Publications by authors named "Jeng Wei"

102 Publications

Effects of Transapical Transcatheter Mitral Valve Implantation.

Front Cardiovasc Med 2021 11;8:633369. Epub 2021 Jun 11.

Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.

In this study, transapical transcatheter mitral valve-in-valve implantation (TAMVI) was compared with surgical redo mitral valve replacement (SRMVR) in terms of clinical outcomes. We retrospectively identified patients with degenerated mitral bioprosthesis or failed annuloplasty rings who underwent redo SRMVR or TAMVI at our medical center. Clinical outcomes were based on echocardiography results. We retrospectively identified patients with symptomatic mitral bioprosthetic valve dysfunction ( = 58) and failed annuloplasty rings ( = 14) who underwent redo SRMVR ( = 36) or TAMVI ( = 36). The Society of Thoracic Surgeons Predicted Risk of Mortality scores were higher in the TAMVI group (median: 9.52) than in the SRMVR group (median: 5.59) (-value = 0.02). TAMVI patients were more severe in New York Heart Association (-value = 0.04). The total procedure time (skin to skin) and length of stay after procedures were significantly shorter in the TAMVI group, and no significant difference in mortality was noted after adjustment for confounding factors (-value = 0.11). The overall mean mitral valve pressure gradient was lower in the TAMVI group than in the SRMVR group at 24 months ( < 0.01). Both groups presented a decrease in the severity of mitral and tricuspid regurgitation at 3-24 months. In conclusion, the statistical analysis is still not robust enough to make a claim that TAMVI is an appropriate alternative. The outcome of the patient appears only to be related to the patient's pre-operative STS score. Additional multi-center, longitudinal studies are warranted to adequately assess the effect of TAMVI.
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http://dx.doi.org/10.3389/fcvm.2021.633369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225931PMC
June 2021

Corrigendum to 'Tangible dynamic changes in resilience, nutrition, and leisure activity of older patients with cardiovascular disease and possible sarcopenia: A longitudinal study' [Archives of Gerontology and Geriatrics AGG, Volume 91, July-August 2021, 104416].

Arch Gerontol Geriatr 2021 Jun 10;96:104456. Epub 2021 Jun 10.

Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan, No.12, 225 Lane, Zhi-Sing Road, Taipei Taiwan, 11260, Taiwan, ROC.

Aim And Objectives: The purpose of this study was to explore the inter-relationships among resilience, nutrition, and leisure activity of older patients with cardiovascular disease and possible sarcopenia. Besides, the patterns of these three variables over a long-term follow-up was examine.

Material And Methods: Quantitative longitudinal study design was used in this study. Sarcopenia is related to aging, lack of physical activity, and malnutrition. Complex inter-relationships exist in patients with regards to their resilience, nutritional status, leisure activities. A generalized estimating equation (GEE) was used for long-term follow-up observations, and data were collected form one month (T1), three months (T2) and six months (T3). A demographic questionnaire and the Chinese versions of the Resilience Scale (CRS), the Mini-Nutritional Assessment (MNA), and the Leisure Time Activities Scale (LTAS), were used to collect data.

Results: A total of 267 eligible participants were enrolled in this study, of whom 53% were men and 47% were women. The interactions among resilience, nutrition, and leisure activity were reported. Resilience was positively correlated with nutrition. Higher resilience was developed higher participation in leisure activities was found in older adults with possible sarcopenia.

Conclusion: Resilience is a key factor for greater participation in leisure activities. Health professionals should develop feasible resilience interventions that would enhance patient's participation in leisure activities. Nutritional consulting and physical activity interventions should be combined in the case of older adults to prevent the occurrence of possible sarcopenia.
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http://dx.doi.org/10.1016/j.archger.2021.104456DOI Listing
June 2021

Malnutrition, Family Support, and Possible Sarcopenia in Patients Undergoing Transcatheter Aortic Valve Implantation.

J Cardiovasc Nurs 2021 May 20. Epub 2021 May 20.

Ching-I Hsu, RN, MSN Registered Nurse, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan. Jeng Wei, MD, MSD President/Professor, Heart Center of Cheng-Hsin Hospital, Taipei, Taiwan. Heng-Hsin Tung, DNP, PhD, RN, FNP Professor, College of Nursing, National Yang Ming Chiao Tung University, Taipei; and Consultant, Tungs' Taichung MetroHarbor Hospital, Taiwan. Li-Ning Peng, MD, PhD Assistant Professor, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan. Liang-Kung Chen, MD, PhD Professor, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taiwan. Chieh-Yu Liu, PhD Professor, National Taipei University of Nursing and Health Science, Taiwan.

Background: Possible sarcopenia, aortic valve stenosis, and malnutrition are important issues that afflict older adults.

Objective: The aims of this study were to compare the differences in nutritional status and family support in older adults with possible sarcopenia and those without sarcopenia after undergoing transcatheter aortic valve implantation (TAVI) and to identify the predictors of malnutrition and demonstrate changes in heart function over time after undergoing TAVI.

Methods: A case-control design was conducted. Possible sarcopenia was identified by measuring calf circumference, grip strength, and gait speed. The Mini Nutritional Assessment-Short Form and numerical family support rating scale were used to collect data. Left ventricular ejection fraction and New York Heart Association (NYHA) functional class were assessed at 5 time points to evaluate heart function.

Results: Eighty-one participants were categorized into those without sarcopenia (34) and those with possible sarcopenia (47). Logistic linear regression showed albumin and possible sarcopenia to be predictors of malnutrition (odds ratio, 5.5; 95% confidence interval, 1.02-30.19). Family support was associated with nutrition status (P = .019). For patient heart function, the results of NYHA functional class and left ventricular ejection fraction improved over time after TAVI. The improvement in NYHA functional class at T2 was significantly different between the 2 groups compared with that at T0.

