Efficacy and safety of transapical transcatheter aortic valve replacement in the treatment of aortic regurgitation in patients with large aortic annulus_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Fei ^1,2 , XU Chennian ² , JIN Ping ² , MA Yanyan ² , GUO Hong ² , ZHOU Guolei ^2,3 , GAO Wei ¹ ,  LIU Yang ² ,  YANG Jian ²

1. Department of Cardiothoracic Surgery, Chinese Medicine Hospital, Xinjiang Medical University, Urumqi, 830000, P.R.China;
2. Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi’an, 710032, P.R.China;
3. Gansu University of Chinese Medicine, Lanzhou, 730000, P.R.China;

Corresponding author：

LIU Yang, Email: liuyangxijing@126.com; YANG Jian, Email: yangjian1212@hotmail.com

Keywords：

Transcatheter aortic valve replacement (TAVR); aortic valve insufficiency; J-valve^TM; efficacy; safety; intervention treatment

DOI：

10.7507/1007-4848.202012114

Video：

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Objective To investigate the feasibility and safety of transcatheter aortic valve replacement (TAVR) through apical approach for aortic regurgitation of large annulus.Methods From November 2019 to May 2020, 10 male patients aged 64.50±4.20 years with aortic valve insufficiency (AI) underwent TAVR in the Department of Cardiovascular Surgery, Xijing Hospital. The surgical instruments were 29^# J-valve^TM modified and the patients underwent TAVR under angiography. The preoperative and postoperative cardiac function, valve regurgitation, complications and left ventricular remodeling were summarized by ultrasound and CT before and after TAVR.Results A total of 10 valves were implanted in 10 patients. Among them, 1 patient was transferred to the aortic arch during the operation and was transferred to surgical aortic valve replacement; the other 9 patients were successfully implanted with J-valve, with 6 patients of cardiac function (NYHA) class Ⅱ, 4 patients of grade Ⅲ. And there was a significant difference between preoperation and postoperation in left ventricular ejection fraction (44.70%±8.78% vs. 39.80%±8.48%, P<0.05) or aortic regurgitation (1.75±0.72 mL vs. 16.51±8.71 mL, P<0.05). After 3 months, the patients' cardiac function was good.Conclusion TAVR is safe and effective in the treatment of severe valvular disease with AI using J-valve.

Citation： ZENG Fei, XU Chennian, JIN Ping, MA Yanyan, GUO Hong, ZHOU Guolei, GAO Wei, LIU Yang, YANG Jian. Efficacy and safety of transapical transcatheter aortic valve replacement in the treatment of aortic regurgitation in patients with large aortic annulus. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(7): 757-764. doi: 10.7507/1007-4848.202012114 Copy

1.	周自强, 胡大一, 陈捷, 等. 中国心房颤动现状的流行病学研究. 中华内科杂志, 2004, 43(7): 491-494.
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5.	王建安. 中国心脏瓣膜病介入治疗的现状与展望. 中华心血管病杂志, 2019, 47(9): 706-709.
6.	Mondal S, Ashish K, Bandyopadhyay D, et al. Role of TAVR in pure native valvular aortic regurgitation: A new paradigm. Int J Cardiol, 2018, 265: 82.
7.	陈翔, 阚通, 储国俊, 等. 新型双环状主动脉瓣支架研制及实验研究. 介入放射学杂志, 2017, 26(4): 344-349.
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9.	De Backer O, Pilgrim T, Simonato M, et al. Usefulness of transcatheter aortic valve implantation for treatment of pure native aortic valve regurgitation. Am J Cardiol, 2018, 122(6): 1028-1035.
10.	Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
11.	Ali OF, Schultz C, Jabbour A, et al. Predictors of paravalvular aortic regurgitation following self-expanding Medtronic CoreValve implantation: The role of annulus size, degree of calcification, and balloon size during pre-implantation valvuloplasty and implant depth. Int J Cardiol, 2015, 179: 539-545.
12.	Wang DD, Qian Z, Vukicevic M, et al. 3D printing, computational modeling, and artificial intelligence for structural heart disease. JACC Cardiovasc Imaging, 2021, 14(1): 41-60.
13.	Smith NL, D'Souza B, Lam D, et al. Does 3D MRI and 3D printing help the colorectal surgeon manage perianal Crohn's disease? Tech Coloproctol, 2021, 25(2): 249-250.
14.	Noor N, Shapira A, Edri R, et al. 3D Printing of personalized thick and perfusable cardiac patches and hearts. Adv Sci (Weinh), 2019, 6(11): 1900344.
15.	Kim YH, Chen SA, Ernst S, et al. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm, 2020, 36(2): 215-270.
16.	Fan Y, Yang F, Cheung GS, et al. Device sizing guided by echocardiography-based three-dimensional printing is associated with superior outcome after percutaneous left atrial appendage occlusion. J Am Soc Echocardiogr, 2019, 32(6): 708-719.
17.	Ricles LM, Coburn JC, Di Prima M, et al. Regulating 3D-printed medical products. Sci Transl Med, 2018, 10(461): eaan6521.
18.	丁鹏等, 3D打印技术结合经心尖导管主动脉瓣植入15例. 中国体外循环杂志, 2019, 17(5): 261-264, 298.
19.	刘欢, 魏来, 杨晔, 等. 经心尖经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): 596-600.

