Objective Secondary tricuspid regurgitation will be aggravated if left uncorrected during the initial surgery. Recently, an aggressive strategy of routine concomitant tricuspid valve repair has been warranted. Follow this strategy, routine concomitant thoracoscopic tricuspid valve repair was performed and the surgical effect and postoperative residual TR were reviewed. Methods A two‐center, retrospective, observational study was conducted. Patients who underwent concomitant thoracoscopic tricuspid valve repair performed by the same surgeon between May 2012 to April 2020 were recruited into the study. The data were collected from the hospital database and outpatient records from the most recent follow‐up to analysis. Results There were 504 patients recruited in this study. No death occurred and all patients were discharged. The average follow‐up time was 7.4 ± 7.5 months. After the surgery, the dimension of right ventricle and pulmonary artery systolic pressure were reduced significantly. There were 11 cases (2.2%) of postoperative residual tricuspid regurgitation. Multiple logistic regression analysis revealed left atrial dimension (p = .002) and tricuspid regurgitation (p = .002) positively associated with the residual tricuspid regurgitation occurrence rate significantly. Kaplan–Meier analysis indicated the more severe the tricuspid regurgitation, the higher the residual tricuspid regurgitation occurrence rate (p < .05). Conclusions The tricuspid valve repair surgery may improve the patients’ prognosis effectively if it was performed at the appropriate timing. The larger the left atrial dimension is, or the more severe the tricuspid regurgitation is, the higher the residual tricuspid regurgitation occurrence rate after concomitant thoracoscopic tricuspid valve repair. Our experience has shown that concomitant thoracoscopic tricuspid valve repair is reliable, effective, and safe, which may be beneficial to right heart remodeling in the short to midterm.
BackgroundTo evaluate the efficacy and safety of aspirin usage for coronary heart disease (CHD) primary prevention in patients with dyslipidemia.MethodsA cross-sectional study was conducted to enrolled subjects with documented dyslipidemia. A total of 202 patients with dyslipidemia were recruited and 138 were undergone aspirin treatment before this indexed admission and 64 had never been treated with aspirin. All subjects were undergone coronary angiography to diagnoses CHD. Clinical characteristics were collected and comparisons were performed between subjects with aspirin and subjects without aspirin therapy. Logistic regression analysis was conducted to assess the relation between aspirin and incident CHD and bleeding events.ResultsCompared to those with aspirin therapy, CHD incidence was significantly higher in subjects without aspirin therapy (23.4 % versus 18.1 %, P < 0.05). Five patients in the aspirin group had gastrointestinal bleeding and no bleeding event was occurred in subjects without aspirin therapy. Subjects with aspirin therapy had higher rate of previous helicobacter pylori (HP) infection (8.7 % versus 4.7 %, P < 0.05). Compared to subjects without CHD, subjects with CHD were older, had higher frequencies of males and smokers, had higher heart rate, serum LDL cholesterol, Lp(a) and Hs-CRP levels. Percentages of subjects with hypertension, diabetes, gastrointestinal bleeding, and HP infection were also considerably higher in CHD group (P < 0.05 for all comparison). Logistic regression analysis revealed that aspirin was associated with reduced incidence of CHD, with odds ratio (OR) of 0.85 (95 % confidence interval (CI): 0.80-0.94, P < 0.05). Regarding safety endpoint, gastrointestinal bleeding risk associated with aspirin was attenuated to nonsignificant after adjusting for HP infection, with OR of 1.16 (95 % CI: 0.99-1.52, P = 0.178).ConclusionAspirin is beneficial for reducing incident CHD, while modestly increases gastrointestinal bleeding risk. Screening subjects with previous HP infection may avoid aspirin-related gastrointestinal bleeding.
Stenosis of the critical blood vessels, which occurs in a variety of cardiovascular and cerebrovascular diseases, is one of leading causes of death in the world. Vascular stenosis will significantly alter the hemodynamic features in the vessel. Hemodynamic shear stress, one of the most important physical parameters of blood flow, will be dramatically elevated at the stenotic site. When platelets flow through the constricted site, they will sense these abnormally high shear stresses, and then respond by activating, sticking to the vascular wall, and aggregating at these sites. The shear-dependent platelet activation inspired a novel targeting platform-shear stress activated drug targeting delivery. The shear-activated drug delivery systems preferentially release their content under elevated shear stress, providing a novel approach to cure various diseases, in particular, cardiovascular diseases. In this review, we, on one hand, introduced the features of hemodynamic shear stress under both physiological and pathological conditions. On the other hand, we summarized the carriers displaying sensitivity to shear stress, such as liposomes, aggregations, gels, emulsions, in addition to the factors affecting the mechanical properties of them. Lastly, the clinical applications and prospects of this novel drug targeting strategy were discussed. It is hoped that, with a better understanding of shear stress-sensitive carriers and their targeted principle, a novel targeted drug delivery strategy will be one day applied in the clinics of the future.
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