Transcatheter aortic valve replacement is an effective treatment for aortic stenosis currently, especially in elderly, surgical high-risk, and surgical procedures-intolerant patients with severe aortic stenosis. After several generations of updates in design and function, the self-expandable valves have shown significant efficacy in treating aortic stenosis patients with bicuspid aortic valve, bioprosthetic valve failure or small annulus, and superiority in terms of valve durability, and the favorable hemodynamic outcomes could translate into clinical endpoint benefit. This literature review summarizes the advantages and recent advances of the self-expandable valves in transcatheter aortic valve replacement.
An elderly female patient, with systemic multiple organ dysfunction, suffered from severe aortic valve stenosis, was to undergo transcatheter aortic valve replacement (TAVR). She was intolerance of the computed tomography examination before surgery. Bedside echocardiography was employed to evaluate the patient’s aortic valve stenosis, valve anatomy and type, the condition of aortic root, the distance from coronary to aortic root, and lower-extremity vascular access. Finally, the emergent TAVR was successfully performed under general anesthesia, and the aortic valve trans-prosthetic gradient met a remarkable decrease after surgery.
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.
ObjectiveTo systematically review the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with sorafenib and TACE only treating the intermediate or advanced hepatocellular carcinoma (HCC) in Chinese people.
MethodsThe PubMed, Embase, Cochrane Library, CBM, CNKI, VIP, and Wanfang Data for randomized controlled trials (RCT) on TACE combined with sorafenib (TACE combined with sorafenib group) and TACE (TACE alone group) from inception to December 2014 were searched. The literatures and data were screened and extracted. The meta analysis was performed using RevMan 5.1 software.
ResultsSix RCTs involving 498 patients with HCC were included. The results of meta analysis showed that the objective response rate[OR=2.28, 95% CI (1.52-3.42), P < 0.000 1] and the disease control rate[OR=6.62, 95% CI (4.12-10.65), P < 0.000 01] were higher, the 1-year survival rate[OR=3.27, 95% CI (2.06-5.22), P < 0.000 01] and 2-year survival rate[OR=4.55, 95% CI (2.28-9.07), P < 0.000 1] were longer, the safety and tolerability of adverse reactions were better in the TACE combined with sorafenib group as compared with the TACE alone group.
ConclusionsIn Chinese people, compared with TACE alone group, TACE combined with sorafenib group have higher objective response rate, disease control rate, 1-year survival rate, and 2-year survival rate. However, due to the lower quality of included literatures, these conclusions should be treated cautiously.
ObjectiveTo investigate the operation of transcatheter aortic valve replacement (TAVR), the use of TAVR instruments and the current situation of TAVR-related nursing in our country, to reveal the characteristics of TAVR in various hospitals in our country, and to provide reference data for improving perioperative nursing and industry development of TAVR. MethodsA questionnaire survey was conducted among the head nurses of the cardiac catheterization laboratories of 51 hospitals in China that carried out TAVR operations, with a total of 5 items and 23 questions. The current situation of TAVR operation methods, intraoperative instruments and nursing care in China were analyzed. ResultsThe number of hospitals in China which started conducting TAVR and the beginning year were: 2 in 2010, 1 in 2012, 1 in 2013, 1 in 2015, 11 in 2016, 13 in 2017, 15 in 2018 and 7 in 2019; the number of transfemoral TAVR in 2019: 32 (62.75%) hospitals conducted on less than 20 patients, 7 (13.73%) hospitals 20-<50 patients, 6 (11.76%) hospitals 50-100 patients and 6 (11.76%) hospitals more than 100 patients; TAVR strategies adopted by most hospitals were: general anesthesia (90.20%), the use of vascular sealers (80.39%), backing by cardiac surgeon (74.51%) and using homemade prosthetic valves. Conclusion At present, the number of TAVR carried out in Chinese hospitals is still far behind that of developed countries in Europe and the United States. Our country has adopted the form of multidisciplinary cardiac team cooperation and formed a TAVR nursing model with Chinese characteristics.
