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Yuki Hashimoto Mitsuaki Ishida Hironori Ryota Tomohisa Yamamoto Hisashi Kosaka Satoshi Hirooka So Yamaki Masaya Kotsuka Yoichi Matsui Hiroaki Yanagimoto Koji Tsuta Sohei Satoi 《Pancreatology》2019,19(3):443-448
Objective
Adipophilin is a lipid droplet-associated protein, and its expression has been correlated with aggressive clinical behavior in some types of carcinomas, though its role in pancreatic ductal adenocarcinoma (PDAC) has not been clarified. This study aimed to evaluate the role of adipophilin in PDAC.Methods
By immunohistochemical staining using tissue microarrays, we analyzed the expression profiles of adipophilin in 181 consecutive PDAC patients who underwent macroscopic margin-negative resection from January 2008 to December 2015. Overall survival (OS) and recurrence-free survival (RFS) were compared based on adipophilin expression, and the risk factors for OS, RFS, and early recurrence (within 6 months) were analyzed.Results
Of the 181 evaluated patients, 51 (28.2%) were positive for adipophilin expression. A histopathological grade of 3 (p?=?0.0012), higher CA19-9 level (p?=?0.0016), and R1 status (p?=?0.028) were significantly associated with adipophilin-positive patients who had significantly poor OS and RFS compared to those associated with adipophilin-negative patients (p?=?0.0007 and p?=?0.0022, respectively). They also showed a significantly higher incidence of early recurrence (p?=?0.030), based on multivariate analyses.Conclusions
Adipophilin is a potential independent prognostic marker for PDAC. 相似文献3.
Ali Gheysarzadeh Amir Ansari Mohammad Hassan Emami Amirnader Emami Razavi Mohammad Reza Mofid 《Pancreatology》2019,19(3):429-435
Background
Low-density lipoprotein receptor-Related Protein-1 (LRP-1) has been reported to involve in tumor development. However, its role in pancreatic cancer has not been elucidated. The present study was designed to evaluate the expression of LRP-1 in Pancreatic Ductal Adenocarcinoma Cancer (PDAC) as well as its association with prognosis.Methods
Here, 478 pancreatic cancers were screened for suitable primary PDAC tumors. The samples were analyzed using qRT-PCR, western blotting, and Immunohistochemistry (IHC) staining as well as LRP-1 expression in association with clinicopathological features.Results
The relative LRP-1 mRNA expression was up-regulated in 82.3% (42/51) of the PDAC tumors and its expression (3.72?±?1.25) was significantly higher than that in pancreatic normal margins (1.0?±?0.23, P?<?0.05). This up-regulation was stage dependent (P?<?0.05). A similar pattern of LRP-1 protein expression was discovered (P?<?0.05). The high expression of LRP-1 in the PDAC tissues was strongly correlated with the low survival time (P?=?0.001), TNM classification (P?=?0.001), low differentiations status (P?=?0.001), lymphatic invasion (P?=?0.01) and Perineural Invasion (PNI) status (P?=?0.001).Conclusions
Our finding for the first time revealed that LRP-1 expression inversely associated with poor prognosis and PNI in PDAC tumor. 相似文献4.
Swapna Kanade Gita Nataraj Preeti Mehta Daksha Shah 《The Indian journal of tuberculosis》2019,66(1):139-143
Setting
Department of Microbiology.Objective
To determine the common mutations responsible for rifampicin resistance in TB cases detected by Xpert MTB/RIF assay.Design
Results of Xpert MTB/RIF assay performed from 2013 to 2017 were analysed for missing probes in different types of specimens containing rifampicin resistant MTB.Results
Successful results were obtained in14872 of the total 15129 specimens processed by Xpert MTB/RIF assay, of which 9458 (63.6%) were sputum and 5414 (36.4%) were extrapulmonary specimens. MTB was detected in 1624 (17.17%) sputum and 1121 (20.70%) extrapulmonary specimens of which 409 (25.18%) and 277 (24.71%) were rifampicin resistant respectively.Probe E (83.82%) was the commonest probe responsible for rifampicin resistance followed by D (3.93%) and B (3.79%). Mutation in probe C (0.29%) was very rare. Combination of missing probes like AB (0.73%), DE (1.16%) and ADE (0.14%) was observed. 22 (3.2%) specimens showed presence of all five probes.Conclusion
Xpert MTB/RIF assay uses various combinations of probe to detect MTB along with rifampicin resistance and is a valuable diagnostic tool. It can become a useful epidemiological tool to identify dynamics of transmission of TB by addition of few more probes to identify mutations at specific codons. 相似文献5.
