OBJECTIVES: To evaluate the one-year outcomes of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) using SAPIEN 3 valve for treating mitral bioprosthetic valve failure. METHODS: A retrospective analysis was conducted on 26 patients with mitral bioprosthetic valve failure who underwent ViV-TMVR at West China Hospital, Sichuan University, between November 2022 and July 2024. The age of patients was 71.5 (64.5, 74.5) years, and 69.2% were female. Bioprosthetic valve failure occurred at (9.7±3.7) years after initial surgical implantation, with the most common failure mode being mixed stenosis and regurgitation (53.8%). The SAPIEN 3 valve was implanted via either a transseptal or transapical approach. Echocardiography was performed preoperatively, immediately post-procedure, and at 1 month, 6 months, and 1 year post-procedure. Outcomes included all-cause mortality, New York Heart Association (NYHA) functional class, Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score, and postoperative complications. RESULTS: The procedure was performed via the transseptal approach in 21 patients (80.8%) and the transapical approach in 5 patients (19.2%). All procedures were technically successful. No paravalvular leakage was observed immediately post-procedure, and mitral valve hemodynamics improved significantly. At the 1-year follow-up, 2 patients had died. Two patients (8.3% of survivors) were of NYHA functional class Ⅲ, and KCCQ-12 score improved to (88.4±14.6) points (both P<0.01). Echocardio-graphy at 1 year postoperatively showed significant reductions in peak mitral valve velocity [to (2.29±0.32) m/s] and mean transvalvular pressure gradient [to (9.5±3.5) mmHg, 1 mmHg=0.133 kPa] compared to baseline (both P<0.05). No moderate or severe mitral regurgitation or paravalvular leakage was observed. The proportion of patients with moderate-to-severe pulmonary hypertension decreased from 65.4% preoperatively to 13.0% at 1 year (P<0.05). CONCLUSIONS ViV-TMVR with the SAPIEN 3 valve for mitral biopro-sthetic valve failure is associated with high procedural success, significantly improved valve hemodynamics of the mitral value, alleviation of pulmonary hypertension, enhanced quality of life, and a low rate of complications at 1 year after the operation.
Humans ; Female ; Male ; Retrospective Studies ; Aged ; Bioprosthesis ; Heart Valve Prosthesis ; Mitral Valve/surgery* ; Heart Valve Prosthesis Implantation/methods* ; Middle Aged ; Prosthesis Failure ; Treatment Outcome ; Mitral Valve Insufficiency/surgery*

Objective:To investigate the safety and efficacy of transcatheter aortic valve replacement (TAVR) with self-expandable bioprosthetic valves (Evolut PRO, Medtronic Inc.) in elderly patients with aortic stenosis.Methods:This single-center, single-arm, retrospective cohort study included all consecutive patients who underwent TAVR using Evolut PRO at West China Hospital of Sichuan University between May 2022 and July 2024, and collected all their data at baseline, postoperative, and 30 days. The primary endpoint was all-cause mortality, and secondary endpoints included cardiac mortality, stroke, permanent pacemaker implantation(PPI), bleeding events, vascular and peripheral access complications, acute kidney injury, and hemodynamic data.Results:70 patients were included in the study, including 25 of (35.7%) tricuspid aortic valve (TAV), 23 (32.9%) of Type 0 bicuspid aortic valve (BAV) 20 (28.6%) of Type 1 BAV, and 2 (2.9%) of Type 2 BAV. The mean age was (72.9±6.6) years, 37 (52.9%) were male, and 70 (100%) had a New York Heart Association (NYHA) grade Ⅲ or Ⅳ. Sixty-nine (98.6%) achieved successful surgery, and 1 patient (1.4%) was converted intraoperatively to open-chest surgery. At 30 days, all-cause and cardiovascular mortality were 0, the incidence of stroke was 0, the rate of PPI was 8.7%, and no moderate or greater paravalvular leaks were observed. All patients improved to Class Ⅰ or Ⅱ after receiving TAVR. The mean aortic valve gradient (AVG) decreased from (54.1 ± 18.0 )mmHg(1mmHg=0.133kPa) at baseline to (10.5 ± 5.2)mmHg at 30 days. There were no significant differences in the results among the Type 0 BAV, Type 1/2 BAV, and TAV groups.Conclusion:Evolut PRO is safe and effective in early clinical treatment of elderly patients with aortic valve stenosis.

