Transcatheter aortic valve implantation in patients with severe symptomatic aortic valve stenosis: systematic review of cost-effectiveness analysis

The European Journal of Health Economics - Transcatheter aortic valve implantation (TAVI) is a less invasive and costly treatment for patients with severe aortic stenosis (AS). This study aimed to...     

Ambulatory nursing care for patients with aortic valve disease

This study aimed at characterizing the profile of outpatients with aortic valve dysfunction, identifying their knowledge about the disease, their major limitations during everyday activities and their means of coping with their predicament. The data obtained by semi-structured interviews with 12 patients and analyzed by quantitative and qualitative methods enabled to identify how the patients perceive the illness and the treatment as well as the implications to their everyday activities, that is, they allowed to capture reality from the subject's perspective, which is the knowledge for the elaboration of an educational proposal.     

Coronary arteriography rates in Switzerland--how do they vary?

Coronary heart disease is a leading cause of death for both sexes in developed countries. Controversy has arisen about the health benefits and risks of coronary surgery and, more recently of coronary angioplasty. As a clinical prerequisite to these interventions, coronary arteriography can be considered an indicator of invasive services offered to coronary heart disease patients. We collected data on characteristics of all patients subjected to coronary arteriography during 1984 in Switzerland. A total of 4921 coronary arteriographies were performed among 4359 patients; this corresponds to 77 procedures/100,000 residents and 68 patients/100,000 residents. Rates for men are 4.2 times women's rates, and the highest utilization rate for both sexes are observed in the group aged 40-64. Large variations characterize cantonal and regional coronary arteriography rates. Similarly, the distribution of centers practising this procedure is not uniform. These observations are placed in the context of the general practice of coronary angiography, changes expected in the face of by-pass surgery and angioplasty expansion, and coronary heart disease data.     

Predictors of health-related quality of life decline after transcatheter aortic valve replacement in older patients with severe aortic stenosis

Background

Transcatheter aortic-valve implantation (TAVI) has been shown to improve survival and quality of life in patients with severe aortic stenosis. However, one-third of patients have poor outcome as death, functional decline or quality of life (QoL) decline. The aim of this study was to determine cardiac and geriatric predictors of physical and mental QoL decline 6 months after a TAVI procedure in patients aged 75 and older.

Methods

Between January 2013 and June 2014, we did a prospective and multicenter study including patients ≥ 75 years old referred for TAVI. The primary outcome was the measure of QoL, assessed by the Short Form 36 survey (SF-36), before and 6 months after the intervention. Association between QoL decline and baseline characteristics including cardiac and geriatric factors was analysed by logistic regression models.

Results

Mean age of the 150 patients studied was 83.7 years old and 56% were men. The primary end point, mean SF-36 physical summary score, significantly improved between baseline and 6-month (33.6 vs. 36.4, p=0.003) whereas mental component score significantly decreased (48.2 vs. 36.4, p-value<0.001). However, patients with presence of depressive symptoms before the intervention had mental QoL improvement at six months (OR 0.04 [0.01-0.19], p-value<0.001) and no significant geriatric predictors were associated with physical QoL decline.

Conclusion

The mental QoL significantly decreased and patients with preoperative depressive symptoms had mental QoL improvement at six months. Researches are needed to confirm that mental QoL of patients with depressive symptoms can be improved by TAVI.

     

主动脉瓣感染性心内膜炎瓣膜置换术后远期效果

 目的 探讨自体主动脉瓣单独受累感染性心内膜炎（IE）对外科主动脉瓣置换术（SAVR）远期预后的影响。方法 回顾性分析2013年1月—2017年12月在首都医科大学附属北京安贞医院行SAVR的自体主动脉瓣单独受累IE患者的病历资料,同时采用倾向性评分匹配（PSM）非IE对照组患者,对所有入组患者进行长期随访,观察术后生存率及并发症累积发生风险,中位随访时间为69个月。结果 共纳入2 821例患者,其中IE SAVR患者143例（IE组）,非IE的SAVR患者2 678例（对照组）。IE组患者长期生存率低于非IE配对对照组,差异有统计学意义（P=0.044）。IE患者SAVR手术后更容易发生缺血性脑卒中事件,差异有统计学意义（P=0.035）,且缺血性脑卒中事件为影响患者生存的独立危险因素（P=0.014）,发生缺血性脑卒中患者的死亡风险更高（HR=2.811;95%CI：1.233~6.408）。IE组患者大出血累积发生率和主动脉瓣再手术率与非IE配对对照组比较,差异均无统计学意义（均P>0.05）,且均不是影响患者生存的独立危险因素（均P>0.05）。结论 与非IE对照组患者相比,自体主动脉瓣单独受累IE患者行SAVR后发生死亡、缺血性卒中的风险更高。应加强对IE患者行SAVR后的密切随访,重点预防脑卒中等并发症。     

重度三尖瓣病变行三尖瓣置换术27例临床应用

目的 探讨三尖瓣置换术(TVR)手术指征及方式,总结三尖瓣病变的手术治疗经验.方法 2005年9月至2010年5月共施行TVR 27例,其中置换生物瓣膜23例,机械瓣膜4例;同期行二尖瓣置换术8例,二尖瓣、主动脉瓣双瓣膜置换术4例,房间隔缺损修补术4例.结果 手术病死率为11.1％(3/27),其中2例术后死于重度低心排血量综合征,1例术后第7天死于多器官功能衰竭.术后二次开胸止血1例,经积极治疗后顺利康复出院.随访率91.7％(22/24),1例术后3年死于生物瓣膜毁损,1例术后19个月死于脑栓塞.随访期间心功能NYHA分级恢复至Ⅰ级6例,Ⅱ级14例.结论 行TVR的患者中、远期病死率均较高,对于严重的三尖瓣病变患者,正确的手术方式、合理的围手术期处理是手术成功的关键.对于年龄大于50岁、随访不便以及未生育适龄女性患者来说,优先考虑置换生物瓣膜.