ObjectiveTo assess outcomes of transcatheter aortic valve replacement (TAVR) for pure native aortic valve regurgitation.MethodsA total of 129 patients underwent transfemoral TAVR in Fuwai Hospital from May 2019 to October 2020 were retrospectively analyzed. There were 83 males and 46 females with an average age of 72.26±8.97 years. The patients were divided into a pure native aortic valve regurgitation group (17 patients) and an aortic valve stenosis group (112 patients).ResultsThe incidence of valve in valve was higher in the pure native aortic valve regurgitation group (47.0% vs. 16.1%, P<0.01). There was no statistical difference between the two groups in conversion to surgery, intraoperative use of extracorporeal circulation, intraoperative left ventricular rupture, postoperative use of extracorporeal membrane oxygenation (ECMO), peripheral vascular complications, disabled stroke, death, or pacemaker implantation. There was no statistical difference in the diameter of annulus (25.75±2.21 mm vs. 24.70±2.90 mm, P=0.068) or diameter of outflow tract (25.82±3.75 mm vs. 25.37±3.92 mm, P=0.514) between the pure native aortic valve regurgitation group and the aortic valve stenosis group.ConclusionTransfemoral TAVR is a feasible method for patients with pure native aortic valve regurgitation. The diameter of annulus plane, the diameter of outflow tract and the shape of outflow tract should be evaluated.
Objective To investigate the left ventricular reverse remodeling (LVRR) in patients with aortic valve insufficiency with reduced ejection fraction (AIrEF) and aortic valve insufficiency with preserved ejection fraction (AIpEF) after transcatheter aortic valve replacement (TAVR). MethodsThe clinical and follow-up data of patients who underwent TAVR in the Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2018 to 2021 were retrospectively analyzed. According to the guideline, the patients with left ventricular ejection fraction<55% were allocated to an AIrEF group, and the patients with left ventricular ejection fraction≥55% were allocated to an AIpEF group. ResultsA total of 50 patients were enrolled. There were 19 patients in the AIrEF group, including 15 males and 4 females with a mean age of 74.5±7.1 years. There were 31 patients in the AIpEF group, including 19 males and 12 females with a mean age of 72.0±4.8 years. All patients underwent TAVR successfully. Echocardiographic results showed that TAVR significantly promoted LVRR in the patients. Significant LVRR occurred in the early postoperative period (the first day after the surgery) in both groups. It remained relatively stable after the LVRR in the early postoperative period (the first day after surgery) in the AIpEF patients, while it continued to occur in the early postoperative period (the first day after surgery) to three months after the surgery in the AIrEF patients, and then remained relatively stable. Compared to preoperative values, AIrEF patients had a reduction in the average left ventricular end-diastolic volume index and left ventricular end-systolic volume index by 16.8 mL/m2 (P=0.003) and 8.6 mL/m2 (P=0.005), respectively, and the average left ventricular end-diastolic diameter index and end-systolic diameter index decreased by 2.5 mm/m2 (P=0.003) and 1.9 mm/m2 (P=0.003), respectively on the first day after the surgery. In comparison to the first day after the surgery, AIrEF patients experienced an average increase of 12.1% in the left ventricular ejection fraction three months after the surgery (P＜0.001). ConclusionTAVR has achieved good therapeutic effects in patients with aortic valve insufficiency, significantly promoting the LVRR in patients, and has better curative effects in AIrEF patients.
The first aortic valve repair was performed in 1958, but the clinical outcome was limited. Since the invention of prosthetic valves, aortic valve replacement has become and still maintained the dominated surgical treatment option. As the impact of the prosthetic valve-related event to quality of life of the patients and the studies of the mechanism of aortic regurgitation and the functional anatomy of aortic root grow, the application of aortic valve repair gets more popular, and the short- and mid-term outcomes are good.
ObjectiveTo summarize the indication and surgical experiences of valve replacement, high-risk factors and long-term results for aortic regurgitation and large left ventricle. MethodsWe retrospectively analyzed the clinical data of 42 patients with aortic regurgitation and left ventricle end-diastolic diameter (LVEDD) ≥70 mm and left ventricle end-systolic diameter (LVESD) ≥ 50 mm in our hospital from March 2004 through December 2012. There were 38 males and 4 females,aged 16-73 (45.86±14.99) years. The patients underwent aortic valve replacement, who were evaluated by echocardiography at pre-operation, pre-discharge and early follow-up. The follow up period was 12-132 months. ResultsEarly death occurred in one patient. And five patients died during the follow-up. One week after surgery in 41 patients, LVEDD (62.00±13.21 mm), LVESD (50.71±14.02 mm), indexed LVEDD (35.23±8.58 mm/m2), indexed LVESD (28.92±9.08 mm/m2), LVEF (46.41%±12.49%), were significantly smaller than those before the operation (P<0.01). Heart function grades, preoperative EF, LVEDD and indexed LVEDD were the predictors for left ventricular function recovery. One-year, 5-year, 10-year survival rate was 92.9%, 90.2%, 83.8%, respectively. ConclusionMost of patients with aortic regurgitation and large left ventricle still have indications for surgical treatment, but severe left ventricular dysfunction and ventricular arrhythmia are high risk factors for long-term survival.
