| Objective:To describe the morphology of severe aortic stenosis(AS)in Chinese patients and its impact on sizing strategies and outcomes of transcatheter aortic valve replacement(TAVR).Methods:Patients with severe AS who underwent multi-detector computed tomographic(MDCT)imaging prior to TAVR were consecutively enrolled from 2012 to 2019.The anatomy and morphology of the aortic root were assessed.Primary outcome was device success rate of TAVR and secondary outcomes included VARC-3 clinical outcomes.Results:A total of 293 patients were enrolled.Among them,95 patients(32.42%)had bicuspid valve(BiAV).BiAV morphology were Sievers type 1 and Sievers type 0 in 49(51.58%)and 46(48.42%),respectively.The BiAV patients had significantly thicker leaflets than tricuspid valve(TriAV)ones(6.78±3.05 mm vs.5.03 ± 2.83 mm,p<0.001).Calcium distributed mostly on the leaflets level.The HU-850 calcium volume of BiAV patients were more severe as compared to TriAV ones[581.30 mm3(IQR:417.50-934.95 mm3)vs.358.45 mm3(IQR:206.40-668.40 mm3),p(0.001].“Downsize”strategy was performed in 198 patients(67.58%)who received self-expanding transcatheter heart valves(THVs).When compared with annulus-based sizing strategy,it achieved similar device success rate(80.02%vs.83.33%,p=0.79),and valve hemodynamic performance in the overall cohort as well as in BIAV and subtypes BiAV groupsConclusion:Chinese TAVR patients have more bicuspid morphology and severe leaflets calcification.Downsize sizing strategy provided a non-inferior device success rate and THV hemodynamic performance in self-expanding TAVR procedure,specially in BiAV patients.Objectives:To analyze the efficacy and safety of transcatheter aortic valve replacement(TAVR)for the treatment of severe symptomatic aortic valve stenosis in pa.tients with low coronary artery ostium height(≤10 mm).Evaluating the risk of coronary artery occlusion.Methods:A total of 622 patients who underwent TAVR in Fuwai Hospital from Dec.2012 to Dec.2021 were selected,including 556 patients with coronary artery ostium height>10 mm.66 patients with coronary artery ostium height.≤10 mm were included after preoperative imaging assessment to excluded the patients with high-risk of coronary artery occlusion.The clinical data,surgical methods and results of the selected patients were retrospectively analyzed.Results:The clinical baseline da.ta of the two groups were similar.Technical success rate(83.28%)was achieved.There was no significant difference.in the rate of second valve implantation,pacemaker implantation,death,stroke and incidence of serious vascular complications(P>0.05).The mean gradient was significantly reduced(P<0.01)and the aortic valve area was significantly expanded(P<0.01),with no statistical difference between the two groups(P>0.05).There wa.s no significant difference in the incidence of coronary artery occlusion between the two groups(0.72%vs.0,P=0.49).Patients with coronary a.rtery ostium height,10 mm need more coronary a.rtery protection[6.06%vs.1.44%,P<0.01].No patients had coronary artery occlusion,perioperative death,stroke or other complications after coronary artery protection.Conclusions:Patients underwent careful image assessment with low coronary artery height who underwent transcatheter aortic valve replacement is safe and effective.It is a feasible method to evaluate coronary artery occlusion risk in patients wi th low coronary artery height combined wi th morphological characteristics,coronary artery ostium level,valve leaflet characteristics and sinus width.Appropriate coronary artery protection in patients with hi gh-risk of coronary artery occlusion can efficiently prevent coronary artery occlusion.Objective:The purpose of this study was to access the safety and efficacy of transcarotid transcatheter aortic valve replacement(TAVR).Methods:The clinical data of 21 symptomatic severe aortic valve stenosis patients who had high or prohibitive risk for surgery and suitable for transcarotid TAVR in Fuwai hospital,Airforce medical military university Xijing hospital,The second affiliated hospital of Nanchang university,The first affiliated hospital of Dalian medical university,Beijing Hospital from September 2017 to February 2019 were retrospectively analyzed.The patients were followed up to observe the safety and efficacy of the procedure.Results:There were13 male and 8 female patients in this cohort,and age was 58-91(72.8+8.5)years old.20 patients were treated by right carotid artery approach.One patient developed carotid artery hematoncus after the procedure,and was fully recovered.Two patients were implanted with permanent pacemaker because of third degree atrioventricular block during the procedure.TAVR procedure was successful in all patients.All patients were followed up at(30±7)days after the procedure,and there were no adverse events.There was no moderate or severe paravalvular leakage.Echocardiography examination showed that LVEF was increased 1 month after the procedure(61.44%±6.48%vs 51.90%±13.17%,P<0.05),the transvalvular mean gradient was reduced at 1 week after procedure and 1 month after procedure[(14.90±8.03)mm Hg(1mmHg=0.133kPa)vs(59.48±22.43)mmHg,P<0.01,(13.11±8.45)mmHg vs(59.48±22.43)mmHg,P<0.01].Conclusion:Our result indicates that transcarotid TAVR is safe and effective for patients with severe aortic valve stenosis.Objective:To analyze the efficacy and safety of balloon dilated transcatheter aortic valve replacement(TAVR)in patients with severe symptomatic aortic valve stenosis.Methods:Patients who underwent TAVR surgery with balloon dilated aortic valve in a single center of Fuwai Hospital from December 2012 to December 2020 were selected,and the clinical data,surgical methods and outcomes of the admitted patients were retrospectively analyzed.Results:A total of 51 patients were included in the study,including 20 cases of SAPIEN XT(SXT)prosthetic valve implantation,31 cases of SAPIEN 3(S3)prosthetic valve implantation,and 26 cases of male patients(50.98%),with an average age of(77.51±6.42)years,and an average risk of STS death of(5.2+2.2)%.The mean follow-up time of patients was 1011.51 days.The all-cause mortality was 12.72%,and was lower in S3 patients than SXT patients(3.23%vs.25%,P=0.03).The success rate of early operation was higher(94.12%).The early safety end point was 86.27%,higher in S3 group(93.55%vs.75.00%,P<0.05).The mean inter-valve pressure difference of the patient after surgery was significantly reduced,the valve opening area was significantly expanded,and no moderate or above perivalvular leakage was observed.The patient’ s left ventricular ejection fraction was significantly improved after surgery,and presented a continuous trend of increase,while the left ventricular end diastolic diameter was progressively reduced.No structural valve degeneration was found in the mid-term follow-up.Conclusion:TAVR is safe and effective in the treatment of balloon dilated cardiac valve,especially the new generation S3 system.The hemodynamics of the patient improved significantly,and mid-term ultrasound follow-up indicated that the valve had no structural function degradation. |
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