Objective To compare the clinical and hemodynamic results of patients undergoing transcatheter aortic valve replacement (TAVR) with different vascular approaches. Methods We retrospectively analyzed the baseline status, procedure status, procedure-related clinical complications defined by Valve Academic Research Consortium-2 consensus document, and postoperative hemodynamic results of patients with severe aortic stenosis who underwent TAVR between April 2012 and January 2019 in West China Hospital of Sichuan University. Results A total of 436 patients were enrolled, including 58 patients undergoing surgical cutdown and 378 patients undergoing percutaneous puncture. The prevalence of tumor in the surgical cutdown group was higher than that in the percutaneous puncture group (8.62% vs. 2.65%, P=0.037), while the other baseline characteristics, including age, male proportion, body mass index, and Society of Thoracic Surgeons scores, were similar between the two groups (P>0.05); the proportion of patients with aortic regurgitation equal to or greater than a moderate degree in the surgical cutdown group was lower than that in the percutaneous puncture group (22.41% vs. 35.98%, P=0.043), and there was no statistically significant difference in other preoperative cardiac ultrasound-related indicators (P>0.05). The procedure success rate was high in both groups (96.55% vs. 98.68%, P=0.236). Immediately after operation, the incidences of new-onset left bundle branch block (43.10% vs. 24.87%, P=0.004), severe bleeding (12.07% vs. 4.23%, P=0.030), and mild bleeding (20.69% vs. 3.44%, P<0.001) were higher in the surgical cutdown group than those in the percutaneous puncture group, and the postoperative hemodynamics indicated that there was no statistically significant difference in maximum blood flow velocity between the two groups [(2.37±0.52) vs. (2.50±1.67) m/s, P=0.274]. At the 1 year follow-up, the cardiac death rate (5.17% vs. 3.17%, P=0.696) and all-causes mortality rate (8.62% vs. 8.47%, P=1.000) between the two groups were not statistically different.Conclusions Compared with percutaneous puncture, surgical cutdown is associated with a higher incidence of bleeding events, while the incidence of other clinical complications such as vascular complications and the postoperative hemodynamic outcomes were similar.
Coronavirus disease 2019 that started in Wuhan, Hubei Province in December 2019, has spread rapidly across China. Radiography provides an important basis for clinical diagnosis of coronavirus disease 2019 and plays a crucial role in fighting against the epidemic. In the face of public health emergencies, how to quickly set up a team for accurate prevention and control in the first time and how to carry out radiological examination and diagnosis ina scientific, orderly, safe and efficient manner are the key measures to support the hospital in effectively responding to the epidemic. This paper summarized the innovative management experience of the radiology department of West China Hospital of Sichuan University in the prevention and control of nosocomial infection and discipline construction in the fight against the outbreak of coronavirus disease 2019.