Objective To evaluate the safety and efficacy of transcatheter aortic valve replacement (TAVR) using the SAPIEN 3 system. MethodsThis was a prospective, multicenter, single arm study in 4 centers in China. The clinical data of 50 patients with high-risk symptomatic severe aortic stenosis who underwent TAVR using the SAPIEN 3 system from June 2017 to June 2019 were analyzed, including 27 males and 23 females aged 76.8±6.1 years. ResultsThe Society of Thoracic Surgeon score was 6.0%±2.8%. Totally, 20.0% of patients had severe bicuspid aortic stenosis. The operation time was 41.8±16.5 min and the hospital stay time was 8.5±5.0 d. At the postoperative 30-day follow-up, no all-cause mortality occurred and the device success rate was 89.5%. Major vascular complications occurred in one (2.0%) patient, stroke in one (2.0%) patient, new pacemaker implantation in one (2.0%) patient, as well as coronary artery obstruction in one (2.0%) patient. There was no moderate or moderate/severe paravalvular leak. The aortic pressure gradient was decreased from 49.2±16.2 mm Hg before the operation to 12.4±4.6 mm Hg at the postoperative 30-day follow-up, and the valvular area was increased from 0.6±0.3 cm2 to 1.3±0.3 cm2 (P<0.01). Moreover, the New York Heart Association classification in 83.7% of the patients was improved during the follow-up. ConclusionThis pre-marketing multicenter study has demonstrated the safety and effectiveness of transfemoral TAVR with the SAPIEN 3 transcatheter valve system in Chinese aortic stenosis patients at high risk for surgery.
With the expanding indications for transcatheter aortic valve replacement (TAVR) guidelines, combined valvular disease is often encountered in the clinic, and existing relevant studies have shown that preoperative moderate to severe mitral regurgitation is associated with higher mortality. In these patients, the optimal treatment strategy for TAVR with evidence-based heart failure, TAVR with transcatheter mitral intervention, or staging transcatheter therapy are unclear. Therefore, a comprehensive assessment of the anatomy and function of the aortic and mitral valves, as well as an in-depth assessment of the patient’s baseline risk profile, are the basis for an individualized approach to treatment. This article will review the results of the relevant research to better help clinicians diagnose and treat relevant patients.
Objective To evaluate the short-term efficacy of transcatheter aortic valve replacement (TAVR) using Venus A-Plus valve delivery system in patients with severe aortic stenosis. Methods The clinical data of patients undergoing TAVR in our hospital from August 2018 to March 2022 were collected and divided into a Venus A-PLUS and a Venus A group according to the type of valve delivery system used. The perioperative data of the two groups were compared. ResultsA total of 121 patients were included, including 70 patients in the Venus A-Plus group (45 males and 25 females with a mean age of 67.81±6.62 years), and 51 patients in the Venus A group (33 males and 18 females with a mean age of 68.25±7.01 years). All patients underwent TAVR, and the postoperative hemodynamic features (left ventricular ejection fraction, mean cross-valve pressure difference, peak flow rate) were significantly improved (P<0.05). There was no statistical difference in surgical success rate, all-cause mortality, conversion to thorax opening, midvalve placement, moderate or above perivalvular regurgitation, new left bundle branch block or new right bundle branch block between the two groups (P>0.05). Conclusion TAVR with Venus A-Plus valve delivery system in patients with severe aortic stenosis is satisfactory, safe and reliable.
