Expert recommendations for standardized perioperative management after transapical transcatheter aortic valve implantation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHANG Haibo ¹ , HOU Xiaotong ² ,  GUO Yingqiang ³ , Writting Group of Procedure Specifications for TA-TAVR

1. Heart Surgery Valve Center, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, P. R. China;
2. Department of Intensive Care, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, 100029, P. R. China;
3. Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

ZHANG Haibo, Email: zhanghb2318@163.com; GUO Yingqiang, Email: drguoyq@hotmail.com

Keywords：

Transcatheter aortic valve implantation; transapical approach; aortic valve regurgitation; perioperative management

DOI：

10.7507/1007-4848.202304023

Video：

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The technique of transcatheter aortic valve implantation has become increasingly mature. Although the transapical approach has a certain degree of minimally invasive trauma, it still has the characteristics such as heart beating without cardiopulmonary bypass, and the low technical requirements of catheter guide wire. In particular, the valve path is short and coaxial, which is easy to manipulate, and pure regurgitation and stenosis can be easily operated and are not subject to the limit of peripheral artery stenosis. It is still one of China's main approaches for transcatheter aortic valve replacement. Its perioperative management still has specific features and differs from the femoral artery approach. In addition, there is little relevant literature abroad. Therefore, domestic experts in this field were organized to discuss the development of perioperative management specifications to provide reference and techniques support for developing this field in China and further improve the quality of clinical operation and perioperative management. It will provide more safe and more effective medical services to these patients.

Citation： ZHANG Haibo, HOU Xiaotong, GUO Yingqiang, Writting Group of Procedure Specifications for TA-TAVR. Expert recommendations for standardized perioperative management after transapical transcatheter aortic valve implantation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 927-935. doi: 10.7507/1007-4848.202304023 Copy

1.	Huang H, Kovach CP, Bell S, et al. Outcomes of emergency transcatheter aortic valve replacement. J Interv Cardiol, 2019, 2019: 7 598581.
2.	Kolte D, Khera S, Vemulapalli S, et al. Outcomes following urgent/ emergent transcatheter aortic valve replacement: Insights from the STS/ACC TVT registry. JACC Cardiovasc Interv, 2018, 11(12): 1175-1185.
3.	Grover FL, Vemulapalli S, Carroll JD, et al. 2016 annual report of the Society of Thoracic Surgeons/American College of Cardiology transcatheter valve therapy registry. J Am Coll Cardiol, 2017, 69(10): 1215-1230.
4.	Arnold M, Schulz-Heise S, Achenbach S, et al. Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging. JACC Cardiovasc Interv, 2010, 3(11): 1126-1132.
5.	Iontis GC, Juni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with Severe aortic stenosis undergoing TAVI: A meta-analysis. J Am Coil Cardiol, 2014, 64(2): 129-140.
6.	Munoz-Garcia AJ, Hemandez-Garcia JiM, Jimenez-Navarro MF, et al. Factors predicting and having an impact on the need for a permanent pacemaker after corevalve prosthesis implantation using the new accutrak delivery catheter system. JACC Cardiovasc Interv, 2012, 5(5): 533-539.
7.	van Rosendael PJ, Delgado V, Bax JJ. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: A systematic review. Eur Heart J, 2018, 39(21): 2003-2013.
8.	Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
9.	Belle EV, Juthier F, André Vincentelli, et al. Procedural predictors of post-TAVR aortic regurgitation for balloon-expendable and self-expendable devices? Insights from the France 2 registry. JACC, 2013, 61(10): E1872.
10.	Khatri PJ, Webb JG, Rodés-Cabau J, et al. Adverse effects associated with transcatheter aortic valve implantation: A meta-analysis of contemporary studies. Ann Intern Med, 2013, 158(1): 35-46.
