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.
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 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.
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.
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.
The technique of transcatheter aortic valve implantation has become increasingly mature. Although the transapical approach has a certain degree of minimally invasive trauma, it still has the characteristics such as heart beating without cardiopulmonary bypass, and the low technical requirements of catheter guide wire. In particular, the valve path is short and coaxial, which is easy to manipulate, and pure regurgitation and stenosis can be easily operated and are not subject to the limit of peripheral artery stenosis. It is still one of China's main approaches for transcatheter aortic valve replacement. Its perioperative management still has specific features and differs from the femoral artery approach. In addition, there is little relevant literature abroad. Therefore, domestic experts in this field were organized to discuss the development of perioperative management specifications to provide reference and techniques support for developing this field in China and further improve the quality of clinical operation and perioperative management. It will provide more safe and more effective medical services to these patients.
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.
Objective To investigate the feasibility and early efficacy of transapical transcatheter aortic valve replacement (TAVR) combined with transcatheter mitral valve edge-to-edge repair (TEER) in patients with high-risk aortic valve lesions combined with severe mitral regurgitation. Methods The clinical data of patients who underwent "one-stop" transapical TAVR+TEER in our hospital from August 2022 to October 2023 were retrospectively analyzed. Results Five patients were collected, including 3 males and 2 females with a mean age of 66.6±1.8 years. Four patients had aortic valve insufficiency combined with mitral regurgitation and one had aortic valve stenosis and insufficiency combined with mitral regurgitation. All patients successfully completed transapical TAVR+TEER, and the immediate postoperative echocardiographic results revealed that none of them had more than mild perivalvular leakage and mitral regurgitation, and the prosthetic valves were in good position and function. At 1 week postoperatively, echocardiographic results showed 5 patients with no displacement of the prosthetic valve, detachment of the mitral clip, or damage to the leaflets. At 1 month postoperatively, cardiac function was improved to varying degrees in 4 patients, and 1 patient died of multiorgan failure. At 2 months postoperatively, 1 patient died of cerebrovascular accident, and at 3 months postoperatively the echocardiographic results of the remaining 3 patients revealed that there was no more than mild perivalvular leakage or mitral regurgitation, and the patients' postoperative cardiac function and daily life ability were significantly improved. Conclusion In high-risk aortic valve lesions combined with severe mitral regurgitation, "one-stop" transapical TAVR+TEER is feasible with favorable early efficacy and safety.
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.
ObjectiveTo assess the early outcome of transapical transcatheter aortic valve replacement (TAVR) for patients with aortic insufficiency. MethodsThe patients with aortic valvular disease who underwent transapical TAVR from October 2020 to October 2022 in the Department of Cardiac and Vascular Surgery, the First Affiliated Hospital of Anhui Medical University were enrolled in the current retrospective study. The patients with aortic stenosis were assembled in a group A, and the patients with aortic insufficiency were assembled in a group B. The improvements of heart function and complications were assessed for the two groups. ResultsA total of 56 patients were enrolled, including 32 males and 24 females with an average age of 73.34±5.10 years. There were 31 patients in the group A and 25 patients in the group B. There was no statistical difference between the two groups in the age, gender, height, weight, hypertension, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, renal disorder or classification of heart function (P>0.05). Also, there was still no statistical difference in the rate of permanent peacemaker implants, emergent open surgery, valve re-implants, or perivalvular leakage (P>0.05). After TAVR, the left ventricular diastolic diameter, left ventricular ejection fraction, complicated moderated mitral and tricuspid regurgitation were significantly improved in both groups compared with preoperative findings (P<0.05); however, there was no statistical difference in these parameters between groups (P>0.05). ConclusionInterventional valve (J-Valve) in the treatment of patients with aortic insufficiency through transapical TAVR significantly improves cardiac function and reduces functional valve regurgitation.