Objective:To investigate the safety and efficacy of transcatheter aortic valve replacement (TAVR) with self-expandable bioprosthetic valves (Evolut PRO, Medtronic Inc.) in elderly patients with aortic stenosis.Methods:This single-center, single-arm, retrospective cohort study included all consecutive patients who underwent TAVR using Evolut PRO at West China Hospital of Sichuan University between May 2022 and July 2024, and collected all their data at baseline, postoperative, and 30 days. The primary endpoint was all-cause mortality, and secondary endpoints included cardiac mortality, stroke, permanent pacemaker implantation(PPI), bleeding events, vascular and peripheral access complications, acute kidney injury, and hemodynamic data.Results:70 patients were included in the study, including 25 of (35.7%) tricuspid aortic valve (TAV), 23 (32.9%) of Type 0 bicuspid aortic valve (BAV) 20 (28.6%) of Type 1 BAV, and 2 (2.9%) of Type 2 BAV. The mean age was (72.9±6.6) years, 37 (52.9%) were male, and 70 (100%) had a New York Heart Association (NYHA) grade Ⅲ or Ⅳ. Sixty-nine (98.6%) achieved successful surgery, and 1 patient (1.4%) was converted intraoperatively to open-chest surgery. At 30 days, all-cause and cardiovascular mortality were 0, the incidence of stroke was 0, the rate of PPI was 8.7%, and no moderate or greater paravalvular leaks were observed. All patients improved to Class Ⅰ or Ⅱ after receiving TAVR. The mean aortic valve gradient (AVG) decreased from (54.1 ± 18.0 )mmHg(1mmHg=0.133kPa) at baseline to (10.5 ± 5.2)mmHg at 30 days. There were no significant differences in the results among the Type 0 BAV, Type 1/2 BAV, and TAV groups.Conclusion:Evolut PRO is safe and effective in early clinical treatment of elderly patients with aortic valve stenosis.

Objective:To evaluate the efficacy between pedicle screws combined with vertebroplasty (PSV) and pedicle screws combined with intermediate screws (PSIS) for the treatment of osteoporotic thoracolumbar fracture (OTLF).Methods:PubMed, Cochrane Library, Web of Science, CNKI, VIP and Wanfang database were searched for all randomized controlled trial (RCT) or case-control trial (CCT) studies that comparing PSV and PSIS for the treatment of OTLF. Two reviewers independently screened the studies in the light of the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. The Meta-analysis was performed using the RevMan 5.4 software. The subjects were divided into PSV group and PSIS group according to different treatment methods. Operation time, intraoperative blood loss, postoperative incision infection rate, postoperative short-, mid- and long-term visual analogue scale (VAS) score, postoperative short- and mid-term Oswestry disability index (ODI), hospitalization time, postoperative short-, mid- and long-term Cobb angle, postoperative short-, mid- and long-term anterior vertebral height ratio (VBH) and implant failure rate were compared between the two groups.Results:A total of 12 studies were enrolled for review, involving 870 subjects (433 in PSV group and 437 in PSIS group). The results showed insignificant difference between the two groups in operation time ( WMD=7.07, 95% CI -4.00, 18.13, P>0.05), intraoperative blood loss ( WMD=0.62, 95% CI -7.19, 8.43, P>0.05), postoperative incision infection rate ( OR=0.65, 95% CI 0.10, 4.08, P>0.05), postoperative short-term Cobb angle ( WMD=-0.19, 95% CI -0.43, 0.05, P>0.05) and postoperative short-term VBH ( WMD=0.91, 95% CI -1.30, 3.13, P>0.05). However, there was significant difference between the two groups in postoperative short-term VAS score ( WMD=-0.59, 95% CI -1.02, -0.15, P<0.05), mid-term VAS score ( WMD=-0.41, 95% CI -0.65, -0.16, P<0.05), long-term VAS score ( WMD=-0.51, 95% CI -0.59, -0.43, P<0.05), postoperative short-term ODI ( WMD=-6.26, 95% CI -9.65, -2.87, P<0.05), postoperative mid-term ODI ( WMD=-2.44, 95% CI -3.43, -1.45, P<0.05), hospitalization time ( WMD=-2.65, 95% CI -4.61, -0.68, P<0.05), postoperative mid-term Cobb angle ( WMD=-1.40, 95% CI -2.41, -0.39, P<0.05), postoperative long-term Cobb angle ( WMD=-1.06, 95% CI -1.59, -0.52, P<0.05), postoperative mid-term VBH ( WMD=3.06, 95% CI 1.31, 4.81, P<0.05), postoperative long-term VBH ( WMD=4.11, 95% CI 2.44, 5.77, P<0.05) and implant failure rate ( OR=2.06, 95% CI 0.11, 0.59, P<0.05). Conclusion:Compared with PSIS, PSV can not reduce the operation time, intraoperative blood loss and incision infection in the treatment of OTLF, but it can significantly relieve pain, improve function, decrease reduce hospitalization time, help to maintain Cobb angle and anterior vertebral height after operation, and reduce implant failure rate.

