and blood loss were recorded to compare the results between groups and to establish a surgical method with minimal invasion,simplicity,safety,and high success rates.Results In group 1,a total of 15 cases of surgeries were performed,in which two sheep died; the operative mortality was 13.3％ （2/15）.In group 2,a total of 15 cases of surgeries were performed,and the surgical mortality rate was 0 （0/15）.The operation time and blood loss in group 2 was significantly better than that in group 1.The postoperative echocardiograms showed that,after the surgeries by these two methods,the blood flows were normal,and the valves can open and close freely.Autopsy after 6 months showed that the inner wall and the valves of pulmonary valved conduit were smooth with no thrombus formation.Conclusion These two off-pump methods are feasible and safe with fewer traumas; but the second method is better and particularly suitable for the establishment of a juvenile animal model.展开更多
Background Cryopreserved conduit valved homografts （CVH） have been widely used in surgical treatment of cardiac disease. This study aimed to determine the extent of host cell ingrowth and the durability and immunoge...Background Cryopreserved conduit valved homografts （CVH） have been widely used in surgical treatment of cardiac disease. This study aimed to determine the extent of host cell ingrowth and the durability and immunogenicity of CVH,and to compare the performance of CVH stored at 4℃ and CVH cryopreserved in liquid nitrogen at -196℃.Methods Heterotopic transplants of canine CVH stored at 4℃ （n=14） and cryopreserved in liquid nitrogen （n=14） were made onto the abdominal aorta of recipient dogs. Animals were sacrificed at 7 and 15 days and at 1, 3, 6, 9, and 12months after transplantation to excise the implanted CVHs. Tissue DNA extraction and quantitative polymerase chain reaction （PCR） were performed to calculate the ratio of donor cells and host cells in the CVH. The tissue viability of CVH after implantation was analyzed by detecting alkaline fibroblast growth factor 2 （FGF-2） using immunohistochemical staining and by observation under transmission electron microscope and scanning electron microscope.Results All the animals survived and recovered well. There were few repopulating host cells （0.04-0.83%） in the implanted CVH at 7 or 15 days. The ratio of ingrowing host cells into the CVH continued rising after implantation and reached 40%-47% in the 12th month postoperation. Histology, transmission electron microscopy and FGF-2immunohistochemical staining indicated that fibroblasts and the host＇s endothelial cells were the main cellular elements invading the CVH. There were no significant differences in results between CVH stored at 4℃ and CVH cryopreserved in liquid nitrogen.Conclusions Host cells growing into CVH are very important for maintaining the long-term structure and function of the implanted CVH. There is no significant difference between CVH storing at 4℃ or in liquid nitrogen in regard to the ingrowth of host cells or of morphologic features after CVH allografting.展开更多
A high-temperature and high-pressure valve is the key equipment of a wind tunnel system;it controls the generation of high-temperature and high-pressure gas.To reduce the adverse impact of high-temperature and high-pr...A high-temperature and high-pressure valve is the key equipment of a wind tunnel system;it controls the generation of high-temperature and high-pressure gas.To reduce the adverse impact of high-temperature and high-pressure gas on the strength of the valve body,a cooling structure is set on the valve seat.This can significantly reduce the temperature of the valve body and valve seat.The effects of its structure on the cooling characteristics and stress of the valve seat are studied,and six main parameters that can completely describe the geometry of the cooling structure are proposed.The central composite design method is used to select sample points,and the multi-objective genetic algorithm(MOGA)method is used for optimal structural design.A modification method according to the main parameters for the valve seat is proposed.The results show that the cooling structure weakens the pressure-bearing capability of the valve seat.Among the six main parameters of the valve seat,the distance from the end face of the lower hole to the Z-axis and the distance from the axis of the lower hole to the origin of the coordinates have the most obvious effects on the average stress of the valve seat.An optimum design value is proposed.This work can provide a reference for the design of high-temperature and high-pressure valves.