Yiran Zhou Jiewei Lin Wei Wang Hao Chen Xiaxing Deng Chenghong Peng Dongfeng Cheng Baiyong Shen 《Pancreatology》2019,19(3):414-418
Objectives
This study aimed to use a retrospective data base to investigate whether a standard lymphadenectomy during distal pancreatectomy should include the No. 9 lymph nodes (LNs) for resectable pancreatic ductal adenocarcinoma (PDAC) located in the body and tail of the pancreas.Methods
Data from 169 patients undergoing curative distal pancreatectomy for PDAC between Jan 1, 2013 and Dec 31, 2016 were collected. According to the tumor location, patients were divided into three groups: pancreatic neck tumor, pancreatic body and tail tumor with margin-to-bifurcation-distance (MTBD)?≤?2.5?cm and pancreatic body and tail tumor with MTBD?>?2.5?cm. The metastatic rate of the No. 9 LNs was compared among the 3 groups. The survival outcomes were analyzed.Results
The involvement rate for No. 9 LNs was 20.7% (6/29) for pancreatic neck tumors, 17.6% (15/85) for body and tail tumors with MTBD?≤?2.5?cm and 1.8% (1/55) for MTBD?>?2.5?cm. The No. 9 LNs were significantly more frequently involved in neck or body and tail tumors with MTBD ≤2.5?cm than with the cases with MTBD >2.5?cm (OR 0.082, P?=?0.016). No. 9 LN involvement was not associated with worse survival compared with survival associated with involvement of other LNs (P?=?0.780).Conclusions
For PDAC located in the neck or in the body and tail of the pancreas with MTBD?≤?2.5?cm, the involvement rate for No. 9 LNs is high. Standard lymphadenectomy should include the No. 9 LNs. 相似文献6.
Bart M.G. Baekelandt Morten W. Fagerland Marianne J. Hjermstad Turid Heiberg Knut J. Labori Trond A. Buanes 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):275-282
Background
Long-term effects of complications in pancreatic surgery have not been systematically evaluated. The objectives were to assess potential effects of complications on survival and patient reported outcomes (PROs) as well as feasibility of PRO questionnaires in patients with periampullary and pancreatic tumors.Methods
From October 2008 to December 2011, 208 patients undergoing pancreatic surgery were included in a prospective observational study. ESAS, EORTC QLQ-C30 and QLQ-PAN26 questionnaires were completed at inclusion, then every third month. Complications were recorded according to the Clavien-Dindo (CD) classification and Comprehensive Complication Index (CCI).Results
148 complications were registered in 100 patients (48%), 36 patients (17%) had CD IIIa or above. 125 patients (60%) completed baseline questionnaires, 80 (39%) responded after three and 54 (28%) after six months. Complications were associated with reduced long-term survival in patients with pancreatic ductal adenocarcinoma (PDAC) (p = 0.049) and other malignant diseases. No significant relationship was found between complications and PROs, except for anxiety, which was significantly increased in patients with complications.Conclusion
Postoperative complications led to increased anxiety at 3 months after surgery and were associated with reduced long-term survival in patients with malignancy. A short, patient derived, disease specific questionnaire is required in the clinical research context. 相似文献7.
