Modified Bentall procedure with mitral valve replacement in a patient with Marfan syndrome: a case report

Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder characterized by fibrillin-1 protein abnormalities, predisposing individuals to cardiovascular complications such as aortic root dilation and mitral valve prolapse (MVP). Management often requires surgical intervention, with the modified Bentall procedure being a standard approach for aortic root replacement. However, managing concomitant mitral valve pathology poses additional challenges due to the complex anatomical relationship between the two valves and the prolonged nature of the procedure. We present a case report of a 35-year-old male with Marfan syndrome who underwent a successful simultaneous modified Bentall procedure and mitral valve replacement for concurrent aortic root aneurysm and mitral valve prolapse. Surgical interventions involved meticulous attention to detail to mitigate risks associated with malpositioned coronary ostial sutures, debridement of the severely calcified mitral valve, and achieving hemostasis. Following surgery, the patient exhibited favorable postoperative outcomes, with evidence of optimal valve function and improved systolic and diastolic parameters, indicative of a successful recovery.

Válvulas de rápido implante versus válvulas tradicionales en reemplazo valvular aórtico en pacientes de riesgo intermedio / Rapid-Deployment Valve versus Conventional Valves in Aortic Valve Replacement in Intermediate-Risk Patients

RESUMEN Introducción: El reemplazo valvular aórtico (RVA) en pacientes con riesgo quirúrgico intermedio (RI) es el más desafiante al momento de decidir el tipo de prótesis a utilizar. Las válvulas de rápido implante (RD-V) serían una alternativa a considerar en este grupo específico. Objetivos: Comparar mortalidad temprana, complicaciones postoperatorias y parámetros hemodinámicos transvalvulares en el RVA con válvulas tradicionales vs. RD-V en pacientes de RI. Material y métodos: Estudio retrospectivo y observacional de pacientes consecutivos de RI (STS-PROM 4-8) intervenidos por RVA con prótesis tradicionales y RD-V en el período 2007-2023. Resultados: Se incluyeron 205 pacientes (140 con prótesis tradicionales vs. 65 con RD-V). El riesgo preoperatorio fue semejante en ambos grupos (STS-PROM 5,07% vs. 5,7%, p=0,210). El abordaje miniinvasivo fue más frecuente en RD-V (32,3% vs 0,7%, p<0,001). El tiempo de circulación extracorpórea y clampeo fue significativamente menor en RD-V (134,5 vs.100 min y 104 vs 73 min respectivamente, p<0,001). Hubo tendencia a menor implante de marcapasos con las válvulas tradicionales (4,3% vs. 10,8%, p=0,075). No se observaron diferencias significativas en las complicaciones postoperatorias; hubo fuerte tendencia a menor mortalidad a los 30 días con RD-V (0% vs. 5,7% para válvulas tradicionales, p=0,057). El gradiente protésico medio postoperatorio fue significativamente menor para el grupo RD-V (7,90±3,3 mmHg vs. 12,74±6,07 mmHg, p<0,001). No hubo diferencias respecto a incidencia de trombosis valvular o endocarditis protésica. Conclusiones: Las válvulas de rápido implante presentaron tendencia a menor mortalidad, menor tiempo de circulación extracorpórea/clampeo, mejor perfil hemodinámico y mayor facilidad de implante por abordaje miniinvasivo.

ABSTRACT Background: Aortic valve replacement (AVR) in intermediate-risk (IR) patients is particularly challenging when determining the type of prosthesis to use. Rapid-deployment valves (RD-V) are emerging as a potential alternative in this patient population. Objectives: To compare early mortality, postoperative complications, and transvalvular hemodynamic parameters between AVR with conventional valves and RD-V in IR patients. Methods: We conducted a retrospective observational study of consecutive IR patients (STS-Prom score 4-8) undergoing AVR with conventional prostheses and RD-V between 2007 and 2023. Results: A total of 205 patients were included (140 AVR vs. 65 RD-V). Surgical risk was similar between both groups (STS-Prom 5.07 % vs. 5.7 % respectively, p = 0.210). The minimally invasive approach was more common in the RD-V group (32.3% vs. 0.7%, p < 0.001). The cardiopulmonary bypass time and aortic cross-clamp time was significantly shorter in the RD-V group (134.5 vs. 100 min and 104 vs. 73 min, respectively, p < 0.001). There was a trend to lower incidence of pacemaker implantation in the conventional valve group (4.3% vs. 10.8%, p = 0.075). There were no significant differences in postoperative complications, and a strong trend to lower 30-dat mortality with RD-V (0% vs. 5.7% for conventional valves, p = 0.057). The mean postoperative gradient across the prosthesis was significantly lower in the RD-V group (7.90 ± 3.3 mm Hg vs. 12.74 ± 6.07 mm Hg, p < 0.001). There were no differences in the incidence of valve thrombosis or prosthetic endocarditis. Conclusions: Rapid deployment valves demonstrated trend to lower mortality, shorter cardiopulmonary bypass time and aortic cross-clamp time, improved hemodynamic profile, and were easier to implant via a minimally invasive approach.

