This article interprets the core content of Chinese expert consensus on the CT examination for transcatheter aortic valve replacement and Chinese expert consensus on standardized evaluation of CT for transcatheter aortic valve replacement, and elaborates on the technical points of preoperative and postoperative CT examination for transcatheter aortic valve replacement (TAVR), including patient preparation, data acquisition, image reconstruction, and contrast agent use strategies. The article also provides an in-depth interpretation of the crucial elements in standardized CT evaluation for TAVR, covering assessments of aortic root anatomy, cardiac morphology, coronary arteries, and surgical access routes. The article emphasizes the significance of the above consensuses in standardizing TAVR-related CT examinations, improving diagnosis and treatment quality, and promoting the development of cardiovascular intervention therapy in China.
Transcatheter mitral valve edge-to-edge repair (TEER) has become an essential treatment option for patients with severe mitral regurgitation at high or prohibitive surgical risk. However, the surgical devices and procedural steps of the surgery are intricate, and there is currently a lack of standardized TEER procedures in China. Based on existing evidence and the accumulated experience in clinical practice, this article briefly introduces the definition, indications, contraindications, and surgical devices of TEER. It also provides a systematic and detailed elaboration on the procedural steps, key technical points, complications, and their management measures, offering guidance for the standardized implementation and widespread adoption of TEER in clinical practice in China.
Objective To analyze the echocardiographic characteristics of above grade 3+ mitral regurgitation (MR) patients by 3D transesophageal echocardiography (3D-TEE) in transcatheter edge-to-edge repair (TEER) and compare the intervention rate of TEER treatment in patients with different risk stratification. Methods We retrospectively analyzed the clinical data of 91 patients with above grade 3+ MR in Anzhen Hospital between June 2021 and April 2022. There were 45 males and 46 females aged 66.5±15.9 years. According to pathogenesis, the patients were divided into different anatomical groups and risk stratification groups. There were 34 patients in a simple degenerative group (simple DMR group), 28 patietns in a complex disease group (Complex group), 14 patients in a simple ventricular functional reflux group (simple VFMR group), 9 patients in a simple atrial functional reflux group (simple AFMR group), and 6 patients in a mixed functional reflux group (mixed FMR group). All patients were examined with a unified standard of transthoracic echocardiography (TTE) and 3D-TEE to compare the characteristic three-dimensional structural changes of the mitral valve in each group. According to the three partition strategy of preoperative anatomical evaluation of TEER, the risk stratification was conducted for the enrolled patients, which was divided into three regions from light to heavy: green area, yellow area, and red area. TEER treatment intervention rate of patients with different risk stratification was calculated. Results Ant leaf angle and post leaf angle were negative in the simple DMR and Complex groups, and non-planar angle, prolapse height and prolapse volume were higher than those of the other groups (P=0.000). Ant leaf angle and post leaf angle were positive in the VFMR group and the mixed FMR group. Anterior and posterior (AP) diameter of valve ring (P=0.036), tenting height and tenting volume were higher than those of other groups (P=0.000). AP diameter, tenting height and tenting volume were changed mildly in patients with simple AFMR. MR patients in red and yellow zone achieved a 28.1% TEER intervention rate.Conclusion Standardized TTE and TEE examinations are crucial for the qualitative and quantitative diagnosis of MR in the echo core-lab. 3D-TEE mitral valve parameter can help determine the exact pathogenesis of MR and to improve the interventional rate of challenging MR patients.
Transcatheter mitral valve edge-to-edge repair (TEER) has become an important treatment opinion for patients with severe mitral regurgitation (MR) at high risk for surgery. The devices and procedural techniques of TEER are complex and require excellent team cooperation. However, there is still a lack of standardized clinical pathways in China. Based on the latest evidence, the expert group wrote this clinical pathway to guide and optimize TEER therapy in clinical practice. It demonstrates the following key issues of clinical concern: (1) TEER team building; (2) preoperative clinical evaluation of TEER patients; (3) imaging assessment before TEER procedure; (4) standardized procedures for TEER; (5) TEER for complex MR; (6) the standard process of perioperative comprehensive management; and (7) full life-cycle rehabilitation and follow-up. This clinical pathway might be helpful to facilitate the standardized development of TEER therapy and application, and promote the improvement of management and life quality for patients with MR.
Objective To explore the clinical effects of emergency transcatheter aortic replacement (TAVR) on the treatment of patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis during hospitalization. Methods The study selected 44 patients from 8 heart valve centers from January 2018 to January 2021. All patients received emergency TAVR treatment. The patients’ baseline clinical data, cardiac ultrasound indicators, and postoperative hospital stay were collected. Paired t-test and McNemar test were used to compare and analyze the preoperative and postoperative cardiac ultrasound indexes, moderate to severe aortic stenosis, and cardiac function. Results The average age of the patients was (72.0±7.9) years. Valve displacement occurred in one patient during the operation, and the surgical success rate was 97.7%. Four cases died during hospitalization, and the mortality rate was 9.1%. The median length of hospital stay was 11.5 d. The postoperative aortic valve area was significantly higher than that before surgery [(0.5±0.2) vs. (3.8±1.6) mm2, P<0.05], the mean transvalvular pressure of the aortic valve was significantly lower than that before operation [(64.0±24.9) vs. (11.3±4.6) mm Hg (1 mm Hg=0.133 kPa), P<0.05], the peak aortic flow velocity was significantly lower than that before operation [(4.5±0.7) vs. (1.9±0.7) m/s, P<0.05], the left ventricular end diastolic inner diameter was lower than that before operation [(59.0±7.2) vs. (56.1±7.3) mm, P<0.05], the left ventricular ejection fraction increased significantly compared with that before operation [(30.1±10.4)% vs. (40.9±11.0)%, P<0.05], and the cardiac function improved significantly compared with that before operation (P<0.05). During the operation, 2 cases (4.5%) underwent valve-in-valve implantation, 11 cases (25.0%) underwent percutaneous coronary intervention during the same period. During the postoperative hospital stay, 1 case (2.3%) developed stroke, 3 cases (6.8%) experienced severe bleeding, 5 cases (11.4%) had severe vascular complications, 2 cases (4.5%) experienced acute myocardial infarction, 30 cases (68.2%) had small or trace paravalvular regurgitation, 3 cases (6.8%) received permanent pacemaker implantation, and 5 cases (11.4%) developed acute kidney injury. Conclustion Emergency TAVR is an effective and feasible treatment plan for patients with acute refractory heart failure or cardiogenic shock secondary to severe aortic stenosis.
Aortic stenosis (AS) is the most common primary valve lesion requiring surgery or transcatheter intervention in modern era. Its prevalence is rising rapidly as a consequence of the aging population. Transcatheter aortic valve replacement (TAVR) as a therapy option for older high-risk symptomatic severe AS patients has emerged and is currently extending its indications towards surgery intermediate- and low-risk subjects. Considering the common characteristics of frailty and high comorbidity among AS patients, cardiac rehabilitation (CR) has been proven to improve not only survival but also quality of life in previous reports. CR as a classⅠ recommendation in guidelines for the prevention and treatment of cardiovascular disease has been widely used in clinical practice. The purpose of this article is to sort out the current CR programs for TAVR patients in global medical management, and explore the CR optimization program fit for China medical model in post COVID-19 pandemic era.