Conclusions: The nutrition level was higher among participants without sarcopenia than those with possible sarcopenia. Approximately 90% of the participants indicated that they had high family support. Demographic factors and albumin levels could be used to evaluate risk of malnutrition. Patients without possible sarcopenia showed greater improvement in NYHA class.
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http://dx.doi.org/10.1097/JCN.0000000000000819DOI Listing
May 2021

Tangible dynamic changes in resilience, nutrition, and leisure activity of older patients with cardiovascular disease and possible sarcopenia: A longitudinal study.

Arch Gerontol Geriatr 2021 Jul-Aug;95:104416. Epub 2021 Apr 8.

Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei City 11217, Taiwan, ROC. Electronic address:

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http://dx.doi.org/10.1016/j.archger.2021.104416DOI Listing
June 2021

Perioperative Concerns of Anomalous Origin of the Left Main Coronary Artery From the Pulmonary Artery.

Asian J Anesthesiol 2021 03 21;59(1):35-36. Epub 2021 Jan 21.

Department of Anesthesiology, Cheng Hsin General Hospital, Taipei, Taiwan.

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http://dx.doi.org/10.6859/aja.202103_59(1).0004DOI Listing
March 2021

Rationale and design of the ADAPT-TAVR trial: a randomised comparison of edoxaban and dual antiplatelet therapy for prevention of leaflet thrombosis and cerebral embolisation after transcatheter aortic valve replacement.

BMJ Open 2021 01 5;11(1):e042587. Epub 2021 Jan 5.

Division of Cardiology, Asan Medical Center, Songpa-gu, Seoul, The Republic of Korea

Introduction: Optimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) is still unknown. We hypothesised that the direct factor Xa inhibitor edoxaban can potentially prevent subclinical leaflet thrombosis and cerebral embolisation compared with conventional dual antiplatelet therapy (DAPT) in patients undergoing TAVR.

Methods And Analysis: The ADAPT-TAVR trial is an international, multicentre, randomised, open-label, superiority trial comparing edoxaban-based strategy and DAPT strategy in patients without an indication for oral anticoagulation who underwent successful TAVR. A total of 220 patients are randomised (1:1 ratio), 1-7 days after successful TAVR, to receive either edoxaban (60 mg daily or 30 mg daily if patients had dose-reduction criteria) or DAPT using aspirin (100 mg daily) plus clopidogrel (75 mg daily) for 6 months. The primary endpoint was an incidence of leaflet thrombosis on four-dimensional, volume-rendered cardiac CT imaging at 6 months post-TAVR. The key secondary endpoints were the number of new lesions and new lesion volume on brain diffusion-weighted MRI and the changes in neurological and neurocognitive function assessment between immediate post-TAVR and 6 months of study drug administration. Detailed clinical information on thromboembolic and bleeding events were also assessed.

Ethics And Dissemination: Ethic approval has been obtained from the Ethics Committee/Institutional Review Board of Asan Medical Center (approval number: 2017-1317) and this trial is also approved by National Institute of Food and Drug Safety Evaluation of Republic of Korea (approval number: 31511). Results of this study will be disseminated in scientific publication in reputed journals.

Trial Registration Number: NCT03284827.
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http://dx.doi.org/10.1136/bmjopen-2020-042587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786793PMC
January 2021

Clinical Experience of Patients With Hepatitis C Treated With Direct-Acting Antivirals After Heart Transplantation.

Transplant Proc 2021 Mar 17;53(2):665-672. Epub 2020 Dec 17.

Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan. Electronic address:

Background: Hepatitis C increases the mortality and morbidity of patients after heart transplant. Direct-acting antivirals (DAAs) are the primary drugs for hepatitis C treatment. However, such drugs are expensive and frequently unaffordable for patients. In DAA treatment, the assessment of drug interaction is crucial.

Methods: We investigated a retrospective case series study from January 2017 to December 2019. Sustained virologic response 12 (SVR12) was used to assess the effectiveness of DAA treatment. Data on patients' demographic information, timing of hepatitis C virus (HCV) infection (before or after heart transplant), HCV genotypes and viral loads, DAAs used (branded drugs or generic drugs), and drug interaction assessments were collected.

Results: Fifteen heart transplant patients received hepatitis C treatments during the study period, 11 of whom were infected because their donors had hepatitis C. After DAA treatment, HCV was undetectable in all patients, and 93.3% of them achieved SVR12. Nine patients used the generic sofosbuvir/velpatasvir, and 88.9% of them achieved SVR12. A total of 256 drugs were used with DAAs; 51 records of drug interactions were noted, 3 of which were contraindications, and the remaining records were potential interactions. Patients who used sofosbuvir or elbasvir/grazoprevir experienced fewer drug interactions.

Conclusions: DAA treatment is effective for hepatitis C treatment in patients after heart transplant. Patients who cannot afford branded drugs because of their prices can use generic drugs as an alternative. Drug interactions must be surveyed during DAA treatment.
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http://dx.doi.org/10.1016/j.transproceed.2020.10.035DOI Listing
March 2021

A decentralized framework for cultivating research lifecycle transparency.

PLoS One 2020 18;15(11):e0241496. Epub 2020 Nov 18.

Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan.

