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51.
Brunilda Alushi Frederik Beckhoff David Leistner Marcus Franz Markus Reinthaler Barbara E. Stähli Andreas Morguet Hans R. Figulla Torsten Doenst Francesco Maisano Volkmar Falk Ulf Landmesser Alexander Lauten 《JACC: Cardiovascular Imaging》2019,12(4):591-601
Objectives
The authors investigated the development of pulmonary hypertension (PH), predictors of PH regression, and its prognostic impact on short, mid-, and long-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS).Background
PH represents a common finding in patients with AS. Although TAVR is frequently associated with regression of PH, the predictors of reversible PH and its prognostic significance remain uncertain.Methods
In this study, 617 consecutive patients undergoing TAVR between 2009 and 2015 were stratified per baseline tertiles of pulmonary artery systolic pressure (PASP) as follows: normal (PASP <34 mm Hg), mild-to-moderate (PASP ≥34 mm Hg and <46 mm Hg), and severe PASP elevation (PASP ≥46 mm Hg). After TAVR, 520 patients with PH at discharge were stratified according to the presence or absence of PASP reduction. Primary outcome was all-cause mortality at 30 days, 1 year, and long-term follow-up at a maximum of 5.9 years.Results
In patients with both mild-to-moderate and severe PH at baseline, PASP decreased significantly at discharge (ΔPASP 3.0 ± 9.3 mm Hg and 12.0 ± 10.0 mm Hg, respectively) and 1 year (ΔPASP 5.0 ± 9.7 mm Hg and 18.0 ± 14.0 mm Hg, respectively). At a median follow-up of 370 days (interquartile range [IQR]: 84 to 500 days), the risk of all-cause mortality was similar among baseline PASP groups at all time intervals evaluated. After TAVR, a significant regression of PH was observed in 46% of patients. Contrarily, patients with residual PH had a higher risk of all-cause mortality at 30 days (hazard ratio [HR]: 3.49, 95% confidence interval [CI]: 1.74 to 6.99; p < 0.001), 1 year (HR: 3.12, 95% CI: 2.06 to 4.72; p < 0.001), and long-term (HR: 2.47, 95% CI: 1.74 to 3.49; p < 0.001). Left ventricular ejection fraction (LVEF) >40% (odds ratio [OR]: 3.56, 95% CI: 2.24 to 5.65; p < 0.001), baseline PASP ≥46 mm Hg (OR: 3.26, 95% CI: 2.07 to 5.12; p < 0.001), absence of concomitant tricuspid regurgitation (TR) ≥ moderate (OR: 0.53, 95% CI: 0.34 to 0.84; p < 0.001), and logistic EuroSCORE <25% (OR: 1.59, 95% CI: 1.04 to 2.45; p = 0.03) were independent predictors of PASP reduction.Conclusions
In most patients with PH and AS, TAVR is associated with a significant early and late reduction of PASP. Patients with reversible PH after TAVR are at lower risk of all-cause mortality at early, mid-, and long-term follow-up. Therefore, the presence of PH should not preclude treatment with TAVR. 相似文献52.
楔状缺损是一种常见的牙体硬组织非龋性疾病,刷牙、酸的作用、牙颈部结构及力作用是其常见的病因。近20年来,临床研究中根据该病的一些特殊表现,研究了力对楔状缺损形成的影响,本文就引起楔状缺损的力因素这个病因作一综述。 相似文献
53.
Фʥ����̷�������ι������ �������Һ� 《中国实用口腔科杂志》2015,8(12):760-764
??Centric relation is a vital factor in the prosthodontics of full denture?? occlusion reconstruction?? checkup and treatment of occlusion dysfunction?? dental prosthodontics?? orthodontic treatment?? temporomandibular joint disorder and so on. Traditional methods to construct the centric relation mainly include gothic arch tracing??swallowing and occluding method??retroflex licking method ??functional reflex method??Chin-point guidance method??bimanual manipulation method??recording of mandibular movement?? Myo-monitor?? and so on. All of them are quite flexible and difficult to repeat the same position??which is not suitable for the beginners. Patients' active cooperation is also necessary. This review summarized traditional methods to construct the centric relation?? and introduced a new tool named Leaf Gauge which can be used to record the accurate centric relation. It does not need sufficient clinical experience and is easy to grasp. 相似文献
54.
目的比较超声引导下竖脊肌平面阻滞和椎旁神经阻滞对VATS患者术后镇痛和恢复的影响。方法纳入拟择期进行VATS的患者80例,年龄18~80岁,ASA分级Ⅰ~Ⅱ级,体重≥40kg。患者被随机分配到竖脊肌平面阻滞组(ESPB组,n=40)和椎旁神经阻滞组(PVB组,n=40),分别使用30、20mL 0.375%罗哌卡因进行阻滞。主要观察指标是术后第1天的40项恢复量表(QoR-40)评分,次要观察指标是术后1、6和12h的NRS疼痛评分。同时记录患者术中舒芬太尼的使用量、术后并发症的发生情况以及患者满意度。结果ESPB组和PVB组术后第1天的QoR-40量表评分(P=0.829)及术后1、6和12h的NRS疼痛评分差异均无统计学意义(P=0.0655、P=0.423、P=0.426)。两组患者术中舒芬太尼的使用量和术后并发症的发生情况也均无明显差异。ESPB组的患者满意度更高(P=0.0033)。结论超声引导下竖脊肌平面阻滞在加快VATS患者康复和术后镇痛方面与椎旁神经阻滞效果相当。竖脊肌平面阻滞可以作为一种新型的区域神经阻滞技术广泛应用于临床。 相似文献
55.
56.
Construction of a single complete denture (SCD) is a challenging clinical situation especially when the opposing natural dentition is not in a normal plane of occlusion. Mal-aligned, tilted or supra-erupted teeth in the opposing arch are some of the problems that should be corrected to achieve a balanced occlusion in patients who require SCD. Achieving harmonious occlusal plane is a primary objective of any restorative procedure to facilitate natural mandibular movements and ease of mastication. Establishment of normal occlusal plane in opposite arch is pre-requisite to maintain the stability of the SCD. This clinical report describes restoration of mandibular teeth (with severe attrition and deranged occlusion) by establishing normal plane of occlusion with the help of custom made occlusal plane template (OPT) followed by construction of a complete denture in maxillary arch. 相似文献
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