Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences最新文献

{"title":"Experience of the use of Sentinel cerebral embolic protection device during transcatheter aortic valve replacement.","authors":"Lan Zhang, Xinmin Liu, Ziwei Xi, Fei Yuan, Jing Yao, Zhengming Jiang, Yunfeng Yan, Guangyuan Song","doi":"10.3724/zdxbyxb-2024-0532","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2024-0532","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the feasibility, efficacy and safety of the Sentinel Cerebral Embolic Protection Device (CEPD) during transcatheter aortic valve replacement (TAVR). This study is a subgroup analysis of the Chinese Registry of moderate to severe valvular heart disease (CREDIT), which has been registered at the Chinese Clinical Trial Registry (ChiCTR2300075006).</p><p><strong>Methods: </strong>Patients undergoing TAVR with the Sentinel CEPD from October 2023 to September 2024 were retrospectively enrolled. A total of 80 patients were included, with a median age of 72 (68, 76) years, including 52 males (65.0%) and 28 females (35.0%), 62 patients (77.5%) with tricuspid valves, and 18 (22.5%) with bicuspid valves; 34 patients (42.5%) with type Ⅰ aortic arch, 24 patients (30.0%) with type Ⅱ aortic arch, 12 patients (15.0%) with type Ⅲ aortic arch, and 10 patients (12.5%) with bovine-type aortic arch. Clinical data of the patients were summarized and analyzed. The primary endpoints were success rate of Sentinel CEPD implantation, as well as all-cause death, symptomatic stroke, transient ischemic attack, and Sentinel CEPD access vessel complications during hospitalization and within 30 days postoperatively.</p><p><strong>Results: </strong>In the 80 patients, Self-expanding valves were used in 68 cases (85.0%) and balloon-expandable valves in 12 cases (15.0%). Seventy-nine patients (98.8%) successfully underwent TAVR with Sentinel CEPD deployment. 98.8% (79/80) successful CEPD deployment. Macroscopically visible debris was captured in 93.8% (75/80) by filters of Sentinel CEPD. Although the procedure time for Sentinel CEPD placement was slightly longer in patients with bovine aortic arch, there was no statistically significant difference in deployment time among different aortic arch types (<i>P</i>>0.05). During hospitalization and within 30 days postoperatively, only one case of transient ischemic attack occurred, there was no all-cause mortality, symptomatic stroke, or access-site vascular complications related to the Sentinel CEPD observed.</p><p><strong>Conclusions: </strong>The Sentinel CEPD demonstrates high feasibility across aortic arch types, potential efficacy in embolic capture, and excellent safety in TAVR.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidimensional characteristics of the tumor microenviron-ment and advances in therapeutic intervention strategies.","authors":"Hongdan Chen, Long Zhang, Chong Li","doi":"10.3724/zdxbyxb-2025-0090","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2025-0090","url":null,"abstract":"<p><p>The tumor microenvironment (TME) is a critical determinant of tumor initiation, progression, and therapeutic response. Its marked heterogeneity underscores the need for a more comprehensive understanding of its composition and function. In addition to the extensively studied \"classical\" TME, emerging evidence highlights the significant roles of the tumor mechanical microenvironment and the tumor microbial microenvironment in modulating treatment efficacy. These non-classical dimensions not only independently influence tumor behavior but also interact dynamically with classical TME components. Mechanical cues within the TME, including matrix stiffness and solid stress, significantly affect drug distribution and treatment efficacy, suggesting that mechanical remodeling represents a potential strategy to enhance therapeutic outcomes. Concurrently, tumor-associated microbiota and their metabolites participate in immune regulation and metabolic reprogramming, contributing to tumor development and offering novel therapeutic targets. Moreover, recent advances have broadened our understanding of the multilayered regulatory landscape of the TME through the investigation of previously underappreciated factors such as neural regulation, metabolic niche dynamics, spatiotem-poral heterogeneity, and epigenetic modulation. This review systematically summarizes the characteristics of these diverse TME dimensions and explores their integration with precision drug delivery strategies. We highlight recent progress in therapeutic interventions targeting the classical TME, mechanical forces, and microbiota-related pathways, and propose interdisciplinary approaches aimed at facilitating the development of more personalized and effective anticancer therapies.