Research transparency has been advocated as a key means of addressing the current crisis of reproducibility. This article proposes an enhanced form of research transparency, termed lifecycle transparency. Over the entire lifecycle of a research effort, this approach captures the syntactical contexts of artifacts and stakeholders, such as timestamps, agreements, and/or dependency requirements for completing each research phase. For example, such contexts might include when, where, and from whom patients' consent and institutional review board approvals were received before a clinical trial was carried out. However, as existing open-science tools are often dedicated to certain research phases or disciplines, and thus insufficient to support lifecycle transparency, we propose a novel decentralized framework to serve as a common medium for interaction among open-science tools, and produces irrefutable and immutable proofs of progress that can be verified automatically.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241496PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7673512PMC
December 2020

Delayed Coronary Obstruction after Transcatheter Aortic Valve Replacement - An Uncommon But Serious Complication.

Acta Cardiol Sin 2020 Sep;36(5):409-415

Heart Center, Cheng Hsin General Hospital.

As transcatheter aortic valve replacement (TAVR) becomes the mainstream treatment for valvular aortic stenosis, it is vitally important to recognize its associated procedural complications. Among the clinically relevant but uncommonly seen complications, the development of delayed coronary obstruction (DCO) occurring during the early post-procedural phase or even later following the index TAVR procedure, has been reported. These reports have raised concerns as TAVR comes more common in lower-risk patients. In this review article, we explored the implications of DCO for pre-procedural computed tomography evaluation, valve selection and sizing, intra-procedural manipulation, and approaches to post-procedural management.
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http://dx.doi.org/10.6515/ACS.202009_36(5).20200516ADOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490610PMC
September 2020

What drives and inhibits researchers to share and use open research data? A systematic literature review to analyze factors influencing open research data adoption.

PLoS One 2020 18;15(9):e0239283. Epub 2020 Sep 18.

Department of Library and Information Science, National Taiwan University, Taipei, Taiwan.

Both sharing and using open research data have the revolutionary potentials for forwarding scientific advancement. Although previous research gives insight into researchers' drivers and inhibitors for sharing and using open research data, both these drivers and inhibitors have not yet been integrated via a thematic analysis and a theoretical argument is lacking. This study's purpose is to systematically review the literature on individual researchers' drivers and inhibitors for sharing and using open research data. This study systematically analyzed 32 open data studies (published between 2004 and 2019 inclusively) and elicited drivers plus inhibitors for both open research data sharing and use in eleven categories total that are: 'the researcher's background', 'requirements and formal obligations', 'personal drivers and intrinsic motivations', 'facilitating conditions', 'trust', 'expected performance', 'social influence and affiliation', 'effort', 'the researcher's experience and skills', 'legislation and regulation', and 'data characteristics.' This study extensively discusses these categories, along with argues how such categories and factors are connected using a thematic analysis. Also, this study discusses several opportunities for altogether applying, extending, using, and testing theories in open research data studies. With such discussions, an overview of identified categories and factors can be further applied to examine both researchers' drivers and inhibitors in different research disciplines, such as those with low rates of data sharing and use versus disciplines with high rates of data sharing plus use. What's more, this study serves as a first vital step towards developing effective incentives for both open data sharing and use behavior.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239283PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500699PMC
November 2020

Developing a Heart Transplantation Self-Management Support Mobile Health App in Taiwan: Qualitative Study.

JMIR Mhealth Uhealth 2020 08 19;8(8):e18999. Epub 2020 Aug 19.

School of Nursing, National Yang-Ming University, Taipei, Taiwan.

Background: Heart transplantation (HTx) is the most effective treatment for end-stage heart failure patients. After transplantation, patients face physiological, psychological, social, and other health care problems. Mobile health (mHealth) apps can change the delivery of conventional health care to ubiquitous care and improve health care quality. However, a dearth of mHealth apps exists for patients with HTx worldwide, including in Taiwan.

Objective: The aim of this study was to investigate the information needed and to develop a preliminary framework for an mHealth app for post-HTx patients.

Methods: A qualitative approach with individual in-depth interviews was conducted at a heart center in the regional hospital of northern Taiwan from June to November 2017. Patients that had undergone HTx and their health professionals were recruited for purposeful sampling. A semistructured interview guideline was used for individual interviews and transcribed. Thematic analysis was used for data analysis.

Results: A total of 21 subjects, including 17 patients and 4 health professionals, were recruited for the study. The following five major themes were identified: reminding, querying, experience sharing, diet, and expert consulting. Minor themes included a desire to use the app with artificial intelligence and integration with professional management.

Conclusions: An intelligent mHealth app that addresses the five main themes and integrates the processes of using a mobile app could facilitate HTx self-management for Taiwanese patients.
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http://dx.doi.org/10.2196/18999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468636PMC
August 2020

Rapid growth of right sinus Valsalva aneurysm dissecting into interventricular septum.

Anatol J Cardiol 2020 07;24(1):E2-E3

Department of Cardiology, Heart Center, Cheng Hsin General Hospital; Taipei-Taiwan.

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http://dx.doi.org/10.14744/AnatolJCardiol.2020.92566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414810PMC
July 2020

Performance and short-term outcomes of three different transcatheter aortic valve replacement devices in patients with aortic stenosis: A single-center experience.

J Chin Med Assoc 2019 Nov;82(11):827-834

Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC.

Background: Data on whether different transcatheter aortic valve replacement (TAVR) devices and delivery approaches can achieve equally favorable outcomes when performed by a single heart team are scarce. We sought to compare the performance and short-term outcomes of three different TAVR devices-self-expanding Medtronic CoreValve (MCV), mechanically expanded Lotus valve, and balloon-expandable Edwards SAPIEN XT (SXT)-for the treatment of severe aortic stenosis (AS) in a single large-volume center in Taiwan.

Methods: We retrospectively reviewed consecutive patients who underwent TAVR for the treatment of severe AS. Clinical outcomes were reported following Valve Academic Research Consortium 2 (VARC-2) criteria. The composite primary endpoint was combined all-cause mortality, myocardial infarction (MI), or disabling stroke within 180 days.

