Transcatheter aortic valves implantation have been widely used in patients with high risk of non-surgical or surgical procedures since the first implantation in 2002, and have achieved good therapeutic results. However, as one of the main complications after transcatheter aortic valve implantation, paravalvular regurgitation seriously affects the outcome of patients. This article reviews recent researches on transcatheter aortic valve paravalvular regurgitation, and summarizes the influencing factors of paravalvular regurgitation after transcatheter aortic valve implantation and the corresponding countermeasures. This review can provide guidance and reference for clinical application and research of transcatheter aortic valves.
Objective To identify the heart sounds of aortic stenosis by deep learning model based on DenseNet121 architecture, and to explore its application potential in clinical screening aortic stenosis. Methods We prospectively collected heart sounds and clinical data of patients with aortic stenosis in Tianjin Chest Hospital, from June 2021 to February 2022. The collected heart sound data were used to train, verify and test a deep learning model. We evaluated the performance of the model by drawing receiver operating characteristic curve and precision-recall curve. Results A total of 100 patients including 11 asymptomatic patients were included. There were 50 aortic stenosis patients with 30 males and 20 females at an average age of 68.18±10.63 years in an aortic stenosis group (stenosis group). And 50 patients without aortic valve disease were in a negative group, including 26 males and 24 females at an average age of 45.98±12.51 years. The model had an excellent ability to distinguish heart sound data collected from patients with aortic stenosis in clinical settings: accuracy at 91.67%, sensitivity at 90.00%, specificity at 92.50%, and area under receiver operating characteristic curve was 0.917. Conclusion The model of heart sound diagnosis of aortic stenosis based on deep learning has excellent application prospects in clinical screening, which can provide a new idea for the early identification of patients with aortic stenosis.
ObjectiveTo study the correlation between Periostin, interleukin-33 (IL-33), and chronic cough after thoracoscopic lobectomy in patients with coronary artery bypass grafting (CABG) combined with lung cancer. Methods A total of 102 lung cancer patients at Tianjin Chest Hospital from January 2022 to January 2024 were prospectively enrolled, and they were divided into a chronic cough group and a non chronic cough group based on whether chronic cough occurred after surgery. Serum levels of Periostin and IL-33 were measured on the 1st, 7th, and 14th days post-lobectomy. The Pearson method was employed to analyze the correlation between Periostin and IL-33 levels and the severity of cough. Univariate and multivariate logistic regression analyses were conducted to identify factors influencing the occurrence of chronic cough. Additionally, ROC curve analysis was utilized to assess the potential value of serum Periostin and IL-33 levels in predicting postoperative chronic cough. Results In patients with chronic cough, the peripheral blood Periostin and IL-33 levels measured on days 7 and 14 were significantly higher than those in patients with non-chronic cough, and the interactions between the two groups and at different time points were significant (P<0.001). The degree of cough was positively correlated with the levels of Periostin and IL-33 on days 7 and 14 (P<0.05), but had no significant correlation with the levels on day 1 (P>0.05). In patients with lung cancer, after thoracoscopic lobectomy, Periostin [OR=1.619, 95%CI (1.295, 2.025)] and IL-33 [OR=1.831, 95%CI (1.216, 2.758)] on day 7 and Periostin on day 14 [OR=1.952, 95%CI (1.306, 2.918)] and IL-33 [OR=1.742, 95%CI (1.166, 2.603)] were identified as risk factors for chronic cough. ROC curve analysis showed that the sensitivity of Periostin on day 7 was 69.05%, the specificity was 71.67%, and the AUC was 0.756 [95%CI (0.616, 0.893)]. The sensitivity of Periostin on day 14 increased to 71.43% and the specificity was 76.67%, AUC was 0.762 [95%CI (0.633, 0.898)]. At the same time, the critical value of IL-33 on day 7 was 45.03 pg/mL, the sensitivity and specificity were both 83.33%, the AUC was 0.884 [95%CI (0.789, 0.980)], and the critical value of IL-33 on day 14 was 56.01 pg/mL, the sensitivity was 85.71%, the specificity was 80.00%, and the AUC was 0.899 [95%CI (0.799, 0.999)]. Further regression analysis showed that the sensitivity was 95.24%, the specificity was 95.00%, and the AUC reached 0.993 [95%CI (0.979, 1.000)]. Conclusion Periostin and IL-33 levels, measured at various time points, are abnormally elevated following thoracoscopic lobectomy in patients with combined CABG and lung cancer. These levels significantly correlate with cough severity. Given their predictive potential for chronic cough, these markers are deemed valuable biomarkers.
