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Objective:To evaluate the effectiveness and prognosis of emergent transcatheter aortic valve replacement (TAVR) and to provide standardized procedural suggestion for the development of emergent TAVR in China.Methods:From January 2020 to April 2021, 12 patients who underwent emergent or salvage TAVR in the Second Affiliated Hospital Zhejiang University School of Medicine were retrospectively enrolled from the TORCH registry (Transcatheter Aortic Valve Replacement Single Center Registry in Chinese Population, a prospective cohort study; NCT02803294). Baseline, periprocedural and 30-day follow up data were collected. Post-operative data were compared with pre-operative data using Paired-Samples test.Results:Patients’ median Society of Thoracic Surgeons score (STS score) was 15.432%. There was a significant decrease of mean gradient after emergent TAVR procedure (1.69 m/s vs. 4.90 m/s, P<0.01). During the 30-day follow up, there were 1 patient (8.3%) died and 2 patients received permanent pacemaker implantation. No disabling stroke, acute kidney injury, major vascular complication occurred during the first month after emergent TAVR. Among the survival patients, there was a significant releasing of heart failure symptoms to New York Heart Association function stage Ⅰ/Ⅱ in 81.8% patients at 30-day follow up. Left ventricular ejection fraction also improved significantly from (47.4±9.5)% to 58.8±8.0% ( P= 0.026). The mean gradient were (1.57±0.30) cm 2 and no patients had a moderate or severe paravalvular leakage. Besides, a significant decrease of pro-B-type natriuretic peptide (1 089.9 pg/mL vs. 12 215.5 pg/mL , P=0.001) and troponin T (0.020 ng/mL vs. 0.337 ng/mL, P=0.003) were found at 30 days after emergent TAVR. Conclusions:For patients with severe aortic stenosis and acute cardiac decompensated, emergent TAVR is a safe and effective rescue treatment.
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To overcome the bottlenecks of treatment for stroke and comprehensively improve the treatment efficiency, we need to do three jobs: public health education, entering hospital in time, and specialized stroke treatment. Lack of public knowledge about stroke is the most important bottleneck restricting the treatment of stroke in China. Public health education is the foundation of treatment for stroke. Another bottleneck is whether the patients can enter a capable hospital in time. Optimizing the referral system, establishing a regional stroke network, and applying modern referral tools and information network can help the patients entering the target hospital in time. Specialized treatment of stroke refers to the quick access to professional treatment for stroke, which requires to avoid delay in hospital; and the effective strategy is to build and optimize the green channel for stroke treatment.
RESUMO
Objective To develop a thyrocricoid puncture device to study its cure effect in rescuing patients who suffer from the obstruction of upper respiratory tract caused by war wounds,traffic accidents and pharyngolaryngeal tumor.Methods The clinical emergency cure effect of 268 cases of upper respiratory tract obstruction and 33 cases of sudden death were taken retrospective analysis,who received puncture and intubation through cricothyriod membrane ventilation and high-frequency oxygen supply.Results The achievement ratios in puncture and catheterization,oxygen supply,sputum suction and intratracheal administration on all the patients were very high.Conclusion The thyrocricoid puncture device is safe,easy to carry and operate,of mini-wound and effective in rescuing patients suffering from serious upper respiratory tract obstruction and cardiopulmonary resuscitation(CPR),can adapt to the scene of the wounded in war and peace and can be applied in clinic.