Transcatheter aortic valve replacement (TAVR) for aortic stenosis has been confirmed to be safe and efficient, and its status has gradually increased with the continuous updating of guidelines. But for severe pure aortic valve regurgitation, it has long been considered a relative contraindication to TAVR. However, many elderly, high-risk patients with pure aortic regurgitation have also been treated with TAVR and prognosis was improved through off-label use of transcatheter heart valves due to contraindications to surgery or intolerance. But because of the complexity and challenging anatomic features, high technical requirements, limited device success rate, high rate of complications, and lack of randomized controlled studies to confirm its safety and efficacy, TAVR treatment of pure aortic regurgitation has been evolving in a debate. In recent years, with the application of new-generation valves and an increasing number of studies, some new insights have been gained regarding TAVR for severe aortic regurgitation, and this article will review the progress of research on TAVR for severe pure aortic regurgitation.
Reoperation due to degenerated bioprostheses is an important factor of high-risk thoracic surgeries. In 2020 ACC/AHA guideline, Valve in Valve (ViV) was recommended for high-risk patient instead of surgical mitral valve replacement. This report described a 77-year-old male patient with a failed mitral bioprosthetic valve, evaluated at high risk of surgery, received a transvenous, transseptal transcatheter mitral valve replacement (TMVR). Tracheal intubation was removed at CCU 3 h after surgery without discomfort such as polypnea. The patient was transferred out of the CCU and discharged on the 3rd day. Compared with transapical access, transvenous transseptal access was less invasive, with shorter duration in CCU and hospitalization.
Objective To explore the clinical effects of emergency transcatheter aortic replacement (TAVR) on the treatment of patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis during hospitalization. Methods The study selected 44 patients from 8 heart valve centers from January 2018 to January 2021. All patients received emergency TAVR treatment. The patients’ baseline clinical data, cardiac ultrasound indicators, and postoperative hospital stay were collected. Paired t-test and McNemar test were used to compare and analyze the preoperative and postoperative cardiac ultrasound indexes, moderate to severe aortic stenosis, and cardiac function. Results The average age of the patients was (72.0±7.9) years. Valve displacement occurred in one patient during the operation, and the surgical success rate was 97.7%. Four cases died during hospitalization, and the mortality rate was 9.1%. The median length of hospital stay was 11.5 d. The postoperative aortic valve area was significantly higher than that before surgery [(0.5±0.2) vs. (3.8±1.6) mm2, P<0.05], the mean transvalvular pressure of the aortic valve was significantly lower than that before operation [(64.0±24.9) vs. (11.3±4.6) mm Hg (1 mm Hg=0.133 kPa), P<0.05], the peak aortic flow velocity was significantly lower than that before operation [(4.5±0.7) vs. (1.9±0.7) m/s, P<0.05], the left ventricular end diastolic inner diameter was lower than that before operation [(59.0±7.2) vs. (56.1±7.3) mm, P<0.05], the left ventricular ejection fraction increased significantly compared with that before operation [(30.1±10.4)% vs. (40.9±11.0)%, P<0.05], and the cardiac function improved significantly compared with that before operation (P<0.05). During the operation, 2 cases (4.5%) underwent valve-in-valve implantation, 11 cases (25.0%) underwent percutaneous coronary intervention during the same period. During the postoperative hospital stay, 1 case (2.3%) developed stroke, 3 cases (6.8%) experienced severe bleeding, 5 cases (11.4%) had severe vascular complications, 2 cases (4.5%) experienced acute myocardial infarction, 30 cases (68.2%) had small or trace paravalvular regurgitation, 3 cases (6.8%) received permanent pacemaker implantation, and 5 cases (11.4%) developed acute kidney injury. Conclustion Emergency TAVR is an effective and feasible treatment plan for patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis.