Objective:To compare the efficacy of percutaneous vertebroplasty (PVP) in the treatment of osteoporotic lumbar compression fracture (OLCF) via the approach through midpoint transverse process-transition zone of articular process and the unilateral transpedicular approach.Methods:A prospective cohort study was conducted to analyze the clinical data of 794 patients with OLCF treated in Honghui Hospital affiliated to Xi′an Jiaotong University School of Medicine from January 2017 to December 2019. The patients were divided into transitional-zone puncture group (400 patients, 400 vertebrae) and pedicle puncture group (394 patients, 394 vertebrae) according to the envelope method. The transitional-zone puncture group was treated with PVP via the approach through midpoint transverse process-transition zone of articular process, and the pedicle puncture group was treated with PVP via the unilateral transpedicular approach. The operation time and radiation dose were documented. The visual analogue score (VAS) and Oswestry dysfunction index (ODI) were evaluated before operation and at 1 day, 3 months, 1 year after operation. The cement distribution and the incidence of complications such as cement leakage, re-fracture of the injured vertebra, spinal cord nerve injury and facet joint injury were detected.Results:The patients were composed of 270 males and 524 females, at the age of 68.9-78.5 years [(73.7±4.8)years]. All patients were followed up for 12-14 months [(13.4±0.8)months]. The operation time and radiation dose in transitional-zone puncture group were reduced compared with pedicle puncture group ( P<0.01). There was no significant difference in VAS and ODI between the two groups before operation (all P>0.05). The VAS between transitional-zone puncture group [(2.1±0.9)points, (2.3±1.1)points, (2.7±1.3)points] and pedicle puncture group [(2.3±0.7)points, (2.5±0.9)points, (2.9±1.1)points] was obviously reduced from that before operation (all P<0.01), significantly different at 1 day, 3 months, 1 year after operation ( P<0.05 or 0.01). The ODI between transitional-zone puncture group (14.3±1.8, 13.6±3.4, 11.3±4.4) and pedicle puncture group (25.5±5.7, 20.7±6.3, 20.6±6.9) was significantly different at 1 day, 3 months, 1 year after operation (all P<0.01), and all were obviously reduced from that before operation (all P<0.01). With regard to the cement distribution, the number of bilaterally cemented vertebrae in transitional-zone puncture group (324) was more than that in pedicle puncture group (94) ( P<0.01). The incidence of cement leakage, re-fracture of the injured vertebra and facet joint injury was 8.25%(22/400), 0.00%(0/400) and 3.25%(13/400) in transitional-zone puncture group, significantly different from 20.81%(82/394), 2.03%(8/394) and 9.90%(39/394) in pedicle puncture group ( P<0.05 or 0.01). There was no significant difference in spinal cord nerve injury between the two groups ( P>0.05). Conclusion:For OLCF, PVP via the approach through the midpoint transverse process-transition zone of articular process and the unilateral transpedicular approach are both effective, but the former has advantages of shorter operation time, smaller radiation dose, greater dispersion of bone cement and lower incidence of cement leakage, re-fracture of the injured vertebra and facet joint injury.

Objective To evaluate the role of emergency and staged hepatectomy in peritoneal metastasis associated with ruptured hemorrhage of resectable hepatocellular carcinoma (HCC) patients,and investigate the impact of surgery timing-selecting on peritoneal metastasis of postoperative HCC patients.Methods A retrospective analysis was conduct on the pooled data from 38 HCC patients with spontaneously ruptured hemorrhage treated in our hospital from August 2011 to January 2016.These patients were divided into emergency group who underwent hepatectomy within 24 hours at admission,and staged group who underwent the procedure one week after admission.Perioperative events,overall survival (OS) and disease-freesurvival (DFS) rates,incidence of recurrent and metastatic disease were compared between the two groups.Results The perioperative blood loss and transfusion were much more in emergency group than staged group (both P ＜ 0.05).Nevertheless,the incidence of postoperative mortality was not significantly different (6.0％ vs 0％,P ＞ 0.05).The median survival was 22.5 months in emergency group versus 14.2 months in staged group.The 6-month,1-year,3-year OS rates in emergency group were 88.2％,82.4％ and 30.3％ respectively,and 6-month,1-year,3-year DFS rates were 81.3％,54.7％ and 27.3％.The 1-year OS and 6-month DFS rates were higher than those of staged group (both P ＜ 0.05).The incidence of peritoneal metastasis in staged group was higher than that in emergency group,but it was not significantly different (38.1％ vs 29.4％,P ＞ 0.05).Univariate and multivariate analysis indicated that tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were the risk factors for peritoneal metastasis after hepatectomy for HCC patients with spontaneously ruptured hemorrhage.Conclusions Emergency hepatectomy would warrant a better short-term prognosis compared with staged hepatectomy for the HCC patients with spontaneously ruptured hemorrhage.Staged hepatectomy would not raise the possibility of postoperative peritoneal metastasis.The predictors of tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were risk factors for peritoneal metastasis after hepatectomy for spontaneously ruptured HCC patients.

