The main purpose of this study is to observe and analyze the characteristics and the clinical significance of long-term echocardiogram data in patients after mechanical aortic valve replacement operation. Fifty-five cases were recruited over 5 years after mechanical aortic valve replacement operation, with complete echocardiogram examination profiles. The 55 subjects were divided into predominate aortic stenosis group and predominate aortic regurgitation group, based on preoperative examinations. And another way of division was also carried out that according to the effective orifice area index (EOAI), the subjects were divided into three groups, i.e., severe prosthesis-patient mismatch (PPM) group, moderate PPM group, and non PPM group. Characteristics of long-term echocardiogram data of the subjects were analyzed. Patients with aortic stenosis showed significantly decreased thickness of intraventricular septum and left ventricular posterior wall about half a year after operation (P<0.05). Half a year after operation, patients with aortic regurgitation showed decreased left ventricular internal dimension diastole and left ventricular internal dimension systole, and increased ejection fraction (P<0.05). Differences in mean aortic valve pressure gradient, forward blood flow across the aortic valves, and ejection fraction were not significant among those with severe PPM, moderate PPM, and non PPM groups (P>0.05). Number of cases of ascending aorta dimension increased as time goes on and pathogenesis of other valve diseases. A conclusion could be drawn that the heart function of patients with aortic valve disease could be improved after mechanical aortic valve replacement operation, but pathologies in other valves and ascending aorta might be increased, and therefore periodical postoperative echocardiogram evaluation with long tem pharmaceutical therapy could be necessary.
Objective To search and review the best clinical evidence to compare the clinical therapeutic effects and safety between TAVR and SAVR, thereby guiding its clinical use and providing references of treatments for such patients. Methods EMbase (1974～2016), MEDLINE (1996～2016) and The Cochrane Library (Issue 5, 2016) were systematically retrieved to collect randomized control trials, case-control studies and meta-analyses. Then, we assessed the quality of all the evidences to develop treatments based on those evidences and the situations of such patients. Results We identified 21 articles, including 2 articles of meta-analysis. With regard to the mortality and incidence of cardiovascular events, TAVR was not worse than SAVR. In addition, TAVR was more dominant than SAVR for patients who combined more basic diseases. Conclusion TAVR is one of the effective treatments for most patients with severe AS after sufficient assessment.
The first aortic valve repair was performed in 1958, but the clinical outcome was limited. Since the invention of prosthetic valves, aortic valve replacement has become and still maintained the dominated surgical treatment option. As the impact of the prosthetic valve-related event to quality of life of the patients and the studies of the mechanism of aortic regurgitation and the functional anatomy of aortic root grow, the application of aortic valve repair gets more popular, and the short- and mid-term outcomes are good.
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.
ObjectiveTo systematically review the efficiency and safety of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis at intermediate-low risk compared with surgical aortic valve replacement (SAVR).MethodsTwo researchers searched literatures independently in databases including PubMed, Embase, Scopus, Cochrane Library, China Biology Medicine disc, China National Knowledge Internet, VIP database for studies published from January 2012 to October 2017, then screened for propriate studies, collected information from different follow-up period all on the principle of Cocharan handbook. At last statistal analysis was performed in RevMan 5.3 to calculate relative risk (RR) and its 95% confidence interval (CI).ResultsThirteen studies were enrolled in this Meta-analysis with 10 753 patients, including 5 263 cases in TAVR group and 5 490 cases in SAVR group. Meta-analysis showed that there were no statistically significant differences in all-cause mortality between TAVR group and SAVR group in 30 days, 1 year or 2 years after operation [RR=0.96, 95%CI (0.75, 1.24), P=0.78; RR=0.84, 95%CI (0.68, 1.03), P=0.09; RR=0.97, 95%CI (0.84, 1.14), P=0.75]; while stroke more preferred SAVR no matter 30 days or 1 year [RR=0.64, 95%CI (0.51, 0.80), P<0.000 1;RR=0.76, 95%CI (0.63, 0.92), P=0.004].ConclusionThere is no significant difference in all-cause mortality of intermediate-low risk patients undergoing TAVR and SAVR, but TAVR perfoms better in terms of srtoke.
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.
Transcatheter aortic valve replacement (TAVR) has been a crucial treatment for elder patients with aortic stenosis in developed countries, which is still at its beginning in China. TAVR is a risky and complicated technic; and to promise the long-term development of it, we need to build a multiple disciplinary heart team consisted of doctors from different specialties and guided by various disciplines, also to guarantee the team operates well. In order to help Chinese doctors understand heart team well, this article describes component parts and requirement for each member of the team, in aspect of cardiologist, cardiac surgeon, echocardiologist, radiologist, anesthesiologist and nursing team; and discuss team operation mechanism through pre-procedural evaluation, procedural cooperation, peri-procedural management and post-procedural follow-up.
Valvular heart disease (VHD) is a common cardiac disease. Patients with severe VHD have a poor prognosis. With the development of minimal invasive treatments in VHD, especially with the wide application of transcatheter aortic valve replacement in aortic stenosis, these diseases have been regained attention. The disease spectrum and modes of treatment have also changed. However, we currently lack a large population-based VHD-related epidemiologic study in China. In this article, we will summarize the current status of VHD in China using available epidemiologic data.
Transcatheter aortic valve replacement (TAVR) developed rapidly since firstly introduced to clinical practice in 2002. In 2015, Experts Consensus for Transeatheter Aortic Valve Replacement (abbreviated as the Consensus) helped TAVR develop normatively and safely in China. This article interpreted the Consensus in combination of new evolutions of TAVR field: first, the indications of TAVR expand from inoperative and high risk patients to the intermediate risk patients; second, although the Consensus recommended pre-dilation with balloon of modest size, the necessity of pre-dilation is under debate; third, the Consensus pointed out main complications of TAVR, and the main strategies to avoid complications are careful pre-procedural analysis and development of new device; fourth, our experts had made outstanding contribution to TAVR in the treatment of patients with bicuspid aortic valve, which still has many problems to be solved urgently.
Transcatheter aortic valve replacement (TAVR) is an emerging alternative for the treatment of aortic stenosis (AS). Evidence from clinical trials sprang up continuously, and guidelines have listed TAVR as an alternative for part of AS patients. Although old guidelines only recommended TAVR for surgical high-risk or in-operable AS patients, the latest guidelines have expanded its indications enormously. Moreover, there are ongoing TAVR studies on low-risk patients, asymptomatic patients, pure aortic regurgitation patients, bicuspid aortic valve patients,etc. It is believed that the indication of TAVR will continue to expand. More and more patients will benefit from TAVR in the foreseeable future.