Early efficacy of "one-stop" transapical transcatheter aortic valve replacement combined with mitral valve edge-to-edge repair in the treatment of multivalvular disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GONG Wenhui , WEI Xiaoyong , GAO Xiaotian , XU Jinguo , WENG Guangdong ,  ZHANG Chengxin

Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230088, P. R. China;

Corresponding author：

ZHANG Chengxin, Email: zhangchengxin@ahmu.edu.cn

Keywords：

Critical multivalvular disease; "one-stop"; transapical transcatheter aortic valve replacement; transapical transcatheter mitral valve edge-to-edge repair

DOI：

10.7507/1007-4848.202312083

Video：

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Objective To investigate the feasibility and early efficacy of transapical transcatheter aortic valve replacement (TAVR) combined with transcatheter mitral valve edge-to-edge repair (TEER) in patients with high-risk aortic valve lesions combined with severe mitral regurgitation. Methods The clinical data of patients who underwent "one-stop" transapical TAVR+TEER in our hospital from August 2022 to October 2023 were retrospectively analyzed. Results Five patients were collected, including 3 males and 2 females with a mean age of 66.6±1.8 years. Four patients had aortic valve insufficiency combined with mitral regurgitation and one had aortic valve stenosis and insufficiency combined with mitral regurgitation. All patients successfully completed transapical TAVR+TEER, and the immediate postoperative echocardiographic results revealed that none of them had more than mild perivalvular leakage and mitral regurgitation, and the prosthetic valves were in good position and function. At 1 week postoperatively, echocardiographic results showed 5 patients with no displacement of the prosthetic valve, detachment of the mitral clip, or damage to the leaflets. At 1 month postoperatively, cardiac function was improved to varying degrees in 4 patients, and 1 patient died of multiorgan failure. At 2 months postoperatively, 1 patient died of cerebrovascular accident, and at 3 months postoperatively the echocardiographic results of the remaining 3 patients revealed that there was no more than mild perivalvular leakage or mitral regurgitation, and the patients' postoperative cardiac function and daily life ability were significantly improved. Conclusion In high-risk aortic valve lesions combined with severe mitral regurgitation, "one-stop" transapical TAVR+TEER is feasible with favorable early efficacy and safety.

Citation： GONG Wenhui, WEI Xiaoyong, GAO Xiaotian, XU Jinguo, WENG Guangdong, ZHANG Chengxin. Early efficacy of "one-stop" transapical transcatheter aortic valve replacement combined with mitral valve edge-to-edge repair in the treatment of multivalvular disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(10): 1467-1474. doi: 10.7507/1007-4848.202312083 Copy

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2.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
3.	Pibarot P, Salaun E, Dahou A, et al. Echocardiographic results of transcatheter versus surgical aortic valve replacement in low-risk patients: The PARTNER 3 trial. Circulation, 2020, 141(19): 1527-1537.
4.	Mack M, Carroll JD, Thourani V, et al. Transcatheter mitral valve therapy in the United States: A report from the STS-ACC TVT registry. J Am Coll Cardiol, 2021, 78(23): 2326-2353.
5.	Chen J, Yang Y, Wei L. One-stage transcatheter aortic valve replacement and transcatheter edge-to-edge repair for aortic and mitral regurgitation. Eur Heart J, 2023, 44(15): 1377.
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7.	马燕燕, 刘洋, 杨剑, 等. 心尖入路经导管主动脉瓣置换术CT影像评估规范. 中国胸心血管外科临床杂志, 2023, 30(5): 647-659.Ma YY, Liu Y, Yang J, et al. Evaluation specification of CT images for transapical transcatheter aortic valve replacement. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(5): 647-659.
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9.	Ando T, Takagi H, Briasoulis A, et al. A systematic review of reported patients of combined transcatheter aortic and mitral valve interventions. Catheter Cardiovasc Interv, 2018, 91(1): 124-134.
10.	张帅, 陆文远, 唐汉玮, 等. 中国合并心力衰竭的老年心脏瓣膜病患者的临床特征与外科治疗现状. 中国循环杂志, 2023, 38(5): 520-525.Zhang S, Lu WY, Tang HW, et al. Clinical characteristics and surgical treatment status of aged patients with valvular heart disease and heart failure in China. Chin Circ J, 2023, 38(5): 520-525.
11.	Unger P, Pibarot P, Tribouilloy C, et al. Multiple and mixed valvular heart diseases. Circ Cardiovasc Imaging, 2018, 11(8): e007862.
12.	Shi J, Wei L, Chen Y, et al. Transcatheter aortic valve implantation with J-valve: 2-year outcomes from a multicenter study. Ann Thorac Surg, 2021, 111(5): 1530-1536.
13.	Ferruzzi GJ, Silverio A, Giordano A, et al. Prognostic impact of mitral regurgitation before and after transcatheter aortic valve replacement in patients with severe low-flow, low-gradient aortic stenosis. J Am Heart Assoc, 2023, 12(17): e029553.
14.	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.
15.	Kische S, D'Ancona G, Paranskaya L, et al. Staged total percutaneous treatment of aortic valve pathology and mitral regurgitation: Institutional experience. Catheter Cardiovasc Interv, 2013, 82(4): E552-E563.
16.	Carrasco-Chinchilla F, Estévez-Loureiro R, Andraka L, et al. Percutaneous mitral repair with mitraclip in patients treated with transcatheter aortic valve implantation. Rev Esp Cardiol (Engl Ed), 2017, 70(12): 1144-1145.
17.	Witberg G, Codner P, Landes U, et al. Transcatheter treatment of residual significant mitral regurgitation following TAVR: A multicenter registry. JACC Cardiovasc Interv, 2020, 13(23): 2782-2791.
18.	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.
19.	Duchenne J, Turco A, Bézy S, et al. Papillary muscles contribute significantly more to left ventricular work in dilated hearts. Eur Heart J Cardiovasc Imaging, 2019, 20(1): 84-91.
20.	Pan W, Zhou D, Wu Y, et al. First-in-human results of a novel user-friendly transcatheter edge-to-edge mitral valve repair device. JACC Cardiovasc Interv, 2019, 12(23): 2441-2443.

