Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for severe aortic stenosis. The localization and anchor of many transcatheter heart valves available in the clinic today are dependent on the calcific aortic valve leaflet of patients. We reported here a successful case of transapical aortic valve implantation with Ken-Valve heart valve in an 82-year-old male patient with pure severe aortic regurgitation without native valve calcium. Postoperative follow-up (3 months after the surgery) showed that the cardiac function significantly improved. The echocardiography indicated that the Ken-Valve prosthesis worked well without perivalvular regurgitation. The short-term clinical effect was satisfactory. The Ken-Valve with three position anchors is proved to be suitable for the treatment of pure aortic regurgitation.
Transcatheter aortic valve replacement (TAVR) techniques have been rapidly developed in recent years. Current guidelines and studies mainly focus on aortic stenosis patients treated by transfemoral approach, but they are not completely appropriate to patients with isolated aortic regurgitation or other patients who need transapical TAVR (TA-TAVR), which affects the standardized treatment of those patients. Therefore, our team pronounced the operational standards for TA-TAVR, based on fully reviewing the literatures worldwide, combined with the opinions of experts from 15 heart centers with rich experience in carrying out TA-TAVR in China. This standard aims to provide clinicians with standardized diagnosis and treatment principles of TA-TAVR and improve the quality of TA-TAVR in China.
ObjectiveTo determine the clinical efficacy of transcatheter aortic valve replacement (TAVR) for severe aortic regurgitation (AR) combined with severe mitral regurgitation (MR). MethodsThe clinical data of 13 patients who underwent TAVR due to severe AR combined with severe MR from March 2018 to September 2021 in our hospital were retrospectively analyzed, including 10 males and 3 females with a mean age of 72.54±2.35 years. The echocardiographic findings of all patients were compared preoperatively and postoperatively. ResultsSurgeries were performed successfully in all patients without intraoperative death or conversion to sternotomy. The operation time was 118.15±11.42 min, intraoperative blood loss was 100.00 (75.00, 250.00) mL, and the length of hospital stay after surgery was 9.00 (4.50, 11.00) d. The mean follow-up duration was 10.00 (6.50, 38.50) months, during which there were 2 patients with mild to moderate AR, 6 with mild AR, and 5 with no AR; meanwhile, severe MR decreased significantly (P=0.001) even without active intervention, including 4 mild to moderate MR and 9 mild MR patients. Compared to preoperative indexes, the left atrial diameter [46.00 (41.00, 52.50) mm vs. 35.00 (34.00, 41.00) mm, P<0.001], left ventricular end-systolic diameter [45.00 (36.00, 56.00) mm vs. 35.00 (28.00, 39.00) mm, P=0.002] and left ventricular end-diastolic diameter (62.62±2.40 mm vs. 51.08±2.49 mm, P<0.001) showed a decreasing trend during the follow-up. ConclusionIn selected patients with severe AR combined with severe MR, TAVR alone improves AR and combined MR at the same time.
ObjectiveTo explore the risk factors for 24-hour death in acute type A aortic dissection (ATAAD) patients with conservative treatment.MethodsFrom January 2009 to January 2018, 243 ATAAD patients who received non-surgical intervention were admitted in Beijing Anzhen Hospital, including 167 males and 76 females with an average age of 53.0±12.0 years. The risk factors for 24-hour mortality were analyzed.ResultsThe total in-hospital mortality rate was 37.9% (93/243), and 13.6% (33/243) patients died within 24 hours of onset. We found that left ventricular end diastolic diameter [LVEDD, OR=0.45, 95%CI (0.25, 0.83), P<0.01] and aortic regurgitation [OR=7.26, 95%CI (1.67, 31.53), P<0.01] were independent risk factors for 24-hour death in patients with ATAAD.ConclusionIn this study, LVEDD and aortic regurgitation are identified as independent risk factors for 24-hour mortality in ATAAD patients. Therefore, patients with aortic regurgitation and small LVEDD should be treated with sugery as soon as possible.
Patients with Takayasu arteritis combined with aortic valve disease often have a poor prognosis following surgical valve replacement, frequently encountering complications such as perivalvular leakage, valve detachment, and anastomotic aneurysm. This article presents a high-risk case wherein severe aortic valve insufficiency associated with Takayasu arteritis was successfully managed through transcatheter aortic valve implantation via the transapical approach. The patient had satisfactory valve function with no complications observed during the six-month postoperative follow-up period. This case provides a minimally invasive and feasible alternative for the clinical management of such high-risk patients.
ObjectiveTo summarize and analyze the risk factors and management of artificial valve slippage in transcatheter aortic valve implantation (TAVI).MethodsWe retrospectively analyzed the clinical data of 131 patients undergoing TAVI surgery in our center from September 2017 to May 2019, including 62 patients through transapical approach and 69 patients through transfemoral artery approach.ResultsA total of 131 patients received TAVI surgery, among whom 4 patients had slipped during the operation, 2 patients via transfemoral artery approach, and another 2 patients via transapical. The average age was 77±9 years with one female (25%). Preoperative evaluation, higher position and poor coaxial were main risk factors for valve slip in TAVI.ConclusionValve slippage is also a serious complication in TAVI surgery. Reasonable and effective treatment can avoid thoracotomy.
