Lifelong management of patients with aortic regurgitation_West China Medical Journal

Authors：

DONG Chen , ZHU Jianbing , ZHENG Yaofu , DONG Wei , HUA Jinghai ,  PENG Xiaoping

Department of Cardiology, the First Affiliated Hospital of Nanchang Universit, Jiangxi Institute of Hypertension, Nanchang, Jiangxi 330006, P. R. China;

Corresponding author：

PENG Xiaoping, Email: cdyfypxp@163.com

Keywords：

Aortic regurgitation; transcatheter aortic valve replacement; lifelong management

DOI：

10.7507/1002-0179.202308130

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Aortic regurgitation (AR) is a common heart valve disease, and aortic valve replacement is an important treatment at present. With the advent of new methods such as transcatheter aortic valve replacement, patients with high-risk AR have been effectively treated. In particular, the emergence of new generations of transcatheter prosthetic valve systems has made the treatment of patients with AR more and more abundant. To treat patients with AR, it is necessary to establish the concept of “once diagnosed, lifelong management”, delay the progression of the disease through various means, and ultimately reduce the mortality of patients with AR and improve the quality of life. Therefore, this article reviews the basic characteristics of AR patients in China, the development and challenges faced by transcatheter aortic valve replacement surgery, follow-up, and postoperative rehabilitation plans, aiming to help physicians use different methods in a reasonable and standardized manner when facing AR patients with different causes and disease progression, and achieve the goal of achieving correct and effective lifelong management of AR patients.

Citation： DONG Chen, ZHU Jianbing, ZHENG Yaofu, DONG Wei, HUA Jinghai, PENG Xiaoping. Lifelong management of patients with aortic regurgitation. West China Medical Journal, 2023, 38(9): 1391-1395. doi: 10.7507/1002-0179.202308130 Copy

