Early clinical experience of transcatheter aortic valve implantation via apical approach for high-risk aortic valve disease in single-center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHANG Li , WANG Pingfan , WANG Fengling , LI Yuzhen , LIU Haixia , LIU Jianhua , LIU Xuping , XIAO Changbo , GAO Xia , WU Gang , ZHANG Xianghui , CUI Cong , CHEN Yuxin , ZHENG Yi

Henan Provincial Chest Hospital, Zhengzhou, 450003, P.R.China;

Corresponding author：

ZHANG Li, Email: zlhn1990@163.com

Keywords：

Aortic valve disease; transcatheter aortic valve implantation; heart apex approach; high-risk severe disease

DOI：

10.7507/1007-4848.201904035

Video：

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Objective To summarize the clinical experience in the treatment of high-risk patients with severe aortic valve disease by transcatheter aortic valve implantation (TAVI) via heart apex approach and to evaluate the early efficacy.Method Five patients who underwent TAVI via heart apex approach from September 2017 to February 2019 in Henan Thoracic Hospital were retrospectively analyzed, including 3 males and 2 females, aged 65-84 (74.6±4.5) years.Result All operations were performed through a small left incision into the thoracic cavity (3-5 cm), and then through the J-Valve transport system, the aortic valve was successfully released via heart apex after precise positioning under digital subtraction angiography. One patient developed ventricular fibrillation during the operation, and the operation was completed with the assistance of emergency femoral arteriovenous catheterization cardiopulmonary bypass; one patient underwent percutaneous coronary intervention first because of severe coronary stenosis; one patient had paroxysmal atrial fibrillation during the perioperative period, and had hepatorenal insufficiency and thrombocytopenia after the operation, and was improved after medical treatment; one patient had perivalvular leak during the operation, and was improved after re-implantation of the valve; one patient was in stable condition during operation and recovered smoothly after operation. Surgery was successful in all 5 patients. The follow-up time was 2-19 months, and the early clinical effect was good.Conclusion The short-term clinical efficacy of TAVI via heart apex approach in the treatment of high-risk severe aortic valve disease is definite and safe, but the long-term and medium-term effects need to be further evaluated.

Citation： ZHANG Li, WANG Pingfan, WANG Fengling, LI Yuzhen, LIU Haixia, LIU Jianhua, LIU Xuping, XIAO Changbo, GAO Xia, WU Gang, ZHANG Xianghui, CUI Cong, CHEN Yuxin, ZHENG Yi. Early clinical experience of transcatheter aortic valve implantation via apical approach for high-risk aortic valve disease in single-center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1194-1198. doi: 10.7507/1007-4848.201904035 Copy

1.	Cribier A, Eltchaninoff H, Bash A, et al. Percultaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
2.	国家心血管病专家委员会微创心血管外科专业委员会. 中国经导管主动脉瓣置入术(TAVI)多学科专家共识. 中华胸心血管外科杂志, 2018, 34(12): 705-712.
3.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
4.	Gotzmann M, Hehen T, Germing A, et al. Short-term effects of transcatheter aortic valve implantation on neurohormonal activation, quality of life and 6-minute walk test in severe and symptomatic aortic stenosis. Heart, 2010, 96(14): 1102-1106.
5.	Baumgartner H, Falk V, Bax JJ, et al. The 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
6.	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. J Am Coll Cardiol, 2017, 70(2): 252-289.
7.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of valvular heart disease: executive summary:a report of the American College of Cardiology/American Heart Association Task Force on practice guideline. Circulation, 2014, 129(23): 2440-2492.
8.	Liu H, Yang Y, Wang W, et al. Transapical transcatheter aorticvalve replacement for aortic regurgitation with a second—generation heart valve. J Thorac Cardiovasc Surg, 2018, 156(1): 106-116.
9.	Yoon SH, LeFevre T, Ahn JM, et al. Transcatheter aortic valve replacement with early and new·-generation devices in bicuspid aortic valve stenosis. J Am Coll Cardiol, 2016, 68(11): 1195-1205.
10.	Yousef A, Simard T, Webb J, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve: A patient level multi-center analysis. Int J Cardiol, 2015, 189: 282-288.
11.	Wet L, Liu H, Zhu L, et al. A new transcaiheter aortic valve replacement system for predominant aortic regurgiration implantation of the J-Valve and early outcome. JACC-Cardiovasc Intev, 2015, 8(14): 1831-1841.
12.	魏来, 杨晔, 王春生, 等. 经导管主动脉瓣置换术: 心脏外科新纪元、新机遇、新挑战. 中华外科杂志, 2016, 54(8): 577-581.
13.	Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC expert consensus decision pathway for transeatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology task force on clinical expert consensus documents. J Am Coll Cardiol, 2017, 69: 1313-1346.
14.	Malaisrie SC, Iddriss A, Flaherty JD, et al. Transcatheter aortic valve implantation. Curr Atheroscler Rep, 2016, 18(5): 27.
15.	Petronio AS, Sinning JM, Van Mieghem N, et al. Optimal implantation depth and adherence to guidelines on permanent pacing to improve the results of transcatheter aortic valve replacement with the medtronic corevalve system: the corevalve prospective, international, post-market ADVANCE-Ⅱ study. JACC Cardiovasc Interv, 2015, 8(6): 837-846.
16.	潘文志, 葛均波. 经导管主动脉瓣置换术2013年进展回顾. 中国介入心脏病学杂志, 2014, 22(1): 52-54.
17.	刘欢, 魏来, 杨晔, 等. 经心尖导管主动脉瓣置换术治疗高龄高危主动脉瓣关闭不全. 中华外科杂志, 2016, 54(8): 596-560.

