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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 valve annulus and sinus-tube joint diameters in normal adults of Chinese Han ethnic group

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Chinese Medical Journal 2008年第12期121卷 1093-1095页

作者： ZHU Dan ZHAO Qiang Shanghai Institute of Cardiovascular Diseases Zhongshan Hospital Fudan University Shanghai 200032 China

Background The anatomic value of the aortic root is important for aortic valve repair. This study was to determine the normal diameters of the aortic valve annulus （AVA） and sinus-tube joint （STJ） in the healthy adults of Chinese Han ethnic group, and to provide a morphological foundation for potential clinical application.Methods Echocardiography was performed in 326 normal subjects, who were divided into 5 groups according to their age. The diameters of the AVA and STJ were measured in the parasternal long-axis view, and normalized to body surface area （BSA）. They were averaged for each age group and for each gender. Differences were then determined between the normalized diameters for each age group and for both genders. Pearson＇s product-moment correlation coefficient was used to determine the differences between AVA and STJ diameters. It was also used to determine any positive or negative correlations between the above two variables and age. BSA, weight, and height.Results The diameters of the AVA and STJ of Han nationality patients increased with an increase in age, BSA, weight, and height. The correlation coefficient between AVA diameter and BSA was 0.4944 （P 〈0.0001）, between AVA diameter and age, 0.1138 （P〈0.05）, between AVA diameter and weight, 0.4521 （P〈0.001）, and between AVA diameter and height, 0.4713 （P 〈0.001）. The correlation coefficient between STJ diameter and BSA was 0.3910 （P 〈0.0001）, between STJ diameter and age, 0.3667 （P 〈0.0001）, between STJ diameter and weight, 0.4586 （P 〈0.0001）, and between STJ diameter and height, 0.3736 （P 〈0.0001）. The difference between the above two diameters was statistically significant at 2.42±2.45 mm （paired t-test; t=-17.25; P 〈0.0001）. AVA and STJ diameters were similar in both genders of each group when indexed to BSA.Conclusions The diameters of the AVA and STJ of adults of Chinese Han ethnic group increase with age, BSA, weight, and height. The diameters of the AVA and the STJ are similar in both genders, when indexed to BSA. The diameter of the AV

关键词： aortic valve anatomy echocardiography

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An unusual anterior mitral leaflet perforation in a patient with no infective endocarditis:a case report

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Emergency and Critical Care Medicine 2024年第1期4卷 39-41页

作者： Kaiming Wei Yu Yao Chuanzhen Liu Yuan Cao Department of Cardiovascular Surgery Qilu Hospital of Shandong UniversityJinanShandongChina Department of Emergency Medicine Qilu Hospital of Shandong UniversityJinanShandongChina National Key Laboratory for Innovation and Transformation of Luobing Theory The Key Laboratory of Cardiovascular Remodeling and Function ResearchChinese Ministry of EducationChinese National Health Commission and Chinese Academy of Medical SciencesDepartment of CardiologyQilu Hospital of Shandong UniversityJinanShandongChina.

Background:Mitral valve perforation refers to the occurrence of cracks or openings in the structure of the mitral valve,allowing blood to escape through these gaps.Typically,this is caused by infective endocarditis and the most common site is the anterior leaflet.However,it is crucial to explore other potential causes of valve damage,particularly when conventional risk factors are not apparent.Case presentation:We present a case of a middle-aged male patient who developed mitral valve perforation because of aortic valve regurgitation in the absence of infective endocarditis.Conclusion:Exploring such rare cases contributes to a deeper understanding of valvular diseases and enhances clinical decision making for effective management.

关键词： Anterior mitral leaflet aortic valve Case report Perforation Prolapse Regurgitation

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Percutaneous aortic valve replacement using a W-model valved stent： a preliminary feasibility study in sheep

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Chinese Medical Journal 2009年第6期122卷 655-658页

作者： BAI Yuan ZONG Gang-jun WANG Yan-yan JIANG Hai-bin LI Wei-ping WU Hong ZHAO Xian-xian QIN Yong-wen Department of Cardiology Changhai Hospital Second Military Medical University Shanghai 200433 China Department of Ultrasonography Changhai Hospital Second Military Medical University Shanghai 200433 China Department of Cardiology 101 Hospital of PLA Wuxi Jiangsu 210044 China Department of' Internal' Medicine Zhongshan Hospital Fudan University Shanghai 200032 China

