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@#Objective To systematically review the efficacy and safety of transfemoral transcatheter aortic valve replacement (TFTAVR) under local anesthesia (LA) and general anesthesia (GA). Methods Electronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang and CBM were searched to collect randomized controlled trial and cohort studies on clinical outcomes of TFTAVR under LA and GA from inception to September 2020. Two authors independently screened literature, extracted data and assessed the quality of studies, and a meta-analysis was performed by using Stata 16.0 software. Results A total of 30 studies involving 52 087 patients were included in this study. There were 18 719 patients in the LA group and 33 368 patients in the GA group. The results of meta-analysis showed that the in-hospital all-cause mortality rate [RR=0.65, 95%CI (0.45, 0.94), P=0.021], 30-day all-cause mortality rate [RR=0.73, 95%CI (0.62, 0.86), P<0.001], 30-day stroke [RR=0.82, 95%CI (0.68, 0.98), P=0.025], cardiac arrest [RR=0.50, 95%CI (0.34, 0.73), P<0.001], ICU stay time [RR=−6.86, 95%CI (−12.31, −1.42), P=0.013], and total hospital stay time [RR=−2.02, 95%CI (−2.59, −1.45), P<0.001] in the LA group were all better than those in the GA group. There was no significant difference in the in-hospital stroke [RR=0.83, 95%CI (0.69, 1.00), P=0.053], in-hospital myocardial infarction (MI) [RR=1.74, 95%CI (0.43, 7.00), P=0.434], or 30-day MI [RR=0.77, 95%CI (0.42, 1.42), P=0.404] between the two groups. Conclusion LA provides a safe and effective way to induce sedation without intubation, and may be a good alternative to GA for TFTAVR.
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@#Objective To systematically review the clinical outcome of patients with new-onset left bundle branch block (LBBB) following transcatheter aortic valve replacement (TAVR). Methods Electronic search was performed in PubMed, EMbase, Cochrane Library, Web of Science, CNKI, Wanfang and CBM databases to identify studies about the new-onset LBBB after TAVR from inception to March 19, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 15.0 software. Results A total of 17 cohort studies were included, covering 9 205 patients, including 2 202 patients with new-onset LBBB and 7 003 without new-onset LBBB after TAVR. The results of meta-analysis showed that patients with new-onset LBBB after TAVR at 30-day (RR=1.65, 95%CI 1.30 to 2.10, P<0.001) and 1-year (RR=1.30, 95%CI 1.16 to 1.45, P<0.001) all-cause mortality was higher than no new-onset LBBB group. One-year cardiovascular mortality was higher in the new-onset LBBB group (RR=1.47, 95%CI 1.21 to 1.79, P<0.001). In the occurrence of 30-day (RR=1.51, 95%CI 1.10 to 2.08, P=0.011) and 1-year (RR=1.34, 95%CI 1.14 to 1.58, P=0.001) rehospitalization rate, 30-day (RR=3.05, 95% CI 1.49 to 6.22, P=0.002) and 1-year (RR=2.15, 95%CI 1.52 to 3.03, P<0.001) pacemaker implantation, the incidence of patients with new-onset LBBB was higher than that of the no new-onset LBBB group. Conclusion Compared with the patients without LBBB after TAVR, the clinical prognosis of patients with new-onset LBBB after TAVR is poor. In the future, the management and follow-up of the patients with LBBB after TAVR should be further strengthened to improve the prognosis of patients.
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@#Objective To compare the complications of transcatheter aortic valve replacement (TAVR) between aortic valve stenosis (AS) patients ≥90 years and patients <90 years, and to explore the efficacy and safety of TAVR in AS patients ≥90 years. Methods Databases including PubMed, The Cochrane Library, EMbase, Medline, CNKI, Wanfang Data and China Biology Medicine disc (CBMdisc) were searched by computer from inception to May 2019. Two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. RevMan 5.3 and Stata 15.0 were used for meta-analysis. Results A total of 12 cohort studies were included, including 60 186 patients (11 350 patients ≥90 years and 48 836 patients <90 years). Meta-analysis showed that compared with the patients <90 years, those ≥90 years had higher all-cause mortality in the hospital (OR=1.51, 95%CI 1.37 to 1.66, P<0.000 01), on postoperative 30 d (OR=1.68, 95%CI 1.50 to 1.89, P<0.000 01) and at postoperative 1 year (OR=1.36, 95%CI 1.25 to 1.48, P<0.000 01), and had higher incidence of stroke (OR=1.31, 95%CI 1.18 to 1.46, P<0.000 01), bleeding events (OR=1.14, 95%CI 1.07 to 1.20, P<0.000 01) and vascular complications (OR=1.31, 95%CI 1.18 to 1.46, P<0.000 01). Conclusion All-cause mortality and the incidence of some complications after TAVR in AS patients ≥90 years are higher than those in patients <90 years, but this difference is clinically acceptable. Therefore, TAVR treatment is safe and effective for elderly patients.
