Perioperative aortic dissection rupture after endovascular stent graft placement for treatment of type B dissection

Background  The perioperative aortic dissection (AD) rupture is a severe event after endovascular stent graft placement for treatment of type B AD. However, this life-threatening complication has not undergone systematic investigation. The aim of the study is to discuss the reasons of AD rupture after the procedure.

Methods  The medical record data of 563 Stanford type B AD patients who received thoracic endovascular repair from 2004 to December 2011 at our institution were collected and analyzed. Double entry and consistency checking were performed with Epidata software.

Results  Twelve patients died during the perioperation after thoracic endovascular repair, with an incidence of 2.1%, 66.6% were caused by aortic rupture and half of the aortic rupture deaths were caused by retrograde type A AD. In our study, 74% of the non-rupture surviving patients had the free-flow bare spring proximal stent implanted, compared with 100% of the aortic rupture patients (74% vs. 100%, P=0.213). The aortic rupture patients are more likely to have ascending aortic diameters ≥4 cm (62.5% vs. 9.0%, P=0.032), involvement the aortic arch concavity (62% vs. 27%, P=0.041) and have had multiple stents placed (P=0.039).

Conclusions  Thoracic AD endovascular repair is a safe and effective treatment option for AD with relative low in-hospital mortality. AD rupture may be more common in arch stent-graft patients with an ascending aortic diameter ≥4 cm and with severe dissection that needs multi-stent placement. Attention should be paid to a proximal bare spring stent that has a higher probability of inducing an AD rupture. Post balloon dilation should be performed with serious caution, particularly for the migration during dilation.

     

先天性主动脉瓣二叶畸形的外科治疗

目的 总结先天性主动脉瓣二叶畸形患者的临床特点及外科治疗经验.方法 回顾性分析2008年1月-2010年12月我科行外科手术治疗的先天性主动脉瓣二叶畸形患者34例,年龄23-78(51.0±12.4)岁,其中男性28例(82.3%),女性6例(17.6%).单纯主动脉瓣狭窄10例(29.4%),主动脉瓣狭窄伴关闭不全19例(55.8%),单纯主动脉瓣关闭不全5例(14.7%).合并主动脉根部扩张30例(88.2%),合并感染性心内膜炎6例(17.6%).行单纯主动脉瓣置换术32例,行Bentall 术1例,主动脉瓣置换+ 升主动脉置换术1例.其中21例植入机械瓣,13例植入生物瓣.结果 无死亡及其他严重并发症.术后超声心动图示升主动脉内径((45.4±5.9)mm vs(40.9±6.5)mm,P<0.05)及左室舒张末内径(LVEDD)((56.9±15.5)mm vs 年44.3±9.0)mm,P<0.05)较术前明显减小.结论 先天性主动脉瓣二叶畸形合并主动脉根部扩张要根据病情行不同方式手术.     

经导管主动脉瓣膜植入与常规主动脉瓣膜置换手术在多风险因素主动脉瓣狭窄患者中的应用

［摘要］ 目的评价经导管主动脉瓣膜植入（transcatheter aortic valve implantation,TAVI）与常规主动脉瓣膜置换在高风险因素患者中应用的安全性及效果。 方法选择主动脉瓣狭窄患者80例,按手术方式分为常规组47例、小切口组18例和TAVI组15例。常规组采用常规开胸主动脉瓣膜置换手术,小切口组采用胸骨上段小切口主动脉瓣膜置换手术,TAVI组采用全身麻醉非体外循环下TAVI。比较3组患者手术效果及并发症发生情况。 结果小切口组24 h引流量明显少于常规组（P＜0.01）。常规组和小切口组阻断时间差异无统计学意义（P＞0.05）。小切口组手术时间、呼吸机辅助通气时间、重症监护室（intensive care unit,ICU）停留时间短于常规组,术中出血量少于常规组（P＜0.01）;TAVI组手术时间、呼吸机辅助通气时间、ICU停留时间短于常规组和小切口组,术中出血量少于常规组和小切口组,平均动脉压（mean artery pressure,MAP)变化值大于常规组和小切口组,住院费用多于常规组和小切口组（P＜0.05或P＜0.01）。3组并发症发生率差异无统计学意义（P＞0.05）。 结论TAVI手术在治疗高风险因素的患者中较常规主动脉瓣膜置换手术安全性高,创伤小,并发症少,恢复快,值得临床推广应用。     