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microfluidic photo-crosslinking fabrication of silk fibroin/hyaluronic acid composite microsphere-reinforced hydrogels.","authors":"Ruyue Wang, Yunlu Chen, Chenqi Wu, Shujing Li, Zhenjie Liu, Feng Chen","doi":"10.3724/zdxbyxb-2024-0698","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2024-0698","url":null,"abstract":"<p><strong>Objectives: </strong>To fabricate an injectable composite microsphere hydrogel reinforced with silk fibroin/hyaluronic acid microspheres, achieving synergistic enhance-ment of mechanical robustness and biofunctionality.</p><p><strong>Methods: </strong>Methacrylated hyaluronic acid (HAMA) and thiolated silk fibroin (SF-GSH) precursors were synthesized. Monodis-perse microspheres (43~130 μm) generated via microfluidics were UV-crosslinked (420 nm) through thiol-ene click reaction. These microspheres were embedded in a HAMA/SF-GSH matrix to form photo-crosslinked composites. The physicochemical and biological properties of composite microsphere hydrogels were systematically characterized by ¹H-NMR, optical microscopy, rheometer, scanning electron microscopy, inverted confocal microscopy, rheology, X-ray energy dispersive spectrometer, compression testing, degrada-tion/swelling assays, calcein-AM/PI double staining, CCK-8 assay, etc.</p><p><strong>Results: </strong>The grafting rates of methacrylated hyaluronic acid and thiolated silk fibroin was 48.03% and 17.99%, respectively. The diameter of microsphere hydrogel was evenly distributed in the range of 43~130 μm. The gelation time of the composite microsphere hydrogel system was 48~115s. The laser confocal imaging confirmed dynamic regulation charac-teristics of the composite microsphere hydrogel system. The compressive strength of the composite microsphere hydrogel reached 22.7 kPa, and maintained structural integrity at 40% strain after 20 compression cycles. The composite microsphere hydrogels exhibited differential deswelling behaviors in simulated physiological environments, and the reducing microsphere particle size could significantly enhance its stability under moist conditions. The degradation rate of the composite microsphere hydrogel was 49% after 200 h of degradation, and the water retention rate maintained at 49%~62% after 96 h of degradation. Biocompatibility assays confirmed >95% cell viability and unimpaired cell migration abilities.</p><p><strong>Conclusions: </strong>The silk fibroin/hyaluronic acid composite microsphere hydrogel developed with microfluidic photo-crosslinking strategy in this study has charac-teristics of rapid fabrication, adjustable mechanical properties, enhanced environmental stability and excellent biocompatibility, its unique injectability and water retention provide a new material solution for tissue repair and regenerative medicine.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metaplastic carcinoma of the breast with heterologous mesen-chymal (neuroectodermal) differentiation: a clinicopathological analysis and literature review.","authors":"Xiaolin Wang, Kai Wang, Yajian Wang, Hongyan Wang","doi":"10.3724/zdxbyxb-2025-0264","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2025-0264","url":null,"abstract":"<p><p>A 32-year-old woman presented with a gradually enlarging left breast mass over one year. Breast magnetic resonance imaging (MRI) revealed a mass at the 9 o'clock position in the left breast, classified as BI-RADS category 6. She underwent endoscopic left breast-conserving surgery and sentinel lymph node biopsy. Histological examination (H&E staining) revealed a tumor composed of sheets of epithelioid cells and fascicles of spindle cells, with areas of transition between the two components. Epithelioid cells were small, round to short-spindled, with scant cytoplasm, crowded arrangement, and coarse chromatin. Spindle cells were loosely arranged with indistinct borders, mildly eosinophilic cytoplasm, inconspicuous nucleoli, and intervening pale pink matrix. Immuno-histochemistry (IHC) demonstrated: Epithelioid cells were diffusely positive for CK8/18 and CAM5.2; partially positive for pan-CK and CK7; focally positive for CK5/6, CK14, high molecular weight cytokeratin (HCK), and P63; diffusely positive for E-cadherin; and negative for vimentin. Spindle cells were positive for synaptophysin (Syn), CD56, glial fibrillary acidic protein (GFAP), and vimentin, but negative for epithelial markers (pan-CK, CK7, CK8/18, CAM5.2, E-cadherin). The final diagnosis was metaplastic carcinoma with heterologous mesenchymal (neuroectodermal) differentiation. Postopera-tively, the patient received 8 cycles of EC-T systemic chemotherapy. Follow-up with breast MRI and chest CT every 3 months for 23 months (1 year and 11 months) showed no evidence of tumor recurrence or metastasis.