Results: A total of 231 patients (MCV n=112, Lotus n=18, and SXT n=101) were included. The device and procedural success rates were similar among all three TAVR devices. At 30 days, there was no significant difference in all-cause mortality, cardiovascular mortality, periprocedural MI, stroke, major vascular complications, life-threatening bleeding, acute kidney injury (AKI, stage 2/3), or VARC-2 composite early safety endpoints. There was no difference among groups in the rate of primary endpoint within 180 days. Lack of procedural success, presence of acute coronary occlusion during TAVR, and presence of AKI (stage 3) after TAVR were independent predictors of adverse outcomes.

Conclusion: TAVR using MCV, Lotus, or SXT was associated with similar 30- and 180-day clinical outcomes. The presence of periprocedural complications was one of the main determinants of short-term adverse outcomes.
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http://dx.doi.org/10.1097/JCMA.0000000000000187DOI Listing
November 2019

Quantification of Stent Creep by Three-Dimensional Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve-in-Valve Implantation for Failed Bioprostheses.

Acta Cardiol Sin 2019 Jul;35(4):380-386

Heart Center, Cheng Hsin General Hospital.

Background: Transcatheter aortic valve-in-valve implantation (aVIV) has been used to treat bioprosthetic failure due to "stent creep", defined as inward flexion or bending of stent posts. The aim of this study was to develop quantitative three-dimensional transesophageal echocardiography (3D-TEE) geometric analysis of failed bioprostheses to determine the incidence of stent creep in patients undergoing aVIV and its contribution to the hemodynamics of those valves.

Methods: We retrospectively examined the 3D-TEE of 22 consecutive patients (age 74.4 ± 11.3 years; M/F = 12/10) who underwent aVIV for failed bioprostheses. The modes of bioprosthesis failure included stenosis (n = 8), regurgitation (n = 9), and combined (n = 5). The degree of stent creep was assessed by calculating the triangular area obtained by projecting the apex of stent posts on a reconstructed plane. This measured area was divided by that of the regular triangle defined by the base of stent posts to calculate a ratio, which we termed the "stent creep ratio" (SCR).

Results: The mean SCR was lower in the patients with failed prostheses than that in the controls (0.82 ± 0.16 vs. 0.96 ± 0.05, p = 0.02). The SCR was negatively correlated with the peak trans-aortic pressure gradient (r = -0.62, p < 0.01). An SCR cut-off point of 0.79 was associated with aortic peak velocity > 4 m/s (AUC = 0.81, sensitivity = 0.79, specificity = 0.83). Fourteen of the 22 patients had pre- and post-aVIV 3D-TEE, and the SCR was corrected satisfactorily from 0.81 ± 0.13 to 1.04 ± 0.19 (p < 0.01).

Conclusions: SCR measured by 3D-TEE is feasible to quantitatively evaluate stent creep. Stent creep is an important mode of structural deterioration in surgical bioprostheses, which can be treated by aVIV.
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http://dx.doi.org/10.6515/ACS.201907_35(4).20181126ADOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6656973PMC
July 2019

Computed Tomography-Determined Muscle Quality Rather Than Muscle Quantity Is a Better Determinant of Prolonged Hospital Length of Stay in Patients Undergoing Transcatheter Aortic Valve Implantation.

Acad Radiol 2020 03 31;27(3):381-388. Epub 2019 May 31.

Heart Center, Cheng-Hsin General Hospital, No. 45, Zhenxing Street, Beitou District, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address:

Rationale And Objectives: Computed tomography (CT)-determined skeletal muscle measures have been used for predicting postoperative outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). We investigated the impact of CT-determined muscle quantity (measured as psoas muscle area [PMA] and psoas muscle index [PMI]) and quality (measured as psoas muscle density [PMD]) on hospital length of stay (LOS) after TAVI.

Methods: We retrospectively identified 182 consecutive patients who underwent TAVI between March 2013 and August 2017 with adequate preprocedural CT imaging. Baseline demographic and clinical data, the Society of Thoracic Surgeons score, the essential frailty toolset (EFT) frailty rating, and precontrast PMD, PMA, and PMI were obtained in all study patients. The primary outcome was prolonged postoperative LOS defined as greater than 14 days.

Results: Patients with prolonged LOS had a significantly higher Society of Thoracic Surgeons score (p < 0.001) and significantly lower PMD (p < 0.001) than those with LOS ≤14 days. More patients with prolonged LOS had concomitant peripheral vascular disease (p  = 0.001), had undergone percutaneous coronary interventions (p = 0.022), and had an EFT score ≥4 (p < 0.001) compared to those without prolonged LOS. Neither PMA (p = 0.123) nor PMI (p = 0.271) were associated with prolonged LOS. Multivariate analysis identified EFT score ≥4, the presence of peripheral vascular disease, and PMD as independent predictors of prolonged LOS.

Conclusion: The precontrast CT-determined muscle quality measurement PMD is a simple and objective predictor of prolonged LOS after TAVI.
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http://dx.doi.org/10.1016/j.acra.2019.05.007DOI Listing
March 2020

One-stage aortic replacement for type A aortic dissection: using a Vasoring and a conventional elephant trunk graft.

Eur J Cardiothorac Surg 2019 Jul;56(1):189-196

Cardiovascular Surgery, Tung's Taichung Metro Harbour Hospital, Taichung, Taiwan.

Objectives: We used a vascular ring connector (Vasoring) and a conventional elephant trunk graft for complete repair in open surgery for type A aortic dissection. This report described the immediate and mid-term results of this new technique.

Methods: We used a rigid titanic ring as a stent in the vascular graft for rapid sutureless anastomosis in the reconstruction of type A aortic dissection.

