ObjectiveTo describe the status of quality of life (QOL) and self-management behavior in patients following mechanical heart valve replacement, and explore the relationship between QOL and self-management behavior. MethodsConvenient sampling was used to recruit 352 patients following mechanical heart valve replacement in a high-level hospital in Chengdu between January 2011 and June 2012. General information questionnaire, MOS SF-36 scales, and self-management behavior questionnaire were used to collect data. T-test was used to analyze the difference between patients and normal people. And correlation analysis was used to see the correlation between QOL and self-management. ResultsFor MOS SF-36 scale results in patients within one year after surgery, physical functioning (PF) score was 73.44±15.11, role-physical (RP) was 49.52±39.17, body pain (BP) was 63.13±17.93, general health (GH) was 58.85±14.88, vitality (VT) was 63.54±18.10, social functioning (SF) was 76.67±17.40, role-emotional (RE) was 64.96±41.37, and mental health (MH) was 72.76±17.40. All these scores of the patients were significantly lower than the norm of Sichuan Province (P<0.05) except the dimension of mental health. For patients one year or more after surgery, PF score was 76.53±14.41, RP 58.44±39.21, BP 68.16±18.26, GH 61.39±13.57, VT 68.47±16.37, SF 79.79±19.34, RE 72.94±37.29, and MH 75.87±14.70, among which PF, RE, BP and GH scores were lower than the norm (P<0.05). The average total score of self-management behavior was 143.21±20.63. QOL and self-management behavior were positively correlated. ConclusionThere is still a gap between patients following mechanical heart valve replacement and normal people in terms of quality of life. Patients' self-management behavior is positively correlated with the quality of life. Good self-management behavior contributes to the improvement of QOL.
OBJECTIVE: To explore the possibility of detergent acellularized porcine heart valve serving as a scaffold for tissue engineering valve. METHODS: The porcine aortic valves were acellularized by use of trypsin-EDTA. Triton X-100, RNase and DNase treatment. Biomechanical characteristics of fresh valves and acellularized valve were tested; also fresh valves, acellularized valve and valves treated with method of bioprothetic treatment were implanted subcutaneously in rats; frequently seeded with bovine aortic endothelial cells(BAECs), and then cultured for 7 days. RESULTS: The acellularization procedure resulted in complete removal of the cellular components while the construction of matrix was maintained. The matrix could be successfully seeded with in vitro expanded BAECs, which formed a continuous monolayer on the surface. There is no significant difference of PGI2 secretion of BAECs between cells seeded onto the acellular leaflets and that onto the wells of 24-wells plate (P gt; 0.05). CONCLUSION: Acellularied porcine aortic valve can be applied as a scaffold to develop tissue engineering heart valve.
ObjectiveTo explore the effect of pulmonary hypertension on the clinical efficacy of Cox Maze Ⅳ procedure in treating atrial fibrillation (AF) patients with valvular heart disease.MethodsThe clinical data of 84 patients who received cardiac valve replacement and Cox Maze Ⅳ ablation in our hospital from July 2017 to January 2020 were retrospectively analyzed. According to the estimation of pulmonary artery pressure (PAP) by ultrasound, the patients were divided into two groups: a group A (PAP<45 mm Hg, 20 males, 26 females with an average age of 59.1±7.8 years) and a group B (PAP≥45 mm Hg, 15 males and 23 females with an average age of 58.5±8.5 years). The PAP was less than 70 mm Hgin all patients. A systematic follow-up review was performed for 6 months after operation. The recovery and recurrence rate of sinus rhythm after surgical ablation were compared between the two groups, and the efficacy was analyzed.Results(1) All the patients completed the operation successfully, and there was no statistical difference in the ablation time between the two groups (P>0.05); no patients died of pulmonary infection after the operation, and one patient underwent implantation of a permanent pacemaker due to conduction block. (2) At the end of the operation and 3 months after the operation, the conversion rate of AF in the group A was 91.3% (42 patients) and 82.6% (38 patients), respectively, and in the group B was 89.5% (34 patients) and 73.7% (28 patients), respectively (P>0.05). The conversion rate of AF was 82.6% (38 patients) in the group A and 63.2% (24 patients) in the group B at 6 months after operation (P=0.043). Binary logistic regression analysis showed that PAP≥45 mm Hg had a significant effect on the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease [P=0.014, OR=5.661, 95%CI (1.429, 22.432)].ConclusionPAP may be an influencing factor for the long-term effect of surgical Maze procedure in treating AF patients with valvular heart disease. Although the long-term recurrence rate of AF in the moderate pulmonary hypertension group is higher than that in the group A, the overall effect is still safe and effective; therefore it is still worth promoting in clinical application.
