As the indications for transcatheter aortic valve replacement (TAVR) expand to low-risk young patients, the number of patients undergoing percutaneous coronary intervention (PCI) after one or more TAVR may increase. The coronary access for PCI after TAVR has become a very practical and severe problem. Coronary re-intervention poses technical difficulties, and compared to balloon expandable valve, the use of self-expanding valve is more challenging for the coronary access for PCI after TAVR. This article discusses the selection of appropriate valves before TAVR, the implementation of intraoperative commissural alignment technology, and the techniques for mastering the coronary access for PCI after TAVR, in order to improve the success rate of the coronary access for PCI after TAVR.
With the development of transcatheter aortic valve replacement, it has become the first-line treatment for elderly patients with aortic valve stenosis. A case of transcatheter aortic valve replacement in a patient at high risk of coronary artery occlusion was reported. The use of intravascular ultrasound to observe the spatial relationship between the coronary ostia and the valve was the characteristic of this case. This patient was an elderly male who was assessed as a high risk of acute coronary artery occlusion before transcatheter aortic valve replacement. After fully evaluation of the patient’s surgical risks\benefits, the strategy was formulated. Percutaneous coronary intervention was the first step. At the same time, intravascular ultrasound was used to observe the spatial relationship between the coronary ostia and the valve, and balloon was embedded for coronary protection. The procedure went smoothly.
Objective
To systematically review the health utility scores for patients with breast cancer in China.
Methods
PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched from inception to November, 2016 to collect studies for health utility scores for breast cancer in China. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was performed using Stata 12.0 software.
Results
A total of 6 studies were included. Compared with modeling studies, the range of utility scores from cross-sectional studies was narrower. The results of meta-analysis showed the utility scores for breast cancer were 0.77 (95%CI 0.67 to 0.87), 0.77 (95%CI 0.68 to 0.86) at stage 0 to Ⅰ, 0.76 (95%CI 0.66 to 0.85) at stage Ⅱ, 0.74 (95%CI 0.65 to 0.83) at stage Ⅲ and 0.73 (95%CI 0.65 to 0.81) at stage Ⅳ, respectively. Meanwhile, we descripted the median of utility scores of all studies, and the corresponding values were 0.81 (range 0.65 to 0.83), 0.82 (range 0.65 to 1.00) at stage 0, 0.82 (range 0.65 to 0.90) at stage Ⅰ, 0.77 (range 0.67 to 0.86) at stage Ⅱ, 0.70 (range 0.64 to 0.82) at stage Ⅲ and 0.70 (range 0.30 to 0.80) at stage Ⅳ, respectively.
Conclusion
Research on the health utility scores of breast cancer is still limited in China. Utility scores are decreasing among different clinical stages, with lowest score at late stage cancer. These findings can be used in further cost-utility evaluation on various breast cancer interventions.
The short-term mortality of patients with severe aortic stenosis is high, which presents a great challenge to clinical treatment. With the development of transcatheter aortic valve replacement (TAVR), emergent TAVR brings hope for the treatment of these patients. We present here a case of emergent TAVR procedure. The patient was an elderly male who had previously undergone surgical mitral valve replacement. After fully assessing the risk/benefit of TAVR procedure, emergent TAVR was performed for the patient. The patient was in good condition at two-month follow-up. Emergent TAVR is a good option for critical high-risk patients with severe aortic stenosis.
ObjectiveTo evaluate the value and experience of a multi-disciplinary team (MDT) approach in the management of patients with lower extremity arteriosclerosis obliterans (ASO). MethodsA retrospective analysis was conducted of 46 consecutive patients with ASO who were treated with MDT model at Zhongshan Hospital, Fudan University, from May 2021 to April 2024. All subjects had critical limb ischemia (Rutherford grade 4 or more) and at least one major organ dysfunction. Overall mortality, above-ankle amputation rate, and below-ankle amputation rate were recorded. The frequency and depth of involvement of each specialty in the MDT process were also documented. ResultsOf the 46 patients, 37 (80.4 %) were male and 9 (19.6 %) were female, with a mean age of (74.33±11.8) years. Major comorbidities included diabetes mellitus in 40 cases, cardiac disease in 30, hypertension in 31, renal insufficiency in 22, prior cerebral infarction in 14, and chronic obstructive pulmonary disease in 11. Overall mortality was 13.04% (6/46). The total amputation rate was 32.61% (15/46), comprising above-ankle amputation in 19.57% (9/46) and below-ankle amputation in 13.04% (6/46). Seventeen disciplines participated in the MDT; in addition to vascular surgery, the most actively involved departments were endocrinology, cardiology, and nephrology. ConclusionThe MDT model offers unique advantages in the management of critical lower-extremity ASO. By coordinating revascularization timing, extent, and modality, prioritizing comorbid conditions, tailoring operative plans, and optimizing peri-operative support, the MDT approach reduces mortality, improves limb-salvage rates, and enhances both prognosis and quality of life.