经股动脉球囊扩张式主动脉瓣置换术的初步经验

目的探讨经股动脉球囊扩张式主动脉瓣置换术治疗严重主动脉瓣狭窄患者的可行性。方法选取3例严重主动脉瓣钙化狭窄的患者,术前评估无法耐受传统开放手术,行经股动脉球扩式主动脉瓣置换术。结果 3例均经股动脉完成,其中1例经心尖穿刺辅助完成。3例手术全部成功,术后患者主动脉瓣功能显著改善,无并发症,无死亡。结论经股动脉球扩式主动脉瓣置换术可用于国人严重主动脉瓣狭窄患者,但在术前准备与评估、术中操作等方面提出了更高的要求。     

Clinical characteristics and prognosis of heart failure with normal left ventricular ejection fraction in elderly patients

heart failure with normal ejection fraction. Based on the previous studies, HFNEF has a significant morbidity and mortality and is associated with a similar prognosis to heart failure with reduced ejection fraction (HFREF). The present study aimed to investigate the clinical characteristics and prognosis of HFNEF in elderly patients.

Methods  Consecutive elderly patients (≥60 years old) hospitalized for the first episode of heart failure (HF) in Beijing Hospital from January 2003 to December 2009 were retrospectively recruited. Three hundred and ten patients with HF were eligible for our study. As recently recommended, a cut-off value of 50% was used to distinguish HFNEF (LVEF≥50%) from HFREF (LVEF<50%). Data were retrospectively obtained from hospital records and databases. Follow-up data were obtained by telephone and from hospital records. For every eligible patient, the clinical characteristics and prognosis were collected and compared between the HFNEF and HFREF groups.

Results  Patients with HFNEF accounted for 54.5% of all cases of elderly patients with HF. Compared with HFREF, the elderly patients with HFNEF had a higher proportion of females (62.1% vs. 32.6%, P <0.001), higher body mass index (BMI) ((24.9±4.7) vs. (23.5±4.0) kg/m², P=0.011), higher systolic blood pressure at admission ((141.5±22.6) vs. (134.3±18.6) mmHg, P=0.002), but lower hemoglobin levels ((118.3±22.7) vs. (125.8±23.8) g/L, P=0.005). The incidence of coronary heart disease (43.2% vs. 65.2%, P <0.001) and myocardial infarction (16.6% vs. 46.1%, P <0.001) were significantly lower in elderly patients with HFNEF than in those with HFREF (P <0.001). With a mean follow-up of 33.5 (0.5–93) months, 120 patients (38.7%) died, including 94 (30.3%) cardiac deaths. The HFNEF group had fewer deaths than the HFREF group at the end of the first follow-up (46/169 (27.2%) vs. 58/141 (41.1%)) and at the end of the second follow-up (56/169 (33.1%) vs. 64/141 (45.4%)). Kaplan-Meier survival analysis showed a significantly higher survival rate in elderly patients with HFNEF than those with HFREF (P=0.021 for total mortality and P <0.001 for cardiac mortality). Multiple Logistic regression analysis showed that LVEF <50% was an independent risk factor for death in elderly patients with HF.

Conclusions  More than half of elderly patients with HF have a normal LVEF. The prognosis of the elderly patients with HFNEF is poor, though slightly better than the elderly patients with HFREF.

     

主动脉瓣返流对顺式阿曲库铵临床药效学的影响

【目的】 对比研究顺式阿曲库铵在主动脉瓣关闭不全(AI)中重度主动脉瓣返流患者诱导阶段药效学的改变&#65377;【方法】 30例患者纳入此项研究中:实验组选择主动脉瓣关闭不全,中重度返流择期行主动脉瓣瓣膜替换术患者15例(AI组)&#65377;另选择15例行普通外科手术的非心脏病患者作为对照组(C组)&#65377;两组患者均给予芬太尼5 μg/kg + 异丙酚0.5 ~ 2 mg/kg + 顺式阿曲库铵0.1 mg/kg(2倍ED95)麻醉诱导,麻醉维持采用异丙酚 + 瑞芬太尼的全凭静脉麻醉方式&#65377;应用TOF-WATCH SX加速度仪记录顺式阿曲库铵的起效时间&#65380;无反应时间&#65380;临床作用时间及恢复指数&#65377;【结果】 AI组的起效时间(min)较C组明显延长 (5.6 ± 0.8 vs 3.4 ± 0.4,P < 0.001)&#65377;两组患者的恢复时间和恢复指数差异没有显著性&#65377; 【结论】 顺式阿曲库铵用于中重度主动脉关闭不全患者的麻醉诱导,和对照组比较药物起效时间明显延长,但持续时间恢复指数并没有区别&#65377;     