1. 周自强, 胡大一, 陈捷, 等. 中国心房颤动现状的流行病学研究. 中华内科杂志, 2004, 43(7): 491-494.
2. Hegglin R, Scheu H, Rothlin M. Aortic insufficiency. Circulation, 1968, 38(1 Suppl): 77-92.
3. Andreas M, Coti I, Laufer G, et al. Valve-in-valve transcatheter aortic valve implantation into a novel, sutureless bioprosthesis: Technical considerations. EuroIntervention, 2018, 13(16): 1902-1903.
4. Mastrobuoni S, Tamer S, de Kerchove L, et al. Valve sparing: Aortic root replacement with the reimplantation technique. Multimed Man Cardiothorac Surg, 2015, 2015: mmv012.
5. 王建安. 中国心脏瓣膜病介入治疗的现状与展望. 中华心血管病杂志, 2019, 47(9): 706-709.
6. Mondal S, Ashish K, Bandyopadhyay D, et al. Role of TAVR in pure native valvular aortic regurgitation: A new paradigm. Int J Cardiol, 2018, 265: 82.
7. 陈翔, 阚通, 储国俊, 等. 新型双环状主动脉瓣支架研制及实验研究. 介入放射学杂志, 2017, 26(4): 344-349.
8. Shoar S, Naderan M, Hosseini F, et al. Comment on "Transcatheter aortic valve replacement in patients with pure native aortic valve regurgitation: A systematic review and meta-analysis". Clin Cardiol, 2019, 42(1): 167-168.
9. De Backer O, Pilgrim T, Simonato M, et al. Usefulness of transcatheter aortic valve implantation for treatment of pure native aortic valve regurgitation. Am J Cardiol, 2018, 122(6): 1028-1035.
10. Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol, 2017, 70(22): 2752-2763.
11. Ali OF, Schultz C, Jabbour A, et al. Predictors of paravalvular aortic regurgitation following self-expanding Medtronic CoreValve implantation: The role of annulus size, degree of calcification, and balloon size during pre-implantation valvuloplasty and implant depth. Int J Cardiol, 2015, 179: 539-545.
12. Wang DD, Qian Z, Vukicevic M, et al. 3D printing, computational modeling, and artificial intelligence for structural heart disease. JACC Cardiovasc Imaging, 2021, 14(1): 41-60.
13. Smith NL, D'Souza B, Lam D, et al. Does 3D MRI and 3D printing help the colorectal surgeon manage perianal Crohn's disease? Tech Coloproctol, 2021, 25(2): 249-250.
14. Noor N, Shapira A, Edri R, et al. 3D Printing of personalized thick and perfusable cardiac patches and hearts. Adv Sci (Weinh), 2019, 6(11): 1900344.
15. Kim YH, Chen SA, Ernst S, et al. 2019 APHRS expert consensus statement on three-dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS. J Arrhythm, 2020, 36(2): 215-270.
16. Fan Y, Yang F, Cheung GS, et al. Device sizing guided by echocardiography-based three-dimensional printing is associated with superior outcome after percutaneous left atrial appendage occlusion. J Am Soc Echocardiogr, 2019, 32(6): 708-719.
17. Ricles LM, Coburn JC, Di Prima M, et al. Regulating 3D-printed medical products. Sci Transl Med, 2018, 10(461): eaan6521.
18. 丁鹏等, 3D打印技术结合经心尖导管主动脉瓣植入15例. 中国体外循环杂志, 2019, 17(5): 261-264, 298.
19. 刘欢, 魏来, 杨晔, 等. 经心尖经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): 596-600.

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Efficacy and safety of transapical transcatheter aortic valve replacement in the treatment of aortic regurgitation in patients with large aortic annulus

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