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Objective@#To evaluate the efficacy and safety of different bridging anticoagulant therapies in patients undergoing mechanical heart valve replacement (MHVR) surgery.@*Methods@#Consecutive patients undergoing MHVR surgery from January 2018 to December 2018 in First Hospital of Lanzhou University were prospectively enrolled in this study. Patients were divided into unfractionated heparin (UFH) group and low molecular weight heparin (LMWH) group according to the postoperative bridging anticoagulation methods. Preoperative clinical data and postoperative related time and cost parameters, including drainage time, duration of stay in intensive care unit (ICU), postoperative time (interval from end of operation to discharge) and INR stabilization time (interval from start of bridge anticoagulation to INR value reaching the standard for 2 consecutive days) of all enrolled patients were collected, and all patients were followed up for 4 weeks and thromboembolic or bleeding events were analyzed. Multivariate logistic regression was used to determine the independent prognostic factors of thromboembolic or bleeding events after MHVR receiving various bridging anticoagulant therapies.@*Results@#A total of 217 patients were included in the study, including 120 patients in the UFH group and 97 patients in the LMWH group. Stroke occurred in two patients in the UFH group, while no stroke event occurred in the LMWH group. The incidence of bleeding events was significantly higher (9.28%(9/97) vs. 1.67%(2/120), P=0.02), while the drainage time, duration of stay in ICU, postoperative time, INR stabilization time were all significantly shorter in LMWH group than in UFH group (all P<0.05). Multivariate logistic regression analysis showed that bridging anticoagulation therapies (OR=0.18, 95%CI 0.04-0.86, P=0.03), fibrinogen level (OR=1.99, 95%CI 1.16-3.41, P=0.01) and creatinine level (OR=1.05, 95%CI 1.01-1.08, P=0.04) were independent prognostic factors for bleeding events.@*Conclusion@#LMWH use is associated with increased risk of bleeding events, but can significantly reduce the drainage time, duration of stay in ICU, postoperative time, INR stabilization time in patients post MHVR surgery.
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Objective:To investigate the diagnosis and treatment of intravenous leiomyomatosis involving the heart.Methods:From March 2009 to December 2018, 5 patients with intravenous leiomyomatosis with cardiac involvement were collected from The First Hospital of Lanzhou University.All patients were admitted to the hospital as space occupying lesions of right atrium.The relevant data such as echocardiography, CT and MRI were recorded.The preoperative diagnosis, surgical methods and therapeutic effect of the patients were analyzed and summarized.Results:All the 5 patients were female with an average age of (45.8±2.2) years old.Their clinical manifestations were chest tightness and shortness of breath.Three patients had a history of giant hysteromyoma.Echocardiography was performed in all patients, and 3 of them obviously extended to the inferior chamber.Cardiopulmonary bypass was established and thoracoabdominal incision was performed, and the tumors were completely resected in 5 patients, and the origin of tumors was consistent with the result of MRI in 3 cases.The tumor originated from the right uterine vein in 3 cases, and 2 cases originated from the right ovarian vein and was intubated in the femoral vein.The operation was smooth and the postoperative recovery was good.All patients were discharged smoothly.No tumor recurrence was found in pelvic cavity, inferior vena cava and heart after 1 year follow-up.Conclusion:Venous leiomyomatosis involving the heart is rare and easy to be misdiagnosed.Most of them are diagnosed as right atrial space occupying lesions.The diagnosis can be improved by echocardiography, CT and MRI before operation.The operation mode should be adjusted according to the intraoperative findings and different origins, and the tumor should be completely removed as far as possible, and combined with gynecology consultation if necessary.The short-term follow-up showed good prognosis.