Results: A total of 65 consecutive patients with Stanford type A aortic dissection underwent open surgery performed by a single surgeon from November 2007 to February 2017. All patients underwent aortic reconstruction with vascular grafts and Vasorings (21 patients in the ascending aorta and 44 patients in the total aortic arch). For total aortic arch replacement, we implanted the conventional vascular graft in the proximal descending thoracic aorta as an elephant trunk graft. Concomitant procedures included the Bentall procedure (9 patients), the David operation (6 patients), coronary artery bypass grafting (9 patients), heart transplantation (1 patient), mitral valve replacement (2 patients) and endovascular aortic repair (1 patient). The mean duration of postoperative endotracheal intubation was 17.0 ± 11.8 h. The average blood loss was 520 ± 743 ml, and 25% of patients required no blood transfusion. The in-hospital mortality rate was 6%.

Conclusions: The combined use of the vascular ring connector and the conventional elephant trunk graft may reduce bleeding and pump time, stop the blood flow in the false lumen and allow the 1-stage total arch replacement to be performed safely. The conventional elephant trunk graft is free from stent graft-induced new entry.
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http://dx.doi.org/10.1093/ejcts/ezy455DOI Listing
July 2019

Nonthrombotic pulmonary embolism caused by intravenous leiomyomatosis: A case report.

Medicine (Baltimore) 2019 Jan;98(3):e14118

Heart Center, Cheng-Hsin General Hospital, Taipei.

Rationale: Pulmonary embolism is a potentially devastating medical condition. Although deep-vein thrombosis is the most common etiology, a nonthrombotic pulmonary embolism is not uncommon.

Patient Concerns: A 45-year-old woman was admitted to our hospital for progressive effort dyspnea for 3 weeks.

Diagnosis: Echocardiography revealed a mobile mass extending from the right atrium to the bilateral proximal pulmonary artery. As the mass was no response to thrombotic therapy, intravenous leiomyomatosis was suspected. Computed tomography (CT) revealed a hypo-attenuated tumor extending from the ovarian vein to the pulmonary artery.

Interventions: A 1-stage operation for the surgical removal of the tumor, right salpingo-oophorectomy and subtotal hysterectomy were performed. Surgical specimen was identified as uterine leiomyomatosis without malignant transformation.

Outcomes: The patient was followed- up for 2 years and subsequent CT did not reveal any notable lesions.

Lessons: Nonthrombotic pulmonary embolism is a potentially life-threatening complication. This case indicated intravenous leiomyomatosis should be considered in the differential diagnosis for certain cases. Complete surgical excision was the only curative treatment.
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http://dx.doi.org/10.1097/MD.0000000000014118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370129PMC
January 2019

CCN family member 1 deregulates cholesterol metabolism and aggravates atherosclerosis.

Acta Physiol (Oxf) 2019 03 19;225(3):e13209. Epub 2018 Nov 19.

Graduate Institute and Department of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan.

Aim: CCN family member 1 (CCN1) is an extracellular matrix cytokine and appears in atherosclerotic lesions. However, we have no evidence to support the role of CCN1 in regulating cholesterol metabolism and atherosclerosis.

Methods: Apolipoprotein E-deficient (apoE ) mice were used as in vivo model. Oxidized low-density lipoprotein (oxLDL)-induced macrophage-foam cells were used as in vitro model. RT-PCR and western blot analysis were used for evaluating gene and protein expression, respectively. Conventional assay kits were used for assessing the levels of cholesterol, triglycerides, and cytokines.

Results: We show predominant expression of CCN1 in foamy macrophages in atherosclerotic aortas of apoE mice. In apoE mice, CCN1 treatment worsened hyperlipidaemia, systemic inflammation, and the progression of atherosclerosis. In addition, CCN1 decreased the capacity of reverse cholesterol transport and downregulated the protein expression of ATP-binding cassette transporter A1 (ABCA1) and ABCG1 in atherosclerotic aortas. Notably, CCN1 decreased the protein expression of cholesterol clearance-related proteins, including ABCG5, ABCG8, liver X receptor α (LXRα), cholesterol 7α-hydrolase and LDL receptor in liver, and exacerbated hepatic lipid accumulation. In macrophages, treatment with oxLDL increased CCN1 expression. Inhibition of CCN1 activity by neutralizing antibody or small interfering RNA attenuated the oxLDL-induced lipid accumulation. In contrast, cotreatment with CCN1 or overexpression of CCN1 augmented oxLDL-induced lipid accumulation by impairing apolipoprotein AI- and high-density lipoprotein-dependent cholesterol efflux, which was attributed to downregulation of LXRα-dependent expression of ABCA1 and ABCG1.

Conclusion: Our findings suggest that CCN1 plays a pivotal role in regulating cholesterol metabolism and the development of atherosclerosis.
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http://dx.doi.org/10.1111/apha.13209DOI Listing
March 2019

Quality of life, demoralization syndrome and health-related lifestyle in cardiac transplant recipients - a longitudinal study in Taiwan.

Eur J Cardiovasc Nurs 2019 02 18;18(2):149-162. Epub 2018 Sep 18.

4 Heart Center, Cheng-Hsin Hospital, Taipei, Taiwan, R.O.C.

Background: Quality of life is an outcome indicator after health care treatment, and the factors that affect quality of life change over time after heart transplantation. As such, quality of life as related to heart transplantation warrants further investigation.

Aims: The purposes of this study were to compare different post-transplant times of cardiac transplant recipients in terms of their quality of life, demoralization syndrome and health-related lifestyle and to identify the predictors of quality of life in Taiwan.