Objective To investigate the impact of red blood cell suspension infusion across various perioperative periods on patients with valvular heart disease. Methods The patients with valvular heart disease admitted to Tianjin Chest Hospital from 2018 to 2020 were selected. Based on the timing of perioperative red cell suspension infusion, patients were categorized into three groups: a group 1 receiving intraoperative red cell suspension infusion, a group 2 receiving red cell suspension infusion within 24 hours after entering the ICU, and a group 3 receiving red cell suspension infusion at both time points. The laboratory results, perioperative blood component infusion volume, and other relevant parameters were retrospectively analyzed. After propensity score matching, the differences in different variables among the three groups were compared. Results After propensity score matching, 102 patients were enrolled, including 52 males and 50 females, with an average age of (61.74±10.58) years. There were 34 patients in each group. The preoperative hemoglobin (Hb) value of the group 2 was significantly higher than that of the group 1 and the group 3, and the amount of red cell suspension and autoblood transfusion was the lowest (P<0.05). In the group 1, Hb was the highest after surgery, Hb was the highest within 24 hours after surgery. HCT was the highest within 24 hours after surgery (P<0.05). The group 1 had the lowest plasma, platelet and cryoprecipitate infusion volumes, and the shortest cardiopulmonary bypass time, aortic occlusion time, postoperative ICU stay and hospital stay, and the least blood loss, total drainage volume (P<0.05). The difference between postoperative Hb and preoperative △Hb1 was significantly increased in the group 1 (P<0.05). Conclusion The intraoperative infusion of suspended red blood cells in patients with heart valves can be used to indicate to clinicians that patients have a better prognosis at discharge, review and follow-up.
ObjectiveTo investigate the relationship between the changes in preoperative serum creatinine (Cr), myoglobin (Mb), alanine aminotransferase (ALT) and postoperative fibrinogen (Fib), C- reactive protein (CRP) expression levels and postoperative hypoxemia in patients with aortic dissection aneurysm (ADA), and construct a predictive model. Additionally, the study explores the role of transpulmonary pressure-guided positive end expiratory pressure (PEEP) in improving postoperative hypoxemia. MethodsA retrospective analysis was conducted on the clinical data of ADA patients admitted to Tianjin Chest Hospital from April 2021 to August 2023. Patients were divided into a hypoxemia group [partial pressure of oxygen/fraction of inspiration oxygen (PaO2/FiO2) ≤200 mm Hg] and a non-hypoxemia group (PaO2/FiO2 >200 mm Hg) based on whether they developed postoperative hypoxemia. Univariate and multivariate regression analyses were used to identify risk factors for postoperative hypoxemia in ADA patients and to construct a predictive model for postoperative hypoxemia. The receiver operating characteristic (ROC) curve was plotted, and the Hosmer-Lemeshow goodness-of-fit test was used to evaluate the predictive value of the model. Furthermore, the impact of different ventilation modes on the improvement of postoperative hypoxemia was analyzed. From April 2021 to August 2023, 16 ADA patients with postoperative hypoxemia who received conventional mechanical ventilation were included in the control group. From September 2023 to December 2024, 28 ADA patients with postoperative hypoxemia who received transpulmonary pressure-guided PEEP were included in the experimental group. ICU stay duration, mechanical ventilation duration, hospital mortality rate, and respiratory and circulatory parameters were analyzed to evaluate the effect of transpulmonary pressure-guided PEEP on patients with postoperative hypoxemia after acute aortic dissection. ResultsA total of 98 ADA patients were included, of which 79 (80.61%) were males and 19 (19.39%) were females. Their ages ranged from 32 to 79 years, with an average age of (49.4±11.2) years. Sixteen (16.3%) patients developed postoperative hypoxemia. Body mass index (BMI), smoking history, cardiopulmonary bypass (CPB) duration, preoperative serum Cr, Mb, ALT, and postoperative Fib and CRP showed a certain correlation with postoperative hypoxemia in ADA patients (P<0.05). There was no statistical difference in other baseline data between the two groups (P>0.05). Logistic regression analysis results indicated that BMI [OR=1.613, 95%CI (1.260, 2.065)] and preoperative