Objective To summarize the current progress in the genetic modification of vascular prostheses and to look forward to the future of genetic modification in vascular prostheses. Methods PubMed onl ine search with the key words of “vascular prostheses, gene” was undertaken to identify articles about the genetic modification of vascular prostheses. Then these articles were reviewed and summarized. Results To improve long-term patency of vascular prostheses, various genes were transfected into seeded cells. The antithrombosis activity of local vessels increased. Conclusion Progresses in tissue engineering and molecular biology make possible endothel ial ization and genetic modification of vascular prostheses. However, because most relevant researches are still basic experiments, further study is needed before cl inical appl ication.
Transcatheter aortic valve replacement (TAVR) as a mature technology has been widely applied in Western countries. In China, with the first two domestic prostheses being approved for commercial use, the technology now is expecting a fast development. In this article, we reviewed the features of Chinese aortic stenosis patients, the early Chinese experience of TAVR, the application of domestic prostheses and remaining problems.
Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis. The localization and anchor of many transcatheter heart valves available in the clinic today are dependent on the calcific aortic valve leaflet of patients. We reported here a successful case of transapical aortic valve implantation with Ken-Valve heart valve in an 82-year-old male patient with pure severe aortic regurgitation without native valve calcium. Postoperative follow-up (3 months after the surgery) showed that the cardiac function significantly improved. The echocardiography indicated that the Ken-Valve prosthesis worked well without perivalvular regurgitation. The short-term clinical effect was satisfactory. The Ken-Valve with three position anchors is proved to be suitable for the treatment of pure aortic regurgitation.
ObjectiveTo investigate whether the recombinant human growth hormone (rhGH) can promote endothelialization, inhibit vascular intimal hyperplasia, and improve long-term patency rate by the treatment of rhGH after vascular prostheses bypass.
MethodsBetween August 2007 and January 2009, 94 patients with lower extremity arteriosclerotic occlusive disease were treated. Among them, 32 patients (34 limbs) who met the selection criteria were enrolled in this study. All cases were randomly divided into study group (16 cases, 18 limbs) and control group (16 cases, 16 limbs). There was no significant difference (P>0.05) in gender, age, disease time, location of lesions, the Trans-Atlantic Inter-Society Consensus (TASC) grade, and basic diseases between 2 groups. The patients with superficial femoral artery disease received above-knee femoro-popliteal prostheses bypass. The patients who had combined abdominal-iliac artery disease received concurrent abdominal-femoral and femoro-popliteal prostheses bypass. Subcutaneous injection of 9 U rhGH was given every night for 7 days in study group, and saline was applied in control group. Ultrasonography was taken after 2 weeks and 3 months of operation to observe the patency and measure the wall thickness of vascular prostheses.
ResultsAfter operation, 1 patient of control group died of renal failure caused by acute thrombosis. After 2 weeks, ultrasonography showed no obvious intimal hyperplasia in 2 groups; the wall thickness was (0.13±0.02) cm in study group and (0.15±0.03) cm in control group, showing no significant difference (t=-1.720, P=0.108). After 3 months, the wall thickness was (0.17±0.06) cm in study group and was (0.26±0.09) cm in control group, showing significant difference (t=-2.240, P=0.045). All cases were followed up 36-60 months (mean, 56.4 months). The 5-year primary patency rate was 52.5% in study group and 35.7% in control group, showing no significant difference (χ2=1.470, P=0.225).
ConclusionThe rhGH can improve endothelialization in vascular prostheses and can inhibit postoperative vascular intimal hyperplasia in clinical application.
