Mitral regurgitation (MR) with multi-pathogenesis is a common disease in cardiac surgery department. MR can be classified into two categories-primary mitral regurgitation and secondary mitral regurgitation. With the development of cardiac intervention, numerous patients who cannot tolerate open heart surgery for the reason of high risk of surgery receive the treatment of intervention and achieve the favorable endpoint. The technique of transcatheter therapy which could be used to treat MR is comprised of leaflet repair, annuloplasty and implantation of artificial chordae. Comparing to primary mitral regurgitation, surgical effect of secondary mitral regurgitation is not desirable for the reasons of complex pathophysiologic mechanism. Hence, based on the perspective of surgeon, we will introduce the research progress of transcatheter interventional mitral valve repair which is focused on the treatment of primary mitral valve regurgitation and reviewed from three aspects of surgical risks, surgical types and outlook.
Mitral regurgitation (MR) is the most common valvular heart disease, however, majority of patients are not suitable for open heart surgery due to comorbidity such as organ and heart dysfunction. Transcatheter edge-to-edge mitral valve repair has become an effective treatment option for high-risk patients with MR. Two patients were enrolled in this study inlcuding one 60-year degenerative mitral regurgitation patient and one 72-year functional mitral regurgitation patient. Transcatheter repair procedure was successfully done for the two patients without postoperative complication.
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.
Objective To investigate the early safety and efficacy of transapical transcatheter aortic valve implantation (TAVI) for high-risk elderly patients with pure aortic valve insufficiency. Methods A prospective multicenter clinical study of domestic J-valveTM TAVI for high-risk native non-calcified aortic valve insufficiency was conducted from April 2014 to May 2018, and the early postoperative results were analyzed. A total of 82 patients were enrolled, including 62 patients from West China Hospital, Sichuan University, 16 patients from Zhongshan Hospital, Fudan University, and 4 patients from Beijing Fuwai Hospital, National Center for Cardiovascular Diseases. There were 55 males and 27 females. The age was 61-90 (73.8±6.3) years. The logistic EuroSCORE was 10.0%-44.4% (17.5%±8.1%). All patients underwent TAVI using J-ValveTM system. Clinical evaluation and echocardiography were performed preoperatively and 1 month postoperatively. Multislice spiral CT was reviewed before discharge. Results Three patients were transferred to thoracotomy for cardiopulmonary bypass operation, and 1 patient had decreased cardiac function due to leakage of the valve 1 week after surgery. The overall technical and procedural success rate was 95.1% and 93.9%, respectively. During hospitalization, 1 patient died of moderate pericyclosis complicated with multiple organ failure, and 1 patient died of pulmonary infection. Six (7.6%) patients received pacemaker implantation due to new onset Ⅲ° atrioventricular block. Echocardiographic follow-up showed paravalvular leak was observed in the few of patients, mild paravalvular leak was in 13 patients on the 30th day. Two patients showed moderate paravalvular leak. Left ventricular end-diastolic volume decreased from 197.7±66.8 mL (pre-TAVI) to 147.2±53.3 mL (30-day post-TAVI) (P<0.05). Mean pressure gradient was 9.5±4.1 mm Hg (30-day post-TAVI). Conclusion This multicenter study demonstrates that TAVI with the J-Valve system for the treatment of pure aortic regurgitation is associated with sustained clinical and functional cardiovascular benefits in high-risk patients with symptomatic aortic regurgitation early-term follow-up. Our results further support that TAVI with the specific designed J-Valve system is an acceptable alternative therapy for high-risk patients with pure AR. Our result demonstrates good early-term durability and preserved hemodynamic function. The procedure appears to offer an adequate and lasting resolution for selected patients with pure aortic regurgitation.
ObjectiveTo discuss the operation skill and clinical effects of using domestic balloon-expandable Prizvalve? transcatheter "valve-in-valve" to treat the degenerated bioprosthesis in the tricuspid position.MethodsAll the admitted surgical tricuspid valve bioprosthetic valve replacement patients were evaluated by computerized tomography angiography (CTA), ultrasound, and 3D printing technology, and 2 patients with a degenerated bioprosthesis were selected for tricuspid valve "valve-in-valve" operation. Under general anesthesia, the retro-preset Prizvalve? system was implanted into degenerated tricuspid bioprosthesis via the femoral vein approach under the guidance of transesophageal echocardiographic and fluoroscopic guidance.ResultsTranscatheter tricuspid valve implantation was successfully performed in both high-risk patients, and tricuspid regurgitation disappeared immediately. The operation time was 1.25 h and 2.43 h, respectively. There was no serious complication in both patients, and they were discharged from the hospital 7 days after the operation.ConclusionThe clinical effect of the degenerated tricuspid bioprosthetic valve implantation with domestic balloon-expandable valve via femoral vein approach "valve-in-valve" is good. Multimodality imaging and 3D printing technology can safely and effectively guide the implementation of this innovative technique.