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 Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality.The prevalence of at least moderate valvular heart disease is 2.5%across all ...BACKGROUND Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality.The prevalence of at least moderate valvular heart disease is 2.5%across all age groups,but its prevalence increases with age.Mitral regurgitation and aortic stenosis are the most frequent types of valvular heart disease in the community and hospital context,res-pectively.Surgical valve replacement(or mitral valve repair)is the standard of care for treating heart valve disease.However,the replacement of a prosthetic heart valve can lead to complications,either in the peri-procedural phase or in the long-term follow-up period.CASE SUMMARY We present a case of a 71-year-old female patient with a history of mitral valve replacement and warfarin anti-coagulation therapy.She was admitted to the intensive care unit due to spontaneously reperfused ischemic stroke of probable cardioembolic etiology.A dysfunctional mitral prosthesis was identified due to malfunction of one of the fixed discs.Furthermore,a possible microthrombotic lesion was suspected.Therefore,systemic thrombolysis was performed with subsequent normalization of mitral disc opening and closing.CONCLUSION This case underscores the critical importance of a multidisciplinary approach for timely decision-making in critically ill patients with prosthetic valve complications.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
Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durabl...Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.展开更多
Valvular Heart Disease(VHD),including stenosis and regurgitation,is a significant contributor to global cardiovascular morbidity.Current prosthetic solutions mechanical and bioprosthetic heart valves each present majo...Valvular Heart Disease(VHD),including stenosis and regurgitation,is a significant contributor to global cardiovascular morbidity.Current prosthetic solutions mechanical and bioprosthetic heart valves each present major limitation.Mechanical valves require lifelong anticoagulation due to thrombogenicity,while bioprosthetic valves suffer from structural degeneration and limited durability.Polymeric Heart Valves(PHVs)have emerged as promising alternatives,aiming to integrate the mechanical resilience of synthetic materials with the biocompatibility and hemodynamic performance of natural valves.Recent studies have explored advanced polymers such as Polyhedral Oligomeric Silsesquioxane–Polycarbonate–Urea–Urethane(POSS-PCU),Silicone–Polyurethane Urea(SiPUU),and nanocomposites like Polyvinyl Alcohol(PVA)and SIBS for their enhanced thromboresistance,calcification resistance,and long-term mechanical durability.Complementary to material innovation,fabrication methods such as 3D printing,Melt Electrospinning Writing(MEW),and Focused Rotary Jet Spinning(FRJS)offer patient-specific designs and microstructural control.This review systematically compares traditional and next-generation prostheses,examines mechanical and biological performance,and discusses critical design challenges including porosity,thrombogenicity,and leaflet calcification.Finite Element Analysis(FEA)and Computational Fluid Dynamics(CFD)are highlighted for optimizing design and simulating physiological conditions.By presenting recent preclinical progress and manufacturing strategies,this review outlines a translational roadmap toward clinically viable,biomimetic polymeric heart valves capable of addressing the needs of both adult and pediatric patients.Compared to traditional bioprosthetic tissues,advanced polymers offer better resistance to calcification,reduced thrombogenicity,and tunable mechanical properties.展开更多
Background Transcatheter Aortic Valve Implantation(TAVI)has changed the treatment paradigm of the aortic stenosis(AS).It has become the treatment of choice in patients with symptomatic AS and surgical high risk,and a ...Background Transcatheter Aortic Valve Implantation(TAVI)has changed the treatment paradigm of the aortic stenosis(AS).It has become the treatment of choice in patients with symptomatic AS and surgical high risk,and a valid alternative to surgical aortic valve replacement in patients with low and medium surgical risk.Despite numerous evidence on clinical results,indications and benefits,only a few studies analyse it from patient's perspective and the impact of TAVI on them.The objective of this study is to evaluate the experience of patients undergoing TAVI.Methods Cross-sectional,descriptive observational study in two Spanish hospitals,with a establish Nurse TAVI program,with100 patients undergoing TAVI.A specific questionnaire was designed(VALVEX questionnaire)and a pilot study was conducted by a multidisciplinary team of doctors,nurses and patients.The questionnaire was given to patients at 30 days after TAVI procedure during the follow up at the TAVI nurse clinic.Results The study demonstrated a mean satisfaction of 9 for the TAVI program,with 96%of patients that would recommend TAVI to other patients.Patients scored a high satisfaction on the information received prior to the procedure.During the procedure and admission,the satisfaction was high in relation to the care received.During the follow up,satisfaction was high in relation to the role of the TAVI nurse,for the information and continuation of care during the procedure,in reducing anxiety,organising their admission and understanding the process.However,questions with less scores were related to hospital catering,delay between diagnosed and treatment,and patient decision-making process.Conclusion The evaluation of patient experience allows us to improve the information given to the patient during their TAVI process and it can also allow patients to be more relax,aware and prepared for the procedure.Continuous follow up enables monitoring of patient recovery and helps to discuss any doubts improving patient's satisfaction.The use of PREMs and PROMs associated to TAVI pathway combined with an active participation of the patient on the design of the questionnaire is essential for keeping the patient in the centre of the TAVI pathway.