Early clinical efficacy of emergency transcatheter aortic valve replacement for severe aortic stenosis_West China Medical Journal

Authors：

JIANG Zhengming ¹ , LI Guangzhao ² , HU Caina ¹ , ZHOU Zheng ³ , ZHANG Longyan ⁴ , YANG Jian ⁵ , SHANG Xiaoke ⁶ , LI Jie ⁷ , PAN Wenzhi ⁸ , FANG Zhenfei ⁹ , LI Fei ¹⁰ , SONG Guangyuan ¹¹ , WU Yongjian ³ ,  CHEN Kui ¹

1. Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P. R. China;
2. Department of Cardiology, People’s Hospital of Zhengzhou, Zhengzhou, Henan 450000, P. R. China;
3. Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, P. R. China;
4. Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, Hubei 430022, P. R. China;
5. Department of Cardiovascular Surgery, Xijing Hospital of Air Force Military Medical University, Xi’an, Shaanxi 710032, P. R. China;
6. Department of Cardiovascular Surgery, Union Hospital Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P. R. China;
7. Department of Cardiology, Guangdong Provincial People’s Hospital, Guangzhou, Guangdong 510062, P. R. China;
8. Department of Cardiology, Fudan University Zhongshan Hospital, Shanghai 200032, P. R. China;
9. Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan 410007, P. R. China;
10. Department of Cardiology, Xijing Hospital of Air Force Military Medical University, Xi’an, Shaanxi 710032, P. R. China;
11. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100037, P. R. China;

Corresponding author：

CHEN Kui, Email: chenkui@hotmail.com

Keywords：

Emergency transcatheter aortic valve replacement; Aortic valve stenosis; Cardiogenic shock; Heart failure; Early clinical effect

DOI：

10.7507/1002-0179.202108251

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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.

Citation： JIANG Zhengming, LI Guangzhao, HU Caina, ZHOU Zheng, ZHANG Longyan, YANG Jian, SHANG Xiaoke, LI Jie, PAN Wenzhi, FANG Zhenfei, LI Fei, SONG Guangyuan, WU Yongjian, CHEN Kui. Early clinical efficacy of emergency transcatheter aortic valve replacement for severe aortic stenosis. West China Medical Journal, 2021, 36(11): 1522-1527. doi: 10.7507/1002-0179.202108251 Copy

1.	Prendergast BD, Redwood SR. Transcatheter aortic valve replacement. Circulation, 2019, 139(24): 2724-2727.
2.	Gleason TG, Reardon MJ, Popma JJ, et al. 5-Year outcomes of self-expanding transcatheter versus surgical aortic valve replacement in high-risk patients. J Am Coll Cardiol, 2018, 72(22): 2687-2696.
3.	Durko AP, Reardon MJ, Kleiman NS, et al. Neurological complications after transcatheter versus surgical aortic valve replacement in intermediate-risk patients. J Am Coll Cardiol, 2018, 72(18): 2109-2119.
4.	Kolte D, Vlahakes GJ, Palacios IF, et al. Transcatheter versus surgical aortic valve replacement in low-risk patients. J Am Coll Cardiol, 2019, 74(12): 1532-1540.
5.	Nagao K, Taniguchi T, Morimoto T, et al. Acute heart failure in patients with severe aortic stenosis - insights from the CURRENT AS registry. Circ J, 2018, 82(3): 874-885.
6.	Carabello BA, Green LH, Grossman W, et al. Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation, 1980, 62(1): 42-48.
7.	Kolte D, Khera S, Vemulapalli S, et al. Outcomes following urgent/emergent transcatheter aortic valve replacement: insights from the STS/ACC TVT registry. JACC Cardiovasc Interv, 2018, 11(12): 1175-1185.
8.	Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol, 2013, 62(11): 1002-1012.
9.	Lancellotti P, Magne J, Dulgheru R, et al. Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics. JAMA Cardiol, 2018, 3(11): 1060-1068.
10.	Holmes DR Jr, Nishimura RA, Grover FL, et al. Annual outcomes with transcatheter valve therapy: from the STS/ACC TVT registry. Ann Thorac Surg, 2016, 101(2): 789-800.
11.	Enta Y, Miyasaka M, Taguri M, et al. Patients’ characteristics and mortality in urgent/emergent/salvage transcatheter aortic valve replacement: insight from the OCEAN-TAVI registry. Open Heart, 2020, 7(2): e001467.
12.	Bongiovanni D, Kühl C, Bleiziffer S, et al. Emergency treatment of decompensated aortic stenosis. Heart, 2018, 104(1): 23-29.
13.	Surkan MJ, Gibson W. Interventions to mobilize elderly patients and reduce length of hospital stay. Can J Cardiol, 2018, 34(7): 881-888.
14.	Wijeysundera HC, Li L, Braga V, et al. Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation. Open Heart, 2016, 3(2): e000468.
15.	Serletis-Bizios A, Durand E, Cellier G, et al. A prospective analysis of early discharge after transfemoral transcatheter aortic valve implantation. Am J Cardiol, 2016, 118(6): 866-872.
16.	Huang H, Kovach CP, Bell S, et al. Outcomes of emergency transcatheter aortic valve replacement. J Interv Cardiol, 2019(3): 7598581.
17.	Frerker C, Schewel J, Schlüter M, et al. Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis. EuroIntervention, 2016, 11(13): 1530-1536.
18.	Vallabhajosyula S, Patlolla SH, Sandhyavenu H, et al. Periprocedural cardiopulmonary bypass or venoarterial extracorporeal membrane oxygenation during transcatheter aortic valve replacement: a systematic review. J Am Heart Assoc, 2018, 7(14): e009608.
19.	Higuchi R, Tobaru T, Hagiya K, et al. Outcomes of patients requiring extracorporeal membrane oxygenation in transcatheter aortic valve implantation: a clinical case series. Heart Vessels, 2018, 33(11): 1343-1349.
20.	Singh V, Damluji AA, Mendirichaga R, et al. Elective or emergency use of mechanical circulatory support devices during transcatheter aortic valve replacement. J Interv Cardiol, 2016, 29(5): 513-522.

