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Anatomical morphology of the aortic valve in Chinese aortic stenosis patients and clinical results after downsize strategy of transcatheter aortic valve replacement

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Chinese Medical Journal 2022年第24期135卷 2968-2975页

作者： Guannan Niu Walid Ben Ali Moyang Wang Hasan Jilaihawi Haitong Zhang Qian Zhang Yunqing Ye Xinmin Liu Jing Yao Qinghao Zhao Yubin Wang Zheng Zhou Lizhi Zhang Xinshuang Ren Yunqiang An Bin Lu Thomas Modine Yongjian Wu Guangyuan Song Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseaseChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100037China Structural Heart Intervention Program Department of SurgeryMontreal Heart InstituteMontreal H1T 1C8QuebecCanada Heart Valve Center NYU Langone HealthNew YorkNY 10016USA Interventional Center of Valvular Heart Disease Anzhen Hospital Affiliate of Capital University of Medical SciencesBeijing 100029China Eagles Corelab. YingKe Medical(Beijing)Co.LtdBeijing 100160China Department of Radiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Service Médico-Chirurgical:Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle Hôpital Cardiologique de Haut LévèqueCHU BordeauxBordeaux 33000France

Background:The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement(TAVR)for symptomatic severe aortic stenosis(AS),and the impact of sizing strategies and related procedural outcomes.Methods:Patients with severe AS who underwent TAVR were consecutively enrolled from 2012 to 2019.The anatomy and morphology of the aortic root were assessed."Downsize"strategy was preformed when patients had complex morphology.The clinical outcomes of patients who performed downsize strategy were compared with those received annular sizing strategy.The primary outcome was device success rate,and secondary outcomes included Valve Academic Research Consortium-3 clinical outcomes variables based on 1-year follow-up.Results:A total of 293 patients were enrolled.Among them,95 patients(32.4%)had bicuspid aortic valve.The calcium volume(Hounsfield Unit-850)of aortic root was 449.90(243.15-782.15)mm3.Calcium is distributed mostly on the leaflet level.Downsize strategy was performed in 204 patients(69.6%).Compared with the patients who performed annular sizing strategy,those received downsize strategy achieved a similar device success rate(82.0%[73]vs.83.3%[170],P=0.79).aortic valve gradients(downsize strategy group vs.annular sizing group,11.28 mmHg vs.11.88 mmHg,P=0.64)and percentages of patients with moderate or severe paravalvular regurgitation 2.0%(4/204)vs.4.5%(4/89),P=0.21were similar in the two groups at 30 days after TAVR.These echocardiographic results were sustainable for one year.Conclusions:Chinese TAVR patients have more prevalent bicuspid morphology and large calcium volume of aortic root.Calcium is distributed mostly on the leaflet level.Compare with annular sizing strategy,downsize strategy provided a non-inferior device success rate and transcatheter heart valve hemodynamic performance in self-expanding TAVR procedure.

关键词： aortic stenosis China Sizing strategy Transcatheter aortic valve replacement aortic valve Morphology

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aortic stenosis and Heyde’s syndrome:A comprehensive review

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World Journal of Clinical Cases 2021年第25期9卷 7319-7329页

作者： Dennisdhilak Lourdusamy Vamsee Krishna Mupparaju Navila Fahmida Sharif Uzoma N Ibebuogu Internal Medicine Methodist South HospitalMemphisTN 38116United States Internal Medicine University of Tennessee Health Science CenterMemphisTN 38103United States Cardiovascular Diseases University of Tennessee Health Science CenterMemphisTN 38163United States

Heyde’s syndrome is an under reported systemic disease of gastrointestinal and cardiac manifestation in older adults.It is characterized by a triad of aortic stenosis,angiodysplasia with bleeding and acquired von Willebrand syndrome.It is characterized by proteolysis of high molecular weight multimers of von Willebrand Factor and loss of platelet mediated homeostasis.Heyde’s syndrome is a treatable condition in most cases,especially in the current era of evolution in interventional cardiology and gastroenterology.There are currently no established guidelines in the management of this condition due to paucity of high quality studies,which warrant future trials.High index of suspicion and increasing the awareness of the syndrome among the general practitioners and sub-specialists will improve the diagnostic potential of Heyde’s syndrome.Future studies may change the management aspect of Heyde's syndrome and pave a path for drawing specific guidelines and algorithms.The aim of our review article is to summarize the basic pathophysiology,diagnostics and management of Heyde’s syndrome with a special attention to Transcatheter aortic valve replacement.

