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.
This paper reports a case of severe stenosis and calcification of functional bicuspid aortic valve treated with transcatheter aortic valve replacement (TAVR). Before the operation, echocardiography and multi-detector computed tomography were used to evaluate the ascending aorta, coronary artery, iliac artery anatomy, valve morphology, and valve calcification. During the operation, femoral artery perforation occurred after suturing the puncture site. The treatment of compression and hemostasis with peripheral balloon was performed. After the operation, neuropsychiatric symptoms appeared. The result of brain MRI indicated multiple acute cerebral infarction. Anticoagulant, antiplatelet, and neurotrophic drugs were used. After 1-year follow-up, echocardiography showed a little reflux signal around the artificial aortic valve, and the patient’s nervous system examination showed no obvious abnormality. TAVR indications will continue to expand in the near future with the innovation of evaluation, devices, and technology. The summary of operation data can promote progress of TAVR and reduce the occurrence of complications.
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.
In recent years, heart valve disease has been increasing year by year. Transcatheter aortic valve replacement (TAVR) has become the first-line surgical method for patients with severe aortic stenosis due to the advantages of small surgical trauma and rapid postoperative recovery. In the context of the rapid development of TAVR, the postoperative complications of TAVR seriously affect the surgical success rate and patient prognosis. Therefore, the prevention and nursing of complications after TAVR are particularly important. This article will review the assessment, prevention and care of the complications such as arrhythmia, vascular complications, perivalvular leakage, stroke, and acute renal failure after TAVR in combination with the current situation at home and abroad, in order to enhance the clinical medical workers’ understanding of the complications.
Before transcatheter aortic valve replacement (TAVR), echocardiography is the first choice for preoperative screening of suitable patients, which can be used to observe the morphology of aortic valve, determine the cause of aortic stenosis, and evaluate the severity of aortic stenosis and other cardiac structure and function. During TAVR procedure, echocardiography is mainly used for real-time monitoring of complications and immediate postoperative evaluation. After TAVR, echocardiography can be used to evaluate the shape and function of the prosthesis valve and monitor long-term complications. This article reviews the research progress of echocardiography in TAVR for guiding clinical practice.
This article reports a patient diagnosed with severe aortic stenosis. After admission, the cardiac multidisciplinary team performed transcatheter aortic valve replacement (TAVR) emergently due to its unstable hemodynamics. The procedure was successful, and the initial cardiogram during the operation after TAVR suggested that the stenosis was greatly improved. But gradually the next day bedside echocardiography suggested that the transvalvular pressure difference increased and the prosthetic valve forward blood flow accelerated. Acute valve thrombosis after TAVR was taken into consideration. Warfarin and heparin were administrated for anticoagulation, after which the pressure difference across the valve and the forward blood flow rate of the artificial valve were evenly improved.
A 78-year-old female patient was admitted to West China Hospital of Sichuan University because of “amaurosis and polypnea for 4+ years”. The examination results before admission showed that severe stenosis of aortic valve, bicuspid aortic valve malformation, severe horizontal heart with 61.54° aortic angle. The preoperative evaluation of the patient indicated that the Society of Thoracic Surgeons score was 17.9%, which was high risk for surgery. After discussion by the heart team, the aortic stenosis was finally relieved by transcatheter aortic valve replacement. The operation was successfully completed by using the method of pulling and releasing the device with the same side basket. One month follow-up showed that the patient’s condition was stable and no complications occurred. This case aims to provide a reference for the treatment of horizontal heart with aortic stenosis. In the future, it is hoped that through continuous clinical practice, such patients will be provided with a safer and more efficient treatment plan.
Circulatory collapse is a common complication of transcatheter aortic valve replacement (TAVR), mainly due to new severe aortic regurgitation after balloon pre-dilation. This article reports the case of an 80-year-old female patient with severe aortic stenosis, who had a type 1 bicuspid aortic valve, with calcified aortic valve commissure between the right and left coronary cusps. During the procedure of TAVR, severe aortic regurgitation was caused by pre-dilation with 20 mm and 23 mm balloons. Then circulatory collapse and cardiogenic shock occurred. After the emergency deployment of the Venus A L26 valve, the cardiovascular hemodynamics was immediately improved. This case suggests that oversized balloon dilation should be avoided to prevent circulatory collapse caused by massive aortic regurgitation.
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.
We update the "2021 expert consensus on clinical pathway for transcatheter aortic valve replacement in China" using the Delphi method. By searching for evidence related to the clinical pathways of transcatheter aortic valve replacement (TAVR) in PubMed, CIKI, and Wanfang Database over the past four years, 35 core viewpoints were proposed in four directions: TAVR team composition and clinical evaluation, perioperative imaging assessment, surgical process, and perioperative and postoperative long-term management of patients. The specific updates include: refining the responsibilities and composition of the TAVR team, clarifying the steps and content of clinical evaluation; emphasizing the core position of CT in perioperative imaging assessment, and introducing the application of new technologies such as artificial intelligence, numerical simulation, and 3D printing; optimizing the TAVR surgical process, including anesthesia selection, access establishment, valve selection and release, and others; and proposing management strategies for special types of patients (such as emergency TAVR, simplified TAVR, pure aortic regurgitation, combined coronary heart disease and atrial fibrillation). In addition, the consensus also emphasizes the importance of postoperative follow-up and rehabilitation, and provides detailed antithrombotic and rehabilitation guidance. The update of this consensus will further promote the standardized development of TAVR technology in China and improve clinical treatment effects.