Objective To analyze the medium-and long-term r esults of tricuspid valve replacement(TVR), to summarize the experience in opera tive therapy for tricuspid valve disease. Methods From January 1998 to May 2006, sixty seven patients had undergone TVR. The etiology was rheumatic disease in 25 cases, congenital disease in 37 cases, degenerative disease in 1 case, infective endocarditis in 3 cases, a nd cardiac tumor in 1 case. All operations were performed under general anesthes i a and by cardiopulmonary bypass. Bioprostheses was replaced in 28 patients, whil e mechanical valve was replaced in 39 patients. Associated procedure included mi tral valve replacement in 13 cases, mitral valve replacement and aortic valve replac ement in 12 cases, repair of ventricular septal defect in 1 case, repair of atri al septal defect in 1 case, and radioablation of atrial fibrillation in 3 case s. Results The operative mortality was 11.94% (8/67)，among these patients , 6 cases died of serious heart failure,1 case died of ventricular fibrillation, 1 case died of multi organ failure. During follow-up, 1 patient died of biopro thesis dysfunction 1 year after the operation, 1 patient died of cerebral emboli s m 6 years after the operation. Through statistical analysis, it showed that the mortality of TVR in rheumatic tricuspid valve disease was higher than that in co ngenital tricuspid valve disease ［5.56%（2/36）vs. 24.00% (6/25); χ2=4.425 , P=0.036］; the mortality in second time operation was higher than that in first time operation ［30.00%（3/10）vs. 8.77% (5/57);χ2=3.646，P=0.033 ］; while there was no significant difference in immediate and long-term result s with different choice of bioprosthetic or mechanical valve in TVR (χ2=0.002 , P=0.961). Conclusion Operative an d follow-up mortality is high in the TVR, valve replac ement is the last selection for the treatment of serious tricuspid disease, appr opriate operative technique and perioperative therapy is the key for success o f the operation.
Objective
To analyze the mid-term results of surgical treatment for prosthetic valve endocarditis (PVE).
Methods
We retrospectively analyzed the clinical data of 22 PVE patients operated in our institution from January 2006 to June 2016. There were 14 males and 8 females, aged 31-62 (49.6±11.8) years. PVE occurred following single valve replacements in 20 patients, including aortic valve replacements in 12 and mitral valve replacements in 8. Two patients suffered PVE after multi-valve replacement, which was aortic and mitral valves. Mechanical valves were used in all patients. Early PVE (<1 year after valve implantation) was detected in 10 patients, and late PVE (>1 year after valve implantation) in 12 patients. Blood culture was negative in 6 patients. Fifteen patients underwent emergent or urgent surgery (within one week after definite diagnosis) and 7 elective surgery. Paravalvular abscess was detected in 12 patients and repaired bovine pericardium.
Results
Three patients (13.6%) died postoperatively in hospital, among whom two died of multiple systemic organ failure, and the other died of cerebral hemorrhage. Main postoperative complications included low cardiac output syndrome in 5 patients (22.7%), renal dysfunction in 6 (27.3%), respiratory failure in 5 (22.7%) and pulmonary infection in 4 (18.2%). During the follow-up of 6-120 (53.6±20.8) months, 2 deaths were observed in the middle term, including one sudden death and the other of cerebral infarction. No recurrent infection or valve-related surgery was observed during the follow-up. The survival rate was 86.4% in 1 year and 70.4% in 5 years.
Conclusion
PVE is a very severe disease with high mortality. Early surgical treatment and complete removal of infectious tissues have preferable early- and mid-term results.
ObjectiveTo compare the early clinical outcome of GenesisⅡ high-flexion versus standard prostheses in total knee arthroplasty (TKA), and evaluate whether high-flexion prostheses can improve the postoperative range of motion (ROM).
MethodsBetween September 2007 and December 2011, 80 patients (85 knees) consecutively underwent posterior cruciate-sacrificing TKA with GenesisⅡ systems. Finally, we reviewed 60 patients (60 knees) including 32 knees in high-flexion group and 28 knees in standard group. The follow-up time was 2.7 years in average. The postoperative knee ROM and the rate of complication of the two groups were evaluated.
ResultsThe mean postoperative knee ROM of 32 knees was 112.8° in the high-flexion group and was 108.9° in the standard group. The mean postoperative HSS score was 86.6 and 84.2, respectively. The postoperative knee ROM, hospital for special surgery (HSS) score and the rate of complication did not show significant difference between the two groups.
ConclusionThe high-flexion prosthesis is no better than the ordinary prosthesis in terms of the range of motion. We need more mid to long-term studies to do further research.