Background Percutaneous aortic valve replacement is a promising strategy in the treatment of patients with aortic valve stenosis. And many kinds of valved stents have been implanted in selected patients worldwide. However, the clinical experience is still limited. We developed a W-model valved stent and evaluated the feasibility and safety of percutaneous implantation of the device in the native aortic valve position.Methods A self expanding nitinol stent with W-model, containing porcine pericardium valves in its proximal part, was implanted in six sheep by means of a 14 French catheter through the right common iliac artery under guidance of fluoroscopy. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded. These sheep were followed up shortly after procedure with supra-aortic angiogram and left ventriculography. Additionally, one sheep was sacrificed after the procedure for anatomic evaluation.Results It was possible to replace the aortic valve in the beating heart in four sheep. The procedure failed in two sheep due to coronary orifice occlusion in one case and severe aortic valve regurgitation in the other case. One sheep was killed one hour after percutaneous aortic valve replacement for anatomic evaluation. There were no signs of damage of the aortic JntJma, or of obstruction of the coronary orifice,Conclusions Percutaneous aortic valve replacement with a W-model valved stent in the beating heart is possible. Further studies are mandatory to assess safety and efficacy of this kind of valved stent in larger sample size and by longer follow-up period.

关键词： percutaneous aortic valve valved stent bioprosthesis

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Characteristics and outcomes following transcatheter aortic valve replacement in China:a report from China aortic valve transcatheter replacement registry(CARRY)

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Chinese Medical Journal 2021年第22期134卷 2678-2684页

作者： Yi-Ming Li Tian-Yuan Xiong Kai Xu Zhen-Fei Fang Lei Jiang Jun Jin Sheng-Hu He Yi-Ning Yang Jing-Jing He Yu-Heng Jia Yi Zhang Yong Peng Yuan Feng Mao Chen Department of Cardiology West China HospitalSichuan UniversityChengduSichuan 610041China Department of Cardiology General Hospital of Northern Theater CommandShenyangLiaoning 110000China Department of Cardiology The Second Xiangya Hospital of Central South UniversityChangshaHunan 410013China Department of Cardiology The Affiliated Hospital of Qingdao UniversityQingdaoShandong 266000China Department of Cardiology Xinqiao Hospital of Third Military Medical UniversityChongqing 400037China Department of Cardiology Subei People’s HospitalYangzhouJiangsu 225001China Department of Cardiology The First Affiliated Hospital of Xinjiang Medical UniversityWulumuqiXinjiang 830011China.

Background:The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement(TAVR)and a subsequent paradigm shift in the contemporary management of severe aortic stenosis(AS).We conducted a multi-centric TAVR registry based on Chinese patients(the China aortic valve tRanscatheter Replacement registrY[CARRY])to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions.Methods:CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site.Seven hospitals in China participated in the CARRY,and 1204 patients from April 2012 to November 2020 were included.Categorical variables were compared using the chi-squared test,and continuous variables were analyzed using a t test or analysis of variance(ANOVA)test.The Kaplan–Meier curve was used to estimate the risk of adverse events during follow-up.Results:The mean age of the patients was 73.8±6.5 years and 57.2%were male.The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0(3.7–8.9).Regarding the aortic valve,the proportion of bicuspid aortic valve(BAV)was 48.5%.During the hospital stay,the stroke rate was 0.7%,and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%.The in-hospital all-cause mortality rate was 2.2%.After 1 year,the overall mortality rate was 4.5%.Compared to patients with tricuspid aortic valve(TAV),those with BAV had similar in-hospital complication rates,but a lower incidence of in-hospital mortality(1.4%vs.3.3%)and 1 year mortality(2.3%vs.5.8%).Conclusions:TAVR candidates in China were younger,higher proportion of BAV,and had lower rates of post-procedural complications and mortality than other international all-comer registries.Given the use of early generation valves in the majorit

关键词： aortic stenosis aortic valve Transcatheter aortic valve replacement

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Bioprosthetic valve Size Selection to Optimize aortic valve ReplacementSurgical Outcome: A Fluid-Structure Interaction Modeling Study

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Computer Modeling in Engineering & Sciences 2021年第4期127卷 159-174页