Procedural results and 30-day clinical events analysis following Edwards transcatheter aortic valve implantation in 48 consecutive patients: initial experience

Background  Transcatheter aortic valve implantation (TAVI) is a rapidly evolving strategy for therapy of aortic stenosis. We presented the procedural results and analyzed the death causes of 30-day mortality and clinical events in patients who underwent TAVI with Edwards prosthetic valves in University Hospital of Caen, France.

Methods  The patients with severe aortic stenosis but at high surgical risk or inoperable were considered as candidates for TAVI. Forty-eight patients undergoing TAVI from July 2010 to September 2011 were enrolled in this registry. The Edwards prosthetic valves were solely used in this clinical trial.

Results  Overall 48 patients underwent TAVI, 28 of which accepted TAVI by trans-femoral (TF) approaches, 20 by trans-apical approaches (TA). The aortic valve area (AVA) was (0.70±0.23) cm², left ventricular ejection fraction (LVEF) was (57.4±17.6)%, Log EuroSCORE was (19.2±15.8)%, mean gradient was (47.0±16.6) mmHg. There were no significant differences between TF and TA groups in all these baseline parameters. Device success rate was 95.8%, and procedural success rate was 93.7% in total. Procedural mortality was 6.7% (3/48): two deaths in TA group (10%), and one death in TF group (3.6%). Forty-six Edwards valves were implanted: 10 Edwards Sapien and 36 Edwards XT. Procedure-related complications included cardiac tamponade in 2 cases (4.2%), acute myocardial infarction (AMI) in 1 case (2.1%), permanent pacemaker implantation in 1 case (2.1%), life-threatening and major bleeding in 3 cases; access site related major complication in 1 case, AKI stage 3 in 3 cases (6.3%), minor stroke in 1 case (2.1%). Thirty-day survival rate was 89.6%. There were 5 deaths in total (10.4%): 4 in TA group (20%) and 1 in TF group (3.6%).

Conclusion  The procedural success rate and 30-day mortality were acceptable in these high risk patients with Edwards prosthetic valves in the first 48 TAVI.

     

Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: a meta analysis

Background Transcatheter aortic valve implantation (TAVI) has emerged as the treatment choice for non-operable patients with severe symptomatic aortic stenosis (AS) and may be a good alternative to sur...     

无症状重度主动脉瓣狭窄患者手术与非手术治疗探讨

目的比较无症状重度主动脉瓣狭窄患者手术治疗与非手术治疗心源性死亡率的差别。方at分析我院心脏外科2007年1月-2010年12月122名无症状重度主动脉瓣狭窄患者心源性死亡率,手术组65例,行主动脉瓣置换手术,非手术组57例选择常规治疗。结朵手术组心源性死亡率明显低于非手术组。结论对于无症状的重度主动脉瓣狭窄患者手术及非手术治疗,仍存在争议,但若存在高危因素,则需考虑行手术治疗。     

急诊心脏瓣膜置换术41例的临床分析

目的总结重症瓣膜患者行急诊外科治疗的经验。方法1998年7月~2007年7月,对41例重症瓣膜患者急诊行心脏瓣膜置换术,其中感染性心内膜炎24例,二尖瓣重度狭窄7例,主动脉瓣重度狭窄2例,二尖瓣腱索断裂5例,主动脉瓣重度关闭不全合并瓦氏窦瘤破裂2例,介入术后主动脉瓣关闭不全1例。结果全组无手术死亡,术后2例再发机械瓣膜感染,4例并发肾功能衰竭,2例并发低心排,3例脑梗死症状加重,最终均死亡,其余顺利康复,死亡率为26.8%。结论符合手术指征的危重瓣膜患者应该急诊行瓣膜置换术,术后应注意肺脏和肾脏的保护,并且合理使用抗生素。     

