Transcatheter Aortic Valve
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2021 ◽  
Vol 8 ◽  
Yijian Li ◽  
Yuan Feng ◽  
Xi Li ◽  
Lei Zuo ◽  
Tao Gu ◽  

With the development of minimally invasive technologies in the medical field, more and more technologies can replace surgical thoracotomy and relieve the pain of disease via minimally invasive methods. We reported a case of aortic valve stenosis combined with left ventricular outflow track obstruction treated by two minimally invasive techniques, transcatheter aortic valve replacement and transthoracic echocardiography–guided percutaneous intramyocardial septal radiofrequency ablation, and followed up for 2 years.

Rafail A. Kotronias ◽  
Jonathan J.H. Bray ◽  
Skanda Rajasundaram ◽  
Flavien Vincent ◽  
Cedric Delhaye ◽  

Background: Access site vascular and bleeding complications remain problematic for patients undergoing transcatheter aortic valve replacement (TAVR). Ultrasound-guided transfemoral access approach has been suggested as a technique to reduce access site complications, but there is wide variation in adoption in TAVR. We performed a systematic review and meta-analysis to compare access site vascular and bleeding complications according to the Valve Academic Research Consortium-2 classification following the use of either ultrasound- or conventional fluoroscopy-guided transfemoral TAVR access. Methods: Medline, Embase, Web of Science, and The Cochrane Library were searched to November 2020 for studies comparing ultrasound- and fluoroscopy-guided access for transfemoral TAVR. A priori defined primary outcomes were extracted: (1) major, (2) minor, and (3) major and minor (total) access site vascular complications and (4) life-threatening/major, (5) minor, and (6) life-threatening, major, and minor (total) access site bleeding complications. Results: Eight observational studies (n=3875) were included, with a mean participant age of 82.8 years, STS score 5.81, and peripheral vascular disease in 23.5%. An ultrasound-guided approach was significantly associated with a reduced risk of total (Mantel-Haenszel odds ratio [MH-OR], 0.50 [95% CI, 0.35–0.73]), major (MH-OR, 0.51 [95% CI, 0.35–0.74]), and minor (MH-OR, 0.59 [95% CI, 0.38–0.91]) access site vascular complications. Ultrasound guidance was also significantly associated with total access site bleeding complications (MH-OR, 0.59 [95% CI, 0.39–0.90]). The association remained significant in sensitivity analyses of maximally adjusted minor and total vascular access site complications (MH-OR, 0.51 [95% CI, 0.29–0.90]; MH-OR, 0.44 [95% CI, 0.20–0.99], respectively). Conclusions: In the absence of randomized studies, our data suggests a potential benefit for ultrasound guidance to obtain percutaneous femoral access in TAVR. REGISTRATION: URL: ; Unique identifier: CRD42020218259.

2021 ◽  
Rui Li ◽  
Jiechun Zhang ◽  
Jiaxi Shi ◽  
Lijin Qing ◽  
Wei Wu

Abstract Background: Multidisciplinary clinical manifestations of Heyde's syndrome and finite accuracy of corresponding examinations toward Heyde's triad make it easily omitted or misjudged in practice. Moreover, aortic valve replacement is often delayed because of the contradiction between anticoagulation and hemostasis. Herein, we present a rare case of atypical Heyde's syndrome whose confirmed intermittent bleeding angiodysplasia was not observed via mesenteric arteriography again, but severe bleeding was dramatically improved by transcatheter aortic valve implantation(TAVI) following laparotomy.Case presentation: A 64-year-old female experienced refractory gastrointestinal bleeding and deteriorating exertional dyspnea with a history of hypertension. Exploratory laparotomy was performed because the hemorrhage persisted and repeated transfusions. The subsequent histological examination revealed angiodysplasia. Heyde's syndrome was not suspected until she bled again combined with aortic valve stenosis detected by echocardiography 3 years later. TAVI was consequently performed in a stable condition with the invisibility of angiodysplasia. The post-procedure and follow-up were uneventful.Conclusions: The visible figures of angiodysplasia or shortage of HMWM-vWFs should not be indispensable for the clinical diagnosis of Heyde's syndrome. Laparotomy could be a bridging therapy to aortic valve replacement for severe hemorrhagic patients, and TAVI may benefit high-risk patients with a stable condition.