Curva de Aprendizagem da Mortalidade Hospitalar da Substituição da Válvula Aórtica Transcateter: Insights do Registro Nacional Brasileiro / Learning Curve for In-Hospital Mortality of Transcatheter Aortic Valve Replacement: Insights from the Brazilian National Registry

Resumo Fundamento Dados robustos sobre a curva de aprendizagem (LC) da substituição da válvula aórtica transcateter (TAVR) são escassos nos países em desenvolvimento. Objetivo Avaliar a LC da TAVR no Brasil ao longo do tempo. Métodos Analisamos dados do registro brasileiro de TAVR de 2008 a 2023. Pacientes de cada centro foram numerados cronologicamente em número sequencial de caso (NSC). A LC foi realizada usando um spline cúbico restrito ajustado para o EuroSCORE-II e o uso de próteses de nova geração. Ainda, os desfechos hospitalares foram comparados entre grupos definidos de acordo com o nível de experiência, com base no NSC: 1º ao 40º caso (experiência inicial), 41º ao 80º caso (experiência básica), 81º ao 120º caso (experiência intermediária) e 121º caso em diante (experiência alta). Análises adicionais foram conduzidas de acordo com o número de casos tratados antes de 2014 (>40 e ≤40 procedimentos). O nível de significância adotado foi p <0,05. Resultados Foram incluídos 3194 pacientes de 25 centros. A idade média foi 80,7±8,1 anos e o EuroSCORE II médio foi 7±7,1. A análise da LC demonstrou uma queda na mortalidade hospitalar ajustada após o tratamento de 40 pacientes. Um patamar de nivelamento na curva foi observado após o caso 118. A mortalidade hospitalar entre os grupos foi 8,6%, 7,7%, 5,9%, e 3,7% para experiência inicial, básica, intermediária e alta, respectivamente (p<0,001). A experiência alta foi preditora independente de mortalidade mais baixa (OR 0,57, p=0,013 vs. experiência inicial). Centros com baixo volume de casos antes de 2014 não mostraram uma redução significativa na probabilidade de morte com o ganho de experiência, enquanto centros com alto volume de casos antes de 2014 apresentaram uma melhora contínua após o caso de número 10. Conclusão Observou-se um fenômeno de LC para a mortalidade hospitalar do TAVR no Brasil. Esse efeito foi mais pronunciado em centros que trataram seus 40 primeiros casos antes de 2014 que naqueles que o fizeram após 2014.

Abstract Background Robust data on the learning curve (LC) of transcatheter aortic valve replacement (TAVR) are lacking in developing countries. Objective To assess TAVR's LC in Brazil over time. Methods We analyzed data from the Brazilian TAVR registry from 2008 to 2023. Patients from each center were numbered chronologically in case sequence numbers (CSNs). LC was performed using restricted cubic splines adjusted for EuroSCORE-II and the use of new-generation prostheses. Also, in-hospital outcomes were compared between groups defined according to the level of experience based on the CSN: 1st to 40th (initial-experience), 41st to 80th (early-experience), 81st to 120th (intermediate-experience), and over 121st (high-experience). Additional analysis was performed grouping hospitals according to the number of cases treated before 2014 (>40 and ≤40 procedures). The level of significance adopted was <0.05. Results A total of 3,194 patients from 25 centers were included. Mean age and EuroSCORE II were 80.7±8.1 years and 7±7.1, respectively. LC analysis demonstrated a drop in adjusted in-hospital mortality after treating 40 patients. A leveling off of the curve was observed after case #118. In-hospital mortality across the groups was 8.6%, 7.7%, 5.9%, and 3.7% for initial-, early-, intermediate-, and high-experience, respectively (p<0.001). High experience independently predicted lower mortality (OR 0.57, p=0.013 vs. initial experience). Low-volume centers before 2014 showed no significant decrease in the likelihood of death with gained experience, whereas high-volume centers had a continuous improvement after case #10. Conclusion A TAVR LC phenomenon was observed for in-hospital mortality in Brazil. This effect was more pronounced in centers that treated their first 40 cases before 2014 than those that reached this milestone after 2014.