ObjectiveTo summarize the clinical result of a combined technical system for bicuspid aortic valve (BAV) repair. MethodsPatients who diagnosed as BAV and sever aortic regurgitation (AR) underwent a strategy of combined repair technics including annuloplasty, sinus plasty, leaflet plasty, sinus-tubular junction (STJ) plasty depending on anatomy pathological characteristics between October 2019 and January 2021 were enrolled. The clinical data of the patients were analyzed.ResultsA total of 17 patients were enrolled. There were 11 males and 6 females with an average age of 18-49 (32.4±13.6) years. Fifteen patients had typeⅠand 2 patients had typeⅡBAV according to Sievers classification. Annuloplasty was applicated in 13 patients, sinus plasty in 8 patients, leaflet plasty in 17 patients, and STJ plasty in 11 patients, respectively. The cardiopulmonary bypass (CPB) time was 95 (84, 135) min, aortic cross-clamping time was 68 (57, 112) min, and the ICU stay time was 17 (12, 25) h. After the operation, mild AR was presented in 14 patients, moderate AR in 1 patient and severe AR in 2 patients. The latter 3 patients underwent second operation under CPB, after then, 1 patient had mild AR and 2 patients had moderate AR. The follow-up time was 13.1±4.6 months. At the latest follow-up, 12 patients had mild AR and 5 patients had moderate AR, and no patient had reoperation. ConclusionA combined technical system for BAV repair can be used effectively and safely with an acceptable short and middle-term result.
ObjectiveTo explore growth pattern of neo-aortic root as well as development of neo-aortic regurgitation after arterial switch operation (ASO) for Taussig-Bing anomaly. MethodsFrom 2002 to 2017, the patients who received ASO, and were discharged alive from Shanghai Children’s Medical Center and followed up for more than 3 years were retrospectively involved in this study. ResultsA total of 127 patients were enrolled. There were 98 (77.2%) males, the median age at ASO was 73.0 d and the average weight was 4.7 kg. Forty-five (35.4%) children were complicated with mild or mild-to-moderate pulmonary insufficiency (PI) before ASO. The average follow-up time was 7.0 years. During the follow-up, 14 (11.0%) children presented moderate or greater neo-aortic regurgitation (neo-AR). The diameter of neo-aortic annulus and sinus of Valsalva was beyond normal range during the entire follow-up. The average diameter of neo-aortic annulus was 18.0 mm at 5 years and 20.5 mm at 10 years. The average diameter of sinus of Valsalva was 25.9 mm at 5 years and 31.1 mm at 10 years. Neo-AR continued to develop over time. The diameter of children who developed moderate or greater neo-AR was constantly larger than that of children who did not (χ2=18.3, P<0.001). Preoperative mild or mild-to-moderate PI was an independent risk factor for the development of moderate or greater neo-AR during mid-to-long term follow-up (c-HR=3.46, P=0.03). ConclusionThe diameters of neo-aortic annulus and sinus of Valsalva of Taussig-Bing children who receive ASO repair continue to expand without normalization. The dilation of annulus correlates with the development of neo-AR. PI before ASO repair increases the risk of neo-AR development.
Patients with bicuspid aortic valve are often complicated with aortic dilatation. If the aortic valve is of good quality, aortic root replacement with aortic valve preservation is feasible. A 35-year-old male patient with bicuspid aortic regurgitation complicated with ascending aortic aneurysm underwent Remodeling+Ring (modified Yacoub) operation. Echocardiography showed that there was no aortic regurgitation on the 3rd day after operation, and the patient was discharged satisfactorily on the 6th day after operation. Remodeling+Ring surgery ensures the physiological movement of the aortic valve, solves the enlarged annulus, avoids the problems caused by valve replacement, and significantly improves the quality of life of patients, which is worth popularizing.
Objective To evaluate the early clinical effect of reimplantation in the treatment of bicuspid aortic valve (BAV) with aortic root aneurysm. Methods The clinical data of 25 patients with BAV and aortic root aneurysm[mean diameter: 45-63 (52.68±5.55) mm] undergoing reimplantation in West China Hospital from November 2019 to May 2021 were retrospectively reviewed. There were 22 males and 3 females. The mean age was 15-65 (50.00±13.10) years and body surface area was 1.79±0.23 m2. ResultsThe pathological classification of BAV malformation was confirmed during the operation: Type 0 in 3 patients and Type 1 in 22 patients. There were 12 patients undergoing cusp central plication, and 2 patients were sutured with a closed fusion crest. Postoperative valve leaflet coaptation height was 0.78±0.15 cm, and effective height was 1.27±0.19 cm. In operation, maximum aortic valve flow velocity was 1.65±0.42 m/s, pressure difference was 5.46±3.05 mm Hg, and aortic valve annulus diameter was 21.32±0.95 mm. Cardiopulmonary bypass time was 225.84±35.34 min, and aortic block time was 189.60±26.51 min. In-hospital time was 11.64±3.07 d, ICU stay time was 2.64±0.99 d, and mechanical ventilation time was 1.48±0.87 d. The follow-up time was 17.20±4.70 months, and no death or major complications occurred during the follow-up in all patients. The cardiac function of the patients significantly improved postoperatively (P≤0.05). Echocardiography suggested that 12 patients had no aortic regurgitation, 10 minor aortic regurgitation, 3 mild aortic regurgitation, and no patients with moderate or more severe regurgitation. The diameter of the aortic sinus, left ventricular end-diastolic diameter and volume decreased during the follow-up, compared to preoperative ones (P≤0.05). The maximum flow velocity of the aortic valve was 1.54±0.36 m/s, and the pressure difference was 5.17±2.38 mm Hg during the follow-up. ConclusionReimplantation technology has a good clinical effect for highly selective BAV patients. It can effectively avoid long-term postoperative anticoagulation, but the maximum flow rate after surgery is slightly increased, which may be related to the configuration of BAV itself. While compared with valve replacement, the effect is still worthy of recognition.