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@#Objective To compare the clinical outcomes of bicuspid aortic valve stenosis (BAV) and tricuspid aortic valve stenosis (TAV) after transcatheter aortic valve replacement (TAVR). Methods A computer-based search in PubMed, EMbase, The Cochrane Library, CBM, CNKI and Wanfang databases from their date of inception to March 2019 was conducted. Two reviewers independently screened the articles, extracted data and evaluated their quality. RevMan 5.3 and Stata 15.0 softwares were used for meta-analysis. Results The selected 15 cohort studies contained 45 770 patients, including 1 500 of BAV patients and 44 270 of TAV patients. The results showed that no statistical difference was found in postoperative in-hospital mortality [OR=1.29, 95%CI (0.91, 1.83), P=0.15], 30-day mortality [OR=1.23, 95%CI (0.86, 1.77), P=0.25], and 1-year mortality [OR=1.14, 95%CI (0.87, 1.50), P=0.33] between the two groups. The surgical success rate [OR=0.57, 95%CI (0.44, 0.74), P<0.01], postoperative bleeding events [OR=0.72, 95%CI (0.58, 0.91), P<0.01] and postoperative vascular injury [OR=0.68, 95%CI (0.47, 0.97), P=0.03] of patients in the BAV group were lower than those in the TAV group. The incidence of paravalvular leak in the BAV group was higher than that in the TAV group [OR=1.47, 95%CI (1.13, 1.90), P<0.01]. No significant difference was found between the two groups in terms of conversion to surgery, postoperative myocardial infarction, postoperative renal failure, postoperative neurologic events, postoperative valve gradient difference and pacemaker implantation. Conclusion Compared with TAV, the application of TAVR in BAV patients is feasible and effective.
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Objective To evaluate the clinical effect of talonavicular arthrodesis and the influence of adjacent joints use trephine percutaneous osteotomy in the treatment of talonavicular arthralgia.Methods From June 1999 to June 2009,24 patients were performed talonavicular arthrodesis due to a variety of painful disorder of talonavicular joint with trephine percutaneous osteotomy.There were 13 males and 11 females,with an average age of 45 years(range,37-72 years).The indications for the procedure included 15cases with posttraumatic arthritis,6 cases with rheumatoid arthritis,and 3 cases with degenerative arthritis.AOFAS system and visual analogue scale(VAS)were used to evaluate the change of function and arthralgia.Graves score system was used to evaluate the influence of adjacent joints.Results All patients were followed up 10-120 months,with the mean of 48 months.Only one case suffered skin brim necrosis of incision and got delayed healing after 3 weeks.The average AOFAS ankle-hind foot score improved from 45.2 points preoperatively to 84.5 points postoperatively.The excellent and good rate was 87.5%.VAS pain scores decreased from 8.1 to 2.4 postoperatively.Twenty-three patients were satisfied and one dissatisfied with the results.Postoperative radiology showed the union evidence in 23 patients at 6 months postoperatively(successful fusion rate of 95.8%).One joint nonunion occurred and required revision arthrodesis with iliac crest bone graft.There was an increase of Ⅰ grade in arthritic scores for 8 cases and Ⅱ grade for 1 case.Conclusion Talonavicular arthrodesis with trephine percutaneous osteotomy has the advantages of low trauma,high successful fusion rate and can acquire satisfactory clinical effect in the treatment of painful malalignment of talonavicular joints.
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Objective To introduce a new technique of talocalcaneal joint fusion with trephine and evaluate its clinical effects. Methods From June 1997 to October 2001, 18 cases complained of pain, weakness, limited range of motion and tenderness of ankle were treated with subtalar joint fusion. Of 18 cases, there were 12 males and 6 females with an average age of 47 years (range, 35 to 59 years). The lesions of subtalar joint were identified as traumatic osteoarthritis in 8, degenerative osteoarthritis in 5, congenital bone bridge in 2, rheumatoid arthritis in 2 and refractory inflammation of tarsal sinus. The AP and lateral view X-ray films were taken to measure the width and length of sutalar joint and talocalcaneal angle so as to choose the trephine of appropriate diameter (?11.5 mm, 12 mm, 13 mm )and guide the direction and length of osteotomy. Posterolateral approach was used in 14, and anterolateral approach in 4 depending on the location of lesion at subtalar joint. The trephine was inserted into subtalar joint slowly, the bone block inside the trephine was removed, rotated to 90?, then reimplanted in situ in 14 cases; Autograft of iliac crest was harvested and implanted by trephine in 4. Results All of the affected feet were immobilized with a cast postoperatively for 12 to 16 weeks. The patients were followed up for an average of 25 months ranging from 5 months to 4 years. All the wounds healed well at 2 weeks, the callus appeared at 4 weeks, and the bony fusion was obtained at 16 weeks displayed by postoperative X-ray films. The scores of ankle pain by VAS measurement were improved from preoperative 83.8 to postoperative 32.5. There were no severe complications, only 1 case suffered from dropping foot and recovered 10 months later, and 1 case complained of discomfort of foot. Conclusion Subtalar joint fusion with trephination is an effective procedure with many advantages such as: minimal invasive surgery, easy to perform, higher fusion rate and preserving mechanical stability of hind foot.