Hiroaki Yokoyama ◽  
Futoshi Yamanaka ◽  
Koki Shishido ◽  
Tomoki Ochiai ◽  
Shohei Yokota ◽  

Background Ventricular‐arterial coupling predicts outcomes in patients with heart failure. The arterial elastance to end‐systolic elastance ratio (Ea/Ees) is a noninvasively assessed index that reflects ventricular‐arterial coupling. We aimed to determine the prognostic value of ventricular‐arterial coupling assessed through Ea/Ees after transcatheter aortic valve replacement to predict clinical events. Methods and Results We retrieved data on 1378 patients (70% women) who underwent transcatheter aortic valve replacement between October 2013 and May 2017 from the OCEAN‐TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry. We determined the association between Ea/Ees and the composite end point of hospitalization for heart failure and cardiovascular death by classifying the patients into quartiles based on Ea/Ees values (group 1: <0.326; group 2: 0.326–0.453; group 3: 0.453–0.666; and group 4: >0.666) during the midterm follow‐up after transcatheter aortic valve replacement. During a median follow‐up period of 736 days (interquartile range, 414–956), there were 247 (17.9%) all‐cause deaths, 89 (6.5%) cardiovascular deaths, 130 (9.4%) hospitalizations for heart failure, and 199 (14.4%) composite events of hospitalization for heart failure and cardiovascular death. The incidence of the composite end point was significantly higher in group 2 (hazard ratio [HR], 1.76; 95% CI, 1.08–2.87 [ P =0.024]), group 3 (HR, 2.43; 95% CI, 1.53–3.86 [ P <0.001]), and group 4 (HR, 2.89; 95% CI, 1.83–4.57 [ P <0.001]) than that in group 1. On adjusted multivariable Cox analysis, Ea/Ees was significantly associated with composite events (HR, 1.47 per 1‐unit increase; 95% CI, 1.08–2.01 [ P =0.015]). Conclusions These findings suggest that a higher Ea/Ees at discharge after transcatheter aortic valve replacement is associated with adverse clinical outcomes during midterm follow‐up. Registration URL: . Unique identifier: UMIN000020423.

2021 ◽  
Chang-Gan Chen ◽  
Bei-Bei Xi ◽  
Qiu-Feng Deng ◽  
Xin-Yuan Zhang ◽  
Wei-Cheng Lin ◽  

Abstract Background: Previous studies have shown that transcatheter aortic valve implantation (TAVI) is the best alternative therapy to surgical aortic valve replacement (SAVR) in high-risk surgical patients with aortic stenosis (AS). However, it is not clear whether TAVI can be utilised in low-risk surgical patients with AS. This study aimed to evaluate the safety and efficacy of TAVI in low-risk patients.Methods: From the outset of our initiative until June 2021, PubMed, EMBASE, and Cochrane were thoroughly searched, yielding the selection of 3 randomised controlled trials including 2633 patients with AS, to assess outcome measures at distinct follow-up time periods. Results: The mean Society of Thoracic Surgeons Predicted Risk of Mortality score of patients was 2.2. At the 30-day and 1-year follow-up, TAVI was associated with a lower incidence of all-cause mortality, cardiovascular mortality, acute kidney injury (stage 2 or 3), life-threatening or significant bleeding, and new atrial fibrillation (NAF), but an increased risk of permanent pacemaker implantation. At the 2-year follow-up, TAVI only had an advantage in NAF (RR, 0.27; 95% CI, 0.14–0.51; P<0.0001) without any significant difference in any of the other outcome measures.Conclusions: For low-risk surgical patients with AS, the efficacy of TAVI was superior to that of SAVR by the 30-day and 1-year follow-up. This was most evident by the 2-year follow-up, except for the advantages of NAF, with no other significant differences.

2021 ◽  
Vol 21 (1) ◽  
Hui Li ◽  
Wenduo Zhang ◽  
Bo Xia ◽  
Fucheng Sun ◽  
Jiefu Yang ◽  

Abstract Background Delayed coronary artery occlusion (CAO) is a rare but fatal complication after transcatheter aortic valve replacement, chimney stenting is the standard technique for established CAO or impending CAO. Case presentation We describe a female patient who developed non-ST elevation myocardial infarction after receiving transcatheter aortic valve replacement and chimney stenting 4 months prior. An angiogram revealed delayed coronary artery occlusion with a deformed stent, which was never reported. This patient was subsequently treated with a new chimney stent. Conclusions For self-expanding valves, the coronary ostium is protected by chimney stenting, delayed coronary artery occlusion can occur and cause catastrophic complications.

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