Objective To evaluate the coronary artery ostium obstruction caused by the commissure of transcatheter heart valve (THV) with the markers on THV under X-ray, which was identified by observing the position relationship between the commissure of THV and the coronary artery ostium from analyzing aortic root computed tomographic angiography (CTA) images after transcatheter aortic valve replacement (TAVR). Methods A retrospective analysis was performed on 25 patients undergoing TAVR who were checked with electrocardiographically gated CTA for the aortic root after the TAVR procedure between January 2020 and December 2021 in General Hospital of Northern Theater Command. The images of THV with the lowest position of non-coronary sinus and the right anterior oblique and caudal in most cases were observed when the THVs were deployed. The position relationships of the three markers on the THV after valve release were recorded, which were divided into three conditions, namely the three markers being averagely distributed, the middle marker being close to left, and the middle marker being close to right. Postoperative CTA images of the patients were analyzed. The angle between the commissure of THV and the coronary artery ostium was measured, and the angles in each group were presented as medium (lower quartile, upper quartile). Results A total of 17 patients were finally included. The angles between the commissure of THV and the left coronary artery ostium were 19.0 (16.0, 31.0)°, 36.0 (15.0, 44.0)°, and 3.0 (3.0, 5.0)° in the markers averagely distributed group (n=7), the middle marker close to left group (n=6), and the middle marker close to right group (n=4), respectively, which were significantly different (P=0.033). The angles between the commissure of THV and the right coronary artery ostium were 43.0 (25.0, 51.0)°, 47.0 (41.0, 57.0)°, and 13.0 (7.5, 21.0)° in the markers averagely distributed group, the middle marker close to left group, and the middle marker close to right group, respectively, which were significantly different (P=0.017). There was significant difference in the obstruction degrees of left coronary artery ostium by the commissure of THV (P=0.008), and no significant difference in the obstruction degrees of right coronary artery ostium (P=0.062). When the middle marker was close to right, there was no more than moderately obstruction on the right coronary artery ostium and no any obstruction on the left coronary artery ostium. When the middle marker was close to left, the obstruction rate of the left coronary artery ostium with more than moderate degree was 4/6 (66.7%) and it was 6/6 (100.0%) for the right coronary artery ostium. Conclusions The degree of coronary artery ostium obstruction by the commissure of THV can be accurately evaluated by using markers on THV. Among them, when the middle marker is close to right, the commissures of THV are least likely to block the coronary artery ostium.
ObjectiveTo analyze the effects of cardiovascular surgery on Williams syndrome (WS).MethodsThe clinical data of 68 WS patients undergoing cardiovascular surgery in the Department of Cardiac Surgery, Guangdong Provincial People's Hospital from January 2010 to January 2020 were retrospectively analyzed. There were 48 males and 20 females with a median age of 2.8 years ranging from 3 months to 33 years. Except one patient undergoing the coarctation repair, the rest 67 patients underwent surgical interventions to correct supravalvular aortic stenosis (SAVS) and pulmonary artery stenosis with hypothermic cardiopulmonary bypass, concommitant with 3 patients of relief of left ventricular outflow tract obstruction, 2 patients of relief of right ventricular outflow tract obstruction, 2 patients of mitral valvuloplasty, 3 patients of ventricular septal defect repair and 1 patient of arterial catheter ligation.ResultsTwo (2.9%) patients died of sudden cardiac arrest on the next day after surgery. One (1.5%) patient died of cardiac insufficiency due to severe aortic arch stenosis 3 years after surgery. The effect of SAVS was satisfactory. Two (2.9%) patients progressed to moderate aortic valvular regurgitation during postoperative follow-up. A total of 5 (7.4%) patients were re-intervened after operation for arch stenosis or pulmonary stenosis.ConclusionWS patients should be diagnosed early, followed up and assessed for cardiovascular system diseases, and timely surgical treatment has a good clinical effect.
ObjectiveTo compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) in oncology and non-oncology patients with severe aortic stenosis (AS).MethodsA computer-based search in PubMed, The Cochrane Library, EMbase, CBM, CNKI and Wanfang databases from their date of inception to December 2021 was performed, together with reference screening, to identify eligible clinical trials. Two investigators screened the articles, extracted data, and evaluated quality independently. RevMan 5.3 and Stata 12.0 softwares were used for meta-analysis.ResultsThe selected 8 cohort studies contained 57 988 patients, including 12 335 cancer patients and 45 653 non-cancer patients. The results of meta-analysis showed that in patients with cancer, the 30-day mortality [OR=0.74, 95%CI (0.65, 0.84), I2=0%, P<0.000 01], stroke [OR=0.87, 95%CI (0.76, 0.99), I2=0%, P=0.04] and acute kidney injury [OR=0.81, 95%CI (0.76, 0.85), I2=49%, P<0.000 01] were lower than those in patients without cancer. The 1-year mortality [OR=1.46, 95%CI (1.15, 1.86), I2=62%, P=0.002] and late mortality [OR=1.51, 95%CI (1.24, 1.85), I2=61%, P<0.000 1] were higher in patients with cancer.ConclusionIt is effective and safe in cancer patients with severe AS undergoing TAVI. However, compared with patients without cancer, it is still high in long-term mortality, and further study of the role of TAVI in cancer patients with AS is necessary.