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-7"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Hydrogel Drug Delivery Systems for Myocardial Infarction Treatment.","authors":"Jia Yang, Zheng Zhou, Xiahong Xie, Mingzhou Ye","doi":"10.3724/zdxbyxb-2025-0087","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2025-0087","url":null,"abstract":"<p><p>Myocardial infarction (MI) has the highest mortality rate among cardio-vascular diseases. Hydrogel biomaterials mimicking the extracellular matrix (ECM) have recently demonstrated excellent biocompatibility, low immunogenicity, favorable biode-gradability, and multifunctionality, showcasing significant potential for MI treatment. Hydrogels can provide mechanical support to the damaged myocardium, alleviating pathological remodeling. Moreover, their porous structure makes them ideal carriers for localized and sustained drug delivery. Hydrogels derived from various matrices-including polysaccharides, polypeptides, proteins, decellularized extracellular matrix (dECM), and synthetic polymers-exhibit distinct properties in terms of biocompatibility, mechanical performance, and drug delivery capacity. These hydrogels support tissue regeneration and enable targeted release of diverse therapeutics, meeting the varied therapeutic demands of myocardial repair. Specific signals within the MI microenvironment-such as low pH, overexpression of specific enzymes, and elevated reactive oxygen species (ROS) levels-can trigger responsive drug release from hydrogels, significantly enhancing therapeutic efficacy while reducing systemic side effects. This review summarizes recent advances in hydrogel-based drug delivery systems for MI treatment, focusing particularly on the characteristics and advantages of different hydrogel materials for myocardial repair. Furthermore, the responsive drug release behavior of hydrogels is analyzed in the context of the cardiac injury microenvironment, providing a reference for future research.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomaterials of different sizes for enhanced adoptive cell transfer therapy in solid tumors.","authors":"Jiaxin Chen, Rui Liu, Yingqi Tang, Chenggen Qian","doi":"10.3724/zdxbyxb-2024-0651","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2024-0651","url":null,"abstract":"<p><p>Adoptive cell therapy (ACT) shows significant efficacy against hema-tological malignancies but is limited in solid tumors by poor T-cell infiltration, immu-nosuppressive microenvironments, and systemic toxicity. Biomaterials spanning nano- to macroscales-including nanoparticles (NPs), microspheres/microneedles, and hydrogels-offer unique advantages for <i>ex vivo</i> cell engineering, <i>in vivo</i> delivery, and tumor micro-environment modulation. Specifically, NPs enable gene delivery, artificial antigen-pre-senting cell (aAPC) engineering, and immune microenvironment remodeling. Microspheres/microneedles improve immune cell expansion, targeted activation, and localized retention. Hydrogels enhance ACT via in situ genetic engineering, 3D culture support, and cytokine co-delivery. This review summarizes advances in biomaterial-enhanced ACT, highlighting their potential to improve delivery efficiency, amplify antitumor responses, and reduce toxicity. These insights may accelerate the clinical translation of ACT for solid tumors.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"He<b>'</b>s Yangchao Formula Ameliorates Premature Ovarian Insuf-ficiency via Remodeling Gut Microbiota to Promote Granulosa Cell Glycolysis.","authors":"Fangxuan Lin, Qing Liu, Ying Zhao, Yun Chen, Ruye Wang, Chenyun Miao, Qin Zhang","doi":"10.3724/zdxbyxb-2024-0604","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2024-0604","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the molecular mechanism by which He's Yangchao Formula improves ovarian function in premature ovarian insufficiency (POI) mice through intestinal flora modulation.