Andrew M. Goldsweig Kevin F. Kennedy J. Dawn Abbott W. Schuyler Jones Poonam Velagapudi Frank J. Rutar Jeptha C. Curtis Thomas T. Tsai Herbert D. Aronow 《JACC: Cardiovascular Interventions》2019,12(5):473-480
Objectives
The aims of this study were to determine the incidence of actionably high radiation dosages and to identify predictors of increased patient dosage.Background
Peripheral endovascular intervention using fluoroscopic imaging has become a mainstay of treatment for lower extremity peripheral artery disease but exposes patients to ionizing radiation.Methods
Patient radiation dosage, quantified as dose-area product (DAP), was obtained from the National Cardiovascular Data Registry Peripheral Vascular Intervention Registry. The percentage of procedures exceeding a DAP of 500 Gy · cm2, the threshold above which follow-up for radiation-related adverse effects is indicated by the National Council on Radiation Protection and Measurements, was determined. A multivariate regression model was generated to identify patient and procedural factors associated with increasing DAP.Results
Among 17,174 procedures performed at 73 sites, patient DAP exceeded 500 Gy · cm2 in 7%. Independent predictors of increased patient DAP in order from greatest magnitude of effect included more proximal lesion location, bifurcation lesion, male sex, diabetes, hypertension, prior percutaneous coronary intervention, increasing lesion length, and increasing body mass index; antegrade vascular access, critical limb ischemia, and increasing age predicted decreased DAP.Conclusions
Radiation dosage with the potential for tissue injury occurs in 1 of every 14 patients undergoing lower extremity endovascular interventions, and all such patients are exposed to the potential for subsequent malignancy. Pre-procedural assessment of patients’ risk for elevated radiation dosage may allow targeted use of radiation mitigation strategies in patients at increased risk for elevated exposure. 相似文献8.
Ju Youn Kim Sung-Hwan Kim Jun-Pyo Myong Yoo Ri Kim Tae-Seok Kim Ji-Hoon Kim Sung-Won Jang Yong-Seog Oh Man Young Lee Tai-Ho Rho 《Journal of the American College of Cardiology》2019,73(10):1123-1131
Background
Patients with mitral stenosis and atrial fibrillation (AF) require anticoagulation for stroke prevention. Thus far, all studies on direct oral anticoagulants (DOACs) have excluded patients with moderate to severe mitral stenosis.Objectives
The aim of this study was to validate the efficacy of DOACs in patients with mitral stenosis.Methods
The study population was enrolled from the Health Insurance Review and Assessment Service (HIRA) database in the Republic of Korea, and it included patients who were diagnosed with mitral stenosis and AF and either were prescribed DOACs for off-label use or received conventional treatment with warfarin. The primary efficacy endpoint was ischemic strokes or systemic embolisms, and the safety outcome was intracranial hemorrhage.Results
A total of 2,230 patients (mean age 69.7 ± 10.5 years; 682 [30.6%] males) were included in the present study. Thromboembolic events occurred at a rate of 2.22%/year in the DOAC group, and 4.19%/year in the warfarin group (adjusted hazard ratio for DOAC: 0.28; 95% confidence interval: 0.18 to 0.45). Intracranial hemorrhage occurred in 0.49% of the DOAC group and 0.93% of the warfarin group (adjusted hazard ratio for DOAC: 0.53; 95% confidence interval: 0.22 to 1.26).Conclusions
In patients with AF accompanied with mitral stenosis, DOAC use is promising and hypothesis generating in preventing thromboembolism. Our results need to be replicated in a randomized trial. 相似文献9.
Linn S. Nymo Kjetil Søreide Dyre Kleive Frank Olsen Kristoffer Lassen 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):319-327
Background
Centralization of pancreatic resections is advocated due to a volume-outcome association. Pancreatic surgery is in Norway currently performed only in five teaching hospitals. The aim was to describe the short-term outcomes after pancreatoduodenectomy (PD) within the current organizational model and to assess for regional disparities.Methods
All patients who underwent PD in Norway between 2012 and 2016 were identified. Mortality (90 days) and relaparotomy (30 days) were assessed for predictors including demographic data and multi-visceral or vascular resection. Aggregated length-of-stay and national and regional incidences of the procedure were also analysed.Results
A total of 930 patients underwent PD during the study period. In-hospital mortality occurred in 20 patients (2%) and 34 patients (4%) died within 90 days. Male gender, age, multi-visceral resection and relaparotomy were independent predictors of 90-day mortality. Some 131 patients (14%) had a relaparotomy, with male gender and multi-visceral resection as independent predictors. There was no difference between regions in procedure incidence or 90-day mortality. There was a disparity within the regions in the use of vascular resection (p = 0.021).Conclusion
The short-term outcomes after PD in Norway are acceptable and the 90-day mortality rate is low. The outcomes may reflect centralization of pancreatic surgery. 相似文献10.