作者： Caili Li Dalin Tang Jing Yao Christopher Baird Haoliang Sun Chanjuan Gong Luyao Ma Yanjuan Zhang Liang Wang Han Yu Chun Yang Yongfeng Shao School of Mathematics Southeast UniversityNanjing210096China School of Biological Science&Medical Engineering Southeast UniversityNanjing210096China Mathematical Sciences Department Worcester Polytechnic InstituteWorcesterMA 01609USA Department of Cardiology First Affiliated Hospital of Nanjing Medical UniversityNanjing210029China Department of Cardiac Surgery Boston Children’s HospitalHarvard Medical SchoolBostonMA 02115USA Department of Cardiovascular Surgery First Affiliated Hospital of Nanjing Medical UniversityNanjing210029China Department of Anesthesiology First Affiliated Hospital of Nanjing Medical UniversityNanjing210029China China Information Technology Designing&Consulting Institute Co. Ltd.Beijing100048China

aortic valve replacement(AVR)remains a major treatment option for patients with severe aortic valve disease.Clinical outcome of AVR is strongly dependent on implanted prosthetic valve size.Fluid-structure interaction(FSI)aortic root models were constructed to investigate the effect of valve size on hemodynamics of the implanted bioprosthetic valve and optimize the outcome of AVR surgery.FSI models with 4 sizes of bioprosthetic valves(19(No.19),21(No.21),23(No.23)and 25 mm(No.25))were constructed.Left ventricle outflow track flow data from one patient was collected and used as model flow conditions.Anisotropic Mooney–Rivlin models were used to describe mechanical properties of aortic valve leaflets.Blood flow pressure,velocity,systolic valve orifice pressure gradient(SVOPG),systolic cross-valve pressure difference(SCVPD),geometric orifice area,and flow shear stresses from the four valve models were compared.Our results indicated that larger valves led to lower transvalvular pressure gradient,which is linked to better post AVR outcome.Peak SVOPG,mean SCVPD and maximum velocity for valve No.25 were 48.17%,49.3%,and 44.60%lower than that from valve No.19,respectively.Geometric orifice area from valve No.25 was 52.03%higher than that from valve No.19(1.87 cm2 vs.1.23 cm2).Implantation of larger valves can significantly reduce mean flow shear stress on valve leaflets.Our initial results suggested that larger valve size may lead to improved hemodynamic performance and valve cardiac function post AVR.More patient studies are needed to validate our findings.

关键词： Fluid-structure interaction aortic valve aortic valve replacement bioprosthetic valve prosthesis–patient mismatch

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Preliminary feasibility and hemodynamic performance of a newlydeveloped self-expanding bioprosthesis and 16-F delivery system in transcatheter aortic valve implantation in sheep

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The Journal of Biomedical Research 2012年第3期26卷 211-218页

作者： Jing Cai Yanhui Sheng Shijiang Zhang Wei Sun Rong Yang Liping Miao Xiangqing Kong Department of Cardiology the First Affiliated Hospital Nanjing Medical University Nanjing Jiangsu 210029 China. Department of Cardiac Surgery the First Affiliated Hospital Nanjing Medical University Nanjing Jiangsu 210029 China.

We sought to evaluate the feasibility and hemodynamic performance of a new self-expanding bioprosthesis and 16-F delivery system in sheep. A 23-mm new self-expanding aortic bioprosthesis was implanted in sheep （n = 10） with a 16-F catheter via the right common carotid artery, Each sheep underwent angiography and coronary angiography before intervention, immediately and 1 h after stent implantation. Electrocardiographic monitoring was carded out during and 2 h after the procedure. Transthoracic echocardiography was employed to detect he- modynamic performance before intervention, immediately and 1 and 2 h after stent implantation. All sheep were euthanized 2 h after successful implantation for macroscopic inspection. In all cases, the new self-expanding aortic bioprosthesis was successfully delivered to the aortic root and released with a 16-F catheter. Successful implantation was achieved in 8 of 10 sheep. Hemodynamic performance and device position of successful implantation were stable 2 h after device deployment. Atrioventricular block was not observed. We conclude that it is feasible to implant the new self-expanding aortic valve with a 16-F delivery system into sheep hearts via the retrograde route.