</p><p><strong>Methods: </strong>Forty female ICR mice (aged 6-8 weeks) were intraperitoneally injected with cyclophosphamide (150 mg/kg) to establish a POI model, while 10 untreated mice served as the blank control. Successfully modeled mice were randomly divided into four groups (<i>n</i>=10/group): low-dose He's Yangchao Formula (6 g crude herb/kg), high-dose He's Yangchao Formula (25 g crude herb/kg), positive control (estradiol), and model control (distilled water). Treatments were admin-istered daily by gavage for 6 weeks. Vaginal exfoliated cells were stained with Wright-Giemsa solution to monitor estrous cycles. Serum estradiol and follicle-stimulating hormone (FSH) levels were measured by ELISA. Ovarian FSH receptor (FSHR) expression was assessed by immunohistochemistry. Glycolysis-related proteins pyruvate kinase M2 (PKM2) and glucose transporter 4 (GLUT4) were analyzed by Western blotting and immuno-fluorescence. Fecal samples from blank control, model control, and high-dose groups underwent metagenomic sequencing to evaluate intestinal microbiota diversity and com-position.</p><p><strong>Results: </strong>He's Yangchao Formula restored estrous cyclicity, increased serum estradiol (<i>P</i><0.05), decreased serum FSH (<i>P</i><0.05), and upregulated FSHR expression in granulosa cells (<i>P</i><0.05). Metagenomic analysis revealed significant structural differences in intestinal flora among blank control, model control, and high-dose groups (<i>P</i><0.01). The high-dose group showed reduced abundance of conditional pathogens (e.g., <i>Alistipes</i>, <i>Prevotella</i>, <i>Odoribacter</i>, <i>Blautia</i>, <i>Rikenella</i>) compared to the model control (<i>P</i><0.05). Functional enrichment analysis indicated involvement of glycolysis-related pathways. Concordantly, PKM2 and GLUT4 expression was downregulated in the model control but upregulated in He's Yangchao Formula groups (<i>P</i><0.05).</p><p><strong>Conclusions: </strong>He's Yangchao Formula ameliorates POI in mice by remodeling intestinal flora structure, enhancing glycolytic activity, improving ovarian sex hormone secretion, increasing granulosa cell FSHR expression, and restoring estrous cyclicity.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancement in neutrophil-based drug delivery systems.","authors":"Zihan Zhou, Longguang Tang","doi":"10.3724/zdxbyxb-2025-0093","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2025-0093","url":null,"abstract":"<p><p>Neutrophils, as the most abundant immune cells in the human body, possess the inherent ability to rapidly migrate to sites of inflammation or infection. Novel drug delivery systems leveraging neutrophils capitalize on their natural targeting and phagocytic capabilities to achieve precise drug delivery. Efficient drug loading into neutrophils within neutrophil-based delivery systems can be achieved through physical adsorption, chemical conjugation, and phagocytosis. Design strategies emphasize carrier selection and targeting ligand design to enhance delivery precision. Compared to traditional drug delivery systems, neutrophil-based systems offer significant advantages, including excellent biocompatibility and strong tissue penetration. These properties can significantly improve drug bioavailability and reduce adverse reactions associated with non-target tissue accumulation. However, the system also faces several challenges requiring resolution, such as difficulties in cell collection and preservation, the need for stability optimization, difficulties for large-scale production, and a lengthy clinical translation cycle. In disease treatment applications, neutrophil-based drug delivery systems enable the precise delivery of anti-cancer drugs to tumor sites, potentially disrupting the immunosuppression of tumor microenvironment and enhancing therapeutic efficacy. For brain diseases, their unique ability to cross the blood-brain barrier facilitates effective drug delivery. In chronic inflammatory diseases, they can precisely deliver anti-inflammatory agents to mitigate inflammation. Performance enhancements for neutrophil-based systems, such as the development of novel nanomaterials and optimization of targeting ligand affinity, aim to improve the accuracy and efficiency of drug delivery. This review comprehensively explores the design strategies, advantages, challenges, and future directions of neutrophil-based drug delivery systems. It summarizes research progress in disease treatment applications, aiming to offer key insights for the development of novel drug delivery systems and thus advancing precision medicine and targeted therapy.