Factores predictivos negativos para hemorragia mayor en posoperados de cambio valvular aórtico por minitoracotomía / Negative predictors of major bleeding in postoperative aortic valve replacement via mini-thoracotomy

Resumen Introducción: La estenosis aórtica es la valvulopatía más común y requiere tratamiento quirúrgico. Las técnicas quirúrgicas mínimamente invasivas han surgido como alternativas a la esternotomía media tradicional. Objetivo: Analizar los posibles factores de riesgo asociados a la hemorragia mayor a lo habitual en pacientes sometidos a cambio valvular aórtico por minitoracotomía anterior derecha, y compartir los resultados encontrados en nuestro centro. Materiales y método: Se llevó a cabo un estudio observacional, longitudinal y retrospectivo con pacientes operados por minitoracotomía anterior derecha entre julio de 2015 a diciembre de 2022. Se recopilaron datos demográficos y clínicos, así como información sobre las variables generales y quirúrgicas relevantes. Resultados: Se observó una edad media de 58 años en los pacientes estudiados, con una mayor presencia de hombres menores de 65 años. De los pacientes estudiados, solo 3 (4.47%) presentaron hemorragia mayor a lo habitual. Se encontró una asociación entre la edad avanzada y el tiempo de circulación extracorpórea (minutos) con hemorragia mayor a lo habitual. Conclusiones: Los resultados del estudio indican que la incidencia de hemorragia mayor a lo habitual fue baja en la cirugía mínimamente invasiva realizada. La edad avanzada y el tiempo prolongado de circulación extracorpórea se identificaron como factores de riesgo significativos para hemorragia mayor a lo habitual. Sin embargo, se destaca la necesidad de realizar estudios con una muestra más amplia para comprender mejor estos factores y la seguridad de la cirugía mínimamente invasiva.

Abstract Introduction: Aortic stenosis is the most common valvular heart disease requiring surgical treatment. Minimally invasive surgical techniques have emerged as alternatives to traditional median sternotomy. Objective: To analyze the possible risk factors associated with major bleeding in patients undergoing aortic valve replacement via right anterior mini-thoracotomy and to share the results found in our center. Materials and methods: A retrospective, observational, longitudinal study was conducted in patients undergoing right anterior mini-thoracotomy from July 2015 to December 2022. Demographic and clinical data, as well as relevant surgical and echocardiographic variables, were collected. Results: The mean age of the study population had a mean age of 58 years, with a predominance of men under 65 years of age. Only three patients experienced major bleeding 4.47%. Advanced age and extracorporeal circulation time (minutes) were associated with bleeding. No significant differences were found in other variables analyzed. Conclusions: The study results indicate a low rate of postoperative bleeding in minimally invasive surgery. Advanced age and prolonged extracorporeal circulation time were identified as significant risk factors for major bleeding. However, further studies with a larger sample size are needed to better understand these factors and the safety of minimally invasive surgery.

Observation of the prophylactic use of prokinetic agents in patients after tricuspid valve replacement under cardiopulmonary bypass / 药学实践与服务

Objective To analyze the postoperative therapeutic effect of prokinetic agents in patients after tricuspid valve replacement （TVR） under cardiopulmonary bypass. Methods Patients received TVR under cardiopulmonary bypass （during June 2010 to December 2021） in the department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University were selected as the subjects of our study. The data of basic characteristics, first postoperative defecation time and postoperative recovery condition were collected and retrospectively analyzed in the patients taking prokinetic agents within three days after surgery （prevention group） and patients not taking prokinetic agents within three days after surgery （control group）. Results A total of 184 patients were selected, including 101 in the prevention group and 83 in the control group. The first defecation time of patients in the prevention group was significantly earlier than that in the control group （P<0.05）. The incidences of abdominal distension and pulmonary infection in the prevention group were significantly lower than that in the control group. The length of time in ICU, postoperative mechanical ventilation and nasogastric tube decompression in the prevention group were significantly shorter than that in the control group （P<0.05）. Conclusion Taking prokinetic agents within three days after TVR under cardiopulmonary bypass could effectively improve the prognosis of patients.