Due to the lack of calcification of the aortic valve, it is difficult to provide effective support for the fixation of artificial valve in aortic stenosis characterized by leaflet thickening. There is a risk of postoperative perivalvular leakage and secondary valve implantation, which is widely regarded as a relative contraindication for transcatheter aortic valve replacement (TAVR). But aortic valvuloplasty and self-expanding transcatheter aortic valve has showed its safety and efficacy. This paper reports a patient with bicuspid aortic valve characterized by leaflet thickening treated with TAVR. After the operation, the patient’s symptom of exertional dyspnea was significantly improved, New York Heart Association class increased to Ⅱ, no perivalvular leakage was found, and the mean transaortic pressure gradient and the maximum aortic valve velocity decreased significantly.
Transcatheter aortic valve replacement has revolutionized the management of aortic stenosis and become the gold standard for the treatment of symptomatic and severe aortic valve stenosis in elderly patients. With the improvement in design and materials, newer generation transcatheter aortic valve prostheses had overcome the limitations of early-generation devices that were susceptible to paravalvular leak, atrioventricular block and vascular complications, to a certain extent. This review provides an update on the latest advances in transcatheter aortic valve prostheses.
ObjectiveTo introduce the role of three dementional computed tomograph (3D-CT) for patients underwent transcatheter aortic valve implantation (TAVI) procedure in perioperative evaluation.
MethodsFrom April 2014 to June 2015, we retrospectively analyzed clinical data of 28 patients with severe aortic stenosis underwent successful TAVI procedure using new second-generation device, who were enrolled in this study including 12 males and 16 females at mean age of 72.8±4.5 years. We used 3D-CT to get the perioperative relative evaluation, including valve morphology and calcification degree, annular diameter, aoronary ostium height, ascending aorta, aortic sinus diameter, left ventricular-aortic angle, optimal intraoperative angiogram projection angle. Based on the evaluation by 3D-CT image, the prosthesis size, balloon size, best intraoperative imaging projection angle and approach of apex were then chosen.
ResultsAll patients with severe aortic stenosis underwent successful TAVI procedure with mean logistic Euro-SCORE I:26.2%±7.9%. CT image revealed that mean aortic annular diameter was 24.6±1.8 mm with mean valve prosthesis size 25.8±1.1 mm and pre-dilation balloon size 23.1±1.2 mm and 76.8% patients were of tricuspid aortic valve with severe calcification and 25% patients were of asymmetric calcification. Optimal intraoperative angiogram image was achieved in 92.9% patients with the help of preoperative CT image. There was a statistic difference in mean transvalvular gradient after valve implantation (54.1±15.3 mm Hg vs. 13.1±8.5 mm Hg, P<0.05). And there was no mortality or severe complication postoperatively.
Conclusion3D-CT image palys an important role during perioperative evaluation of TAVI procedure and it can be helpful for Chinese doctors to operate TAVI successfully.
Patients with severe aortic stenosis will gradually develop symptoms of heart failure. Aortic valve replacement is an effective treatment at present, while transcatheter aortic valve replacement is suitable for high-risk elderly patients. This article reports a patient with severe aortic valve stenosis and severe scoliosis who underwent transcatheter aortic valve replacement. Detailed preoperative evaluation and avoidance of peripheral vascular injury were the characteristics of this case. The patient was an elderly male with severe scoliosis. After fully evaluating the risks and benefits of surgery, a surgical strategy was formulated. The patient was in the supine position to complete the preoperative CT, and then the long sheath was used to pass through the thoracoabdominal aortic angle during the operation. After angiography-assisted adjustment and determination of the optimal release angle, the valve was accurately released, and the operation went smoothly without serious peripheral vascular damage.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis with surgical taboos or high risk. With the update of the guidelines, the indication of TAVR has been extended to the intermediate-risk aortic stenosis population, and even has a tendency to further expand to the low-risk population. This review highlights the research progress and new evidence of TAVR in respects of patient selection, valve and approach selection, ethnic differences, and surgical complications such as perivalvular leakage, cardiac conduction block, vascular complications, stroke, acute kidney injury, and coronary artery occlusion.