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-10"},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances of inhalable nano-formulations.","authors":"Yinjia Luo, Xiao Yue, Ziyu Zhao, Xuejuan Zhang","doi":"10.3724/zdxbyxb-2024-0650","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2024-0650","url":null,"abstract":"<p><p>Nano-drug delivery systems (NDDSs) offer significant benefits, including high specific surface area, structural and functional diversity, and surface modifiability. When further engineered into inhalable nano-formulations, they can facilitate precise pulmonary drug delivery, enhance pulmonary bioavailability, and improve therapeutic efficacy. The nebulization stability of nano-drugs can be enhanced through structure optimization, surface modification, dispersion medium optimization, and device refinement. Furthermore, pulmonary delivery efficiency is improved by strategies such as employing blending excipients to enhance the re-dispersibility of nanoparticle agglomerates, optimizing microcarrier design, and innovating preparation processes. This review summarizes inhalable nano-formulations for the treatment of respiratory diseases, highlighting the key challenges and corresponding strategies encountered in combining NDDSs with inhalation drug delivery systems. It aims to provide a reference for the future development of inhalable nano-formulations.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical efficacy and safety of transcatheter aortic valve replacement for patients with severe pure native aortic regurgitation.","authors":"Jiantao Chen, Yi Zhang, Kangni Feng, Suiqing Huang, Hanri Xiao, Mengya Liang, Zhongkai Wu","doi":"10.3724/zdxbyxb-2024-0515","DOIUrl":"https://doi.org/10.3724/zdxbyxb-2024-0515","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the early clinical efficacy and safety of trans-catheter aortic valve replacement (TAVR) for patients with severe pure native aortic regurgitation (PNAR).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 48 PNAR patients who underwent TAVR at the Department of Cardiac Surgery, the First Affiliated Hospital of Sun Yat-sen University between March 2019 and February 2025, including 25 cases with transfemoral approach (TF-TAVR group) and 23 cases with transapical approach (TA-TAVR group). Efficacy and safety were assessed by analyzing baseline characteristics, all-cause mortality, and procedure-related complications.</p><p><strong>Results: </strong>Compared with the TA-TAVR group, the TF-TAVR group exhibited significantly smaller aortic annulus circumference and diameter, left ventricular outflow tract circumference and diameter, diameters of the left, right, and non-coronary sinuses, and sinotubular junction (STJ) diameter, with a shorter distance from the STJ to the aortic valve basal ring plane (all <i>P</i><0.01). Additionally, the TF-TAVR group had a smaller annulus angle (<i>P</i><0.05), and showed a deeper prosthesis implantation depth relative to the aortic valve basal ring plane (<i>P</i><0.01). Post-TAVR, both groups demonstrated significant improvement in left ventricular end-diastolic diameter (both <i>P</i><0.05), but only the TA-TAVR group showed significant reduction in left ventricular end-systolic diameter (<i>P</i><0.05). The overall technical success rate was 91.67%, and device success rate was 83.33%. For primary outcomes, in-hospital mortality occurred in 2 patients (4.17%). No additional deaths were reported at 60 d or 90 d after surgery. During 90-180 d after surgery, one patient in the TF-TAVR group (4.76%) died of sudden cardiac death, and one in the TA-TAVR group (6.25%) died of gastrointestinal bleeding. During 180 d-1 year after surgery, one patient in the TF-TAVR group (9.09%) died of low cardiac output syndrome. No statistically significant differences were observed in 1-year Kaplan-Meier survival curves between two groups (<i>P</i>>0.05). No conduction block events occurred in TA-TAVR group, while high-grade atrioventricular block, left bundle branch block, permanent pacemaker implantation occurred in TF-TAVR group during hospitalization or 1-year follow-up (12.00%, 4.00%, and 12.00%, respectively).</p><p><strong>Conclusions: </strong>TAVR demonstrates high success rates and acceptable safety for severe PNAR patients who are unable to undergo traditional surgical procedures. Although TF-TAVR may face more challenges in certain complex cases than TA-TAVR, the overall outcomes are promising.</p>","PeriodicalId":24007,"journal":{"name":"Zhejiang da xue xue bao. Yi xue ban = Journal of Zhejiang University. Medical sciences","volume":" ","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}