A pediatric left ventricular assist device (LVAD) implantation model was established to simulate pediatric LVAD support and research the mechanism of heart reverse remodeling. Heart failure (HF) is a prevalent global cardiovascular disease. LVAD implantation is an essential method to treat HF. However, existing pediatric LVAD implantation models remain underdeveloped, and the mechanism of LVAD treatment resulting in ventricular reverse remodeling was unclear, especially among children, though there was a lot of research uncovering the possible target. Therefore, it's necessary to find out the mechanism, especially in children. A good model is the foundation for testing the function of a new pediatric LVAD and disclosing the key mechanism. We established a young landrace pig LVAD implantation model, which could be used to assume pediatric LVAD security and effectiveness. After the LVAD was implanted, the LVAD pump maintained stable and uninterrupted blood flow for over 1 month. Besides, the vital signs, including hemodynamics, were stable and within the ideal and normal ranges. This model accurately replicates hemodynamic conditions in clinical patients post-LVAD implantation. It could be used to trace the continuous changes after LVAD implantation. At the same time, it can be used to disclose the reactivity and safety of child LVAD implantation. This protocol is an easy and standard general process to build a uniformization model for child LVAD implantation research.

Background: Cardiovascular disease (CVD) prevention in ageing populations requires simple and clinically accessible markers that may help identify individuals at elevated risk. Tooth loss is a common oral condition in middle-aged and older adults and may reflect cumulative inflammatory burden, impaired oral function, and broader health vulnerability. However, longitudinal evidence from nationally representative populations across different countries remains limited. We investigated whether a baseline of missing teeth was independently associated with incident CVD in three nationally representative ageing cohorts from China, the United States, and England. Methods: We analyzed data from the China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), and the English Longitudinal Study of Ageing (ELSA). Participants aged 45 years or older without baseline CVD and with available baseline tooth status were included. Missing teeth were assessed at baseline as a dichotomous exposure. Incident CVD was defined as newly reported heart disease and/or stroke during follow-up. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with sequential adjustment for sociodemographic, lifestyle, and clinical covariates. Kaplan-Meier, subgroup, and sensitivity analyses were also performed. Results: A total of 31,805 participants were included, comprising 13,451 from CHARLS, 11,384 from HRS, and 6970 from ELSA. During follow-up, 2336 incident CVD events occurred in CHARLS, 2914 in HRS, and 545 in ELSA. In fully adjusted models, missing teeth was associated with a higher risk of incident CVD in all three cohorts, with HRs of 1.31 (95% CI, 1.14-1.50) in CHARLS, 1.43 (95% CI, 1.29-1.57) in HRS, and 1.86 (95% CI, 1.49-2.31) in ELSA. Kaplan-Meier analyses showed consistently lower CVD-free survival among participants with missing teeth, and the associations remained broadly robust across subgroup and sensitivity analyses. Conclusions: In three nationally representative cohorts from China, the United States, and England, a baseline of missing teeth was independently associated with a higher risk of incident CVD among middle-aged and older adults. These findings suggest that missing teeth may serve as a simple and clinically accessible marker of elevated cardiovascular risk and support greater integration of oral health into cardiovascular risk assessment and preventive strategies for ageing populations.

PURPOSE:This study aimed to summarize 8-year clinical outcomes for patients who underwent transcatheter aortic valve replacement (TAVR) with the J-Valve system and evaluate the long-term durability and hemodynamic performance of the valve. METHODS:Between July 2014 and June 2015, 21 patients underwent transapical TAVR with the J-Valve system. Systematic clinical and echocardiographic follow-up was conducted on 18 patients for up to 8 years. RESULTS:Eight years post-TAVR with the J-Valve system, the all-cause mortality rate was 16.7%, with no prosthesis failures or thrombosis. Moderate to severe valve deterioration was observed in 50% of patients with aortic stenosis (AS), whereas no such deterioration was noted in patients with pure aortic regurgitation (PAR). At 8 years following TAVR, the effective orifice area measured 2.27 ± 0.50 cm2 in patients with PAR and 1.35 ± 0.38 cm2 in those with AS. Additionally, patients with AS exhibited a mean pressure gradient of 17.90 ± 10.61 mmHg. Over 8 years, PAR patients experienced a significant reduction in left ventricular end-diastolic diameter from 61.50 ± 2.08 mm to 48.67 ± 7.23 mm (p < 0.001), whereas AS patients showed no significant change. CONCLUSION:The J-Valve system demonstrates favorable long-term outcomes in TAVR, with excellent durability and hemodynamic performance in PAR patients.