Mb [OR=2.344, 95%CI (1.048, 5.246)], ALT [OR=1.012, 95%CI (1.000, 1.024)], Cr [OR=1.752, 95%CI (1.045, 2.940)], postoperative Fib [OR=1.165, 95%CI (1.080, 1.258)] and intraoperative CPB time [OR=1.433, 95%CI (1.017, 2.020)] were influencing factors of postoperative hypoxemia in ADA patients (P<0.05). Based on this, a prediction model for postoperative hypoxemia in ADA patients was established. The area under the curve corresponding to the optimal critical point was 0.837 [95%CI (0.799, 0.875)], with a sensitivity of 87.5% and a specificity of 79.3%. The Hosmer-Lemeshow goodness of fit test showed P=0.536. Before treatment, there were no statistical differences in respiratory and circulatory parameters between the control group and the experimental group (P>0.05). After treatment, the levels of PEEP, PaO2/FiO2, end-expiratory esophageal pressure, and end-inspiratory transpulmonary pressure in the experimental group were higher than those in the control group (P<0.05). The duration of mechanical ventilation and ICU stay in the experimental group were shorter than those in the control group (P<0.05), while there was no statistical difference in mortality between the two groups (P=0.626). ConclusionThe hypoxia prediction model based on preoperative Cr, Mb, ALT and postoperative Fib levels, combined with transpulmonary pressure-guided PEEP optimization, provides a scientific basis for the precise management of postoperative hypoxemia in ADA. This approach not only improves the predictive ability of hypoxemia risk but also significantly improves the postoperative oxygenation status of patients through personalized mechanical ventilation strategies, providing new insights into the management of postoperative complications.
ObjectiveTo summarize the results and clinical experience of transcatheter valve-in-valve implantation using domestic self-expanding valve in patients with aortic degenerated bio-prosthesis. MethodsFrom January 2019 to April 2023, the patients who underwent transcatheter valve-in-valve surgery in the Department of Cardiac Surgery of Tianjin Chest Hospital due to surgical bio-prosthesis failure were included. Characteristics of valves, perioperative complications, and hemodynamic manifestations during the early postoperative and follow-up period were analyzed. ResultsA total of 24 patients were enrolled, including 14 males and 10 females with an average age of 68.17±7.72 years, and the average interval between the two operations was 10.48±4.09 years. All patients were successfully discharged without complications such as coronary artery obstruction and pacemaker implantation, and the average transvalvular pressure gradient was 16.39±6.52 mm Hg before discharge. During the median follow-up time of 16 months, the left ventricular diastolic inner diameter and ejection fraction were continuously improved. ConclusionTranscatheter valve-in-valve using domestic self-expanding valves is safe and feasible to treat aortic bioprosthetic valve failure. Sound patient selection and surgical strategies are critical to achieve good hemodynamics.
ObjectiveTo investigate the factors influencing international normalized ratio (INR)>3.0 in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. MethodsA retrospective analysis was performed on the clinical data of patients who underwent mechanical heart valve replacement surgery and received warfarin anticoagulation therapy at West China Hospital of Sichuan University from January 1, 2011 to June 30, 2022. Based on the discharge INR values, patients were divided into two groups: an INR≤3.0 group and an INR>3.0 group. The factors associated with INR>3.0 at the time of discharge were analyzed. ResultsA total of 8901 patients were enrolled, including 3409 males and 5492 females, with a median age of 49.3 (43.5, 55.6) years. The gender, body mass index (BMI), New York Heart Association (NYHA) cardiac function grading, INR, glutamic oxaloacetic transaminase, and preoperative prothrombin time (PT) were statistically different between the two groups (P<0.05). Multivariate logistic regression analysis revealed that lower BMI, preoperative PT>15 s, and mitral valve replacement were independent risk factors for INR>3.0 at discharge (P<0.05). ConclusionBMI, preoperative PT, and surgical site are factors influencing INR>3.0 at discharge in patients undergoing warfarin anticoagulation therapy after mechanical heart valve replacement. Special attention should be given to patients with lower BMI, longer preoperative PT, and mitral valve replacement to avoid excessive anticoagulation therapy.