先天性主动脉瓣下狭窄的外科治疗

目的探讨先天性主动脉瓣下狭窄（congenital subvalvular aortic stenosis，CSAS）的临床特点及手术疗效。方法全组32例，男16例，女16例。年龄4～57岁，平均年龄31岁；纤维隔膜型24例，纤维肌束型6例，弥漫型2例；手术在体外循环下进行，单纯纤维隔膜切除24例，纤维隔膜切除并室间隔肌肉切除术7例，Kono术1例。主动脉瓣机械瓣置换术6例，主动脉瓣成形3例，主动脉瓣二尖瓣机械瓣替换1例，同期矫治其它合并畸形。结果术后无早期死亡。全部患者术后瓣下压差较术前显著下降，术前、后LVEDD，EF差异无显著性。全部病例随访，随访时间1～60个月。长期生存者，心功能恢复至Ⅰ级31例，Ⅱ级1例。结论CSAS一旦确诊，应尽早手术。手术关键要根据病理解剖特点彻底疏通左室流出道。     

主动脉窦瘤破裂术中主动脉瓣关闭不全的处理

目的：总结1989至2002年间31例主动脉窦瘤破裂(RASV)患者术中处理主动脉瓣的经验。方法：患者年龄为9-45(平均26．7)岁。超声心动图提示有主动脉瓣关闭不全(AR)27例。在全身麻醉体外循环下完成心内直视手术，窦瘤破口及合并室间隔缺损均在右心室面予以补片修补，窦瘤颈部予以荷包加固缝合。其中20例患者因瓣叶游离缘被拉长脱垂，致瓣口轻、中度关闭不全，采用瓣缘折叠法修复；11例瓣叶无法折叠修复者，实施主动脉瓣置换。结果：全组患者术后恢复顺利，无手术死亡；3例发生低心排血量，均痊愈出院。结论：RASV合并AR不单纯由主动脉瓣脱垂引起，往往合并有窦瘤引发的瓣叶退行性变，术前应做好换瓣准备，对较严重的AR应积极行主动脉瓣置换。     

经导管主动脉瓣置换术的现状与发展趋势

目前,尽管严重主动脉狭窄的治疗指南仍以外科手术置换(surgical aortic valve replacement,SAVR)为治疗标 准,但随着大血管外科技术的不断发展,经导管主动脉瓣置换术(transcatheter aortic valve implantation,TAVI)逐渐成为 高危和禁忌SAVR患者的常规治疗措施。近年来各瓣膜厂商,包括国内医药公司,对瓣膜技术极力地推进,使得TAVI 技术取得了显著成效,加上其并发症也得到了有效控制,TAVI有望在治疗主动脉狭窄乃至关闭不全上取代传统术 式,应用前景可观。     

Congenital quadricuspid aortic valve: analysis of 11 surgical cases

Background  Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR). The diagnosis and treatment of the disease were reported in 11 cases.

Methods  Eleven patients (nine men and two women, mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated. Medical records, echocardiograms and surgical treatment were reviewed.

Results  In accordance with the Hurwitz and Roberts classification, the patients were classified as type A (n=2), type B (n=7), type F (n=1) and type G (n=1). Three patients were associated with other heart diseases, including infective endocarditis and mitral prolaps, left superior vena cava, aortic aneurysm. All had aortic regurgitation (AR) except two with aortic stenosis (AS), detected by color-flow Doppler echocardiography. The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography. All patients underwent successful aortic valve replacement.

Conclusion  Quadricuspid aortic valve is a rare cause of aortic insufficiency, while echocardiography plays an important role in diagnosing the disease. Aortic valve replacement is the major therapy for the disease.

     

