Progress of transcatheter aortic valve replacement in patients with atrioventricular regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHENG Yang , CHEN Fei , LI Xi , ZHU Lei ,  CHEN Mao

Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

CHEN Mao, Email: hmaochen@vip.sina.com

Keywords：

Transcatheter aortic valve replacement; aortic valve stenosis; mitral regurgitation; tricuspid regurgitation; review

DOI：

10.7507/1007-4848.202304008

Video：

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Abstract Full text Figures/Tables Video References Cited by

As the indications for transcatheter aortic valve replacement (TAVR) expand, multi-valve lesions are becoming more common in clinical practice. Moderate to severe atrioventricular regurgitation, particularly when persistent after TAVR, significantly increases the risk of adverse events. Therefore, many studies have evaluated factors that contribute to the improvement of atrioventricular regurgitation. However, this field remains controversial due to the heterogeneity of retrospective studies and the lack of randomized controlled trials. Despite advances in atrioventricular valve intervention techniques, evidence for atrioventricular regurgitation intervention after TAVR is still scarce. The management decision for atrioventricular regurgitation in patients who underwent TAVR is complex and must take into account the severity of valve disease, anatomical characteristics, quality of life, and procedural complexity. We conducted a review of atrioventricular regurgitation in patients who have received TAVR in hope that it will help decision-making in clinical practice.

Citation： CHENG Yang, CHEN Fei, LI Xi, ZHU Lei, CHEN Mao. Progress of transcatheter aortic valve replacement in patients with atrioventricular regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(8): 1193-1198. doi: 10.7507/1007-4848.202304008 Copy