Methods: This longitudinal study, which used convenience sampling, was conducted in one medical center. Participants were divided into three groups (1, 2 and 3) based on post-transplant time. Four questionnaires, that is, demographic, quality of life, including a physical and mental component summary (PCS and MCS), demoralization and health-related lifestyle, were used to collect data at baseline and at three, six and 12 months. Hierarchical regression was used to identify the predictors of quality of life.

Results: There were 99 participants, who were divided into three groups: Group 1 ( n = 31), Group 2 ( n = 29) and Group 3 ( n = 39). The majority of participants were male, with a mean age of 53.68 years. In each group, fewer than half had good quality of life, and one-third had demoralization syndrome. Demoralization syndrome combined with post-transplant time, age, use of mechanical circulatory support during hospitalization and stress status accounted for 35.2% of PCS for all participants. Further, demoralization syndrome combined with age and religion accounted for 40.3% of MCS for all participants.

Conclusions: The results indicated that quality of life, demoralization syndrome and health-related lifestyle were correlated over time. Demoralization was an independent predictor of quality of life.
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http://dx.doi.org/10.1177/1474515118800397DOI Listing
February 2019

Clinical Outcomes of VasoRing Connector in Patients With Acute Type A Aortic Dissection.

Ann Thorac Surg 2018 09 26;106(3):764-770. Epub 2018 Apr 26.

Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.

Background: Outcomes of acute type A aortic dissection repair may be improved when VasoRing connectors (VRC [Sunwei Technology, Taipei, Taiwan]) are used to facilitate aortic anastomosis. In the present study, we compared the results of acute type A aortic dissection repair using VRC and conventional suture technique.

Methods: A total of 68 patients who underwent acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure at our institution were enrolled. Records of patients receiving aorta anastomosis with VRC (n = 33) and conventional suture (n = 35) were retrospectively compared. All the surgical results were collected and analyzed.

Results: The results showed that the VRC group exhibited significance in total operative time (326 ± 80 minutes versus 362 ± 34 minutes, p = 0.023), cardiopulmonary bypass time (97 ± 10 minutes versus 134 ± 15 minutes, p < 0.001), aortic cross-clamp time (97 ± 10 minutes versus 134 ± 15 minutes, p < 0.001), and circulatory arrest time (15 ± 4 minutes versus 50 ± 8 minutes, p < 0.001) compared with the suture group. Use of VRC for aortic anastomosis led to significantly less perioperative blood loss (442 ± 75 mL versus 849 ± 419 mL, p < 0.001) compared with conventional suture for aortic anastomosis There was no reoperation for postoperative bleeding in the VRC group whereas reoperation for postoperative bleeding occurred in 20% of the suture group (0% versus 20%, p = 0.011). Postoperative blood loss, amount of blood transfusion, and acute kidney injury requiring hemodialysis were also significantly less in the VRC group than the suture group.

Conclusions: Use of VRC shortened operative time and improved bleeding control incorporating standard methods for aortic anastomoses during acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure. Long-term follow-up and randomized comparison are needed to confirm VRC efficacy.
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http://dx.doi.org/10.1016/j.athoracsur.2018.03.056DOI Listing
September 2018

Use of Internal Endoconduit for Unfavorable Iliac Artery Anatomy in Patients Undergoing Transcatheter Aortic Valve Replacement - A Single Center Experience.

Acta Cardiol Sin 2018 Jan;34(1):37-48

Heart Center, Cheng-Hsin General Hospital.

Background: Transfemoral (TF) access is associated with lower rates of surgical conversion and mortality compared with non-TF access for transcatheter aortic valve replacement (TAVR). Therefore, efforts should be made to make this procedure even less invasive, allowing more TAVR procedures to be performed through femoral access. We herein describe our single-center experience of using one-stage percutaneous internal endoconduits for TAVR in patients with unfavorable iliac artery anatomy.

Methods: Between March 2013 andMarch 2016, 113 consecutive patients with severe aortic stenosis at high risk for conventional cardiac surgery underwent TAVR at the Cheng Hsin General Hospital. The patients can be divided into Cohort A (March 2013-December 2014) and Cohort B (January 2015-March 2016).

Results: In the Cohort A, 6 out of the 53 (11.4%) with unfavorable iliac artery anatomy were treated by trans-subclavian approach (n = 3, 5.7%) or direct aortic approach (n = 3, 5.7%); while in the Cohort B, none (0%) of the 5 patients with unfavorable iliac artery anatomy among 60 consecutive TAVR cases needed non-TF approach (Cohort A vs. Cohort B = 11.4% vs. 0%, p = 0.024) and they were all successfully treated with the use of an internal endoconduit.

Conclusions: The use of internal endoconduits can further increase the number of patients who can be treated through femoral artery access for TAVR and substantially reduce the need of non-TF approaches.
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http://dx.doi.org/10.6515/ACS.201801_34(1).20170911ADOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777942PMC
January 2018

Gap between guidelines and clinical practice in heart failure with reduced ejection fraction: Results from TSOC-HFrEF registry.

J Chin Med Assoc 2017 Dec 9;80(12):750-757. Epub 2017 Oct 9.

Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address:

Background: Heart failure (HF) is a global health problem. Guidelines for the management of HF have been established in Western countries and in Taiwan. However, data from the Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed suboptimal prescription of guideline-recommended medications. We aimed to analyze the reason of non-prescription and clinical outcomes as a result of under-prescription of medications.

Methods: A total of 1509 patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan by the end of October 2014. Prescribed guideline-recommended medications and other relevant clinical parameters were collected and analyzed at discharge and 1 year after index hospitalization.