Outcome analysis of functional mitral regurgitation after transcatheter aortic valve replacement in patients with severe bicuspid aortic stenosis / 复旦学报（医学版）

Objective To explore the relationship between the types of bicuspid aortic valves(BAV)and the outcome of functional mitral regurgitation(FMR)and the affecting factors of FMR.Methods From Jun 2018 to Sep 2022,patients with severe BAV aortic valve stenosis(AS)complicated with FMR underwent post transcatheter aortic valve replacement(TAVR)in Zhongshan Hospital,Fudan University were retrospectively analyzed.The baseline information and imaging data of different BAV patients were collected.Logistic regression was used to analyze the factors affecting the outcome of FMR(improvement and non-improvement).Result A total of 100 patients with TAVR were included,including 49 patients with type 0 of BAV and 51 patients with type 1 of BAV.Compared with patients of type 1,patients of type 0 had younger age[(72.78±6.09)y vs.(77.00±8.35)y,P=0.050],lower male ratio(47%vs.73%,P= 0.009)higher BMI[(23.19±2.62)kg/m2 vs.(21.99±3.13)kg/m2,P=0.041],and lower incidence of aortic regurgitation(69%vs.92%,P=0.040).Compared with the non-improvement group,the improvement group had a lower incidence of coronary heart disease(5%vs.18%,P=0.042),higher incidence of pulmonary hypertension(20%vs.2%,P=0.007),larger left ventricular diastolic diameter[(51.98±6.74)mm vs.(48.04±7.72)mm,P=0.009]and higher maximum flow velocity[(4.86±0.95)cm/s vs.(4.47±0.75)cm/s,P= 0.023]of the aortic valve.The results of Logistic regression analysis showed that preoperative pulmonary hypertension,left ventricular end-diastolic diameter and maximum valvular flow velocity of BAV patients were the potential affecting factors of FMR improvement after TAVR.Conclusion No significant difference was found in FMR improvement between BAV patients of type 0 and type 1 after TAVR.For BAV patients with AS,preoperative pulmonary hypertension,larger left ventricular end-diastolic diameter,and faster aortic valve flow velocity were associated with higher FMR improvement rate.

A one-stop comparative study of CTA scan delay protocol for TAVI/TAVR patients / 西安交通大学学报(医学版)

Objective To compare the effect of preoperative CTA examination using group injection test and group injection tracking delay protocol on image quality in patients with transcatheter aortic valve implantation(TAVI)/transcatheter aortic valve replacement(TAVR).Methods A total of 43 patients who underwent TAVI/TAVR preoperative one-stop CTA examination in our hospital were randomly divided into two groups,and preoperative CTA examination was performed using group injection tracking and group injection test.After the scanning was completed,the aortic root sinus(C1),the proximal left and right coronary arteries(C2,C3),the ascending aorta(A1),the abdominal aorta(A2),the left and right femoral arteries(A3,A4),and the CT value and SD value of the paraspinal muscles of the same layer were measured;the signal-to-noise ratio(SNR)and contrast-to-noise ratio(CNR)of the corresponding parts were calculated.The obtained data results were compared and analyzed from both subjective and objective aspects.Results There was no significant difference in image quality between the two groups in the aortic root sinus(C1),the proximal left and right coronary arteries(C2,C3),or the ascending aorta(A1)(P＞0.05).At the renal artery level,there was a significant difference in image quality between the abdominal aorta(A2)and the left and right femoral artery levels(A3,A4)(P＜0.05).Conclusion In the preoperative one-stop CTA examination of TAVI/TAVR patients,the CTA images below the renal artery level can obtain better image quality than the group injection tracking method.