1.	Leon MB, Mack MJ, Hahn RT, et al. Outcomes 2 years after transcatheter aortic valve replacement in patients at low surgical risk. J Am Coll Cardiol, 2021, 77(9): 1149-1161.
2.	周达新, 潘文志, 吴永健,等. 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.
3.	Omar S, Aneni E, Escolar E, et al. Tricuspid regurgitation and in-hospital outcomes after transcatheter aortic valve replacement in high-risk patients. J Thorac Dis, 2020, 12(5): 2963-2970.
4.	Twing AH, Gokhale S, Slostad B, et al. Impact of transcatheter aortic valve implantation among patients with co-existing mild to moderate mitral regurgitation. Am J Cardiol, 2022, 177: 84-89.
5.	Matsuura K, Kumaaru H, Kohsaka S, et al. Impact of concomitant mitral regurgitation during transcatheter aortic valve replacement on 1-year survival outcomes. J Cardiol, 2023.
6.	Muratori M, Fusini L, Tamborini G, et al. Mitral valve regurgitation in patients undergoing TAVI: Impact of severity and etiology on clinical outcome. Int J Cardiol, 2020, 299: 228-234.
7.	Cremer PC, Wang TKM, Rodriguez LL, et al. Incidence and clinical significance of worsening tricuspid regurgitation following surgical or transcatheter aortic valve replacement: Analysis from the PARTNER Ⅱ A trial. Circ Cardiovasc Interv, 2021, 14(8): e010437.
8.	Vollenbroich R, Stortecky S, Praz F, et al. The impact of functional vs degenerative mitral regurgitation on clinical outcomes among patients undergoing transcatheter aortic valve implantation. Am Heart J, 2017, 184: 71-80.
9.	Miura M, Yamaji K, Shirai S, et al. Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement. Can J Cardiol, 2020, 36(7): 1112-1120.
10.	Boerlage-van Dijk K, Wiegerinck EM, Takama T, et al. Mitral regurgitation prior to transcatheter aortic valve implantation influences survival but not symptoms. Int J Cardiol, 2016, 204: 95-100.
11.	Mavromatis K, Thourani VH, Stebbins A, et al. Transcatheter aortic valve replacement in patients with aortic stenosis and mitral regurgitation. Ann Thorac Surg, 2017, 104(6): 1977-1985.
12.	Toggweiler S, Boone RH, Rodés-Cabau J, et al. Transcatheter aortic valve replacement: Outcomes of patients with moderate or severe mitral regurgitation. J Am Coll Cardiol, 2012, 59(23): 2068-2074.
13.	Kiramijyan S, Magalhaes MA, Koifman E, et al. Impact of baseline mitral regurgitation on short- and long-term outcomes following transcatheter aortic valve replacement. Am Heart J, 2016, 178: 19-27.
14.	Barbanti M, Webb JG, Hahn RT, et al. Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: Insight from the Placement of Aortic Transcatheter Valve (PARTNER) trial cohort A. Circulation, 2013, 128(25): 2776-2784.
15.	Bedogni F, Latib A, De Marco F, et al. Interplay between mitral regurgitation and transcatheter aortic valve replacement with the CoreValve Revalving System: A multicenter registry. Circulation, 2013, 128(19): 2145-2153.
16.	Giannini C, Angelillis M, Fiorina C, et al. Clinical impact and evolution of mitral regurgitation after TAVI using the new generation self-expandable valves. Int J Cardiol, 2021, 335: 85-92.
17.	Costantino MF, Dores E, Innelli P, et al. The beneficial effects of TAVI in mitral insufficiency. Cardiovasc Ultrasound, 2015, 13: 49.
18.	Cortés C, Amat-Santos IJ, Nombela-Franco L, et al. Mitral regurgitation after transcatheter aortic valve replacement: Prognosis, imaging predictors, and potential management. JACC Cardiovasc Interv, 2016, 9(15): 1603-1614.
19.	Mauri V, Körber MI, Kuhn E, et al. Prognosis of persistent mitral regurgitation in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol, 2020, 109(10): 1261-1270.
20.	Feldt K, De Palma R, Bjursten H, et al. Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement. Int J Cardiol, 2019, 294: 32-36.
21.	吴宏祥, 谭桐, 魏培坚, 等. 单纯经导管主动脉瓣置换术治疗重度主动脉瓣反流合并重度二尖瓣反流的单中心回顾性研究. 中国胸心血管外科临床杂志, 2022, 29(8): 971-976.
22.	Freitas-ferraz AB, Lerakis S, Barbosa Ribeiro H, et al. Mitral regurgitation in low-flow, low-gradient aortic stenosis patients undergoing TAVR: Insights from the TOPAS-TAVI registry. JACC Cardiovasc Interv, 2020, 13(5): 567-579.
23.	Witberg G, Codner P, Landes U, et al. Effect of transcatheter aortic valve replacement on concomitant mitral regurgitation and its impact on mortality. JACC Cardiovasc Interv, 2021, 14(11): 1181-1192.
24.	Sethi A, Kodumuri V, Prasad V, et al. Does the presence of significant mitral regurgitation prior to transcatheter aortic valve implantation for aortic stenosis impact mortality? Meta-analysis and systematic review Cardiology, 2020, 145(7): 428-438.
25.	Medranda GA, Schwartz R, Green SJ. Predictors and outcome impact of mitral regurgitation in transcatheter aortic valve replacement. Cardiovasc Revasc Med, 2021, 32: 35-40.
