Transapical transcatheter aortic valve replacement for aortic regurgitation in a patient with extremely horizontal aorta_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WEI Peijian ^1,2 ,  LIU Jian ¹ , ZHUANG Weitao ^2,3 , MA Jiexu ^1,2 , CHEN Zhao ¹ , LIU Yanjun ¹ , TAN Tong ^1,2 , WU Hongxiang ¹ , XIE Nianjin ⁴ , CHEN Jimei ¹ ,  GUO Huiming ¹

1. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
2. Shantou University Medical College, Shantou, 515041, Guangdong, P. R. China;
3. Department of Thoracic Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;
4. Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, P. R. China;

Corresponding author：

LIU Jian, Email: jianliu_gdpph@sina.com; GUO Huiming, Email: guohuiming@gdph.org.cn

Keywords：

Transapical; transcatheter aortic valve replacement; horizontal aorta

DOI：

10.7507/1007-4848.202105009

Video：

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An 81-year-old male patient was admitted to Guangdong Provincial People's Hospital due to chest distress and shortness of breath after activity for half a year. Examination after admission revealed severe aortic insufficiency, tricuspid aortic valve and extremely horizontal aorta with an aortic root angulation of 99°. The Society of Thoracic Surgeons score was 7%. And taking the strong demand of the patient and his family into consideration, we decided to perform transapical transcatheter aortic valve replacement after multidisciplinary evaluation. The procedure was successfully performed by means of low deployment land zone and traction of pre-exist Prolene suture. Three-month follow-up confirmed the normal function of aortic prosthetic valve without residual regurgitation. This case provides a reference for the interventional treatment in patients with extremely horizontal aorta.

Citation： WEI Peijian, LIU Jian, ZHUANG Weitao, MA Jiexu, CHEN Zhao, LIU Yanjun, TAN Tong, WU Hongxiang, XIE Nianjin, CHEN Jimei, GUO Huiming. Transapical transcatheter aortic valve replacement for aortic regurgitation in a patient with extremely horizontal aorta. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 662-666. doi: 10.7507/1007-4848.202105009 Copy

1.	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.
2.	Zhu D, Hu J, Meng W, et al. Successful transcatheter aortic valve implantation for pure aortic regurgitation using a new second generation self-expanding J-valve^TM system — The first in-man implantation. Heart Lung Circ, 2015, 24(4): 411-414.
3.	Wei L, Liu H, Zhu L, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-valve and early outcome. JACC Cardiovasc Interv, 2015, 8(14): 1831-1841.
4.	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.
5.	Chan PH, Alegria-Barrero E, Di Mario C. Difficulties with horizontal aortic root in transcatheter aortic valve implantation. Catheter Cardiovasc Interv, 2013, 81(4): 630-635.
6.	Sarkar K, Ussia GP, Tamburino C. Trans catheter aortic valve implantation with core valve revalving system in uncoiled (horizontal) aorta. Overcoming anatomical and technical challenges for successful deployment. Catheter Cardiovasc Interv, 2011, 78(6): 964-969.
7.	Popma JJ, Reardon MJ, Yakubov SJ, et al. Safety and efficacy of self-expanding TAVR in patients with aortoventricular angulation. JACC Cardiovasc Imaging, 2016, 9(8): 973-981.
8.	Abramowitz Y, Maeno Y, Chakravarty T, et al. Aortic angulation attenuates procedural success following self-expandable but not balloon-expandable TAVR. JACC Cardiovasc Imaging, 2016, 9(8): 964-972.
9.	D'Ancona G, Kische S, El-Mawardy M, et al. Aortic annulus angulation does not attenuate procedural success of transcatheter aortic valve replacement using a novel self-expanding bioprosthesis. Heart Vessels, 2019, 34(12): 1969-1975.
10.	Kaneko U, Hachinohe D, Kobayashi K, et al. Evolut self-expanding transcatheter aortic valve replacement in patients with extremely horizontal aorta (aortic root angle≥70°). Int Heart J, 2020, 61(5): 1059-1069.
11.	潘文志, 龙愉良, 周达新, 等. 2020年经导管瓣膜治疗主要进展. 中国胸心血管外科临床杂志, 2021, 28(4): 371-375.
12.	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.
13.	Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
14.	周达新, 潘文志, 吴永健, 等. 经导管主动脉瓣置换术中国专家共识（2020更新版）. 中国介入心脏病学杂志, 2020, 28(6): 301-309.

1. 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.
2. Zhu D, Hu J, Meng W, et al. Successful transcatheter aortic valve implantation for pure aortic regurgitation using a new second generation self-expanding J-valve^TM system — The first in-man implantation. Heart Lung Circ, 2015, 24(4): 411-414.
3. Wei L, Liu H, Zhu L, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-valve and early outcome. JACC Cardiovasc Interv, 2015, 8(14): 1831-1841.
4. 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.
5. Chan PH, Alegria-Barrero E, Di Mario C. Difficulties with horizontal aortic root in transcatheter aortic valve implantation. Catheter Cardiovasc Interv, 2013, 81(4): 630-635.
6. Sarkar K, Ussia GP, Tamburino C. Trans catheter aortic valve implantation with core valve revalving system in uncoiled (horizontal) aorta. Overcoming anatomical and technical challenges for successful deployment. Catheter Cardiovasc Interv, 2011, 78(6): 964-969.
7. Popma JJ, Reardon MJ, Yakubov SJ, et al. Safety and efficacy of self-expanding TAVR in patients with aortoventricular angulation. JACC Cardiovasc Imaging, 2016, 9(8): 973-981.
8. Abramowitz Y, Maeno Y, Chakravarty T, et al. Aortic angulation attenuates procedural success following self-expandable but not balloon-expandable TAVR. JACC Cardiovasc Imaging, 2016, 9(8): 964-972.
9. D'Ancona G, Kische S, El-Mawardy M, et al. Aortic annulus angulation does not attenuate procedural success of transcatheter aortic valve replacement using a novel self-expanding bioprosthesis. Heart Vessels, 2019, 34(12): 1969-1975.
10. Kaneko U, Hachinohe D, Kobayashi K, et al. Evolut self-expanding transcatheter aortic valve replacement in patients with extremely horizontal aorta (aortic root angle≥70°). Int Heart J, 2020, 61(5): 1059-1069.
11. 潘文志, 龙愉良, 周达新, 等. 2020年经导管瓣膜治疗主要进展. 中国胸心血管外科临床杂志, 2021, 28(4): 371-375.
12. 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.
13. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med, 2019, 380(18): 1706-1715.
14. 周达新, 潘文志, 吴永健, 等. 经导管主动脉瓣置换术中国专家共识（2020更新版）. 中国介入心脏病学杂志, 2020, 28(6): 301-309.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Transapical transcatheter aortic valve replacement for aortic regurgitation in a patient with extremely horizontal aorta

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