Influencing factors of delirium after cardiac valve replacement under cardiopulmonary bypass with propofol sedation / 新乡医学院学报

Objective To investigate the influencing factors of delirium after cardiac valve replacement went under car-diopulmonary bypass(CPB)with propofol sedation.Methods A total of 152 patients underwent cardiac valve replacement under CPB in Nanyang Central Hospital from January 2020 to December 2022 were selected as research objects,and they were randomly divided into observation group A[50 ≤bispectral index(BIS)＜60]and observation group B(35≤BIS＜45)according to the depth of propofol sedation,with 76 cases in each group.The clinical data such as age,gender,body mass index(BMI),diabetes,hypertension,coronary heart disease,chronic obstructive pulmonary disease,sleep disorder,nutritional disorder,anxiety,depression,smoking history,drinking history,preoperative cardiac insufficiency,intraoperative hypoxemia,intraoperative hypoproteinemia,postoperative acute renal injury,secondary intubation,massive blood transfusion,excessive pain,postoperative left ventricular ejection fraction(LVEF),surgical method and CPB time were collected,and the incidence of postoperative delirium of patients was evaluated by the confusion assessment method of intensive care unit(CAM-ICU)method.The incidence of postoperative delirium of patients between observation group A and observation group B was compared.The influencing factors of postoperative delirium occurrence was analyzed by using univariate and multivariate logis-tic regression analysis.Results Among the 152 patients underwent heart valve replacement,36 patients experienced postoperative delirium,with an incidence of 23.68％.The incidence of postoperative delirium of patients in the observation group A and the observation group B was 38.16％(29/76),9.21％(7/76),respectively;the incidence of postoperative delirium of patients in the observation group A was significantly higher than that in the observation group B(x2=17.617,P＜0.05).The gender,BMI,diabetes,hypertension,coronary heart disease,cognitive disorder,sleep disorder,nutritional disorder,anxiety,depression,smoking history,drinking history,intraoperative hypoxemia,intraoperative hypoproteinemia,postoperative acute renal injury,secondary intubation,massive blood transfusion,and surgical method were not related to postoperative delirium(P＞0.05);the age,chronic obstructive pulmonary disease,preoperative heart failure,excessive pain,postoperative LVEF,and CPB time were associated with postoperative delirium(P＜0.05).Multivariate logistic regression analysis showed that age 60 years,preoperative cardiac dysfunction,excessive pain,and CPB time≥100 minutes were risk factors for postoperative delirium(P＜0.05),while postoperative LVEF≤50％and propofol sedation depth of 35≤BIS＜45 were protective factors for postoperative delirium(P＜0.05).Conclusion Propofol sedation depth of 35≤BIS＜45,postoperative LVEF ≥50％can effectively reduce the risk of postoperative delirium after cardiac valve replacement under CPB.Age≥60 years old,preoperative cardiac insufficiency,excessive pain,and CPB time≥100 min can increase the risk of postoperative delirium.

Short-term effects of dapagliflozin on non-diabetic patients with severe aortic stenosis after tran-scatheter aortic valve replacement / 新乡医学院学报

