CJC open · 2024
Transapical Transcatheter Aortic Valve Implantation with the J-Valve System in Aortic Regurgitation.
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Zhu Pengxiong, Li Jinping, Xue Bangde, Huang Jing, Ling Yun, Zhang Qi, Liu Jun
Аннотация
BACKGROUND: Aortic regurgitation (AR) is a condition associated with significant morbidity and mortality, particularly in severe cases. The J-Valve system, next-generation transcatheter heart valve, may overcome the procedural challenges associated with treating pure AR. This study reported the outcome of use of the J-Valve for treatment of AR.
METHODS: This study observed 47 patients undergoing transcatheter aortic valve implantation (TAVI) with the J-Valve system. Diagnostic evaluation included transthoracic echocardiography and multislice computed tomography to assess AR severity and anatomic characteristics essential for TAVI. Follow-up evaluations were conducted at various intervals postoperation to evaluate outcomes.
RESULTS: The patients had a mean age of 73.0 ± 9.0 years and a median ejection fraction of 58.0% (interquartile range, 45.0%-64.0%). The median European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was 3.0% (interquartile range, 2.0%-6.7%). The procedural success rate was 100%, with no need for a second valve implantation or conversion to sternotomy. Short-term outcomes showed significant improvements in the New York Heart Association functional classification (P < 0.001), the left ventricular ejection fraction (P = 0.009), and the left ventricular end-diastolic diameter (P < 0.001). A singular case of valve migration and severe perivalvular leakage due to Behçet's disease prompted a revised approach incorporating immunomodulation therapy.
CONCLUSIONS: TAVI with the J-Valve system presents a viable alternative for managing severe AR, demonstrating high procedural success and substantial clinical improvement. However, the case of valve migration due to Behçet's disease highlights the need for careful preoperative screening and consideration of autoimmune disorders in differential diagnoses.
METHODS: This study observed 47 patients undergoing transcatheter aortic valve implantation (TAVI) with the J-Valve system. Diagnostic evaluation included transthoracic echocardiography and multislice computed tomography to assess AR severity and anatomic characteristics essential for TAVI. Follow-up evaluations were conducted at various intervals postoperation to evaluate outcomes.
RESULTS: The patients had a mean age of 73.0 ± 9.0 years and a median ejection fraction of 58.0% (interquartile range, 45.0%-64.0%). The median European System for Cardiac Operative Risk Evaluation (EuroSCORE II) was 3.0% (interquartile range, 2.0%-6.7%). The procedural success rate was 100%, with no need for a second valve implantation or conversion to sternotomy. Short-term outcomes showed significant improvements in the New York Heart Association functional classification (P < 0.001), the left ventricular ejection fraction (P = 0.009), and the left ventricular end-diastolic diameter (P < 0.001). A singular case of valve migration and severe perivalvular leakage due to Behçet's disease prompted a revised approach incorporating immunomodulation therapy.
CONCLUSIONS: TAVI with the J-Valve system presents a viable alternative for managing severe AR, demonstrating high procedural success and substantial clinical improvement. However, the case of valve migration due to Behçet's disease highlights the need for careful preoperative screening and consideration of autoimmune disorders in differential diagnoses.