Objective To evaluate the efficacy of transcatheter aortic valve implantation (TAVI) for native aortic valve regurgitation. MethodsLiterature from The Cochrane Library, PubMed, EMbase, Cochrane Controlled Trials Registry, ClinicalTrials.gov and China Biomedical Literature Database from January 2002 to May 2021 were searched by computer. The literature on TAVI or transcatheter aortic valve replacement treatment for simple aortic reflux were collected. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of the literature. Meta-analysis was performed using STATA 14.0 software. ResultsA total of 15 studies including 1 394 patients were included. The Newcastle-Ottawa Scales of the studies were≥6 points. The success rate of prosthetic valve implantation was 72.0%-100.0%, and there was no report of serious complications such as surgical death, myocardial infarction, and valve annulus rupture. The 30-day all-cause mortality rate was 6.3% [95%CI (3.4%, 9.1%)]. The incidence of stroke within 30 days and the rate of postoperative permanent pacemaker implantation were 2.0% [95%CI (1.0%, 4.0%)] and 6.0% [95%CI (4.0%, 10.0%)], respectively, and were both within acceptable limits. ConclusionFor patients with simple high-risk aortic regurgitation, TAVI can obtain satisfactory treatment effects and has low postoperative complications rate, and it may be a potential treatment option for such patients.
Transcatheter aortic valve replacement (TAVR) techniques have been rapidly developed in recent years. Current guidelines and studies mainly focus on aortic stenosis patients treated by transfemoral approach, but they are not completely appropriate to patients with isolated aortic regurgitation or other patients who need transapical TAVR (TA-TAVR), which affects the standardized treatment of those patients. Therefore, our team pronounced the operational standards for TA-TAVR, based on fully reviewing the literatures worldwide, combined with the opinions of experts from 15 heart centers with rich experience in carrying out TA-TAVR in China. This standard aims to provide clinicians with standardized diagnosis and treatment principles of TA-TAVR and improve the quality of TA-TAVR in China.
As technology advances, current evidence supports the use of devices for valvular heart disease interventions, including transcatheter aortic valve implantation, transcatheter mitral or tricuspid valve repair, and transcatheter mitral valve implantation. These procedures require antithrombotic therapy to prevent thromboembolic events during the perioperative period, and these therapies are associated with an increased risk of bleeding complications. To date, there are challenges and controversies regarding how to balance the risk of thrombosis and bleeding in these patients, and therefore the optimal antithrombotic regimen remains unclear. In this review, we summarize the current evidence for antithrombotic therapy after transcatheter intervention in patients with valvular heart disease and highlight the importance of an individualized approach in targeting these patients.
ObjectiveTo summarize and analyze the risk factors and management of artificial valve slippage in transcatheter aortic valve implantation (TAVI).MethodsWe retrospectively analyzed the clinical data of 131 patients undergoing TAVI surgery in our center from September 2017 to May 2019, including 62 patients through transapical approach and 69 patients through transfemoral artery approach.ResultsA total of 131 patients received TAVI surgery, among whom 4 patients had slipped during the operation, 2 patients via transfemoral artery approach, and another 2 patients via transapical. The average age was 77±9 years with one female (25%). Preoperative evaluation, higher position and poor coaxial were main risk factors for valve slip in TAVI.ConclusionValve slippage is also a serious complication in TAVI surgery. Reasonable and effective treatment can avoid thoracotomy.
Objective To analyze the clinical intervention effect of multi-disciplinary team (MDT) nursing mode on patients after transcatheter aortic valve implantation (TAVI). Methods A total of 89 patients who were admitted to our hospital and underwent TAVI surgery from April to December 2021 were selected, including 64 males and 25 females, with an average age of 64.7±11.8 years. The subjects were divided into a MDT intervention group (n=42) and a control group (n=47) according to different postoperative nursing intervention methods. Clinical effectivenesses were compared between the two groups. Results The left ventricular ejection fraction in the two groups significantly increased on the 7th day after the operation, and the increase in the MDT intervention group was more obvious, with no statistical difference between the two groups (P=0.14). On the 7th day after surgery, forced vital capacity/predicated value and forced expiratory volume in one second/predicated value significantly decreased, and decreased more significantly in the control group than those in the MDT intervention group with statistical differences (P=0.01). The ICU stay time (P=0.01), hospital stay time (P<0.01) and total postoperative pulmonary complications rate (P=0.03) in the MDT intervention group were significantly shorter or lower than those in the control group The evaluation results of the anxiety and depression status of the patients before and after nursing intervention showed that the scores of anxiety and depression in the two groups were significantly lower than before, and the scores of each scale in the MDT intervention group were lower. The score of quality of life of the two groups significantly improved at the end of 6 months after surgery, and in the MDT intervention group it was significantly higher than that in the control group (P=0.02). Conclusion MDT intervention mode can promote the rapid recovery of patients after TAVI, effectively reduce the risk of postoperative pulmonary complications, and improve the postoperative quality of life.