Mitral regurgitation is one of the most common heart valve diseases. Transcatheter edge-to-edge repair (TEER) is currently the most developed and commonly used interventional technique for mitral regurgitation and is recommended by the latest European and American guidelines for patients who are at high surgical risk. TEER device usually consists of a clamping device and a delivery system. The trajectory of the clamping device is called the trajectory, and the trajectory can be well established with the five dimensions movement of the delivery system: left-right oscillation, anterior-posterior oscillation, overall parallel movement, the clamping device's own clockwise rotation, and vertical up-and-down movement. The delivery system's anteroposterior and lateral oscillations are concentrated on the virtual puncture site. Furthermore, the location of the septal puncture site has a significant impact on the establishemnt of the trajectory. The evulation of three variables and adherence to the "4M principles" are necessary for the successful TEER. The three variables are: the position of the clip in the center of the regurgitation,the arm orientation of the clip perpendicular to the boundary of anterior and posterior leaflets, as well as the appropriate length of clamping. The "4M principles" include favorable valve morphology, residual mitral regurgitation below grade 2+, mean transvalvular pressure≤5 mm Hg, and an appropriate amount of leaflets clamping. Patients' baseline situation, the degree of mitral regurgitation and ventricular remodeling, as well as the valve morphology and the outcome of the procedure, are the factors determining the prognosis of patients after TEER.
Objective To analyze the safety and effectiveness of ultrasound-guided thoracoscopic atrial septal defect (ASD) closure. Methods We prospectively collected the clinical data of 12 patients with ASD treated by ultrasound-guided thoracoscopic ASD closure in Fuwai Hospital from January to September 2017. The characteristics of the patients' ASD and operation, operation safety and effectiveness, postoperative complications and follow-up results were analyzed. Results Among the 12 patients, 10 were successfully treated with ultrasound-guided thoracoscopic ASD closure. Two patients switched to ASD repair under thoracoscopy-assisted cardiopulmonary bypass. The size of the ASD was 17-40 (27.22±8.97) mm and the size of the occluder was 36 (30-42) mm. The average postoperative length of hospital stay was 6 days. There were no complications such as arrhythmia, bleeding and pericardial effusion after operation. The average follow-up was 6 (3-10) months after the operation. During the follow-up, no Ⅲ-degree conduction block, occluder dislocation, residual shunt or cardiac pericardial effusion was found. Conclusion Ultrasound-guided thoracoscopic ASD closure is a minimally invasive, safe and effective treatment. This technique provides a new minimally invasive surgical option for patients with large defect diameter and poor edge condition.
With the prevalence of atrial fibrillation and the increasing use of intracardiac pacemakers, the incidence of isolated tricuspid regurgitation is gradually increasing. Severe isolated tricuspid regurgitation has a seriously negative effect on the survival rate and life quality of patients. As the major invasive therapy, surgery is not routinely carried out due to high perioperative mortality. This article attempts to summarize the etiology, natural course and adverse consequences of isolated tricuspid regurgitation, current treatment strategies, surgical indications and techniques, efficacy evaluation, prognostic factors and transcatheter treatment progress of isolated tricuspid regurgitation, aiming to provide references for cardiologists and further researches.
ObjectiveTo compare the clinical outcomes of transcatheter aortic valve implantation (TAVI) in oncology and non-oncology patients with severe aortic stenosis (AS).MethodsA computer-based search in PubMed, The Cochrane Library, EMbase, CBM, CNKI and Wanfang databases from their date of inception to December 2021 was performed, together with reference screening, to identify eligible clinical trials. Two investigators screened the articles, extracted data, and evaluated quality independently. RevMan 5.3 and Stata 12.0 softwares were used for meta-analysis.ResultsThe selected 8 cohort studies contained 57 988 patients, including 12 335 cancer patients and 45 653 non-cancer patients. The results of meta-analysis showed that in patients with cancer, the 30-day mortality [OR=0.74, 95%CI (0.65, 0.84), I2=0%, P<0.000 01], stroke [OR=0.87, 95%CI (0.76, 0.99), I2=0%, P=0.04] and acute kidney injury [OR=0.81, 95%CI (0.76, 0.85), I2=49%, P<0.000 01] were lower than those in patients without cancer. The 1-year mortality [OR=1.46, 95%CI (1.15, 1.86), I2=62%, P=0.002] and late mortality [OR=1.51, 95%CI (1.24, 1.85), I2=61%, P<0.000 1] were higher in patients with cancer.ConclusionIt is effective and safe in cancer patients with severe AS undergoing TAVI. However, compared with patients without cancer, it is still high in long-term mortality, and further study of the role of TAVI in cancer patients with AS is necessary.