Results: At discharge, 62% of patients were prescribed with either angiotensin-converting enzyme-inhibitors (ACEI) or angiotensin receptor blockers (ARB); 60% were prescribed with beta-blockers and 49% were prescribed with mineralocorticoid receptor antagonists (MRA). The proportions of patients at ≥50% of the target dose for ACEI/ARB, beta-blockers and MRA were 24.4%, 20.6%, 86.2%, respectively. At 1-year follow-up, dosages of ACEI/ARB and MRA were up-titrated in about one-fourth patients, and dosages of beta-blocker were up-titrated in about 40% patients. One-year mortality rate was lowest in patients who received at least 2 classes of guideline-recommended medications with ≥50% of the target dose, and highest in those who received 0 or 1 class of medications.

Conclusion: The TSOC-HFrEF registry demonstrated the under-prescription of guideline-recommended medications and reluctance of physicians to up-titrate medications to target dose. Action plan needs be formulated in order to improve physician's adherence to HF guidelines.
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http://dx.doi.org/10.1016/j.jcma.2017.04.011DOI Listing
December 2017

Incremental benefit of three-dimensional transesophageal echocardiography in the assessment of a primary pericardial hemangioma.

Echocardiography 2017 Aug 13;34(8):1210-1215. Epub 2017 Jun 13.

Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan.

Hemangiomas are rarely found in the heart and pericardial involvement is even more rare. We report a case of primary pericardial hemangioma, in which three-dimensional transesophageal echocardiography (3DTEE) provided incremental benefit over standard two-dimensional images. Our case also highlights the importance of systematic cropping of the 3D datasets in making a diagnosis of pericardial hemangioma with a greater degree of certainty. In addition, we also provide a literature review of the features of cardiac/pericardial hemangiomas in a tabular form.
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http://dx.doi.org/10.1111/echo.13591DOI Listing
August 2017

Transesophageal echocardiography for incremental value of Amplatezer cribriform septal occluder for percutaneous transcatheter closure of complex septal defects: Case series.

J Chin Med Assoc 2017 Jun 25;80(6):333-340. Epub 2017 Apr 25.

Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address:

Background: The anatomy of septal defects can be complex and morphologically unpredictable. Balloon sizing of such defects may not be feasible, and an appropriately sized commercial occluder may not be available. Therefore, percutaneous transcatheter closure of such defects can be challenging because of an increased risk of complications. In this study, we have described the efficacy and safety of transcatheter closure of complex septal defects using Amplatzer cribriform occluder devices, assessed by real time three-dimensional (RT 3D) color Doppler transesophageal echocardiography (TEE).

Methods And Results: Four complex septal defects were involved in this investigation: (1) reimplanted multiple atrial septal defects (ASD) with one device embolization; (2) postinfarction ventricular septal defect; (3) long tunnel patent foramen ovale; and (4) postoperative residual ASD. All patients underwent percutaneous transcatheter interventions due to the high risk of surgical complications, and one of the three available cribriform ASD device sizes (18 mm, 25 mm, or 35 mm) was implanted. Perioperative RT 3D TEE combined with fluoroscopy was used for monitoring during the procedure. All defects were successfully occluded by cribriform septal occluder devices using the transcatheter technique.

Conclusion: Our patients with complex septal defects were successfully treated by transcatheter closure using an Amplazter cribriform septal occluder device with careful planning based on patient presentation and close interdisciplinary collaboration. RT 3D color Doppler TEE provided precise information for the selection of the appropriate occluder device and facilitated the procedure by guiding the catheter through the often challenging patient anatomy.
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http://dx.doi.org/10.1016/j.jcma.2017.03.003DOI Listing
June 2017

Circulating Adiponectin Levels Following Treatment Can Predict Late Clinical Outcomes in Chronic Heart Failure.

Acta Cardiol Sin 2017 Mar;33(2):139-149

Heart Center, Cheng Hsin General Hospital.

Background: Circulating adiponectin concentration increases in patients with chronic heart failure (HF). We sought to explore the prognostic value of temporal changes in adiponectin concentration following treatment for chronic HF.

Methods: Serum adiponectin levels were measured at baseline and after a 3-month anti-failure treatment in 124 patients with symptomatic chronic systolic HF. Major adverse cardiac events (MACE) including death, heart transplantation, or hospitalization with worsening HF during a median follow-up period of 752 days were determined.

Results: Univariate and multivariate analysis showed that high levels of adiponectin after a 3-month treatment were associated with a 3.8-fold increased risk of MACE (p = 0.03), independent of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Moreover, the combining of circulating levels of adiponectin with NT-proBNP provided independent and additional prognostic value in identifying high risk patients with MACE during follow-up.

Conclusions: Changes in adiponectin and NT-proBNP over time provide prognostic information. When adiponectin is used in conjunction with NT-proBNP in chronic HF, the prognostic value may be better than if each biomarker is used separately.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364155PMC
http://dx.doi.org/10.6515/acs20160427bDOI Listing
March 2017

Lifestyle changes in heart transplant recipients.

Int J Nurs Pract 2017 Feb 8;23(1). Epub 2017 Jan 8.

National Taipei University of Nursing and Health Science, Taipei, Taiwan.

The purpose of this study was to understand the lifestyle; examine the relationships among lifestyle, medical factors, and stress status; and determine the predictors of better lifestyle in heart transplant recipients in Taiwan. A prospective design with convenience sampling was used. Data were collected through the Health-Promoting Lifestyle Profile-II and demographic questionnaires, which included personal information, stress status, and medical information. Pearson correlations, 1-way analysis of variance, independent t tests, paired t tests, and hierarchical regression were used to analyze the factors related to better lifestyle. A total of 80 heart transplant recipients participated. The mean score for lifestyle decreased from baseline to 3 months and was even lower at 6 months. Nevertheless, the trend for some participants was the opposite-their lifestyle improved over the 6-month period after baseline. Notably, the trend for each of the 6 subscales was not consistent with the mean of the total score. Stress status accounted for 12.8% of lifestyle. When stress status was combined with family income and creatinine, the 3 factors accounted for 32.2% of lifestyle. This study demonstrated that maintenance of a healthy lifestyle fluctuates after transplantation. Demographic factors and stress status can help to identify people who are more likely to have a poor lifestyle.
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http://dx.doi.org/10.1111/ijn.12504DOI Listing
February 2017

Successful continuous-flow left ventricular assist device implantation with adjuvant tricuspid valve repair for advanced heart failure.

