Early bioprosthesis failure: report of three cases and literature review.

BACKGROUND: We experienced three rare early bioprosthesis failure (EBF) cases. In this study, we analyze the causes and discuss the coping strategy of EBF. METHODS: We reviewed all cases of EBF in patients who received a bioprosthesis replacement in Changhai Hospital between January 2001 and January 2014, and reviewed related articles that were published between 1994 and 2014, searching for keywords in PubMed such as "bioprosthesis," "heart valve prosthesis," "early failure," and "bioprosthesis failure." RESULTS: Only three cases were found in Changhai Hospital during this time period. The reasons for EBF in these 3 cases were: native valve attachment, early calcification caused by metabolic syndrome, and early valve thrombosis. Literature review identified an additional 14 cases. The reasons for EBF in these 14 cases were as follows: native valve attachment in 6 cases; metabolic abnormalities in 3 cases; early valve thrombosis in 2 cases; chronic inflammation in 2 cases; and improper operation in 1 case. CONCLUSIONS: EBF is a rare but serious complication. The cause of EBF is complex. Appropriate preventive measures should be developed according to the condition of the patient.

A meta-analysis of transfemoral versus transapical transcatheter aortic valve implantation on 30-day and 1-year outcomes.

BACKGROUND: Transfemoral (TF) and transapical (TA) are two commonly used accesses in transcatheter aortic valve implantation (TAVI). Currently, the influence of TAVI access choice on 30-day and 1-year outcomes is unclear. The purpose of this study was to compare the 30-day and 1-year outcomes between TF-TAVI and TA-TAVI. METHODS: Studies published from 2002 to September 2014 were collected by searching PubMed and Web of Knowledge. Studies were selected by two independent investigators. 30-day and 1-year outcomes were endpoints. Odds ratios (ORs) and hazard ratio (HR) with 95% confidence interval (CI) were computed. Fixed effect model was used if I2 < 50%; if I2 > 50%, random effect model was used. RESULTS: 14 studies met inclusion criteria and were included in our analysis (3837 patients in TF group, 1881 patients in TA group). Two were retrospective trials and the others were prospective trials. Our meta-analysis showed that compared with TA group, TF group had a lower 30-day mortality (7.5% versus 11.6%) and higher 1-year survival [HR 0.75, 95% CI (0.66, 0.86)], but the Logistic EuroSCORE was higher in TA group (P = 0.00). TF group had a significantly higher stroke rate of 4.0% compared with 2.2% in TA group at ≤30 days. The incidence of major vascular complications was significantly higher in TF group compared with TA group (8.2% versus 5.3%). MI was more common in TA group (2.4%) compared with TF group (1.2%), but there were no significant difference [0.46, 95% CI (0.20, 1.06)]. CONCLUSIONS: TF-TAVI had a higher 30-day and 1-year survival rate compared with TA-TAVI, but these differences might be because of the higher Logistic EuroSCORE in TA group. Stroke and major vascular complications rates were higher in TF-TAVI patients at ≤30 days.

Catamenial pneumothorax associated with multiple diaphragmatic perforations and pneumoperitoneum in a reproductive woman.

Catamenial pneumothorax (CP) is considered to be an extremely rare entity, characterized by recurrent pneumothorax occurring between the day before and within 72 hours after the onset of menses, usually in the right-side thorax cavity in women of reproductive age.The etiology remains obscure. We report a rare case of CP complicated with multiple diaphragmatic perforations as the only thoracoscopy finding, and also with right-side isolated pneumoperitoneum confirmed by a chest X-ray. This case strongly supports the hypothesis that CP may be caused by the air through the perforations of the diaphragm.

Hemodynamics of transcatheter tricuspid valve replacement with Lux-Valve.

Objective: Transcatheter tricuspid valve intervention (TTVI) has emerged as an alternative treatment option for high-risk and inoperable patients with symptomatic tricuspid regurgitation (TR). However, scarce data in hemodynamic profiles were available on TTVI. In this paper, we attempt to report the hemodynamic profiles of LuX-Valve. Methods: 30 patients from July 2020 to July 2021 were enrolled in this study. The patient was diagnosed with severe symptomatic TR. The clinical, invasive hemodynamic, and echocardiographic data were collected. Results: The surgical success rate was 100%. The cardiac index and stroke volume increased sharply from 2.42(2.27, 2.85) and 47.8(43.6, 62.0) to 3.04 ± 0.63 and 57.2 ± 14.7, respectively. With the elimination of TR and the increase of forward blood flow of the tricuspid valve, the extravascular lung water [798.0 (673.0, 1147.0) vs. 850.3 ± 376.1, P < 0.01] increased subsequently. The peak right atrium pressure decreased after Lux-Valve implantation (21.0 ± 6.4 vs. 19.4 ± 6.5, P < 0.05). On the contrary, the nadir right atrium pressure increased [10.0(8.0, 15.0) vs. 12.0(10.0, 17.0), P < 0.01]. Notably, the right atrium pressure difference dropped sharply from 9.0(5.0, 13.0) to 5.0(4.0, 8.0) after Lux-Valve implantation. There was no significant change in the pulmonary artery pressure. The right atrium volume decreased from 128(83, 188) to 91(67, 167) mL at 1 month and 107(66,157) mL at 6 months. With the remolding of the right heart chamber, the tricuspid annulus diameter shrank significantly from 42.5 ± 5.6 to 36.6 ± 6.3 mm at 1 month and 36.0 (33.0, 38.0) at 6 months. Conclusion: Invasive right atrium pressure may act as a potential candidate for TR evaluation and procedural guidance. Elimination of TR by LuX-Valve implantation improves the cardiac output and right atrium pressure and has no significant effect on the pulmonary artery pressure even with the increment of forward blood flow, suggesting the hemodynamic superiority of transcatheter tricuspid valve replacement but needs further study.