升主动脉扩张及主动脉瓣功能障碍对二叶式主动脉瓣患者主动脉弹性影响的磁共振成像研究

 目的 通过磁共振成像研究升主动脉扩张和主动脉瓣功能障碍对二叶式主动脉瓣（bicuspid aortic valve,BAV）患者中段升主动脉（middle ascending aorta,mid-AA）和近端降主动脉（proximal descending aorta,PDA）弹性的影响。方法 前瞻性选取复旦大学附属中山医院2019年10月至2021年3月间130名BAV患者和30名健康志愿者做3.0 T磁共振检查,测量其主动脉扩张度。根据升主动脉直径和主动脉瓣功能将BAV患者分为4组：BAV伴正常或轻度瓣膜功能障碍且升主动脉不扩张组（BAV-CTL组,n=30）;BAV伴正常或轻度瓣膜功能障碍且升主动脉扩张组（Dilated BAV-NF组,n=40）;BAV伴中重度主动脉瓣狭窄（aortic stenosis,AS）且升主动脉扩张组（Dilated BAV-AS组,n=30）;BAV伴中重度主动脉瓣关闭不全（aortic insufficiency,AI）且升主动脉扩张组（Dilated BAV-AI组,n=30）。在右肺动脉平面测量mid-AA和PDA的面积,计算其扩张度。采用Student’s t检验和Mann-Whitney U检验比较连续性变量,卡方检验或Fisher精确检验比较分类变量。结果 在无严重瓣膜功能障碍者中,BAV伴升主动脉扩张组较不扩张组mid-AA扩张度降低［2.77（IQR：1.45~6.26）vs.1.52 （IQR：1.08~2.19）,P=0.004］。在升主动脉扩张者中,BAV伴中重度AI组主动脉扩张度较伴正常或轻度瓣膜功能障碍组高［mid-AA：1.52（IQR：1.08-2.19） vs. 2.29 （IQR：1.60~4.08）,P=0.006;PDA：3.70（IQR：2.89~4.70） vs. 4.79 （IQR：2.93~6.80）,P=0.024］;BAV伴中重度AI组主动脉扩张度较伴中重度AS组高［mid-AA：1.60 （IQR：0.99~2.26） vs. 2.29 （IQR：1.60~4.08）,P=0.022;PDA：3.73 （IQR：2.38~4.40） vs. 4.79 （IQR：2.93~6.80）,P=0.014］。结论 升主动脉扩张和AI是影响BAV患者主动脉弹性的主要因素,主动脉扩张对弹性的影响局限于升主动脉,而AI对主动脉弹性的影响范围更广。     

10137例胃息肉的临床及病理特征分析

目的 分析重庆地区胃息肉的临床及病理特征.方法 回顾性分析西南医院消化内镜中心数据库2007年1月至2016年12月检出的10 137例胃息肉患者的内镜报告及临床资料.结果 10年间胃息肉的病理谱发生了显著的变化,增生性息肉所占比例由66.39％下降到43.05％(P＜0.001),而胃底腺息肉由25.04％上升到48.47％ (P ＜0.001);H.pylori感染率由57.78％下降到37.42％(P＜0.05);异型增生发生率由3.79％下降到0.90％ (P ＜0.001);高级别上皮内瘤变(high-grade intraepithelial neoplasia,HIN)发生率由1.81％下降到0.56％ (P ＜0.01).增生性胃息肉所占比例随着年龄增加而呈下降的趋势,由≤30岁组的73.62％下降到＞70岁组的48.69％ (P ＜0.001);腺瘤性息肉检出率随着年龄的增加而上升,由31 ～ 40岁组的0.34％上升到＞70岁组的6.28％(P＜0.001);异型增生和HIN在60岁以上人群中发生率分别是不超过60岁人群的3.89倍和4.75倍(P＜0.001).反流性食管炎发生率在胃底腺组(6.86％)明显高于非胃底腺组(3.54％)(P＜0.001);胃底腺息肉组中H.pylori感染率(28.48％)明显低于非胃底腺息肉组(45.30％) (P ＜0.001);异型增生发生率在腺瘤性、增生性和胃底腺息肉中分别为60.47％、0.53％和0.20％;HIN发生率在腺瘤性、增生性和胃底腺息肉中分别为47.67％、0.07％和0.03％.胃息肉的数量及位置分布在不同时间段、不同年龄组、不同病理类型间均存在差异.结论 重庆地区10年间增生性胃息肉明显下降,几乎无恶变风险的胃底腺息肉已成为主要的病理类型;临床中是否有必要对所有胃息肉进行切除治疗,应结合息肉病理类型、临床特征及患者意愿后做出差异性的管理策略.     

瓣膜类型对主动脉瓣置换术后早期心功能影响的分析

目的分析主动脉瓣置换术后瓣膜类型对患者术后早期心功能的影响。方法回顾性分析在我科行主动脉瓣置换手术的68例患者,年龄23～73(48.9±11.2)岁,其中男54例,女14例。病变类型:单纯主动脉瓣狭窄5例,主动脉瓣狭窄伴关闭不全21例,单纯主动脉瓣关闭不全42例。其中53例植入机械瓣,15例植入生物瓣。结果无死亡及其他严重并发症。术后超声心动图示升主动脉内径[(37.9±5.3)vs(40.5±5.7)mm,P<0.05]较术前明显减小,术后左心室舒张末内径[(46.2±9.1)vs(58.9±11.6)mm,P<0.05]较术前明显减小,生物瓣及机械瓣两组患者术前及术后左心室舒张末内径、左心室射血分数、升主动脉直径等比较,差异无统计学意义,左心室舒张末内径和升主动脉直径的术前及术后的变化值比较,差异无统计学意义。结论主动脉瓣置换术可改善患者心功能,瓣膜的类型在主动脉瓣置换术中对心功能的改善无影响。     

