ObjectiveTo compare the efficacy and safety of Venus A-Valve and other overseas devices in transcatheter aortic valve replacement (TAVR) for patients with severe aortic stenosis (AS).MethodsWe retrospectively analyzed the baseline characteristics, procedural details, and postprocedural outcomes of severe AS patients who underwent TAVR with Venus A-Valve or overseas devices between April 2012 and January 2019 in West China Hospital of Sichuan University.ResultsA total of 342 AS patients undergoing TAVR were finally included, 238 with Venus A-Valve and the other 104 with overseas devices (43 with CoreValve, 33 with Lotus, 21 with SAPIEN XT, and 7 with SAPIEN 3). Baseline characteristics were comparable between the two groups, and the proportion of patients with bicuspid aortic valve was around 50% in both groups. After successful valve implantation, all patients’ hemodynamics were significantly improved, with the median of maximum velocity decreased to 2.30 m/s (inter-quartile range: 0.60 m/s) and 2.50 m/s (inter-quartile range: 0.62 m/s), respectively (P=0.003). Postprocedural 30-day and 1-year all cause mortalities were similar (30-day: 5.9% vs. 1.9%, P=0.086; 1-year: 8.4% vs. 5.8%, P=0.307), while low incidence of procedure-related complications and improved life quality were achieved in both groups.ConclusionTAVR with the domestic Venus A-Valve is feasible, safe, and can produce favorable outcomes for AS patients, and especially for Chinese TAVR population with a high prevalence of bicuspid aortic valve.
This article described the clinical diagnosis and treatment of a patient with bicuspid aortic stenosis occurring severe mitral regurgitation during transcatheter aortic valve replacement. Before transcatheter aortic valve replacement, the patient’s information about medical history, signs, evaluation of CT and echocardiography were collected. After discussion by the heart team, the trans-femoral aortic valve replacement was performed. After the valve was placed during the procedure, a severe mitral regurgitation occurred. No clear causes were found, and the patient’s hemodynamics was stable. The patient recovered well during follow-up, so surgery and other treatments were not considered. This article discussed the possible mechanism and solutions of mitral regurgitation during transcatheter aortic valve replacement, and owned certain value for similar cases to refer to.
Due to the lack of calcification of the aortic valve, it is difficult to provide effective support for the fixation of artificial valve in aortic stenosis characterized by leaflet thickening. There is a risk of postoperative perivalvular leakage and secondary valve implantation, which is widely regarded as a relative contraindication for transcatheter aortic valve replacement (TAVR). But aortic valvuloplasty and self-expanding transcatheter aortic valve has showed its safety and efficacy. This paper reports a patient with bicuspid aortic valve characterized by leaflet thickening treated with TAVR. After the operation, the patient’s symptom of exertional dyspnea was significantly improved, New York Heart Association class increased to Ⅱ, no perivalvular leakage was found, and the mean transaortic pressure gradient and the maximum aortic valve velocity decreased significantly.
Objective To compare the efficacy and safety of transcatheter aortic valve replacement (TAVR) in aortic stenosis patients with bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV). Methods This retrospective study included 252 consecutive patients with severe and symptomatic aortic valve stenosis undergoing TAVR in West China Hospital form April 2012 to September 2017, in whom 4 patients were excluded because of valve failure after surgical aortic valve replacement. Results Of the 248 patients, 131 had BAV and 117 had TAV. Baseline characteristics were similar between the two groups, including age [(73.56±6.35) vs. (74.31±6.35) years, P=0.354], male proportion (51.9% vs. 63.2%, P=0.072). Society of Thoracic Surgeons score for BAV patients was lower than that for TAV patients [(7.56±4.01)% vs. (8.78±5.14)%, P=0.037]. Procedural success rate was high in both BAV and TAV groups (95.4% vs. 98.3%, P=0.359). There was no difference in 30-day all-cause mortality (6.1% vs. 2.6%, P=0.176) between the two groups; the aortic valve maximum velocity of valve hemodynamics after TAVR was similiar [(2.39±0.53) vs. (2.31±0.45) m/s, P=0.262] between the two groups. Conclusions Patients with BAV show similar procedural and clinical outcomes to patients with TAV. Therefore, TAVR appears to be a safe and effective procedure for patients with BAV as well as those with TAV.
A 78-year-old female patient was admitted to West China Hospital of Sichuan University because of “amaurosis and polypnea for 4+ years”. The examination results before admission showed that severe stenosis of aortic valve, bicuspid aortic valve malformation, severe horizontal heart with 61.54° aortic angle. The preoperative evaluation of the patient indicated that the Society of Thoracic Surgeons score was 17.9%, which was high risk for surgery. After discussion by the heart team, the aortic stenosis was finally relieved by transcatheter aortic valve replacement. The operation was successfully completed by using the method of pulling and releasing the device with the same side basket. One month follow-up showed that the patient’s condition was stable and no complications occurred. This case aims to provide a reference for the treatment of horizontal heart with aortic stenosis. In the future, it is hoped that through continuous clinical practice, such patients will be provided with a safer and more efficient treatment plan.
Aortic stenosis accounts for a large proportion of valvular heart disease in China. This article described an unusual case of severe aortic stenosis with severe cardiopulmonary decompensation treated by emergency transcatheter aortic valve replacement. Preoperative assessment was performed by transesophageal echocardiography. The extracorporeal membrane oxygenation team was informed to be ready. During the operation, no obvious perivalve leakage was observed after valve released. The transvalvular pressure gradient decreased to 7 mm Hg (1 mm Hg=0.133 kPa).The patient’s symptoms were completely relieved after the operation, and no adverse events occurred during the hospitalization. After discharge, color Doppler echocardiography showed that stenosis was eliminated, cardiac function was improved, no significant perivalvular leakage was observed, and pulmonary hypertension reduced to moderate. The success of this operation confirmed the efficacy of emergency transcatheter aortic valve replacement, and showed that after a rigorous evaluation, emergency transcatheter aortic valve replacement may be a reasonable choice for patients with severe aortic valve stenosis.
Transcatheter aortic valve replacement (TAVR) is a mature technology. Because of the complicated valvular anatomy and the severe non-symmetrical valve calcification, the patient with bicuspid aortic valve stenosis (BAVs) once having a lower procedure successful rate, was considered as the relative contradiction for TAVR. However, with the application of the skirted and retrievable next generation prosthesis system, the outcomes of the treatment have been greatly improved. In this article, we summarized the current situation of TAVR applied in BAVs, and the outcomes difference of the old and new generation prosthesis systems.
This article reports a patient diagnosed with severe aortic stenosis. After admission, the cardiac multidisciplinary team performed transcatheter aortic valve replacement (TAVR) emergently due to its unstable hemodynamics. The procedure was successful, and the initial cardiogram during the operation after TAVR suggested that the stenosis was greatly improved. But gradually the next day bedside echocardiography suggested that the transvalvular pressure difference increased and the prosthetic valve forward blood flow accelerated. Acute valve thrombosis after TAVR was taken into consideration. Warfarin and heparin were administrated for anticoagulation, after which the pressure difference across the valve and the forward blood flow rate of the artificial valve were evenly improved.