In recent years, transcatheter aortic valve replacement (TAVR) has developed rapidly in China, and the number and quality of operations have increased significantly. TAVR has become an important treatment strategy for patients with severe aortic stenosis and regurgitation following surgical aortic valve replacement. Prosthesis-patient mismatch (PPM) is one of the main complications after TAVR, but the incidence of TAVR-related PPM is significantly lower than surgical aortic valve replacement. Most studies believe that PPM has no significant effect on the clinical prognosis of most patients after TAVR, and only increases postoperative mortality in a specific population. This article will review the incidence, influencing factors, impact on clinical prognosis and related coping strategies of PPM after TAVR.
Objective To investigate and evaluate the safety and effectiveness of the Chimney technique in mitral valve reoperation. Methods The clinical data of mitral valve reoperation patients who underwent Chimney surgery in Wuhan Asia Heart Hospital from 2019 to 2021 were retrospectively analyzed. Results A total of 26 patients were collected, including 7 males and 19 females, aged 27-67 (53.46±11.18) years. All patients had previous mitral valve surgery, including 23 mitral valve replacements and 3 mitral valve repairs. All patients received Chimney technique using the ideal artificial sized mitral valve, and 1 patient died of neurological complications in hospital. The cardiopulmonary bypass time and the aortic cross-clamping time were 231.11±77.05 min and 148.50±52.70 min, respectively. The mean diameter of the implanted mitral valve prosthesis was 29.08±0.68 mm, which was statistically different from pre-replacement valve prosthesis size of 26.69±0.77 mm (P＜0.001). The mean transvalvular pressure gradient of the prosthetic mitral valve measured on postoperative echocardiography was 14.77±5.34 mm Hg, which was statistically different from preoperative value of 20.92±9.83 mm Hg (P=0.005). Conclusion The Chimney technique is safe and effective for reoperation in patients with small mitral annuli, which can not only reduce the risk of reoperation, but also obtain larger prosthetic valve implants with good hemodynamic characteristics and clinical outcomes.
Objective To investigate and evaluate the safety and efficacy of the aortic-mitral annular enlargement technique (double annular enlargement) in patients with small-size valve prostheses after prior valve surgery. MethodsThe clinical data of patients who underwent double valve annular enlargement in Wuhan Asia Heart Hospital from April 2020 to April 2022 were retrospectively analyzed. Results A total of 30 patients were collected, including 2 males and 28 females aged 9-78 (52.71±3.53) years. All patients had previous heart valve surgery, including 1 patient receiving the third heart surgery. All patients were operated on successfully and there were no postoperative in-hospital deaths. There was no postoperative bleeding which needed a secondary open-chest hemostasis, and one patient underwent permanent pacemaker implantation due to postoperative sick sinus syndrome. The mean diameter of the implanted prosthetic aortic valve was 24.23±1.60 mm, which was significantly larger than that of the preoperative aortic valve (21.03±1.90 mm, P＜0.001). The mean diameter of the implanted prosthetic mitral valve was 28.33±1.21 mm, which was significantly larger than that of the preoperative mitral valve (25.43±0.84 mm, P＜0.001). The mean peak gradient difference across the prosthetic aortic valve on postoperative echocardiography was 18.17±6.44 mm Hg, which was significantly lower than that of the preoperative aortic valve (82.57±24.48 mm Hg, P＜0.001). The mean peak gradient difference of the postoperative prosthetic mitral valve was 12.73±5.45 mm Hg, which was significantly lower than that of the preoperative mitral valve (19.43±8.97 mm Hg, P=0.003). Conclusion The double annular enlargement technique is safe and effective for reoperation in patients with a history of valve surgery with a small aortic root to obtain both a larger size prosthetic valve for a larger orifice area and stability of the mitral-aortic valve union, resulting in good postoperative hemodynamic characteristics and clinical outcomes.