Over the past 20 years, transcatheter mitral valve edge-to-edge repair (TEER) has become an important treatment option for patients with severe mitral regurgitation (MR) who are at high surgical risk. Initially, several landmark clinical studies established the basis of TEER for primary and secondary MR, but they only involved clinically stable patients with appropriate mitral valve anatomy. With the increasing experience of interventional therapy, the iteration of equipment and the improvement of intraoperative imaging technology, the scope of use of TEER has been continuously expanded, and its indications have been continuously expanded to more complex mitral valve lesions and clinical situations. Therefore, in clinical practice, selecting the appropriate device according to the individual anatomical characteristics of the patient can minimize MR and complications, thereby optimizing immediate and long-term prognosis. This article mainly introduces the pathogenesis and related mechanisms of MR, the main TEER devices and their clinical evidence, the limitations of TEER, and the future development direction.
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.
Transcatheter aortic valve replacement (TAVR) has become a common theraputic option for aortic stenosis, but the evidence for precise anatomy for TAVR is accumulating. This paper presents the case of an 71-year-old female patient who had an extremely high risk of coronary obstruction due to both coronary ostia lying too low. The patient underwent TAVR with the help of coronary protection successfully. During the procedure, the patient was protected with wires only for both coronaries. After deployment, angiofluoroscopy suggested that chimney stenting should be applied for left coronary. The whole procedure was unenventful and both coronaries were seen.
Objective To explore the feasibility of transcatheter closure of congenital heart disease (CHD) under the guidance of transthoracic echocardiography (TTE). Methods A total of 37 patients with CHD who received transcatheter closure under the guidance of transthoracic echocardiography from November 2013 through November 2015 in our hospital were recruited. There were 15 males and 22 females, aged 1 to 16 years. Among them 32 patients suffered atrial septal defect and 5 patients had patent ductus arteriosus. The transcatheter closure of CHD was performed under the guidance of TTE. The patients underwent echocardiography follow-up at one, three and six months after surgery. Results Closure devices were successfully implanted in 37 patients under TTE guidance. The procedure was simple and safe. During the follow-up, no severe complication such as valvular injury, pericardial effusion, residual shunt and peripheral vascular injury occurred. Conclusion Transcatheter closure of CHD under TTE guidance is a feasible method and worth further clinical application.
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.
This article reports a case of a 70-year-old female patient who developed bioprosthetic mitral valve deterioration 4 months after her initial valve replacement surgery, manifesting as severe regurgitation and New York Heart Association Class Ⅲ. Due to the high risk of a redo open-heart surgery, she underwent a transapical transcatheter mitral valve-in-valve procedure. Intraoperatively, a J-Valve prosthesis was successfully implanted under echocardiographic and fluoroscopic guidance. Immediate transesophageal echocardiography confirmed an optimal valve position, complete resolution of regurgitation, and no significant paravalvular leak or left ventricular outflow tract obstruction. The patient's postoperative course was uneventful. She was extubated 16 hours post-procedure with significant improvement in cardiac function. Follow-up echocardiography showed normal prosthetic valve function.
Transcatheter aortic valve replacement (TAVR) has been confirmed to be safety and efficacy for high-risk elderly aortic stenosis, and the clinical effect of TAVR for medium and low-risk aortic stenosis is not worse than that of surgery. The development of surgical techniques and instruments has made cardiologists attempt to broaden the surgical indications. Many elderly and high-risk patients with pure native aortic regurgitation have been treated “off label” with similar techniques, completing artificial valve replacement, restoring valve function and improving the prognosis. However, due to the high requirements of surgical techniques and surgical complications, there is a lack of randomized controlled studies to confirm its safety and effectiveness. Unlike aortic stenosis, native aortic regurgitation presents unique challenges for transcatheter valves. In this article, the authors review current advances in the treatment of aortic valve regurgitation with TAVR.
It has been 20 years since the first transcatheter aortic valve replacement (TAVR) was performed internationally in 2002, and the development of TAVR technology in China has also been more than 10 years. The reliability of TAVR has been clinically proven, and it has also brought good benefits to patients with aortic stenosis. With the gradual progress of technology, TAVR has a trend to surpass surgical aortic valve replacement and become the mainstream surgery for patients with aortic stenosis. This article will review the relevant issues in the development of TAVR technology in recent years, based on existing research, and provide certain clinical references for the future development of TAVR technology.
Transcatheter aortic valve replacement (TAVR) has become one of the main treatments for severe aortic stenosis. However, percutaneous coronary intervention (PCI) is often required in elderly patients who combine with coronary artery disease. This paper reports a case of one-stop TAVR+PCI operation for a 71-year-old male patient with left main bifurcation lesions and severe aortic stenosis. During the procedure, first of all, the coronary arteries were assessed by angiography, and the pigtail catheter was implanted in the left ventricle after the straight guidewire transvalved successfully; then PCI was performed on the diseased coronary arteries; finally, the stenosis of aortic valve was treated with TAVR. After operation, the hemodynamics of the patient was stable and symptoms were significantly improved, showing a good clinical effect of one-stop operation of TAVR+PCI.
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.