Objective To study the process conditions for new gel Capto DEAE ion exchange chromatography to purify prothrombin complexes concentrates.Methods After removal of cryoprecipitate by centrifugation, healthy human plasma was mixed with DEAE-Sephadex A-50 gel.After that, the gel were washed and eluted to obtain eluate; then, the eluate, after being ultrafiltered, was loaded on a column packed with Capto DEAE-gel for chromatography to prepare PCC which was later determined for activities of coagulation factors Ⅱ,Ⅶ,Ⅸ,Ⅹ and anticoagulation protein C, with their yield calculated.Besides, the protein concentration of PCC was determined using the Bradford method, based on which the specific activity of the four coagulation factors and protein C were calculated. According to the results, purification effect of Capto DEAE-gel on the PCC was analyzed. Results Under different experimental conditions, the yield and purity of the coagulation factors FⅡ,FⅨ and FⅩ were high, and the equilibrum degree of the three factors was good;however, the yield and purity of coagulation factor FⅦwere very low.When the three variables ( sodium citrate, NaCl and pH) in balanced solution, washing solution and elution were 0.020-0.028 mol/L, 0.10-0.15 mol/L and 6.9-7.2;0.012-0.020 mol/L, 0.10-0.15 mol/L and 6.9-7.2;0.005-0.012 mol/L, 2.4 mol/L and 7.2-7.5 , respectively,the yield and purity of PCC prepared from Capto DEAE-gel were good. Under this condition, yield of factor Ⅸ was ( 74.40 ±10.89 )% and purity of factor Ⅸ was ( 3.31 ±0.31 ) IU/mL.Under different experimental conditions, yield and specific activity of anticoagulant protein C were higher.Conclusion The purity of four coagulation factors and anticoagulation protein C of PCC prepared by the new method that combined the batch adsorption with DEAE-sephadex A-50 was combined with column chromatography packed with Capto DEAE-gel are higher than those prepared by the routine procedure.Furthermore, the PCC are better than these products obtained by traditional process, whose purity are 2.17-3.31IU/mg.Therefore, these studies will lay the groundwork for exploring novel preparation process of producing PCC.

Objective To study the inlfuence factors on detection of activity of four coagulation factors in prothrombin complex concentrates (PCC) by several factors. Methods Using Pharmacopoeia of the People’s Republic of China (2010) as reference, the activity of four coagulation factors in PCC were investigated by choosing different pre-treatments, different diluents, different salt concentration, different standard human plasma and different company reagents. Results The activity of FII, FVII, FX were decreased and FIX was increased in the condition of adding protamine sulfate, and there were no differences of four coagulation factors whether warm bath in 37 for 15 min or not. However, the differences of four coagulation factors were significant by using deficient plasma, saline, distilled water and commercial dilution buffer(P<0.05). The activity of coagulation factor II, X in 1 mol/L salt concentration of PCC were significantly lower than in 0.25 mol/L(P<0.05), while coagulation factor VII, IX were not. The activity of FII, FVII, FIX, and FX were different by using different standard human plasma to make standard curve. The activity of four coagulation factors existed significant difference(P=0.00) by using SIEMENS company reagents and domestic reagents. Conclusion Choosing different pre-treatments, different dilution buffers, salt concentration, standard human plasma and commercial kits will inlfuence the detection result of coagulation factors.

Neuroendocrine carcinoma of the pancreas is uncommon in clinic,which has a low malignancy,maintains indolent patterns of growth,and has a good long-term prognosis.However,because of its atypical clinical manifestation,its delayed presentation often results in distant metastasis,in which the liver is the most common site.Currently,the treatment of pancreatic neuroendocrine liver metastasis is limited and requires a diverse and multidisciplinary combination of therapy.This manuscript will discuss the current status of treating pancreatic neuroendocrine carcinoma liver metastasis.