Mariana B. Zilio Tatiana F. Eyff André L.F. Azeredo-Da-Silva Vivian P. Bersch Alessandro B. Osvaldt 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):259-267
Background
Gallstones and alcohol are currently the most frequent aetiologies of acute pancreatitis (AP). The aim of this study is to quantify these aetiologies worldwide, by geographic region and by diagnostic method.Methods
A systematic review of observational studies published from January 2006 to October 2017 was performed. The studies provided objective criteria for establishing the diagnosis and aetiology of AP for at least biliary and alcoholic causes. A random-effects meta-analysis was used to assess the frequency of biliary (ABP), alcoholic (AAP) and idiopathic AP (IAP) worldwide and to perform 6 subgroup analyses: 2 compared diagnostic methods for AP aetiology and the other 4 compared geographic regions.Results
Forty-six studies representing 2,341,007 patients of AP in 36 countries were included. The global estimate of proportion (95% CI) of aetiologies was 42 (39–44)% for ABP, 21 (17–25)% for AAP and 18 (15–22)% for IAP. In studies that used discharge code diagnoses and in those from the US, IAP was the most frequent aetiology. ABP was more frequent in Latin America than in other regions.Conclusion
Gallstones represent the main aetiology of AP globally, and this aetiology is twice as frequent as the second most common aetiology. 相似文献11.
Pim B. Olthof Mamoru Miyasaka Bas Groot Koerkamp Jimme K. Wiggers William R. Jarnagin Takehiro Noji Satoshi Hirano Thomas M. van Gulik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):345-351
Background
Perihilar cholangiocarcinoma (PHC) often requires extensive surgery which is associated with substantial morbidity and mortality. This study aimed to compare an Eastern and Western PHC cohort in terms of patient characteristics, treatment strategies and outcomes including a propensity score matched analysis.Methods
All consecutive patients who underwent combined biliary and liver resection for PHC between 2005 and 2016 at two Western and one Eastern center were included. The overall perioperative and long-term outcomes of the cohorts were compared and a propensity score matched analysis was performed to compare perioperative outcomes.Results
A total of 210 Western patients were compared to 164 Eastern patients. Western patients had inferior survival compared to the East (hazard-ratio 1.72 (1-23-2.40) P < 0.001) corrected for age, ASA score, tumor stage and margin status. After propensity score matching, liver failure rate, morbidity, and mortality were similar. There was more biliary leakage (38% versus 13%, p = 0.015) in the West.Conclusion
There were major differences in patient characteristics, treatment strategies, perioperative outcomes and survival between Eastern and Western PHC cohorts. Future studies should focus whether these findings are due to the differences in the treatment or the disease itself. 相似文献12.
Xiu-Ping Zhang Yu-Zhen Gao Ya-Bo Jiang Kang Wang Zhen-Hua Chen Wei-Xing Guo Jie Shi Yao-Jun Zhang Min-Shan Chen Wan Y. Lau Shu-Qun Cheng 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(3):335-344
Background
Lymph node metastasis (LNM)has widely been recognized as a poor prognostic indicator for hepatocellular carcinoma (HCC) patients. Preoperative prediction of LNM is important for clinicians to decide on treatment. This study was designed to develop a simple and convenient system to predict LNM.Methods
Consecutive HCC patients who were suspected to have LNM were divided into a training, an internal validation and an external validation cohort. The receiver operating characteristic (ROC) analysis was used to determine the threshold value of the preoperative serological variables. A nomogram visualization system model was then established.Result
Of the 287 patients, there were 31 patients who had LNM (10.8%), and 21 of 203 patients (10.3%) were in the training cohort and 10 of 84 patients (11.9%) in the internal validation cohort. Sixteen of 176 patients (9.1%) in the external validation cohort had LNM. The serological indices including neutrophil/lymphocyte rate, age, platelet, prothrombin time, and total protein, were included in the nomogram. The areas of the ROC curve were 0.846, 0.679 and 0.738 in predicting LNM in the training cohort, the internal validation cohort and the external validation cohort, respectively.Conclusion
The scoring system constructed using the preoperative serological variables predicted LNM in HCC patients. 相似文献13.
