Objective To evaluate the safety and efficacy of transcatheter aortic valve replacement (TAVR) using the SAPIEN 3 system. MethodsThis was a prospective, multicenter, single arm study in 4 centers in China. The clinical data of 50 patients with high-risk symptomatic severe aortic stenosis who underwent TAVR using the SAPIEN 3 system from June 2017 to June 2019 were analyzed, including 27 males and 23 females aged 76.8±6.1 years. ResultsThe Society of Thoracic Surgeon score was 6.0%±2.8%. Totally, 20.0% of patients had severe bicuspid aortic stenosis. The operation time was 41.8±16.5 min and the hospital stay time was 8.5±5.0 d. At the postoperative 30-day follow-up, no all-cause mortality occurred and the device success rate was 89.5%. Major vascular complications occurred in one (2.0%) patient, stroke in one (2.0%) patient, new pacemaker implantation in one (2.0%) patient, as well as coronary artery obstruction in one (2.0%) patient. There was no moderate or moderate/severe paravalvular leak. The aortic pressure gradient was decreased from 49.2±16.2 mm Hg before the operation to 12.4±4.6 mm Hg at the postoperative 30-day follow-up, and the valvular area was increased from 0.6±0.3 cm2 to 1.3±0.3 cm2 (P<0.01). Moreover, the New York Heart Association classification in 83.7% of the patients was improved during the follow-up. ConclusionThis pre-marketing multicenter study has demonstrated the safety and effectiveness of transfemoral TAVR with the SAPIEN 3 transcatheter valve system in Chinese aortic stenosis patients at high risk for surgery.
This paper discusses a female patient with severe aortic stenosis, who was preoperatively assessed to be at high risk of left coronary artery occlusion, but developed complete occlusion of the right coronary artery during the procedure of transcatheter aortic valve replacement, leading to hemodynamic disorder. Surgical treatment under emergency cardiopulmonary bypass played a critical role in rescuing the patient.
“Valve-in-valve” technique is an effective method to treat the bioprosthesis structural valve degeneration. In this paper, an 82-year-old male patient with severe aortic valve regurgitation had underwent surgical aortic valve replacement. He had a bioprosthesis structural valve degeneration which caused severe aortic stenosis more than 3 years after surgery. His symptoms of chest distress and short breath were aggravated progressively, and not relieved by conventional treatment. As the deterioration in his unstabled circulation system, an emergency transcatheter aortic valve replacement was conducted for him. The operation was finally successful, the symptoms were relived significantly after operation, and then the follow-up indicated that he had a good recovery.
This case was a 78-year-old woman characterized exertional dyspnea and diagnosed with severe aortic stenosis. Preoperative evaluation revealed that the patient had a very high surgical risk, so transcatheter aortic valve replacement (TAVR) was proposed. But this patient was at high risk of coronary obstruction. After weighing advantages and disadvantages, the heart team decided to choose TAVR under the protection of guide wire and balloon at last. Left coronary ostia obstruction happened after self-expanding valve released during TAVR. Then, emergency “chimney” stent implantation was performed. Finally, TAVR and coronary revascularization was successfully completed. The patient’s condition was improved after TAVR and being good in follow-up. Based on this case, risk factors of coronary obstruction during TAVR and effectiveness and safety of “chimney” stent technique was discussed.
Transcatheter aortic valve replacement has revolutionized the management of aortic stenosis and become the gold standard for the treatment of symptomatic and severe aortic valve stenosis in elderly patients. With the improvement in design and materials, newer generation transcatheter aortic valve prostheses had overcome the limitations of early-generation devices that were susceptible to paravalvular leak, atrioventricular block and vascular complications, to a certain extent. This review provides an update on the latest advances in transcatheter aortic valve prostheses.
ObjectiveTo evaluate the changes of ascending aortic (AA) diameter after transcatheter aortic valve replacement (TAVR), and evaluate the safety and efficacy of TAVR in patients with AA dilation. MethodsWe retrospectively included 87 patients who underwent TAVR at our center from 2016 to 2019. These patients were divided into 2 groups based on the preoperative AA diameter. There were 17 patients in the AA diameter≥45 mm group (including 10 males, aged 74.4±5.6 years), and 70 patients in the AA diameter<45 mm group (including 39 males, aged 75.9±7.0 years). Results The baseline variables were similar between two groups (P>0.05). The overall device success rate was 97.7% (85/87). The median computed tomography (CT) follow-up time was 24.2±11.8 months in patients with AA diameter≥45 mm and 23.0±10.7 months in patients with AA diameter<45 mm, and the median annual dilation rate of AA were 0.36 mm/year and 0.00 mm/year, respectively. No statistical significance was observed between two groups (P>0.05). No adverse aortic events occurred during the follow-up period. ConclusionTAVR is safe and effective in patients with preoperative AA diameter≥45 mm, and the AA diameter remains stable after the procedure. Patients with preoperative AA diameter≥45 mm and AA diameter<45 mm have similar annual dilation rates.
This paper reports a case of severe stenosis and calcification of functional bicuspid aortic valve treated with transcatheter aortic valve replacement (TAVR). Before the operation, echocardiography and multi-detector computed tomography were used to evaluate the ascending aorta, coronary artery, iliac artery anatomy, valve morphology, and valve calcification. During the operation, femoral artery perforation occurred after suturing the puncture site. The treatment of compression and hemostasis with peripheral balloon was performed. After the operation, neuropsychiatric symptoms appeared. The result of brain MRI indicated multiple acute cerebral infarction. Anticoagulant, antiplatelet, and neurotrophic drugs were used. After 1-year follow-up, echocardiography showed a little reflux signal around the artificial aortic valve, and the patient’s nervous system examination showed no obvious abnormality. TAVR indications will continue to expand in the near future with the innovation of evaluation, devices, and technology. The summary of operation data can promote progress of TAVR and reduce the occurrence of complications.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis with surgical taboos or high risk. With the update of the guidelines, the indication of TAVR has been extended to the intermediate-risk aortic stenosis population, and even has a tendency to further expand to the low-risk population. This review highlights the research progress and new evidence of TAVR in respects of patient selection, valve and approach selection, ethnic differences, and surgical complications such as perivalvular leakage, cardiac conduction block, vascular complications, stroke, acute kidney injury, and coronary artery occlusion.
Patients with severe aortic stenosis will gradually develop symptoms of heart failure. Aortic valve replacement is an effective treatment at present, while transcatheter aortic valve replacement is suitable for high-risk elderly patients. This article reports a patient with severe aortic valve stenosis and severe scoliosis who underwent transcatheter aortic valve replacement. Detailed preoperative evaluation and avoidance of peripheral vascular injury were the characteristics of this case. The patient was an elderly male with severe scoliosis. After fully evaluating the risks and benefits of surgery, a surgical strategy was formulated. The patient was in the supine position to complete the preoperative CT, and then the long sheath was used to pass through the thoracoabdominal aortic angle during the operation. After angiography-assisted adjustment and determination of the optimal release angle, the valve was accurately released, and the operation went smoothly without serious peripheral vascular damage.
The implantation of bioprosthetic heart valves have increased dramatically due to the aging population and the widespread application of transcatheter aortic valve replacement (TAVR). TAVR is increasingly being used in younger, lower-risk patients with a longer life expectancy, so it is important to overcome structural valve degeneration and ensure long-term TAVR durability. Although the mid-term durability results of the TAVR valve are encouraging, its long-term durability needs to be further explored. This article will mainly introduce the influencing factors of TAVR valve durability, evaluation criteria for structural valve degeneration, clinical research results related to TAVR valve durability, and problems to be solved.