Objective To investigate the short-term efficacy of dapagliflozin in the treatment of non-diabetic patients with severe aortic stenosis after transcatheter aortic valve replacement(TAVR).Methods A total of 84 non-diabetic patients with severe aortic stenosis after TAVR who were admitted to Zhengzhou Cardiovascular Hospital from March 2019 to September 2022 were selected as research subjects.According to the postoperative treatment,the patients were divided into control group and observation group,with 42 patients in each group.Patients in both groups underwent TAVR.The patients in the control group were given routine treatments such as antiplatelet drugs,cardiac remodeling improvement drugs,and diuretics after TAVR;patients in the observation group were given dapagliflozin 10 mg daily for 6 months in addition to treatment in the control group.The left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),aortic valve peak gradient(AVPG)and aortic valve peak velocity(AVPV)of patients in the two groups were measured by using an ultrasound diagnostic instrument before surgery,3 days and 6 months after TAVR;before surgery and 6 months after the TAVR,low-density lipoprotein cholesterol(LDL-C)in serum of patients in the two groups was detected by direct measurement method,lipoprotein a[Lp(a)]level in serum was detected by latex agglutination reaction method,hypersensitive C-reactive protein(hs-CRP)level in serum was detected by rate scattering turbidimetry;the levels of N-terminal pro B-type natriuretic peptide(NT-proBNP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and interleukin-1 β(IL-1 β)in serum were detected by using enzyme-linked immunosorbent assay;the glycated hemoglobin level of patients in the two groups was measured by ion exchange chromatography.Results There was no statistically significant difference in LVEF,LVESD and LVEDD of patients in the two groups before and 3 days after surgery(P＞0.05);after 3 days of surgery,the AVPG and AVPV of patients in the two groups were significantly lower than those before surgery(P＜0.05).Six months after surgery,the LVEF of patients in the two groups was significantly higher than that before and 3 days after surgery,while LVESD,LVEDD,AVPG and AVPV were significantly lower than those before and 3 days after surgery(P＜0.05).There was no statistically significant difference in LVEF,LVESD,LVEDD,AVPG and AVPV between the control group and the observation group before and 3 days after surgery(P＞0.05).After 6 months of surgery,the LVEF of patients in the observation group was significantly higher than that in the control group,while LVESD and LVEDD were significantly lower than those in the control group(P＜0.05);there was no statistically significant difference in AVPG and AVPV of patients between the observation group and control group(P＞0.05).Before surgery,there was no statistically significant difference in body mass index(BMI),LDL-C and Lp(a)of patients between the two groups(P＞0.05).Six months after surgery,the BMI,LDL-C and Lp(a)of patients in the two groups were significantly lower than those before surgery,and the BMI,LDL-C and Lp(a)of patients in the observation group were significantly lower than those in the control group(P＜0.05).Before surgery,there was no statistically significant difference in the hs-CRP,NT-proBNP,IL-6,TNF-α and IL-1 β of patients between the two groups(P＞0.05);six months after surgery,the hs-CRP,NT-proBNP,IL-6,TNF-α and IL-1 β of patients in the two groups were significantly lower than those before surgery,and the hs-CRP,NT-proBNP,IL-6,TNF-α and IL-lβ of patients in the observation group were significantly lower than those in the control group(P＜0.05).There was no statistically significant difference in glycated hemoglobin of patients between the two groups before and six months after surgery(P＞0.05),and no statistically significant difference in glycated hemoglobin of patients in the two groups six months after surgery compared with that before surgery(P＞0.05).Conclusion Dapagliflozin can effectively improve cardiac structural remodeling,regulate lipid metabolism,reduce the expression of inflammatory factors and promote the recovery of heart function in non-diabetic patients with severe aortic stenosis after TAVR.

Minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis through upper ministernotomy or right anterior thoracotomy / 中国胸心血管外科临床杂志

@#Objective To evaluate the clinical effect of minimally invasive aortic valve replacement with Perceval sutureless aortic bioprosthesis in upper ministernotomy or right anterior thoracotomy. Methods From March to November 2022, the patients with simple aortic valve disease were enrolled in the Department of Cardiovascular Surgery of West China Hospital, Sichuan University. After preoperative evaluation, Perceval sutureless bioprosthesis was successfully used to perform aortic valve replacement through the upper ministernotomy or right anterior thoracotomy. The perioperative clinical data and ultrasonic measurement data of all patients were recorded. Results A total of 5 patients with simple aortic valve disease were included, including 3 females and 2 males, with a mean age of 71.2 years. Perceval sutureless bioprosthesis was successfully implanted in 5 patients, with a success rate of 100%. There were 3 patients receiving upper ministernotomy and 2 patients receiving right anterior thoracotomy. Two patients underwent ascending aortic plasty at the same time. The mean cardiopulmonary bypass time was 61.0 min, and aortic cross-clamping time was 32.2 min. All patients were discharged successfully without perivalvular leakage, atrioventricular block or stroke. Conclusion The implantation method of Perceval sutureless bioprosthesis is simple, which can effectively reduce the perioperative risk by shortening the overall operation time, cardiopulmonary bypass time and aortic cross-clamping time. At the same time, its clinical application has promoted the development and popularization of minimally invasive aortic valve replacement, which together with Perceval sutureless bioprosthesis effectively combinates surgical effect and minimally invasive treatment, and has a good clinical application prospect because of its reliable safety and effectiveness.

Transcatheter aortic valve replacement (TAVR) annual report 2023 / 中国胸心血管外科临床杂志

@#Transcatheter aortic valve replacement (TAVR) has seen a surge in clinical research, basic research, and innovative device development both domestically and internationally in the previous 2023. This article aims to review the progress of TAVR in the past year from the perspectives of international, and domestic research development of application. It highlights new clinical and basic research findings both domestically and internationally, the emergence of new devices and technologies, and the development and use of TAVR in China. Finally, it provides an outlook on the trajectory of TAVR development in 2024.