关键词： Heyde's syndrome aortic stenosis Angiodysplasia Transcatheter aortic valve replacement Gastrointestinal bleed Anti platelet

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Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement

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World Journal of Cardiology 2023年第5期15卷 253-261页

作者： Ramdas G Pai Padmini Varadarajan Department of Cardiology University of California Riverside School of MedicineRiverside/St.Bernardine Medical CenterSan BernardinoRiversideCA 92521United States Department of Cardiology University of California Riverside School of MedicineRiversideCA 92521United States

BACKGROUND Mitral regurgitation(MR)is commonly seen in patients with severe aortic stenosis(AS)undergoing aortic valve replacement(AVR).But the long-term implications of MR in AS are unknown.AIM To investigate MR’s impact on survival of patients undergoing surgical AVR for severe AS.METHODS Of the 740 consecutive patients with severe AS evaluated between 1993 and 2003,287 underwent AVR forming the study cohort.They were followed up to death or till the end of 2019.Chart reviews were performed for clinical,echocardiographic,and therapeutic data.MR was graded on a 1-4 scale.Mortality data was obtained from chart review and the Social Security Death Index.Survival was analyzed as a function of degree of MR.RESULTS The mean age of the severe AS patients who had AVR(n=287)was 72±13 years,46%women.Over up to 26 years of follow up,there were 201(70%)deaths,giving deep insights into the determinants of survival of severe AS who had AVR.The 5,10 and 20 years survival rates were 75%,45%and 25%respectively.Presence of MR was associated with higher mortality in a graded fashion(P=0.0003).MR was significantly associated with lower left ventricular(LV)ejection fraction and larger LV size.Impact of MR on mortality was partially mediated through lower LV ejection fraction and larger LV size.By Cox regression,MR,lower ejection fraction(EF)and larger LV end-systolic dimension were independent predictors of higher mortality(χ^(2)=33.2).CONCLUSION Presence of greater than 2+MR in patients with severe AS is independently associated with reduced survival in surgically managed patients,an effect incremental to reduced EF and larger LV size.We suggest that aortic valve intervention should be considered in severe AS patients when>2+MR occurs irrespective of EF or symptoms.

关键词： aortic stenosis Mitral regurgitation aortic valve replacement Long term survival

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Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis： a meta analysis

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Chinese Medical Journal 2013年第6期126卷 1171-1177页

作者： WU Yi-cheng ZHANG Jian-feng SHEN Wei-feng ZHAO Qiang Department of Cardiac Surgery Rui Jin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China Department of Cardiology Rui Jin Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200025 China

Background Transcatheter aortic valve implantation （TAVI） has emerged as the treatment choice for non-operable patients with severe symptomatic aortic stenosis （AS） and may be a good alternative to surgery for those at very high or prohibitive surgical risk. We performed a meta-analysis to evaluate the comparative benefits of TAVI versus surgical aortic valve replacement （SAVR） in patients with severe AS. Methods A comprehensive literature search of PubMed, Embase, ScienceDirect and Cochrane Central Register of Codtrolled trials was performed, and randomized trials as well as cohort studies with propensity score analysis were included. Results One randomized trial （n=699） and six retrospective cohort studies （n=781） were selected for meta-analysis. Mortality at 30-day and 1-year follow-up was comparable between TAVI and SAVR. Despite similar incidences of stroke, myocardial infarction, re-operation for bleeding, and renal failure requiring dialysis, TAVI was associated with a lower occurrence rate of new-onset atrial fibrillation （OR 0.51,95% CI 0.33-0.78） and shorter procedural time （mean difference -67.50 minutes, 95% CI -87.20 to -47.81 minutes）. Post-operative aortic regurgitation and permanent pacemaker implantation were more common in patients after TAVI than in those with SAVR （OR 5.53, 95% CI 3.41-8.97; OR 1.71, 95% CI 1.02-2.84, respectively）. Conclusion In patients with severe symptomatic AS, TAVI and SAVR did not differ with respect to short- and mid-term survival, but the incidence of permanent pacemaker implantation and post-procedural aortic regurgitation remain relatively high after TAVI.