Yusheng Jie Jiao Gong Cuicui Xiao Jun Zheng Zhiwei Zhang Xinhua Li Zhiliang Gao Bo Hu Yutian Chong 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(4):499-507
Background
Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy arising from the liver. Fibulin-1 has been demonstrated to be involved in various cancers, however, its role in ICC remains unclear.Methods
To study the clinical value and potential molecular mechanism of Fibulin-1 in ICC, immunohistochemistry and bioinformatic analyses were performed using data in the Gene Expression Omnibus Datasets and The Cancer Genome Atlas database.Results
Fibulin-1 expression was overexpressed in ICC tissues compared with adjacent non-cancerous tissues, and was significantly associated with unfavorable overall survival. Moreover, similar genes were identified by Gene Expression Profiling Interactive Analysis and microarray data set. Next, functional and pathway enrichment analysis demonstrated that Fibulin-1 was overrepresented in the pathways of extracellular matrix organization and angiogenesis, which are associated with tumor progression and potential for metastasis. Gene set enrichment analysis indicated that the gene sets of epithelial mesenchymal transition, TGF-beta signaling pathway and angiogenesis were enriched in tissues with high Fibulin-1 level. Furthermore, Fibulin-1 silencing suppressed the ability of ICC tumor cells to form colonies and siFibulin-1 repressed the endogenous protein level of p-AKT.Conclusion
Collectively, this study suggests that Fibulin-1 overexpression may play key roles in the carcinogenesis and progression of ICC via regulation of tumor-related pathways. 相似文献14.
Marco Del Chiaro Elena Rangelova Asif Halimi Zeeshan Ateeb Chiara Scandavini Roberto Valente Ralf Segersvärd Urban Arnelo Caroline S. Verbeke 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):219-225
Background
Few studies have investigated the outcome of pancreatectomy associated with artery resection (PAR).Methods
Retrospective analysis of a cohort of operated borderline or locally advanced pancreatic cancer patients with surgically confirmed arterial involvement. Short and long-term outcome were analyzed and compared in patients who underwent PAR (Group 1) and palliative surgery (Group 2).Results
Of 73 patients who underwent surgical exploration with intent of resection, 34 underwent PAR (±venous resection) (Group 1) and 39 underwent palliation (Group 2). 23 patients (67.7%) in Group 1 underwent combined artery-vein resection (AVR). Operation time was longer and blood loss higher in group 1 compared to group 2. There were no differences in post-operative mortality (2.9% vs 2.6%, p = 0.9) and post-operative surgical complications (38.2% vs 25.6%, p = 0.2). The 1, 3 and 5 years survival in Group 1 was superior to Group 2 (63.7%, 23.4% and Q3 23.4% vs 41.7%, 3.2% and 0, p = 0.003).Conclusion
PAR seems to be safe and feasible in well selected patients and associated with an advantage of survival compared to palliation, in patients affected by locally advanced pancreatic cancer. 相似文献15.
Pierpaolo Cavallo Luna Carpinelli Fabiana Zingone Immacolata Sepe Mario De Santis Carolina Ciacci 《Pancreatology》2019,19(3):409-413
Background
Benign Pancreatic Hyperenzymemia (BPH) is characterized by a long-term increase of serum pancreatic enzymes (PE) in otherwise healthy subjects. The study investigates the prevalence and correlates of the condition using data from Electronic Health Records (EHR) in a large sample of general population, to identify subjects potentially affected by BPH.Methods
Cross-sectional retrospective observational study integrated by a follow-up visit.Results
The database of a reference laboratory identified, out of 577.251 admittances from 2011 to 2015, 4964 patients tested at least for one PE assay and 1688 subjects who had at least 3?PE tests (normal or increased) over two years. Forty-two individuals showed an increase of PE at least three times throughout 2 years without any evidence of pancreatic disease, even after matching with the ICD 9-CM code in the GPs database. Data retrieved at follow-up visit showed that for 34 the diagnosis of BPH could be made.Conclusions
Our data indicate that BPH prevalence among subjects underwent blood testing for multiple PE testing is 2%. This condition, even if not a disease, is perceived by nearly all the BPH patients as a serious threat to their life. Further studies are needed to manage its heavy psychological impact. 相似文献16.