1.	Corrigan DJ. On permanent patency of the mouth of the aorta, or inadequacy of the aortic valves. Edinb Med Surg J, 1832, 37(111): 225-245.
2.	Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J, 2003, 24(13): 1231-1243.
3.	Akinseye OA, Pathak A, Ibebuogu UN. Aortic valve regurgitation: a comprehensive review. Curr Probl Cardiol, 2018, 43(8): 315-334.
4.	Maurer G. Aortic regurgitation. Heart, 2006, 92(7): 994-1000.
5.	Pan W, Zhou D, Cheng L, et al. Aortic regurgitation is more prevalent than aortic stenosis in Chinese elderly population: implications for transcatheter aortic valve replacement. Int J Cardiol, 2015, 201: 547-548.
6.	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
7.	Rahhab Z, El Faquir N, Tchetche D, et al. Expanding the indications for transcatheter aortic valve implantation. Nat Rev Cardiol, 2020, 17(2): 75-84.
8.	Holmes DR Jr, Mack MJ, Kaul S, et al. 2012 ACCF/ AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol, 2012, 59(13): 1200-1254.
9.	中国医师协会心血管内科医师分会结构性心脏病专业委员会. 中国经导管主动脉瓣置换术临床路径专家共识 (2021 版). 中国介入心脏病学杂志, 2022, 30(1): 7-16.
10.	Costanzo P, Bamborough P, Peterson M, et al. Transcatheter aortic valve implantation for severe pure aortic regurgitation with dedicated devices. Interv Cardiol, 2022, 17: e11.
11.	Flint N, Wunderlich NC, Shmueli H, et al. Aortic Regurgitation. Curr Cardiol Rep, 2019, 21(7): 65.
12.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
13.	Hamirani YS, Dietl CA, Voyles W, et al. Acute aortic regurgitation. Circulation, 2012, 126(9): 1121-1126.
14.	Eikelboom JW, Connolly SJ, Brueckmann M, et al. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med, 2013, 369(13): 1206-1214.
15.	de Meester C, Pasquet A, Gerber BL, et al. Valve repair improves the outcome of surgery for chronic severe aortic regurgitation: a propensity score analysis. J Thorac Cardiovasc Surg, 2014, 148(5): 1913-1920.
16.	Hammermeister K, Sethi GK, Henderson WG, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the veterans affairs randomized trial. J Am Coll Cardiol, 2000, 36(4): 1152-1158.
17.	El Khoury G, de Kerchove L. Principles of aortic valve repair. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S26-S29.
18.	Aicher D, Fries R, Rodionycheva S, et al. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg, 2010, 37(1): 127-132.
19.	王建安. 经导管主动脉瓣置换术适应证的变迁. 华西医学, 2018, 33(2): 140-144.
20.	Ducrocq G, Himbert D, Hvass U, et al. Compassionate aortic valve implantation for severe aortic regurgitation. J Thorac Cardiovasc Surg, 2010, 140(4): 930-932.
21.	Krumsdorf U, Haass M, Pirot M, et al. Technical challenge of transfemoral aortic valve implantation in a patient with severe aortic regurgitation. Circ Cardiovasc Interv, 2011, 4(2): 210-211.
22.	Diemert P, Lange P, Greif M, et al. Edwards Sapien XT valve placement as treatment option for aortic regurgitation after transfemoral CoreValve implantation: a multicenter experience. Clin Res Cardiol, 2014, 103(3): 183-190.
23.	Hira RS, Vemulapalli S, Li Z, et al. Trends and outcomes of off-label use of transcatheter aortic valve replacement: insights from the NCDR STS/ACC TVT registry. JAMA Cardiol, 2017, 2(8): 846-854.
24.	Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
25.	De Backer O, Pilgrim T, Simonato M, et al. Usefulness of transcatheter aortic valve implantation for treatment of pure native aortic valve regurgitation. Am J Cardiol, 2018, 122(6): 1028-1035.
26.	Wernly B, Eder S, Navarese EP, et al. Transcatheter aortic valve replacement for pure aortic valve regurgitation: “on-label” versus “off-label” use of TAVR devices. Clin Res Cardiol, 2019, 108(8): 921-930.
27.	罗一纯, 刘路路, 石峻, 等. 应用 J-Valve 瓣膜经导管主动脉瓣置换术治疗高危单纯主动脉瓣反流多中心研究早期临床结果. 中国胸心血管外科临床杂志, 2019, 26(8): 737-743.
28.	Jørgensen TH, Thyregod HGH, Ihlemann N, et al. Eight-year outcomes for patients with aortic valve stenosis at low surgical risk randomized to transcatheter vs. surgical aortic valve replacement. Eur Heart J, 2021, 42(30): 2912-2919.
29.	Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
30.	Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
31.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
32.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
33.	Galusko V, Thornton G, Jozsa C, et al. Aortic regurgitation management: a systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes, 2022, 8(2): 113-126.
34.	Detaint D, Messika-Zeitoun D, Maalouf J, et al. Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study. JACC: Cardiovasc Imaging, 2008, 1(1): 1-11.
35.	Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
36.	Hansen D. Exercise intervention after transcatheter aortic valve implantation: current evidence and issues to be resolved. Eur J Prev Cardiol, 2018, 25(8): 791-793.
37.	Völler H, Salzwedel A, Nitardy A, et al. Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve implantation. Eur J Prev Cardiol, 2015, 22(5): 568-574.
38.	Ambrosetti M, Abreu A, Corrà U, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the secondary prevention and rehabilitation section of the European association of preventive cardiology. Eur J Prev Cardiol, 2021, 28(5): 460-495.
39.	Xu L, Wei J, Liu J, et al. Inspiratory muscle training improves cardiopulmonary function in patients after transcatheter aortic valve replacement: a randomized clinical trial. Eur J Prev Cardiol, 2023, 30(2): 191-202.
40.	Stachon P, Kaier K, Heidt T, et al. Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008-2015. Catheter Cardiovasc Interv, 2020, 95(4): 810-816.

