Safety and efficacy of transcatheter tricuspid valve replacement with LuX-Valve in patients with severe tricuspid regurgitation / 中华心血管病杂志

Objectives: To evaluate the safety and efficacy of LuX-Valve on the treatment of severe tricuspid regurgitation (TR). Methods: This is a prospective observational study. From September 2018 to March 2019, 12 patients with severe TR, who were not suitable for surgery, received LuX-Valve implantation in Changhai Hospital. LuX-Valve was implanted under general anesthesia and the guidance of transesophageal echocardiography and X-ray fluoroscopy. Access to the tricuspid valve was achieved via a minimally invasive thoracotomy and transatrial approach. Main endpoints were surgery success and device success. Surgery success was defined as successful implanting the device and withdrawing the delivery system, positioning the valve correctly and stably without severe or life-threatening adverse events. Device success was defined as satisfied valve function (TR severity reduction ≥ 2 grades, tricuspid gradient ≤ 6 mmHg (1 mmHg=0.133 kPa)), absence of malposition, valve failure and reintervention, major adverse events including device related mortality, embolization, conduction system disturbances and new onset shunt across ventricular septum at day 30 post implantation. Results: A total of 12 patients with severe to torrential TR were included in this study. The age was (68.5±6.9) years and 7 were female. All patients had typical right heart failure symptoms. Procedural success was achieved in all cases, there was no intraprocedural mortality or transfer to open surgery. TR significantly improved after LuX-Valve implantation (none/trivial in 8 patients, mild in 3 patients and moderate in 1 patient). The average device time was (9.2±4.2) minutes. Intensive care unit duration was 3.0 (2.0, 4.8) days. One patient died at postoperative day 18 due to non-surgery and device reasons. Transthoracic echocardiography at 30 days after operation showed that TR was significantly reduced (none/trivial in 8 patients, mild in 2 patients and moderate in 1 patient) and device success was achieved in 11 cases. All survived patients experienced a significant improvement in life quality with significantly improvement in New York Heart Association (NYHA) classification (Ⅰ and Ⅱ: 6/11 post operation vs. 0/11 before operation, P=0.012) and there were no device related complications in this patient cohort. Conclusions: LuX-Valve implantation is feasible, safe and effective for the treatment of patients with severe TR.

Two-dimensional echocardiography in evaluating left ventricular morphology and systolic function at early stage after transcatheter aortic valve implantation / 第二军医大学学报

Objective To monitor and analyze the cardiac morphology and functional status at early stage after transcatheter aortic valve implantation (TAVI) by two-dimensional echocardiography. Methods A total of 33 patients with TAVI were selected from Dec. 2017 to Dec. 2019 in the Department of Cardiovascular Surgery of our hospital. The age, gender, New York Heart Association (NYHA) cardiac function classification, previous cardiac surgery history, Society of Thoracic Surgeons (STS) score, surgical approach, complication, other basic data, as well as echocardiography data were collected before and after TAVI (0-2 months). Results Thirty-three patients met the inclusion criteria, including 20 patients with severe aortic stenosis (SAS group), eight patients with severe aortic regurgitation (SAR group), and five patients with SAS combined with SAR (combined group). In the early postoperative period, one patient in SAS group was hospitalized twice for heart failure aggravated by arrhythmia, four patients in SAS group had tiny perivalvular leakage and one patient had large perivalvular leakage; moderate perivalvular leakage occurred in one patient in SAR group, and mild perivalvular leakage occurred in one patient in the combined group. Compared with the preoperative values, early after operation 33 cases had decreased left ventricular end-diastolic volume (LVEDV), left atrial volume (LAV), and maximum aortic valve pressure gradient (AVPGmax), increased effective aortic valve area (AVA) (all P0.01), and unchanged left ventricular ejection fraction (LVEF), interventricular septum thickness (IVST), and posterior wall thickness (PWT) significantly (all P0.05). In SAS group, LVEF and AVA increased, while LAV and AVPGmax decreased significantly (P0.05 or P0.01). In SAR group, LVEDV and LAV decreased, while IVST increased significantly (P0.05 or P0.01). In combined group, LVEDV, LAV and AVPGmax decreased, while AVA increased significantly (P0.05 or P0.01). Conclusion Early after TAVI, the cardiac remodeling and systolic function are improved to different degrees in patients with SAS, SAR, and SAS combined with SAR. High risk patients with SAR alone or combined with SAS can benefit from TAVI.

Electrocardiogram during perioperative period of transcatheter aortic valve replacement: Characteristics and clinical implications / 第二军医大学学报

Objective: To summarize the characteristics and clinical implications of electrocardiogram (ECG) during the perioperative period of transcatheter aortic valve replacement (TAVR). Methods: From Dec. 2017 to Dec. 2018, 20 patients with severe aortic valve stenosis or severe aortic valve insufficiency who underwent TAVR were admitted to Department of Cardiovascular Surgery of our hospital. Eight cases had transapical aortic valve implantation with J-Valve self-expandable valves and 12 cases had transfemoral aortic valve implantation with Venus-A self-expandable valves. Arrhythmia incidence was analyzed based on the ECG results during perioperative period. Results: All the 20 cases were complicated with severe heart failure (New York Heart Association classification of cardiac function III-IV). The mean age of patients was (77.8 ± 4.9) years. TAVR was successfully performed in all the 20 patients. The mean follow-up period was (8.0 ± 3.1) months. In the Venus-A self-expandable valve group, there were 2 cases of new onset grade III atrioventricular block (resolved 7-12 d postoperatively), 6 cases of new onset left bundle branch block (LBBB), and 2 cases of new onset right bundle branch block (RBBB). In J-Valve self-expandable valve group, there were 4 cases of new onset LBBB, 2 cases of new onset RBBB and 3 cases of multifocal ventrical tachycardia plus ventricular premature beat. Conclusion: New onset LBBB arrhythmia has a high incidence during the perioperative period of TAVR.