关键词： aortic stenosis transcatheter aortic valve implantation surgery meta-analysis

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What is the real practice of exercise echocardiographic testing in asymptomatic patients with severe aortic stenosis？

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Chinese Medical Journal 2013年第24期126卷 4649-4654页

作者： Eun Jeong Cho Sung-Ji Park Jung-Eun Song Seol-Hwa Kim Yung-Joo Lee Ji-Hye Gakt Sung-A Chang Sang-Chol Lee Seung Woo Park Division of Cardiology Department of Internal MedicineCardiovascular Imaging Center Cardiac and Vascular CenterSamsung Medical Center Sungkyunkwan University School ofMedicine Seoul Republic of Korea

Background Although exercise testing has been suggested to help predict clinical outcome, limited data are available to guide how exercise Doppler echocardiography （ECG） can be used clinically in asymptomatic patients with aortic stenosis （AS）. The aim of this study was to assess the clinical value of exercise echocardiographic testing in asymptomatic patients with severe AS. Methods Symptom-limited treadmill exercise testing using the modified Bruce protocol was performed in 31 asymptomatic patients （mean age （62＋11） years） with severe AS （aortic valve area 〈1 cm2, peak aortic velocity （AV Vmax）〉4 m/sec, or a mean transaortic pressure gradient （AV mean PG）〉40 mmHg （1 mmHg=0.133 kPa）） with normal left ventricular （LV） systolic function （LV ejection fraction （EF）〉50%）. Clinical symptoms, vital signs, ECG, and Doppler hemodynamics were obtained during and/or immediately after exercise. Results aortic valve replacement （AVR） was performed in 18 patients during follow-up. The patients who had AVR exhibited higher baseline AV mean PG （51 （35-84） vs. 44 （25.2-57.0） mmHg; P=0.031）. There were no significant differences between the AVR group and non-AVR group including exercise duration （7.47 （2.32-11.59） vs. 7.25 （4.06- 10.52） minutes, P=0.917）, exercise capacity （10.1 （4.6-12.8） vs. 10.1 （7.0-12.8） metabolic equivalents, P=0.675）, and an increment in AV mean PG by exercise （18.5 （3.2-48.0） vs. 12.6 （4.4-32.1） mmHg, P=0.366）. Univariate regression analysis revealed that independent determinant of AVR was the baseline AV mean PG （P=-0.031）. Conclusions Although additional value of exercise ECG was demonstrated, baseline transaortic mean pressure gradient is the major determinant of AVR. Further large-scale prospective studies are required to determine whether surgery should be recommended in the presence of an abnormal exercise ECG in asymptomatic severe AS.

关键词： aortic stenosis exercise echocardiography asymptomatic, aortic valve replacement

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Current treatment status in patients with severe aortic valve stenosis and outcome of long term follow-up at advanced age： a Chinese single center study

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Chinese Medical Journal 2011年第18期124卷 2879-2882页

作者： PEI Han-jun WU Yong-jian YANG Yue-jin XU Bo CHEN Ji-lin QIAO Shu-bin LI Jian-jun QIN Xue-wen YAO Min YUAN Jin-qing CHEN Jue LIU Hai-bo YOU Shi-jie GAO Run-lin Department of Cardiology Cardiovascular Institute and Fu WaiHospital Chinese Academy of Medical Sciences and Peking UnionMedical College Beijing 100037 China

