ObjectiveTo investigate the reliability and safety of the technique of percutaneous left ventricular transapical access guided by cardiac three dimensional CT angiography (3D-CTA) combined with echocardiography applied in structural heart defects.MethodsThe clinical data of 9 patients (7 males and 2 females with a median age of 50 years ranging from 43 to 64 years) with paravalvular leaks closed by percutaneous left ventricular transapical access in West China Hospital, from April 2015 to August 2018, were retrospectively analyzed. We applied preoperative cardiac 3D-CTA to define the puncture site and trace, which was established by combining with real-time guidance of transesophageal echocardiography (TEE/3D-TEE), and an occluder was deployed at the apical access point for hemostasis with real-time guidance of transthoracic echocardiography (TTE).ResultsThe puncture needles were successfully introduced into the left ventricular cavity at one time in all patients without injury of lung tissue, coronary artery or papillary muscle. There was no occluder displacement or apex bleeding. One patient developed pleural effusion caused by intercostal artery injury.ConclusionThat cardiac 3D-CTA is used to define puncture sites and trace with advantages of simplicity and repeatability. A safe access and secure exit of left ventricle can be achieved by combining with real-time guidance of echocardiography. There are acceptable technology-related complications.
According to the needs of CT image evaluation for transapical transcatheter aortic valve replacement (TAVR), 20 clinical questions were proposed by the Delphi method, 15 questions were initially determined, and 12 clinical questions were summarized and determined by domestic experts. PubMed, Web of Science, Wanfang, and CNKI databases were searched by computer to collect the relevant literature from inception to November 2022, and finally 53 studies were included. Based on evidence-based study and evaluation experience, 3 meetings were held to give recommendations for preoperative CT data acquisition method, preoperative imaging evaluation of aortic root, imaging evaluation of transapical approach, preoperative auxiliary guidance of TAVR by CT images combined with 3D printing, and postoperative imaging evaluation of transapical TAVR, hoping to promote the standardized and successful development of transapical TAVR in China.
ObjectiveTo evaluate the safety and efficacy of transapical mitral valve repair with moderate-to-severe or severe mitral regurgitation (MR) by using LifeClip system. Methods We retrospectively analyzed the clinical data of 7 symptomatic patients with moderate-to-severe or severe MR who received transapical mitral valve repair by using the LifeClip system in our hospital from July to November 2021. There were 5 males and 2 females with an average age of 76.0±7.5 years. ResultsThere were 2 patients with degenerative MR and 5 patients with functional MR. All of the procedures were successful and 6 patients received 1 LifeClip while the other one patient received 2. The operation time was 135.7±46.9 min, the mechanical ventilation time was 12 (3, 14) h, and the hospital stay time was 18.1±4.1 d. No serious complications or death occurred during the perioperative or follow-up period. MR reduction by ≥2 grades was achieved in all the patients at the one-month follow-up. The classification of cardiac function was improved in varying degrees. Conclusion Transapical mitral valve repair using the LifeClip system shows good safety and efficacy for severe MR patients, and MR degree is significantly improved at early follow-up. However, the benefit of LifeClip should be validated in a larger sample size of Chinese population and through long-term follow-up.
ObjectiveTo research the procedure for creating an animal model of mitral regurgitation by implanting a device through the apical artificial chordae tendineae, and to assess the stability and dependability of the device. MethodsTwelve large white swines were employed in the experiments. Through a tiny hole in the apex of the heart, the artificial chordae tendineae of the mitral valve was inserted under the guidance of transcardiac ultrasonography. Before, immediately after, and one and three months after surgery, cardiac ultrasonography signs were noted. Results All models were successfully established. During the operation and the follow-up, no swines died. Immediately after surgery, the mitral valve experienced moderate regurgitation. Compared with preoperation, there was a variable increase in the amount of regurgitation and the values of heart diameters at a 3-month follow-up (P<0.05). ConclusionIn off-pump, the technique of pulling the mitral valve leaflets with chordae tendineae implanted transapically under ultrasound guidance can stably and consistently create an animal model of mitral regurgitation.