单中心100例经导管主动脉瓣置换(TAVR)结果分析

目的 报道单中心100例经导管主动脉瓣置换术(transcatheteraortic valve replacement,TAVR)结果,总结相关经验。方法 连续入选2010年10月至2018年3月在我中心行TAVR的主动脉瓣狭窄患者100例,观察分析手术成功率、死亡率、术后并发症等结果。结果 患者平均年龄(78.1±6.8)岁,其中男性68例,胸外科协会(Society of Thoracic Surgeons's,STS)平均分数9.9±6.0。12例患者经颈动脉途径,87例经股动脉,1例经升主动脉。均使用自膨胀瓣膜,手术成功率97%。术中预扩张球囊平均大小(19.6±2.0) mm,后扩张球囊平均大小(21.4±2.2) mm,瓣膜植入平均深度为瓣环下(4.3±3.4) mm。术前、术后平均跨主动脉瓣压分别为(51.3±19.7) mmHg和(11.7±6.1) mmHg (P<0.001),术前、术后瓣口面积分别为(0.6±0.2) cm2和(1.7±0.5) cm2 (P<0.001)。随访30天内,死亡率为2%,中风发生率为1%,永久心脏起搏器植入率9%,TAVR术后起搏器植入组与非起搏器植入组的瓣膜植入深度分别为(7.2±3.1) mm和(4.2±3.3) mm (P=0.011)。二叶式主动脉瓣组与三叶式主动脉瓣组在并发症及血流动力学方面未见明显异常。结论 TAVR对我国主动脉瓣狭窄患者具有较高的安全性及有效性,二叶式与三叶式主动脉瓣膜的手术结果相似。TAVR永久性起搏器植入发生率较低,这与植入深度密切相关,可能与较小球囊扩张有关。     

Effect of pulmonary autograft transplantation in the surgical treatment of aortic valve disease

Background Aortic root replacement with pulmonary autograft （Ross procedure） has the advantages of good haemodynamics and growth potential without the need for anticoagulation. In this study, we reviewed our experience of the Ross procedure for patients with aortic valve disease. Methods From October 1994 to January 2005, 42 Ross procedures were performed in our centre. There were 30 males and 12 females. The mean age was 28＋15 years （range, 5-56 years）. Congenital heart disease （CHD） with aortic valve stenosis （AS） and/or aortic valve insufficiency （AI） in 40 cases including one associated with ventricular septal defect （VSD）, degenerated aortic valve disease with AS in 1 and subacutive bacterial endocarditis （SBE） with AI in 1 were studied. The diagnosis was made by ultracardiography （UCG） in all patients. The mean aortic valve annulus diameter （AVD） was （2.45±0.31） cm and pulmonary valve annulus diameter （MPVD） was （2.34±0.21） cm. All patients had normal pulmonary valves. The New York Heart Association （NYHA） function class was Ⅱ in 36 cases and Ⅲin 6 cases. The operation was performed under moderate hypothermic cardiopulmonary bypass （CPB） with aortic root replacement using pulmonary autograft and pulmonary valve replacement with a homograft. Results There was no early hospital mortality. Postoperative UCG showed normal aortic valve function in all our patients. The mean gradient across the aortic valve was （6.11±0.12） mmHg. The left ventricular diastole diameter （LVDD） decreased significantly from （62±5） mm to （56±3） mm （P 〈0.001）. The mean postoperative left ventricular ejective fraction （LVEF） was 0.49±0.23. All patients were in NYHA class Ⅰ-Ⅱ. Follow-up was completed in 38 cases for a mean period of 3.2 years （range 1-10 years）. All survivors were in NYHA class Ⅰ with normal neo-aortic and pulmonary valve function. One patient died after secondary operation due to homograft fungal endocarditis 1 year af     

Transcatheter aortic valve implantation: preliminary experience in West China Hospital

Transcatheter aortic valve implantation (TAVI) is a promising alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis (AS) who were deemed at a high surgical risk.This novel technique has kept evolving rapidly throughout the world in the past decade,but was not introduced to China until recently.Here we report our clinical experience in TAVI based on the largest cohort of Chinese patients in a single center.