ObjectiveTo summarize the characteristics of bicuspid aortic valve (BAV) aortopathy and analyze the association between aortopathy and BAV phenotype and patterns of valvular dysfunction.MethodsClinical data of 191 patients who underwent the first aortic valve replacement in Fuwai Hospital from June 2017 to March 2018 were retrospectively analyzed, including 143 males and 48 females with an average age of 53.91±12.52 years. All patients underwent multidetector computed tomography (MDCT) and echocardiography before the operation, excluding patients with aortic coarctation. The BAV aortopathy phenotype was classified during operation. The characteristics of BAV aortopathy were analyzed by cluster and artificial analysis. BAV anatomic phenotype was divided into two types according to the direction of valve opening: BAV-AP and BAV-LR.ResultsFour distinct BAV aortopathy phenotypes were identified: a common type (n=70, 36.6%), with no dilation or mild dilation of aorta; a root type (n=24, 12.6%), with predominant dilatation of aortic sinus; an ascending aorta type (n=72, 37.7%), with predominant dilatation of ascending aorta; an arch type (n=25, 13.1%), with predominant dilatation of aortic arch dilatation. The root type was mainly in young patients, while the arch type was mainly in elderly patients (P<0.05). BAV-AP and aortic insufficiency were most prevalent in root type, while BAV-LR and aortic stenosis were most prevalent in arch type (P<0.05). There were 111 (58.1%) patients undergoing aortic surgery, and the coincidence rate of BAV aortopathy phenotype and aortic surgery was 80.6%.ConclusionAccording to the location of aortic dilation, BAV aortopathy can be divided into four types. There is an association between BAV aortopathy and valvular phenotype and dysfunction.
The patient underwent prostatectomy before two months. After the operation, he suffered from intermittent fever, chest tightness, and suffocation. Combined with the history, symptoms, signs, laboratory examination, echocardiography, imaging examination (CT), and the positive blood culture for Enterococcus faecalis, the admitting diagnosis was aortic stenosis and insufficiency, mitral insufficiency, cardiac function grade Ⅲ (New York Heart Association grade), infective endocarditis, and aneurysm of aortic sinus. After 4-week antimicrobial drug treatment, the patient was in a stable condition with normal body temperature, multiple negative blood cultures, and normal laboratory-related examinations. After careful and sufficient preparation, transcatheter aortic valve replacement operation was performed in the hybrid operating room with 32 mm Venus-A valve. The operation was successful and the patient was discharged on the seventh day after operation. He continued to be treated with antimicrobial drugs for 4 weeks after surgery, and his temperature was normal. He had no chest tightness, asthma, or other symptoms. One, three, and six months after operation, blood tests and erythrocyte sedimentation rate were normal, electrocardiogram showed sinus rhythm, and echocardiography showed a maximum aortic valve pressure difference of 7 mm Hg (1 mm Hg=0.133 kPa), no perivalvular leak and no pericardial effusion.
ObjectiveTo investigate the feasibility and safety of transcatheter aortic valve replacement (TAVR) through apical approach for aortic regurgitation of large annulus.MethodsFrom November 2019 to May 2020, 10 male patients aged 64.50±4.20 years with aortic valve insufficiency (AI) underwent TAVR in the Department of Cardiovascular Surgery, Xijing Hospital. The surgical instruments were 29# J-valveTM modified and the patients underwent TAVR under angiography. The preoperative and postoperative cardiac function, valve regurgitation, complications and left ventricular remodeling were summarized by ultrasound and CT before and after TAVR.ResultsA total of 10 valves were implanted in 10 patients. Among them, 1 patient was transferred to the aortic arch during the operation and was transferred to surgical aortic valve replacement; the other 9 patients were successfully implanted with J-valve, with 6 patients of cardiac function (NYHA) class Ⅱ, 4 patients of grade Ⅲ. And there was a significant difference between preoperation and postoperation in left ventricular ejection fraction (44.70%±8.78% vs. 39.80%±8.48%, P<0.05) or aortic regurgitation (1.75±0.72 mL vs. 16.51±8.71 mL, P<0.05). After 3 months, the patients' cardiac function was good.ConclusionTAVR is safe and effective in the treatment of severe valvular disease with AI using J-valve.