While biventricular assist devices (BiVADs) remain underutilized in Western countries for biventricular heart failure (BHF), their application is expanding in China. This consensus synthesizes international guidelines, medical evidence, and Chinese clinical expertise to establish standardized protocols for BiVAD management. Key recommendations include: (1) Preoperative right heart catheterization and echocardiography for central venous pressure (CVP): pulmonary capillary wedge pressure (PCWP) ratio and pulmonary artery pulsatility index (PAPi) assessment (Class I); (2) BiVAD indication in refractory BHF or high-risk right heart failure post-left ventricular assist device (LVAD) implantation (Class IIa); (3) Right atrial implantation as the preferred surgical approach (Class IIa); (4) Warfarin-based anticoagulation (INR 2.0-2.5) with aspirin, avoiding direct oral anticoagulants (DOACs) (Class III). The guidance addresses critical gaps in patient selection, pump speed titration, and complication management, positioning integrated BiVAD systems as a promising solution for complex BHF.

Background Performing transcatheter aortic valve replacement (TAVR) in patients with high-risk quadricuspid aortic valve (QAV) may be feasible, but uncertainties remain regarding the development of a comprehensive procedural plan and predicting the outcomes.Case summary We report a case of a 70-year-old patient with a high-risk (EuroSCORE II: 11.2%) QAV (type B) and severe aortic regurgitation (regurgitant jet area measuring 9.8 cm2). To avoid high-risk surgery, we selected a 29-mm J-Valve for the transapical TAVR without the occurrence of paravalvular leak based on a patient-specific 3D printed model. Computational fluid dynamics simulations were performed to evaluate the hemodynamic parameters pre- and post-TAVR and showed that the trans-aortic valve pressure gradient decreased from 4.7 mmHg to 3.5 mmHg, the peak trans-aortic velocity decreased from 1.02 m/s to 0.89 m/s, and the low wall shear stress area was increased from 18.92 cm2 to 19.15 cm2. These findings suggest the effectiveness of the TAVR procedure. Based on the simulation results, the procedure was successfully implemented, leading to an improvement in the patient's clinical status.Conclusion Three-dimensional printing and computational fluid dynamics simulations may be valuable tools for planning, assessing procedural outcomes, and evaluating risks in TAVR procedures for patients with QAV.

OBJECTIVE:Currently, there is limited evidence regarding the long-term durability of available transcatheter heart valves (THVs). The purpose of this analysis is to evaluate the 5-year outcomes of using the J-Valve for transcatheter aortic valve implantation (TAVI) in aortic stenosis (AS) and pure aortic regurgitation (AR). METHODS:From March 2014 to August 2015, all consecutive patients with severe AS and pure AR treated with the J-Valve THV at 3 centers in China were prospectively enrolled in a clinical study. Clinical and echocardiographic follow-up were performed according to study protocol. All results were reported according to the Valve Academic Research Consortium 3 criteria. RESULTS:At 5-year follow-up, the all-cause mortality rate was 15.31% (16/98), with a cardiovascular mortality rate of 7.14% (7/98). The incidence of stroke was 7.14% (7/98), and the permanent pacemaker implantation rate was 8.16% (8/98). Echocardiographic follow-up showed left ventricular ejection fraction significantly improved at 5 years in both patients with AS (58.98 ± 10.45% vs 61.78 ± 9.07%, P for trend <.01) and pure AR (52.86 ± 10.98% vs 61.45 ± 6.90%, P for trend < .01). Structural or hemodynamic valve deterioration occurred in 3 cases (3.06%). In total, 97.59% of patients had significant improvement in New York Heart Association functional class over the 5-year follow-up, which is associated with significant improvement in quality of life. CONCLUSIONS:Our study demonstrates that TAVI with the J-Valve THV provides excellent 5-year clinical and echocardiographic outcomes, suggesting TAVI with a dedicated THV is a good alternative treatment for AS and pure AR in selected high-risk patients.

Although significant progress has been made in heart transplantation, issues such as graft preservation, primary graft dysfunction, cardiac allograft vasculopathy, and long-term immune tolerance remain unresolved. Due to anatomical size and immunological differences, mouse models are unable to effectively replicate clinical heart transplantation surgeries and immune responses. In contrast, pig models, which share more similarities with humans in terms of heart anatomy and immune response, are particularly suitable for orthotopic heart transplantation research. In this study, we established a biatrial orthotopic heart transplantation model in Bama miniature pigs. The transplanted hearts demonstrated prompt and robust contractility postoperatively without signs of elevated central venous pressure or other hemodynamic complications. Following a short period of intensive care unit monitoring, the pigs regained consciousness and resumed spontaneous feeding, indicating stable postoperative recovery. In summary, this model offers a clinically relevant experimental platform for evaluating new technologies and therapeutic approaches in the field of heart transplantation research.