11.	Jabbour R J, Tanaka A, Finkelstein A, et al. Delayed coronary obstruction after transcatheter aortic valve replacement. JACC, 2018, 71(14): 1513.
12.	Stortecky S, Heg D, Tueller D, et al. Infective endocarditis after transcatheter aortic valve replacement. J Am Coll Cardiol, 2020, 75(24): 3020-3030.
13.	Jonas L, Michael J, Reardon, et al. Incidence and outcomes of infective endocarditis after transcatheter or surgical aortic valve replacement. Am Heart Assoc, 2021, 10(19): e020368.
14.	David H, Jeffrey J, Michael J. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med, 2014, 371(10): 967-968.
15.	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.
16.	Sherwood MW, Xiang K, Matsouaka R, et al. Incidence, temporal trends, and associated outcomes of vascular and bleeding complications in patients undergoing transfemoral transcatheter aortic valve replacement: Insights from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry. Circ Cardiovasc Interv, 2020, 13(1): e008227.
17.	Grube E, Laborde JC, Gerckens U, et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: The Siegburg first-in-man study. Circulation, 2006, 114(15): 1616-1624.
18.	Piccardo A, Rusinaru D, Petitprez B, et al. Thrombocytopenia after aortic valve replacement with freedom solo bioprosthesis: A propensity study. Ann Thorac Surg, 2010, 89(5): 1425-1430.
19.	van Straten AHM, Hamad MAS, Berreklouw E, et al. Thrombocytopenia after aortic valve replacement: Comparison between mechanical and biological valves. J Heart Valve Dis, 2010, 19: 394-399.
20.	McCabe JM, Huang PH, Riedl LA, et al. Incidence and implications of idiopathic thrombocytopenia following transcatheter aortic valve replacement with the Edwards Sapien(©) valves: A single center experience. Catheter Cardiovasc Interv, 2014, 83(4): 633-641.
21.	Flaherty MP, Mohsen A, Moore JBt, et al. Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85: 118-129.
22.	Jilaihawi H, Doctor N, Chakravarty T, et al. Major thrombocytopenia after balloon-expandable transcatheter aortic valve replacement: Prognostic implications and comparison to surgical aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85: 130-137.
23.	Gallet R, Seemann A, Yamamoto M, et al. Effect of transcatheter (via femoral artery) aortic valve implantation on the platelet count and its consequences. Am J Cardiol, 2013, 111(11): 1619-1624.
24.	Sedaghat A, Falkenberg N, Sinning JM, et al. TAVI induces an elevation of hemostasis-related biomarkers, which is not causative for post-TAVI thrombocytopenia. Int J Cardiol, 2016, 221: 719-725.
25.	Sexton TR, Wallace EL, Chen A, et al. Thromboinflammatory response and predictors of outcomes in patients undergoing transcatheter aortic valve replacement. J Thromb Thrombolysis, 2016, 41: 384-393.
26.	Dvir D, Généreux P, Barbash IM, et al. Acquired thrombocytopenia after transcatheter aortic valve replacement: Clinical correlates and association with outcomes. Eur Heart J, 2014, 35(38): 2663-2671.
27.	Alec V, Friedhelm B, Fabien P, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Euro Interv, 2022, 43(7): 561-632.
28.	Otto C M, Nishimura R A, 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. J Thorac Cardiovasc Surg, 2021, 162(2): e183-e353.
29.	Jurrien T B, Dirk S, Bianca R, et al. Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: A consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease. Eur Heart J, 2021, 42(23): 2265-2269.
30.	Hielko M, Paul VH, Bernard P, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med, 2016, 374(16): 1590-1593.
31.	Yanagisawa R, Hayashida K, Yamada Y, et al. Incidence, predictors, and mid-term outcomes of possible leaflet thrombosis after TAVI. JACC: Cardiovasc Imaging, 2017, 10(1): 1-11.
32.	Brouwer J, Nijenhuis VJ, Delewi R, et al. Aspirin with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med, 2020, 383(15): 1447-1457.
33.	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.
34.	Visconti G, Focaccio A, Donahue M, et al. RenalGuard System for the prevention of acute kidney injury in patients undergoing transcatheter aortic valve implantation. Euro Interv, 2016, 11(14): e1658-e1661.