In historic perspectives, tricuspid valve was considered as “forgotten valve” in the cardiovascular field. Tricuspid regurgitation (TR) is the main disease of the tricuspid valve, and the number of patients is large. TR patients have mostly treated conservatively with drugs due to high surgical mortality, so the effective treatment of TR patients is far from satisfactory. With the development of interventional technology, transcatheter tricuspid valve intervention (TTVI) is expected to become a better choice. In recent years, a number of TTVI devices have entered clinical trials and achieved good results. Due to the late development of TTVI technology and insufficient accumulation of clinical applications, there are no uniform inclusion criteria and evaluation indicators for research endpoints when conducting clinical trials. This article focuses on the introduction of different instruments of TTVI, and summarizes the current status, research progress and problems of these treatments.
ObjectiveTo explore the feasibility of goat tricuspid regurgitation (TR) model by one chordae tendineae cutter via right anterior-lateral minimal incision.MethodsTR model was established in 6 goats with a self-made tricuspid valve chordae tendineae cutter. The goats were placed in a left lateral position and procedure was performed via a right anterior-lateral minimal thoracotomy in the fourth intercostal. Under the guidance of transesophageal ultrasound and digital subtraction angiography, the chordae tendineae of anterior leaflet was cut until moderate to severe regurgitation was confirmed. Echocardiography and laboratory examinations were performed preoperatively, immediately and 3 months after surgery. Additionally, all goats were sacrificed to clarify pathological evaluation.ResultsTR was successfully established in 6 goats. The right atrium pressure increased significantly immediately after surgery (P<0.05). During a follow-up of 3 months, the progression of TR was aggravated (P<0.05), and the annular diameter increased from 2.15±0.23 cm to 2.65±0.20 cm. Overall, there was no statistically significant change in transvalvular gradient and velocity between preoperation and postoperation. Laboratory test results showed no abnormalities between preoperation and postoperation. Autopsy evaluation demonstrated obvioue chordae tendineae transection of the anterior leaflet.ConclusionIt is feasible to establish TR model via a right minimal anterior lateral thoracotomy in the fourth intercostal space. This novel TR goats model will allow investigation of transcatheter interventional device and serve as a chronic model in the future.
ObjectiveTo compare the in-hospital outcomes of transapical transcatheter aortic valve replacement (TA-TAVR) for bicuspid aortic valve (BAV) patients and tricuspid aortic valve (TAV) patients. MethodsPatients (including BAV and TAV patients) who underwent TA-TAVR with the J-ValveTM in West China Hospital from July 2014 to July 2020 were included consecutively. The clinical outcomes of the patients were analyzed. ResultsA total of 354 patients were included in the study, 75 in the BAV group and 279 in the TAV group. There were 229 males and 125 females with a mean age of 72.2±6.0 years. No death occurred during the procedure, and the overall technical success rate was 97.7%. The all-cause in-hospital mortality rate was 1.4%. Twenty (26.7%) patients with BAV and 46 (16.5%) patients with TAV had mild or higher perivalvular leaks immediately after the procedure. No patients with BAV required permanent pacemaker implantation postoperatively, while 13 (4.7%) TAV patients required permanent pacemaker implantation, with an overall pacemaker implantation rate of 3.7%. One (1.3%) BAV patient and 7 (2.5%) TAV patients developed acute kidney injury postoperatively. One (1.3%) BAV patient and 1 (0.4%) TAV patient developed perioperative myocardial infarction. The average postoperative hospital stay was 7.6±3.6 d for BAV patients and 8.6±6.1 d for TAV patients. There was no statistical difference in primary or secondary in-hospital outcomes between BAV and TAV patients (P>0.05). ConclusionCompared to TAV patients, BAV patients have similar in-hospital outcomes, with a low incidence of adverse clinical outcomes, which provides preliminary evidence for its implementation in Chinese patients with a high proportion of BAV.
Recently, several transcatheter devices for aortic valve replacement and mitral valve repair have been used in clinic, and researchers have designed a variety of tricuspid valve (TV) intervention devices. We reviewed the current status of transcatheter TV intervention, and focused on the structures of these devices and the early results of clinical trials. Undoubtedly, transcatheter intervention for TV is promising, innovational and safe for patients with severe TV regurgitation.
Objective To systematically evaluate the impact of pulmonary hypertension (PH) on the prognosis of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Methods A computerized search was conducted in CNKI, Wanfang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase, and Web of Science databases from inception to June 2023 for cohort studies on the prognostic impact of PH in severe AS patients undergoing TAVR. Two researchers independently screened the literature, extracted data, and assessed the quality of included studies. Stata 17.0 software was used for meta-analysis. Results A total of 16 cohort studies were included, all with Newcastle-Ottawa Scale scores≥7. Meta-analysis results showed that, compared with AS patients without PH, those with PH had significantly higher 1-year all-cause mortality after TAVR [OR=2.10, 95%CI (1.60, 2.75), P<0.01], 30-day all-cause mortality [OR=2.09, 95%CI (1.54, 2.83), P<0.01], and cardiovascular mortality [OR=1.49, 95%CI (1.18, 1.90), P<0.01]. The differences between the two groups in major bleeding events, stroke, myocardial infarction, pacemaker implantation, and postoperative renal failure were not statistically significant. For outcome indicators with significant heterogeneity, subgroup analyses were performed based on PH measurement methods, diagnostic criteria, and different types of PH. The results showed that most subgroup combined results were consistent with the overall findings and that heterogeneity was significantly reduced. Conclusion PH significantly increases the 30-day all-cause mortality, 1-year all-cause mortality, and cardiovascular mortality in patients with severe AS undergoing TAVR.
