Interpretation of the <i>2020 updated version of Chinese Expert Consensus on Transcatheter Aortic Valve Replacement</i>_West China Medical Journal

Authors：

ZHANG Qian ,  WANG Moyang , WU Yongjian

Coronary Heart Disease Center, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing 100037, P. R. China;

Corresponding author：

WANG Moyang, Email: wangmoyang1983@vip.sina.com

Keywords：

Transcatheter aortic valve replacement; Severe aortic stenosis; Valvular heart disease

DOI：

10.7507/1002-0179.202108023

Video：

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Transcatheter aortic valve replacement (TAVR) is an important treatment for patients with symptomatic severe aortic stenosis. The 2020 updated version of Chinese Expert Consensus on Transcatheter Aortic Valve Replacement was born in the process of Chinese exploration for TAVR. It is of epochal guiding significance for TAVR in China, which has entered a stage of rapid development from the initial stage. Moreover, it further promotes the standardized and healthy development of TAVR in China. The 2020 updated version of Chinese Expert Consensus on Transcatheter Aortic Valve Replacement, based on its 2015 version, has included aortic valve stenosis with a low risk of surgical operation as an indication, made more detailed recommendations on the operating specifications of balloon dilation and valve placement during TAVR, added the antithrombotic program after TAVR, and important opinions on the treatment of coronary atherosclerotic heart disease, renal insufficiency, and emergency TAVR. In this article, we will focus on all these updates to interpret the updated consensus in detail.

Citation： ZHANG Qian, WANG Moyang, WU Yongjian. Interpretation of the 2020 updated version of Chinese Expert Consensus on Transcatheter Aortic Valve Replacement. West China Medical Journal, 2021, 36(9): 1191-1195. doi: 10.7507/1002-0179.202108023 Copy

1.	Salinas P, Moreno R, Lopez-Sendon JL. Transcatheter aortic valve implantation: current status and future perspectives. World J Cardiol, 2011, 3(6): 177-185.
2.	中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
3.	中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识(2020更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
4.	Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
5.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation, 2017, 135(25): e1159-e1195.
6.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol, 2014, 63(22): e57-185.
7.	Song G, Jilaihawi H, Wang M, et al. Severe symptomatic bicuspid and tricuspid aortic stenosis in China: characteristics and outcomes of transcatheter aortic valve replacement with the Venus-A valve. Structural Heart, 2018, 2(1): 8.
8.	Zhou D, Pan W, Wang J, et al. VitaFlow™ transcatheter valve system in the treatment of severe aortic stenosis: one-year results of a multicenter study. Catheter Cardiovasc Interv, 2020, 95(2): 332-338.
9.	Husso A, Airaksinen J, Juvonen T, et al. Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve. Clin Res Cardiol, 2021, 110(3): 429-439.
10.	Makkar RR, Yoon SH, Leon MB, et al. Association between transcatheter aortic valve replacement for bicuspid vs tricuspid aortic stenosis and mortality or stroke. JAMA, 2019, 321(22): 2193-2202.
11.	Yoon SH, Kim WK, Dhoble A, et al. Bicuspid aortic valve morphology and outcomes after transcatheter aortic valve replacement. J Am Coll Cardiol, 2020, 76(9): 1018-1030.
12.	Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
13.	Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
14.	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.
15.	Medranda GA, Rogers T, Forrestal BJ, et al. Balloon-expandable valve geometry after transcatheter aortic valve replacement in low-risk patients with bicuspid versus tricuspid aortic stenosis. Cardiovasc Revasc Med, 2021, 6: S1553.
16.	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.
17.	Cavender MA, Kolarczyk L. Pulmonary hypertension and aortic stenosis: further evidence that TAVR is not SAVR. JACC Cardiovasc Imaging, 2019, 12(4): 602-604.
18.	Toutouzas K, Benetos G, Voudris V, et al. Pre-dilatation versus no pre-dilatation for implantation of a self-expanding valve in all comers undergoing TAVR: the DIRECT trial. JACC Cardiovasc Interv, 2019, 12(8): 767-777.
19.	Jilaihawi H, Zhao Z, Du R, et al. Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(18): 1796-1807.
20.	Seeger J, Gonska B, Rodewald C, et al. Apixaban in patients with atrial fibrillation after transfemoral aortic valve replacement. JACC Cardiovasc Interv, 2017, 10(1): 66-74.
21.	Dangas GD, Tijssen JGP, Wöhrle J, et al. A controlled trial of rivaroxaban after transcatheter aortic-valve replacement. N Engl J Med, 2020, 382(2): 120-129.
22.	De Backer O, Dangas GD, Jilaihawi H, et al. Reduced leaflet motion after transcatheter aortic-valve replacement. N Engl J Med, 2020, 382(2): 130-139.
23.	Rodés-Cabau J, Ellenbogen KA, Krahn AD, et al. Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC Scientific Expert Panel. J Am Coll Cardiol, 2019, 74(8): 1086-1106.
24.	Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol, 2013, 61(15): 1585-1595.
25.	Pibarot P, Hahn RT, Weissman NJ, et al. Assessment of paravalvular regurgitation following TAVR: a proposal of unifying grading scheme. JACC Cardiovasc Imaging, 2015, 8(3): 340-360.
26.	Ribeiro HB, Webb JG, Makkar RR, et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol, 2013, 62(17): 1552-1562.
27.	Faroux L, Guimaraes L, Wintzer-Wehekind J, et al. Coronary artery disease and transcatheter aortic valve replacement: JACC state-of-the-art review. J Am Coll Cardiol, 2019, 74(3): 362-372.
28.	Goel SS, Ige M, Tuzcu EM, et al. Severe aortic stenosis and coronary artery disease-implications for management in the transcatheter aortic valve replacement era: a comprehensive review. J Am Coll Cardiol, 2013, 62(1): 1-10.