1. Huang H, Kovach CP, Bell S, et al. Outcomes of emergency transcatheter aortic valve replacement. J Interv Cardiol, 2019, 2019: 7 598581.
2. Kolte D, Khera S, Vemulapalli S, et al. Outcomes following urgent/ emergent transcatheter aortic valve replacement: Insights from the STS/ACC TVT registry. JACC Cardiovasc Interv, 2018, 11(12): 1175-1185.
3. Grover FL, Vemulapalli S, Carroll JD, et al. 2016 annual report of the Society of Thoracic Surgeons/American College of Cardiology transcatheter valve therapy registry. J Am Coll Cardiol, 2017, 69(10): 1215-1230.
4. Arnold M, Schulz-Heise S, Achenbach S, et al. Embolic cerebral insults after transapical aortic valve implantation detected by magnetic resonance imaging. JACC Cardiovasc Interv, 2010, 3(11): 1126-1132.
5. Iontis GC, Juni P, Pilgrim T, et al. Predictors of permanent pacemaker implantation in patients with Severe aortic stenosis undergoing TAVI: A meta-analysis. J Am Coil Cardiol, 2014, 64(2): 129-140.
6. Munoz-Garcia AJ, Hemandez-Garcia JiM, Jimenez-Navarro MF, et al. Factors predicting and having an impact on the need for a permanent pacemaker after corevalve prosthesis implantation using the new accutrak delivery catheter system. JACC Cardiovasc Interv, 2012, 5(5): 533-539.
7. van Rosendael PJ, Delgado V, Bax JJ. Pacemaker implantation rate after transcatheter aortic valve implantation with early and new-generation devices: A systematic review. Eur Heart J, 2018, 39(21): 2003-2013.
8. Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med, 2011, 364(23): 2187-2198.
9. Belle EV, Juthier F, André Vincentelli, et al. Procedural predictors of post-TAVR aortic regurgitation for balloon-expendable and self-expendable devices? Insights from the France 2 registry. JACC, 2013, 61(10): E1872.
10. Khatri PJ, Webb JG, Rodés-Cabau J, et al. Adverse effects associated with transcatheter aortic valve implantation: A meta-analysis of contemporary studies. Ann Intern Med, 2013, 158(1): 35-46.
11. Jabbour R J, Tanaka A, Finkelstein A, et al. Delayed coronary obstruction after transcatheter aortic valve replacement. JACC, 2018, 71(14): 1513.
12. Stortecky S, Heg D, Tueller D, et al. Infective endocarditis after transcatheter aortic valve replacement. J Am Coll Cardiol, 2020, 75(24): 3020-3030.
13. Jonas L, Michael J, Reardon, et al. Incidence and outcomes of infective endocarditis after transcatheter or surgical aortic valve replacement. Am Heart Assoc, 2021, 10(19): e020368.
14. David H, Jeffrey J, Michael J. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med, 2014, 371(10): 967-968.
15. 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.
16. Sherwood MW, Xiang K, Matsouaka R, et al. Incidence, temporal trends, and associated outcomes of vascular and bleeding complications in patients undergoing transfemoral transcatheter aortic valve replacement: Insights from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry. Circ Cardiovasc Interv, 2020, 13(1): e008227.
17. Grube E, Laborde JC, Gerckens U, et al. Percutaneous implantation of the CoreValve self-expanding valve prosthesis in high-risk patients with aortic valve disease: The Siegburg first-in-man study. Circulation, 2006, 114(15): 1616-1624.
18. Piccardo A, Rusinaru D, Petitprez B, et al. Thrombocytopenia after aortic valve replacement with freedom solo bioprosthesis: A propensity study. Ann Thorac Surg, 2010, 89(5): 1425-1430.
19. van Straten AHM, Hamad MAS, Berreklouw E, et al. Thrombocytopenia after aortic valve replacement: Comparison between mechanical and biological valves. J Heart Valve Dis, 2010, 19: 394-399.
20. McCabe JM, Huang PH, Riedl LA, et al. Incidence and implications of idiopathic thrombocytopenia following transcatheter aortic valve replacement with the Edwards Sapien(©) valves: A single center experience. Catheter Cardiovasc Interv, 2014, 83(4): 633-641.
21. Flaherty MP, Mohsen A, Moore JBt, et al. Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85: 118-129.
22. Jilaihawi H, Doctor N, Chakravarty T, et al. Major thrombocytopenia after balloon-expandable transcatheter aortic valve replacement: Prognostic implications and comparison to surgical aortic valve replacement. Catheter Cardiovasc Interv, 2015, 85: 130-137.
23. Gallet R, Seemann A, Yamamoto M, et al. Effect of transcatheter (via femoral artery) aortic valve implantation on the platelet count and its consequences. Am J Cardiol, 2013, 111(11): 1619-1624.
24. Sedaghat A, Falkenberg N, Sinning JM, et al. TAVI induces an elevation of hemostasis-related biomarkers, which is not causative for post-TAVI thrombocytopenia. Int J Cardiol, 2016, 221: 719-725.
25. Sexton TR, Wallace EL, Chen A, et al. Thromboinflammatory response and predictors of outcomes in patients undergoing transcatheter aortic valve replacement. J Thromb Thrombolysis, 2016, 41: 384-393.
26. Dvir D, Généreux P, Barbash IM, et al. Acquired thrombocytopenia after transcatheter aortic valve replacement: Clinical correlates and association with outcomes. Eur Heart J, 2014, 35(38): 2663-2671.
27. Alec V, Friedhelm B, Fabien P, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Euro Interv, 2022, 43(7): 561-632.
28. Otto C M, Nishimura R A, 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. J Thorac Cardiovasc Surg, 2021, 162(2): e183-e353.
29. Jurrien T B, Dirk S, Bianca R, et al. Management of antithrombotic therapy in patients undergoing transcatheter aortic valve implantation: A consensus document of the ESC Working Group on Thrombosis and the European Association of Percutaneous Cardiovascular Interventions (EAPCI), in collaboration with the ESC Council on Valvular Heart Disease. Eur Heart J, 2021, 42(23): 2265-2269.
30. Hielko M, Paul VH, Bernard P, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med, 2016, 374(16): 1590-1593.
31. Yanagisawa R, Hayashida K, Yamada Y, et al. Incidence, predictors, and mid-term outcomes of possible leaflet thrombosis after TAVI. JACC: Cardiovasc Imaging, 2017, 10(1): 1-11.
32. Brouwer J, Nijenhuis VJ, Delewi R, et al. Aspirin with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med, 2020, 383(15): 1447-1457.
33. 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.
34. Visconti G, Focaccio A, Donahue M, et al. RenalGuard System for the prevention of acute kidney injury in patients undergoing transcatheter aortic valve implantation. Euro Interv, 2016, 11(14): e1658-e1661.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Expert recommendations for standardized perioperative management after transapical transcatheter aortic valve implantation

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