26.	Nombela-Franco L, Eltchaninoff H, Zahn R, et al. Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: A meta-analysis. Heart, 2015, 101(17): 1395-1405.
27.	Dominici C, Salsano A, Nenna A, et al. Higher preoperative left atrial volume index predicts lack of mitral regurgitation improvement after transcatheter aortic valve replacement. J Cardiovasc Med (Hagerstown), 2020, 21(5): 383-390.
28.	Chiche O, Rodés-Cabau J, Campelo-Parada F, et al. Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement. Echocardiography, 2019, 36(4): 722-731.
29.	Li X, Hagar A, Wei X, et al. The relationship of mitral annulus shape at CT to mitral regurgitation after transcatheter aortic valve replacement. Radiology, 2021, 301(1): 93-102.
30.	Waller BF, Howard J, Fess S. Pathology of tricuspid valve stenosis and pure tricuspid regurgitation-Part Ⅰ. Clin Cardiol, 1995, 18(2): 97-102.
31.	Worku B, Valovska MT, Elmously A, et al. Predictors of persistent tricuspid regurgitation after transcatheter aortic valve replacement in patients with baseline tricuspid regurgitation. Innovations (Phila), 2018, 13(3): 190-199.
32.	McCarthy FH, Vemulapalli S, Li Z, et al. Association of tricuspid regurgitation with transcatheter aortic valve replacement outcomes: A report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Ann Thorac Surg, 2018, 105(4): 1121-1128.
33.	Sathananthan J, Murdoch DJ, Lindman BR, et al. Implications of concomitant tricuspid regurgitation in patients undergoing transcatheter aortic valve replacement for degenerated surgical aortic bioprosthesis: Insights from the PARTNER 2 aortic valve-in-valve registry. JACC Cardiovasc Interv, 2018, 11(12): 1154-1160.
34.	Dumont C, Galli E, Oger E, et al. Pre- and postoperative tricuspid regurgitation in patients with severe symptomatic aortic stenosis: Importance of pre-operative tricuspid annulus diameter. Eur Heart J Cardiovasc Imaging, 2018, 19(3): 319-328.
35.	Yoshida J, Ikenaga H, Hayashi A, et al. Predictors and outcomes of persistent tricuspid regurgitation after transcatheter aortic valve implantation. Am J Cardiol, 2019, 124(5): 772-780.
36.	Barbanti M, Binder RK, Dvir D, et al. Prevalence and impact of preoperative moderate/severe tricuspid regurgitation on patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85(4): 677-684.
37.	Granot Y, Merdler I, Finkelstein A, et al. Prognostic implication of right ventricular dysfunction and tricuspid regurgitation following transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2021, 98(5): e758-e767.
38.	Leclercq F, Lorca L, Agullo A, et al. Evolution of right ventricular dysfunction and tricuspid regurgitation after TAVI: A prospective study. Int J Cardiol, 2022, 353: 29-34.
39.	Winter MP, Bartko PE, Krickl A, et al. Adaptive development of concomitant secondary mitral and tricuspid regurgitation after transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging, 2021, 22(9): 1045-1053.
40.	Zilberszac R, Gleiss A, Binder T, et al. Prognostic relevance of mitral and tricuspid regurgitation in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging, 2018, 19(9): 985-992.
41.	Lindman BR, Maniar HS, Jaber WA, et al. Effect of tricuspid regurgitation and the right heart on survival after transcatheter aortic valve replacement: Insights from the placement of aortic transcatheter valvesⅡinoperable cohort. Circ Cardiovasc Interv, 2015, 8(4): 10.1161/CIRCINTERVENTIONS. 114.002073 e002073.
42.	Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro heart survey on valvular heart disease. Eur Heart J, 2003, 24(13): 1231-1243.
43.	Yousef S, Arnaoutakis GJ, Gada H, et al. Transcatheter mitral valve therapies: State of the art. J Card Surg, 2022, 37(1): 225-233.
44.	Rudolph V, Schirmer J, Franzen O, et al. Bivalvular transcatheter treatment of high-surgical-risk patients with coexisting severe aortic stenosis and significant mitral regurgitation. Int J Cardiol, 2013, 167(3): 716-720.
45.	Zajarias A, Kodali S, Mccabe JM, et al. Real-world experience with concomitant or staged transcatheter aortic and mitral valve replacements using balloon-expandable valves. Catheter Cardiovasc Interv, 2022, 100(5): 890-900.
46.	Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
47.	Del Val D, Ferreira-Neto AN, Wintzer-Wehekind J, et al. Early experience with transcatheter mitral valve replacement: A systematic review. J Am Heart Assoc, 2019, 8(17): e013332.
48.	Otto CM, Nishimura RA, Bonow RO, 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): e183-e353.
49.	Zhai M, Mao Y, Ma Y, et al. Transcatheter double valve replacement to treat aortic stenosis and severe tricuspid regurgitation with 3D printing guidance after mechanical mitral valve replacement. J Cardiovasc Dev Dis, 2022, 9(9): 296.

