Reflections on the era of valvular intervention—The perspective of surgeons_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Yunlong ,  WANG Yin ,  DONG Nianguo

Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, P.R.China;

Corresponding author：

WANG Yin, Email: wangyin0817@hotmail.com; DONG Nianguo, Email: dongnianguo@hotmail.com

Keywords：

Heart valve diseases; interventional therapy; transcatheter aortic valve replacement (TAVR); surgical aortic valve replacement (SAVR)

DOI：

10.7507/1007-4848.202107094

Video：

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In recent years, the number of interventions for valvular heart disease has been increasing day by day, and it has become a hot topic in the field of cardiovascular surgery. Given the aging global population and trends in the prevalence of valvular disease and the broadening of indications for transcatheter aortic valve replacement (TAVR), a breakthrough of 130000 TAVR procedures is expected by 2026. In the new technology development period, the development potential and technical advantages of heart valve interventional therapy should be faced squarely. This paper focuses on key issues such as comparison of outcomes after TAVR versus surgical aortic valve replacement (SAVR), prosthetic valve endocarditis after TAVR, and broadening of indications for TAVR, as well as recommendations on how surgeons face the era of TAVR. We hope that this article will help and attract the attention of cardiac surgeons.

Citation： WU Yunlong, WANG Yin, DONG Nianguo. Reflections on the era of valvular intervention—The perspective of surgeons. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(12): 1415-1419. doi: 10.7507/1007-4848.202107094 Copy