ObjectiveTo analyze the results of surgical treatment of severe aortic stenosis in infants.MethodsFrom August 2012 to December 2019, 28 infants undergoing aortic valvuloplasty in our hospital were selected, including 22 males and 6 females, aged 62.00 (47.00, 82.50) d. The baseline characteristics of the patients, postoperative complications and follow-up results were analyzed.ResultsTwenty (71.43%) patients had bicuspid aortic valves. Five (17.86%) patients had heart failure and two (7.14%) patients used prostaglandin before surgeries. Postoperative mechanical ventilation time was 25.00 (17.00, 62.75) h, ICU stay was 3.50 (2.00, 8.50) d and postoperative hospital stay was 10.00 (7.00, 16.50) d. Four (14.29%) patients got delayed recovery (ICU stay>14 d). One (3.57%) perioperative death was observed. The follow-up time was 55.00 (43.25, 82.25) months. No death was found during follow-up. Four (14.81%) patients underwent a second operation, including three (11.11%) patients with severe aortic stenosis, and one (3.70%) patient with severe regurgitation.ConclusionInfants with severe aortic stenosis are seriously ill and have a long postoperative recovery time, requiring early surgery. The postoperative follow-up results are satisfactory.
Transcatheter aortic valve replacement (TAVR) is an important treatment for patients with symptomatic severe aortic stenosis. The 2020 updated version of Chinese Expert Consensus on Transcatheter Aortic Valve Replacement was born in the process of Chinese exploration for TAVR. It is of epochal guiding significance for TAVR in China, which has entered a stage of rapid development from the initial stage. Moreover, it further promotes the standardized and healthy development of TAVR in China. The 2020 updated version of Chinese Expert Consensus on Transcatheter Aortic Valve Replacement, based on its 2015 version, has included aortic valve stenosis with a low risk of surgical operation as an indication, made more detailed recommendations on the operating specifications of balloon dilation and valve placement during TAVR, added the antithrombotic program after TAVR, and important opinions on the treatment of coronary atherosclerotic heart disease, renal insufficiency, and emergency TAVR. In this article, we will focus on all these updates to interpret the updated consensus in detail.
Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. The use of new heart valves prosthesis has improved surgical safety and efficacy. This report described a 72-year-old male patient with severe aortic stenosis combined with severe aortic regurgitation, who was evaluated at moderate-high risk of surgery and received a transapical TAVR using the Ken-Valve heart valve. The transcatheter operation time was 8 min, and the blood loss was 50 mL. The tracheal intubation was removed immediately after the surgery. Transesophageal echocardiography on the 4th postoperative day showed that the aortic valve leaflets worked well, and there was no valve orifice and paravalvular leakage. The patient was discharged on the 5th day after the surgery without complications. Transapical TAVR using Ken-Valve was an easy surgical procedure for aortic valve disease, and had short operation time.
Subvalvar aortic stenosis (SAS) refers to a type of disease in which the stenosis of the left ventricular outflow tract is below the aortic valve. It is a disease spectrum that includes multiple diseases ranging from the simple to the complex. This disease has its own characteristics according to different types. The diagnostic criteria and treatment strategies are basically unified, but there are still some disputes about the surgical treatment. Based on the evidence-based data and expert consensus, this paper makes a comprehensive summary and recommendations on the clinical classification, diagnostic criteria and surgical treatment strategies of SAS, which is more suitable for the clinical characteristics of SAS patients in China and more clinically operable.