1. Leon MB, Mack MJ, Hahn RT, et al. Outcomes 2 years after transcatheter aortic valve replacement in patients at low surgical risk. J Am Coll Cardiol, 2021, 77(9): 1149-1161.
2. 周达新, 潘文志, 吴永健,等. 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.
3. Omar S, Aneni E, Escolar E, et al. Tricuspid regurgitation and in-hospital outcomes after transcatheter aortic valve replacement in high-risk patients. J Thorac Dis, 2020, 12(5): 2963-2970.
4. Twing AH, Gokhale S, Slostad B, et al. Impact of transcatheter aortic valve implantation among patients with co-existing mild to moderate mitral regurgitation. Am J Cardiol, 2022, 177: 84-89.
5. Matsuura K, Kumaaru H, Kohsaka S, et al. Impact of concomitant mitral regurgitation during transcatheter aortic valve replacement on 1-year survival outcomes. J Cardiol, 2023.
6. Muratori M, Fusini L, Tamborini G, et al. Mitral valve regurgitation in patients undergoing TAVI: Impact of severity and etiology on clinical outcome. Int J Cardiol, 2020, 299: 228-234.
7. Cremer PC, Wang TKM, Rodriguez LL, et al. Incidence and clinical significance of worsening tricuspid regurgitation following surgical or transcatheter aortic valve replacement: Analysis from the PARTNER Ⅱ A trial. Circ Cardiovasc Interv, 2021, 14(8): e010437.
8. Vollenbroich R, Stortecky S, Praz F, et al. The impact of functional vs degenerative mitral regurgitation on clinical outcomes among patients undergoing transcatheter aortic valve implantation. Am Heart J, 2017, 184: 71-80.
9. Miura M, Yamaji K, Shirai S, et al. Clinical impact of preprocedural moderate or severe mitral regurgitation on outcomes after transcatheter aortic valve replacement. Can J Cardiol, 2020, 36(7): 1112-1120.
10. Boerlage-van Dijk K, Wiegerinck EM, Takama T, et al. Mitral regurgitation prior to transcatheter aortic valve implantation influences survival but not symptoms. Int J Cardiol, 2016, 204: 95-100.
11. Mavromatis K, Thourani VH, Stebbins A, et al. Transcatheter aortic valve replacement in patients with aortic stenosis and mitral regurgitation. Ann Thorac Surg, 2017, 104(6): 1977-1985.
12. Toggweiler S, Boone RH, Rodés-Cabau J, et al. Transcatheter aortic valve replacement: Outcomes of patients with moderate or severe mitral regurgitation. J Am Coll Cardiol, 2012, 59(23): 2068-2074.
13. Kiramijyan S, Magalhaes MA, Koifman E, et al. Impact of baseline mitral regurgitation on short- and long-term outcomes following transcatheter aortic valve replacement. Am Heart J, 2016, 178: 19-27.
14. Barbanti M, Webb JG, Hahn RT, et al. Impact of preoperative moderate/severe mitral regurgitation on 2-year outcome after transcatheter and surgical aortic valve replacement: Insight from the Placement of Aortic Transcatheter Valve (PARTNER) trial cohort A. Circulation, 2013, 128(25): 2776-2784.
15. Bedogni F, Latib A, De Marco F, et al. Interplay between mitral regurgitation and transcatheter aortic valve replacement with the CoreValve Revalving System: A multicenter registry. Circulation, 2013, 128(19): 2145-2153.
16. Giannini C, Angelillis M, Fiorina C, et al. Clinical impact and evolution of mitral regurgitation after TAVI using the new generation self-expandable valves. Int J Cardiol, 2021, 335: 85-92.
17. Costantino MF, Dores E, Innelli P, et al. The beneficial effects of TAVI in mitral insufficiency. Cardiovasc Ultrasound, 2015, 13: 49.
18. Cortés C, Amat-Santos IJ, Nombela-Franco L, et al. Mitral regurgitation after transcatheter aortic valve replacement: Prognosis, imaging predictors, and potential management. JACC Cardiovasc Interv, 2016, 9(15): 1603-1614.
19. Mauri V, Körber MI, Kuhn E, et al. Prognosis of persistent mitral regurgitation in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol, 2020, 109(10): 1261-1270.
20. Feldt K, De Palma R, Bjursten H, et al. Change in mitral regurgitation severity impacts survival after transcatheter aortic valve replacement. Int J Cardiol, 2019, 294: 32-36.
21. 吴宏祥, 谭桐, 魏培坚, 等. 单纯经导管主动脉瓣置换术治疗重度主动脉瓣反流合并重度二尖瓣反流的单中心回顾性研究. 中国胸心血管外科临床杂志, 2022, 29(8): 971-976.
22. Freitas-ferraz AB, Lerakis S, Barbosa Ribeiro H, et al. Mitral regurgitation in low-flow, low-gradient aortic stenosis patients undergoing TAVR: Insights from the TOPAS-TAVI registry. JACC Cardiovasc Interv, 2020, 13(5): 567-579.
23. Witberg G, Codner P, Landes U, et al. Effect of transcatheter aortic valve replacement on concomitant mitral regurgitation and its impact on mortality. JACC Cardiovasc Interv, 2021, 14(11): 1181-1192.
24. Sethi A, Kodumuri V, Prasad V, et al. Does the presence of significant mitral regurgitation prior to transcatheter aortic valve implantation for aortic stenosis impact mortality? Meta-analysis and systematic review Cardiology, 2020, 145(7): 428-438.
25. Medranda GA, Schwartz R, Green SJ. Predictors and outcome impact of mitral regurgitation in transcatheter aortic valve replacement. Cardiovasc Revasc Med, 2021, 32: 35-40.