The possibility of polyoxymethylene (POM) as heart valve leaflet material was investigated by comparing the hemocompatibility with that of 316L stainless steel and low-temperature isotropic pyrolytic carbon (LTIC). Surface hydrophobicity was characterized by water contact angle measurement.Platelet adhesion, APTT/PT/TT and hemolysis rate tests were applied for evaluating hemocompatibility. The results showed that POM was hydrophobic and had a low hemolytic rate, adhesion amount and activation degree of platelets on POM surface were less than 316L stainless steel, and was similar to LTIC. This research pointed out potential application of POM as heart valve leaflets.
Objective To evaluate the quality of anticoagulant therapy in patients with mechanical prosthetic valve replacement during early period through time in therapeutic range(TTR) and fraction of time in therapeutic range(FTTR), and to provide an objective evidence for further improving quality of anticoagulant therapy. Methods All the patients were followed and registered in hospital and at outpatient clinic from July 2012 through April 2014, with a maximum of 6 months after surgery. Targeted international normalized rate (INR) was 1.60 to 2.20, acceptable INR was 1.50 to 2.30. And warfarin weekly dosage adjustment was used as the strategy of anticoagulation management. Adjusting the warfarin dosage when INR was beyond acceptable INR. Events of bleeding, thrombogenesis and thromboembolism, TTR and FTTR of these patients during the follow-up were collected to evaluate quality of anticoagulant therapy in these patients. Results A total 477 patients and 2 755 reports of INR values were included for data analysis. The follow-up time was 78 918 days. Values of INR varied from 0.92 to 7.72(1.83±0.64). Required weekly doses of warfarin in target INR and acceptable INR were 5.00–35.00(18.15±3.99) mg/week and 5.00–39.38(18.29±4.08) mg/week. TTR of target INR and acceptable INR was 36.85%(27 079.5 d/78 918.0 d) and 49.84% (39 331.5 d/78 918.0 d), respectively. FTTR of target INR and acceptable INR was 37.31% (1 028 times/2 755 times), 50.01% (1 378 times/2 755 times), respectively. TTR of target INR and acceptable INR was 46.04%(3 902.5 d/8 475.5 d), 59.49%(5 042 d/8 475.5 d) when the patients’ follow-up was up to six months and FTTR of target INR and acceptable INR value of these patients was 46.81%(206 times/440 times), 60.45%(266 times/440 times). During the follow-up, there were 3 thromboembolism events, 1 transient physical abnormal activity, and 1 thrombogenesis in the left atrium, and there was no bleeding and death events. Conclusion The strategy of anticoagulation management used in our study is reasonable. In order to further improve the patients’ quality of anticoagulant therapy, it is necessary to start anticoagulation after operation as soon as possible, to strengthen the education of patients with anticoagulant knowledge and to increase INR test frequency properly.
ObjectiveTo study the biocompatibility of bioprosthetic heart valve material with a non-glutaraldehyde-based treatment, and to provide the safety data for the clinical application. MethodsAll the tests were conducted according to GB/T16886 standards. The in vitro cytotoxicity was determined by methyl thiazolyl tetrazolium assay. Fifteen guinea pigs were divided into a test group (n=10) and a control group (n=5) in the skin sensitization test. Three New Zealand white rabbits were used in the intradermal reactivity test. Five sites on both sides of the rabbit back were set as test sites and control sites, respectively. In the acute systemic toxicity test, a total of 20 ICR mice were randomly assigned to 4 groups: a test group (polar medium), a control group (polar medium), a test group (non-polar medium) and a control group (non-polar medium), 5 in each group. Forty SD rats were divided into a test group (n=20) and a control group (n=20) in the subchronic systemic toxicity test. ResultsThe viability of the 100% extracts of the bioprosthetic heart valve material with a non-glutaraldehyde-based treatment was 75.2%. The rate of positive reaction was 0.0%. The total intradermal reactivity test score was 0. There was no statistical difference in the body weight between the test group and control group in the acute systemic toxicity test. There was no statistical difference in the body weight, organ weight, organ weight/body weight ratio, blood routine test or blood biochemistry between the test group and control group in the subchronic systemic toxicity test. ConclusionThe bioprosthetic heart valve material with a non-glutaraldehyde-based treatment has satisfying biocompatibility, which conforms to relevant national standards. The material might be a promising material for application in valve replacement.