1. Corrigan DJ. On permanent patency of the mouth of the aorta, or inadequacy of the aortic valves. Edinb Med Surg J, 1832, 37(111): 225-245.
2. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J, 2003, 24(13): 1231-1243.
3. Akinseye OA, Pathak A, Ibebuogu UN. Aortic valve regurgitation: a comprehensive review. Curr Probl Cardiol, 2018, 43(8): 315-334.
4. Maurer G. Aortic regurgitation. Heart, 2006, 92(7): 994-1000.
5. Pan W, Zhou D, Cheng L, et al. Aortic regurgitation is more prevalent than aortic stenosis in Chinese elderly population: implications for transcatheter aortic valve replacement. Int J Cardiol, 2015, 201: 547-548.
6. Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
7. Rahhab Z, El Faquir N, Tchetche D, et al. Expanding the indications for transcatheter aortic valve implantation. Nat Rev Cardiol, 2020, 17(2): 75-84.
8. Holmes DR Jr, Mack MJ, Kaul S, et al. 2012 ACCF/ AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol, 2012, 59(13): 1200-1254.
9. 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 中国经导管主动脉瓣置换术临床路径专家共识 (2021 版). 中国介入心脏病学杂志, 2022, 30(1): 7-16.
10. Costanzo P, Bamborough P, Peterson M, et al. Transcatheter aortic valve implantation for severe pure aortic regurgitation with dedicated devices. Interv Cardiol, 2022, 17: e11.
11. Flint N, Wunderlich NC, Shmueli H, et al. Aortic Regurgitation. Curr Cardiol Rep, 2019, 21(7): 65.
12. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
13. Hamirani YS, Dietl CA, Voyles W, et al. Acute aortic regurgitation. Circulation, 2012, 126(9): 1121-1126.
14. Eikelboom JW, Connolly SJ, Brueckmann M, et al. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med, 2013, 369(13): 1206-1214.
15. de Meester C, Pasquet A, Gerber BL, et al. Valve repair improves the outcome of surgery for chronic severe aortic regurgitation: a propensity score analysis. J Thorac Cardiovasc Surg, 2014, 148(5): 1913-1920.
16. Hammermeister K, Sethi GK, Henderson WG, et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the veterans affairs randomized trial. J Am Coll Cardiol, 2000, 36(4): 1152-1158.
17. El Khoury G, de Kerchove L. Principles of aortic valve repair. J Thorac Cardiovasc Surg, 2013, 145(3 Suppl): S26-S29.
18. Aicher D, Fries R, Rodionycheva S, et al. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg, 2010, 37(1): 127-132.
19. 王建安. 经导管主动脉瓣置换术适应证的变迁. 华西医学, 2018, 33(2): 140-144.
20. Ducrocq G, Himbert D, Hvass U, et al. Compassionate aortic valve implantation for severe aortic regurgitation. J Thorac Cardiovasc Surg, 2010, 140(4): 930-932.
21. Krumsdorf U, Haass M, Pirot M, et al. Technical challenge of transfemoral aortic valve implantation in a patient with severe aortic regurgitation. Circ Cardiovasc Interv, 2011, 4(2): 210-211.
22. Diemert P, Lange P, Greif M, et al. Edwards Sapien XT valve placement as treatment option for aortic regurgitation after transfemoral CoreValve implantation: a multicenter experience. Clin Res Cardiol, 2014, 103(3): 183-190.
23. Hira RS, Vemulapalli S, Li Z, et al. Trends and outcomes of off-label use of transcatheter aortic valve replacement: insights from the NCDR STS/ACC TVT registry. JAMA Cardiol, 2017, 2(8): 846-854.
24. Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
25. De Backer O, Pilgrim T, Simonato M, et al. Usefulness of transcatheter aortic valve implantation for treatment of pure native aortic valve regurgitation. Am J Cardiol, 2018, 122(6): 1028-1035.
26. Wernly B, Eder S, Navarese EP, et al. Transcatheter aortic valve replacement for pure aortic valve regurgitation: “on-label” versus “off-label” use of TAVR devices. Clin Res Cardiol, 2019, 108(8): 921-930.
27. 罗一纯, 刘路路, 石峻, 等. 应用 J-Valve 瓣膜经导管主动脉瓣置换术治疗高危单纯主动脉瓣反流多中心研究早期临床结果. 中国胸心血管外科临床杂志, 2019, 26(8): 737-743.
28. Jørgensen TH, Thyregod HGH, Ihlemann N, et al. Eight-year outcomes for patients with aortic valve stenosis at low surgical risk randomized to transcatheter vs. surgical aortic valve replacement. Eur Heart J, 2021, 42(30): 2912-2919.
29. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med, 2019, 380(18): 1695-1705.
30. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
31. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
32. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
33. Galusko V, Thornton G, Jozsa C, et al. Aortic regurgitation management: a systematic review of clinical practice guidelines and recommendations. Eur Heart J Qual Care Clin Outcomes, 2022, 8(2): 113-126.
34. Detaint D, Messika-Zeitoun D, Maalouf J, et al. Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study. JACC: Cardiovasc Imaging, 2008, 1(1): 1-11.
35. Zoghbi WA, Adams D, Bonow RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr, 2017, 30(4): 303-371.
36. Hansen D. Exercise intervention after transcatheter aortic valve implantation: current evidence and issues to be resolved. Eur J Prev Cardiol, 2018, 25(8): 791-793.
37. Völler H, Salzwedel A, Nitardy A, et al. Effect of cardiac rehabilitation on functional and emotional status in patients after transcatheter aortic-valve implantation. Eur J Prev Cardiol, 2015, 22(5): 568-574.
38. Ambrosetti M, Abreu A, Corrà U, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the secondary prevention and rehabilitation section of the European association of preventive cardiology. Eur J Prev Cardiol, 2021, 28(5): 460-495.
39. Xu L, Wei J, Liu J, et al. Inspiratory muscle training improves cardiopulmonary function in patients after transcatheter aortic valve replacement: a randomized clinical trial. Eur J Prev Cardiol, 2023, 30(2): 191-202.
40. Stachon P, Kaier K, Heidt T, et al. Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008-2015. Catheter Cardiovasc Interv, 2020, 95(4): 810-816.

West China Medical Journal

Lifelong management of patients with aortic regurgitation

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content