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.
An elderly female patient, with systemic multiple organ dysfunction, suffered from severe aortic valve stenosis, was to undergo transcatheter aortic valve replacement (TAVR). She was intolerance of the computed tomography examination before surgery. Bedside echocardiography was employed to evaluate the patient’s aortic valve stenosis, valve anatomy and type, the condition of aortic root, the distance from coronary to aortic root, and lower-extremity vascular access. Finally, the emergent TAVR was successfully performed under general anesthesia, and the aortic valve trans-prosthetic gradient met a remarkable decrease after surgery.
ObjectiveTo systematically review the predictive factors of new-onset conduction abnormalities(NOCAs) after transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) patients. MethodsThe CNKI, VIP, WanFang Data, PubMed, Cochrane Library and EMbase databases were electronically searched to collect the relevant studies on NOCAs after TAVR in patients with BAV from inception to December 5, 2022. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsSix studies involving 758 patients with BAV were included. The results of the meta-analysis showed that age (MD=−1.48, 95%CI −2.73 to −0.23, P=0.02), chronic kidney disease (OR=0.14, 95%CI 0.06 to 0.34, P<0.01), preoperative left bundle branch block (LBBB) (OR=2.84, 95%CI 1.11 to 7.23, P=0.03), membranous septum length (MSL) (MD=0.93, 95%CI 0.05 to 1.80, P=0.04), implantation depth (ID) (MD=−2.06, 95%CI −2.96 to −1.16, P<0.01), the difference between MSL and ID (MD=3.05, 95%CI 1.92 to 4.18, P<0.01), and ID>MSL (OR=0.27, 95%CI 0.15 to 0.49, P<0.01) could be used as predictors of NOCAs. ConclusionCurrent evidence shows that age, chronic kidney disease, LBBB, MS, ID, the difference between MSL and ID, and ID>MSL could be used as predictors of NOCAs. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusion.
Transcatheter aortic valve replacement is an effective treatment for aortic stenosis currently, especially in elderly, surgical high-risk, and surgical procedures-intolerant patients with severe aortic stenosis. After several generations of updates in design and function, the self-expandable valves have shown significant efficacy in treating aortic stenosis patients with bicuspid aortic valve, bioprosthetic valve failure or small annulus, and superiority in terms of valve durability, and the favorable hemodynamic outcomes could translate into clinical endpoint benefit. This literature review summarizes the advantages and recent advances of the self-expandable valves in transcatheter aortic valve replacement.
Objective To evaluate the safety and early-stage efficacy of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) using a new generation balloon-expandable (BE) valve by collecting the baseline and follow-up data. Methods We retrospectively reviewed the clinical data of severe AS patients who received TAVR with BE valve (Sapien 3) in Fuwai Hospital from September 2020 to June 2022. We collected the echocardiographic data as well as follow-up results at post-procedure, 1, 3, 6 and 12 months. According to the Sievers classification criteria, the patients were divided into a normal group and a bicuspid aortic valve group. Results Finally 62 patients were collected, including 31 females and 31 males with an average age of 71.44±9.17 years. There was 61 patients implanted successfully with BE valve and only 1 was transferred to surgical replacement. There was no mortality or severe complications. Echocardiographic assessment showed significant reduction of the pressure gradient (P＜0.001) and the effect was consistent to postoperative 12 months. After the treatment of patients with different aortic valve morphology using balloon dilation, the condition of valve stenosis improved. ConclusionThe use of BE valves has good safety and early efficacy in patients with severe AS of different valve morphology.
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.
