- 作者列表："Mehdiani A","Sorokin VA","Sule J","Smiris K","Stadnik D","Lichtenberg A","Blehm A
BACKGROUND:Full aortic root replacement with biological conduit has limited options. This non-randomized cohort study aims to compare mid-term clinical and hemodynamic results of the BioIntegral (BI) composite biological versus the stentless Freestyle (FS) conduits in patients undergoing full aortic root replacement. METHODS:From February 2013 to July 2017, 265 patients underwent aortic root replacement at a single institution (202 BI, 65 FS). Preoperative, intraoperative and postoperative parameters, complications including stroke, myocardial infarction (MI), endocarditis and reoperation were studied. Hemodynamic performance of both conduits was analyzed by echocardiography. Target endpoints were 30-day mortality, two-year survival, two-year freedom from major adverse valve-related and cardiovascular events. RESULTS:Wider BI conduits were used (BI 27±2 vs. FS 25±2 mm, P<0.0001). The BI group had shorter cardiopulmonary bypass (BI 165±67 vs. FS 200±78 min, P<0.0001) and cross-clamp (BI 102±36 vs. FS 122±40 min, P=0.001) times. Thirty-day mortality was similar in both groups. There were fewer conduit-related reoperations in the BI group (BI 0% vs. FS 3%, P=0.012) but higher postoperative atrial fibrillation (BI 31% vs. FS 17%, P=0.025). No significant differences were observed for stroke (BI 5% vs. FS 10%, P=0.947), MI (BI 3% vs. FS 4%, P=0.583), or infective endocarditis (BI 0% vs. FS 2%, P=0.077). No significant hemodynamic differences were evident on follow-up echocardiography while an improved overall survival trend was seen in the BI group (P=0.062). CONCLUSIONS:FS and BI provide comparable clinical mid-term results and hemodynamic parameters. Simplified implantation technique providing shorter cardiopulmonary bypass and operation times are advantageous for BI.
背景: 用生物导管进行全主动脉根部置换的选择有限。这项非随机队列研究旨在比较接受全主动脉根部置换的患者中生物积分 (BI) 复合生物学与无支架自由式 (FS) 导管的中期临床和血流动力学结果。 方法: 从2013年2月至2017年7月，265例患者在单一机构接受主动脉根部置换术 (202 BI，65 FS)。研究了术前、术中及术后参数，并发症包括卒中、心肌梗死 (MI) 、心内膜炎和再次手术。通过超声心动图分析两个导管的血流动力学性能。目标终点是30天死亡率，2年生存率，2年无主要不良瓣膜相关和心血管事件。 结果: 使用较宽的BI导管 (BI 27 ± 2 vs. FS 25 ± 2毫米，P<0.0001)。BI组心肺转流时间缩短 (BI 165 ± 67 vs. FS 200 ± 78 min，P<0.0001) 和交叉钳夹 (BI 102 ± 36 vs. FS 122 ± 40 min，P = 0.001) 次。两组的30天死亡率相似。BI组中导管相关的再次手术较少 (BI 0% vs. FS 3%，P = 0.012)，但术后房颤较高 (BI 31% vs. FS 17%，P = 0.025)。未观察到卒中 (BI 5% vs. FS 10%，P = 0.947)，MI (BI 3% vs. FS 4%，P = 0.583) 或感染性心内膜炎 (BI 0% vs. FS 2%，P = 0.077) 的显著差异。在随访的超声心动图中没有明显的血流动力学差异，而在BI组中观察到改善的总体生存趋势 (P = 0.062)。 结论: FS和BI提供了可比较的临床中期结果和血流动力学参数。简化的植入技术提供更短的心肺转流和手术时间对于BI是有利的。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.