目的 分析总结经导管主动脉瓣置入的术中护理要点，以指导临床术中护理。 方法 回顾性分析2012年4月－5月新开展经股动脉逆行法经导管主动脉瓣置入术3例患者的临床资料。术前备齐手术用物及急救药品、术中协助患者正确体位，准确使用临时起搏器、除颤仪、认真做好病情及并发症观察和护理，总结术中临床护理方法。 结果 经导管主动脉瓣置入手术顺利成功，术中护理效果满意，无因物品或药品准备不齐及护理不当而影响手术进程、造成患者意外损伤及并发症发生。 结论 经导管主动脉瓣置入术，术前备齐相应的导管导丝，术中操作规范细致、及时、准确传递用物、认真进行临床观察和护理，手术顺利、成功无不良事件发生及并发症发生。
ObjectiveTo systematically assess the efficacy and safety of percutaneous access and surgical cutdown in transfemoral transcatheter aortic valve implantation (TF-TAVI).MethodsWe searched databases including the Cochrane Library, PubMed, OVID, Embase, China National Knowledge Internet and Wanfang Database to collect randomized or non-randomized controlled trials comparing percutaneous access (PC group, the trial/exposure group) with surgical cutdown (SC group, the control group) in TF-TAVI between January 2002 and October 2017. The quality evaluation and data extraction were carried out by 2 reviewers independently. The Meta-analysis was performed using RevMan 5.3.5 software.ResultsA total of 11 literatures involving 4 893 aortic valve stenosis patients treated by TF-TAVI (2 877 patients in PC group and 2 016 patients in SC group) were included in this Meta-analysis. There was no significant difference between PC and SC group in terms of major vascular complications [odds ratio (OR)=0.86, 95% confidence interval (CI) (0.70, 1.06), P=0.17], minor vascular complications [OR=1.43, 95%CI (0.87, 2.37), P=0.16], major bleeding [OR=1.02, 95%CI (0.55, 1.90), P=0.94], minor bleeding [OR=0.90, 95%CI (0.51, 1.61), P=0.73] and all-cause mortality within 30 days [OR=1.03, 95%CI (0.76, 1.40), P=0.85]. As for the length of stay after TAVI, there was significant difference between the two groups [standard mean difference=–0.32, 95%CI (–0.52, –0.12), P=0.002].ConclusionPercutaneous access is as effective and safe as surgical cutdown in TF-TAVI, meanwhile leading to shorter length of stay after TAVI.
Objective To report our experience with enhanced recovery after surgery (ERAS) protocol in patients undergoing transapical transcatheter aortic valve implantation (TAVI) and to determine perioperative predictors for ERAS failure. Methods Between May 2018 and January 2019, 80 patients undergoing TAVI in our hospital were recruited. Among them, 40 patients (24 males, 16 females, aged 73.0±5.0 years) successfully received ERAS, defined as successful extubation in operating room (an ERAS group) and the other 40 patients (28 males, 12 females, aged 73.0±7.0 years, a non-ERAS group) failed to perform ERAS. Results Compared with the non-ERAS group, patients in the ERAS group were associated with a significantly lower incidence of postoperative complications (30.0% vs. 52.5%, P=0.04), shorter postoperative ICU stay (2.2±0.4 d vs. 4.0±4.8 d, P=0.00) and hospital stay (7.0±2.3 d vs. 9.5±4.8 d, P=0.00), and less medical cost (311±20 thousand yuan vs. 347±80 thousand yuan, P=0.00). Independent predictors of ERAS failure were poor preoperative heart function and elevated B-type natriuretic peptides. Conclusion ERAS protocol is feasible and effective in patients undergoing TAVI. Poor preoperative heart function is an independent predictor of failure in early extubation which, in turn, is associated with prolonged ICU and hospital stay and dramatic worsening of patient outcomes.
Before transcatheter aortic valve replacement (TAVR), echocardiography is the first choice for preoperative screening of suitable patients, which can be used to observe the morphology of aortic valve, determine the cause of aortic stenosis, and evaluate the severity of aortic stenosis and other cardiac structure and function. During TAVR procedure, echocardiography is mainly used for real-time monitoring of complications and immediate postoperative evaluation. After TAVR, echocardiography can be used to evaluate the shape and function of the prosthesis valve and monitor long-term complications. This article reviews the research progress of echocardiography in TAVR for guiding clinical practice.