1.	Davidson LJ, Davidson CJ. Transcatheter treatment of valvular heart disease: A review. JAMA, 2021, 325(24): 2480-2494.
2.	王春生, 陆树洋. COMMENCE (SAVR) 研究五年随访结果给中国主动脉瓣膜外科带来的思考. 中国胸心血管外科临床杂志, 2021, 28(8): 877-883.
3.	Carroll JD, Mack MJ, Vemulapalli S, et al. STS-ACC TVT Registry of transcatheter aortic valve replacement. J Am Coll Cardiol, 2020, 76(21): 2492-516.
4.	Otto CM, Nishimura RA, Bonow R O, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2021, 143(5): e72-e227.
5.	Shang X, Chen S, Zhang C, et al. First-in-man implantation of Med-Zenith PT-valve in right ventricular outflow tract for pulmonary regurgitation. JACC Cardiovasc Interv, 2019, 12(19): 1989-1990.
6.	Siontis GCM, Overtchouk P, Cahill TJ, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: An updated meta-analysis. Eur Heart J, 2019, 40(38): 3143-3153.
7.	Zhang XL, Zhang XW, Lan RF, et al. Long-term and temporal outcomes of transcatheter versus surgical aortic-valve replacement in severe aortic stenosis: A meta-analysis. Ann Surg, 2021, 273(3): 459-466.
8.	Salaun E, Clavel MA, Rodés-Cabau J, et al. Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation. Heart, 2018, 104(16): 1323-1332.
9.	Soares JS, Feaver KR, Zhang W, et al. Biomechanical behavior of bioprosthetic heart valve heterograft tissues: Characterization, simulation, and performance. Cardiovasc Eng Technol, 2016, 7(4): 309-51.
10.	杨晧然, 熊恬园, 陈茂. Evolut Low Risk 研究两年随访结果解读. 中国胸心血管外科临床杂志, 2021, 28(8): 884-887.
11.	Sø ndergaard L, Ihlemann N, Capodanno D, et al. Durability of transcatheter and surgical bioprosthetic aortic valves in patients at lower surgical risk. J Am Coll Cardiol, 2019, 73(5): 546-553.
12.	Pibarot P, Ternacle J, Jaber WA, et al. Structural deterioration of transcatheter versus surgical aortic valve bioprostheses in the partner-2 trial. J Am Coll Cardiol, 2020, 76(16): 1830-43.
13.	Bagur R, Pibarot P, Otto CM. Importance of the valve durability-life expectancy ratio in selection of a prosthetic aortic valve. Heart, 2017, 103(22): 1756-1759.
14.	Johnson EL, Wu MCH, Xu F, et al. Thinner biological tissues induce leaflet flutter in aortic heart valve replacements. Proc Natl Acad Sci USA, 2020, 117(32): 19007-19016.
15.	Martin C, Sun W. Comparison of transcatheter aortic valve and surgical bioprosthetic valve durability: A fatigue simulation study. J Biomech, 2015, 48(12): 3026-34.
16.	Alavi SH, Groves EM, Kheradvar A. The effects of transcatheter valve crimping on pericardial leaflets. Ann Thorac Surg, 2014, 97(4): 1260-1266.
17.	Martin C, Sun W. Transcatheter valve underexpansion limits leaflet durability: Implications for valve-in-valve procedures. Ann Biomed Eng, 2017, 45(2): 394-404.
18.	Khan A, Aslam A, Satti KN, et al. Infective endocarditis post-transcatheter aortic valve implantation (TAVI), microbiological profile and clinical outcomes: A systematic review. PLoS One, 2020, 15(1): e0225077.
19.	Regueiro A, Linke A, Latib A, et al. Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death. JAMA, 2016, 316(10): 1083-1092.
20.	Harding D, Cahill TJ, Redwood SR, et al. Infective endocarditis complicating transcatheter aortic valve implantation. Heart, 2020, 106(7): 493-498.
21.	Monteagudo Ruiz JM, Zamorano Gómez JL. Endocarditis after transcatheter aortic valve implantation: A new fiend we hardly know. Eur Heart J, 2019, 40(39): 3270-3272.
22.	Wise J, 冯羽. 经导管主动脉瓣置换术后发生感染性心内膜炎的危险因素已被确认. 中华外科杂志, 2018, 56(6): 446.
23.	Regueiro A, Linke A, Latib A, et al. Infective endocarditis following transcatheter aortic valve replacement: Comparison of balloon- versus self-expandable valves. Circ Cardiovasc Interv, 2019, 12(11): e007938.
24.	Raad II, Hanna HA, Boktour M, et al. Catheter-related vancomycin-resistant enterococcus faecium bacteremia: Clinical and molecular epidemiology. Infect Control Hosp Epidemiol, 2005, 26(7): 658-661.
25.	Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
26.	Thourani VH, Suri R M, Gunter RL, et al. Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients. Ann Thorac Surg, 2015, 99(1): 55-61.
27.	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.
28.	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.
29.	Contorni F, Fineschi M, Iadanza A, et al. How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: From literature review to tips for clinical practice. Heart Fail Rev, 2021. [Epub ahead of print].
30.	Pasala TKR, Ruiz CE. Transcatheter aortic valve replacement for all-comers with severe aortic stenosis: Could it become a reality? Rev Esp Cardiol (Engl Ed), 2018, 71(3): 141-145.
31.	Makkar RR, Blanke P, Leipsic J, et al. Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: Partner 3 cardiac computed tomography substudy. J Am Coll Cardiol, 2020, 75(24): 3003-3015.
32.	Yerasi C, Rogers T, Forrestal BJ, et al. Transcatheter versus surgical aortic valve replacement in young, low-risk patients with severe aortic stenosis. JACC Cardiovasc Interv, 2021, 14(11): 1169-1180.
33.	Landes U, Webb JG, De Backer O, et al. Repeat transcatheter aortic valve replacement for transcatheter prosthesis dysfunction. J Am Coll Cardiol, 2020, 75(16): 1882-1893.
34.	徐东辉, 罗新锦, 张晶, 等. 经导管主动脉瓣置换术在高龄主动脉瓣狭窄患者中的应用. 中华老年多器官疾病杂志, 2021, 20(6): 430-433.
35.	Thourani VH, Edelman JJ, Satler LF, et al. Surgical aortic valve replacement in the transcatheter aortic valve replacement era: Implications for the heart team. JACC Cardiovasc Interv, 2018, 11(21): 2157-2159.
36.	Tokoro M, Sawaki S, Ozeki T, et al. Totally endoscopic aortic valve replacement via an anterolateral approach using a standard prosthesis. Interact Cardiovasc Thorac Surg, 2020, 30(3): 424-430.
37.	Chang C, Raza S, Altarabsheh SE, et al. Minimally invasive approaches to surgical aortic valve replacement: A meta-analysis. Ann Thorac Surg, 2018, 106(6): 1881-1889.
38.	Guo MH, Boodhwani M. Aortic valve repair: From concept to future targets. Semin Thorac Cardiovasc Surg, 2019, 31(4): 650-655.
39.	Tabata M. Transapical approach in transcatheter cardiovascular interventions. Gen Thorac Cardiovasc Surg, 2018, 66(4): 185-191.