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
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
Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wid...Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wide strip of a third patch that is incorporated to the upper margin of the left side of the ventricular septal defect(VSD)patch.This third patch counteracts not only the valvular tissue loss caused by the suture bites but also the rightward displacement of the VSD patch in a bulged fashion that occurs with increased left ventricular pressure after weaning from cardiopulmonary bypass.This unfavorable outcome was addressed with the current technique through augmentation of the left-sided bridging leaflets serving to prevent the separation of them from their corresponding mural leaflets.The concept was applied in two cases with Down syndrome aged 5 months and 6 months,respectively,as a rescue procedure in the same session just after a failed cAVSD repair.Since the immediate-and short-term outcomes of the atrioventricular valves in regard to regurgitation are satisfying,we believe that the technique proposed herein holds promise for the future in terms of tackling residual atrioventricular valve regurgitation.展开更多
A bicuspid aortic valve,from autologous tissue,with growth potential can be constructed using the simple,and reproducible telescoping arterial trunk technique.
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
Hydraulic technology has the outstanding advantages of easy pressure compensation and high power density.It is an indispensable part of subsea equipment,such as deep-sea operations and submersible propulsion.There are...Hydraulic technology has the outstanding advantages of easy pressure compensation and high power density.It is an indispensable part of subsea equipment,such as deep-sea operations and submersible propulsion.There are few studies on electrohydraulic servo valves(EHSVs)in the deep sea.In this work,a novel electro-hydraulic servo rotary valve is designed,and its mathematical model is established.The analysis considers the variations in physical parameters such as temperature,ambient pressure,and oil viscosity resulting from changes in sea depth.This study focuses on the deformation of the rotary valve and the consequent alterations in leakage and friction torque.The findings indicate that at a depth of 12000 m,the fit clearance between the valve spool and the valve sleeve is 0.00413 mm,representing a 17%reduction compared with the clearance in a land environment.Then,the response of the rotary valve to depth is analyzed.The results indicate that the bandwidth of the rotary valve decreases with increasing depth.This study provides a reference for the use of the EHSV in the deep sea.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
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
文摘Objective: To study early results of hand made fresh (autologous/homologous) pericardial valved conduit in achieving right ventricle to pulmonary artery continuity. Method: Between November 2014 and September 2015, 19 cases, with diagnosis of Tetralogy of Fallot with Pulmonary stenosis (PS) or Pulmonary atresia (PA) underwent intracardiac repair and Right Ventricular Outflow Tract (RVOT) reconstruction with hand made fresh [autologous (n = 2)/ homologous (n = 17)] pericardial valved conduit. Mean age of the patients at time of surgery was 6.37 years (range 3 months to 18 years), mean weight was 18.52 kilograms (range 6 kg to 40 kg) and mean size of the conduit was 20.7 mm (range 16 mm to 24 mm). Results: All patients had a smooth post-operative course, with mean ICU (Intensive Care Unit) stay of 3.6 days (range 3 days to 6 days) and mean post-operative hospital stay 8.5 days (range 7 days to 16 days). Intra-operative and Post-operative echocardiography revealed moderate Pulmonary regurgitation (PR) in one patient, mild PR in 5 patients and no or trace PR in 13 patients. No patient has developed conduit stenosis or calcification till now. Conclusion: Autologous or homologous pericardial valved conduit provides good early results and is especially suitable for developing world because of zero cost. Long term usefulness of such option remains to be confirmed in terms of dilation, calcification and freedom from intervention.