ObjectiveTo explore advantages and feasibility of a new prosthesis implantation method after breast cancer surgery by reacquaint breast anatomy. MethodsThe clinicopathologic data of patients with breast cancer were retrospectively collected. The patients underwent the breast cancer surgery and prosthesis implantation with cricoid breast ligament in the Xuzhou Cancer Hospital from January 1, 2021 to May 30, 2023. ResultsA total of 10 patients were collected, with age ranging from 31 to 59 years old. Three patients received postoperative analgesia, 2 patients occurred infection, 1 patient occurred fat liquefaction. All patients did not experience capsular contracture, flap necrosis, or removal of the prosthesis. Two patients had sentinel lymph node metastasis. All patients followed-up 3 to 24 months after surgery. The BREAST-Q questionnaire was used to assess the quality of life and satisfaction after surgery, 3 patients were very satisfied, 5 were satisfied, and 2 were basically satisfied. ConclusionFrom the results of limited cases analysis in this study, it is safe and feasible to implant the prosthesis with cricoid breast ligament in selected patients after breast cancer surgery.
Objective To evaluate the clinical result of using osseointegratedimplants to retain removable orbital prostheses in repairing orbital defects. Methods Two patients with orbital defects caused by orbitaltumor were treated. Each of them got 4 implants. After average 6 months, we performed the secondary operation. After 7 weeks, we took impressions to make the implant-retained prostheses. The magnetic attachment was adopted. The prostheses were made of polysiloxane material(Factor II,Lakeside,Ariz). Results Both of the patients got the successful facial prostheses and were followed up 2 and 8 years respectively. All the implants were integrated well. There were no apparent inflammatory reactions in the soft tissue around percutaneous implants. The patients were satisfied with the facial appearance. Conclusion Implant-retained orbital prostheses are safe and effective in repairing orbital defects.
Objective To analyze the short-term effectiveness and safety of personalized three-dimensional (3D) printed customized prostheses in severe Paprosky type Ⅲ acetabular bone defects. Methods A retrospective analysis was conducted on 8 patients with severe Paprosky type Ⅲ acetabular bone defects and met the selection criteria between January 2023 and June 2024. There were 3 males and 5 females, with an average age of 64.6 years ranged from 56 to 73 years. All primary replacement prostheses were non-cemented, including 1 ceramic-ceramic interface, 1 ceramic-polyethylene interface, and 6 metal-polyethylene interfaces. The time from the primary replacement to the revision was 4 days to 18 years. The reasons for revision were aseptic loosening in 5 cases, revision after exclusion in 2 cases, and repeated dislocation in 1 case. The preoperative Harris score was 39.5±3.7 and the visual analogue scale (VAS) score was 7.1±0.8. The operation time, intraoperative blood loss, hospital stay, and complications were recorded. The hip function was evaluated by Harris score, and the degree of pain was evaluated by VAS score. The acetabular cup abduction angle, anteversion angle, rotational center height, greater trochanter height, and femoral offset were measured on X-ray film. Results The operation time was 95-223 minutes, with an average of 151.13 minutes. The intraoperative blood loss was 600-3 500 mL, with an average of 1 250.00 mL. The hospital stay was 13-20 days, with an average of 16.88 days. All 8 patients were followed up 2-12 months, with an average of 6.4 months. One patient had poor wound healing after operation, which healed well after active symptomatic treatment. One patient had lower limb intermuscular vein thrombosis, but no thrombosis was found at last follow-up. No serious complications such as aseptic loosening, infection, dislocation, and periprosthetic fracture occurred during the follow-up. At last follow-up, the Harris score was 72.0±6.2 and the VAS score was 1.8±0.7, which were significantly different from those before operation (t=?12.011, P<0.001; t=16.595, P<0.001). On the second day after operation, the acetabular cup abduction angle ranged from 40° to 49°, with an average of 44.18°, and the acetabular cup anteversion angle ranged from 19° to 26°, with an average of 21.36°, which were within the “Lewinneck safety zone”. There was no significant difference in the rotational center height, greater trochanter height, and femoral offset between the healthy side and the affected side (P>0.05). ConclusionThe use of personalized 3D printed customized prostheses for the reconstruction of severe Paprosky type Ⅲ acetabular bone defects can alleviate pain and enhances hip joint function, and have good postoperative prosthesis position, without serious complications and have good safety.