1. Davidson LJ, Davidson CJ. Transcatheter treatment of valvular heart disease: A review. JAMA, 2021, 325(24): 2480-2494.
2. 王春生, 陆树洋. COMMENCE (SAVR) 研究五年随访结果给中国主动脉瓣膜外科带来的思考. 中国胸心血管外科临床杂志, 2021, 28(8): 877-883.
3. Carroll JD, Mack MJ, Vemulapalli S, et al. STS-ACC TVT Registry of transcatheter aortic valve replacement. J Am Coll Cardiol, 2020, 76(21): 2492-516.
4. Otto CM, Nishimura RA, Bonow R O, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation, 2021, 143(5): e72-e227.
5. Shang X, Chen S, Zhang C, et al. First-in-man implantation of Med-Zenith PT-valve in right ventricular outflow tract for pulmonary regurgitation. JACC Cardiovasc Interv, 2019, 12(19): 1989-1990.
6. Siontis GCM, Overtchouk P, Cahill TJ, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: An updated meta-analysis. Eur Heart J, 2019, 40(38): 3143-3153.
7. Zhang XL, Zhang XW, Lan RF, et al. Long-term and temporal outcomes of transcatheter versus surgical aortic-valve replacement in severe aortic stenosis: A meta-analysis. Ann Surg, 2021, 273(3): 459-466.
8. Salaun E, Clavel MA, Rodés-Cabau J, et al. Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation. Heart, 2018, 104(16): 1323-1332.
9. Soares JS, Feaver KR, Zhang W, et al. Biomechanical behavior of bioprosthetic heart valve heterograft tissues: Characterization, simulation, and performance. Cardiovasc Eng Technol, 2016, 7(4): 309-51.
10. 杨晧然, 熊恬园, 陈茂. Evolut Low Risk 研究两年随访结果解读. 中国胸心血管外科临床杂志, 2021, 28(8): 884-887.
11. Sø ndergaard L, Ihlemann N, Capodanno D, et al. Durability of transcatheter and surgical bioprosthetic aortic valves in patients at lower surgical risk. J Am Coll Cardiol, 2019, 73(5): 546-553.
12. Pibarot P, Ternacle J, Jaber WA, et al. Structural deterioration of transcatheter versus surgical aortic valve bioprostheses in the partner-2 trial. J Am Coll Cardiol, 2020, 76(16): 1830-43.
13. Bagur R, Pibarot P, Otto CM. Importance of the valve durability-life expectancy ratio in selection of a prosthetic aortic valve. Heart, 2017, 103(22): 1756-1759.
14. Johnson EL, Wu MCH, Xu F, et al. Thinner biological tissues induce leaflet flutter in aortic heart valve replacements. Proc Natl Acad Sci USA, 2020, 117(32): 19007-19016.
15. Martin C, Sun W. Comparison of transcatheter aortic valve and surgical bioprosthetic valve durability: A fatigue simulation study. J Biomech, 2015, 48(12): 3026-34.
16. Alavi SH, Groves EM, Kheradvar A. The effects of transcatheter valve crimping on pericardial leaflets. Ann Thorac Surg, 2014, 97(4): 1260-1266.
17. Martin C, Sun W. Transcatheter valve underexpansion limits leaflet durability: Implications for valve-in-valve procedures. Ann Biomed Eng, 2017, 45(2): 394-404.
18. Khan A, Aslam A, Satti KN, et al. Infective endocarditis post-transcatheter aortic valve implantation (TAVI), microbiological profile and clinical outcomes: A systematic review. PLoS One, 2020, 15(1): e0225077.
19. Regueiro A, Linke A, Latib A, et al. Association between transcatheter aortic valve replacement and subsequent infective endocarditis and in-hospital death. JAMA, 2016, 316(10): 1083-1092.
20. Harding D, Cahill TJ, Redwood SR, et al. Infective endocarditis complicating transcatheter aortic valve implantation. Heart, 2020, 106(7): 493-498.