ObjectiveTo compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) in oncology and non-oncology patients with severe aortic stenosis (AS).MethodsA computer-based search in PubMed, The Cochrane Library, EMbase, CBM, CNKI and Wanfang databases from their date of inception to December 2021 was performed, together with reference screening, to identify eligible clinical trials. Two investigators screened the articles, extracted data, and evaluated quality independently. RevMan 5.3 and Stata 12.0 softwares were used for meta-analysis.ResultsThe selected 8 cohort studies contained 57 988 patients, including 12 335 cancer patients and 45 653 non-cancer patients. The results of meta-analysis showed that in patients with cancer, the 30-day mortality [OR=0.74, 95%CI (0.65, 0.84), I2=0%, P<0.000 01], stroke [OR=0.87, 95%CI (0.76, 0.99), I2=0%, P=0.04] and acute kidney injury [OR=0.81, 95%CI (0.76, 0.85), I2=49%, P<0.000 01] were lower than those in patients without cancer. The 1-year mortality [OR=1.46, 95%CI (1.15, 1.86), I2=62%, P=0.002] and late mortality [OR=1.51, 95%CI (1.24, 1.85), I2=61%, P<0.000 1] were higher in patients with cancer.ConclusionIt is effective and safe in cancer patients with severe AS undergoing TAVI. However, compared with patients without cancer, it is still high in long-term mortality, and further study of the role of TAVI in cancer patients with AS is necessary.
ObjectiveTo systematically evaluate the effects of non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists (VKA) on postoperative anticoagulation in patients undergoing transcatheter aortic valve implantation (TAVI) with combined high-risk atrial fibrillation (AF). MethodsAll clinical research literature on NOAC and VKA in TAVI patients with high-risk AF was collected using computer searches of PubMed, EMbase, The Cochrane Library, CNKI, VIP, and SinoMed. The retrieval schedule was from inception to January 2023. The Newcastle-Ottawa Scale (NOS) was utilized to provide an assessment of the quality of the included literature. Meta-analysis was performed by applying RevMan 5.4 software to the studies that met the quality criteria. ResultsA total of 24 592 patients were incorporated in 7 eligible papers for meta-analysis. Patients with NOAC had a significantly lower risk of all-cause mortality compared with TAVI patients with combined high-risk AF who had VKA [RR=0.74, 95%CI (0.58, 0.94), P=0.01]. During the first year of follow-up, no apparent difference in all-cause mortality was observed between the two groups [RR=0.57, 95%CI (0.17, 1.88), P=0.35]. After a year of following up on patients treated with VKA, all-cause mortality was higher in the group treated with NOAC, and the difference was statistically meaningful [RR=0.73, 95%CI (0.57, 0.95), P=0.02]. Patients in both groups had early stroke [RR=0.50, 95%CI (0.19, 1.28), P=0.15], follow-up stroke [RR=1.04, 95%CI (0.88, 1.22), P=0.64] and bleeding [RR=0.94, 95%CI (0.73, 1.21), P=0.61], severe or life-threatening hemorrhage [RR= 0.80, 95%CI (0.49, 1.31), P=0.38], and acute kidney injury [RR=0.51, 95%CI (0.16, 1.59), P=0.24] were all non-statistically significant differences. ConclusionCompared with the application of VKA, postoperative anticoagulation with NOAC in TAVI patients with combined high-risk AF may reduces all-cause mortality in patients and may yield additional benefit especially in long-term anticoagulation.
Transcatheter aortic valve implantation (TAVI) is an important alternative in treating high-risk patients with aortic valve regurgitation. Transcatheter tricuspid valve implantation (TTVI) is also an important treatment option for high-risk patients with tricuspid regurgitation. We reported a 72-year male patient who underwent TAVI due to severe aortic valve regurgitation using a J-Valve. During a two-year follow-up, the patient developed secondary tricuspid regurgitation to atrial fibrillation, and subsequently received TTVI using a LuX-Valve. Following the interventions, the patient's symptoms were significantly improved, and echocardiography indicated good hemodynamic performance of both transcatheter heart valves. This case highlights the feasibility and effectiveness of performing multiple valve implantations via transcatheter approaches in high-risk elderly patients.