1. Salinas P, Moreno R, Lopez-Sendon JL. Transcatheter aortic valve implantation: current status and future perspectives. World J Cardiol, 2011, 3(6): 177-185.
2. 中国医师协会心血管内科医师分会结构性心脏病专业委员, 中华医学会心血管病学分会结构性心脏病学组. 经导管主动脉瓣置换术中国专家共识. 中国介入心脏病学杂志, 2015, 23(12): 661-667.
3. 中国医师协会心血管内科医师分会结构性心脏病专业委员会. 经导管主动脉瓣置换术中国专家共识(2020更新版). 中国介入心脏病学杂志, 2020, 28(6): 301-309.
4. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
5. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation, 2017, 135(25): e1159-e1195.
6. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol, 2014, 63(22): e57-185.
7. Song G, Jilaihawi H, Wang M, et al. Severe symptomatic bicuspid and tricuspid aortic stenosis in China: characteristics and outcomes of transcatheter aortic valve replacement with the Venus-A valve. Structural Heart, 2018, 2(1): 8.
8. Zhou D, Pan W, Wang J, et al. VitaFlow™ transcatheter valve system in the treatment of severe aortic stenosis: one-year results of a multicenter study. Catheter Cardiovasc Interv, 2020, 95(2): 332-338.
9. Husso A, Airaksinen J, Juvonen T, et al. Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve. Clin Res Cardiol, 2021, 110(3): 429-439.
10. Makkar RR, Yoon SH, Leon MB, et al. Association between transcatheter aortic valve replacement for bicuspid vs tricuspid aortic stenosis and mortality or stroke. JAMA, 2019, 321(22): 2193-2202.
11. Yoon SH, Kim WK, Dhoble A, et al. Bicuspid aortic valve morphology and outcomes after transcatheter aortic valve replacement. J Am Coll Cardiol, 2020, 76(9): 1018-1030.
12. Mack MJ, Leon MB, Smith CR, et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet, 2015, 385(9986): 2477-2484.
13. Leon MB, Smith CR, Mack MJ, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med, 2016, 374(17): 1609-1620.
14. 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.
15. Medranda GA, Rogers T, Forrestal BJ, et al. Balloon-expandable valve geometry after transcatheter aortic valve replacement in low-risk patients with bicuspid versus tricuspid aortic stenosis. Cardiovasc Revasc Med, 2021, 6: S1553.
16. 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.
17. Cavender MA, Kolarczyk L. Pulmonary hypertension and aortic stenosis: further evidence that TAVR is not SAVR. JACC Cardiovasc Imaging, 2019, 12(4): 602-604.
18. Toutouzas K, Benetos G, Voudris V, et al. Pre-dilatation versus no pre-dilatation for implantation of a self-expanding valve in all comers undergoing TAVR: the DIRECT trial. JACC Cardiovasc Interv, 2019, 12(8): 767-777.
19. Jilaihawi H, Zhao Z, Du R, et al. Minimizing permanent pacemaker following repositionable self-expanding transcatheter aortic valve replacement. JACC Cardiovasc Interv, 2019, 12(18): 1796-1807.
20. Seeger J, Gonska B, Rodewald C, et al. Apixaban in patients with atrial fibrillation after transfemoral aortic valve replacement. JACC Cardiovasc Interv, 2017, 10(1): 66-74.
21. Dangas GD, Tijssen JGP, Wöhrle J, et al. A controlled trial of rivaroxaban after transcatheter aortic-valve replacement. N Engl J Med, 2020, 382(2): 120-129.
22. De Backer O, Dangas GD, Jilaihawi H, et al. Reduced leaflet motion after transcatheter aortic-valve replacement. N Engl J Med, 2020, 382(2): 130-139.
23. Rodés-Cabau J, Ellenbogen KA, Krahn AD, et al. Management of conduction disturbances associated with transcatheter aortic valve replacement: JACC Scientific Expert Panel. J Am Coll Cardiol, 2019, 74(8): 1086-1106.
24. Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol, 2013, 61(15): 1585-1595.
25. Pibarot P, Hahn RT, Weissman NJ, et al. Assessment of paravalvular regurgitation following TAVR: a proposal of unifying grading scheme. JACC Cardiovasc Imaging, 2015, 8(3): 340-360.
26. Ribeiro HB, Webb JG, Makkar RR, et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multicenter registry. J Am Coll Cardiol, 2013, 62(17): 1552-1562.
27. Faroux L, Guimaraes L, Wintzer-Wehekind J, et al. Coronary artery disease and transcatheter aortic valve replacement: JACC state-of-the-art review. J Am Coll Cardiol, 2019, 74(3): 362-372.
28. Goel SS, Ige M, Tuzcu EM, et al. Severe aortic stenosis and coronary artery disease-implications for management in the transcatheter aortic valve replacement era: a comprehensive review. J Am Coll Cardiol, 2013, 62(1): 1-10.

West China Medical Journal

Interpretation of the 2020 updated version of Chinese Expert Consensus on Transcatheter Aortic Valve Replacement

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