Application of Chimney technique in mitral valve reoperation: A retrospective study in a single center / 中国胸心血管外科临床杂志

@#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.

Status and prospect of transcatheter valve-in-valve implantation for biological valve degeneration / 中国胸心血管外科临床杂志

@#Along with the coming of aged society, the prevalence of heart valvular disease is significantly increasing, and the use of bioprosthetic valves for treating patients with severe valve disease has increased over the last two decades. As a consequence, a growing number of patients with surgical bioprosthesis degeneration is predicted in the near future. In this setting, valve-in-valve (ViV) transcatheter aortic/mitral valve replacement (TAVR/TMVR) has emerged as an alternative to redo surgery. A deep knowledge of the mechanism and features of the failed bioprosthetic heart valve is pivotal to plan an adequate procedure. Multimodal imaging is fundamental in the diagnostic and pre-procedural phases. The immediate and mid-term clinical and hemodynamic results have demonstrated the safety and feasibility of ViV techniques, but the development of these techniques faces several specific challenges, such as coronary obstruction, potential post-procedural mismatch and leaflet thrombosis. This article reviews the current status and prospects of ViV-TAVR technology in the treatment for biological valve degeneration, and suggests that ViV-TAVR should be promoted and implemented in existing medical centers with good surgical aortic valve replacement experience, so as to provide better treatment for patients.

A Successful Case of Redo-Tricuspid Valve Replacement for Prosthetic Valve Endocarditis Thirty-Two Years after Single Tricuspid Bioprosthetic Valve Replacement / 日本心臓血管外科学会雑誌

We present a successful case of redo-tricuspid valve replacement for tricuspid prosthetic valve endocarditis. A 78-year-old man who underwent tricuspid bioprosthetic valve replacement for severe tricuspid regurgitation thirty-two years earlier was referred to our institution with persistent high fever and back pain. The blood culture was positive for Streptococcus oralis, and echocardiography revealed a mobile vegetation attached to the tricuspid prosthetic valve with moderate tricuspid regurgitation. A clinical diagnosis of prosthetic valve endocarditis was established. Redo-tricuspid bioprosthetic valve replacement was performed following antibiotics therapy. The patient was discharged on postoperative day 49 after 6 weeks of additional antibiotic treatment, and had no recurrence of infection for 6 months after redo-surgery.

A Case of Three Directional Cuff Leakage from the Stent Posts of an Inspilis RESILIA Aortic Valve during Surgical Aortic Replacement / 日本心臓血管外科学会雑誌

We present the case of a 72-year-old male with Inspiris RESILIA aortic valve (Inspiris) transvalvular leakage during surgical aortic valve replacement (AVR). The patient initially underwent AVR for aortic regurgitation with a bicuspid aortic valve at the age of 64. By the age of 72, the valve had deteriorated and it was assessed that redoing the AVR was necessary. The Inspiris was inserted in the supra-annular position using the non-everting mattress suture technique with a COR-KNOT. During weaning off from cardiopulmonary bypass, transesophageal echocardiography (TEE) captured unfamiliar turbulent flows from the three stent posts. Further TEE revealed that these flows originated from the base of the stent posts, which gradually decreased and disappeared by the end of the surgery after administration of protamine. The patient has been discharged uneventfully. Paravalvular leakage has not been observed during the postoperative course and we could not find TVL in TEE 2 months postoperatively. While considering the detailed mechanism, it is possible that there is no need for re-exploration concerning three directional TVL in the Inspiris.

Evaluation of the Aortic Root Using 3D-CT Following Aortic Valve Replacement Employing the Bo Yang Root Enlargement Technique / 日本心臓血管外科学会雑誌

A 65-year-old male was diagnosed with severe aortic stenosis with an indication for surgery and referred to our department. The patient opted for aortic valve replacement using a bioprosthesis. Due to the patient's relatively small native aortic valve area, a concurrent root dilatation maneuver (Bo Yang method) was performed to prevent patient-prosthetic mismatch and to allow for the implantation of a sufficiently larger bioprosthesis, facilitating the valve-in-valve procedure. The successful implantation of an Inspiris 25-mm bioprosthesis was achieved. Post-operative 3D-computed tomography revealed no tilting or misalignment of the bioprosthesis, and a properly sized, undistorted Valsalva sinus was observed. Aortic valve replacement using the Bo Yang root enlargement technique is considered a promising alternative for relatively younger patients requiring aortic valve intervention.

