A New Transcatheter Aortic Valve Replacement System for Predominant Aortic Regurgitation Implantation of the J-Valve and Early Outcome

AbstractObjectivesThis study introduces a newly designed transcatheter aortic valve system, the J-Valve system, and evaluates its application in patients with predominant aortic regurgitation without significant valve calcification. We also report the early results of one of the first series of transapical implantations of this device and aim to offer guidance on the technical aspects of the procedure.BackgroundTranscatheter aortic valve replacement (TAVR) has been widely used in high-risk patients for surgical aortic valve replacement. However, the majority of the TAVR devices were designed for aortic valve stenosis with significant valve calcification.MethodsSix patients with native aortic regurgitation without significant valve calcification (age, 61 to 83 years; mean age, 75.50 ± 8.14 years) underwent transapical implantation of the J-Valve prosthesis (JieCheng Medical Technology Co., Ltd., Suzhou, China), a self-expandable porcine valve, in the aortic position at our institution. All patients were considered to be prohibitive or high risk for surgical valve replacement (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation], 22.15% to 44.44%; mean, 29.32 ± 7.70%) after evaluation by an interdisciplinary heart team. Procedural and clinical outcomes were analyzed.ResultsImplantations were successful in all patients. During the follow-up period (from 31 days to 186 days, mean follow-up was 110.00 ± 77.944 days), only 1 patient had trivial prosthetic valve regurgitation, and none of these patients had paravalvular leak of more than mild grade. There were no major post-operative complications or mortality during the follow-up.ConclusionsOur study demonstrated the feasibility of transapical implantation of the J-Valve system in high-risk patients with predominant aortic regurgitation

Adult and paediatric cough guidelines:Ready for an overhaul?

Cough is one of the most common reasons that patients seek medical attention. Cough guidelines from numerous countries and societies are available to assist the clinician to investigate and manage patients with cough. We review some of the recent progress in the field of cough that may lead to revision of these guidelines. In adults with chronic cough, new causes such as obstructive sleep apnoea have been identified. A new terminology, cough hypersensitivity syndrome (CHS), has been proposed for patients with chronic cough, which emphasises cough reflex hypersensitivity as a key feature. New therapeutic options are now available, particularly for patients with refractory or idiopathic chronic cough, which include gabapentin, speech pathology management and morphine. There has been great progress in the assessment of cough with the development of validated quality of life questionnaires and cough frequency monitoring tools. In children, common aetiologies differ from adults and those managed according to guidelines have better outcomes compared to usual care. New diagnostic entities such as protracted bacterial bronchitis have been described. Paediatric-specific cough assessment tools such as the Parent/Child Quality of Life Questionnaire will help improve the assessment of patients. Further research is necessary to improve the evidence base for future clinical guideline recommendations. Guidelines in future should also aim to reach a wider audience that includes primary care physicians, non-specialists and patients

Comparison of lung resistance (R_L) in mice when the models were set up and the normal saline (NS) control mice).

<p>Comparison of lung resistance (R_L) in mice when the models were set up and the normal saline (NS) control mice).</p

Leukocyte distribution in the bronchoalveolar lavage (BAL) fluid.

<p>(A) Differential cell counts of 200 leukocytes were performed in triplicate for smears prepared of cells in the BAL fluid on day 24, 24 h after the 1^st intranasal OVA challenge. * <i>P</i><0.01 vs. the NS-1 group, and (B) on day 45, 3 weeks after the first intranasal OVA challenge, and (C) on day 49, 24 h after the 2^nd intranasal OVA challenge. * <i>P</i><0.01 vs. the NS-3 group.</p

Pathologic changes in the lung tissues fromOVA-challenged mice.

<p>(A) NS-1; (B) EB-1; (C) AS-1; (D) EB-2; (E) AS-2; (F) NS-3; (G) EB-3; (H) AS-3. Mice in the EB groups and AS groups showed engagement of blood vessels, infiltration by eosinophils. H and E, ×200.</p

The study flow chart.

<p>The study flow chart.</p

Changes in airway responsivenessin response to challenge with aerosolized methacholine.

<p>(A) Changes in lung resistance (R_L) were recorded for 3 min after challenge with aerosolized methacholine on day 24, 24 h after the 1^st intranasal OVA challenge, for 20 sec at the indicated doses. Mice received 3 intraperitoneal injections of 10 µg of ovalbumin (OVA) emulsified with 1.3 mg of aluminum hydroxide on days 0, 7, and 14. They were then intranasally challenged with 10 (the EB-1 group) or 200 µg aerosolized OVA (the AS-1 group) for 3 consecutive days on days 21 to 23. The control mice received an equivalent volume of normal saline for sensitization and intranasal challenge. *<i>P</i><0.05 and ** <i>P</i><0.01, the AS-1 group vs. the NS-1 group; ^#<i>P</i><0.05 and ^{# #}<i>P</i><0.01, the AS-1 group vs. the EB-1 group. (B) Changes in airway reactivity in response to a second challenge with aerosolized methacholine. Changes in R_L were recorded for 3 min after challenge with aerosolized methacholine on day 45, 3 weeks after the first intranasal challenge, for 20 sec at the indicated doses. *P<0.05, the EB-2 group vs. the NS-2 group. (C) Changes in airway reactivity in response to challenge with aerosolized methacholine following the 2^nd intranasal OVA challenge. Changes in lung resistance (R_L) were recorded for 3 min after challenge with aerosolized methacholine on day 49, 24 h after the 2^nd intranasal OVA challenge, for 20 sec at the indicated doses. *<i>P</i><0.05 and ** <i>P</i><0.01, the AS-3 group vs. the NS-3 group; ^#<i>P</i><0.01, the AS-3 group vs. the EB-3 group.</p