Ashika D. Maharaj Liane Ioannou Daniel Croagh John Zalcberg Rachel E. Neale David Goldstein Neil Merrett James G. Kench Kate White Charles H.C. Pilgrim Lorraine Chantrill Peter Cosman Andrew Kneebone Lara Lipton Mehrdad Nikfarjam Jennifer Philip Charbel Sandroussi Peter Tagkalidis Sue M. Evans 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(4):444-455
Background
Best practise care optimises survival and quality of life in patients with pancreatic cancer (PC), but there is evidence of variability in management and suboptimal care for some patients. Monitoring practise is necessary to underpin improvement initiatives. We aimed to develop a core set of quality indicators that measure quality of care across the disease trajectory.Methods
A modified, three-round Delphi survey was performed among experts with wide experience in PC care across three states in Australia. A total of 107 potential quality indicators were identified from the literature and divided into five areas: diagnosis and staging, surgery, other treatment, patient management and outcomes. A further six indicators were added by the panel, increasing potential quality indicators to 113. Rated on a scale of 1–9, indicators with high median importance and feasibility (score 7–9) and low disagreement (<1) were considered in the candidate set.Results
From 113 potential quality indicators, 34 indicators met the inclusion criteria and 27 (7 diagnosis and staging, 5 surgical, 4 other treatment, 5 patient management, 6 outcome) were included in the final set.Conclusions
The developed indicator set can be applied as a tool for internal quality improvement, comparative quality reporting, public reporting and research in PC care. 相似文献17.
Hong Chee Chew Arjun Iyer Mark Connellan Sarah Scheuer Jeanette Villanueva Ling Gao Mark Hicks Michelle Harkness Claudio Soto Andrew Dinale Priya Nair Alasdair Watson Emily Granger Paul Jansz Kavitha Muthiah Andrew Jabbour Eugene Kotlyar Anne Keogh Kumud Dhital 《Journal of the American College of Cardiology》2019,73(12):1447-1459
Background
Transplantation of hearts retrieved from donation after circulatory death (DCD) donors is an evolving clinical practice.Objectives
The purpose of this study is to provide an update on the authors’ Australian clinical program and discuss lessons learned since performing the world’s first series of distantly procured DCD heart transplants.Methods
The authors report their experience of 23 DCD heart transplants from 45 DCD donor referrals since 2014. Donor details were collected using electronic donor records (Donate Life, Australia) and all recipient details were collected from clinical notes and electronic databases at St. Vincent’s Hospital.Results
Hearts were retrieved from 33 of 45 DCD donors. A total of 12 donors did not progress to circulatory arrest within the pre-specified timeframe. Eight hearts failed to meet viability criteria during normothermic machine perfusion, and 2 hearts were declined due to machine malfunction. A total of 23 hearts were transplanted between July 2014 and April 2018. All recipients had successful implantation, with mechanical circulatory support utilized in 9 cases. One case requiring extracorporeal membrane oxygenation subsequently died on the sixth post-operative day, representing a mortality of 4.4% over 4 years with a total follow-up period of 15,500 days for the entire cohort. All surviving recipients had normal cardiac function on echocardiogram and no evidence of acute rejection on discharge. All surviving patients remain in New York Heart Association functional class I with normal biventricular function.Conclusions
DCD heart transplant outcomes are excellent. Despite a higher requirement for mechanical circulatory support for delayed graft function, primarily in recipients with ventricular assist device support, overall survival and rejection episodes are comparable to outcomes from contemporary brain-dead donors. 相似文献18.