文摘Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety of percutaneous implantation of the device in the native aortic valve position.Methods A self expanding nitinol stent with W-model, containing porcine pericardium valves in its proximal part, was implanted in six sheep by means of a 14 French catheter through the right common iliac artery under guidance of fluoroscopy. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded. These sheep were followed up shortly after procedure with supra-aortic angiogram and left ventriculography. Additionally, one sheep was sacrificed after the procedure for anatomic evaluation.Results It was possible to replace the aortic valve in the beating heart in four sheep. The procedure failed in two sheep due to coronary orifice occlusion in one case and severe aortic valve regurgitation in the other case. One sheep was killed one hour after percutaneous aortic valve replacement for anatomic evaluation. There were no signs of damage of the aortic JntJma, or of obstruction of the coronary orifice,Conclusions Percutaneous aortic valve replacement with a W-model valved stent in the beating heart is possible. Further studies are mandatory to assess safety and efficacy of this kind of valved stent in larger sample size and by longer follow-up period.
基金The study was supported by the National Natural Science Foundation of China(81400242 and 81525002)from ESW and HZ,and Program for Distinguished Professor in PUMC from HZ.
文摘Background The prognosis of tetralogy of Fallot with absent pulmonary valve (TOF/APV) without operation is poor. We evaluated the surgical outcome of TOF/APV in a single center. Methods Twenty-two TOF/APV patients underwent complete surgical correction in our hospital. Right ventricular outflow tract reconstruction was performed using bovine jugular vein (BJV)-valved conduit implantation (n=10), homograft-valved conduit implantation (n=2), or monocusp-valve patch (n=10). Health-related quality of life (QOL) was evaluated during follow-up. Results The overall survival at 5 and 10 years was 86.4±7.3% (confidence interval 69.4–97.2%). The survival rates were significantly different between patients with and without bronchial stenosis (40 and 100%, P=0.0003, log-rank test). The survival of patients aged>6 months was higher than those≤6 months (100 vs. 40%, P=0.0003, log-rank test). Patients with BJV-valved conduits had higher systolic gradients from the right ventricle to the pulmonary artery (RV–PA) compared to those with monocusp-valve patches. BJV-valved conduit implantation was a risk factor for post-operative pulmonary-valve stenosis. The QOL score for patients with BJV-valved conduits was lower than those with monocusp-valve patches (P<0.05). No reoperation was performed during follow-up. Conclusions Bronchial stenosis and lower age (≤6 months) were the main factors influencing post-operative survival. The use of a BJV-valved conduit was a main reason for RV–PA restenosis;thus, the use of a BJV-valved conduit may increase the need for repeat intervention and decrease the post-operative quality of life.
基金This work was supported by grants from＇the National Natural Science Foundation of China （No. 81070077 and No. 81270217）, the Beijing High-level Health Expert Foundation （No. 2009-3-44）, and the Capital Medical University Basic and Clinic Cooperative Foundation （No. 11JL09）.
文摘Background The application of pulmonary valved conduit to reconstruct the continuity between right ventricles and pulmonary artery is one of the major surgeries.This study aimed to establish an in vivo model of in situ implantation using pulmonary valved conduit in large animals under off-pump condition to validate the long-term effects of artificial pulmonary valved conduit.Methods Domesticate juvenile male sheep and tissue-engineered poorine pulmonary valved conduit were used for the experiment：30 sheep,weighing （15±3） kg （range 13 to 17 kg） were randomly divided into two groups which were all operated under general anesthesia by off-pump surgery （group 1） and left thoracotomy （group 2）.Two different off-pump surgical methods were used to perform cannulation in sheep pulmonary artery to replace part of sheep pulmonary artery with pulmonary valved conduit which will work together with sheep pulmonary artery and valves.During the experiments,animal survival,complication rates,operating time and blood loss were recorded to compare the results between groups and to establish a surgical method with minimal invasion,simplicity,safety,and high success rates.Results In group 1,a total of 15 cases of surgeries were performed,in which two sheep died; the operative mortality was 13.3％ （2/15）.In group 2,a total of 15 cases of surgeries were performed,and the surgical mortality rate was 0 （0/15）.The operation time and blood loss in group 2 was significantly better than that in group 1.The postoperative echocardiograms showed that,after the surgeries by these two methods,the blood flows were normal,and the valves can open and close freely.Autopsy after 6 months showed that the inner wall and the valves of pulmonary valved conduit were smooth with no thrombus formation.Conclusion These two off-pump methods are feasible and safe with fewer traumas; but the second method is better and particularly suitable for the establishment of a juvenile animal model.