Transcatheter aortic valve replacement (TAVR) is effective in the treatment of severe symptomatic aortic stenosis and its applicable population is also gradually expanding, but it carries risk of ischemic and bleeding events, which underscores the importance of optimizing adjuvant antithrombotic regimens. The release of the 2022 version of Chinese expert consensus on antithrombotic therapy after transcatheter aortic valve implantation has promoted the standardized and safe development of antithrombotic therapy after TAVR in China. Combined with the latest progress of antithrombotic therapy after TAVR, from emphasizing ischemia and bleeding risk assessment, single-agent antiplatelet therapy for patients without anticoagulation indications, the selection of antithrombotic strategies for patients with other antithrombotic indications, antithrombotic strategy changes in postoperative valve thrombosis and bleeding events, this article interprets this consensus.
ObjectiveTo explore the risk factors and potential mechanisms of hypertension events on the same day after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis. MethodsClinical data of patients who underwent TAVI for severe aortic stenosis at Department of Structural Heart Disease, Fuwai Hospital from December 2023 to February 2024 were retrospectively collected. According to the peak systolic blood pressure on the same day after surgery, patients were divided into a hypertension group (≥140 mm Hg) and a normal blood pressure group (<140 mm Hg). Logistic regression model was used to analyze the risk factors for hypertension on the same day after TAVI. ResultsA total of 54 patients after TAVI were included, with 41 patients in the hypertension group, including 18 males and 23 females, with an average age of (72.83±6.78) years; 13 patients in the normal blood pressure group, including 9 males and 4 females, with an average age of (70.00±7.57) years. Univariate analysis found that there were statistical differences in interventricular septal thickness [(13.71±1.98) mm vs. (12.23±1.59) mm, P=0.018], preoperative left ventricular ejection fraction (LVEF)>55% [33 (80.5%) vs. 6 (46.2%), P=0.040], and postoperative same-day LVEF>55% [33 (80.5%) vs. 4 (30.8%), P=0.003]. Multivariate logistic regression analysis found that postoperative same-day LVEF>55% [OR=10.173, 95%CI (1.044, 99.115), P=0.046] was an independent risk factor for hypertension on the same day after TAVI. ConclusionMyocardial contractility mainly participates in the occurrence of hypertension on the same day after TAVI. This study can not only improve our understanding of early hemodynamic changes after TAVI, but also provide a basis for the formulation of early hypertension treatment plans after TAVI to improve the short- and long-term prognosis of patients.
ObjectiveTo study the nursing methods for patients after transcatheter aortic valve implantation (TAVI). MethodsFrom April 2012 to August 2013, 25 patients undergoing TAVI before returning to the coronary care unit (CCU) were included in this study. We reviewed the clinical nursing methods and summarized the clinical nursing experiences. ResultsAmong the 25 patients, there were 1 case complicated with retroperitoneal hematoma, 1 case with hemorrhage of upper digestive tract, 1 case with severe hemorrhage of femoral artery incision site, 1 case with mild hemorrhage of femoral artery puncture site, 1 case with catheter-related infections of right external jugular vein, and 2 cases with hemorrhage related to the loosening of radial artery invasive blood pressure monitoring. All the complications were controlled by reasonable treatments and all the patients were transferred out from CCU with stable vital signs. The mean time of CCU stay was 29 hours ranging from 14 hours to 243 hours. ConclusionDue to special characteristics of patients after TAVI, we should observe carefully, follow the nursing operation rules strictly, discover complications timely, give treatment correctly, and finally ensure the safety of patients during the high risk period.
Transcatheter aortic valve implantation (TAVI) has become the main treatment for elderly patients with middle and high risk aortic stenosis. However, coronary artery occlusion (CAO) related to TAVI is a very serious complication, which often leads to poor prognosis. Therefore, active preoperative prevention is particularly important. Preoperative computed tomography evaluation, bioprosthetic or native aortic scallop intentional laceration and chimney stent implantation technology can prevent TAVI-related coronary orifice obstruction. Ensuring commissural alignment during operation can reduce the occurrence of coronary occlusion, but its long-term prognosis needs further study. In addition, percutaneous coronary intervention is the main treatment, but there are problems such as difficult coronary access after TAVI. This article summarized the research progress in the mechanism, prevention and treatment of CAO related to TAVI.