The study of mechanical properties on heart valves can provide an important theoretical basis for doctors to repair heart valves and prosthetic valve materials research. In this paper, we present the current status of the mechanical property study methods of heart valve, expound the methods and special requirements about uniaxial tensile test and biaxial tensile test of the heart valve, and further discuss several establishment methods of heart valve constitutive models. We also discuss the development trend of heart valve mechanics.
The patients with mechanical prosthetic valve replacement need anticoagulant therapy for all their life. The incidence of thromboembolism and anticoagulation-related bleeding events still account for major postoperative complications after mechanical heart valve replacement. Most of the complications happen in the first half year after operation. Therefore, early anticoagulation therapy is very important. Of course, so far most guidelines focus stating their opinions on long-term anticoagulant therapy. However, there is no consensus about anticoagulant therapy in the early period of postoperation. In this review, we summarize early anticoagulant therapy of the patients with mechanical heart valve replacement through consulting domestic and abroad relevant research in recent years and give an overview of the present situations of early anticoagulant therapy.
OBJECTIVE: To explore the possibility of improving the performance of tissue engineering valve by means of preendothelialization with cultured human umbilical vein endothelial cell(hUVEC) and to develop a new xenogenic bioprosthesis valve material. METHODS: The porcine aortic valves treated by use of glutaraldehyde(GA), epoxychloropropane(EC), L-glutamic acid(L-GA) and cellular extraction(CE) respectively were divided into four groups; group 1(GA), group 2(EC), group 3(EC + L-GA), and group 4(EC + L-GA + CE). The cultured hUVECs were seeded onto the treated porcine aortic valve, then that stuff were examined by means of EC VIII factor staining, living cells counting and microscopy. RESULTS: The cultured hUVEC could adhere to culturing bottle wall an hour later, and propagated to two passages after seven days. The cells increased with serial passage at a 7-day interval. But the hUVEC grew slowly when seeded onto the treated valve material except group 4. The cells in group 4 covered the surface of valve completely seven days later, which could also be seen in group 3 but not completely. There was no cell growing in group 1, and only fewer in group 2. The living cell in groups 3 and 4 were significantly more than in groups 1 and 2 on the 3rd, 7th and 14th days (P lt; 0.01), meanwhile, the number of cells in group 4 were also significantly more than that in group 3 (P lt; 0.05). The covering area of cultured cell on the valve material in groups 3 and 4 was significantly larger than that in groups 1 and 2. The covering area of cell in group 4 was over 95%, and higher than that in group 3(60%-70%). The hUVEC of group 4 arranged in pattern of three dimension. So it could resist rising of foreign power from the cardiac cavity of high pressure and flowing volume. There was no cell on the leaflet surface in group 1, and only a few pinch of cells could be seen in group 2. CONCLUSION: The porcine aortic valve can be used to be an ideal xenogeneic valve scaffold; the scaffold of porcine aortic valve should be treated by use of epoxy-chloropropane, L-glutamic acid and cellular extraction, so that a best growing environment to the hUVEC would be given; the cultured hUVECs used to be source of seed living cell had a boundless prospects; the growing velocity of cultured hUVEC was controllable, which facilitated clinical application; and the endothelial cells of xenogeneic valve material which grew compactly onto the scaffold can resist rising of foreign power from the cardiac cavity itself.
Transcatheter aortic valve replacement has revolutionized the management of aortic stenosis and become the gold standard for the treatment of symptomatic and severe aortic valve stenosis in elderly patients. With the improvement in design and materials, newer generation transcatheter aortic valve prostheses had overcome the limitations of early-generation devices that were susceptible to paravalvular leak, atrioventricular block and vascular complications, to a certain extent. This review provides an update on the latest advances in transcatheter aortic valve prostheses.