21. Monteagudo Ruiz JM, Zamorano Gómez JL. Endocarditis after transcatheter aortic valve implantation: A new fiend we hardly know. Eur Heart J, 2019, 40(39): 3270-3272.
22. Wise J, 冯羽. 经导管主动脉瓣置换术后发生感染性心内膜炎的危险因素已被确认. 中华外科杂志, 2018, 56(6): 446.
23. Regueiro A, Linke A, Latib A, et al. Infective endocarditis following transcatheter aortic valve replacement: Comparison of balloon- versus self-expandable valves. Circ Cardiovasc Interv, 2019, 12(11): e007938.
24. Raad II, Hanna HA, Boktour M, et al. Catheter-related vancomycin-resistant enterococcus faecium bacteremia: Clinical and molecular epidemiology. Infect Control Hosp Epidemiol, 2005, 26(7): 658-661.
25. Reardon MJ, Van Mieghem NM, Popma JJ, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2017, 376(14): 1321-1331.
26. Thourani VH, Suri R M, Gunter RL, et al. Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients. Ann Thorac Surg, 2015, 99(1): 55-61.
27. 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.
28. 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.
29. Contorni F, Fineschi M, Iadanza A, et al. How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: From literature review to tips for clinical practice. Heart Fail Rev, 2021. [Epub ahead of print].
30. Pasala TKR, Ruiz CE. Transcatheter aortic valve replacement for all-comers with severe aortic stenosis: Could it become a reality? Rev Esp Cardiol (Engl Ed), 2018, 71(3): 141-145.
31. Makkar RR, Blanke P, Leipsic J, et al. Subclinical leaflet thrombosis in transcatheter and surgical bioprosthetic valves: Partner 3 cardiac computed tomography substudy. J Am Coll Cardiol, 2020, 75(24): 3003-3015.
32. Yerasi C, Rogers T, Forrestal BJ, et al. Transcatheter versus surgical aortic valve replacement in young, low-risk patients with severe aortic stenosis. JACC Cardiovasc Interv, 2021, 14(11): 1169-1180.
33. Landes U, Webb JG, De Backer O, et al. Repeat transcatheter aortic valve replacement for transcatheter prosthesis dysfunction. J Am Coll Cardiol, 2020, 75(16): 1882-1893.
34. 徐东辉, 罗新锦, 张晶, 等. 经导管主动脉瓣置换术在高龄主动脉瓣狭窄患者中的应用. 中华老年多器官疾病杂志, 2021, 20(6): 430-433.
35. Thourani VH, Edelman JJ, Satler LF, et al. Surgical aortic valve replacement in the transcatheter aortic valve replacement era: Implications for the heart team. JACC Cardiovasc Interv, 2018, 11(21): 2157-2159.
36. Tokoro M, Sawaki S, Ozeki T, et al. Totally endoscopic aortic valve replacement via an anterolateral approach using a standard prosthesis. Interact Cardiovasc Thorac Surg, 2020, 30(3): 424-430.
37. Chang C, Raza S, Altarabsheh SE, et al. Minimally invasive approaches to surgical aortic valve replacement: A meta-analysis. Ann Thorac Surg, 2018, 106(6): 1881-1889.
38. Guo MH, Boodhwani M. Aortic valve repair: From concept to future targets. Semin Thorac Cardiovasc Surg, 2019, 31(4): 650-655.
39. Tabata M. Transapical approach in transcatheter cardiovascular interventions. Gen Thorac Cardiovasc Surg, 2018, 66(4): 185-191.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Reflections on the era of valvular intervention—The perspective of surgeons

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