ObjectiveTo compare the early clinical efficacy and safety of transapical transcatheter aortic valve implantation (TA-TAVI) with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS). MethodsA retrospective study was conducted on patients with severe AS admitted to the Department of Cardiovascular Surgery, The First Affiliated Hospital of University of Science and Technology of China from January 2020 to March 2024. According to the surgical method, patients were divided into a SAVR group and a TA-TAVI group, and the clinical data of the two groups were compared. ResultsA total of 71 patients were included, with 45 in the SAVR group, including 33 males and 12 females, aged 16-75 (60.89±10.88) years; 26 in the TA-TAVI group, including 15 males and 11 females, aged 61-83 (72.85±5.53) years. The results showed that postoperative aortic valve transvalvular flow velocity (2.31±0.38 m/s vs. 2.60±0.50 m/s, P=0.019) and transvalvular pressure gradient (21.09±6.03 mm Hg vs. 28.20±10.79 mm Hg, P=0.001) in the TA-TAVI group were lower than those in the SAVR group. In terms of left ventricular end-diastolic diameter, both preoperative (56.73±7.74 mm vs. 52.36±7.00 mm, P=0.017) and postoperative (52.61±7.18 mm vs. 48.04±4.78 mm, P=0.010) values in the TA-TAVI group were larger than those in the SAVR group. In terms of left ventricular ejection fraction, the preoperative value in the TA-TAVI group was lower than that in the SAVR group (58.00%±13.84% vs. 64.87%±7.63%, P=0.026), but there was no statistical difference between the two groups after surgery (P=0.670). The operation time and drainage volume on the first day after surgery in the TA-TAVI group were shorter or lower than those in the SAVR group (P<0.05). There was no statistical difference between the two groups in the postoperative hospital stay, ICU stay, or postoperative mechanical ventilation time (P>0.05). In addition, no serious complications occurred in patients after SAVR, while perivalvular leakage (2 patients), third-degree atrioventricular block (1 patient), and death (3 patients) occurred in the TA-TAVI group. ConclusionFor elderly patients with severe AS and poor cardiac function, TA-TAVI technology has minimal surgical trauma, high safety and effectiveness, and is a safe and effective treatment option besides traditional surgical operations.
This study aimed to investigate biomechanical properties of synthetic implants for reconstructive surgery of pelvic floor dysfunction. In this dissertation, we chose four synthetic implants, i.e. total pelvic floor repair system (PROLIFT), gynecone TVT obtutator system (TVT-O), intra-vaginal sling placement device (IVS) and acellular dermal matrix (Renov), for tensile test respectively. The biomechanical properties of four synthetic implants were measured and analyzed using a material testing machine (Instron 4302 versatile material testing machine). The biomechanical parameters included ultimate stress strength, modulus of elasticity, maximum load and maximum elongation. The results showed that the maximum load of the four symthetic implants was TVT-O > IVS > PROLIFT > Renov, and the maximum load of TVT-O was significantly higher than PROLIFT and Renov ( P < 0.05). The ultimate stress strength was TVT-O > IVS > PROLIFT > Renov, with no significant differences among them ( P > 0.05). The maximum elongation of the four implants was TVT-O > PROLIFT > IVS > Renov, and the maximum elongation of TVT-O and PROLIFT were both significantly higher than Renov ( P < 0.05). The modulus of elasticity was IVS > Renov > TVT-O > PROLIFT, with no significant differences among them ( P > 0.05). Taken together, the present study demonstrates that the modulus of elasticity of IVS was the highest in the four synthetic implants; TVT-O had the highest mechanical strength; The maximum load, ultimate stress strength and maximum elongation of Renov were all the lowest; The mechanical properties of PROLIFT was the most stable, and its modulus of elasticity was the lowest in the four synthetic implants, which had good extensibility and elasticity. Therefore, it is necessary to pay attention to the biomechanical properties of new pelvic reconstructive materials for the clinical pelvic reconstructive surgery.