Background Surgical aortic valve replacement is the standard treatment for patients with severe aortic stenosis, but some registries have indicated that 30% to 60% of these patients are not treated surgically, usually due to advanced age and/or comorbidities. This single center study in China investigated the current treatment status in the patients with severe aortic stenosis and evaluated the long term clinical outcome in advanced age patients whether or not undergoing aortic valve replacement. Methods Clinical data of 867 consecutive patients with severe aortic stenosis between January 2000 and December 2006 were retrospectively analyzed. The patients 〉65 years old were followed up by telephone or information from medical records. The primary end-point was all-cause mortality. Results The patients＇ average age was （52±19） years （range, 1-91 years）, and 34% were women. The percentages of the patients aged 〈15 years, between 15 and 34 years, between 35 and 54 years, between 55 and 64 years, between 65 and 74 years, and 〉75 years who underwent surgical aortic valve replacement were 82.3%, 87.2%, 88.8%, 78.2%, 65.3% and 22.2% respectively. In the patients （n=256）〉65 years old, 43.4% had New York Heart Association class III and IV symptoms, 39.1% had hypertension, 33.2% had coronary heart disease, and 3.1% had stroke. In the patients not undergoing aortic valve replacement, 1.6% had renal insufficiency, 4.7% had chronic obstructive pulmonary disease, 2.0% had critical hematopathy, and 0.4% had mammary cancer. A total of 186 （72.7%） patients finished the follow-up, and the average duration of the follow-up was （60±2.6） months. In the patients between 65 and 74 years old, the total deaths and cardiac deaths in the patients undergoing aortic valve replacement decreased significantly compared with those with conservative treatment （10.3% vs. 53.7%, P 〈0.001 and 6.3% vs. 50.7%, P〈0.001）. Similarly, in the patients ≥75 years old, there was a significant difference between patients who had surgery and those who had conse

关键词： aortic stenosis aortic valve replacement advanced age comorbidity

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A meta-analysis of 1-year outcomes of transcatheter versus surgical aortic valve replacement in low-risk patients with severe aortic stenosis

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Journal of Geriatric Cardiology 2020年第1期17卷 43-50,I0008-I0010页

作者： Aaqib H Malik Syed Zaid Hasan Ahmad Joshua Goldberg Tanya Dutta Cenap Undemir Martin Cohen Wilbert S Aronow Steven L Lansman Department of Medicine Westchester Medical Center and New York Medical CollegeValhallaNYUSA Department of Cardiology Westchester Medical Center and New York Medical CollegeValhallaNYUSA Section of Cardiothoracic Surgery Department of SurgeryWestchester Medical CenterValhallaNew YorkUSA

Background Transcatheter aortic valve replacement(TAVR)for the treatment symptomatic severe aortic stenosis(AS)is indicated in patients with intermediate or higher surgical risk.Latest trials showed TAVR,and surgical aortic valve replacement(SAVR)perform similarly at 1-year for the composite outcomes of mortality,stroke and rehospitalization.We performed a comprehensive meta-analysis to compare individual outcomes at 1-year for TAVR compared to SAVR in low-risk patients.Methods Pub Med,Embase,and Cochrane central were searched for all the randomized controlled trials(RCTs)that reported 1-year comparative outcomes of TAVR and surgical aortic valve replacement(SAVR).Our conclusions are based upon the random-effects model using Der Simonian-Laird estimator.Results Data from 4 trials and 2887 randomized patients showed that TAVR had lower rates of all-cause mortality,cardiovascular mortality,and atrial fibrillation compared to SAVR at 1-year follow-up(P<0.05 for all).Also,TAVR was also associated with a significantly higher risk of permanent pacemaker implantation and moderate-severe paravalvular leak(P<0.05).Conclusions The latest randomised trial data demonstrates that in short-term,TAVR is safe and effective in reducing all-cause mortality or stroke.Longer follow-up of RCTs is needed to determine the durability of clinical benefits in TAVR over SAVR in low-risk patients.

关键词： aortic stenosis Low surgical risk Meta-analysis Transcatheter aortic valve replacement

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Measuring frailty in patients with severe aortic stenosis:a comparison of the edmonton frail scale with modified fried frailty assessment in patients undergoing transcatheter aortic valve replacement

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Journal of Geriatric Cardiology 2020年第7期17卷 441-446页

作者： Francisco J Romeo Maximiliano Smietniansky Mariela Cal Cristian Garmendia Juan M Valle Raleigh Ignacio MSeropian Mariano Falconi Pablo Oberti Vadim Kotowicz Carla RAgatiello Daniel H Berroca Division of Interventional Cardiology Hospital Italiano de Buenos AiresBuenos AiresArgentina Division of Internal Medicine and Geriatrics Hospital Italiano de Buenos AiresBuenos AiresArgentina Division Cardiology Hospital Italiano de Buenos AiresBuenos AiresArgentina Division of Cardiovascular Surgery Hospital Italiano de Buenos AiresBuenos AiresArgentina

Frailty is generally defined as a clinical syndrome of decreased physiologic reserve which drives to increased vulnerability and susceptibility to different stressors together with poor recovery to homeostasis.[1]The relevance of frailty status in a wide range of prospective cohorts is mostly related to an increasing burden in both mortality,hospital readmissions,disability,and falls.