OBJECTIVE:To compare the effect of high-moderate hypothermic circulatory arrest (HMHCA) versus low-moderate and deep hypothermic circulatory arrest (LDHCA) on postoperative major adverse events (MAEs) after aortic repair procedure for patients with acute type A aortic dissection (ATAAD). METHODS:Between January 2013 and December 2021, a total of 555 patients were treated with aortic repair procedure utilizing the HMHCA strategy and 262 patients utilizing the LDHCA strategy. The impact of different HCA temperatures on the postoperative MAEs was evaluated through the comparison between the HMHCA group and the LDHCA group. RESULTS:The mean age was 48.6 ± 10.8 in the HMHCA group and 47.2 ± 10.4 in the LDHCA group (P = 0.086), with similar female gender distribution (22.3 % vs 24.4 %, P = 0.533). The frequency of preoperative cerebral malperfusion syndrome was lower in the HMHCA group than the LDHCA group (7.0 % vs 11.0 %, P = 0.058). The duration of cardiopulmonary bypass was comparable between the two groups; however, patients in the HMHCA group exhibited longer duration of aortic cross-clamp and shorter duration of HCA process. Bilateral cerebral perfusion was utilized in 11.2 % of HMHCA group and 0.8 % of LDHCA group (P < 0.001). The morbidity of postoperative MAEs was 34.2 % in the HMHCA group and 44.1 % in the LDHCA group (P = 0.008). Multivariable logistic regression analysis demonstrated that HMHCA temperature was significantly associated with lower incidence of postoperative MAEs (OR = 0.601, 95 % CI 0.393-0.919, P = 0.019). CONCLUSIONS:The utilization of high-moderate HCA presents with superior postoperative outcomes compared with low-moderate and deep HCA in patients with ATAAD.

Background An association between increased aortic root dimensions (ARD) and elevated risk of cardiovascular mortality has been reported in the general population. However, evidence regarding the association between ARD and mortality in patients with acute heart failure (AHF) is limited. Methods In a nationwide prospective cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, ARD was measured during diastole using echocardiography and indexed to body mass index (BMI). Cox proportional hazard models were used to validate the association between BMI-indexed ARD and mortality. Additionally, the relationship between BMI-indexed ARD and mortality was presented using restricted cubic spline in all populations, and both sexes. Results A total of 2125 participants with ARD were included in the final analysis, among of 38.4% were women, with a median age of 67 years. Over a median follow-up period of 54.4 (interquartile range: 30.1 to 59.7) months, 895 deaths occurred, with 750 attributed to cardiovascular causes and 145 to non-cardiovascular causes. Compared to the highest tertile group of BMI-indexed ARD, the lowest tertile group had a lower risk of cardiovascular mortality (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.58 to 0.87; P < 0.001) and all-cause mortality (HR, 0.68; 95% CI, 0.56 to 0.81; P < 0.001). Similarly, the middle tertile group also had a lower risk of cardiovascular mortality (HR, 0.78; 95% CI, 0.65 to 0.93; P = 0.007) and all-cause mortality (HR, 0.75; 95% CI, 0.63 to 0.89; P < 0.001). Considering the competing risks, the lowest BMI-indexed ARD groups showed a significant mortality risk of cardiovascular mortality in all populations, and both sexes. Moreover, the relationship between BMI-indexed ARD and mortality was linear in males, while a “J” shaped relationship was observed in females Conclusion Lower BMI-indexed ARD was associated with a decreased risk of all-cause and cardiovascular mortality than those with higher BMI-indexed ARD in AHF. Additionally, a discrepancy was observed between the sexes in the relationship between BMI-indexed ARD and mortality. These findings contribute to the prompt identification of potential mortality risks in patients with AHF.

OBJECTIVES:To investigate the risk factors and prognosis of spinal cord injury (SCI) after surgical procedure in type A aortic dissection (AAD). METHODS:Between January 2013 and December 2021, a total of 1647 patients with AAD underwent surgical procedure. Postoperative SCI occurred in 58 patients, including 24 patients with paraplegia and 34 patients with paraparesis. Factors associated with SCI were identified through comparison between patients with and without SCI. RESULTS:The mean age was 48.8 ± 10.8 years for patients with SCI and 50.1 ± 12.1 years for those without SCI (P = 0.43), with a comparable gender distribution. Median numbers of intercostal and lumbar arteries with involvement were significantly higher in the SCI group (both P < 0.001). The highest (P = 0.033) and lowest (P = 0.001) levels of intraoperative mean arterial pressure (MAP) were significantly lower in the SCI group. Multivariable analysis revealed the number of segmental arteries involved (odds ratio = 1.14, 95% CI 1.08-1.20, P = 0.000), and the duration of hypothermic circulatory arrest (HCA) (odds ratio  = 1.04, 95% CI 1.01-1.08, P = 0.042) was positively associated with the occurrence of SCI. Conversely, the lowest level of MAP was negatively associated with SCI (odds ratio = 0.98, 95% CI 0.96-0.99, P = 0.031). During the long-term follow-up, 14 patients with paraplegia needed a wheel chair, while only 1 patient with paraparesis needed one (P < 0.001). CONCLUSIONS:The risk of postoperative SCI increases when AAD patients experience segmental arteries involved, longer HCA duration and decreased intraoperative MAP during operation.

