Mitral regurgitation (MR) is a kind of valvular heart disease with a complicated pathogenesis. However, the current clinical understanding of MR mostly stays in a purely spatial perspective. We suggest that the evaluation of MR should break through the limited thinking of the area of a two-dimensional single frame, and transfer to a comprehensive evaluation of three-dimensional space-time integration (i.e. four-dimensional space-time). Secondly, it is of significance to pay attention to the time mechanism and time thinking of the occurrence of MR. The amount of MR may be different in different cardiac cycles or within the same cardiac cycle. Finally, changes in the time dimension of cardiac contraction can lead to the occurrence of MR and sometimes it is necessary to understand MR from time thinking rather than spatial thinking.
ObjectiveTo evaluate the efficiency and safety of intraprocedural valve-in-valve deployment for treatment of aortic regurgitation following transcatheter aortic valve replacement (TAVR).MethodsConsecutive patients (n=333) who diagnosed with severe aortic stenosis and underwent TAVR in Zhongshan Hospital affiliated to Fudan University from October 3rd, 2010 to April 21st, 2021 were included. There were 208 males and 125 females aged 76.0±7.0 years. There were 316 patients underwent simple TAVR (simple TAVR group) and 17 patients underwent intraprocedural valve-in-valve deployment following TAVR (valve-in-valve group). Their clinical and echocardiographic outcomes were evaluated and compared.ResultsThere was no significant difference between the two groups of patients at postoperative 30 d and 1 year in all-cause mortality (4.4% vs. 0, P=1.000; 6.3% vs. 0, P=1.000), incidence of pacemaker implantation (10.4% vs. 17.6%, P=1.000; 11.8% vs. 17.6%, P=1.000), incidence of ischemic stroke (1.3% vs. 0, P=1.000; 1.3% vs. 0, P=1.000), mean trans-aortic pressure gradient (11.4±6.4 mm Hg vs. 8.9±4.9 mm Hg, P=0.099; 10.5±7.6 mm Hg vs. 11.2±5.2 mm Hg, P=0.432), left ventricular ejection fraction (62.0%±9.0% vs. 57.0%±12.0%, P=0.189; 63.0%±7.0% vs. 60.0%±8.0%, P=0.170), and incidence of mitral valve dysfunction (0.6% vs. 5.9%, P=1.000; 0.6% vs. 5.9%, P=1.000).ConclusionIt is feasible to treat perivalvular leakage with valve-in-valve technology in the procedure of TAVR, and the short and medium-term effects are satisfied.