ObjectiveTo compare and analyze the clinical effects of two kinds of frame design valves after transcatheter aortic valve replacement (TAVR).MethodsWe retrospectively reviewed 124 patients who underwent TAVR and were followed up for 1 year. There were 71 males and 53 females aged 75.57±6.21 years. These patients were treated with Venus-A or Edwards Sapien aortic valves. The hemodynamics and cardiac function of these two kinds of transcatheter aortic valves (THV) were evaluated by echocardiography. The 30-day mortality and 1-year clinical effect of the patients were calculated.ResultsEight-one patients used Venus-A valve and 43 patients used Edwards Sapien valve. The aortic valve transaortic pressure gradient was reduced and the rate of perivalvular leakage was low (both 2.6%) in both groups, and there was no statistical difference between the two groups. The implantation rate of permanent pacemaker was 17.3% and 11.6%, respectively. The 1-month survival (94.0% and 93.0%) and 1-year survival (94.0% and 91.0%) rates were not statistically different.ConclusionThe two groups of THV with different stent structures have good short-term clinical effect and low implantation rate of permanent pacemaker.
“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.
ObjectiveTo compare the complications of transcatheter aortic valve replacement (TAVR) between aortic valve stenosis (AS) patients ≥90 years and patients <90 years, and to explore the efficacy and safety of TAVR in AS patients ≥90 years.MethodsDatabases including PubMed, The Cochrane Library, EMbase, Medline, CNKI, Wanfang Data and China Biology Medicine disc (CBMdisc) were searched by computer from inception to May 2019. Two reviewers independently screened the literature, extracted the data and evaluated the quality of the included studies. RevMan 5.3 and Stata 15.0 were used for meta-analysis.ResultsA total of 12 cohort studies were included, including60 186 patients (11 350 patients ≥90 years and 48 836 patients <90 years). Meta-analysis showed that compared with the patients <90 years, those ≥90 years had higher all-cause mortality in the hospital (OR=1.51, 95%CI 1.37 to 1.66, P<0.000 01),on postoperative 30 d (OR=1.68, 95%CI 1.50 to 1.89, P<0.000 01) and at postoperative 1 year (OR=1.36, 95%CI 1.25 to 1.48, P<0.000 01), and had higher incidence of stroke (OR=1.31, 95%CI 1.18 to 1.46, P<0.000 01), bleeding events (OR=1.14, 95%CI 1.07 to 1.20, P<0.000 01) and vascular complications (OR=1.31, 95%CI 1.18 to 1.46, P<0.000 01). ConclusionAll-cause mortality and the incidence of some complications after TAVR in AS patients ≥90 years are higher than those in patients <90 years, but this difference is clinically acceptable. Therefore, TAVR treatment is safe and effective for elderly patients.
ObjectiveTo systematically review the efficacy and safety of transfemoral transcatheter aortic valve replacement (TFTAVR) under local anesthesia (LA) and general anesthesia (GA). MethodsElectronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang and CBM were searched to collect randomized controlled trial and cohort studies on clinical outcomes of TFTAVR under LA and GA from inception to September 2020. Two authors independently screened literature, extracted data and assessed the quality of studies, and a meta-analysis was performed by using Stata 16.0 software. ResultsA total of 30 studies involving 52 087 patients were included in this study. There were 18 719 patients in the LA group and 33 368 patients in the GA group. The results of meta-analysis showed that the in-hospital all-cause mortality rate [RR=0.65, 95%CI (0.45, 0.94), P=0.021], 30-day all-cause mortality rate [RR=0.73, 95%CI (0.62, 0.86), P＜0.001], 30-day stroke [RR=0.82, 95%CI (0.68, 0.98), P=0.025], cardiac arrest [RR=0.50, 95%CI (0.34, 0.73), P＜0.001], ICU stay time [RR=−6.86, 95%CI (−12.31, −1.42), P=0.013], and total hospital stay time [RR=−2.02, 95%CI (−2.59, −1.45), P＜0.001] in the LA group were all better than those in the GA group. There was no significant difference in the in-hospital stroke [RR=0.83, 95%CI (0.69, 1.00), P=0.053], in-hospital myocardial infarction (MI) [RR=1.74, 95%CI (0.43, 7.00), P=0.434], or 30-day MI [RR=0.77, 95%CI (0.42, 1.42), P=0.404] between the two groups. ConclusionLA provides a safe and effective way to induce sedation without intubation, and may be a good alternative to GA for TFTAVR.