Background: The J-Valve, an “on-label” transcatheter heart valve, has been used for over a decade in patients with pure native aortic regurgitation (PNAR); however, long-term follow-up outcomes have not yet been documented. This study aims to evaluate the long-term safety and efficacy of transcatheter aortic valve replacement (TAVR) in patients with PNAR. Methods: We retrospectively reviewed 36 patients with PNAR who underwent TAVR using the J-Valve. Clinical data were collected, and follow-up assessments were performed via telephone or during outpatient visits. Results: The median follow-up duration was 5.26 years, and the cumulative 5-year survival rate was 74.0%. The initial procedural success rate of the J-Valve was remarkably high at 94.44%. There was no significant morphological or hemodynamic structural valve deterioration observed among these patients. Only one patient experienced moderate paravalvular leakage, which required surgical aortic valve replacement 4 years after the TAVR. Additionally, no instances of moderate or severe intra-prosthetic regurgitation were detected in this cohort. A significant reduction in left ventricular end-diastolic dimension was observed during the follow-up period compared to pre-operative measurements (p < 0.001). Conclusions: The J-Valve exhibited favorable long-term clinical outcomes, robust valve durability, and optimal hemodynamic performance in patients with PNAR.

While IgG4-related disease affects different organs, it is uncommon to associate it with the aortic valve. The clinical manifestations and prognosis of an uncommon IgG4related aortic valve disease were examined by reporting it. After common activity, a 50-year-old man experienced shortness of breath and chest tightness. IgG4+ was expressed at a level of 4.23 g/L. The aortic valve had severe reflux, and the ascending aorta and aortic sinus were dilated, as evidenced by transesophageal echocardiography. Pathoof valves can be proven.

Introduction: A reduced left ventricular ejection fraction (LVEF) is a known risk factor for double valve replacement or aortic valve replacement in combination with concomitant mitral valve repair (DVR) and is associated with high morbidity and mortality rates. In this study, we sought to analyze the 30-day mortality and long-term survival rates of patients with reduced LVEFs. Methods: A multicenter, retrospective, observational cohort study of patients who underwent DVR was performed at four centers from January 2016 to December 2021. LVEFs were categorized as 41%-50% (n = 120) or <= 40% (n = 58). For the effects of risk factors on 30-day mortality, binary logistic regression was performed. Survival rates were assessed with the Kaplan-Meier method. Results: A total of 178 patients who underwent DVR were included in this study, of whom 67.42% (n = 120) had LVEFs ranging from 41-50% and 32.58% (n = 58) had LVEFs <= 40%. More mechanical valves and tricuspid valve-forming rings were applied in the LVEF <= 40% group (68.97% versus 53.33%, p = 0.047; 31.03% versus 10.83%, p = 0.001). The 30-day mortality rates of DVR patients with LVEFs ranging from 41-50% and <= 40% were 8.33% and 17.24%, respectively (p = 0.078). During the follow-up period, there were no significant differences in long-term survival (log rank p = 0.75). On multivariable logistic regression analysis, age >65 years [odds ratio (OR): 5.559, 95% confidence interval (CI): 1.668-18.524, p = 0.005] and cardiopulmonary bypass (CPB) duration >200 min (OR: 5.031, 95% CI: 1.773-14.277, p = 0.002) were significantly associated with the likelihood of 30-day mortality. Conclusions: Although the differences in 30-day mortality and long-term survival rates between DVR patients with LVEFs ranging from 41-50% and <= 40% were not statistically significant in our cohort, an age >65 years and a CPB duration >200 min were predictors of 30-day mortality.

Partial anomalous pulmonary venous connection is a rare adult congenital heart disease that leads to an anatomical lefttoright shunt. Right superior pulmonary vein and azygos vein open to the superior vena cava, with atrial septal defect and severe pulmonary hypertension are also rare congenital anomalies that result in right-to-left shunt. A 52yearold male presented with dyspnea on exertion and fatigue. He was further diagnosed in our hospital and was found to have the aforementioned congenital abnormalities, causing a bidirectional shunt. On further investigation, he was found to have hypoxemia on oximetry. The patient was treated via surgical corrections of the congenital anomalies, but still showed persistent hypoxemia after the operation. After the related diseases were excluded through various examinations, we finally thought that hypoxemia was probably caused by pulmonary hypertension.