关键词： percutaneous self-expanding bioprothesis aortic valve sheep

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Vascular complications of transcatheter aortic valve replacement:A concise literature review

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World Journal of Cardiology 2017年第7期9卷 574-582页

作者： Muhammad Ali Chaudhry Muhammad Rizwan Sardar Aultman Hospital North-Eastern Ohio UniversityCantonOH 44710United States

Transcatheter aortic valve replacement(TAVR) is a relatively newer therapeutic modality which offers a promising alternative to surgical aortic valve replacement for patients with prohibitive, high and intermediate surgical risk. The increasing trend to pursue TAVR in these patients has also led to growing awareness of the associated potential vascular complications. The significant impact of these complications on eventual clinical outcome and mortality makes prompt recognition and timely management a critical factor in TAVR patients. We hereby present a concise review with emphasis on diverse vascular complications associated with TAVR and their effective management to improve overall clinical outcomes.

关键词： Vascular Transcatheter aortic valve Concise Review

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The Structural Impact of aortic valve Replacement on Mitral Regurgitation

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World Journal of Cardiovascular Surgery 2016年第2期6卷 19-24页

作者： Conor F. Hynes Dominic A. Emerson Michael D. Greenberg Federico E. Mordini Gregory D. Trachiotis Division of Cardiothoracic Surgery Veterans Affairs Medical Center Washington DC USA Division of Cardiology Veterans Affairs Medical Center Washington DC USA Division of Cardiothoracic Surgery The George Washington University Washington DC USA

Background: Structural changes to the mitral annulus occur following aortic valve replacement (AVR) for severe aortic stenosis which may influence functional mitral regurgitation (MR). Methods: A retrospective review of 44 patients who underwent open AVR for aortic stenosis at a single center from 2010-2013 was performed. Patients undergoing concomitant aortic root surgery or with severe MR were excluded. MR was evaluated with preoperative and postoperative transthoracic echocardiograms. Univariate and multivariable analyses were performed to assess for factors associated with postoperative MR improvement and worsening. Results: Prior to AVR, none had severe MR, 5% (2 patients) had moderate, 9% (4 patients) mild-to-moderate, 46% (20 patients) mild, and 23% (9 patients) trace MR. Of patients with pre-operative MR, 44% (16 patients) experienced improvement of MR. Six patients had worsening of MR and the remaining 22 patients had no change. Cases of more severe MR were more likely to improve compared with mild or trace MR (P = 0.04). MR worsening was significantly more likely in patients with bicuspid aortic valves (83% vs. 24%;P = 0.004), and with larger aortic annulus diameters (P = 0.03). MR worsening was less frequent in cases of mitral annular calcification (0% vs 42%;P = 0.04) and left atrial enlargement (17% vs 65%;P = 0.03). Logistic regression analysis revealed negative predictors for MR improvement were mitral annular calcification (P = 0.04) and larger aortic annulus diastolic diameter (P = 0.05). Conclusion: Structural factors such as aortic annular size, mitral annular calcification and valve morphology may impact MR following AVR and should be investigated further as potential targets of surgical therapy.

关键词： aortic valve Replacement Cardiac Anatomy/Pathologic Anatomy Mitral Regurgitation

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Transcatheter aortic valve Dislocation in Left Ventricular Outflow Tract with Successful Repositioning Using “Double Snare” Technique

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International Journal of Clinical Medicine 2021年第1期12卷 7-13页

作者： Matjaž Bunc Luka Vitez Simon Terseglav Tadej Žlahtič Gian Paolo Ussia Clinical Department for Cardiology University Medical Centre Ljubljana Ljubljana Slovenia Department of Medicine Interventional Cardiology Unit University Campus Bio-Medico of Rome Rome Italy

Background: Transcatheter aortic valve implantation (TAVI) is a widely used treatment of severe aortic stenosis. Implantation of a self-expanding valve into a dense calcified aortic annulus can be challenging and may result in device malposition and malfunction. Aim: The aim of our case report is to present a novel technique of transcatheter aortic valve dislocation treatment. Case presentation: An 86-year-old woman with severely calcified aortic valve underwent TAVI using a 27-mm self-expanding Portico valve (Abbott Vasc, USA). In the last phase of implantation, the valve dislocated deep into the left ventricular outflow tract resulting in significant paravalvular regurgitation and patient instability. Repositioning of the valve with a single snare was ineffective because of severe aortic ring calcifications. A novel “double snare” technique was applied and the valve was successfully repositioned upward with an excellent anatomic and haemodynamic result. Conclusion: “Double snare” technique can be an effective strategy for repositioning of deeply implanted self-expanding transcatheter aortic valves. It represents an efficient bailout strategy in case of single snare approach failure, especially in cases of severe aortic ring calcifications.

关键词： aortic valve Transcatheter aortic valve Replacement Complications aortic valve Stenosis

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