ObjectiveTo compare the early clinical efficacy and safety of transapical transcatheter aortic valve implantation (TA-TAVI) with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis (AS). MethodsA retrospective study was conducted on patients with severe AS admitted to the Department of Cardiovascular Surgery, The First Affiliated Hospital of University of Science and Technology of China from January 2020 to March 2024. According to the surgical method, patients were divided into a SAVR group and a TA-TAVI group, and the clinical data of the two groups were compared. ResultsA total of 71 patients were included, with 45 in the SAVR group, including 33 males and 12 females, aged 16-75 (60.89±10.88) years; 26 in the TA-TAVI group, including 15 males and 11 females, aged 61-83 (72.85±5.53) years. The results showed that postoperative aortic valve transvalvular flow velocity [(2.31±0.38) m/s vs. (2.60±0.50) m/s, P=0.019] and transvalvular pressure gradient [(21.09±6.03) mm Hg vs. (28.20±10.79) mm Hg, P=0.001] in the TA-TAVI group were lower than those in the SAVR group. In terms of left ventricular end-diastolic diameter, both preoperative [(56.73±7.74) mm vs. (52.36±7.00) mm, P=0.017] and postoperative [(52.61±7.18) mm vs. (48.04±4.78) mm, P=0.010] values in the TA-TAVI group were larger than those in the SAVR group. In terms of left ventricular ejection fraction, the preoperative value in the TA-TAVI group was lower than that in the SAVR group (58.00%±13.84% vs. 64.87%±7.63%, P=0.026), but there was no statistical difference between the two groups after surgery (P=0.670). The operation time and drainage volume on the first day after surgery in the TA-TAVI group were shorter or lower than those in the SAVR group (P<0.05). There was no statistical difference between the two groups in the postoperative hospital stay, ICU stay, or postoperative mechanical ventilation time (P>0.05). In addition, no serious complications occurred in patients after SAVR, while perivalvular leakage (2 patients), third-degree atrioventricular block (1 patient), and death (3 patients) occurred in the TA-TAVI group. ConclusionFor elderly patients with severe AS and poor cardiac function, TA-TAVI technology has minimal surgical trauma, high safety and effectiveness, and is a safe and effective treatment option besides traditional surgical operations.
Transcatheter aortic valve replacement (TAVR) has entered a new and critical stage after nearly 20 years of rapid development in China. There are various types of TAVR valves with different advantages. TAVR can be performed through various approaches such as transfemoral artery, transapical, trans-carotid artery, or trans-ascending aorta. The first two are more common. Echocardiography plays an important role in the perioperative period of TAVR. Compared to transfemoral approach, transapical TAVR has different key points in perioperative echocardiography which is lack of unified and accurate standards. This standard is specially formulated to focus on the key points of echocardiography in preoperative screening, intraoperative monitoring and postoperative follow-up in order to promote the safe and effective application of transapical TAVR in the clinic.