1. Prendergast BD, Redwood SR. Transcatheter aortic valve replacement. Circulation, 2019, 139(24): 2724-2727.
2. Gleason TG, Reardon MJ, Popma JJ, et al. 5-Year outcomes of self-expanding transcatheter versus surgical aortic valve replacement in high-risk patients. J Am Coll Cardiol, 2018, 72(22): 2687-2696.
3. Durko AP, Reardon MJ, Kleiman NS, et al. Neurological complications after transcatheter versus surgical aortic valve replacement in intermediate-risk patients. J Am Coll Cardiol, 2018, 72(18): 2109-2119.
4. Kolte D, Vlahakes GJ, Palacios IF, et al. Transcatheter versus surgical aortic valve replacement in low-risk patients. J Am Coll Cardiol, 2019, 74(12): 1532-1540.
5. Nagao K, Taniguchi T, Morimoto T, et al. Acute heart failure in patients with severe aortic stenosis - insights from the CURRENT AS registry. Circ J, 2018, 82(3): 874-885.
6. Carabello BA, Green LH, Grossman W, et al. Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation, 1980, 62(1): 42-48.
7. Kolte D, Khera S, Vemulapalli S, et al. Outcomes following urgent/emergent transcatheter aortic valve replacement: insights from the STS/ACC TVT registry. JACC Cardiovasc Interv, 2018, 11(12): 1175-1185.
8. Osnabrugge RL, Mylotte D, Head SJ, et al. Aortic stenosis in the elderly disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol, 2013, 62(11): 1002-1012.
9. Lancellotti P, Magne J, Dulgheru R, et al. Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics. JAMA Cardiol, 2018, 3(11): 1060-1068.
10. Holmes DR Jr, Nishimura RA, Grover FL, et al. Annual outcomes with transcatheter valve therapy: from the STS/ACC TVT registry. Ann Thorac Surg, 2016, 101(2): 789-800.
11. Enta Y, Miyasaka M, Taguri M, et al. Patients’ characteristics and mortality in urgent/emergent/salvage transcatheter aortic valve replacement: insight from the OCEAN-TAVI registry. Open Heart, 2020, 7(2): e001467.
12. Bongiovanni D, Kühl C, Bleiziffer S, et al. Emergency treatment of decompensated aortic stenosis. Heart, 2018, 104(1): 23-29.
13. Surkan MJ, Gibson W. Interventions to mobilize elderly patients and reduce length of hospital stay. Can J Cardiol, 2018, 34(7): 881-888.
14. Wijeysundera HC, Li L, Braga V, et al. Drivers of healthcare costs associated with the episode of care for surgical aortic valve replacement versus transcatheter aortic valve implantation. Open Heart, 2016, 3(2): e000468.
15. Serletis-Bizios A, Durand E, Cellier G, et al. A prospective analysis of early discharge after transfemoral transcatheter aortic valve implantation. Am J Cardiol, 2016, 118(6): 866-872.
16. Huang H, Kovach CP, Bell S, et al. Outcomes of emergency transcatheter aortic valve replacement. J Interv Cardiol, 2019(3): 7598581.
17. Frerker C, Schewel J, Schlüter M, et al. Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis. EuroIntervention, 2016, 11(13): 1530-1536.
18. Vallabhajosyula S, Patlolla SH, Sandhyavenu H, et al. Periprocedural cardiopulmonary bypass or venoarterial extracorporeal membrane oxygenation during transcatheter aortic valve replacement: a systematic review. J Am Heart Assoc, 2018, 7(14): e009608.
19. Higuchi R, Tobaru T, Hagiya K, et al. Outcomes of patients requiring extracorporeal membrane oxygenation in transcatheter aortic valve implantation: a clinical case series. Heart Vessels, 2018, 33(11): 1343-1349.
20. Singh V, Damluji AA, Mendirichaga R, et al. Elective or emergency use of mechanical circulatory support devices during transcatheter aortic valve replacement. J Interv Cardiol, 2016, 29(5): 513-522.

West China Medical Journal

Early clinical efficacy of emergency transcatheter aortic valve replacement for severe aortic stenosis

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