文摘Background Cryopreserved conduit valved homografts （CVH） have been widely used in surgical treatment of cardiac disease. This study aimed to determine the extent of host cell ingrowth and the durability and immunogenicity of CVH,and to compare the performance of CVH stored at 4℃ and CVH cryopreserved in liquid nitrogen at -196℃.Methods Heterotopic transplants of canine CVH stored at 4℃ （n=14） and cryopreserved in liquid nitrogen （n=14） were made onto the abdominal aorta of recipient dogs. Animals were sacrificed at 7 and 15 days and at 1, 3, 6, 9, and 12months after transplantation to excise the implanted CVHs. Tissue DNA extraction and quantitative polymerase chain reaction （PCR） were performed to calculate the ratio of donor cells and host cells in the CVH. The tissue viability of CVH after implantation was analyzed by detecting alkaline fibroblast growth factor 2 （FGF-2） using immunohistochemical staining and by observation under transmission electron microscope and scanning electron microscope.Results All the animals survived and recovered well. There were few repopulating host cells （0.04-0.83%） in the implanted CVH at 7 or 15 days. The ratio of ingrowing host cells into the CVH continued rising after implantation and reached 40%-47% in the 12th month postoperation. Histology, transmission electron microscopy and FGF-2immunohistochemical staining indicated that fibroblasts and the host＇s endothelial cells were the main cellular elements invading the CVH. There were no significant differences in results between CVH stored at 4℃ and CVH cryopreserved in liquid nitrogen.Conclusions Host cells growing into CVH are very important for maintaining the long-term structure and function of the implanted CVH. There is no significant difference between CVH storing at 4℃ or in liquid nitrogen in regard to the ingrowth of host cells or of morphologic features after CVH allografting.
基金supported by the National Natural Science Foundation of China(No.52175067)the Zhejiang Key Research&Development Project(No.2021C01021)+1 种基金the Natural Science Foundation of Zhejiang Province(No.LY20E050016)the Postdoctoral Fellowship Program of China Postdoctoral Science Foundation(CPSF)(No.GZC20241478)。
文摘A high-temperature and high-pressure valve is the key equipment of a wind tunnel system;it controls the generation of high-temperature and high-pressure gas.To reduce the adverse impact of high-temperature and high-pressure gas on the strength of the valve body,a cooling structure is set on the valve seat.This can significantly reduce the temperature of the valve body and valve seat.The effects of its structure on the cooling characteristics and stress of the valve seat are studied,and six main parameters that can completely describe the geometry of the cooling structure are proposed.The central composite design method is used to select sample points,and the multi-objective genetic algorithm(MOGA)method is used for optimal structural design.A modification method according to the main parameters for the valve seat is proposed.The results show that the cooling structure weakens the pressure-bearing capability of the valve seat.Among the six main parameters of the valve seat,the distance from the end face of the lower hole to the Z-axis and the distance from the axis of the lower hole to the origin of the coordinates have the most obvious effects on the average stress of the valve seat.An optimum design value is proposed.This work can provide a reference for the design of high-temperature and high-pressure valves.