Progress of transcatheter aortic valve replacement in 2023 / 中国介入心脏病学杂志

Transcatheter aortic valve replacement(TAVR)has become one of the effective methods for treating patients with aortic valve disease.With the continuous maturity of technology,innovation of instruments and increasing experience,the indications for TAVR has been expanded.Following international trends,the number of TAVR in China has steadily increased with each passing year.In 2023,the long-term follow-up results of TAVR in low-risk AS patients further confirm the long-term benefits of TAVR.The relevant research on TAVR for patients with aortic regurgitation and patients with bicuspid aortic stenosis provide evidence support for the expansion of TAVR indications.At the same time,the development of valve devices and new technological innovations are emerging in an endless stream,and the new concept of full life cycle management is increasingly being valued.Especially in China,the development of local devices is progressing rapidly,and multiple devices have entered the clinical research stage.The clinical manifestations and research results are worth pursuing.

Prediction and risk factor analysis of new-onset conduction disturbance after transcatheter aortic valve replacement / 中国介入心脏病学杂志

Objective To explore the relevant factors of new-onset conduction disturbance(NOCD)after transcatheter aortic valve replacement(TAVR),such as anatomical structure,device type,surgical strategies,etc.,discover relevant predictive factors,and establish a predictive model to assess the risk of conduction blockages.Methods From January 2016 to March 2022,clinical data of symptomatic patients with severe aortic valve stenosis or severe regurgitation who underwent TAVR at Xiangya Second Hospital of Central South University were collected through the hospital information system and imaging database.ECG,echocardiography,CTA,surgical materials,etc.,were extracted and analyzed by specialists.SPSS software was used for statistical analysis,and a multi-factor regression prediction model for NOCDwas built.Results A total of 184 patients were included,the occurrence rate of NOCD after TAVR was 31.0%,pure regurgitation patients'NOCD occurrence rate was 63.6%(7/11).The NOCD group had a larger aortic angles[(57.7±10.3)°vs.(52.0±9.0)°,P＜0.001],larger Oversizing[(129±28)%vs.(120±21)%,P=0.018],deeper implantation depth[(7.2±5.1)mm vs.(4.8±4.2)mm,P=0.001],and higher pure regurgitation patients'proportion[12.3%vs.3.1%,P=0.037]than the non-NOCD group.Multifactorial Logistic regression analysis indicated that an aorta angle＞54.5°(OR 3.78,95%CI 1.86-7.63,P＜0.001)or implantation depth＞5.7 mm(OR 3.39,95%CI 1.68-6.85,P＜0.001)are independent risk factors for new onset conduction disturbances after TAVR,and a predictive model was established with aortic angle,implantation depth,and Oversizing ratio as variables.The receiver operating characteristics curve showed area under ROC curve 0.709,95%CI 0.623-0.795,predicting NOCD after TAVR.Conclusions A retrospective analysis carried out at a single center discovered that the aortic angle in the NOCD group was larger than that in the non-NOCD group,the Oversizing ratio was higher,the implantation location was deeper,and there was a higher proportion of patients with pure regurgitation lesions.An aortic angle greater than 54.5°or an implantation depth more than 5.7 mm were identified as independent risk factors for NOCD after TAVR.

New advances in stroke and cerebral embolism protection devices in transcatheter aortic valve replacement / 中国介入心脏病学杂志

Stroke is one of the most serious complications of transcatheter aortic valve replacement(TAVR),tremendously increasing mortality and the loss of neurocognitive function.Since TAVR is expected to further spread into lower-risk patient groups,there will be greater emphasis to obviate such serious complications.One possible technique for preventing stroke is using cerebral embolic protection devices(CEPDs).CEPDs are designed for capturing or deflecting emboli that are enter route to the brain and hence to protect the brain from embolism.Since this is a rapidly growing field with recent advances,and the impact of CEPD on preventing neurological events is still limited,there is an urgent need for understanding the role of CEPD in preventing clinically significant strokes.Although their clinical utilization is increasing,the risk factors for stroke related to TAVR and evidence for using CEPDs are not yet clear.In this review,we present an overview of the available literature on TAVR related stroke and CEPD,and outline recent advances within this field.