Objective To assess early clinical safety and efficacy of transfemoral transcatheter aortic valve replacement (TF-TAVR) for pure aortic regurgitation (PAR). Methods The clinical data of PAR patients who underwent TAVR in Wuhan Asia Heart Hospital and Wuhan Asia General Hospital from January 2018 to October 2022 were retrospectively analyzed. Patients were divided into a TF-TAVR group and a transapical transcatheter aortic valve replacement (TA-TAVR) group. The clinical data of the patients were analyzed. Results A total of 54 patients were enrolled, including 34 males and 20 females with an average age of 74.43±6.87 years. The preoperative N-terminal pro-B-type natriuretic peptide level was lower [808.50 (143.50, 2 937.00) pg/mL vs. 2 245.00 (486.30, 7 177.50) pg/mL, P=0.015], and the left ventricular end-diastolic diameter (56.00±6.92 mm vs. 63.07±10.23 mm, P=0.005) and sinus junction diameter (32.47±4.41 mm vs. 37.65±8.08 mm, P=0.007) were smaller in the TF-TAVR group. There was no death in the two groups during the hospitalization. Only 1 new death within postoperative 1 month in the TF-TAVR group (cerebral hemorrhage). A total of 2 new deaths in the TF-TAVR group (1 patient of sudden cardiac death and 1 of multiple organ failure), and there was no death in the TA-TAVR group within postoperative 3 months. There was 1 new death in the TA-TAVR group (details unknown), and there was no death in the TF-TAVR group within postoperative 6 months. There was no statistical difference between the two groups in the all-cause mortality and the cumulative survival rate during the follow-up period (P>0.05). The incidence of high atrioventricular block was 36.0% in the TF-TAVR group and 10.3% in the TA-TAVR group (P=0.024). There were no significant differences between the two groups in the perivalvular leakage (≥moderate), valve in valve, a second valve implantation, valve migration, cerebrovascular events, major vascular complications, complete left bundle branch block, new permanent pacemaker implantation or transferring to surgery (P>0.05). However, the incidence rates of complete left bundle branch block and new permanent pacemaker implantation were higher in the TF-TAVR group, accounting for 56.0% and 40.0%, respectively. Conclusion TF-TAVR is a safe and feasible treatment for PAR patients, which is comparable to TA-TAVR in the early postoperative safety and efficacy.
ObjectiveTo evaluate the early and mid-term safety of transcatheter aortic valve replacement via transfemoral (TF), transapical (TAp) and transsubclavian (TSc) approaches by meta-analysis.MethodsWe systematically searched the clinical comparative trials published from inception to June 2019 from PubMed, Web of Science, EMbase and The Cochrane Library, to evaluate the safety of transcatheter aortic valve replacement through TF, TAp or TSc approaches. The information of all-cause mortality at 30 days, 1 year, 2 years and the incidence of common complications at 30 days after operation (including pacemaker-dependent block, major vascular complications, severe bleeding events, acute renal injury and stroke) were exacted, and a meta-analysis was conducted by RevMan 5.3 software.ResultsThis study included 11 literatures, with a total of 7 833 patients, among whom 5 348 patients were treated by TF TAVR, 1 796 patients by TAp TAVR and 689 patients by TSc TAVR. The results of the meta-analysis were as follows: (1) at 30 days after operation, the mortality of TF and TSc approaches were lower than that of the TAp approach (TF vs. TAp: OR=0.57, 95%CI 0.39-0.84, P=0.004; TSc vs. TAp: OR=4.12, 95%CI 1.93-8.79, P=0.000 3). There was no statistical difference between the TF and TSc approaches (TF vs. TSc: OR=0.98, 95%CI 0.38-2.51, P=0.97); at 1 year, there was no statistical difference in mortality among the three approaches (P>0.05); at 2 years, there was no statistical difference between TSc and TF or TAp approaches (TF vs. TSc: OR=1.21, 95%CI 0.95-1.54, P=0.13; TSc vs. TAp: OR=1.02, 95%CI 0.76-1.36, P=0.91). (2) The incidence of acute kidney injury after TF approach was lower than that of the TAp approach (OR=0.30, 95%CI 0.22-0.41, P<0.000 01). (3) There was no statistical difference in major vascular complications between TSc and TF or TAp approaches (TF vs. TSc: OR=0.75, 95%CI 0.38-1.49, P=0.41; TSc vs. TAp: OR=1.37, 95%CI 0.56-3.32, P=0.49). (4) There was no statistical difference in severe bleeding events between TF and TSc (OR=0.97, 95%CI 0.53-1.76, P=0.92). (5) There was no statistical difference in the incidence of postoperative stroke, pacemaker dependent block among the three approaches (P>0.05).ConclusionTAp and TSc approaches are safe and effective. They are not only an alternative to TF approach, but also the first choice in some patients with poor condition of iliofemoral artery.
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. This case provides a minimally invasive and feasible alternative for the clinical management of such high-risk patients.
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.