Rebecca T. Hahn Isaac George Susheel K. Kodali Tamim Nazif Omar K. Khalique Deniz Akkoc Alex Kantor Torsten P. Vahl Amisha Patel Elliott Elias Vivian Ng Roberto Spina Krzysztof Bartus Poonam Velagapudi Isaac Wu Martin Leon Vinayak Bapat 《JACC: Cardiovascular Imaging》2019,12(3):416-429
Objectives
This study presents a single-site experience of 5 patients with severe tricuspid regurgitation (TR) who underwent implantation of a novel transcatheter tricuspid valve replacement device.Background
Functional TR is the most common etiology of severe TR in the developed world and is associated with unfavorable clinical outcomes. Although numerous transcatheter repair devices are currently in early clinical trials, most result in incomplete degrees of TR reduction and functional improvement.Methods
Transcatheter tricuspid valve replacement was performed in 5 patients with compassionate use of the novel GATE System. All patients had symptomatic, massive and/or torrential TR at baseline. All patients had computed tomography, transthoracic and transesophageal echocardiographic assessment of the tricuspid valve and right heart anatomy. All patients had a surgical transatrial approach performed with valve implantation guided by fluoroscopy and intraprocedural transesophageal echocardiography.Results
Baseline characteristics of the patients showed a substantial burden of comorbidities. All patients had successful implantation of the transcatheter valve, with significant reduction of TR to ≤2+. Baseline poor right ventricular (RV) function measured by global longitudinal strain and RV change in pressure divided by change in time were associated with post-implantation RV failure and poor clinical outcomes in this small group. Four of the 5 patients were followed for 3 to 6 months following the initial implantation and showed evidence of RV remodeling, increased cardiac output, and reduction in New York Heart Association functional class.Conclusions
Implantation of a first-generation TTVR device was technically feasible in patients with more than severe TR. Transcatheter tricuspid valve replacement was associated with RV remodeling, increased cardiac output, and improvement in New York Heart Association functional class in most patients. Further studies are needed to refine patient population selection for this device and to determine long-term outcomes. 相似文献19.
Eleonora Avenatti G. Burkhard Mackensen Kinan Carlos El-Tallawi Mark Reisman Lara Gruye Colin M. Barker Stephen H. Little 《JACC: Cardiovascular Interventions》2019,12(6):582-591
Objectives
The authors sought to define the feasibility and performance of 3-dimensional (3D) vena contracta area (VCA) measurement in evaluating total residual mitral regurgitation (MR) following percutaneous edge-to-edge clip (E-EC) mitral valve repair.Background
Residual MR severity after percutaneous repair is not only a determinant of procedural success, but also a major prognostic factor. To date, no single echocardiographic method has been recommended for post-procedural MR quantification, with the evaluation currently relying on a complex, multiparametric appraisal.Method
The authors performed a retrospective study of patients undergoing the E-EC procedure, for which baseline and post-repair 3D color Doppler transesophageal echocardiogram datasets were available. Total VCA was recorded as the sum of individual VCAs (if more than 1) and compared with an expert multiparametric appraisal of MR severity as the reference standard. Receiver-operating characteristic analysis was performed.Results
155 patient studies were available for review. Total VCA correlated with hemodynamic parameters and was significantly reduced after E-EC. Receiver-operating characteristic analysis demonstrated a VCA threshold of 0.27 cm2 for identification of ≥moderate MR, with good diagnostic accuracy (area under the curve 0.81) and a negative predictive value of 92%. Smaller VCA was associated with clinical New York Heart Association functional class improvement at 30-day follow-up.Conclusions
Measurement of VCA is feasible using 3D color Doppler transesophageal echocardiography and provides reliable quantification of MR following E-EC transcatheter mitral valve repair. 相似文献20.
Marc A. Attiyeh Jayasree Chakraborty Lior Gazit Liana Langdon-Embry Mithat Gonen Vinod P. Balachandran Michael I. D&#x;Angelica Ronald P. DeMatteo William R. Jarnagin T. Peter Kingham Peter J. Allen Richard K. Do Amber L. Simpson 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(2):212-218