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 Valvular heart disease affects more than 100 million people worldwide and is associated with significant morbidity and mortality.The prevalence of at least moderate valvular heart disease is 2.5%across all age groups,but its prevalence increases with age.Mitral regurgitation and aortic stenosis are the most frequent types of valvular heart disease in the community and hospital context,res-pectively.Surgical valve replacement(or mitral valve repair)is the standard of care for treating heart valve disease.However,the replacement of a prosthetic heart valve can lead to complications,either in the peri-procedural phase or in the long-term follow-up period.CASE SUMMARY We present a case of a 71-year-old female patient with a history of mitral valve replacement and warfarin anti-coagulation therapy.She was admitted to the intensive care unit due to spontaneously reperfused ischemic stroke of probable cardioembolic etiology.A dysfunctional mitral prosthesis was identified due to malfunction of one of the fixed discs.Furthermore,a possible microthrombotic lesion was suspected.Therefore,systemic thrombolysis was performed with subsequent normalization of mitral disc opening and closing.CONCLUSION This case underscores the critical importance of a multidisciplinary approach for timely decision-making in critically ill patients with prosthetic valve complications.
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Pediatric heart valve replacement(PHVR)remains a challenging procedure due to the uniqueanatomical and physiological characteristics of children,including growth and development,as well asthe long-term need for durable valve function.This review provides an overview of both surgical andtranscatheter options for aortic,mitral,pulmonary,and tricuspid valve replacements in pediatric patients,highlighting the indications,outcomes,and advancements in technology and technique.Surgical valvereplacement traditionally involves the implantation of biological or mechanical prosthetic valves,withbiologicalvalves beingpreferred in children to reduce the need for lifelong anticoagulation therapy.However,the limitation ofbiological prostheses,nanely their inability to grow with the child,necessitates the frequentneed for reoperations.Recent innovations in valve engineering,such as the development of tissue engineeredand expandable valves,aim to address these issues.Transcatheter valve replacement(TVR)has emergedas a promising alternative,particularly for patients with complex anatomy or those who are high-risk fortraditional surgery.While the use of transcatheter devices in children remains limited due to the smallervascular size and limited long-termn data,several studies have demonstrated the feasibility and safety ofthe procedure in certain patient populations.Despite these advancements,challenges related to valvesize,durability,and the need for individualized treatment planning persist.The future of pediatric heartvalve replacemnent will likely involve a multidisciplinary approach combining surgical,transcatheter,andregenerative medicine strategies,aimed at optimizing outcomes,reducing the need for reinterventions,andimproving long-term quality of life for pediatric patients with valvularheart disease.This article discussesall options availab le for patients with valvular dysfunction,making it easy for parents/patients to go to as areference source of information.
文摘Valvular Heart Disease(VHD),including stenosis and regurgitation,is a significant contributor to global cardiovascular morbidity.Current prosthetic solutions mechanical and bioprosthetic heart valves each present major limitation.Mechanical valves require lifelong anticoagulation due to thrombogenicity,while bioprosthetic valves suffer from structural degeneration and limited durability.Polymeric Heart Valves(PHVs)have emerged as promising alternatives,aiming to integrate the mechanical resilience of synthetic materials with the biocompatibility and hemodynamic performance of natural valves.Recent studies have explored advanced polymers such as Polyhedral Oligomeric Silsesquioxane–Polycarbonate–Urea–Urethane(POSS-PCU),Silicone–Polyurethane Urea(SiPUU),and nanocomposites like Polyvinyl Alcohol(PVA)and SIBS for their enhanced thromboresistance,calcification resistance,and long-term mechanical durability.Complementary to material innovation,fabrication methods such as 3D printing,Melt Electrospinning Writing(MEW),and Focused Rotary Jet Spinning(FRJS)offer patient-specific designs and microstructural control.This review systematically compares traditional and next-generation prostheses,examines mechanical and biological performance,and discusses critical design challenges including porosity,thrombogenicity,and leaflet calcification.Finite Element Analysis(FEA)and Computational Fluid Dynamics(CFD)are highlighted for optimizing design and simulating physiological conditions.By presenting recent preclinical progress and manufacturing strategies,this review outlines a translational roadmap toward clinically viable,biomimetic polymeric heart valves capable of addressing the needs of both adult and pediatric patients.Compared to traditional bioprosthetic tissues,advanced polymers offer better resistance to calcification,reduced thrombogenicity,and tunable mechanical properties.