Cardiovasc J Afr 2016 Jul/Aug 23;27(4):e14-e16. Epub 2016 Apr 12.

Heart Centre, Cheng Hsin General Hospital, Taiwan.

The prevalence of end-stage heart failure (HF) is on the increase, however, the availability of donor hearts remains limited. Left ventricular assist devices (LVADs) are increasingly being used for treating patients with end-stage HF. LVADs are not only used as a bridge to transplantation but also as a destination therapy. HeartMate II, a new-generation, continuous-flow LVAD (cf-LVAD), is currently an established treatment option for patients with HF. Technological progress and increasing implantation of cf-LVADs have significantly improved survival in patients with end-stage HF. Here we report a case of a patient with end-stage HF who was successfully supported using cf-LVAD implantation with adjuvant tricuspid valve repair in a general district hospital.
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http://dx.doi.org/10.5830/CVJA-2016-034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340928PMC
February 2017

Incremental value of live/real time three-dimensional transthoracic echocardiography over the two-dimensional technique in assessing carcinoid heart disease involving the aortic valve.

Echocardiography 2016 11 30;33(11):1741-1744. Epub 2016 Sep 30.

Division of Cardiology, Cheng Hsin General Hospital, Taipei, Taiwan.

We present a case of an adult with metastatic carcinoid heart disease, in whom live/real time three-dimensional transthoracic echocardiography provided incremental value over two-dimensional transthoracic echocardiography in assessing involvement of the aortic valve.
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http://dx.doi.org/10.1111/echo.13371DOI Listing
November 2016

In-Hospital Tele-ECG Triage and Interventional Cardiologist Activation of the Infarct Team for STEMI Patients is Associated with Improved Late Clinical Outcomes.

Acta Cardiol Sin 2016 Jul;32(4):428-38

Heart Center, Cheng Hsin General Hospital;

Background: Due to recent advances, door-to-balloon time (D2BT) has been reduced significantly for patients with ST-segment elevation myocardial infarction (STEMI). However, whether this reduction can be translated into a concrete mortality or morbidity benefit is still the subject of controversy. We conducted a before-and-after study to determine the impact of in-hospital tele-electrocardiography (ECG) triage and interventional cardiologist activation of the infarct team on D2BT and long-term clinical outcomes in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

Methods: A total of 272 consecutive patients with acute STEMI undergoing PPCI were enrolled in our study, comprising 102 tele-ECG patients and 170 conventional triage patients. Major adverse cardiovascular and cerebral vascular events (MACCE), including death, recurrent nonfatal MI, nonfatal stroke, and angina-driven target vessel revascularization were recorded during a 3-year follow-up.

Results: The median D2BT of the tele-ECG group was significantly shorter than control group (79 minutes vs. 109 minutes, p < 0.001). The tele-ECG triage group had a higher percentage of patients reaching the D2BT goal (< 90 minutes) (78% vs. 55%; p < 0.001). The MACCE rate was significantly lower in the Tele-ECG versus the control group (23.5% vs. 38.2%, p = 0.012). Tele-ECG group had a lower mortality rate which did not reached statistical significance (2% vs. 5.9%, p = 0.102). In multivariable Cox proportional hazards analyses, the implementation of tele-ECG triage (HR = 0.43, p = 0.003) and the presence of moderate or severe mitral regurgitation at presentation (HR = 1.87, p = 0.029) were discovered as independently associated with MACCE.

Conclusions: In-hospital tele-ECG triage and interventional cardiologist activation can shorten D2BT and is associated with improved late clinical outcomes during a 3-year follow-up in STEMI patients undergoing PPCI.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4963419PMC
http://dx.doi.org/10.6515/acs20150731cDOI Listing
July 2016

Simultaneous rota-stenting and transcatheter aortic valve implantation for patients with heavily calcified coronary stenosis and aortic stenosis.

J Chin Med Assoc 2016 Sep 23;79(9):512-6. Epub 2016 Jun 23.

Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC.

Given that coronary artery disease (CAD) in octogenarians undergoing transcatheter aortic valve implantation (TAVI) often presents with more complex lesions and extensive calcification, rotational atherectomy (RA) may be needed in some cases before stenting. However, data regarding the feasibility and safety of simultaneous RA during TAVI using the Medtronic CoreValve (MCV; Medtronic, Minneapolis, MN, USA) system are lacking. Three out of 107 (2.8%) patients (2 females, average age 85.6 years, mean aortic valve area 0.5 cm(2), mean left ventricular ejection fraction 39%, mean Logistic EuroScore 70%), with complex, heavily calcified coronary stenosis, and severe valvular aortic stenosis (AS) were treated with TAVI and RA due to high surgical risk. After balloon valvuloplasty, all coronary lesions were successfully treated with RA and stenting, immediately followed by transfemoral TAVI with a self-expandable MCV. Our data suggested that in the very elderly patients with severe and heavily calcified CAD and AS who were turned down for cardiac surgery, RA and stenting followed by TAVI may be performed successfully in a combined, single-stage procedure.
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http://dx.doi.org/10.1016/j.jcma.2016.03.007DOI Listing
September 2016
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