Transcatheter aortic valve replacement has revolutionized the management of aortic stenosis and become the gold standard for the treatment of symptomatic and severe aortic valve stenosis in elderly patients. With the improvement in design and materials, newer generation transcatheter aortic valve prostheses had overcome the limitations of early-generation devices that were susceptible to paravalvular leak, atrioventricular block and vascular complications, to a certain extent. This review provides an update on the latest advances in transcatheter aortic valve prostheses.
An elderly female patient, with systemic multiple organ dysfunction, suffered from severe aortic valve stenosis, was to undergo transcatheter aortic valve replacement (TAVR). She was intolerance of the computed tomography examination before surgery. Bedside echocardiography was employed to evaluate the patient’s aortic valve stenosis, valve anatomy and type, the condition of aortic root, the distance from coronary to aortic root, and lower-extremity vascular access. Finally, the emergent TAVR was successfully performed under general anesthesia, and the aortic valve trans-prosthetic gradient met a remarkable decrease after surgery.
Objective To identify the heart sounds of aortic stenosis by deep learning model based on DenseNet121 architecture, and to explore its application potential in clinical screening aortic stenosis. Methods We prospectively collected heart sounds and clinical data of patients with aortic stenosis in Tianjin Chest Hospital, from June 2021 to February 2022. The collected heart sound data were used to train, verify and test a deep learning model. We evaluated the performance of the model by drawing receiver operating characteristic curve and precision-recall curve. Results A total of 100 patients including 11 asymptomatic patients were included. There were 50 aortic stenosis patients with 30 males and 20 females at an average age of 68.18±10.63 years in an aortic stenosis group (stenosis group). And 50 patients without aortic valve disease were in a negative group, including 26 males and 24 females at an average age of 45.98±12.51 years. The model had an excellent ability to distinguish heart sound data collected from patients with aortic stenosis in clinical settings: accuracy at 91.67%, sensitivity at 90.00%, specificity at 92.50%, and area under receiver operating characteristic curve was 0.917. Conclusion The model of heart sound diagnosis of aortic stenosis based on deep learning has excellent application prospects in clinical screening, which can provide a new idea for the early identification of patients with aortic stenosis.
ObjectiveTo discuss the feasibility about the using of transcatheter aortic valve implantation (TAVI) in severe aortic valve stenosis chinese patients, then to make more exploration and accumulate enough experience. MethodsWe selected 10 out-patients with severe aortic valve stenosis and calcified with 9 males and 1 females at age of 76.4 (65-81) years in our hospital from January 2011 to March 2014. All the patients can't tolerate traditional open surgery through preoperative evaluation. So we chose the Sepian TX system, balloon dilated transcatheter aortic valve, to treat them via transfemoral approach. ResultsTen patients accomplished TAVI successfully. One patient was assisted by the left-ventricular puncture. No complication occurred. The function of aortic valve after TAVI improved significantly. The hospital stay time was 3-5 days. The patients were followed up for 3-34 months. One patient died of pulmonary cancer during the following-up. ConclusionTranscatheter balloon dilated aortic valve replacement can be used in chinese severe aortic valve stenosis patient, but more accurate preoperative preparation, evaluation, and operation are needed.
Nowadays, aortic bioprostheses are used more and more widely in clinical practice, but the valve will experience structural valve degradation over time, and eventually lose its function, which is valve failure. Valve failure has become a significant challenge for aortic valve replacement and especially limits the expansion of indications for transcatheter aortic valve replacement. This review focuses on the current status and relevant evidence on the definition, risk factors, epidemiological characteristics, diagnosis and evaluation, treatment strategies of aortic bioprostheses failure. The purpose is to provide a basis for a more comprehensive understanding of aortic bioprostheses failure, finding better coping strategies and further improving the long-term durability of the valve.
Transcatheter aortic valve replacement (TAVR) has become a common theraputic option for aortic stenosis, but the evidence for precise anatomy for TAVR is accumulating. This paper presents the case of an 71-year-old female patient who had an extremely high risk of coronary obstruction due to both coronary ostia lying too low. The patient underwent TAVR with the help of coronary protection successfully. During the procedure, the patient was protected with wires only for both coronaries. After deployment, angiofluoroscopy suggested that chimney stenting should be applied for left coronary. The whole procedure was unenventful and both coronaries were seen.
Transcatheter aortic valve replacement (TAVR) is a mature technology. Because of the complicated valvular anatomy and the severe non-symmetrical valve calcification, the patient with bicuspid aortic valve stenosis (BAVs) once having a lower procedure successful rate, was considered as the relative contradiction for TAVR. However, with the application of the skirted and retrievable next generation prosthesis system, the outcomes of the treatment have been greatly improved. In this article, we summarized the current situation of TAVR applied in BAVs, and the outcomes difference of the old and new generation prosthesis systems.