Objective To discuss the key points of anesthesia for patients undergoing transcatheter aortic valve implantation (TAVI) surgery. Methods We retrospectively collected and analyzed the data of 70 patients who underwent TAVI in the Department of Cardiovascular Surgery, West China Hospital from March 2014 to October 2015. There were 39 males and 31 females with an average age of 73.7±4.5 years. The perioperative preparation and anesthesia points of TAVI were summarized. Results All of the 70 included patients were aged and at high risk severe comorbidities such as ischemic heart disease and stroke. The aortic stenosis and regurgitation occurred in 39 and 31 patients respectively. No patients died during the surgery. The total success rate was 95.7%. Conclusion TAVI is a complex procedure for high risk patients and need more attention during anesthesia. The successful conduction of the procedure requires the whole team to prepare carefully and cooperate closely.
ObjectiveTo evaluate the clinical outcomes of sutureless aortic valve replacement (SU-AVR) and transcatheter aortic valve implantation (TAVI) for aortic valve disease. MethodsWe conducted a computer-based search of databases including CNKI, WanFang Data, VIP, CBM, PubMed, The Cochrane Library, EMbase and Web of Science from the inception of the databases to March 2024. Two reviewers independently screened articles, extracted data and used the Cochrane bias risk assessment tool to evaluate the quality of the included studies. Meta-analysis was performed using Stata 18 software. ResultsThe included 17 studies using propensity-matched analysis consisted of 6 630 patients, including 3 319 patients in the SU-AVR group and 3 311 patients in the TAVI group. The SU-AVR group had lower mortality than the TAVI group at 1-year ［RR=0.58, 95%CI(0.38, 0.87), P=0.009］, 2-year ［RR=0.61, 95%CI(0.43,0.85), P=0.004］ and 5-year ［RR=0.63, 95%CI(0.50,0.79), P=0.000］. The SU-AVR group had a significantly lower rate of new permanent pacemaker implantation (PPI) ［RR=0.75, 95%CI(0.58, 0.98), P=0.037］, moderate-to-severe paravalvular leak (PVL) ［RR=0.20, 95%CI（0.12, 0.32）, P=0.000］, myocardial infarction(MI)［RR=0.30, 95%CI (0.11,0.80), P=0.017］, more-than-mild residual aortic regurgitation (AR)［RR=0.29, 95%CI（0.17, 0.48）, P=0.000］. In addition, the SU-AVR group had a higher postoperative mean aortic gradient [SMD=0.39, 95%CI (0.17, 0.62), P=0.000］than the TAVI group. Conclusion The early and mid-term clinical outcomes of SU-AVR were superior compared to TAVI.
ObjectiveTo summarize the research progress of four mainstream drug-eluting beads (DEB) in transcathete arterial chemoembolization (TACE) for hepatocellular carcinoma in recent years.MethodThrough retrieving relevant literatures at home and abroad, the physicochemical properties, pharmacokinetics, effectiveness, and safety of four mainstream DEBs were reviewed.ResultsThe current mainstream DEBs on the market had the characteristics of high drug loading rate and sustained release of drugs, which could reduce the adverse reactions after the embolization to a certain extent. The safety and tolerance of patients receiving DEB-TACE were slightly higher than those receiving traditional TACE (c-TACE). There were no serious complications after the DEB-TACE, but the short-term and long-term efficacies between the two methods were not significantly different.ConclusionsAt present, most studies believe that the safety and tolerance of DEB are slightly higher than that of c-TACE, but whether the former is more effective than the latter is still controversial at home and abroad, and more high-quality multicenter randomized controlled trials are needed to confirm it.