基金funded by a IBYE23_0002 grant supported by Instituto de investigación biom-édica de Salamanca IBSAL,Castilla y León (Spain) and by a GRS 2860/A1/2023 by Gerencia Regional de Salud o f Castilla y León (Spain)。
文摘Background Transcatheter Aortic Valve Implantation(TAVI)has changed the treatment paradigm of the aortic stenosis(AS).It has become the treatment of choice in patients with symptomatic AS and surgical high risk,and a valid alternative to surgical aortic valve replacement in patients with low and medium surgical risk.Despite numerous evidence on clinical results,indications and benefits,only a few studies analyse it from patient's perspective and the impact of TAVI on them.The objective of this study is to evaluate the experience of patients undergoing TAVI.Methods Cross-sectional,descriptive observational study in two Spanish hospitals,with a establish Nurse TAVI program,with100 patients undergoing TAVI.A specific questionnaire was designed(VALVEX questionnaire)and a pilot study was conducted by a multidisciplinary team of doctors,nurses and patients.The questionnaire was given to patients at 30 days after TAVI procedure during the follow up at the TAVI nurse clinic.Results The study demonstrated a mean satisfaction of 9 for the TAVI program,with 96%of patients that would recommend TAVI to other patients.Patients scored a high satisfaction on the information received prior to the procedure.During the procedure and admission,the satisfaction was high in relation to the care received.During the follow up,satisfaction was high in relation to the role of the TAVI nurse,for the information and continuation of care during the procedure,in reducing anxiety,organising their admission and understanding the process.However,questions with less scores were related to hospital catering,delay between diagnosed and treatment,and patient decision-making process.Conclusion The evaluation of patient experience allows us to improve the information given to the patient during their TAVI process and it can also allow patients to be more relax,aware and prepared for the procedure.Continuous follow up enables monitoring of patient recovery and helps to discuss any doubts improving patient's satisfaction.The use of PREMs and PROMs associated to TAVI pathway combined with an active participation of the patient on the design of the questionnaire is essential for keeping the patient in the centre of the TAVI pathway.
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Residual atrioventricular valve regurgitation after correction of complete atrioventricular septal defect(cAVSD)is still not ideal.As a modification of the double-patch method,our technique comprises a suture-bite-wide strip of a third patch that is incorporated to the upper margin of the left side of the ventricular septal defect(VSD)patch.This third patch counteracts not only the valvular tissue loss caused by the suture bites but also the rightward displacement of the VSD patch in a bulged fashion that occurs with increased left ventricular pressure after weaning from cardiopulmonary bypass.This unfavorable outcome was addressed with the current technique through augmentation of the left-sided bridging leaflets serving to prevent the separation of them from their corresponding mural leaflets.The concept was applied in two cases with Down syndrome aged 5 months and 6 months,respectively,as a rescue procedure in the same session just after a failed cAVSD repair.Since the immediate-and short-term outcomes of the atrioventricular valves in regard to regurgitation are satisfying,we believe that the technique proposed herein holds promise for the future in terms of tackling residual atrioventricular valve regurgitation.
基金funded by internal grants from the Ward Family Heart Center.
文摘A bicuspid aortic valve,from autologous tissue,with growth potential can be constructed using the simple,and reproducible telescoping arterial trunk technique.
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.
基金supported by the National Key Research and Development Program of China(Grant No.2022YFC2805703)the Major Training Program of University Research and Innovation Platform of Gansu Provincial Department of Education(Grant No.2024CXPT-09).
文摘Hydraulic technology has the outstanding advantages of easy pressure compensation and high power density.It is an indispensable part of subsea equipment,such as deep-sea operations and submersible propulsion.There are few studies on electrohydraulic servo valves(EHSVs)in the deep sea.In this work,a novel electro-hydraulic servo rotary valve is designed,and its mathematical model is established.The analysis considers the variations in physical parameters such as temperature,ambient pressure,and oil viscosity resulting from changes in sea depth.This study focuses on the deformation of the rotary valve and the consequent alterations in leakage and friction torque.The findings indicate that at a depth of 12000 m,the fit clearance between the valve spool and the valve sleeve is 0.00413 mm,representing a 17%reduction compared with the clearance in a land environment.Then,the response of the rotary valve to depth is analyzed.The results indicate that the bandwidth of the rotary valve decreases with increasing depth.This study provides a reference for the use of the EHSV in the deep sea.
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.
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.