1. Cribier A, Eltchaninoff H, Bash A, et al. Percultaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation, 2002, 106(24): 3006-3008.
2. 国家心血管病专家委员会微创心血管外科专业委员会. 中国经导管主动脉瓣置入术(TAVI)多学科专家共识. 中华胸心血管外科杂志, 2018, 34(12): 705-712.
3. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
4. Gotzmann M, Hehen T, Germing A, et al. Short-term effects of transcatheter aortic valve implantation on neurohormonal activation, quality of life and 6-minute walk test in severe and symptomatic aortic stenosis. Heart, 2010, 96(14): 1102-1106.
5. Baumgartner H, Falk V, Bax JJ, et al. The 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
6. 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. J Am Coll Cardiol, 2017, 70(2): 252-289.
7. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of valvular heart disease: executive summary:a report of the American College of Cardiology/American Heart Association Task Force on practice guideline. Circulation, 2014, 129(23): 2440-2492.
8. Liu H, Yang Y, Wang W, et al. Transapical transcatheter aorticvalve replacement for aortic regurgitation with a second—generation heart valve. J Thorac Cardiovasc Surg, 2018, 156(1): 106-116.
9. Yoon SH, LeFevre T, Ahn JM, et al. Transcatheter aortic valve replacement with early and new·-generation devices in bicuspid aortic valve stenosis. J Am Coll Cardiol, 2016, 68(11): 1195-1205.
10. Yousef A, Simard T, Webb J, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve: A patient level multi-center analysis. Int J Cardiol, 2015, 189: 282-288.
11. Wet L, Liu H, Zhu L, et al. A new transcaiheter aortic valve replacement system for predominant aortic regurgiration implantation of the J-Valve and early outcome. JACC-Cardiovasc Intev, 2015, 8(14): 1831-1841.
12. 魏来, 杨晔, 王春生, 等. 经导管主动脉瓣置换术: 心脏外科新纪元、新机遇、新挑战. 中华外科杂志, 2016, 54(8): 577-581.
13. Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC expert consensus decision pathway for transeatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology task force on clinical expert consensus documents. J Am Coll Cardiol, 2017, 69: 1313-1346.
14. Malaisrie SC, Iddriss A, Flaherty JD, et al. Transcatheter aortic valve implantation. Curr Atheroscler Rep, 2016, 18(5): 27.
15. Petronio AS, Sinning JM, Van Mieghem N, et al. Optimal implantation depth and adherence to guidelines on permanent pacing to improve the results of transcatheter aortic valve replacement with the medtronic corevalve system: the corevalve prospective, international, post-market ADVANCE-Ⅱ study. JACC Cardiovasc Interv, 2015, 8(6): 837-846.
16. 潘文志, 葛均波. 经导管主动脉瓣置换术2013年进展回顾. 中国介入心脏病学杂志, 2014, 22(1): 52-54.
17. 刘欢, 魏来, 杨晔, 等. 经心尖导管主动脉瓣置换术治疗高龄高危主动脉瓣关闭不全. 中华外科杂志, 2016, 54(8): 596-560.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early clinical experience of transcatheter aortic valve implantation via apical approach for high-risk aortic valve disease in single-center

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