1. Cortés C. Steady advance toward fully percutaneous treatment for multivalvular heart disease. JACC Cardiovasc Interv, 2020, 13(23): 2792-2794.
2. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: Executive summary: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2021, 143(5): e35-e71.
3. Pibarot P, Salaun E, Dahou A, et al. Echocardiographic results of transcatheter versus surgical aortic valve replacement in low-risk patients: The PARTNER 3 trial. Circulation, 2020, 141(19): 1527-1537.
4. Mack M, Carroll JD, Thourani V, et al. Transcatheter mitral valve therapy in the United States: A report from the STS-ACC TVT registry. J Am Coll Cardiol, 2021, 78(23): 2326-2353.
5. Chen J, Yang Y, Wei L. One-stage transcatheter aortic valve replacement and transcatheter edge-to-edge repair for aortic and mitral regurgitation. Eur Heart J, 2023, 44(15): 1377.
6. Varshney AS, Shah M, Vemulapalli S, et al. Heart failure medical therapy prior to mitral transcatheter edge-to-edge repair: The STS/ACC Transcatheter Valve Therapy Registry. Eur Heart J, 2023, 44(44): 4650-4661.
7. 马燕燕, 刘洋, 杨剑, 等. 心尖入路经导管主动脉瓣置换术CT影像评估规范. 中国胸心血管外科临床杂志, 2023, 30(5): 647-659.Ma YY, Liu Y, Yang J, et al. Evaluation specification of CT images for transapical transcatheter aortic valve replacement. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(5): 647-659.
8. 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.
9. Ando T, Takagi H, Briasoulis A, et al. A systematic review of reported patients of combined transcatheter aortic and mitral valve interventions. Catheter Cardiovasc Interv, 2018, 91(1): 124-134.
10. 张帅, 陆文远, 唐汉玮, 等. 中国合并心力衰竭的老年心脏瓣膜病患者的临床特征与外科治疗现状. 中国循环杂志, 2023, 38(5): 520-525.Zhang S, Lu WY, Tang HW, et al. Clinical characteristics and surgical treatment status of aged patients with valvular heart disease and heart failure in China. Chin Circ J, 2023, 38(5): 520-525.
11. Unger P, Pibarot P, Tribouilloy C, et al. Multiple and mixed valvular heart diseases. Circ Cardiovasc Imaging, 2018, 11(8): e007862.
12. Shi J, Wei L, Chen Y, et al. Transcatheter aortic valve implantation with J-valve: 2-year outcomes from a multicenter study. Ann Thorac Surg, 2021, 111(5): 1530-1536.
13. Ferruzzi GJ, Silverio A, Giordano A, et al. Prognostic impact of mitral regurgitation before and after transcatheter aortic valve replacement in patients with severe low-flow, low-gradient aortic stenosis. J Am Heart Assoc, 2023, 12(17): e029553.
14. 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.
15. Kische S, D'Ancona G, Paranskaya L, et al. Staged total percutaneous treatment of aortic valve pathology and mitral regurgitation: Institutional experience. Catheter Cardiovasc Interv, 2013, 82(4): E552-E563.
16. Carrasco-Chinchilla F, Estévez-Loureiro R, Andraka L, et al. Percutaneous mitral repair with mitraclip in patients treated with transcatheter aortic valve implantation. Rev Esp Cardiol (Engl Ed), 2017, 70(12): 1144-1145.
17. Witberg G, Codner P, Landes U, et al. Transcatheter treatment of residual significant mitral regurgitation following TAVR: A multicenter registry. JACC Cardiovasc Interv, 2020, 13(23): 2782-2791.
18. 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.
19. Duchenne J, Turco A, Bézy S, et al. Papillary muscles contribute significantly more to left ventricular work in dilated hearts. Eur Heart J Cardiovasc Imaging, 2019, 20(1): 84-91.
20. Pan W, Zhou D, Wu Y, et al. First-in-human results of a novel user-friendly transcatheter edge-to-edge mitral valve repair device. JACC Cardiovasc Interv, 2019, 12(23): 2441-2443.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early efficacy of "one-stop" transapical transcatheter aortic valve replacement combined with mitral valve edge-to-edge repair in the treatment of multivalvular disease

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