26. Nombela-Franco L, Eltchaninoff H, Zahn R, et al. Clinical impact and evolution of mitral regurgitation following transcatheter aortic valve replacement: A meta-analysis. Heart, 2015, 101(17): 1395-1405.
27. Dominici C, Salsano A, Nenna A, et al. Higher preoperative left atrial volume index predicts lack of mitral regurgitation improvement after transcatheter aortic valve replacement. J Cardiovasc Med (Hagerstown), 2020, 21(5): 383-390.
28. Chiche O, Rodés-Cabau J, Campelo-Parada F, et al. Significant mitral regurgitation in patients undergoing TAVR: Mechanisms and imaging variables associated with improvement. Echocardiography, 2019, 36(4): 722-731.
29. Li X, Hagar A, Wei X, et al. The relationship of mitral annulus shape at CT to mitral regurgitation after transcatheter aortic valve replacement. Radiology, 2021, 301(1): 93-102.
30. Waller BF, Howard J, Fess S. Pathology of tricuspid valve stenosis and pure tricuspid regurgitation-Part Ⅰ. Clin Cardiol, 1995, 18(2): 97-102.
31. Worku B, Valovska MT, Elmously A, et al. Predictors of persistent tricuspid regurgitation after transcatheter aortic valve replacement in patients with baseline tricuspid regurgitation. Innovations (Phila), 2018, 13(3): 190-199.
32. McCarthy FH, Vemulapalli S, Li Z, et al. Association of tricuspid regurgitation with transcatheter aortic valve replacement outcomes: A report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Ann Thorac Surg, 2018, 105(4): 1121-1128.
33. Sathananthan J, Murdoch DJ, Lindman BR, et al. Implications of concomitant tricuspid regurgitation in patients undergoing transcatheter aortic valve replacement for degenerated surgical aortic bioprosthesis: Insights from the PARTNER 2 aortic valve-in-valve registry. JACC Cardiovasc Interv, 2018, 11(12): 1154-1160.
34. Dumont C, Galli E, Oger E, et al. Pre- and postoperative tricuspid regurgitation in patients with severe symptomatic aortic stenosis: Importance of pre-operative tricuspid annulus diameter. Eur Heart J Cardiovasc Imaging, 2018, 19(3): 319-328.
35. Yoshida J, Ikenaga H, Hayashi A, et al. Predictors and outcomes of persistent tricuspid regurgitation after transcatheter aortic valve implantation. Am J Cardiol, 2019, 124(5): 772-780.
36. Barbanti M, Binder RK, Dvir D, et al. Prevalence and impact of preoperative moderate/severe tricuspid regurgitation on patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85(4): 677-684.
37. Granot Y, Merdler I, Finkelstein A, et al. Prognostic implication of right ventricular dysfunction and tricuspid regurgitation following transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2021, 98(5): e758-e767.
38. Leclercq F, Lorca L, Agullo A, et al. Evolution of right ventricular dysfunction and tricuspid regurgitation after TAVI: A prospective study. Int J Cardiol, 2022, 353: 29-34.
39. Winter MP, Bartko PE, Krickl A, et al. Adaptive development of concomitant secondary mitral and tricuspid regurgitation after transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging, 2021, 22(9): 1045-1053.
40. Zilberszac R, Gleiss A, Binder T, et al. Prognostic relevance of mitral and tricuspid regurgitation in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging, 2018, 19(9): 985-992.
41. Lindman BR, Maniar HS, Jaber WA, et al. Effect of tricuspid regurgitation and the right heart on survival after transcatheter aortic valve replacement: Insights from the placement of aortic transcatheter valvesⅡinoperable cohort. Circ Cardiovasc Interv, 2015, 8(4): 10.1161/CIRCINTERVENTIONS. 114.002073 e002073.
42. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro heart survey on valvular heart disease. Eur Heart J, 2003, 24(13): 1231-1243.
43. Yousef S, Arnaoutakis GJ, Gada H, et al. Transcatheter mitral valve therapies: State of the art. J Card Surg, 2022, 37(1): 225-233.
44. Rudolph V, Schirmer J, Franzen O, et al. Bivalvular transcatheter treatment of high-surgical-risk patients with coexisting severe aortic stenosis and significant mitral regurgitation. Int J Cardiol, 2013, 167(3): 716-720.
45. Zajarias A, Kodali S, Mccabe JM, et al. Real-world experience with concomitant or staged transcatheter aortic and mitral valve replacements using balloon-expandable valves. Catheter Cardiovasc Interv, 2022, 100(5): 890-900.
46. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2022, 43(7): 561-632.
47. Del Val D, Ferreira-Neto AN, Wintzer-Wehekind J, et al. Early experience with transcatheter mitral valve replacement: A systematic review. J Am Heart Assoc, 2019, 8(17): e013332.
48. Otto CM, Nishimura RA, Bonow RO, 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): e183-e353.
49. Zhai M, Mao Y, Ma Y, et al. Transcatheter double valve replacement to treat aortic stenosis and severe tricuspid regurgitation with 3D printing guidance after mechanical mitral valve replacement. J Cardiovasc Dev Dis, 2022, 9(9): 296.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Progress of transcatheter aortic valve replacement in patients with atrioventricular regurgitation

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