关键词： aortic stenosis Frailty Transcatheter aortic valve replacement

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Evaluation of Patients with Severe aortic stenosis after TAVI with Self-Expandable vs. Balloon-Expandable Devices

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World Journal of Cardiovascular Diseases 2023年第10期13卷 633-645页

作者： Mohammad Nourizadeh Seifollah Abdi Farideh Roshan Ali Najmeh Assadinia Mehdi Nourizadeh Mohammad Emami Elham Barati Amir Taha Asarian Department of Interventional Cardiology Cardiovascular Intervention Research Center Rajaiee Cardiovascular Medical and Research Center Iran University of Medical Sciences Tehran Iran Fellowship of Echocardiography Department of Cardiology Cardiovascular Research Center Dey Hospital Tehran Iran Department of Pathology Masih Shahid Beheshti University of Medical Science Tehran Iran Cardiovascular Disease Research Center Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran Kings Bournemouth UK

Background: The introduction of transcatheter aortic valve implantation (TAVI) for the treatment of severe aortic stenosis (SAS) has expanded the therapeutic possibilities for successfully managing SAS in cases with intermediate and high surgical risks. However, the complications and outcomes of new devices have not been studied enough. Hence, the purpose of this study is to evaluate the midterm results of the Core Valve and Evolute R self-expandable (SE) devices versus the Edwards SAPIEN balloon-expandable (BE) devices. Methods and Material: This was a quasi-experimental study conducted in Tehran, Iran, from May 2012 to June 2017. SAS patients who were not ideal candidates for surgery were randomly assigned to either SE or BE groups. For each patient, a questionnaire, including four sections comprised of Basic characteristics, echocardiographic, angiographic, and Computed Tomography (CT) scan data was filled. TAVI was followed by echocardiography a week later and after three months they were reevaluated by another questionnaire. Results: The total number of patients was 60. The mean ages of patients undergoing the procedure with SE or BE devices were 81.2 ± 8 and 79.8 ± 7, respectively. Mortality occurred in 20% of the patients (5 cases in the SE group and 7 cases in the BE);mortality causes were 66.6 % cardiac and 33% non-cardiac. Moderate to severe Paravalvular leakage in both groups did not differ significantly. The mortality rate was 5 (41.6%) in the SE group versus 7 (58.3%) in the BE group (P > 0.05). Conclusion: In conclusion, the BE group did not experience fewer paravalvular leaks in comparison with the SE. Morbidity and mortality between the BE and the SE groups did not differ significantly.

关键词： TAVI Balloon-Expandable Valves Self-Expandable Valves Mortality aortic stenosis

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Combined Surgical Treatment of Atherosclerotic Coronary Artery Disease and Moderate aortic Valve stenosis in Patient with Concomitant Lipton’s R-III Type of Single Coronary Artery Anomaly

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Congenital Heart Disease 2021年第6期16卷 647-653页

作者： Milica Karadzic Kocica Hristina Ugrinovic Dejan Lazovic Nemanja Karamarkovic Milos Grujic Borivoje Lukic Oliver Radmili Vladimir Cvetic Mladen Kocica Centre for Anesthesiology and Reanimatology UC Clinical Centre of SerbiaBelgrade11000Serbia Clinic for Cardiac Surgery UC Clinical Centre of SerbiaBelgrade11000Serbia Clinic for Vascular and Endovascular Surgery UC Clinical Centre of SerbiaBelgrade11000Serbia

A single coronary artery is a very rare condition,commonly associated with other congenital anomalies.It could be generally considered as neither benign nor malignant form of congenital coronary artery anomalies since its pathophysiological and clinical implications grossly depend on different anatomical patterns defined by the site of origin and distribution of the branches.By presenting the patient who underwent successful coronary artery bypass grafting and aortic valve replacement surgery in a presence of isolated single coronary artery,we intend to emphasize natural and procedural risks and distinguish casual from causal in this extremely rare clinical and surgical scenario.

关键词： Single coronary artery aortic stenosis angina pectoris aortic valve surgery coronary artery bypass grafting surgery

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